Terminally Ill Adults (End of Life) Bill

Lord Bishop of London Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[The Lord Bishop of London]

My Lords, I will speak particularly in support of Amendments 181, 45 to 49, 58 and 222. It is a privilege to follow the noble Baroness, Lady Hollins, and the noble Lord, Lord Griffiths, whom I thank for sharing their personal stories. They are a reminder to us that this debate touches some of the deepest things within us, and not only should we be kind to each other but we ought also to be kind to ourselves.

I declare my interests as set out in the register, and particularly that I am vice-president of Exeter Hospice Care, chair of the UK Commission on Bereavement, and patron of AtaLoss. Your Lordships will know that, however many amendments there are to this Bill, I do not feel it will ever be safe. But I want to speak on this group because I believe that these amendments are at the heart of the issue of motivation. I remain concerned about the fact that there is currently no real, deep investigation of the motivation for assisted dying.

Amendment 181 is critical for us in monitoring. Even if there were no further restriction on what the motivation is for assisted dying, just knowing and recording it is extremely important because it can give us understanding of why people choose assisted dying, especially if we are serious about properly funding the care and support for people who are dying.

If we are recording the reason why people choose assisted dying, this means that we can highlight reasons why people choose it that do not fall within the aim of this Bill. For example, there is currently no mechanism in the Bill to stop someone receiving an assisted death if they are in pain because they cannot access palliative care. I hope that all of us would believe that, if somebody in that stage of their life wants to live, they should have access to the palliative and social care support that they need.

Professor Katherine Sleeman, the Association for Palliative Medicine and the Royal College of Psychiatrists highlighted the importance of identifying and addressing unmet need. We have already heard about the pressure on our palliative care service. We know that only 30% of hospices are funded by the Government. We have begun to hear about the beds that are closing and the redundancy programmes that are in place. We also know that if hospices are only 30% funded through government funding, 70% comes through voluntary giving. That is unequal across the country, and therefore palliative care services in hospices in areas that are more deprived are likely not to be as good as those in areas where there is higher socioeconomic activity. It is important for us to begin to identify whether there are reasons for people accessing assisted dying that are not within the aim of this Bill. Therefore, asking this question of a person in the preliminary discussion is the bare minimum of what is needed here.

Amendments 45, 46, 47, 48, 49 and 58 all strike at what many other noble Lords have spoken about today: that pressure, coercion, influence, encouragement, whatever word is most legally appropriate, is subtle and complex. When asked about the meaning of pressure during the Select Committee, the Royal College of Psychiatrists cited

“expectation or the worry of letting someone down”.

In a sense, for me, that gets to the heart of why it is so important that we define these feelings and decide what we think about them. We have also heard not only how hard it is to define the term we want to use but how hard it is to spot it. We heard examples of how we are not spotting coercion already today.

We have also heard how hard it is to train. Certainly, one of my concerns in the discussion of the Bill so far has been that often our focus is on medical staff, but actually people spend much more time with support assistants, with nurses, with occupational therapists and a whole range of people, not just medical staff. Often, if somebody wants to talk about dying, it is not with the doctor but with the person who has spent more time with them, and that is a whole array of people. Therefore, training is much broader than I think we often see it.

It is also true that I suspect most of us at times feel obliged to, or a responsibility for, our family. There will be some point in our life, whether through illness or otherwise, when we have felt a burden to others. The reality is that our decisions do not live within a vacuum; they are shaped by the many currents of our life, which are different at different stages. I believe that the Bill’s supporters have decided that the policy intent is that, even if somebody chooses assisted death to save their family the cost of care, that is okay as long as it is their decision and free from coercion. Amendments 47, 48, 49 and 58 demonstrate why this is not okay. They get to the heart of how subtle coercion is. It is not just personal. As we have already heard, it can be society-wide. Discrimination in healthcare provision and failure to resource palliative care or adult social care adequately are examples of this. Indeed, describing indignity as the loss of physical function, or of incontinence, or the reliance on care, is another societal example of this. We need to remind ourselves that each person is of immeasurable value which cannot be diminished by illness, disability or care costs.

I turn finally to Amendment 222, in the name of the noble Baroness, Lady Hollins. Though we have been rightly focusing on the person at the centre of making a choice about their death, as we have heard, death affects so many more people than the person who has died. The National Bereavement Alliance has said that the needs of family members, including children, both before and after death, must be considered and met. We know that people who are bereaved unexpectedly are more likely to experience complex and prolonged grief, which is associated with worse physical and mental health, including suicidal ideation. The bereavement sector forum convened by AtaLoss highlighted the risk that the kind of grief associated with assisted death is very similar. It warned that the impact of failing to address it with the right support will bring costs not just on acute services and social care but on individual people.

That complex grief is also well documented in Canada. The Bill has encouraged helpful conversation about death and dying, but we must make sure that the Bill is clear on guidance and support for many families and friends who are involved with somebody who has requested assisted dying. The work of the UK Bereavement Commission highlighted that people still do not have access today to the bereavement support that they need, and there remains a lack of understanding of the cultural and faith considerations that many communities require for death. I hope that Amendment 222 will be an opportunity for us to be proactive about making sure that family, friends and loved ones can access the bereavement support they require.

[Lord Polak (Con)]

My Lords—

Learning Disabilities Mortality Review Reports

Lord Bishop of London Excerpts

Thursday 13th November 2025 Lords Chamber

[Baroness Merron (Lab)]

It bears repeating that it is shocking that people are dying on average up to 20 years earlier. As I have said, that is unacceptable. We work very closely with Mencap and other organisations, but what we are doing already is, for example, to the point that the noble Lord raised, improving identification of people with a learning disability on GP registers. In particular, a reasonable adjustment digital flag is being implemented in care records to make sure that support is appropriately tailored. In other words, if we do not know who people are and where they are, we cannot provide the support. That is an unacceptable reason.

[The Lord Bishop of London]

My Lords—

[Lord Blunkett (Lab)]

Would my noble friend accept—

--- Later in debate ---

[The Lord Bishop of London]

I thank the noble Lord for giving way.

My Lords, according to the learning disabilities mortality review of adults with a learning disability who died in 2023, 25.6% had a care package that did not meet their needs. We know that local authorities continue to face significant challenges to providing adult social care services. Can the Minister say what action the Government are taking to support local authorities as they respond to more complex needs to make sure that every person, including those with learning disabilities, has the correct care plan?

[Baroness Merron (Lab)]

As the right reverend Prelate says—or is it the most reverend Primate?

Telemedical Abortions

Lord Bishop of London Excerpts

Wednesday 12th November 2025 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I do understand the point my noble friend makes. I can indeed assure your Lordships’ House that, while the Abortion Act is at the heart of this, we have other Acts of Parliament and, as I said at the outset, it is right that Parliament makes that decision. In addition to the groups my noble friend refers to, we commissioned, for example, the Royal College of Paediatrics and Child Health to develop new safeguarding guidance for children and young people under 18 who are accessing medical abortion services, so we understand her concern and are acting on it.

[The Lord Bishop of London]

My Lords, the extension of the regulations to enable early medical abortion to be provided without requiring in-person medical consultation was a significant change. We have heard about the tragic cases of early medical abortion pills being provided outside the law and women being put at risk as a result. We are now three years on from this change. What data has been collected in that time and what does it tell us about the workability of the new system in providing safe abortions within the law?

Care Workers: Foreign Worker Visas

Lord Bishop of London Excerpts

Wednesday 18th June 2025 Lords Chamber

[Baroness Merron (Lab)]

While I absolutely agree about the value of volunteering, as we have discussed before, I should make clear that volunteering is not a substitute for employment on the right pay, the right terms and conditions and with the right status. I also absolutely agree with the noble Lord about the contribution that has been made by those from overseas to supporting our care services, and indeed by all care workers.

As we have discussed in this Chamber, the scheme was not simply closed. It was something that was appropriate for when we were in a pandemic but not for now. In fact, we have introduced a whole range of measures which I will be very pleased to remind the noble Lord of, to ensure that we can have more volunteers who are better used and more highly regarded. They are a complement to our workforce, and very valuable they are too.

[The Lord Bishop of London]

My Lords—

[Lord Laming (CB)]

My Lords—

[Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)]

We will hear from the Bishop next and then the Cross Benches.

[The Lord Bishop of London]

My Lords, as we have heard, concerns around low pay and insecure contracts are long-standing in the social care sector. The Minister made mention of the fair pay agreement; can she explain how this will ensure that a living wage, living hours and living pensions will be paid to staff among the private social care providers?

[Baroness Merron (Lab)]

As noble Lords will be aware, the Employment Rights Bill establishes a framework for fair pay agreements. That will mean an agreement through which adult social care sector pay, as well as other terms and conditions, will be established through negotiating bodies. The negotiations will be reached by employers, workers’ representatives and others, in partnership. That will provide the opportunity to negotiate this in a responsible manner and help address the recruitment and retention crisis in the sector and support the delivery of high-quality care.

Learning Disabilities Nursing

Lord Bishop of London Excerpts

Tuesday 17th June 2025 Lords Chamber

[Baroness Merron (Lab)]

I agree. We have many excellent staff from countries around the globe who are very committed, professional and hard-working. I presume my noble friend is referring to changes in international recruitment. I can assure him that that is why, certainly in respect of care staff, there is a transition period until 2028 to make sure that we have the recruitment in the right place.

[The Lord Bishop of London]

My Lords, the NHS England 2025 best practice guide has a number of suggestions for growing the learning disability nursing workforce, including requiring CQC-registered providers to provide staff with training for learning disabilities and autism. Can the Minister say what the Government are doing to ensure that this is implemented equitably across the integrated care systems?

[Baroness Merron (Lab)]

We are very focused on that, and NHS England is working with all areas of the country and local services to ensure that that is the case. There is a national plan for learning disability nursing that has been developed with key partners and focuses on four priorities: attracting, retaining, developing and celebrating the workforce. It is very important that we elevate the standing of learning disability nurses, to whom we are all grateful.

Adult Social Care

Lord Bishop of London Excerpts

Monday 16th June 2025 Lords Chamber

[Baroness Merron (Lab)]

As the noble Lord rightly outlines, this is a move, over a number of years, to reduce the reliance on international recruitment. I am really glad that just a couple of weeks ago the Department for Education announced the launch of a health and social care foundation apprenticeship, set to begin in August this year. This is focused on young people and will give them a paid route into the sector so that they can earn as well as gain skills and experience. It will be a wonderful foundation for young people, ensuring that they are encouraged into what is an extremely valuable sector and will have the right skills, including technical skills, and the ability to carry out the job. That is just one of the measures but it is an extremely positive initiative, as the noble Lord calls for.

[The Lord Bishop of London]

My Lords, given the well-documented regional and social economic disparities in access to adult social care, in what way are the Government, in focusing on the shortages in the workforce, focusing their efforts on tackling this inequality in access?

[Baroness Merron (Lab)]

In general terms, of course, the independent commission into adult social care will be part of our critical first steps towards delivering a national care service. The commission, as the right reverend Prelate is well aware, will be chaired by the noble Baroness, Lady Casey. I agree with the right reverend Prelate that there are particular demands in certain local areas, and the strategy will take account of that, including the fact that, based on the growth of the population aged 65 and above, the sector may need 540,000 extra new posts by 2040. That is a big challenge, but by setting up the professionalisation, the training, the skilling and the fair pay for people, it is one that we will be in a much better place, across the country, to be able to deliver on.

Covid-19: Day of Reflection

Lord Bishop of London Excerpts

Thursday 20th March 2025 Lords Chamber

Asked by

[The Lord Bishop of London]

To ask His Majesty’s Government, following the COVID-19 Day of Reflection, what steps they are taking to improve support offered to people bereaved as a result of COVID-19.

[The Lord Bishop of London]

My Lords, I declare my interest as the former chair of the UK Commission on Bereavement and other interests as set out in the register. Though we are small in number, I am grateful for the opportunity to hold this debate. I am aware that reflection on the impact of Covid-19 is no longer a particularly attractive subject, but I feel strongly that the impact of this world-changing event will continue to be felt in the years to come.

In our nation’s living memory, there has not been a moment in which so many of us have experienced bereavement at the same time. Over the course of 2020 and 2021 alone, there were an additional 750,000 deaths over what would ordinarily be expected based on the previous five-year period. By the end of 2022, an estimated 16,700 children and young people in the UK had been bereaved of their parent or a primary caregiver through the deaths associated with the pandemic.

On Sunday 9 March, we marked five years since the start of the pandemic with a day of reflection, on which communities up and down the country remembered our national and personal loss. Many of these wounds are still raw, and the BBC reported that sobbing could be heard at the National Covid Memorial Wall. This afternoon, I will discuss the particular disruption to bereavement during the pandemic and the long-term impacts of restricted bereavement.

The UK Commission on Bereavement was launched in June 2021 and, in October 2022, we produced our report, Bereavement Is Everyone’s Business. The report identified a number of key ways that the pandemic disrupted the grieving process of those bereaved. The first, and perhaps the most obvious, is funerals. Restrictions meant that there were delays, restrictions in numbers, social distancing of attendees and changes to collective end-of-life rituals: wakes, shivahs, collective recitation at home, nine nights, and the viewing and embalming of bodies at home were not possible.

As with many aspects of the pandemic, not everyone’s experience was the same. Many religious and ethnic-minority groups faced more significant barriers to organising funerals. Many people reported that finding funeral directors or bereavement organisations with culturally appropriate funeral services was difficult, and that not being able to participate in usual rituals prevented them grieving properly.

Being able to access a meaningful and affordable funeral was already a challenge before the pandemic, and it remained so afterwards. According to SunLife’s Cost of Dying report 2025, the average cost of a simple funeral was £4,285, which is a rise of 134% since data collection began in 2004. It also found that a third of people said that the cost of living crisis had impacted on how they organised a funeral. Almost half said that paying for a funeral had impacted on their mental health. The funeral support service Down to Earth, which is run by Quaker Social Action, notes that a complex relationship exists between somebody’s grief and their paying for a funeral. If somebody gets into debt doing so, that debt can last for years and has a profound impact on their feelings around their bereavement. I have serious concern that people’s ability to access the funeral that they may like is financially determined.

A second way in which the grieving process was disrupted was in the most common experience of social isolation and loneliness. A significant part of the bereavement process for many is being with family and friends to support one another in grief, but 74% of adults who were bereaved during the pandemic said that they experienced social isolation and loneliness after the death of a loved one.

Thirdly, having contact with the dying person at the end of life was heavily restricted, as so many people died in hospital. Some said to the commission that knowing that their loved one was alone in hospital before they died was the hardest part of the bereavement process at the time. Those were the impacts that we saw in our work in 2022, but further work has been undertaken since then and there is more to learn.

New research published in 2023 examined the longer-term impact of grief among those who had lost loved ones during the pandemic. It found that, two years after their bereavement, 29% of people studied met the criteria for prolonged grief disorder. In particular, the social isolation and loneliness in early bereavement contributed to higher levels of prolonged grief symptoms.

According to another study on prolonged grief disorder during Covid 19, there may be a detrimental, long-term psychological outcome for those bereaved individuals regardless of the cause of death of their loved one. We do not yet fully understand all this, but there is a growing body of evidence detailing the ongoing impacts of the pandemic on bereaved people and the difference that accessible, timely and effective bereavement support can have on their bereavement symptoms. In addition, we should not forget those with long Covid who grieve the loss of who they were before they contracted the virus. It is important that we support the ongoing impacts in this area as well.

Following the recommendations of the bereavement commission, there has been much progress which we can commend. This has been and is being worked on by different Governments, including the previous Minister, the noble Lord, Lord Markham. We are glad to see the introduction in the Employment Rights Bill of a new right to bereavement leave for people who have lost a close relative. The Government are also introducing the facility for people to register a death online. The Department for Education in England has consulted on proposals to include grief education in the curriculum. On the housing front, the Ministry of Housing, Communities and Local Government has an amendment to the Renters’ Rights Bill to prevent the use of ground 7 as a ground for eviction—that is, death of a tenant. This increases housing security for bereaved tenants in the private rented sector. It is very welcome.

However, there is more that can be done to support bereaved people. One of the initial recommendations from the UKCB report was for the Government to establish and deliver a cross-departmental strategy for bereavement. It is clear that bereavement and its surrounding issues are multifaceted and in need of cross-government working. A strategy could be a useful way to give this issue the attention it deserves.

The cross-governmental working group was established in 2021 and is a useful space to discuss bereavement-related issues, but there must be much more of a focus if we really are to support bereaved people. There is also the need for wider investment in bereavement services, especially for black, Asian and minority-ethnic communities and others who have been demonstrated as being poorly served. This is particularly significant given that some communities experienced much heavier loss than others during the pandemic, especially in London. If the findings I mentioned earlier prove true, this may mean that some communities are more adversely affected by symptoms of prolonged grief than others, which, of course, leads to poor mental health.

Finally, it seems that everyone, when asked, agrees that it is healthy and good for us as a society to talk about death. However, we are still poor at doing it. I am not going to talk about the substance of the assisted dying debate here, but it has prompted us as a nation to talk about death and dying, though this is still far from a normalised topic for many of us. That is reflected in our planning for and focus on bereavement, both nationally and perhaps personally.

My own experiences as a cancer nurse and as a priest mean that I have sat with people in the final hours of their lives and with people coming to terms with the loss of a loved one. To grieve is a universal experience and part of what it is to be human. My faith prompts me to believe that our feelings and relationships and the grief that comes when we lose somebody important to us are important. These experiences and emotions must be tended to. It is the role of us all, including the state, to do so.

I am grateful to your Lordships’ House for providing the time for this very important debate. Will the Minister agree to meet me and perhaps some of my key colleagues in the bereavement policy space to discuss this further? I hope that the national day of reflection will not confine our thinking on supporting bereaved people to a future crisis or as a thing of the past but that we will take this opportunity to cast a renewed focus on bereavement, because it remains everyone’s business.

Safe Housing and Hospital Discharge

Lord Bishop of London Excerpts

Wednesday 19th March 2025 Lords Chamber

[Baroness Merron (Lab)]

I am glad that the noble Lord shares my enthusiasm for virtual wards. I shall expand on what they are: they allow people to be not in hospital but in their own home, whether it is their personal home or whether their home happens to be in a care home or some other setting, by the use of technology that allows them to be monitored. I recently saw an excellent example of that, and the liberation that it provides for individuals who would much rather not be in hospital is key. The noble Lord will know that, in the 10-year plan, the move from hospital to community is a key pillar, and we will soon be reporting on that. I certainly share his enthusiasm.

[The Lord Bishop of London]

My Lords, the VCSE sector plays a critical role in discharge planning. The Minister may know of a project in Warrington, where a social prescribing link worker and the VCSE team are integrated into the discharge team, and are therefore able to support people on discharge. The pilot has been positive, not least in that it has reduced readmission into hospital. Could the Minister say what support the Government are giving to integrated care boards so that they can enable this type of innovative provision? Can she reassure us that the aspiration to cut the ICBs by 50% will not impact on that potential?

[Baroness Merron (Lab)]

I very much commend the innovation and the commitment of people locally in the way that the right reverend Prelate describes. ICBs would be wise to work closely with the third sector in order to provide support and to tackle the very real challenges. With regard to decisions on how they use their funding, it is for ICBs to take into account the needs of the population and provide accordingly. As I say, it would be a wise ICB that took advantage of the innovation and the commitment in its local area.

NHS England Update

Lord Bishop of London Excerpts

Wednesday 19th March 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord is right to talk about NHS England in all its functions. Bringing it together with the department will not diminish those functions but will allow them to be delivered rather more effectively than they are currently. At the head of the transformation team is Sir James Mackey, the new chief executive of NHS England, working with Dr Penny Dash as chair. Both individuals are well respected across the sector for their outstanding track records, not least on turning round NHS organisations, in Jim’s case, but also on balancing the books, driving up productivity and driving down waiting times—exactly what is needed. But I agree totally with the noble Lord, and we are going to ensure that the necessary functions are continued; it is the way they are delivered that we are changing.

[The Lord Bishop of London]

My Lords, I declare my interest as indicated by the noble Baroness, in that I am a former government Chief Nursing Officer. Following on from the noble Lord’s point, this is a very significant change not just to the NHS but to its workforce. We know from looking back that when there is a reorganisation of the NHS, attention and funds are distracted away from the front line and patient care. The announcement came on the same day as the publication of the NHS staff survey results, which highlighted that only 31% felt that there were enough staff to enable them to do their job, and that 45% felt unwell due to work-related stress. What action will the Government take to make sure that there is not a management distraction, through this reorganisation, away from the front line and patient care in particular? How will staff be supported during this transition, not least those who, I suspect, fear that their jobs are now under threat?

[Baroness Merron (Lab)]

I recognise what the right reverend Prelate is saying. I myself have experienced change in large organisations, and change is never easy. We are talking about job losses; we cannot shy away from that. But it is appropriate that I re-emphasise the reassurance of our respect for and thanks to all those talented and hard-working staff in both the department and NHSE. We will, as I said, work with trade unions on this change in order to be fair and transparent and to deal with it properly. Of course it is uncomfortable, and people naturally find it difficult.

It is also important to look at the benefits. Currently, we have rather too much micromanagement, which frustrates progress and staff. Reducing that is one of the liberations that this will provide, so we can innovate and get on with caring for patients.

On maintaining people’s morale, this is a big challenge for us because morale has not been good at all, so we will pay particular attention to this as we publish the workforce plan later in the summer. This work continues. Senior managers and transformation team are very alive to the points the right reverend Prelate has made, and they will continue in that regard.

Soft Drinks Industry Levy

Lord Bishop of London Excerpts

Tuesday 18th March 2025 Lords Chamber

[Baroness Merron (Lab)]

I would be very pleased to write further to the noble Lord on this matter. I pay tribute to all of those community third sector organisations that work in line with government direction to reduce obesity. There are many aspects to this: it is not just about what community organisations can do but, for example, about implementing TV and online advertising restrictions for less healthy food. In all these ways, we will be able to make progress to reduce obesity.

[The Lord Bishop of London]

My Lords, we know well that diet and nutrition, and the infrastructure from which we can access the food that we eat, determine our health. These things continue to be unequal. The proportion of household income required to afford to follow the Eatwell Guide is 11% in the least deprived areas and 45% in the most deprived areas. What consideration will be given in the NHS plan to these wider issues—including the merits of reformulation policies—to improve the critical determinants of health?

[Baroness Merron (Lab)]

The right reverend Prelate is right to speak about the additional levels of ill health and obesity; a child of 11 in the most deprived areas is twice as likely to be obese as those in the least deprived areas. I can certainly assure her that the 10-year plan, which is soon to be made available, will take account of inequalities in all their aspects, including nutrition and food.