Nationality and Borders Bill

Baroness Hollins Excerpts

Committee stage
Tuesday 8th February 2022 Lords Chamber

Moved by

[Baroness Hollins]

119C: After Clause 37, insert the following new Clause—
“Codes of practice
(1) The Secretary of State must prepare and issue one or more codes of practice for the guidance of immigration officers, medical inspectors and other persons assessing the mental and physical health needs of any asylum seeker in accordance with the United Kingdom’s obligations under Article 12 of the International Covenant on Economic, Social and Cultural Rights 1966.(2) The Secretary of State may from time to time revise a code.(3) Before the end of each review period the Secretary of State must—(a) review each code for the guidance of persons exercising functions under this section, and(b) lay a report of the review before Parliament.But this does not affect the Secretary of State’s function under subsection (2).(4) A review period is—(a) in relation to the first review, the period of 3 years beginning with the day on which this subsection comes into force, and(b) in relation to subsequent reviews, each period of 5 years beginning with the day on which the report of the previous review was laid before Parliament.(5) The Secretary of State may delegate the preparation of the review or revision of the whole or any part of a code so far as he or she considers expedient.(6) It is the duty of a person to have regard to any relevant code if acting in relation to a person seeking asylum in one or more of the following ways—(a) in a professional capacity;(b) for remuneration;(c) for a charity or other not-for-profit body.(7) If it appears to a court or tribunal conducting any criminal or civil proceedings that—(a) a provision of a code, or(b) a failure to comply with a code,is relevant to a question arising in the proceedings, the provision or failure must be taken into account in deciding the question.(8) In this section, “code” means a code prepared or revised under this section.”Member’s explanatory statement
This amendment requires the Secretary of State to lay codes of practice before Parliament providing for guidance to assess the mental and physical health needs of any asylum seeker.

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[Baroness Hollins (CB)]

My Lords, Amendments 119C and 119D propose a code of practice for professionals involved in the assessment and care of people seeking asylum. Refugees and asylum seekers often have complex health needs influenced by experiences prior to leaving their home country, during transit or after arrival in the UK. Common examples include untreated communicable diseases, accidental injuries, hypothermia, malnutrition, poor maternity care and inadequately treated mental illness. These are made worse by the barriers to assessment and treatment that they face right from their arrival in the UK to the conclusion of the process and beyond. One common risk factor for poor health and well-being among this community is trauma. This may be the very trauma that they are fleeing from, the trauma of the journey or the psychological distress of overcrowding, the lack of privacy and the absence of culturally appropriate community support upon their arrival.

The World Health Organization reports double the rate of depression and anxiety in a humanitarian crisis; that is worth noting. Mental illness can influence the ability of asylum seekers to present their claims in a coherent way. The assessment of credibility is a fundamental aspect of the asylum decision-making process, and the decision-making immigration officer needs information to make their decision but they may be faced with a person with symptoms associated with a mental disorder and the psychological effects of trauma, such as memory loss, an inability to express or even feel emotions or profound guilt and shame at what they have experienced. Such trauma, which disproportionately affects women, may also lead to a reluctance or delay in disclosure that can negatively affect the application, as already highlighted in Amendment 40, moved by the noble Baroness, Lady Lister of Burtersett.

The current government policy, as set out in the guidance on adults at risk in immigration detention, centres on indicators of vulnerability, including persons suffering from a mental health condition or impairment; victims of torture; those who have been a victim of sexual or gender-based violence; those who have been a victim of human trafficking or modern slavery; and those suffering from post-traumatic stress disorder.

Once a person has been identified as having an indicator of risk, the “adults at risk” policy identifies levels of evidence for that risk. The level of evidence is used as a measure of the degree of risk, which is then weighed against a range of immigration factors when making decisions regarding the immigration process, particularly the detention of the person. However, the Royal College of Psychiatrists has raised concerns that people with significant mental illness may have difficulty in being effective self-advocates or may lack a full appreciation of the extent of their own vulnerability. They may lack the mental capacity to make decisions relating to their immigration situation. Many do not have access to a robust assessment process or, if identified as lacking relevant capacity, to a system designed to safeguard them or advocate for them in their best interest.

The Helen Bamber Foundation says that in its experience persons with significant mental illness, as well as those with evidence of past torture, sexual gender-based violence and those with PTSD, are being detained despite their mental-health-related vulnerability. The assessment and identification of mental health problems requires appropriately trained staff in a facilitative environment as well as close multidisciplinary working.

For some, the treatment of mental illness will require specialist trauma-focused therapeutic support. I am told that this is not happening in existing facilities, such as Napier Barracks. It is intended that through these amendments the mental health, mental capacity and physical health of asylum seekers would be assessed and considered properly on arrival and throughout the asylum claim processes, and that the treatment and care of asylum seekers would be sufficient to ensure their health and well-being by standardising and regulating a process that would apply to numerous agencies, public, independent and third sector.

The Secretary of State said in the other place that the Bill will increase the fairness of our system so we can better protect those who are in genuine need of asylum and continue to strengthen our proud record of supporting those in need. The amendments seek to support the Government in achieving just that. I beg to move.

[Baroness Hamwee (LD)]

My Lords, my name is on this amendment. The noble Baroness, Lady Hollins, knows whereof she speaks, so I shall not attempt to do more than support her. To me, this is a matter of professional judgment, which she has brought, but also of common sense. What I hope is my common sense has been informed by what I have heard over quite some years, including, very significantly, in the debate that we had last week. It is clear that in the UK—it may in this context be England and Wales—the systems, if they can be called systems, for assessing the health needs of asylum seekers are patchy and often inadequate.

It is also common sense that assessment should start from a solid, informed base, incorporating the best, up-to-date understanding and experience, so a review is important. So is consultation with those who are expert in the field. I support the amendments.

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[Baroness Hamwee (LD)]

Before the noble Baroness responds, it may be that this amendment could be worded to put more emphasis on the guidance of those who come into contact with asylum seekers, rather than just assessment. Does the Minister accept that this is a very specialised area? Without for a moment being critical of the NHS, I suggest that that specialism needs to be recognised and learning from it made available to those who come into contact with the cohort we are discussing.

[Baroness Hollins (CB)]

My Lords, I cut my speech rather, because of the time, and I feel that maybe I did not manage to explain adequately. These are people with complex health needs. They are not just like any other patient in the NHS. They have had very difficult experiences and have difficult mental health needs. It is difficult for them to try to explain about their trauma to the first interpreter or the first person assessing them that they meet. This is something where it often takes years for people to trust sufficiently to be able to explain the impact on their situation, their circumstances, and their life chances. This is not just having an assessment and a conversation. It is about building a relationship of trust when people have experienced the most terrible circumstances. That is the difficulty.

I will give one quick example. One still very troubled lady, whose asylum claim was successful, described her claim and subsequent requests for ongoing support as “seriously retraumatising”. The paperwork that she received was confusing and negative in tone, with any success hidden somewhere in the small print. She asked, “Why do they do that to me? Why can’t they communicate with me? Why should I struggle so much? I feel like I’ve been through another fight”. This lady feels like giving up, despite the fact that her claim was eventually successful.

These amendments seek to see people treated fairly, compassionately and with more skill and understanding, so that they have the best hope of healing and settling in the UK. I thank noble Lords who have supported these amendments. I hope that the Minister will think again and accept the spirit of what I have proposed; otherwise, I and others will bring these amendments back on Report.

I beg leave to withdraw my amendment.

Amendment 119C withdrawn.

Assisted Dying Bill [HL]

Baroness Hollins Excerpts

2nd reading
Friday 22nd October 2021 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I speak with 40 years’ clinical experience, first in general practice but mostly in psychiatry, and as a past president of the British Medical Association.

Stories matter, but other evidence matters too. Consider valid declarations in Clause 4. My own research, published with Dutch colleagues and my noble friend Lady Finlay, found that autistic people and people with mild learning disabilities were given physician-assisted deaths in the Netherlands, rather than addressing the underlying issues of inequality, loneliness, feeling a burden or inadequate support. That is 38 people in recent years. Doctors were shown to be poor judges of decision-making capacity and their recommendations were seemingly influenced by their own assumptions about quality of life.

Clause 4(6) requires the doctor to be present throughout. In summing up, will my noble friend please specify the doctor’s role if the person has not died within, say, six hours? What if after taking the drugs the patient is in pain, vomiting, having a seizure, or dying slowly over hours or days, with their distressed relatives, expecting a quick and gentle death, pleading with the doctor to “do something”? In Oregon, one person took 104 hours to die after taking lethal drugs; eight people survived their suicide attempt.

It is worth noting that, in the Netherlands in 2019, 96% of physician-assisted deaths were euthanasia. Clinicians prefer this. Partly, it is their own convenience and partly the needs of the service. They had to transition to euthanasia because of complications in 8.9% of physician-assisted suicides. We have been promised that this Bill will not introduce euthanasia. This House needs cast-iron assurances from my noble friend that the plan is not to divert already-stretched palliative care teams to this task.

In 2016, Canada legalised assisted dying for people facing imminent death. Five years later, eligibility includes chronic illness and disability, and will shortly include mental illness. In Canada, assisted death is publicly funded and must be provided, but no similar right exists for palliative care. Canadian doctor Leonie Herx, writing in today’s Telegraph, says

“The impact on palliative medicine has been enormous. Hospices that do not offer assisted death face closure and loss of government funding … Administering death is cheaper and easier than providing good care.”


Hospice UK says that expert end-of-life care is not available to about one in four of the people who could benefit. That was 120,000 people in 2015; no wonder we hear stories of failed care. Frankly, the declaration should require doctors to specify what palliative hospice and psychiatric care was available so that any improvement or decline can be monitored.

What if palliative and hospice care became a right and a reality? It is shameful that a quarter of us currently do not and will not have access to palliative care. No wonder people are afraid. Let us campaign for it. Attitudes would shift again because ours and others’ stories would be stories of good deaths. Actually, most of the dozens of emails I received were unique, moving and positive stories. Please oppose this Bill; it is not safe.