Terminally Ill Adults (End of Life) Bill

Debate between Baroness Hayter of Kentish Town and Lord Markham

Committee stage
Friday 9th January 2026 Lords Chamber

[Lord Markham (Con)]

My Lords, I have found this debate to be very helpful, because we all of course want the safest processes possible in all of this. It is clear that we are all reaching to try and find a way that we think will work. To a certain degree, it is all down to whether the best way to do this is through a multidisciplinary panel or a judge-led court process.

The example that the noble Lord, Lord Carlile, gave in terms of life support is quite illustrative, because life support decisions are made by medical professionals. In the vast majority of those cases, they then go through on the basis of that professional advice. It is only in the edge cases or serious cases where there is an appeal process that the family can take to court.

On this proposed process, there is a multidisciplinary panel, very well described by the noble Lord, Lord Pannick, which includes a psychiatrist, social worker and judge—the professionals in this particular area—who will be very well placed to reach a decision in a similar way to life support decisions for which, in the vast majority of cases, everyone is happy that it is the safest and right decision. There is also the oversight role of the commissioner, who is of course a judge in this process and, rather like the example of the life support case, has the ability to oversee and review that case where there are serious concerns. The life support example is a very good one here, given that we are trying to adopt a similar process in the multidisciplinary panel with the oversight of the commissioner.

On a way forward, it may be for the noble and learned Lord, Lord Falconer, and the noble Lord, Lord Carlile, to discuss how those cases can interact. Where the multidisciplinary panel might need oversight, the concern is how that can be triggered and how that can be worked out in terms of the commissioners. We have a framework there that, like the life support example, can get the best of both worlds. That could prove a constructive way forward.

[Baroness Hayter of Kentish Town (Lab)]

I will take the advice of the noble and learned Baroness, Lady Butler-Sloss, and now get rid of what I was going to say, because the noble Lord, Lord Markham, has said most of it. I now have only three points to add, so I thank the noble Lord for that.

First, the big discussion is on whether it should be a court or panel. The reasons for the panel have been put, so I do not need to repeat that. The only thing I would say is that when this was discussed in the Commons, it was not about the capacity of the courts that made them make the change to a panel but about the advice they got that this would be a much better, holistic and patient-focused way of doing it. In fact, making sure that that bit was added was very much welcomed by the British Association of Social Workers and the Association of Palliative Care Social Workers.

Secondly, the mention just now of legal aid says it all. Surely, we do not want this to be an adversarial process. It should not be argued in front of a court that way. I want to be very brief, because I am taking the advice of the noble and learned Baroness to be very brief, but we want this to be a conscientious decision and not one that is adversarial, which is why I think the panel would be so much better.

Lastly, this is not a life-or-death issue, because these people are dying. We are discussing only when they die, not whether. That is different from deciding that a baby will die who was not going to die anyway, or even someone in a permanent vegetative state. That is why I really do not agree that it is right to use the word “suicide”, rather than “assisted dying”. People are dying, and this is the issue of when they die and not whether.

NHS England: Ovarian Cancer

Debate between Baroness Hayter of Kentish Town and Lord Markham

Thursday 2nd May 2024 Lords Chamber

[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

Debate between Baroness Hayter of Kentish Town and Lord Markham

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

Debate between Baroness Hayter of Kentish Town and Lord Markham

Tuesday 17th October 2023 Lords Chamber

[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.