Terminally Ill Adults (End of Life) Bill

Baroness Nicholson of Winterbourne Excerpts

Committee stage
Friday 20th March 2026 Lords Chamber

[Baroness Berridge (Con)]

My Lords, Amendment 174 is in my name, and I am grateful to the noble and learned Lord for the meeting on this issue. This amendment states:

“Any interpreter provided under subsection (4) must be aged 18 … or over”.


It is a probing amendment.

If you put two lawyers in a room and give them wording from the NHS guidance saying that it is “inappropriate” to use children, you would have a fascinating discussion about discretionary versus mandatory, and that is the point behind this amendment. It might be that a different age, say 16, is appropriate, but since meeting with the noble and learned Lord, I have looked at certain guidance from particular NHS hospital trusts. Leicestershire Partnership NHS Trust states that you “must not” use children. The Milton Keynes University Hospital trust says that children “should not” be used as interpreters. So we have overall NHS guidance using the word “inappropriate”, which seems to imply discretion, but then we have certain hospitals—I obviously have not checked them all—using mandatory language. It is important that we consider whether, in this scenario, there should be any discretion to use children, whether they are under 18 or, as I say, under 16.

The TIA process should be mandatory, because it is a substantial process. This is the communication of a profound state of affairs. It includes numerous complicated stages, from a preliminary discussion to different co-ordinating doctors. It involves a Mental Capacity Act assessment and could involve the discussion of quite sensitive information about the administration of lethal substances and their potential complications. It is a serious and, as we have said, irrevocable decision.

My submission to the Minister is that it should not be an option that interpreting lies in the hands of a child, but that we should provide for qualified, skilled adults to be present and to provide that service, so that any relative, including children, can sit, support and have their own potential needs met. Is the noble and learned Lord satisfied that this should be a service provided by the National Register of Public Service Interpreters?

This is not a small problem. The census in 2021 shows that around 7.1% of people in the UK speak English as a second language and around 5% do not speak English well at all. The NHS website states that there are 1 million people who do not speak English well at all, who will need assistance with communication. If we do not provide this within the Bill, it might be that relatives, particularly children, are used in situations where the interpretation services are underfunded in that area—it is local commissioning that provides interpretation services.

I acknowledge that noble Lords may want the lower limit of 16, which some hospitals use, but I find it interesting to note that the limit may in the past have been too low. The former Member of the other place, Sajid Javid, talked about this. He said of his mum:

“I used to go to the doctor’s surgery with her—not because I was ill, but because I had to interpret for her. I was six or seven and an interpreter”.


I believe we should make sure that children in our jurisdiction are not placed in that situation.

From the evidence that was given to the Commons Public Bill Committee by Dr Jamilla Hussain, who is a palliative care specialist, we know that this issue disproportionately affects ethnic-minority communities, though not solely, of course. There are numerous reports of poor communication and interpretation that lead to adverse health effects and life-threatening illnesses being more prevalent in those communities. It would be the safest way possible if we put something mandatory into the Bill that does not allow for the possibility of situations where a young person feels they cannot say something, having been alongside their parent or guardian for many years. Putting something mandatory can actually protect those young people.

In relation to other clauses in the Bill, we have spoken about the profound effect on young people’s brains and development—I believe this is relevant and not repetition—of traumatic events such as the death of a close family member. That casts a new light on the possible neurological impact that interpretation by a child for a relative seeking assisted dying could have; it could give rise to further health conditions as they develop. Reports state that, if a child’s hypothalamic-pituitary-adrenal axis is faced with traumatic stress—in this instance the loss of the primary carer—it can lead to long-term functional and structural changes in key areas of the brain’s development. This can contribute to various psychopathologies, obviously including PTSD. Putting something mandatory into the Bill, so that children cannot be placed in this situation, is important to make it clear for all NHS hospitals which may have to deliver this.

It goes to a conceptual point, raised when I met the noble and learned Lord, about autonomy and choice. There are circumstances in which we limit autonomy and choice, particularly with children; we say that it is better for us all, as the legislature, to have taken a decision to protect those children. It should be mandatory that those under the age of 16 in this context are not taking part in the process of interpretation. It may be that, as we discuss this, there are situations and circumstances, such as terminal illness and advice about treatment, where it should be mandated that children are not involved as interpreters.

[Baroness Nicholson of Winterbourne (Con)]

My Lords, I will speak in support of my own Amendment 171, where I am suggesting that there is an adjustment to insert “hearing or visual impairments”. I declare an interest on both. First, I am a vice-president of Mary Hare School for deaf children, which is one of the world’s most wonderful schools for deaf children, not just in the United Kingdom but internationally; I have been a vice-president for a very long time, as were my parents before me. I do not speak on its behalf. Secondly, my other interest is that I recall my darling mother, who was completely deaf, completely blind and 100% paralysed for 13 months before she died, because of an unfortunate slip-up in an operation. It was, I am afraid, just one of those things. I therefore understand the needs of looking after someone who is 100% disabled, fully blind and fully deaf.

--- Later in debate ---

[Baroness Nicholson of Winterbourne (Con)]

My Lords, I follow the noble Baroness, Lady O’Loan, with reference to our shared amendment, Amendment 174A. I apologise for not raising this in my previous discourse, but the differences are so acute that I just did not feel it right to share them in the same comment, and I believe the Companion allows me to speak twice in Committee.

I declare an interest in this amendment’s matters as I have worked with enclosed communities for most of my life. My most recent responsibilities have been with the AMAR International Charitable Foundation, which I founded about 35 years ago. We have worked consistently with the enforced enclosed community of the Marsh Arabs and the enclosed communities of the Yazidis—the genocide victims—and others, covering different parts of the globe. I work particularly closely with the Church of Jesus Christ of Latter-day Saints—the Mormons, as they were known—and with other enclosed communities.

My concern today is for Muslim women. We have two minority faiths in the United Kingdom where women are deemed to be secondary to men. As the noble and learned Lord will realise, I know very well that women are actually superior to men, not inferior. I am not quite sure whether I will cause a dispute between the right reverend Prelates the Bishop of Newcastle and the Bishop of Southwark on this, but either way I welcome and endorse what they said about minority faith communities in the United Kingdom.

I am speaking particularly strongly about Sunni women who do not speak English. I am sorry to say that, because we in the United Kingdom have made so little effort to help these women become numerate and literate in the language of this country, there are at least a quarter of a million of them—there may be more. Those women, some of the men in their family and even those running the religious side of their lives may believe that verse 74 of the Holy Koran—which places women subservient to men in all cases and puts them at risk of physical violence if they disobey—is the law here. They do not speak English and they do not know our law. Many of them are functionally illiterate and non-numeric in the language of the countries from which they came. In some of those countries, in particular Afghanistan, women do not legally exist at all. The World Health Organization tells me that Afghanistan is the only nation in the world of which this has ever been known.

If a woman comes here from a country such as that—a unique country, in that women do not exist—they will not understand that they are actually a full person here, that they have rights and that they are on the same level as everyone else. It does not matter whether they have money or who they are; if they are a citizen of the United Kingdom, a visitor or even an illegal immigrant, they still have that right as a woman and a citizen.

My colleague on the Cross Benches referred to children in this context. The United Nations Convention on the Rights of the Child was drafted here in this Chamber by our former Member Baroness Faithfull, who was a great lady. The convention, on which I have worked all my life, is very clear about the rights of children, but these rights will not exist in the minds of these women because they do not know about it. That is our fault and our failing as a nation. We have made no effort: we have not helped them learn English, to get out, or to understand their rights here. This is coming not just from Afghanistan but from Sistan and Baluchestan, where it is believed that a woman must drape herself completely. That is not in the Holy Koran at all; there is nothing like that in the Koran.

I hope that all Members of your Lordships’ House have read the Koran. It is an interesting, rich and full document—I have read it a number of times, and it is important that we understand it. It does not say what some of its practitioners claim or offer.

I also suggest clearly that UK law predominates. These women and the men who work with them—who are their families, maybe even groomers—believe that they are doing the right thing. The new law in Iraq, a country I know intimately, declares that girls of nine may be married to men of any age. A huge number of boat people come from Iraq. It is well organised by northern Iraqis in Iraqi Kurdistan who have a wonderful business going, bringing illegal immigrants by boats across the channel to Britain. If you come from Iraq, you come with that thinking and that background. Unless you are taught British law, you will not have any understanding of what you are.

This abuts on our discussion if you are nearly dying—or possibly you are not, but your family wants to get rid of you. It is worth remembering that 11% of all deaths, which is the highest number, are those who have Alzheimer’s or similar diseases. Someone could say: “Mum’s a bit of a burden; granny’s even worse. Aunt can go as well. What about cousin? What about my sister? I don’t actually like her. They will do as they are told”. This will, in a true sense, crucify them. As my noble colleague just said, certainly in Islam, suicide is outside, so they will be declaring themselves to be outside their own faith. Do we expect them to understand enough to do that? I do not think so.

My suggestion to the noble and learned Lord, Lord Falconer, is that perhaps he would grant me a meeting. Since this is not a government Bill, I have taken this round the various religious centres for Islam in London. Nobody has consulted them, and they really like to be consulted because suicide is against Islam. The question they ask me is, “Why haven’t the Government been to see us about this?” I put this forward.

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

May I ask the noble Baroness to speak to the amendment?

[Baroness Nicholson of Winterbourne (Con)]

This Private Member’s Bill has not been discussed with the mosques in London, nor anywhere else. My suggestions are that we have a meeting, that I bring suitable people with me and that we start to open this up. It is against the faith to commit suicide, so this is very important.

[Lord Falconer of Thoroton (Lab)]

Of course I agree to a meeting and the noble Baroness should bring anybody she thinks appropriate to it.

--- Later in debate ---

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I thank everybody who spoke in the debate. I am very conscious that I stand between noble Lords and their lunch, so I will try to sum up quickly. I agree with the noble and learned Lord that we are all trying to ensure the same thing. I am disappointed by his response pointing to his amendments around the right to an independent advocate, because that is only one small part. My Amendment 167 was really about seeking assistance in the preliminary conversation. The reason for that is understanding that, as my noble friend Lord Shinkwin so eloquently said, it is about thinking about the process from the perspective of the person with the communication issues.

Any of us might find ourselves at any moment in our life, through illness, accident or frailty, in this position. Turning the tables and thinking about how we would feel going through this process and the preliminary conversations is really important.

I want to just quickly give examples of why words really matter and why it is not just about independent advocates. We have the next group after lunch on that. In Scotland we had the “right to speak” legislation that went through after the campaigning of Gordon Aikman, and the Scottish Government put in the right for people to access communication aids and support. The problem in practice is that many people have been able to access aids but not the support; that was the essence of my probing.

The noble Baroness, Lady Hollins, mentioned training. Yes, people are trained to support, and independent advocates might be in that camp, but it tends to be very basic. If you consult the Royal College of Speech and Language Therapists, it is extremely concerned about the number of professional people available to support this group of people. Clarity is vital all the way through the process.

I am conscious as time goes on that I cannot mention everybody. The point is that language being either mediated by someone else, culturally shaped or indirect can cause an issue at any point in the process, and therefore we must have support for people with severe communication issues and other issues. I pay tribute to my noble friend Lady Nicholson. We must surely do all we can to ensure that the decision of a person to end their own life is truly that of the individual and not simply a miscommunication.

[Baroness Nicholson of Winterbourne (Con)]

I add my thanks to the noble and learned Lord, Lord Falconer, for his comments. I look forward immensely to the meeting with him. I also point out that his colleague on the Front Bench stood up and said something about me and, of course, I could not hear it. Hearing is a very difficult thing to ignore. I sincerely hope that the amendments will cover that.

[Baroness Fraser of Craigmaddie (Con)]

I beg leave to withdraw my amendment.

NHS Hospitals: Apheresis

Baroness Nicholson of Winterbourne Excerpts

Wednesday 9th October 2024 Lords Chamber

[Baroness Nicholson of Winterbourne (Con)]

Given the welcome switch of the National Health Service from being just restorative to preventive, might the Minister consider discussing the World Health Organization system of women health volunteers and visitors? Then, these discussions can start at a much lower level and people will be much less fearful of the treatment they may eventually have to have in hospital.

[Baroness Merron (Lab)]

Certainly, we want to look at all the ways we can support patients to get the services they need, and that includes providing reassurance and the information they need. I will look at the Baroness’s suggestion.

Covid-19 Update

Baroness Nicholson of Winterbourne Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Nicholson of Winterbourne (Con)]

On behalf of the whole House and the whole population, I congratulate the Minister on his magnificent work during the entirety of the pandemic and, of course, all his colleagues and everyone in the National Health Service. It has truly been a real world-beater and we are all so grateful. I have a matching point on Covid-19. I had understood, maybe wrongly, that males are affected slightly differently to females. Given that hospitals now accept self-identification of males and females, does this impact on the statistics or indeed on the treatment that everyone receives?

[Lord Bethell (Con)]

My Lords, I understand the question put by my noble friend but I am afraid that I do not recognise the anecdote to which she refers in terms of hospitals’ treatment of individuals. Nor do I particularly recognise the generalisation that males and females are affected by the disease differently, but I would be very happy to look into this matter and write to her if I can find more details.

Women’s Health Outcomes

Baroness Nicholson of Winterbourne Excerpts

Thursday 8th July 2021 Lords Chamber

[Baroness Nicholson of Winterbourne (Con)]

I welcome this important debate on women’s health. I congratulate the noble Baroness, Lady Jenkin of Kennington, and thank her profoundly for her deep and permanent commitment to the health and welfare of girls and women.

Like her, I have worked overseas and on the ground as a volunteer on violence against girls and women and, specifically for this debate, on raped and tortured female victims. Indeed the noble Baroness, Lady Bull, and I were working on that together only 10 days ago for Yazidi victims. I seek our Government’s ongoing commitment to the plight of these most special girls and women, both here and in the war-torn nations where I work, above all others. These heavily damaged survivors of continuous rape by different but always violent males deserve the very best of surgical and general healthcare.

My praise for our NHS staff and volunteer rape crisis centre teams in Britain, all of whom treat raped girls and women with outstanding care and sensitivity, is unbounded. However, the natural growth of social concern for difference and our proper national commitment to greater inclusion has led to the appointment of natal males to tend to acutely female needs, such as intimate care for mentally challenged in-patient girls, and to lead staff posts in rape victim settings. I believe the noble Baroness will join me in examining these breaches of customary dignities afforded to women whose capacity is either limited since birth, accident or illness or has been compromised by rape or other indignities. Should they not be care for, nurtured and helped to live by fellow females? Common sense and parental requests suggest they surely should, yet that is not the case today. I urge the Minister, for whom I have the highest respect, to pay heed to research and take steps to correct this situation.

Heathrow Airport: Border Control Passenger Safety

Baroness Nicholson of Winterbourne Excerpts

Tuesday 25th May 2021 Lords Chamber

[Lord Bethell (Con)]

I do not have the statistic that the noble Baroness asked for, but I would be glad to write to her with it. The surge testing and vaccination in areas of VOC outbreak are now in many communities up and down the country that are not correlated with the presence of airports. They are distinct and specific to each of those communities: we work with the local DPH to ensure that the local outbreak plan is tailored to the needs of that community.

[Baroness Nicholson of Winterbourne (Con)]

Can the Minister reassure his noble colleagues that sufficient attention is being paid by the already overworked Heathrow staff to heavily disabled passengers, such as Dr Ros Sinclair, who is a post-polio victim, with all that that implies? Although there is now a distinction between red and amber, highly vulnerable people will none the less suffer if amber lists and disabled passengers are merged. Is there any possibility of entirely separate lanes for those who are disabled?

[Lord Bethell (Con)]

My Lords, I pay tribute to the officials, Heathrow and the carriers for the provisions that they have put in place for those who have exceptional needs for travel. It is a truth that many people travel for health needs, and many must travel in order to address difficult circumstances that they may have. Therefore, it is entirely right that we put in place a system of exemptions and support for those who are either elderly or have some form of disability. My noble friend is entirely right that it is an unfortunate consequence of the administrative burden of red and amber processing at our ports that there are serious delays, and they fall most heavily on the vulnerable.

Puberty-blocker Drugs

Baroness Nicholson of Winterbourne Excerpts

Thursday 10th December 2020 Lords Chamber

[Lord Bethell (Con) [V]]

My Lords, the noble Lord puts his point extremely well. I share his concern for those with trans or gender concerns of any kind. I reassure him that provision of gender identity services at all levels is an absolute priority for the NHS. In the recent court case, we have seen a clarification of the guidelines attributed to some of those services, but it in no way mitigates against or suggests a lack of commitment on the part of the NHS to such services.

[Baroness Nicholson of Winterbourne (Con)]

Will the Minister confirm that since no baby can be born in the wrong body and human sex cannot be changed post- birth, the extensive plastic surgery, castration, double mastectomies and concomitant lifetime of heavy unnatural drug use that follow the introduction of puberty blockers are not the right way to assist a troubled child to gain mental stability and a contented and healthy future?

Covid-19: Vaccination Prioritisation

Baroness Nicholson of Winterbourne Excerpts

Wednesday 25th November 2020 Lords Chamber

[Lord Bethell (Con)]

I hear loud and clear the case for rough sleepers made by both the noble Baroness and my noble friend. The case was made to my colleague, my noble friend Lord Greenhalgh, as well. That is a really important part of the vaccination programme and we will look into the most effective way of doing it. On the noble Baroness’s second point, I am not aware of any moves to try to limit or create mandatory situations for vaccines within the four nations.

[Baroness Nicholson of Winterbourne (Con)]

Might my noble friend consider setting up a network to catch and bring back into circulation those young people technically in care between the ages of 14 and 21 who have none the less been trafficked out of their unmonitored council care homes, given that the vaccination publicity is so enormous that they might well be able to be tempted back into life again?

[Lord Bethell (Con)]

My Lords, the vaccination holds the prospect of returning to some form of normality very quickly. It is exactly the kind of situation that my noble friend points out that will be most welcome. There are a large number of people in various types of care who have not been able to be looked after in the way that they might have been previously. It is extremely valuable that the vaccine will be able to return people to that kinds of support, which they both deserve and need.

Brexit: Counterfeit Medicines

Baroness Nicholson of Winterbourne Excerpts

Thursday 7th February 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Lord, Lord Patel, for his question; obviously he has great expertise in this area. The Government have been clear that life sciences is a key sector for the United Kingdom, and have stated in the political declaration that we want to have close alignment with the European Union, and to continue close collaboration between the EMA and the MHRA going forward. This will be subject to negotiation, depending on the outcome of the exit. However, the MHRA is a world-leading organisation. We can be proud of its expertise in licensing, devices, inspections, batch release and pharmacovigilance. It is globally recognised and respected, and we want to ensure that shared experiences continue, for the benefit of both UK and EU patients.

[Baroness Nicholson of Winterbourne (Con)]

I congratulate my noble friend the Minister. Perhaps I might ask her to stress that the privatisation of our medicines agency, which is the most successful on the globe and which everyone else follows, enables us to sell widely and to contract with other member states in the EU and elsewhere. Our standards are global, and they can now buy in to us. It is a tremendous advance.

[Baroness Blackwood of North Oxford]

My noble friend is absolutely right that the MHRA is globally recognised, and that it has set the standards worldwide. We want to ensure that as we go into EU exit those standards continue, and that our reputation is maintained internationally.

Mental Health Budget: Domestic and Sexual Violence

Baroness Nicholson of Winterbourne Excerpts

Thursday 22nd November 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness is right and I can reassure her that some of the additional £100 million of funding that the Government are providing for this issue is going on children who have been victims of abuse. Indeed, the draft domestic abuse Bill that we look to bring forward this Session will propose tougher sentences when a child has been involved in domestic abuse.

[Baroness Nicholson of Winterbourne (Con)]

My Lords, is it possible for the Department of Health to assist the police in some way? So many victims of sexual violence, several of whom have approached me personally, say that there is quite a long delay between their reporting the violence and the police bringing the perpetrator to court—if the case gets that far. Is there any way to shorten that timescale, without any implication of justice not being allowed or cut too short for the accused? Is there anything that the Department of Health could do to bridge that gap a little? It would be so helpful.

[Lord O’Shaughnessy]

My noble friend is right: that is a really important part of the approach. It is encouraging that 88% of women would now tell someone about abuse they have suffered and that there has been a 20% increase in domestic abuse convictions since 2010. As we discussed in this House last week, we are seeking through the GP contract negotiations to abolish the fees that some GPs charge for the letters needed for referral to legal aid and other things. That is something we continue to push.

Children: Gender Dysphoria

Baroness Nicholson of Winterbourne Excerpts

Wednesday 17th October 2018 Lords Chamber

[Lord O'Shaughnessy]

I agree with the noble Baroness that this is a very real condition; it is rare, particularly in children, but nevertheless it is real. Therefore it is appropriate that those who have it should get the right support. As the noble Baroness, Lady Barker, pointed out, that support may be psychological or endocrinological —whatever is required, multidisciplinary teams will provide it. There has been an increase in the number of resources available as well as a cultural change towards greater acceptance. Ultimately, what this comes down to, and what people worry about, is that children are pressured into being one thing or another when they should be allowed to be themselves.

[Baroness Nicholson of Winterbourne (Con)]

The Minister has mentioned the GRA consultation document already, which is on the web. Would he consider reviewing, withdrawing and reissuing that document? I have known a number of people try to fill it in and it is a little difficult; the language is complex, opaque and many of the linguistic terms are not readily used. I am not certain whether the general public, with whom we are consulting, are normally ready to read 100 pages of explanation before finding a small number of questions in the middle. It is a monumentally complicated paper, which has had little academic consultation, and people with less than a higher level of education have told me they simply cannot understand it. Will the Minister consider reviewing that document?

[Lord O'Shaughnessy]

It is important to distinguish the provisions of the Gender Recognition Act from the health services provided for people with gender dysphoria. Nevertheless I take the noble Baroness’s comments on board; I know some concerns over the document have been raised with the Government Equalities Office, which has responsibility for it; the Department of Health does not have direct responsibility.