Terminally Ill Adults (End of Life) Bill

Debate between Baroness Finlay of Llandaff and Baroness Hayter of Kentish Town

Committee stage
Friday 9th January 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, the noble Lord, Lord Carlile, has done us all a great service. Last night, it was clear that there is a view that some really major parts of this legislation need to be addressed and debated. This is absolutely one of those major parts. It is about where decision-making finally sits. The noble Lord has provided a clarity that could improve safety in relation to the Bill—I will not say to make it safer but to make it less unsafe—and that becomes important.

The scheme that the noble Lord has proposed would reinstate a court-based model that was previously welcomed when the Bill was introduced because of the clarity of decision-making that it provided. On the process of assistance with suicide or having an assisted death, we are not going to argue about the wording here now. That is not appropriate. The clauses relating to the specifics of the lethal dosage of drugs both make the death part of the process clearer and provide better governance oversight. The process also seems to provide some protection for NHS services by putting the decision-making outside healthcare, with clarity of the roles between the two.

I added my name to the amendment to strengthen the conscience clause, Clause 31, so that no registered medical practitioner is under any duty to perform a function in relation to this Bill other than those of notification and recording matters. This avoids eroding NHS clinical services and maintains the core duties and responsibilities of the NHS. It will be particularly important if legislation is passed in Scotland, because we need compatibility of the conscience clause between England and Wales and Scotland. The legislation currently going through in Scotland will have its draft conscience clause removed at the time that the Scottish Parliament goes to vote on it, because the provision of such a conscience clause is not a devolved matter. The exercise of conscience not being a devolved matter will require a statutory instrument passed from this House, or possibly even primary legislation, for it to be then included later in the Scottish legislation.

The noble Baroness, Lady Berridge, raised concerns about the wording of proposed new subsection (1) in Amendment 116. I wonder whether the noble Lord, Lord Carlile, would consider changing that to incorporate the amendment that I have tabled—the proposed new clause would replace Clause 3—over the assessment of capacity. This amendment was developed by the Complex Life and Death Decisions group at King’s; the national expert on mental capacity assessments sits as a key member of that group and as a professor at King’s College.

I hope the proposers of the Bill will recognise that proposed new subsection (2) in Amendment 116 provides very important minimum criteria that must be provided: questions that must be asked when such a decision is to be made. The court can certainly ask for them to be provided to it. It seems as if a panel would be discretionary over whether these criteria were looked at, and it would strengthen confidence in the decision-making to know that they were there, because it would provide transparency and consistency, and a process of appeal would be available. We know that no appeal system exists in the Bill as currently written in relation to panels agreeing to an assisted death being provided, and the real concern there is that these panels could eventually become something of a tick-box exercise under quite a lot of process. As has said been said before, those with a judicial background are not acting in a judicial capacity on the panels, whereas the proposal by the noble Lord, Lord Carlile, provides judicial capacity and processes.

The amendment that seems to be key is Amendment 120: its proposed new subsection (4)(b) would require a statement of medical fact, with the decision-making being taken by the court. Again, it will be much easier for people to provide a statement of medical fact than to feel that they are taking a decision over the provision or non-provision of lethal drugs. In proposed new subsection (5)(a), I hope that the doctor has to be on the specialist register for the specific condition of the patient—I seek clarification on that—or to have been a GP principal for longer than three years. It is important to be clear that this should not be a doctor who is at a training level, even if they have been a trainee for more than three years, because the ultimate responsibility sits with the consultant or the GP under whom they are training. There could be confusion over responsibility if this is not clarified.

On Amendment 120’s proposed new subsection (6)(a), can the noble Lord, Lord Carlile, confirm that it may be not the GP at all who is involved but a hospital consultant or long-term associate specialist who has been providing medical care? These might seem like minutiae, but we are in Committee and discussing amendments that can be changed, and I think it will be important to have that clarity.

It seems that proposed new subsection (5) in Amendment 426 seeks to provide additional security with a court-appointed medical expert. This proposal seems to protect us against going down the route that Canada has gone down. It seems to really attempt seriously to detect undue influence. Allowing interveners is very important; it is all part of the desire for there also to be an appeals process and of getting all the information.

I stress that there is a clarity between decisions about whether somebody is given lethal drugs to significantly shorten their life, accepting that a prognosis of six months is not much more than a guesstimate—in fact, it is a guesstimate—and the position that has been discussed over life support decisions. When a patient is on life support, the decision to cease that intervention is based on two potential factors: one is the futility of continuing with an intervention that is not achieving a therapeutic goal, and the other may be because the patient withdraws their consent for continuing that intervention in an informed way and has capacity to do that. That is fundamentally different from somebody providing lethal doses of drugs with the deliberate intention to shorten a person’s life—which may be by days, weeks or months, but may be by years. As has already been said, we all have experience of people given a very short prognosis that turned out to be completely wrong.

I have some questions for the noble and learned Lord, Lord Falconer. I know that he has already been given a large number of questions to answer, but I think it is really important. First, in 2024 he stated that

“family judges are … completely unsupported”

and that the family justice system is—I think I can quote correctly—“literally crumbling”. Were these the reasons behind the removal of the court oversight when the Bill was considered in the other place?

Secondly, in discussing these proposals with officials, what assessment has been made of the volume of cases outlined in the impact assessment being handled by this system, and what provision has been made for recognising that the numbers in the impact assessment are almost certainly inappropriately low? The data from Australia, New Zealand and other places has shown that, by year three, the uptake will probably be about 10 times higher than written in the impact assessment, because the impact assessment was based on data from quite a long time ago, when the Oregon system was instigated.

Thirdly, what costing has been undertaken for each of the models—the model of the panels as put in with the different numbers that might be involved—and what consideration has been made for a costing over this model?

I ask the Minister: what budget has been put aside to fund the system, whichever model is adopted, and what option appraisal has been undertaken over the safety of individuals and the ability to identify coercion with a higher degree of probability than currently exists and to identify abusive relationships?

As I have said, the financial costs for each model, tested against the impact assessment numbers, appear unrealistically low. I think we all look forward to the questions being answered.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, given the number of questions that have been put to the Minister—and, indeed, to my noble and learned friend and to the mover of this amendment—I wonder whether it might be useful if we now move to the Minister and the others to answer some of these questions. There are so many that it would really help the Committee if we could hear some of the answers.

Professional Qualifications Bill [HL]

Debate between Baroness Finlay of Llandaff and Baroness Hayter of Kentish Town

Tuesday 9th November 2021 Lords Chamber

[Baroness Hayter of Kentish Town (Lab)]

My Lords, I too support Amendment 1. I pay tribute to the noble Lord, Lord Lansley, who has urged and pushed, with perhaps a little more oomph than we could have done from this side. We are very grateful for what he has been able to do there.

I think the Minister will be thanked by quite a few people in the next couple of hours, though there may still be one or two people with a “please” in there for him. He knows that, right from the introduction of the Bill, we were worried about the ability of independent regulators to decide who is fit to practice. The words that the noble Lord, Lord Lansley, used are useful ones around being fit to practice and whether the ability of regulators to decide that could be undermined by a government diktat to set up a new system to recognise overseas practitioners wanting to come here, and therefore potentially lowering standards to meet a government view that there is a homegrown shortage in the relevant profession.

That was a concern not just to us but to the users of regulated service providers. Their confidence in professionals stems very much from the high standards and, indeed, from the enforcement that our independent regulators are able to give in the interests of consumers. But the Government have heard these concerns.

When most of us were away during the summer, the Minister spent a lot of time in meetings, and that is reflected in Amendment 1, which confirms that the regulators can apply their chosen standards as to who should practice in this country. The Minister has already referred to some regulators, and we know that the Nursing and Midwifery Council, for example, and others, have signified that they are content with the amendments. It clearly has to be for a regulator both to determine standards and to make a judgment on who has actually achieved those and therefore can be let loose on consumers or users in this country. So on this amendment, it is a “thank you” from me, and it does not require a further “please”.

[Baroness Finlay of Llandaff (CB)]

My Lords, I add my thanks to the Minister for having met with me and for having, as I know, consulted extremely widely on the Bill. I seek a tad of reassurance from him on his Amendment 1, fully accepting the comments that the noble Lord, Lord Lansley, made on the issues around fitness to practise. It would be very helpful if the Minister could confirm that the ability of any regulator to determine fitness to practise and other issues will be up to that regulator, and that that consultation will extend across the four nations of the UK.

United Kingdom Internal Market Bill

Debate between Baroness Finlay of Llandaff and Baroness Hayter of Kentish Town

Committee stage & Committee: 2nd sitting (Hansard) & Committee: 2nd sitting (Hansard): House of Lords
Wednesday 28th October 2020 Lords Chamber

[Baroness Hayter of Kentish Town (Lab)]

My Lords, I rise to move Amendment 68 but also to speak to Amendments 89, 96 and 102 in my name. I will take Amendments 68 and 96 together. As we discussed on Monday, these are to ensure that, as we go through this process of ensuring a working single market across the UK, we have consumers—in whose interest, after all, public policy needs to act—at the forefront of our minds.

Amendment 68 is particularly important. Noble Lords may recall that, at the start of Part 1, the very first clause outlines the “Purpose of Part 1”. I may have wanted to expand this a little, but at least a purpose is there. As we turn to Part 2, on “UK market access” as it applies to services, it simply says that it will govern the regulation of service providers in the UK, but no objective is set for why this is done.

If we look at the regulation of the financial services sector, for example, we see that clear objectives for their work are set down in the appropriate legislation. It would be good to have a similar set of aims here. My amendment, unsurprisingly, would set the purpose as promoting

“the continued functioning of the internal market for services in the United Kingdom for the benefit and protection of consumers.”

Other colleagues would add other things, and I am sure the noble Baroness, Lady Noakes, if she was in her place, would also prefer a different focus—although I hope that she would recognise that it should still have an eye on consumers. Surely, however, there has to be a purpose for this regulation.

As we have found with the legal profession under the Legal Services Act, for example, or with financial services under the various FiSMA Acts, intervention was needed because uninhibited competition in a market where consumers often cannot shop around or judge the long-term outcome of services—particularly financial services—necessitates some regulatory protections. If they buy a pension scheme, they cannot tell the long-term outcome, which means as a consumer they are very vulnerable. It is the same with legal services; you have no idea if your divorce settlement was good or bad until many years later. Very often there is an intervention for that purpose, but it is clear why the intervention is happening and what its purposes are. We need a similar thing here. Incidentally, given that such interventions often level the playing field, they have not been shown to restrict the growth of the relevant sector, so one does not need to fear that this will inhibit growth in any way.

Amendment 96 would add “the protection of consumers” to the list of legitimate aims whereby a service may be deemed not to be discriminatory. This might mean providing a service only in Welsh or in some other country specific way, but if it is aimed at protecting consumers, that would allow an opt-out, if you like, from it being discriminatory. 

Amendment 89 would remove from the consideration of whether a service provider is discriminating the words,

“it cannot reasonably be considered a necessary means of achieving a legitimate aim.”

I asked not my noble and learned friend here but another of our very learned colleagues how that sounded and whether this phrase was common in law, and at that point, he could not think of an example. It seems a vague definition for a service provider to have to work to. The whole paragraph is fraught with uncertainty as to who would judge that and how something could be reasonably considered necessary, for example, to protect public health, which is defined as a legitimate aim. However, it is a very indistinct definition for someone to decide whether it is discriminatory. Given that service providers sometimes have to act at speed, one has to ask: what sort of certainty would that provide? 

Even more confusingly, when looking at whether something could be reasonably considered as necessary —as if that was not hard enough—a further bit in Clause 20(9) says that has to be decided with regard to

“the effects … in all the circumstances, and”

Whether an alternative way of achieving a legitimate aim was available. We are getting into a lot of legal difficulties for a service provider to be able to judge whether they can tailor-make a service for particular needs if they have to go through quite so many indistinct legal loops. I beg to move.

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, the hour is late, and I will shorten what I was going to say. Amendment 78 is intended to achieve exactly the same objective, in respect of Part 2, as my Amendment 6 does in respect of goods. In other words, it seeks to incentivise both the Government and the devolved Administrations to commit fully to the common frameworks programme and rely on the market access principles only as a fallback when all else fails. The other two amendments in this group, Amendments 67 and 71, are consequential on it, since they would make the point at which the regulations came into force the point from which market access principles would apply. I cannot see why there is any difficulty with that.

Police Reform and Social Responsibility Bill

Debate between Baroness Finlay of Llandaff and Baroness Hayter of Kentish Town

Thursday 16th June 2011 Lords Chamber

[Baroness Finlay of Llandaff]

My Lords, I wish to speak to Amendment 241A in this group and the subsequent amendment, which is in the name of the noble Baroness, Lady Hayter of Kentish Town, who is also supporting my amendment. I should make it clear that these two amendments have not been tabled because we disagree on this issue; we agree so totally and fundamentally that these two amendments are almost belt-and-braces measures. I would have liked to add my name to the noble Baroness’s amendment. They are very slightly different but in no way less important.

The Bill constitutes a very important opportunity to address drink-driving and the catalogue of deaths and casualties that occur on the roads because of alcohol consumption. We both would like to bring down the legal blood alcohol level from 80 to 50 milligrams per hundred millilitres of blood; that would bring us in line with many other countries in Europe. However, the best way forward seems to be to see whether all the measures to be implemented under the Bill have an effect on alcohol consumption—hence the concept of their being subject to a review—and for the review to look at legal limits specifically.

What is the size of the problem? It is estimated that nearly 12,000 reported casualties—5 per cent of all road casualties—are the result of someone driving when over the legal limit and that the number of such people who were killed in 2009 was 380 or 17 per cent of all road fatalities. It is important to remember that pedestrians are sometimes knocked over in these incidents and have a much higher risk of being killed than the person who is in the car, who is usually the person who is over the limit. The injuries sustained by pedestrians are more likely to be fatal as they suffer head or facial injuries, which tend to be more severe.

The number of hospital admissions due to road accidents in general is enormous. There were 39,000 admissions following road traffic accidents in 2009. Looking just at the drink-driving statistics, an average of 3,000 people are killed or seriously injured each year in drink-driving collisions, and nearly one in six of all deaths on the road involve these drivers, as I said. However, the biggest problem occurs with youngsters. Drink-driving among young men in the 17 to 29 age group is particularly high. Provisional figures from 2004 show that some 590 people were killed in crashes in which a driver was over the legal limit, 2,350 were seriously injured and 14,000 were slightly injured. The key group comprises the 17 to 24 year-olds, of whom 6.3 per cent who were breath tested after an accident failed the test. That compares with an average for all ages of 4.4 per cent. People in this age group seem particularly liable to drive when they have had too much to drink and to have an accident when over the drink-drive limit. Recent data from police checks in England and Wales show that one in 20 of under 25 year-olds who were stopped were over the legal limit. That translates into 1,746 young drivers because more than 27,000 people were stopped by the police in total.

How do we stop this catalogue of deaths and serious injuries, not only of people who are over the limit but among others? How do we stop the carnage of young lives that are wasted because they have been driving while over the limit? They may not even realise that they are over their limit but their ability to drive safely is seriously impaired. Fatalities often result from stupid little things such as not looking properly, having slightly slower reactions and driving a little too fast on a wet road. That is the background to these amendments. We cannot leave a Bill like this, which is trying to tackle a major social problem, without addressing this alcohol-associated carnage on our roads.

[Baroness Hayter of Kentish Town]

My Lords, I declare my interests as chair of the All-Party Parliamentary Group on Alcohol Misuse, and as a member of CADD, the Campaign Against Drinking and Driving. As I have already said in the House, members of that body have lost a relative through drink-driving.

I am happy to support the amendment moved by the noble Lord, Lord Brooke of Sutton Mandeville. I will take his wise words on how to tackle these matters back to Camden. I also support Amendment 241A, standing in the names of the noble Baroness, Lady Finlay, and myself, and Amendment 241B, standing in my name, which would have the effect of reducing the blood alcohol level for young drivers, should the review show a case for further reform action.

Statistics on death as a result of alcohol impairment are well known, if not acted upon. We tend to concentrate on death but life-shattering and painful injuries are also a major issue. Indeed, it is mostly thanks to medical advances practised by people such as the noble Baroness, Lady Finlay, and others, as well as the speed and expertise of rescue crews and paramedics, that many who would otherwise have died following these accidents have been saved. However, they are not necessarily saved from a life of pain and impairment. As the Select Committee in another place has emphasised,

“drink driving is a preventable activity … On average, … one person dies every day”,

because drivers were over the limit. The Transport Committee also agreed that,

“medical and statistical evidence supports a reduction in the current drink drive limit of 80mg … per 100ml blood”.

However, as we know, the Government do not support such a reduction, at least for the moment, and nor did the committee, despite the wise recommendation of a reduction to 50 milligrams by Sir Peter North, although the Transport Committee would prefer a 20 rather than 50 milligram limit, which is effectively zero.

Despite the lack of action, I do not give up hope. In particular, it is worth looking within the generality of drivers at the susceptibility of the young to the effects of alcohol. This would also help to achieve the Transport Committee's aim that the Government should work to achieve a 20 milligram level by first introducing a lower limit for young drivers. New Zealand has recognised that young bodies are more affected by alcohol. It therefore has lower limits for young drivers. As its data show, young people start with a relatively high crash risk. For drivers under 20, even at 50 milligrams their risk of having a crash is six times the level of a driver over 30 years of age with the same alcohol consumption. That is why the drink-drive limit in New Zealand is 20 milligrams per 100 millilitres for those under 20.

The evidence is clear: drink for drink, young drivers are more likely to have accidents than older drivers, quite apart from their level of experience. New Zealand is planning further action to deter young people from drinking and driving, with policies closer to those of America where the drinking age is 21. The Federal Highway Administration estimates that having a drinking age of 21 saves 1,000 young American lives a year, so New Zealand is going to raise the purchase age for alcohol to 20 years. The House will be delighted to hear that that is not where I want to go, but I want to protect our young drivers—and, as the noble Baroness said, their victims, whether they are on the streets or in the cars of those young drivers—from any temptation to drink before getting behind a wheel.