Terminally Ill Adults (End of Life) Bill

Baroness Rafferty Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

We should find a way of having a proportionate safeguard that aligns the fundamental principles of best interest decision-making in suicide prevention and removing barriers to living well before accepting that a person genuinely chooses to end their life.

[Baroness Rafferty (Lab)]

My Lords—

[Baroness Coffey (Con)]

My Lords, I still have tabled amendments to speak to, but I will let the noble Baroness, Lady Rafferty, go first.

[Baroness Rafferty (Lab)]

I thank the noble Baroness so much. I speak as a nurse and a former president of the Royal College of Nursing. I thank the right reverend Prelate the Bishop of London for referring to the broader family of health practitioners who are impacted by the Bill.

I also note the comments made by the noble Baroness, Lady Berridge, about training. I wonder whether the noble Baroness is aware of the current intercollegiate guidance on safeguarding, which covers many of the types of abuse touched upon in our current debate. Secondly, does she agree that many of the scenarios that have been presented and portrayed in this debate could provide very helpful material for the training that would be provided were the Bill to be passed?

[Lord Goodman of Wycombe (Con)]

My Lords, I will be extremely brief. Rather than speak to my own Amendment 229, I simply suggest to the Committee that the bulk of the evidence we heard in the Select Committee suggests that the amendments that have been put forward and debated in this group are extremely important and essential. I will quote very briefly from the Select Committee’s report before sitting down. The Royal College of Psychiatrists said that every applicant should be

“holistically assessed at the stage of preliminary discussion, including for mental health need”.

Dr Luke Geoghegan, of the British Association of Social Workers, took the view that

“all applicants should have a safeguarding assessment”.

The British Geriatrics Society recommended in its evidence to us

“a requirement for all people requesting an assisted death to undergo a holistic assessment of needs”.

The next group of witnesses that produced a similar view was Standing Together Against Domestic Abuse, which called for a multidisciplinary assessment framework.

I could go on, but I recommend to the noble and learned Lord, Lord Falconer, when he replies to the debate, to take these points on. A central question in this debate, posed by the noble Lord, Lord Pannick, has been: are the protections in the Bill better than the protections we have at the moment? I suggest to the Committee that that is not the question. The question is not, are the protections better than those we have at the moment, but are they as good as they could be? The answer in many cases is that they are not, and I hope that the noble and learned Lord takes these points on board when he replies to the debate.

Tobacco and Vapes Bill

Baroness Rafferty Excerpts

2nd reading
Wednesday 23rd April 2025 Lords Chamber

[Baroness Rafferty (Lab)]

My Lords, I support this Bill, and I am delighted that the noble Lord, Lord Jopling, is still alive to speak so eloquently on the topic of prevention. I also thank my noble friend the Minister for navigating us so clearly through a path to prevention. This Bill presents an intergenerational approach to prevention that is a real step change towards smoking cessation.

As a relative newcomer to the House and to this topic, it has been fascinating to listen to the veterans among us who have lived this campaign for so many years and have personal experience. I pay tribute to my noble friend Lady Thornton, the noble Baroness, Lady Northover, and many who have been in the seats of policy-making before. I also commend the arguments mounted to take well-targeted aim at the pre-emptive points that might be made from libertarian quarters against this Bill. The myth busting must continue in this regard.

As a nurse and former president of the Royal College of Nursing, I welcome the Bill and the impact it can have on reducing tobacco use and negative health outcomes. I support the Royal College of Nursing as a member of the Smoke-free Action Coalition. It is important to call time on the legacy effects of harm from tobacco and reinforce its regulatory rigour.

As a young nurse, I witnessed at first hand the consequences of smoking for patients in the vascular ward where I worked as a staff nurse. I will spare noble Lords the gory details, but having your leg amputated was no incentive for patients to give up smoking, reflecting its deadly hold over human behaviour. That was in the 1970s, when there were few, if any, smoking cessation programmes. The prevailing wisdom was that smoking could calm nerves and relieve stress, until evidence suggested that the relationship between tobacco use and mental health is bidirectional and much more complex. Recent evidence suggests that smoking cessation is associated with reduced depression, reduced anxiety and stress, and improved mood and quality of life compared with continuing to smoke.

A more recent myth busted in many psychiatric hospitals concerns increased violence resulting from smoking cessation as one of the factors preventing the introduction of smoke-free policies. Research led by King’s College London revealed an almost 40% drop in physical assaults between patients and towards staff following the introduction of a comprehensive smoke-free policy at a large NHS mental health trust. Such interventions need to be multipronged and aligned with NICE guidelines. Smoke-free policies in hospitals have included staff training and engagement alongside tobacco dependence treatment, including offering nicotine replacement therapy within 30 minutes of arrival on a ward and permitting the use of e-cigarettes.

We have reached an important inflection point in taking action to extend smoke-free spaces and bolster population health. Evidence suggests that smoking cessation needs support, and encounters within healthcare settings provide the perfect opportunity. That support includes funding. Our manifesto commitment to ensure that all hospitals integrate opt-out smoking cessation interventions into routine care means that supporting smokers must be a priority in the Government’s shift to prevention.

Nurses and midwives represent the largest healthcare workforce and have historically been at the forefront of delivering smoking cessation programmes. As we have heard, exposure to tobacco smoke during pregnancy is the single biggest modifiable risk factor for poor birth outcomes, including stillbirth, miscarriage, preterm birth, low birth weight, heart defects and sudden infant death. It is therefore gratifying to hear our Chief Nursing Officer, Duncan Burton, advocate that nurses and midwives get behind the new Bill.

School and public health nurses have also spoken out about children who are struggling at school seeing vaping not only as cool but as a coping mechanism, often in response to unmet mental health needs. We need to support regulatory measures with wraparound mental health service provision.

The Royal College of Midwives has been strongly advocating for smoke-free pregnancy pathways. Although many nurses and midwives are already leading this work, we need to ensure that new nurses have the competencies to deliver tobacco dependence treatment and act as advocates of this Bill.

The Bill is an important public and population health intervention, with the capacity to reduce health inequalities. As a noble Lord mentioned, we need to use Nelson’s mantra and be bold. I commend the Bill to your Lordships’ House.

NHS England Update

Baroness Rafferty Excerpts

Wednesday 19th March 2025 Lords Chamber

[Baroness Rafferty (Lab)]

My Lords, can my noble friend the Minister kindly confirm that the role of the Chief Nursing Officer for England will migrate to DHSC?

[Baroness Merron (Lab)]

My noble friend will know—as I am sure the right reverend Prelate knows—that the Chief Nursing Officer has always played a role in advising Ministers; that the case was long before the establishment of NHS England and will continue long afterwards. The chief executive, Sir James, has announced his new transformation team, and that includes NHS England’s Chief Nursing Officer.