Terminally Ill Adults (End of Life) Bill

Baroness Coussins Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

My Lords, we should thank the noble Baronesses, Lady Gerada and Lady Pidgeon, for raising important counters to a lot of these contributions, because it is important that we do not fetishise face-to-face communication as infallible. It offers no guarantee that comprehension happens, that people listen and that there is no misunderstanding. We should know that because we sit face to face in this Committee every Friday and goodness knows it has not guaranteed much of that.

I have put my name to several of the amendments in this group because, despite what the noble Baroness, Lady Pidgeon, just said about how we must make this as easy as possible for people with six months to live, the Bill’s sponsors have rightly built the need for eligibility into the Bill. You cannot just wander in and say, “I’ve got six months to live, get rid of me”; you have to pass the eligibility assessment. We are trying to work out whether face to face as the default would be a better way of guaranteeing that there is no abuse, which is reasonable.

I remember the ITV documentary referenced by the noble Baroness, Lady Coffey, in which I heard the Bill’s sponsor in the other place, Kim Leadbeater, admit that she was uncomfortable with what has been labelled “death by Zoom”—the model that she was watching in Oregon. Despite what the noble Baroness, Lady Gerada, said, it was actually Kim Leadbeater who rightly noted that it looked too much like a tick-box exercise. We need to be wary of anything that goes in that direction, but, because this is what I saw in that documentary, I expected a basic requirement in the Bill for face-to-face assessment, except in exceptional circumstances. So I ask the noble and learned Lord, Lord Falconer, to respond on why the Bill still permits so many encounters with doctors, including the panel, to be conducted remotely, meaning that somebody may access assisted death without having seen a doctor face to face. One might pause on that, at least.

Despite the virtues of telemedicine, of which there are many—we can all see the reasons why, on occasion, it is important, just as we all use Zoom for meetings and so on—this is a question of whether it is superior and whether it can be relied on. The noble Baroness, Lady Smith of Newnham, gave a vivid example in response to the contribution from the noble Baroness, Lady Jay, in which she said, “At least the noble Baroness, Lady Gerada, knows what it is like to be the doctor doing the consultation”. Well, some of us know what it is like to be the patient on the other end of it. To be honest, it is not always a case of “trust the expert” and all that, because there absolutely may be crossed wires, hanging around, frustration and all sorts of things going wrong.

Professor Martin Vernon, who chairs the ethics and law special interest group at the British Geriatrics Society, said:

“Assessing somebody remotely, digitally, without a face-to-face assessment, particularly if they have complex health and social care needs, is nigh-on impossible”.


There is something in that, too, which we should consider. Non-face-to-face Zoom or phone encounters are particularly challenging for certain groups, such as people with communication difficulties. The noble Baroness, Lady Nicholson, reminded us of the issues for people with hearing difficulties in our debate on a previous group. We all know that there are difficulties of language.

Of course, older people are likely to make up the majority of those being assessed for assisted dying. Without wanting to caricature oldies as being technically illiterate—although there is a smidgen of truth there—there is something else to consider. Older people sometimes present their best selves on the phone. They put on their best voice. There is nothing wrong with that, but they chat away as though everything is fine and, even on Zoom, they sit there looking their best.

However, when you see them face to face—I am not now talking about a doctor assessing them—they are dishevelled, pale and frail. Something else happens. Because the assisted dying decision involves highly emotional and existential issues, purely remote assessments potentially undermine the relational aspects of care that will help ensure that decisions are well considered and autonomously made. We have to think about those direct, personal interactions. The noble Baroness, Lady Jay, is right: these are the last six months of your life—allegedly; that is what you have been told. People are vulnerable, distressed and not quite sure. All these amendments are suggesting is that it would possibly be better to see the doctor. If you cannot get there, that is all fine, nobody is being inhumane; but the doctor sees you and assesses what is going on. It is a necessary if not sufficient way of establishing the eligibility criteria.

Finally, the noble Lord, Lord Empey, talked about how this might be appropriate for online legal proceedings. I am sure that the noble and learned Lord is aware of the evidence on the use of video links in court proceedings and trials. In Transform Justice’s survey of court users, 70% of respondents said that it was difficult to recognise whether someone who was on video had a disability, while 74% believed that those who had no legal representation were disadvantaged by appearing on video; in other words, the vulnerable always suffer in those instances.

The report similarly found that there were significant issues in assessing evidence and character. We can learn from other areas, but the main thing is that the default should be face to face. That should be in the Bill. I agree with Kim Leadbeater on that one—that is a headline. I do not understand why, Kim Leadbeater having noted that, it is not in the Bill. There should be exceptions if people are too ill, too far away or having a ball in Tenerife for their last six months. Yes, we get all that, but the default point is: face to face, where possible, as much as possible.

[Baroness Coussins (CB)]

My Lords, if we are to have remote assessments, it is very important that we have an exception for one group of people who might be seeking assisted dying: those who require the services of a public service interpreter. Elsewhere in the Bill, the provision of interpreters is acknowledged and provided for. This is one situation where face-to-face consultations are essential. During Covid, there was a huge rise in remote interpreting in the criminal justice system. A number of studies, including a very robust piece of research by the Magistrates’ Association, showed that there were problems with remote interpreting, for reasons ranging from dodgy technology to missed cues because of missed body language.

In these circumstances, more than anything else, a face-to-face consultation or assessment is right and appropriate, where the services of a public service interpreter are needed for the benefit of the person seeking help.

[Baroness Whitaker (Lab)]

My Lords, that provision is in the Bill, if the noble Baroness would just look. I am afraid that I cannot put my finger on the actual clause, but the assessing doctor is required to provide interpreters where necessary.

NHS Plan: Consultation

Baroness Coussins Excerpts

Monday 2nd December 2024 Lords Chamber

[Baroness Merron (Lab)]

I agree with the right reverend Prelate. Integrated care systems, which are responsible for reflecting the needs of the community and its spending, must follow guidance, and it is important that we identify the seldom-heard groups. We have built into the consultation plans a “workshop in a box”—a toolkit to support discussion in local communities, which ICBs are rolling out. It is a good way of encouraging ICBs to talk directly to local communities.

[Baroness Coussins (CB)]

My Lords, will the consultation be published in languages other than English, with proactive efforts to encourage responses from people whose first language is not English? Secondly, will the department make sure that it consults with public service interpreters working in NHS settings?

[Baroness Merron (Lab)]

I can confirm that both the online portal and the “workshop in a box” to which I just referred will be available in easy read and British Sign Language versions, and in other languages. Attention has been given to those for whom English is not their first language; in-person events can be tailored to their needs—for example, by having smaller groups. The staff to whom the noble Baroness refers are a major group being asked to provide input; indeed, they are taking part in online workshops and can respond online.

Covid-19 Inquiry

Baroness Coussins Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Baroness Coussins (CB)]

My Lords, I welcome the opportunity to contribute to this debate and will highlight some important language-related issues, which arguably are implicit in the report’s conclusions on the way in which communications and public health messaging contribute to preparedness and resilience, but which in my view need to be explicit, spelled out and acted on if future emergencies are not to leave some groups in society still disproportionately vulnerable.

I declare my interests as co-chair of the All-Party Group on Modern Languages and vice-president of the Chartered Institute of Linguists. The APPG made a detailed submission to the inquiry chaired by the noble and learned Baroness, Lady Hallett, on a number of issues. I am disappointed that none has been explicitly referred to, especially as they all seem to me to go to the very heart of the report’s overarching recommendations on the importance of the response to whole-system civil emergencies and for the need better to target vulnerable people. Will the Minister agree to look closely at the APPG’s recommendations, and ensure that they are explicitly woven into the Government’s response to and implementation of the inquiry’s recommendations?

Past and current experience in both the health service and the justice system has demonstrated all too starkly that, unless the needs of people who require translation or interpreting services are explicitly acknowledged and provided for, they will all too often instead be on the receiving end of casual, inadequate, unqualified or non-existent language services, to the obvious detriment of their health or human rights. I will flag up some headings of our key concerns and recommendations, as the detail can be found in our submission to the inquiry, which is already in the public domain.

First, as the report acknowledges—and as has been flagged up already today by the right reverend Prelate the Bishop of London—people from some ethnic minority groups had a significantly higher risk of being infected by Covid-19 and dying from it. There is evidence to show that the absence or delay of provision of public health messaging in languages other than English may have been a contributory factor to this. The 2023 report by the Race Equality Foundation, UCL and Doctors of the World stated that black and minority ethnic groups after two years were still three to five times more likely than white British adults to be unvaccinated and that the lack of targeted outreach and promotion contributed to this unequal take-up.

Back in October 2020, the Government’s own quarterly report on Covid inequalities talked of improving public health communication for the so-called hard-to-reach groups, including people from ethnic minority backgrounds, but, strangely, also included a footnote that said:

“Translation into foreign languages is discouraged except in extraordinary circumstances because it conflicts with the government’s approach to integration”.


There was also a significant disparity between the Government’s response to, and preparedness for, the needs of British Sign Language users, as compared with the needs of people who speak little or no English. The former are covered by the AIS, the accessible information standard, but the latter are not. The APPG agreed with Healthwatch England that the AIS should be amended as part of better preparedness and inclusiveness in future emergency responses.

The second health issue concerns the test and trace scheme, which operated primarily as an English-only service. The National Audit Office reported that test and trace had stated that its call centres offered a language interpreter service. The claim was repeated by Ministers in Parliament, but an investigation by Sky News reported that DHSC claims that translations existed in up to 130 languages were “brazen” and “bizarre”. Local government appeared to be no more consistent, publishing advice in English that non-English speakers should dial 119 or use the Covid app if they needed to contact test and trace in another language. Now, given that the function of test and trace was meant to be contacting people proactively, putting the onus on them to contact the service for information in a language they did not even speak was never likely to be effective.

The third health issue concerns public service interpreters working in the NHS. Most are freelance and many complained that no one was taking responsibility for providing them with PPE. The Government funded the provision of a quarter of a million clear face masks for British Sign Language interpreters, but no equivalent provision was made for spoken word interpreters. In answers to Oral and Written Questions I tabled, the noble Lord, Lord Bethell, the Minister responsible at the time, helpfully clarified in July 2020 that individual hospitals were responsible for providing the interpreters with PPE and in December he said that GP practices had a similar obligation. Nevertheless, many public service interpreters found that in practice they were expected to turn up having procured their own PPE. The all-party group believes that, if the provision of language services were included in the accessible information standard that I mentioned earlier, this kind of support and equipment would in future be more easily identified and forthcoming and would be one clear way in which overall preparedness could be improved.

This inquiry report focuses on the health aspects of the pandemic, but there were other parts of the public sector where language-related issues arose, notably in the justice system, because lockdown measures prompted a large shift towards remote court hearings, which required the use of public service interpreters in virtual proceedings. A series of major reports found significant concerns about the suitability of remote interpreting, including misunderstandings, delays, poorly performing technology and missed verbal and non-verbal cues. The APPG recommends that the MoJ should caution against any systematic trend towards more wide- spread use of this practice until and unless the right lessons have been learned from the Covid experience. The same concerns and caution also apply, of course, to the suitability of remote interpreting in healthcare settings.

Education also suffered in various ways and the impact of Covid on pupils and students was more marked in the case of disadvantaged families and communities. One example is the children of asylum seekers living in asylum facilities and refugee centres who faced especially acute deprivation, often with no provision of laptops for access to basic education.

I look forward to the Minister’s response on the issues I have raised and hope that in future the Government will be more attuned than in the past to the need to be explicit about language issues, cultural sensitivities and translation and interpreting services in the context of any future pandemic or other emergency situation.

Covid-19 Update

Baroness Coussins Excerpts

Monday 14th September 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness is entirely right that the isolation protocol is extremely onerous for some people and has a huge impact on their life, mental health, income and social life. I completely understand the point she is making. We are keeping the question of financial support under review and will continue to look at this important subject.

[Baroness Coussins (CB) [V]]

My Lords, picking up on one of the points made by the noble Baroness, Lady Thornton, what arrangements have been made to enable compliance with the rule of six for asylum seekers living in reception centres or hostels that have communal facilities for eating, sleeping, washing, cooking and leisure time? This could be a national issue, not just in Hammersmith. Also, why is there no link on the National Asylum Support Service website to any Covid information or advice in languages other than English and Welsh?

[Lord Bethell (Con)]

My Lords, asylum hostels are one example of a very great many that will have to put thoughtful arrangements in place in order to comply with the rule of six. I pay tribute to their efforts.

Covid-19: Personal Protective Equipment

Baroness Coussins Excerpts

Thursday 16th July 2020 Lords Chamber

[Lord Bethell [V]]

My Lords, the big lesson from Covid is that the quantity of PPE needed for a disease like this is massively more that could ever have been expected, particularly compared with our past experience. It has hit every country in the world and has hit the global supply chains incredibly hard. A benign lesson is that British manufacturers are capable of stepping up the challenge, and I salute their work. Contamination from itinerant workers was always one of the greatest challenges of the care sector, and we have put in a huge amount of work and financial resources to avoid the need for workers who move from home to home.

[Baroness Coussins (CB) [V]]

My Lords, when I asked the Minister on 24 June to ensure that interpreters in the NHS would not be forgotten when stockpiling PPE in case of a second wave, he very helpfully told the House that he would continue to press the department on this. So, I am mystified that I still have not had a reply to my simple question of 12 May, asking who is responsible for providing PPE for freelance NHS interpreters. Can the Minister enlighten me today?

[Lord Bethell [V]]

The noble Baroness is entirely right to champion the role of interpreters. Their role in the recent Leicester lockdown has been incredibly important: there could not have been an incident that better highlights the importance of language skills in the healthcare setting, and I pay tribute to the noble Baroness for championing those. The care of interpreters is an incredibly complex question and entirely depends on where they are sited. It is the responsibility of individual trusts to look after interpreters in hospital settings but, in other settings, it may be that of other organisations.

Personal Protective Equipment

Baroness Coussins Excerpts

Wednesday 24th June 2020 Lords Chamber

[Lord Bethell [V]]

My noble friend Lord Dobbs is entirely right: British companies have done an amazing job of stepping up to this challenge. I pay testament to Survitec, Bollé, Jaguar Land Rover, Don & Low and Burberry, which have all made huge contributions, and to the 350 firms we are currently negotiating with to create a new domestic supply. Nearly 2 billion items of PPE have been supplied through UK-based manufacturers. The moment when we are exclusively and entirely dependent on UK supply is some way off, but this provides a critical cushion and helps to build resilience for these important products.

[Baroness Coussins (CB) [V]]

My Lords, the Minister will not be surprised that I want to ask once again about interpreters in the NHS. I appreciate that because of Covid-19 many hospitals are using interpreters by telephone, but there must still be many cases where the physical presence of an interpreter is needed, Covid-related or otherwise. No answer has yet been given to my Written Question of 12 May about who is responsible for providing PPE for interpreters. I would also like to be reassured by the Minister, who I know appreciates the importance of interpreters, that they will not be forgotten when it comes to stockpiling PPE to cope with a possible second wave, when interpreters are likely to be needed more often if the disproportionate level of infection among certain minority groups continues.

[Lord Bethell [V]]

The noble Baroness is entirely right to emphasise the disproportionate balance of infection among BAME people and the importance of interpreters in ensuring that they get the treatment they deserve. However, we are emphasising the use of telephone services because we want to keep people out of areas of potential infection. That remains part of the service that we deliver, and telephone arrangements are proving extremely effective. However, I take on board her point about providing PPE for those interpreters who are on site, and I will continue to press those in the department who oversee this important area of activity.

Covid-19: Track and Trace System

Baroness Coussins Excerpts

Thursday 18th June 2020 Lords Chamber

[Lord Bethell [V]]

My noble friend is entirely right that local action is central to an effective response to Covid-19. We are working extremely hard through the JCVI to take the intelligence from our testing programme to identify hotspots when they occur and to move resources to those areas to support local directors of public health and local infection officials with the resources they need, whether in terms of testing or surge control of the disease.

[Baroness Coussins (CB) [V]]

My Lords, the Government have translated Covid-19 advice and information into a number of languages, but can the Minister assure me that proper mechanisms and a budget have also been built into the “track and trace” system for the use of interpreters where needed—by that I mean professionally qualified human beings, not a down-the-line Google Translate service—so that no one from any minority group experiences delayed or inadequate instructions about contacts or isolation, which could be damaging at best and fatal at worst?

Health: Stroke Survivors

Baroness Coussins Excerpts

Thursday 28th June 2018 Grand Committee

[Baroness Coussins (CB)]

My Lords, I declare an interest as co-chair of the All-Party Group on Modern Languages. I quite understand if, at this point, other noble Lords wonder if I have wandered into the wrong debate, but please bear with me as I hope to convince noble Lords that there is an important link between the recovery of stroke victims and languages. This is borne out by robust research and has the potential to bring significant benefits to patients, as well as leading to some cost-effective decisions for the NHS.

In January this year, the All-Party Group on Modern Languages heard from a panel of experts on the cognitive benefits of learning a second or subsequent language. The panel comprised, among others, the neuroscientist Dr Thomas Bak of Edinburgh University, who is president of the cognitive disorders research group of the World Federation of Neurology. His main clinical research interest is the relationship between language, cognition and the brain. He was accompanied by Dr Dina Mehmedbegovic from University College London’s Institute of Education. She is developing interdisciplinary work with neuroscientist colleagues to provide a broader evidence base for advocating the cognitive benefits of lifelong language learning.

The bottom line is that people who speak more than one language recover cognitively from strokes more successfully than those who do not. In Dr Bak’s study of 2015:

“The percentage of patients with intact cognitive functions post stroke was more than twice as high in bilinguals than in monolinguals”,


and,

“bilingualism emerged as an independent predictor of poststroke cognitive impairment”.

For the sake of clarity, I emphasise—with Dr Bak’s authority—that the word “bilingual” in this context means simply having the ability to communicate, not having a perfect command of a language. His detailed findings included that 40.5% of bilinguals had normal cognitive functions after a stroke, compared to only 19.6% of monolinguals. Looking at that the other way round, he found that that only 49% of bilinguals had cognitive impairment after a stroke, compared with 77.7% of monolinguals. This research was reported in 2015 in the American Stroke Association journal. A further significant finding was that late acquisition of another language has a similar protective effect to early acquisition. It is never too late to start learning another language in order to benefit in this way.

Research has also examined the impact which learning and using more than one language had on delaying the onset of Alzheimer’s and other forms of dementia, and found that it can indeed cause a delay of four to five years, including for vascular dementia, which is the type caused by strokes. Similarly with aphasia, a common language disorder caused by brain damage such as stroke, bilingualism leads to less severe impairment and better recovery. This finding was reported by Paplikar et al earlier in 2018. Dr Bak is involved in a project in Scotland, in partnership with Alzheimer Scotland and Edinburgh University, and supported by an ESRC grant. It is called Lingo Flamingo, and teaches languages to Alzheimer’s sufferers to improve their cognitive resilience.

Will the Minister consider supporting a similar initiative in England and Wales for stroke survivors? Drs Bak and Mehmedbegovic argue that, by increasing multilingualism in the population, we could expect to reduce the incidence of dementia, saving billions of pounds. I understand that the current total cost of dementia care is around £26 billion a year. Exactly the same argument can be made for the long-term treatment of stroke survivors, and I hope that the Minister will agree to take this proposition back to the department.

As always in scientific research, there are some discrepancies in findings across different studies, but on this proposition—that learning and using more than one language improves long-term recovery after a stroke—there is now converging evidence from different studies, different populations, different countries and even different continents that supports the conclusions that I have highlighted. However, to transform the research findings into practical policy, we need to change the general attitude towards language learning in the UK. I am pleased to say that, following the APPG meeting that I referred to earlier, Nick Gibb, the Schools Minister, requested further details of the research for the Department for Education to consider. The DfE’s interest of course lies in the cognitive benefits of language learning for children, of which there are also plenty, although not for elaboration in today’s debate. However, the Minister here today will, I hope, be sufficiently interested and intrigued by my contribution also to want to follow up this innovative research and find out more.

Dr Bak says that,

“promoting language learning and use is one of the cheapest, simplest and most effective means of improving cognitive functions across all ages”,

and he points out that the work of the Lingo Flamingo project is scalable, so if funds were available for a pilot project for stroke survivors, he could have it up and running within months. This would be a fast and measurable initiative. Is the Minister tempted to find out more and would he like me to arrange a meeting for him with Dr Bak?

Health: Diet

Baroness Coussins Excerpts

Tuesday 13th July 2010 Lords Chamber

[Earl Howe]

My Lords, there is, and I am grateful to my noble friend. He will know that the healthier food mark initiative is one thing that the Government can do to enable the public sector to lead by example, in schools, hospitals and care homes. The healthier food mark has been developed over the past two years as a benchmark to raise the level of nutrition and sustainability of food served in the public sector. It sets clear guidelines on healthier and more sustainable food and recognises achievement, so I hope that it will lead the way.

[Baroness Coussins]

Will the Minister explain why the Government are scrapping the extension of free school meals when there is such a clear link between nutrition and academic performance? Would it not be better and more cost-effective in the long run to make sure that as many children as possible from low-income families get at least one nutritious meal a day?

[Earl Howe]

My Lords, the school fruit and vegetable scheme is continuing. However, future responsibility for running it will no longer lie with central government; it has been devolved to primary care trusts.