Terminally Ill Adults (End of Life) Bill

Baroness Hayter of Kentish Town Excerpts

Friday 21st November 2025 Lords Chamber

[Baroness Hayter of Kentish Town (Lab)]

I think it might be appropriate to hear from somebody who is not against the Bill. We have heard endless interventions.

[Lord Polak (Con)]

My Lords, I want to respond to the noble Lord, Lord Griffiths, who is a member of the Labour Party. With respect, I would like the Committee to listen.

[Lord in Waiting/Government Whip (Lord Lemos) (Lab)]

Does my noble friend Lady Hayter want to make one point? Then we can hear from the noble Lord, Lord Polak.

[Baroness Hayter of Kentish Town (Lab)]

My one point is that it would very nice if somebody who supports the Bill could also have a hearing.

[Lord Polak (Con)]

It is a shame, because I have a particular and important point to raise in response to the noble Lord, Lord Griffiths.

[Lord Polak (Con)]

I will. I was given six months to live 37 years ago. I do not often share this personal issue. I stand here today as living proof that prognosis is not certainty. Estimates are sometimes wrong and sometimes wildly wrong. That experience shapes my approach to this legislation and underlines why safeguards matter so profoundly.

When I spoke at Second Reading, I made it clear that I was against the premise of the Bill, and that remains my conviction. However, if the House decides that the Bill should proceed, it must do so with the strongest possible protections, and I support many of the amendments that were mentioned, particularly Amendment 46 in the name of the noble Baroness, Lady Finlay.

In listening to the debate, I was particularly moved by the noble Lords, Lord Evans, Lord Carlile and Lord Deben, and by the noble Baroness, Lady Fox, on the issue of coercion and encouraging. I actually pay tribute to the noble and learned Lord, Lord Falconer, on this whole issue, which is so difficult. I understand. I think that he is plastering over gaping wounds in the Bill. In fact, I think he must have more plasters than my local pharmacy. I will return to this properly when I speak to my own amendments, but I want to say that this vital piece of legislation is not fit for purpose, no matter how many amendments or how many plasters. I think we need to look.

I shall end with just these words: when we debate matters of life and death, we do so with the utmost seriousness. I believe that those who brought forward the Bill are acting from the highest motives, and I respect that, but in moments such as these, I know the whole House feels the absence of the wise counsel of the late Lord Sacks. He reminded us that purity of motive does not guarantee rightness of outcome. Our responsibility here is clear: to ensure that the law we craft is robust, precise and overridingly safe.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, this has been something of an unbalanced debate, so I hope it might be possible to hear from someone who supports the Bill. I was particularly anxious to come before the noble Lord, Lord Polak—for whom I have a lot of respect; we agree on many other issues—to respond very soon after the right reverend Prelate the Bishop of London. She was very honest when she said that she did not support the Bill, and I think she said that it was unamendable. Here we are, however, discussing amendments.

The noble Lord, Lord Carlile, spoke earlier about whether we should discuss a form of wording on which we could all agree. The question then would be: if we can agree a form of wording, would he then support the Bill? My feeling is that these amendments are not about making the Bill acceptable so that those putting them forward could then support it but are a way of trying to stop our discussion and proper scrutiny, because they do not want the Bill to go ahead.

[Lord Deben (Con)]

My Lords—

[Baroness Hayter of Kentish Town (Lab)]

If I could just finish. It has been a long time in this debate without hearing from my side—I want to come on to something that the noble Lord, Lord Deben, said anyway.

The amendments to this Bill are about coercion or pressure. As stated by the noble Lord, Lord Pannick, the situation at the moment is that people can go to Dignitas without even proving to a doctor that they are dying, and without any check as to whether there is coercion or pressure, or whether someone is going to inherit their house. They can go, and that is the way they end their life, and they feel it is not worth living any longer. On the definition of coercion, are we really content with continuing the status quo where there is absolutely no check—from a psychiatrist, a social worker, a lawyer, or anyone else—on whether they have been coerced? That is the alternative: allowing the status quo to continue with no checks whatever.

We have to ask, therefore, whether these discussions about definition are really about that, or whether they are about trying to stop the Bill. Perhaps we could discuss whether those who want the wording changed would then support the Bill. If they would, let us get down to discussing that, but if they are never going to, they are wasting the time of those who want it to go through.

[Lord Carlile of Berriew (CB)]

My Lords—

[Noble Lords]

Order!

[Baroness Hayter of Kentish Town (Lab)]

I do not have to give way. I have been speaking for three minutes, and I have listened for some hours. I am sure the noble Lord can come back; it is Committee stage, so he can speak again.

People have talked personally. Both my parents died when I was a child. People know that one of them died tragically and very suddenly; the other did so in enormous pain at the end. As a child, I went through that, so I understand about bereavement and grief, and seeing someone die in great pain. We have all been through that, and some of us come to a different conclusion. We come to a conclusion that no matter how we define pressure or coercion—the discussions we are having—what we want is the ability to move forward and help those who want help to bring things forward a few days earlier. I do not know whether the noble Lord, Lord Deben, has been through probate when trying to sell a house, but for someone who is already dying and may be a month off, bringing it forward a month or a couple of weeks would not make that much difference. We are finding excuses.

I am sorry not to have given way, but I have listened for some hours, and it is only appropriate that someone who supports the Bill also gets the chance to speak today.

[Baroness Hollins (CB)]

Before the noble Baroness sits down, can I just ask which amendments she was speaking to, because this is Committee and not Second Reading? Every amendment that I have tabled is designed to make the Bill better and I feel quite concerned to be accused of time-wasting.

[Baroness Hayter of Kentish Town (Lab)]

I was talking to the debate on coercion, because there is no check on it for the existing way of ending one’s life early, which is to go to Dignitas. I was asking whether, if the Bill is changed in the way that, for example, the noble Lady, Lady Hollins, would like, she would then support it.

[Baroness Butler-Sloss (CB)]

My Lords, before the noble Baroness sits down, there are two separate situations here, and I wonder whether she agrees. One is that there are many of us who do not like the Bill, but there is a real probability that the Bill will pass, and if it passes, we want it better than it is at the moment. Consequently, we are not wasting time.

[Baroness Hayter of Kentish Town (Lab)]

I was not suggesting wasting time. I was asking whether, if these changes were agreed, people would then allow the Bill to proceed.

[Lord Carlile of Berriew (CB)]

Before the noble Baroness sits down, I have great admiration for her, but I and many others resent her waving her hands at us. The reason we wish to have the sorts of discussions that I was mentioning was so that, believe it or not, we can make a judgment as to whether we are prepared to support the Bill, or to be silent on whether we support the Bill, or to oppose it at Third Reading. It is unworthy of the noble Baroness to allege that all of us here who are expressing concerns are wasting time. It is not true, and it is what she said.

[Baroness Hayter of Kentish Town (Lab)]

I never said that about wasting time. The words did not come; I did not say them. I was asking whether the people who want a better definition will then be able to support the Bill.

[A noble Lord]

They can decide at the end.

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[Baroness Hayter of Kentish Town (Lab)]

I hope that the right reverend Prelate is not going to push for a vote at Third Reading. The task for this House is scrutiny of the Bill both at this stage and on Report, and I hope that that is what we will do.

[Lord Sandhurst (Con)]

My Lords, I will not be long. I speak to Amendment 726, which, as those of you who get that far in the list of amendments will see from the explanatory statement, is one of a number of amendments that I have been prompted to put down by the Law Society. They are intended to make the Bill safer in operation.

I would also like the House to know that I speak free from religious belief, but I do speak as a world-weary lawyer with many years’ practice at the sharp end in both medical negligence matters and legal professional negligence matters. I am all too conscious of my own experience of having seen things go wrong even where the people concerned were decent, honest professionals. Some of them, of course, although professionals, were neither decent nor honest. I have also sat as a legal assessor for five years at the General Medical Council, and I appeared as counsel for a north-eastern NHS trust in a very messy inquiry about 20 years ago about the misdoings of a Doctor Neale, who had featured in a “Panorama” programme—some of you may know about that. I have seen things go wrong on the ground for the past 30 or 40 years of my life.

It is with that in mind that I put down, among others, Amendment 726 with the support of the Law Society. I stress that the Law Society is neutral in principle but has looked at this Bill with what can be described as lawyers’ eyes. Its amendment is designed to make the Bill safer and better in practice. This amendment would “require” and not just permit—that is the difference—the Secretary of State to issue a code of practice in connection with what we are concerned with today; that is, capacity and so on, and the absence of coercion. A code is necessary. In Clause 39 of the Bill, there is provision for other codes of practice to be made; this is simply to add an additional code.

I suggest that this is a perfectly safe, non-destructive amendment that would improve the Bill in respect of a very important practice. As we have heard, coercion—I use the word loosely to cover a wide range of subtle pressures—must be addressed, and it should come from the Secretary of State. The panels that will oversee all this will not be enough. This must come from the Government, looking at things carefully and putting down a code of practice which says: “This is how the panels must address this”. We cannot have a postcode lottery with a panel in one part of England adopting one approach and another adopting a much tougher approach. We need uniformity.

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[Lord Empey (UUP)]

My Lords, there is one aspect of coercion that we have not so far discussed. It was mentioned tangentially by the noble Baroness, Lady Hollins. It is institutional coercion. As somebody who has unfortunately had to bring a loved one into hospital to be treated and discharged on a large number of occasions in recent years, I have become familiar with the process called “clerking”, where an individual is brought into the hospital, the paperwork obviously has to be brought to bear, the healthcare staff have to fill it in and so on.

If this legislation gets on to the statute book, in whatever form, it has to be translated into paper that the health service will have to deliver when a patient is brought into a hospital. We already have the “Do not resuscitate” aspect of an induction, and we will now have to have another set of paperwork. I have seen how it works frequently: the pressure that the staff are under from time to time, and the fact that the people coming and going and dealing with a patient are frequently different and they change at 8 am in the morning and 8 pm in the evening. That paperwork has to be done by an individual, sometimes a relatively junior member of staff, and all these things have to be translated into a box that has to be ticked.

How is that to be done? The actual process that one has to go through, particularly dealing with somebody who is seriously ill, is challenging in itself, and when you have to ask the person, “Do you want me to tick the box that says, ‘Do not resuscitate’?”, that is a big thing to do, and the person needs to be coherent, informed et cetera. We are moving things to a stage well beyond that.

I had the experience of being in a hospice and, while it was not an issue with pain that was the problem, when the consultant comes along and says to your loved one, “Have you considered the D-word?”, that sobers you up. Somebody who was perfect intellectually, who had the ability and the capability, shut down completely and could not cope with, “Have you considered the D-word?”. So, I say to noble Lords, these are emotional things, coercion is a very hard thing to define, but I have to say to the noble Lord, Lord Pannick, that the difference between his scenario and what we are facing is that the state is co-operating, providing the mechanism and delivering the mechanism for a person to end their life. That is the antithesis of what the medical profession and the National Health Service have stood for since its inception.

With regard to how we treat things in this House, when Bills come to us, of course we have a view on whether we are for them or against them. I remember when the Brexit legislation came before this House and I gently remind the noble Baroness, Lady Hayter, that she was not running to try to improve it so that she could get into the Content Lobby. It is the way things are. On an issue such as this, we have to be driven by our conscience, not by our parties or anything else, but let us remember that this will have to be translated into the room where the patient is sitting. What box is a junior nurse or a junior auxiliary going to be asked to tick? What is the question? Who is going to fill it out?

As the noble Lord, Lord Hunt of Kings Heath, said, if we had had a royal commission and a proper government Bill, we could have answered these questions, instead of having to sit here and go through the whole process again. I just ask the noble and learned Lord, Lord Falconer, to bear these things in mind. These are gaps in the system which the staff are going to have to face. There will be shifts coming on and there will be some members of those shifts who will refuse to participate. What kind of chaos is that going to create? These things need to be thought through and they are not thought through.

[Baroness Hayter of Kentish Town (Lab)]

I just remind the noble Lord, Lord Empey, that of course I did vote for the Brexit legislation and in fact led the Labour Party into the Lobby to support the final agreement on Brexit.

[Lord Harper (Con)]

My Lords, I support the thrust of the amendments in this group, but first, I want to say a word or two on one of the issues that has come up in this morning’s debate. I hope the Committee will indulge me if I just quote a few lines from yesterday’s maiden speech by the right reverend Prelate the Bishop of Chester. The House was a little less well-attended for the debate on the Sustainable Aviation Fuel Bill in which he spoke, but I thought his words yesterday, the ones I am going to read, are very relevant to the debate and the tone of it, so I hope the Committee will forgive me. He said that

“communication is a vital gift for those of us who nurture and curate community. In communication, we need to learn to speak and to listen. This is almost always done in person and directly. Indeed, I argue that one of our primary vocations in this noble House is to be with and to listen, for few disciplines are more vital in the search for wisdom—the search I so often witness in your Lordships’ House. The question for me is not so much how we can be great again, but how we can be kindly present. Greatness is great, but grace is greater”.—[Official Report, 20/11/25; col. 965.]

I think those were wise words. They moved me and I think they are relevant to how we conduct ourselves in this debate on these vital issues.

The noble Lord, Lord Carlile, referred to how useful this debate was, and I believe that it is vital. That is why I quoted those words from the right reverend Prelate. We have raised a range of issues, all connected to people’s capacity to make an informed choice. The point of the debate is for us all—but especially the Bill’s sponsor, the noble and learned Lord, Lord Falconer of Thoroton—to listen to the concerns that have been expressed. I agree with the noble Lord, Lord Carlile, that the noble and learned Lord will then have the opportunity to talk to noble Lords and to bring forward on Report amendments that deal with these issues.

Part of the problem here, and the reason there are many amendments on the Marshalled List and the debate will be lengthy—the noble Lord, Lord Watts, referred to that—is that the House of Commons spent, I think, 17 hours in Committee, focusing on just the first three clauses of this legislation because they are very important. That involved just 23 Members of Parliament. Almost all the proposals that we are discussing were brought up in the House of Commons, but almost all were rejected or disposed of. If some had been accepted and dealt with in the House of Commons, all we may have been doing here is tidying up some of the wording or improving the amendments. However, we have to address them from scratch because they were not dealt with in the House of Commons.

It is our job in the House of Lords to scrutinise legislation and to deal with the things that have not been dealt with. We do that on behalf of people— a number of today’s amendments deal with vulnerable people who do not have the same opportunities that we have. The one thing that we all have in common in this House is that we are all privileged. I am referring not to our material circumstances but to the fact that we have a voice. Many people in this country do not have a voice. Many of the people who have been touched on in these amendments—people of poor material circumstances; people undergoing coercive control, as my noble friend Lord Gove suggested; and people who have severe disabilities—have no one to speak for them. It is our responsibility and duty to make sure that we test these issues and make sure the Bill is as good as it can be.

The noble Baroness, Lady Hayter of Kentish Town, asked whether the noble Lord, Lord Carlile, would support the Bill if some of these things were dealt with. That is not really the question. I have been very clear that I do not support the change, and I will set out why in a moment in relation to one of the amendments. However, I have to confront the possibility that the Bill may become law; I will not find that welcome, but the noble Baroness will. If it becomes law, it is absolutely my responsibility—and the responsibility of everyone in this House—to make sure that the Bill has in it all the protections for vulnerable people. If we were to fail to do that, we would have failed the people of this country, whom we are supposed to support—that is our duty. There will be some people in this House who will, if the Bill is improved, support it; there are some who will not, but that is not the point. The point is to get the Bill in as good a shape as possible.

Let me now turn to the amendments. I will deal first with Amendment 45 on encouragement, so powerfully spoken to by the noble Baroness, Lady Fox of Buckley. The reason that word is important was demonstrated in the short debate between the noble Lords, Lord Pannick and Lord Carlile, on the present position. I hesitate, as a humble accountant, to trespass in the debate between those learned noble Lords, but I will make two points. First, there is a fundamental difference between someone refusing treatment or not having treatment and someone taking deliberate steps to kill themselves. Those are fundamentally different things, and trying to elide them is not helpful to the debate.

The noble Lord, Lord Pannick, talked about the status quo. As I understand it, the current position if you assist somebody to take their own life and the DPP investigates is that the guidance contains the concept of encouragement. There is a specific point, when the DPP is considering whether to prosecute you, about whether you have encouraged somebody to take their own life or tried to talk them out of it. If you have encouraged them not to take their own life but you have, none the less, assisted them, the current position is that that is treated much more favourably than if you had not tried to discourage them. That subtle position in the status quo is something we should maintain, because something very important will happen if this legislation passes, which is why I do not support it: it will, effectively, change society’s view of suicide. In some circumstances it will, effectively, support suicide where currently we do not. In those circumstances, the use of “encouraged” is vital. That is why I support the amendment.

Terminally Ill Adults (End of Life) Bill

Baroness Hayter of Kentish Town Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Baroness O'Loan (CB)]

My Lords, the noble Baroness has told us a very sad story about her brother, but it really is not on the issue that I am speaking of today. It is, of course, the case that decisions about life and death are made. What I am saying is that, in this case, the decision is to ask the state to enable the person to administer that, and for the state to bring all the forces and resources available to do it. That is what we are debating today: does the Bill provide a situation in which “capacity” is the correct term to use in this clause?

I support Amendment 2. The use of the word “capacity” is undoubtedly provided for in the Mental Capacity Act. This Bill says that

“references to a person having capacity are to be read in accordance with the Mental Capacity Act”,

which is very helpful. The Mental Capacity Act was not passed to deal with the decision to end one’s own life, but rather it was formulated with the basic assumption that a person has capacity. In November 2021, the Supreme Court said in A Local Authority v JB:

“‘A person must be assumed to have capacity unless it is established that he lacks capacity’”.


It continued:

“This principle requires all dealings with persons who have an impairment of, or a disturbance in the functioning of, the mind or brain to be based on the premise that every individual is competent until the contrary is proved. … Competence is decision-specific so that capacity is judged in relation to the particular decision, transaction or activity involved. P may be capable of making some decisions, but not others”.


Therefore, there are circumstances in which capacity cannot be assumed and a person may not be capable of understanding, to the necessary extent, the information that should underpin any decision-making, or of analysing the consequences of that information or of making a decision in their own best interests. When these conditions are not fulfilled, the Mental Capacity Act requires, in particular circumstances, that a decision be made by a third party, but always in the best interests of the person. As the Royal College of Psychiatrists told us in evidence,

“an assessment of a person’s mental capacity to decide to end their own life is an entirely different and more complex determination requiring a higher level of understanding”

than assessing capacity for treatment decisions.

We have received very helpful evidence from Professor Gareth Owen, Professor Alex Ruck Keene, and Professor Katherine Sleeman of the Complex Life and Death Decisions group at King’s College London. They have stated quite clearly that

“the MCA 2005 was not designed to be a universal framework for determining capacity.  It is primarily a workaround for the inability of a person to give consent to actions required to secure their health and social care needs. In the MCA 2005, the principles applying to and the test for capacity apply in a context where a decision can be taken on a ‘best interests’ basis for the person if they lack capacity”.

In the context of the Terminally Ill Adults (End of Life) Bill, they state that,

“no such best interests decision could ever be made”.

Capacity is not a constant state. It may fluctuate depending on a variety of circumstances, including some illnesses, disabilities and the side-effects of medication. A person can have capacity in relation to one decision and not another. A person may have capacity at one time, but not another. It is an enormously complex issue. When the decision in question is the decision to end one’s own life, capacity to make that decision requires very significant analysis in each case at the time in question.

That is the reason why “capacity” is not an adequate word to deal with the situation in which a person is coming to make a clear, settled, and informed decision. “Capacity” cannot be the test. “Ability” is a wider test, and there will be opportunity for the Committee to consider what that might look like as we go through future groups.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, this issue was well discussed in the Select Committee, and I want to refer to Professor Sir Chris Whitty, who I think knows a little bit about this. I want also to respond to and endorse the words of the noble Baroness, Lady O’Loan, because she talked about concentrating on the interests of the person concerned. They were not exactly her words, but she was saying how important that was. We are talking here about someone who is dying. They are in the last months of their lives and, under the Bill, they must have capacity throughout the stage for which this legislation will provide. In other words, at each stage, they must have capacity. Professor Sir Chris Whitty, who knows a lot about this, spoke on it—it is on page 153 of the committee’s report, if anyone would like to look. He said:

“There is plenty of evidence, and it goes with common sense, that, when people use an existing system that they have used for many years, that they are used to and that has been tested in the courts, they are far more likely to be able to follow a reproducible and sensible pattern of making decisions than if they are faced with a completely new approach which they have not used previously and in which there may well be legal ambiguities the courts have not yet adjudicated on”.


If we want this Bill to work, as I assume the House of Commons did when it sent it to us, and as I think a majority of this House does, we must give to doctors and everyone else a form of words that they already understand, they can use and, above all, what is in the best interests of the patient in front of them.

[Baroness Noakes (Con)]

My Lords, I am a little confused about this debate. The debate is on Amendment 2, which would replace “capacity” with “ability”, but we have heard hardly anything about ability. We have heard from the noble Lord, Lord Pannick, who said that it would replace a defined term with an undefined term, which is an issue we should take seriously, but most of the debate has been about whether the definition of “capacity” in this Bill—that in the Mental Capacity Act—is the right one to use. We are not debating whether “ability” is a better term; I hope that we can do that and move on to some other important areas in this Bill.

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[Baroness Hayter of Kentish Town (Lab)]

Does the noble Baroness accept that someone can take their own life now? They are dying; it is completely legal for them to commit suicide without anyone doing any checks about whether they have capacity, ability or anything else. So the Bill is in fact adding a safeguard that is not there at the moment, because at the moment someone can take their own life.

[Baroness Fraser of Craigmaddie (Con)]

I thank the noble Baroness for her intervention. Every suicide is a tragic situation, and I am sure that all of us would wish to help that person. But that is not what the Bill is about. It is about whether we find a method where they have a settled will to make a decision—to make a choice.

Terminally Ill Adults (End of Life) Bill

Baroness Hayter of Kentish Town Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Baroness Hayter of Kentish Town (Lab)]

My Lords, we have heard three arguments against the Bill: from those who oppose assisted dying in principle, those who say it will undermine pressure for palliative care, and others who think that the Bill is faulty.

There is not much I can say to those whose objections are deeply religious, but I disagree with the right reverend Prelate the Bishop of London that enabling a dying person to end their own life means that we, as a society, believe that

“some lives are not worth living”.—[Official Report, 12/9/25; col. 1785.]

I say no; it means that we value our fellow human beings and their choice to hasten the inevitable, at a time of their choosing.

I acknowledge the views of the noble Baroness, Lady May, although I do not think she should prevent others from exercising a different view. I disagree with her that:

“As a society, we believe that suicide is wrong”.—[Official Report, 12/9/25; col. 1784.]


As the noble Lord, Lord Pannick, says: it is legal, but there are no safeguards—particularly when people go to Switzerland. As we have heard from a former DPP and a former chief constable, the current need to interrogate the loved ones of those who have legally taken their own life is a situation none of us would want to face.

As the noble Lord, Lord Purvis, and others have said, the Bill is not about people choosing to die. They are dying. The Bill is about helping to make those final days easier for those who so choose. It is about dying people who want a loved one with them; the Bill allows that. It is not just about a medical intervention. It is for those who want a loved one with them, if they choose to end their own life, when the pain, discomfort, indignity or scale of intervention become unbearable.

Some noble Lords claim that the Bill would undermine pressure for palliative care. But there is no evidence for that. Indeed, the Bill has already led to more discussions about dying; the need for dignity, support and help; and it may even have increased the likelihood of improved provision. I say to those noble Lords: campaign away for palliative care, but do not do so at the expense of those who have had palliative care and then, in their final hours, want help to die.

Palliative care is about improving the quality of the last part of life for those approaching death, by managing pain and other symptoms—often in their own home. Why, when those symptoms are no longer manageable, should professional help be unavailable at a time and manner of their choosing and in their own surroundings, alongside those they love?

I address the argument from those—who would otherwise support assisted dying, rather than those who never would—who say that this Bill is not right. Our task is not to undermine the clear public desire, and the Commons’ support, for this measure. Our task here is to ensure that it achieves its ends but with proper safeguards, albeit not with so much bureaucracy that its purpose is defeated. We should look for genuine improvements, helped by a timely Select Committee and then by the whole House, without derailing its timetable. Let the Commons then have the final word.

There is a right to die; it is already in law. This is about helping those who, in their final days, when the inevitable is coming, can have the comfort of professional help as well as having their families around them if they choose to end their life.

NHS: Single-sex Provision for Staff and Patients

Baroness Hayter of Kentish Town Excerpts

Wednesday 8th January 2025 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, would the Minister agree—

[Baroness Hayter of Kentish Town (Lab)]

My Lords, NHS England wrote to me on the—

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

I think we will hear from the noble Baroness, Lady Thornton, first.

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[Baroness Merron (Lab)]

I know that everybody in your Lordships’ House will take the view that the NHS is there both as an employer—as all employers are; this is not specific to the NHS—and in its service to patients. It is there to treat all with the right dignity and respect. We have a legislative framework to which reference can always be made. We will see what further guidance is needed—and that may be to all employers, not just the NHS. Again, I cannot emphasise enough the need for careful consideration and the involvement of all staff, on what has to be a trust-wide basis, because everybody is different in terms of their estate and what their challenges may be. It is not as simple as numbers: it is about fairness and dignity for all.

[Baroness Hayter of Kentish Town (Lab)]

My Lords—

[Lord Cashman (Non-Afl)]

My Lords—

[Lord Kennedy of Southwark (Lab Co-op)]

We will hear from the noble Baroness, Lady Hayter.

[Baroness Hayter of Kentish Town (Lab)]

NHS England wrote to me to confirm that any patient can choose the sex of a chaperone. Will the new guidance define what is meant by “sex” in that case?

[Baroness Merron (Lab)]

There is, of course, already a definition in legislation of what that means. I know my noble friend will understand that I cannot predict what the guidance will be, but I will certainly pick up the point she has made.

Palliative and End-of-life Care: Funding

Baroness Hayter of Kentish Town Excerpts

Wednesday 4th September 2024 Lords Chamber

[Baroness Merron (Lab)]

As the noble Lord will be aware, statutory guidance and service specifications are provided to support commissioners in ICBs to meet their duty. As I am sure the noble Lord is also aware, NHS England has developed a palliative and end-of-life care dashboard that brings all the relevant local data together and helps commissioners to understand the situation so that they can provide for their local populations. This is part of ongoing work for this new Government to see how we meet requirements to provide dignity, compassion and service at the end of life and just prior to the end of life.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, although I pay enormous tribute to the hospice movement, there will be some people for whom end-of-life care means assisted dying. We will have the Second Reading of the Bill in November. I hope that my noble friend will be able to give strong government time, if not government support, to enable that Bill to make good progress.

[Baroness Merron (Lab)]

The Prime Minister has already reiterated his commitment to allow time for a Private Member’s Bill and a free vote. I recognise that this is an extremely sensitive issue with deeply held views on the various sides of the debate. Our commitment is to ensure that any debate on assisted dying in Parliament will take place in a broader context of access to high-quality palliative and end-of-life care and that we will have robust safeguards to protect vulnerable groups, if the will of Parliament is that the law should change.

NHS England: Ovarian Cancer

Baroness Hayter of Kentish Town Excerpts

Thursday 2nd May 2024 Lords Chamber

Asked by

[Baroness Hayter of Kentish Town]

To ask His Majesty’s Government what assessment they have made of NHS England London stating that “anyone with ovaries can get ovarian cancer” in a social media post rather than referring to “women”, whereas at other times NHS England refers to “men” in relation to prostate cancer; and whether this wording has been market tested with women, including those for whom English is a second language, to ensure that it is fully understood.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

We are writing to NHS England about NHS London’s social media post, to reiterate the expectation that biological sex should be front and centre of all health-related information. Removing language around biological sex has the potential for unintended health consequences. The Government are committed to upholding the rights of women and girls, which is why we are consulting on updates to the NHS constitution, including the use of clear language based on biological sex.

[Baroness Hayter of Kentish Town (Lab)]

I warmly welcome the Minister’s response, which is probably welcomed across the House. Given the Government’s welcome assurance that “single-sex wards” means “biologically single-sex wards”, will he also discuss with the GMC the video on its website that advises doctors to ask trans patients which wards they would prefer to go in? Perhaps he could also talk to the GMC about its practice of allowing doctors to change their gender on the register without any advice that they should inform patients of their biological sex. Although I approve of the Government saying so, it is very hard for patients to ask for a doctor of a particular sex for intimate care if they do not know the sex of their doctor.

[Lord Markham (Con)]

First, I thank the noble Baroness for all her work in this space. I will continue to work closely with her, including by writing to and meeting the GMC as necessary on all these matters. On her second point, while I respect that many clinicians may wish to keep their information private, we have to understand that, for many people, it is the patient’s right to be treated by someone of a particular biological sex and to know what that is. We have to make sure that those feelings and understandable sensitivities—which are sometimes religious—are catered for.

Cass Review

Baroness Hayter of Kentish Town Excerpts

Wednesday 17th April 2024 Lords Chamber

[Lord Markham (Con)]

Yes, absolutely, and I thank my noble friend for correcting me and giving me the opportunity to correct that. Again being very honest, this shows that part of the challenge in setting up the new services is that this has become such a difficult, toxic space, and finding and recruiting staff who want to work in this area is a real challenge as well.

[Baroness Hayter of Kentish Town (Lab)]

I thank the Government, the Minister and indeed the Opposition for their very robust response and welcome to the report. I am really sorry that the Lib Dems have chosen to use Stonewall’s briefing in what we have heard tonight; I hope that is not the whole of the Lib Dem position.

I note that the Government have already met with the GMC over the weekend, and they have been in contact with the CQC. However, just last month, the Royal College of General Practitioners tried to cancel a conference posing exactly the questions covered by Dr Cass in her excellent report. It allowed this conference—it was called “First Do No Harm” and I had the privilege to open it—only after an enormous amount of persuasion; it did it under duress, with bad grace and some hostility. That was the Royal College of General Practitioners.

Will the Government also meet the Royal College of General Practitioners and indeed the Royal College of Psychiatrists, the Royal College of Nursing, the Professional Standards Authority and all the other regulators, many of which seem to have been blind when all this was going on, and ensure that they all engage with the conclusions and the recommendations of Cass, whether those professionals over which they have oversight are working in the NHS or in the private health sector? These puberty blockers were being prescribed years after we knew they were irreversible, when Stonewall still said they were reversible, and when the doctors should have known but still prescribed them. Will the Government therefore engage with all those regulators to ensure that Cass is implemented in full?

[Lord Markham (Con)]

Yes, and that is an excellent point. Again, I thank the noble Baroness in this area. The questions that she raised earlier in the year in terms of some of the language from the GMC really added to the debate and represented a step forward. Therefore, although I am sure it is happening already, I will doubly check that it is.

General Medical Council: Internal Guidance

Baroness Hayter of Kentish Town Excerpts

Tuesday 17th October 2023 Lords Chamber

Asked by

[Baroness Hayter of Kentish Town]

To ask His Majesty’s Government what discussion they have held with the General Medical Council on its removal of the words “mother” and “women” from its internal guidance for pregnant or menopausal staff, and whether this reflects advice to doctors as to how to treat and describe patients.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Government have not had any discussions with the General Medical Council on its internal guidance for pregnant or menopausal staff. The GMC is independent from the Government and its internal guidance is produced for its staff. It is not for doctors registered with the GMC. The Government are clear that biological sex matters and that there are different health needs between the sexes. Removing language around biological sex has the potential for unintended and adverse health consequences.

[Baroness Hayter of Kentish Town (Lab)]

I do not think that Answer is quite satisfactory and I am sorry that the Minister used the words “pregnant staff” rather than “pregnant women”. Maybe the GMC lost out on medical lessons, where they would have learned that men produce sperm. We produce eggs and when they are fertilised in our wombs, we give birth and become mothers. When that is over, it is us who go through the menopause. The GMC has a statutory duty; it is the register of all the doctors who work in the NHS and it has a duty to maintain public confidence. I wonder how many mothers would have confidence in a doctor who thinks that men can have babies. The Minister should engage with the GMC and I ask him to do so, because although its internal guidance may have upset some of us, it regulates doctors and the language it uses matters in how it oversees, trains and interviews them. I hope the Government will take this a little more seriously.

[Lord Markham (Con)]

I can definitely confirm that we are taking it very seriously. The Secretary of State was clear in his speech at the recent party conference that it is vital that we recognise the importance of the different biological health needs. That means being clear about describing a woman as a woman. I apologise: the noble Baroness was quite right to pick me up on that point, but we are very clear that biological sex is absolutely vital in addressing people’s health needs. It is clear that we are addressing women as women and men as men.

Mental Health Services for Rough Sleepers

Baroness Hayter of Kentish Town Excerpts

Monday 21st March 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for her Question and for her continued conversations with me on a number of different health-related issues; I am learning quite a lot from those. I understand that the data will be collected at some point, and I hope that that will be done regularly. If the noble Baroness will allow me, I write to her with more details, but I know that the top-level answer to that question is that we are about to get the data.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, about two-thirds of people who are homeless cite alcohol misuse as one of the reasons that first made them homeless, and for about one in 10 people who die homeless, alcohol is the main cause of death. Can the Minister assure us that all this work will include a proper alcohol treatment programme, so that the underlying problems are dealt with in addition to the other mental health problems?

[Lord Kamall (Con)]

The noble Baroness makes the very important point that a number of people who are homeless suffer from alcoholism and alcohol abuse—and indeed drug abuse. For some of these people, the issues they are suffering from are often interrelated. Therefore, in the joined-up thinking we are looking at, charities, civil society organisations and the NHS are making sure that we treat the various symptoms in an integrated way.

Health and Care Bill

Baroness Hayter of Kentish Town Excerpts

Lords Hansard - Part 3 & Committee stage
Wednesday 26th January 2022 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Green group is operating on the lark and owl system —appropriately enough, you might say. My noble friend Lady Jones of Moulsecoomb attached her name to Amendment 203 in the name of the noble Baroness, Lady Meacher. I am going to be brief, as I am aware of the pressures. I find it very hard to see why anyone would resist Amendment 203. It is about providing appropriate structures and law to ensure that people’s views are heard and respected.

When I looked at this, I thought of the very old feminist slogan, “the personal is political”. What could be more personal or political than a person having control over the nature of their own death, being able to express their wishes and ensuring that they are heard and recorded.

It is worth saying that I was not able to take part in an earlier debate about the funding for palliative care. We should see much better investment in palliative care in the UK; we should not see volunteers rattling fundraising buckets for hospices to meet their basic needs. But that goes along with the right of individuals to be in control, knowing that they will be heard and listened to, and their wishes acted on. That would allow them to be in a situation of much less fear.

I also want, very briefly, to offer the Green group’s support for Amendment 297. Support for assisted dying is Green Party policy. I want to reflect back to October last year, when the Private Member’s Bill was being debated. There was a very respectful, silent crowd outside, holding up signs saying “Choice, Compassion, Dignity”. I ask people considering this to make sure that those people can be heard in this House and this can be debated.

As the noble Lord, Lord Forsyth, said, it is not about a change in the law; it is about a guarantee of parliamentary consideration, as the courts have requested. It might surprise the noble Lord to know that I preceded him on this. I am trying to remember the details—I was not aware that any fuss had been made about this procedure, but it was either in the Agriculture Bill or the Environment Bill that I put down an amendment in this form. I would not consider myself a procedural innovator, so this is something that has been done many times before.

I want to make one final point. It is perhaps not of legal significance, but, in a way, it is a legal issue. Assisted dying is already available to people in our society—to people who have the funds, the knowledge and the remaining health to get to Dignitas, in Switzerland. This is very much an equalities issue around a right that some people have and some people do not. There is also the fact that, to be guaranteed to be fit to travel, some people are now dying before they need to because we have that inequality.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, I have added my name to Amendment 297 from the noble Lord, Lord Forsyth. He has made the case, so there is not much more to say. At the core of that amendment, in proposed new subsection (2)(b), all we are asking is

“to enable Parliament to consider the issue.”

That is really all we ask.

We know, as has been said, that the public want change. I believe that the House, at its full strength, wants change. The courts have said that it is not for them, judges, the Crown Prosecution Service, the Law Commission or anyone else to decide. It is the role of Parliament to take a decision of this importance.

By failing to allow a full debate and a decision in Parliament, as the noble Lord, Lord Forsyth, has just said, the Government are effectively siding with those who want no change. That is not a neutral position: it is allowing no change by forbidding those who want to put the issue to Parliament from being able to do that. That is done partly through the number of wrecking amendments that we have seen. I know that the Chief Whip has lots of other demands on his time, but my judgment is that, even if he did not, he would not give time for this—for what would be necessary, given the number of wrecking amendments.

All the Government are doing is accepting, as the noble Baroness, Lady Bennett, has just said, that people with money can go to Switzerland. More importantly, there are no safeguards. Those who oppose assisted dying say that it exposes people to pressure from their families. The whole point of having safeguards is that you will have to go and get permission before it happens, and someone has to test that. At the moment, you can go to Switzerland and there is no check—there is not even a check for whether you are dying. There is no check on whether you are of fit mind; there is no check on whether you are under pressure from a family member. You can just go, if you have the money, but there are no checks. The Government are allowing that to continue: our citizens are able, if they have the money, without any safeguards, to go quite legally to that country and end their lives when they are facing the end of life anyway. That really is not how this country ought to be.

What is important is that we allow Parliament to decide. I can only think that those who have turned up wanting to oppose this are actually afraid that Parliament will decide that it wants change. I often do not like things that Parliament does—unsurprisingly, sitting where I do, on this side of the House—but we are a democratic country and we should let Parliament take the decision on this.