Terminally Ill Adults (End of Life) Bill

Baroness Rafferty Excerpts

Committee stage
Friday 24th April 2026 Lords Chamber

[Lord Farmer (Con)]

I will continue. Almost 250 Members of this House have been involved in a massive and sustained effort to try to make the Bill safe and workable. The House staff, as we have heard, have been outstanding in their service to us all and I am sure we are extremely thankful and grateful to them for that. Much has been imputed, particularly in the press, about our motivation in closely scrutinising the Bill, including that we are cruel. At no time have we been unaware of the suffering that the Bill’s supporters have wanted to alleviate. However, it is not compassionate to pass a Bill without addressing the many concerns raised by royal colleges, three committees of this House, myriad disability groups and others: that would be cruel to the poor and the vulnerable. Yet we, and by extension they, have been shown not a little contempt at times when we have taken time to lay out how the Bill would affect them. We need to be wary of contempt when courtesy, as we were reminded at the beginning, is the currency of this House.

I continue to have a quiet concern about the language used. Orwell described political language as

“designed to make lies sound truthful and murder respectable, and to give an appearance of solidity to pure wind”.

First, we talk about “assisted dying”, when we surely mean “assisted suicide”. Assisted dying is what Dame Cicely Saunders said hospices and palliative care would provide. She said:

“You matter to the last moment of your life, and we will do all we can to help you not only to die peacefully, but also to live until you die.”


I urge this Government to do what no previous Government have done and make high-quality palliative care sustainable and universally available.

Secondly, the legal qualifier for assistance is terminal illness within six months to live. As we have heard already, when that prognosis has at least a 20% to 30% unreliability, according to evidence given to the Select Committee, we should not pretend that legal solidity exists where actually there might be pure wind. Thirdly, any notion that noble Lords are filibustering rather than legitimately scrutinising the Bill is unsustainable, given both the length of the Bill and the proceedings in the Commons, and the fact that the mean length of speeches in this House has actually been under five minutes.

Finally, I detect an assumption that anyone who is religiously motivated should not be heard or impose their views on anyone else. We do not impose our views, but we do echo a very substantial number of people outside this Chamber whose faith is partly why the Bill evokes deep concern. In contrast, every day of our lives, secular humanism is imposed on us, with its assumptions about the primacy of individual autonomy and the irrationality of belief. Such assumptions deny that human existence is inherently relational, deny the loneliness of hyperindividualism and deny that it takes more faith to believe that this incredible world in which we live came from nothing than to believe that there is something or someone behind it:

“Does he who make the eye not see?”

Finally, there are very many ethical, medical and practical reasons why this Bill has needed robust and lengthy scrutiny from a very diverse group of Peers. The process in this House and evidence from other countries have profoundly challenged the assumption that the service that the Bill attempts to provide can be safe. Many here say that this is based not on faith, but on evidence. To return to what I said at the beginning, this House has a premier global reputation for its thoroughness of scrutiny. When I was in Brussels, I talked to an Italian lawyer working for the European Commission who said that the work received from this House was second to that from no other secondary Chamber in the world. I believe that we have lived up to that reputation over the course of this Bill.

[Baroness Rafferty (Lab)]

My Lords, I speak for the first time in this debate as a nurse and former dean of the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care at King’s College London. Our patron saints include Florence Nightingale and Cicely Saunders. It would be hard to imagine two more rigorous and formidable expert witnesses to comment on the debates that we have been having these past few weeks. Both were deeply committed Christians, driven by the alleviation of human suffering and providing the practical means to do so through nursing and palliative care. Both were accomplished scientists, Nightingale being hugely influential in public health, epidemiology, statistics and social science, as Cicely Saunders was in physiology and the psychology of pain, coining the concept of total pain to convey the holistic sense of suffering.

But both had more speculative sides to their characters. In the case of Nightingale, it was a fascination with Thomas à Kempis, Teresa of Ávila and the medieval mystics. She committed some of her thoughts to paper, consulting Benjamin Jowett, regius professor of Greek and theology at Balliol College, Oxford, who became her spiritual confessor. Cicely Saunders’s library reveals a similar quest to understand Christian ethics and the existential nature of the human condition. Both were deeply interested in, as well as troubled and possibly tormented by, the challenge of squaring the existence of a benign God with the dark side of the soul and human suffering. Perhaps the ultimate question in their minds was an eschatological one. How will it all end? How will life end and what will death be like?

In a sense, that is what we have been wrestling with over the past months, struggling to reconcile very different perspectives on how it will end for ourselves, loved ones, patients and relatives. Some of us believe in enabling people to exercise autonomy over the end of life and the nature of their deaths—to have agency over the end. We have heard testimony from people who have chosen this path, as well as from relatives and loved ones. They have spoken powerfully of the sense of freedom and relief it has provided and the physical, emotional and spiritual sense of peace for all concerned.

There are those who do not agree that this should be possible. Such views are profoundly personal. I happen to have witnessed some very difficult deaths of patients and close family members. That has convinced me that assisted dying is a positive step in easing people through to a good ending. Denying that option to people who would like to avail themselves of it, when we can offer it and international evidence demonstrates that it is safe to do so, seems not only cruel but unethical. When seen in the context of a Bill that has passed in the elected Chamber and is supported by public opinion, it seems like a dereliction of duty. It is not our job to defy or block the democratic process. I implore noble Lords: it is time to dissolve our differences and do the right thing by finding a way to pass this Bill.

[The Archbishop of Canterbury]

My Lords, I shall briefly make some reflections. It is a great privilege to follow my friend, the noble Baroness, Lady Rafferty; I thank her for her contribution. I recognise the enormous amount of work that has gone into this Committee stage. I am grateful to the noble and learned Lord, Lord Falconer, for meeting me; I thank him for the time that he has given me.

Noble Lords will know that I oppose the Bill in principle, both as a priest and as a nurse, but it is clear that some things unify us. Whether we support the Bill or oppose it, we are unified by the fact that we want people to die in a dignified, pain-free and compassionate way, with the least possible fear. I also believe that we are unified in the belief that there needs to be investment in palliative care now. I welcome the new modern framework for palliative care that the Government have introduced, but recognise that financial investment still needs to occur.

We are also unified around the fact that if this Bill or topic comes back in some form, we need to do our work differently. There is no doubt in my mind that this is one of the biggest societal shifts that we are seeing or will see. Therefore, we need to take our role seriously, as we have done. There is something about our learning for this process and looking forward to how we do it differently when it comes back. I was very taken by the view of the noble and learned Baroness, Lady Butler-Sloss, of pre-legislative scrutiny, although I do not know the details. We should look seriously at that.

We are also united in knowing that this touches some of our deepest emotions. I am grateful to those who have shared their own experiences and stories; I have felt very humbled listening to them. For me, as a Christian, this is clearly an eschatological question, as my friend, the noble Baroness, Lady Rafferty, said. Of course, for me, as a Christian, death is not the end. There is hope in death and life everlasting. As we talk about these things that touch us deeply, we need to look after each other and ourselves and recognise that this process will have impacted us, as well as those listening.

Midwives: Graduate Guarantee

Baroness Rafferty Excerpts

Tuesday 21st April 2026 Lords Chamber

[Baroness Merron (Lab)]

On the second point, the noble Baroness is quite right: it is important that midwives have that time. That is what we anticipate will be the case—I refer her to the forthcoming workforce plan, which will improve the situation. With regard to the position that the noble Baroness describes, I agree that this needs sorting out, and I recognise the figures that she has shared. That is why we have brought in the graduate guarantee scheme—so that we can get people from their training and education into the NHS and can ensure that midwives are recruited on the basis of looking to the future rather than of the existing headcount. So we are future-proofing this.

[Baroness Rafferty (Lab)]

My Lords, the graduate guarantee applies also to nurses but, sadly, the provision is quite patchy. What steps are the Government taking to support employers to recruit newly qualified nurses?

Cancer Outcomes in the UK

Baroness Rafferty Excerpts

Tuesday 21st April 2026 Grand Committee

[Baroness Rafferty (Lab)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Watkins, a fellow nurse. I add my congratulations to the noble Lord, Lord Patel, on securing such a timely debate. There is a lot to commend in the National Cancer Plan for England, but, speaking as a nurse and a workforce researcher, I think that there are definitely challenges, as we have heard, to be met in ensuring that services meet the physical, psychological and social impact of cancer care.

Cancer detection rates are increasing alongside survival rates and complexities of diagnostics as well as care pathways in a population with growing co-morbidities. The national cancer plan advocates for every cancer patient to have access to a clinical nurse specialist, as we have heard. However, it is uncertain how likely it is that this will be achieved with the lack of nurse specialists currently available in the workforce, as the noble Lord, Lord Patel, highlighted.

There is strong evidence that specialist and advanced practice nurses are cost-effective and clinically effective. These highly skilled and educated nurses lead clinical services and the administration of complex chemotherapy protocols. Anyone in contact with chemotherapy services will be aware that this is nurse-led and stressful work, as the pressure is on to ensure that high volumes of patients are treated safely. Burnout rates for chemotherapy nurses remain high. Specialist and advanced practice nurses are a precious human resource that needs to be supported.

One of the challenges to accessing treatment is the availability of training and education for specialist nurses, as highlighted by the noble Baroness, Lady Watkins. According to a recent survey by the UK Oncology Nursing Society, training and education is patchy across the country. Two factors constrain the expansion of this highly skilled cancer workforce: the limited supply of supervisors to support advanced practice nurses and funded opportunities to develop their capacity. Access to training and education is essential to build the necessary confidence and competence in delivering ever more complex care. Core to these skills are expertise in advanced communication, psychological support skills, which the noble Baroness, Lady Watkins, highlighted, and symptom assessment and management.

Nurses are also integral to cancer research, especially the running of clinical trials, as the noble Baroness, Lady Bottomley, highlighted. The MRC trials infrastructure demonstrates a high reliance on research nurses for patient recruitment, and the review conducted by the noble Lord, Lord O’Shaughnessy, into commercial trials showed a worrying decline in the number of such trials conducted in the UK. This has profound implications for our standing as a life science destination and the part that that plays in our economic growth.

Oncology nurses are also researching patient outcomes and filling important gaps in the evidence base of symptom management through their research. I shall provide some examples from my experience as a supervisor of doctorates—one of my students happens to be here today, which is brilliant. One student undertook a co-design study with patients who had developed peripheral neuropathy from chemotherapy, which is a horrible side effect. She was intent on mitigating some of the further complications of this painful—terribly painful, in fact—and debilitating condition. Another is currently examining the sexual recovery of women after bladder removal for cancer. It is quite staggering that this remains largely a hidden problem yet has profound impacts on the women concerned and their partners, often traumatising women in the process. Another student pioneered a new way of measuring workload for cancer nurses. Strong evidence links patient mortality and education in acute care, so it is not inconceivable that the same principles might apply to cancer patients.

Despite the value placed on specialists and advanced practice nurses, it is worth noting that the British Medical Association has recently raised concerns about the expansion of advanced practice nurses substituting for medical roles, arguing that some employers are using them to replace doctors and that that poses a threat to patient safety. It is unclear what the specifics of this evidence might be but, based on my own and colleagues’ research, nurse autonomy poses no threat to multidisciplinary teamwork. On the contrary, it is an essential underpinning for enhanced interprofessional working between nurses and doctors.

Turning the plan into a reality requires a workforce that is supported, skilled and enabled to work differently. The Government’s forthcoming NHS long-term workforce plan refresh will be a pivotal moment to set the direction for cancer care. It must set out how nursing roles will be funded and supported to deliver the plan. Can the Minister confirm what support the Government are putting in place to enable the professional career development of cancer nurses?

NHS: Violence Against NHS Staff

Baroness Rafferty Excerpts

Monday 2nd March 2026 Lords Chamber

Asked by

[Baroness Rafferty]

To ask His Majesty’s Government what steps they are taking to reduce violence against NHS staff.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, the department and NHS England are working with NHS employers and trade unions to prevent and reduce violence in the NHS by improving prevention, security, reporting and investigation, as well as enhancing training and post-incident support. As announced in the 10-year plan, the Government will strengthen existing measures by introducing this spring a new set of staff standards to ensure that NHS organisations are held to account for improvements.

[Baroness Rafferty (Lab)]

I thank my noble friend the Minister for her, as ever, detailed and insightful response, but I am sure she is also aware that certain groups are disproportionately affected by violence in the workplace. Black and Asian nurses make up over 30% of the total number of registered nurses in England yet report higher exposure to both verbal and physical abuse than their white counterparts. How are the Government supporting NHS trusts to protect staff from all forms of violence and racism?

[Baroness Merron (Lab)]

I agree with my noble friend that racism, violence and abuse in the NHS, and indeed anywhere, are quite unacceptable and there is clearly so much more that we have to do. The Government’s progress is about the establishment of the workforce race equality standard, which measures NHS organisations against nine indicators, including bullying and harassment. The report about the standard was published in June of last year. We also have the equality, diversity and inclusion improvement plan, which again identifies six high-impact areas for employers, and this is expected to be strengthened by the introduction of a new staff standard on tackling racism, which is due in April.

Better Start Longitudinal Programmes

Baroness Rafferty Excerpts

Tuesday 10th February 2026 Lords Chamber

[Baroness Merron (Lab)]

I hope I can be helpful to the noble Baroness. In the Best Start for Life strategy, we committed that each Best Start Family Hub will have a children and family services practitioner to support children and families who have additional needs. I feel that this new offer will help parents to understand their child’s development and identify emerging needs sooner. Importantly, it will also support vital join-up across the services, keeping children who have particular needs at the very centre.

[Baroness Rafferty (Lab)]

My Lords, would my noble friend the Minister confirm what the Department of Health and Social Care has taken from the Better Start work to inform its maternity and baby strategy?

[Baroness Merron (Lab)]

As my noble friend knows, we are absolutely focused on improving quality and consistency of care for women throughout pregnancy, birth and the critical months that follow. That is why we have appointed the noble Baroness, Lady Amos, to lead an independent investigation and why the Secretary of State will chair a maternity and neonatal taskforce to address the recommendations of the investigation. It is very much part of our work to give babies the very best start in life.

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.