Terminally Ill Adults (End of Life) Bill

Baroness Gerada Excerpts

Friday 6th February 2026 Lords Chamber

Experts and charities say that the Bill does not contain any provision to prevent individuals with eating disorders being classified as terminally ill. They support the amendments to make the Bill safer, all of which were rejected in Committee in the other place. I ask that noble Lords think carefully about the amendments before the House and support Amendments 89, 91, 92, 101 and 103.

[Baroness Gerada (CB)]

My Lords, I am completely in favour of Amendment 87. I have permission to use the name of my patient, Melanie Spooner, who died from anorexia nervosa—she died from taking her own life. The end point of anorexia nervosa is often that the patient wants to die. As such, it is a terrible mental illness, and I think that not conflating and excluding this group is absolutely the right way forward.

One other issue has been bothering me ever since I have been coming to these Fridays: it is the conflation of the words assisted suicide with assisted death. For a decade now, I have been looking after those bereaved following the death by suicide of their loved ones, and I have about 100 people whom I care for. Suicide is often a violent act; it is often an act done alone and it is often done to punish people—I am terribly sorry if anyone here knows people who have killed themselves. It is a very prolonged bereavement, and a very complicated grief that affects up to 60 to 70 people in its wake.

Assisted death, as we have heard from the group that came from Australia, can sometimes be filled with hope and sometimes with joy, with family around for those last moments. It affects both groups: those whom I look after, who have been bereaved following suicide, and the relatives of those who have taken voluntary assisted death. It is such a small thing, but it really grates, and it is one of the most inappropriate and irresponsible ways of conflating the language.

[Baroness O'Loan (CB)]

Before the noble Baroness sits down, can I ask her whether she is aware that recent research has shown that 42% of people think that assisted death is actually the provision of palliative care, and that it is actually quite important to distinguish between the two?

[Baroness Gerada (CB)]

I was not aware of that research. The evidence shows, and we heard it from the Australian group, that where voluntary assisted death is in place, the provision of palliative care is improved. In Australia, a great deal more resource was put in to providing palliative care. My point, however, is: please can we no longer conflate the language of assisted suicide with that of voluntary assisted death.

[Lord Moore of Etchingham (Non-Afl)]

My Lords, I of course agree with the noble Baroness, Lady Gerada, that there are many different motives for killing yourself, but we are talking about making a law here. It is very important that the natural and ordinary meaning of words is established and preserved. Suicide means killing yourself, and what is proposed in the Bill is killing yourself with assistance. It is very important to keep explaining that to people, because otherwise they will be permanently misled about what is actually happening.

NHS: Corridor Care

Baroness Gerada Excerpts

Wednesday 4th February 2026 Lords Chamber

[Baroness Merron (Lab)]

I agree with the need for more adult social care, but there is a whole range of factors that affect discharge delays, including the number of people who present. What the noble Lord outlined was not right and not the way in which his mother-in-law should have been dealt with. I know he would not expect me to comment further on individual circumstances, but if somebody is being considered for corridor care, that should be appropriately risk-assessed by clinical teams. The exact point he made is something that I have asked about. There should be a named nurse, and the provisions he talked about, such as food and drink, should have been there.

[Baroness Gerada (CB)]

My Lords—

[Lord Swire (Con)]

My Lords—

[Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)]

We will have the Cross Benches and then we will come to the Conservative Benches.

[Baroness Gerada (CB)]

We know from evidence that you can avoid hospital admission by improving continuity of care by general practitioners. When will the Minister redress the imbalance whereby GPs are funded from only 8% of the NHS budget yet deliver 70% to 80% of its care?

[Baroness Merron (Lab)]

We very much appreciate the role that GPs play. Corridor care is related to a whole range of factors, not only the position of GPs. I have heard what the noble Baroness has said and will gladly relate it to my ministerial colleague.

Medical Training (Prioritisation) Bill

Baroness Gerada Excerpts

2nd reading
Wednesday 4th February 2026 Lords Chamber

[Baroness Gerada (CB)]

My Lords, I also congratulate the noble Lords, Lord Roe and Lord Duvall, on entering this House. As a newbie myself—I have been here only about six weeks—I know that it is an enormous privilege, as well as incredibly hard work.

The principle at the heart of this Bill is the right one: UK-trained medical graduates should be properly prioritised for the foundation programme and subsequent specialist training. No one can dispute that it is wrong that UK graduates, educated at a cost of billions to the taxpayer, are forced to compete with overseas students, pushing many doctors abroad and depleting the talent pool that should be powering the NHS. I am grateful to the Minister for engaging with me over the last few days both personally and in meetings.

However, I have some serious concerns. The first, as has been alluded to, relates to Malta. As the only Member of this House to have Maltese heritage— I thank the noble Lord, Lord Stevens, for reminding me that I have two George Crosses, one from having Maltese nationality and the other from working in the NHS—this is especially important to me. Like many noble Lords, I have received letters and concerns, but I have also received representation from all quarters in the UK and in Malta about the impact of the Bill on Malta, including from its Minister for Health and Active Ageing. He wrote a letter to our government health team where he said:

“Whilst acknowledging the supreme interest of ‘home-grown’ graduates, this development raises serious concerns for this Ministry and the people of Malta. Aside from risking to undermine two centuries of proud tradition and the dissolution of a strong bilateral relationship in healthcare, this strategy puts the training and specialisation of Maltese graduates in jeopardy”.


This matters because Malta has a long, deep and historic relationship with the United Kingdom, and not just in medicine, although I will stick to that. For nearly 200 years, since the first Maltese doctor received their licence to practise from the Royal College of Surgeons, British and Maltese medicine have grown side by side: the same language, the same exams and, for many years, the same training programme. This is why it has been possible for doctors such as my father, who came to this country in 1963, to dedicate their professional lives to the service of the NHS. This is a small group of doctors but they have had an enormous impact—tonight I should have been at a conference celebrating the power and impact that Maltese doctors have had—from revolutionary surgery treatment for Parkinson’s to revolutionary, innovative treatments for cancer.

Nowadays, each year around 50 doctors complete their specialty training in the NHS, under a special arrangement in which the Maltese Government cover 70% of their salary, with a contractual agreement that these doctors return to Malta. It is a so-called finishing school; they come here to do parts of the training that they cannot get in Malta, such as for sickle cell in haematology. It is a win-win. The NHS gets talented, skilled doctors, often working in hard-to-fill non-training grade posts, at very little cost to it.

This Maltese-UK relationship has been strengthened in recent years, as we have heard, with the establishment in Malta of a UK-based medical school, Queen Mary University of London. This is a multi-million pound initiative of QMUL and the Maltese Government. Since 2009, QMUL has delivered an integrated training programme, awarding an MBBS degree that is academically and regulatorily identical to the UK London programme. These are not rich kids buying a medical degree; they are hard-working students, among the top performers across the MBBS exam. The diversity of the campus in Malta mirrors that of the UK: 80% are from Black and minority-ethnic groups, 20% are disabled and 65% are women. Their training is aligned to NHS principles and practice. Nearly 80% of them do part of their training in a UK NHS hospital. Of course they understand the NHS—nearly 70% of these students are British nationals or have indefinite leave to remain in the UK. Deprioritising these doctors risks abandoning a small, committed cohort without a fallback, simply because they choose to fund their own training. This seems unfair.

I will briefly move to another area where I have serious concerns. This legislation will disadvantage many international graduates already in training who have spent thousands of pounds in good faith and were encouraged to come to this country to train. I have received representation from the British Association of Physicians of Indian Origin, which is seriously concerned about this. These international medical graduates have been disadvantaged since the start of the NHS; they have been subject to racism, bullying, disproportionate complaints and punishment, and failure to progress in their career. They now risk losing employment, their visa status and everything they have worked for. This seems unfair, especially given the assurance by the UK Foundation Programme that the same preference informed allocation method used in 2024 and 2025 would be used for 2026. Should there not be transitional arrangements for these doctors, who have relied on public assurances?

As is often said, if one intervenes in a complex system, there is no guarantee that outcomes will be achieved but there is a guarantee of unintended consequences. I look forward to engaging with the Minister further and hope we can redress some of these issues.

Terminally Ill Adults (End of Life) Bill

Baroness Gerada Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Baroness Gerada (CB)]

My Lords, I assure the noble Baroness, Lady Coffey, that this issue will never be a routine tick-box exercise. Being in Tenerife rather than Torbay is the choice of the patient. If they want to spend that time there before they return to the UK and die, it is not our choice. Videos allow patients and their families to be together for those assessments. There is no ethical or clinical reason why an assisted dying request, or aspects of care included in the clauses laid out, must be face to face. What matters is capacity, choice and informed consent, not physical proximity.

During Covid, I assessed thousands of patients’ capacity, consent and safeguarding issues remotely, with no evidence of increased coercion or harm. Patients can already refuse life-sustaining treatments such as renal dialysis, have feeding withdrawn or make advanced decisions to remove treatment without face-to-face legal requirements. Face-to-face assessment requirements, as laid out in these amendments, are a policy choice, not a clinical or ethical necessity. What protects patients is careful assessment, independence, documentation and review, not the distance between two chairs.

--- Later in debate ---

[Lord Markham (Con)]

To follow on from that, as my noble friend said right at the beginning, the amendment was put down in such a blunt fashion absolutely to stimulate this sort of debate. What has been really useful in this debate is finding that there is a broad degree of consensus that AI can be valuable as an input to decision-making, but it should not be used as the output: as the final decision-maker. As mentioned, AI can detect the progression of cancers and can probably do better prognosis or improve, especially over the time that we are looking at here, so that you can get better assessments of how long someone is likely to live.

On the AI in the chat box, there are very many instances where it could be very useful in terms of detecting coercion if it is talking to someone over quite a long period of time. Therefore, in all of this we see that, with inputs to the decision-making process, AI has a valuable part to play, but I think we would also absolutely agree that the final decision-maker in terms of an output clearly has to be a human; obviously they will be armed with the inputs from AI, but the human will make the final decision. I think that is what the Bill does, if I am correct, in that it is very clear that the decision-makers, the panels, the doctors and everything are those people, but at the same time—although I guess the Bill is silent on this—obviously it enables AI as an input.

I hope this debate is useful in that it shows a degree of consensus and that in this instance we probably have the right balance, but, again, I would be interested to hear from the Bill sponsor in his response whether that is the case.

[Baroness Gerada (CB)]

My Lords, under this amendment as it stands, we would have patients who could not have computerised records, because we have AI sitting behind every computer. The AI starts at the beginning. It starts with our telephone system, so, in fact, the patient would not even be able to use the telephone to access us; they or a relative would have to come in. They certainly would not be allowed to have computerised records, because of the digital and AI systems that we have in order to pick out diseases and to make sure that we are safely practising.

They also would not be able to have electronic prescribing, in many ways, because the pharmacy end too uses AI to make sure that patients are not being overmedicated and for drug interactions, et cetera, and, if they are using a computer system, AI is also used to digitally scribe consultations. So I understand the essence of this amendment, which I think, as many have said, is to not allow AI to decision-make somebody at the end of their life, but, as it stands, I have to warn noble Lords that it is unworkable in clinical practice.

[Baroness Berridge (Con)]

My Lords, I am grateful to my noble friend for laying such a broad amendment, and obviously I agree with much of what the right reverend Prelate said. It is interesting that this is coming straight after the debate on face-to-face conversations. We are all used to ticking the “I am not a robot” box, but AI now has the ability to create persons, and it is often very difficult if you are not face to face to judge whether the person on screen is actually a person. I cannot believe we have got there quite so quickly.

However, it is also important to consider about public confidence and understanding at the moment. This is, as we keep saying, such an important life-or-death decision. There is a lack of understanding and people are potentially worried about these implications, often with regard to employment but also other purposes. For instance, as I was preparing this, it made me reflect, as the noble Baroness, Lady Gerada, said, on how your GP uses AI. When Patchs told me recently that the NHS guidance was that I should not take an over-the-counter drug for more than two weeks, I queried it.

However, only yesterday, I thought: was that answer actually from my GP or was it from an AI tool sitting behind the system? We really need to be careful with the level of public understanding and awareness of its use. This use of AI is also one step on and connected to Clause 42, which relates to advertising. I am grateful that the noble and learned Lord is going to bring forward some amendments on that clause. I hope that the connection with AI, as well as the Online Safety Act 2023, have been considered. If I have understood the noble and learned Lord correctly, I am disappointed that we have had no assurance that those amendments will be with us by the end of Committee, when the noble and learned Lord gave evidence on 22 October last year and accepted that there was additional work to be done on Clause 42.

I said at Second Reading that the Bill is currently drafted for an analogue age. I am not wanting to take us back to some kind of quill and no-use-of-AI situation. Obviously, as other noble Lords have said, the Bill do not deal with the pressure or coercion not being from a human being. It also does not consider that coercion can now be more hidden with the use of AI. The Bill does not deal with people being able to learn to answer certain tools by watching YouTube. Therefore, we could be in a situation where someone who would not qualify if there was a face-to-face non-AI system could learn those answers and qualify.

There are also good studies to say that its use in GP practices has had some inaccuracies. In many circumstances, there is a lack of transparency and accountability in tracing where the decision has come from. We do not even understand the algorithms that are sending us advertisements for different shops, let alone how they could be connected to a decision such as this.

Finally, my biggest concern is that there will be a limited number of practitioners who will want to participate in this process. That has been accepted on numerous occasions in your Lordships House. I will quote from a public letter written on 12 June last year. All of Plymouth’s senior palliative medicine doctors were signatories to a letter warning us of the risks of the Bill and saying that the

“changes would significantly worsen the delivery of our current health services in Plymouth through the complexity of the conversations required when patients ask us about the option of assistance to die”.

That is relevant for two reasons. First, if we have a shortage of practitioners in parts of the country, such as the south-west if those doctors’ opposition to the Bill translates into not being involved, there may therefore be an increased temptation to resort to more use of AI. I hope that the noble and learned Lord or the Minister can help on this point.

Many of these systems—I am speaking as a layperson here—rely on data groups and information within the system: the learning is created from that. If you have a very small pool of practitioners and some form of AI being used, does that not affect the creation of the AI tool itself? I hope that I have explained that correctly. With such a small group doing it, will that not affect the technology itself?

Terminally Ill Adults (End of Life) Bill

Baroness Gerada Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Lord Rook (Lab)]

I absolutely agree with that. The reason why the doctor is able to do that is because he gives consistency and continuity of care. He does not see patients on one occasion on one big issue, but is able to travel with them in a longitudinal relationship, and that gives him the ability to make those decisions.

[Baroness Gerada (CB)]

As a GP, I understand the sentiment behind this amendment and the power of continuity; in fact, it was what my maiden speech was about yesterday. But modern general practice works in multidisciplinary teams. We have nurse prescribers, pharmacists and physician associates. We also work with other team members, especially with those at the end of their life, such as palliative care teams and oncology teams. While I understand the need to have a GP involved, I think it is rather reductive. We deliver continuity in today’s world through our medical record, which is a complete record of the individual from cradle to grave. I would say it is with the primary healthcare team that the individual has a relationship rather than with an individual.

On a point of clarification, the average patient over the age of 75 consults their GP team—the primary healthcare team—around 10 times per year, so I do not recognise the figure that most elderly people at the end of their life have no access to the GP. We reach out to our elderly patients and we try to deliver the best possible care we can to them, especially when they are approaching the end of their life.

--- Later in debate ---

[Lord Deben (Con)]

I agree with that, but the point of the amendment from the noble Lord, Lord Rook, is to tie together a period of someone being in the National Health Service. I agreed with the comments made by the lawyers about “normally resident”, rather than other words. The noble and learned Lord who introduced the Bill might consider that this amendment will give some confidence to those who had a concern because it means that “normally resident” has been underlined by the fact that someone has in fact been in a general practice of the National Health Service. I cannot see that it does any harm, given that there is a year in any case. It underlines what the noble Lord reminded us of: the idea that this should be a part of the normal way in which people are dealt with.

I do not like the Bill very much, but it is our job to make it work. To do that, it is more valuable to fix it within the National Health Service as we have it, rather than trying to invent a service that we might well like to have—and I am old enough to remember when we did have it. Let us not pretend, when things are not as they ought to be.

[Baroness Gerada (CB)]

My Lords, if a patient is at the end of their life in any practice in the NHS, that patient will be discussed at a multidisciplinary team meeting. The patient will be put on an end-of-life pathway and will have a named clinician within the practice to do their care. This would include assisted dying. There is absolutely no way that a patient, unless in an extraordinary situation—and I take the point about Wales, which has a desperate problem with GPs—would not be cared for in that way. That is how our contract is; that is how we want to care for our patients. We would code it on the notes so that every single person consulting with that patient would know that this patient was an assisted dying choice, and they would get the care that I have just described.

With respect to the arbitrary 12 months or 24 months, many patients choose to move at the end of their life. They choose to move to the place where their loved ones are. Many choose to do something such as go abroad to the countries that they may have come from and come back right towards the end of their life. To put in an arbitrary barrier of 12 or 24 months is not putting the patient first; it is putting an arbitrary time limit first.

[Baroness Falkner of Margravine (CB)]

My Lords, I wonder whether the Minister in winding up could advise us what the Companion says about Peers making speeches on the same amendment over several points of the passage of that amendment.

It is a pleasure to follow the noble Lord, Lord Deben, speaking to the amendment from the noble Lord, Lord Rook. There is a lacuna in Clause 1(1)(d), which, by requiring registration with a GP, does not cover the practical point of what happens to people who have lost contact with their GP. They may have lost contact for no other reason than being so ill, perhaps with cancer as that is the main illness that people who might be seeking assisted dying have, that they have been taken into private care—those who are lucky enough.

An increasing proportion of the population of the United Kingdom now uses private care, not least because employers provide it as part of a package. So, coming to continuity of care, if we must have the light-touch amendment of the noble Lord, Lord Rook, in the Bill, to clarify and strengthen Clause 1(1)(d), I will share with the Committee very briefly a practical experience of what it means to have advanced cancer and the interaction with the GP. My GP practice, having failed to diagnose me over six months, as I mentioned in my Second Reading speech, slipped away the moment I engaged with private care, although every single consultation with a private practitioner is sent to the GP. Nevertheless, between 30 August 2024, when I was first diagnosed, and late this September, I had no contact whatever with my GP practice. I was finally invited to come in and was told I had fallen between the cracks—it must have been a pretty large crack to have lasted 14 months.

I noticed in the equality impact assessment that 66% of the people who sought assisted dying in the two jurisdictions quoted were people who had cancer. My question to the noble and learned Lord when he winds up on this debate is therefore, what consideration has been given, in having Clause 1(1)(d) in the Bill, as to the relationship of the private oncologist who is treating that patient with the local GP, given that terminally ill people in significant enough numbers that we need to be conscious about them in the Bill may well have been—shall I say—passed on from the GP?

As a final point, once I had the diagnosis, I had the experience of requesting treatment at my local—within a walkable distance—leading cancer teaching hospital in the United Kingdom. When I rang about that after the diagnosis, I was told by my GP, “They won’t take you, because now you’ve gone private”. I leave that for noble Lords to reflect on.

Wheelchair and Community Equipment Strategy

Baroness Gerada Excerpts

Thursday 11th December 2025 Lords Chamber

[Baroness Gerada (CB) (Maiden Speech)]

My Lords, I rise for the first time with gratitude, humility and, if I am honest, a certain amount of surprise, until I remember how hard it is to see a GP these days—and having me in the House at least solves that problem. It is a great honour to stand here, particularly in such a significant debate that concerns dignity, fairness and independence. I thank the noble Baroness, Lady Kennedy of The Shaws, and the noble Lord, Lord Patel of Bradford, who so kindly introduced me. I also thank the staff of this House for their warm welcome, their patience with my many questions and their kindness.

Here is a little bit about me. I have Maltese heritage and was born in Nigeria, where my father worked as a doctor. My parents arrived in this country in the early 1960s as proud citizens of the Commonwealth. They taught me that success rests on courage, hard work and a commitment to the quiet dignity of public service. My father became a general practitioner in the NHS. His surgery was the front room of our home and patients have therefore been part of my life from a very early age. As a young girl, Dad would take me on home visits in communities still bearing the scars of the Second World War. Through him, I learned what general practice truly involves: not only medicine but community, continuity and compassion, and that the measure of a doctor lies not only in what they know but in how he or she cares.

I have now worked in the NHS for more than 50 years, beginning as a Saturday girl in our local pharmacy. In 1990, after completing my training in psychiatry, I became a GP in Kennington, and I have lived and worked in the community I serve ever since. Being well known in the area has its advantages. I recall my bicycle being stolen during a home visit; the next day, it was returned to the surgery with a note reading, “Sorry, doc. It won’t happen again”. Of course, it can never happen when I visit this House, as my little Brompton has two armed policemen guarding it every day—thank you, officers.

My patients have included the great, the good and, given that I work in the Division Bell zone, occasionally the difficult. My very first patient was a young woman who suffered a stillbirth. Decades later, I look after her children and now their children too. That continuity, seeing lives unfold across time, gives general practice its unique moral and social power. It allows us to see people as whole human beings, not as isolated organs or diagnoses. We are interpreters of experience, translators of suffering and witnesses to change. We observe how illness is linked to housing, poverty, work and the myriad pressures of everyday life. This is not the soft end of medicine; it is its foundation: the undramatic, continuous care that underpins the entire National Health Service. GPs carry out more than 300 million patient consultations every year—80% of all NHS contacts—for less than 10% of its budget. Most of our encounters end without referral, admission or prescription. When general practice thrives, the whole system does. It prevents illness, supports self-care, protects hospitals from becoming overwhelmed and saves money, and it is where the story of our NHS begins anew every day.

It is a privilege to be among the very few GPs admitted to this noble House, and now that I have completed my maiden speech, my first surgery is tomorrow—10 minutes only and only one problem allowed. Thank you very much.