Terminally Ill Adults (End of Life) Bill

Debate between Baroness Butler-Sloss and Baroness Browning

Committee stage
Friday 14th November 2025 Lords Chamber

[Baroness Browning (Con)]

My Lords, many years ago, in another place, I served on the pre-legislative scrutiny committee and was present taking what became the Mental Capacity Act through the House of Commons. When I came to your Lordships’ House in 2010, I was fortunate enough to secure a House of Lords inquiry to look post-legislatively at how the Mental Capacity Act was working. From the evidence we took at the time, we found that the ability of the medical profession—by which I mean not just doctors but all those across the piece, including social care workers—was not as ideal as it perhaps sounds in today’s Committee. Whatever is built into the Bill to assess either capacity or ability, there will need to be a heck of a lot of training for us all to feel comfortable that the professionals involved know how to go about their task.

I draw the Committee’s attention to the report last month of the National Audit Office, whose press release stated:

“The Department for Health and Social Care (DHSC) and NHS England (NHSE) do not clearly understand what proportion of palliative and end-of-life care is delivered by independent adult hospices, and therefore, how much they are reliant on the sector, or what the real impact of government funding is”.


We have heard that palliative care is patchy. I know from my own recent experience with a close relative that, had I not been somebody capable of organising it myself, it would not have taken place. We are not dealing with finite disciplines in the debate on this group, and I caution the Committee that it is not as perfect out there as it sounds today.

[Baroness Butler-Sloss (CB)]

My Lords, I declare that I was a vice-president of Hospiscare in Exeter. I am probably the only person in this Committee who has tried cases of capacity, again and again, both as a High Court judge and in the Court of Appeal. One case was so difficult that the Court of Appeal, where I was presiding, sat until 1 am. Noble Lords may not have thought that the Court of Appeal did that very often. It is important for your Lordships to realise that some cases that I tried were extremely easy to try—one in particular involved a Miss B, who was obviously competent—but other cases were extraordinarily difficult. One case—the one that we did until 1 am—concerned somebody with a needle phobia who was expected to need a caesarean, and she objected because she could not bear the idea of a needle. At one in the morning, we took the view that she did not have the mental capacity to decide on her caesarean. She was hugely relieved and had the operation without any trouble. But that was not a unique case—the time was, but not the problem.

Mental Health Bill [HL]

Debate between Baroness Butler-Sloss and Baroness Browning

Committee stage
Monday 24th February 2025 Lords Chamber

[Baroness Browning (Con)]

My Lords, I support the noble Baroness, Lady Parminter, on the particular point that she raises about eating disorders in her amendment and on a more general point.

In an earlier debate, I tried to make the case that people being diagnosed with autism by clinicians should be seen by clinicians who specialise in autism. I was reminded of this very much when the Minister, responding to an earlier amendment this afternoon, talked about parity of esteem in the health service between the physical health support provided and that for mental health. In the world of physical health, if you were to see an orthopaedic consultant, you would not necessarily see the same consultant, depending on the condition that you had. The same applies today with cardiology, whereby cardiologists now have more specialisms within that and you would therefore see the appropriate person. As raised by the noble Baroness, Lady Parminter, the facilities that go along with such specialised treatment and assessment are very important.

I put it to the Minister, prompted by the noble Baroness, Lady Parminter, and by the Minister’s own words, that it really is about time that, with regard to mental health as a generic term, whatever the condition, we stop—as they did even within my lifetime—locking people up in some old Victorian institution where they all get the same treatment, facilities and so on. Today, with our increased knowledge of mental health and of medication for mental health, and with the increased number of specialisms that we are now aware of, particularly around eating disorders, it is really about time, if there is truly to be parity of esteem, that mental health is treated as physical health is treated, and that the specialisms that occur and the specialists there to work within those specialisms are given weight within legislation so that facilities and specialists can be provided—because we know that they are not.

At the heart of the Bill before us is the fact that we are taking autism and learning disabilities out of the Mental Health Act 1983, in which they were all treated the same—lumped in together and treated by the same clinicians, whether they had a specialism in that area or not. This is a real opportunity for the Minister and the Government to make sure that there is true parity of esteem and that conditions such as eating disorders are respected and treated in the way in which they should be.

[Baroness Butler-Sloss (CB)]

My Lords, I remember a specific case of a friend’s 17 year-old daughter who was suffering from an eating disorder. She had to go into hospital, where she was not treated at all well; she was criticised for not eating—the very thing she had gone into hospital to get help for. She did not for quite some time get any specialised help on how to deal with her eating disorder. This amendment would deal with that issue.

Mental Health Bill [HL]

Debate between Baroness Butler-Sloss and Baroness Browning

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Baroness Browning (Con)]

My Lords, I have added my name to this amendment. I will not detain the Committee long, but I support the amendment and I want to flag the point my noble friend made about Wales and England. To my certain knowledge, when people living further north around the Shropshire border, for example, are admitted, they will almost certainly be offered placements in north Wales. It is important that there is some harmony in these regions; otherwise, it will cause additional problems. I hope my noble friend will press his amendment in due course to make sure that that harmony exists.

[Baroness Butler-Sloss (CB)]

My Lords, I will speak to Amendment 61. I recognise that the purpose of the Bill is to give children and those under 16 greater rights and opportunities to be heard. I entirely agree with that; it is absolutely sensible. But there is a danger of ignoring the fact that parents are basically not considered anywhere in the Bill. They are not in the contents of the Bill or any of the schedules.

Most parents are suitable; some parents are not. It may be that my amendment should perhaps be put in slightly different way, as the noble Baroness, Lady Berridge, has done. I recognise that there is a small percentage of parents who may not have total parental responsibility or, if they do have it, they are in the situation of one parent having what used to be called custody and the other having what used to be called access. For most parents, they care about their children. As far as I can see, they are completely ignored, but they do have something to contribute.

I am not suggesting for a moment that parents should make the decisions. What I am asking the Minister to do is to give them the chance to be heard; that is all I ask. They really should, throughout the Bill, be consulted where that is appropriate, but they are not put in for consultation, as far as I can see, in any part of the Bill. This is one place where that really will not do.

Speaking as a parent and grandparent, I would be extremely upset if my child was about to be detained and everybody was discussing what should happen to my child, but nobody asked me. At the moment, as far as I understand, the Government do not seem to think that parents, special guardians or anybody else who happens to have parental responsibility need to be consulted.