Terminally Ill Adults (End of Life) Bill

Lord Blencathra Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, I will speak to my Amendment 376. It is a pleasure to follow the noble Lord, Lord Empey. Last Friday, like many of your Lordships, I sat here all day and did not say a word. My amendment was in the following group, but sadly we did not get to it. However, there was an excellent discussion, and I want to pay tribute to some of the contributors: my noble friend Lord Deben, the noble Lord, Lord Mawson, and indeed the noble and learned Lord, Lord Falconer.

The noble and learned Lord said something that rang a bell; he referred to studied diligence, and how healthcare professionals and the whole system will study how best to conduct these assessments. When he said “studied diligence”, it reminded me of some experiences that I had as a Member of Parliament in helping people in very distressing circumstances with the healthcare of loved ones and trying to navigate the system. The thing that struck me was studied neglect. Studied neglect is quite difficult to detect, because it is not always obvious.

Many of us in this House have a routine, which is what makes us get up every day, and as you get older, that routine becomes very important. You have a good night’s sleep, you wake up in the morning, you shower, you clean your teeth, you exercise and you go to work, or to functions in the community. You eat well—you eat healthily. You can lead a normal life, as many of us do in this House, but something may happen to you—you may slip, trip and fall, and you may find yourself in hospital. That is when things can go wrong, because you are out of that routine of a good night’s sleep and getting up in the morning. For every week that you lie in bed, you lose 10% of your muscle strength. You do not get up, you do not do your routine, you do not shower and you do not clean your teeth. Things start happening to you, and you can go downhill very quickly.

Those things can happen through daily life—but the thing that really concerns me about this Bill, and the reason why I tabled this particular amendment insisting on face-to-face diagnosis from the healthcare professionals having to make this decision, is based on my experience as an MP. Close family and friends can have a malign influence by slowly but surely—this is why I referred to it as studied neglect—not encouraging a loved one to get out of bed in the morning, so that routine declines. They stop showering in the morning; they do not go for their manicure or pedicure or to get their hair done, and they start to decline. People who we always regard as very smart for their age can decline very quickly. The loved ones around them can engineer that, so that when social workers and healthcare professionals meet those people, it is not obvious what is happening. They are not sleeping properly, not looking after themselves properly and not eating properly, and therefore they decline. Nutrition is very important. You also have medication, and there can be no clear care plan; as one grows older, we take lots more medication, and that medication can be increased when it does not need to be increased or indeed not given at all.

That is why I am using the phrase “studied neglect”, to the “studied diligence” of noble and learned Lord, Lord Falconer. We really have to look very carefully at the malign forces that, I am afraid, are out there in society. They look at granny and, as my noble friend Lord Deben says, the £2 million house sitting there, and can slowly but surely—but still relatively quickly—see the demise of granny and realise those capital assets. That is the reason why I put this amendment forward.

Crucial steps in the assisted dying process should be undertaken with direct, in-person interaction, to increase the likelihood that the individual’s request is truly voluntary, informed and free from coercion. The necessity for direct interaction with a person, particularly through face-to-face contact, is driven by the importance of rigorous safeguards and scrutiny, and of upholding patient autonomy in a process that culminates in an irreversible outcome, called death. I could use many more examples but, in the interests of time, I beg to move this amendment.

[Lord Blencathra (Con)]

My Lords, I will speak to my Amendment 320B and three others in my name in this group. The first clinical gateway in this Bill is the most important moment any of us will ever legislate for: the moment a doctor begins the process that can lead to a life being ended. That gateway must be treated with the utmost care; it should not be reduced to a convenience-driven video call.

My amendment is simple and proportionate: it creates a presumption that the co-ordinating doctor’s first assessment takes place in person, and it asks only that, if the presumption is displaced, the doctor records why an in-person meeting was not possible for medical reasons. That is not micromanagement; it is common sense. It is the minimum standard of human contact that we should expect before opening a pathway that is irreversible.

Why does this matter? First, capacity and voluntariness are relational judgments. Clinicians do not assess capacity from words alone: they read people’s faces; they notice the hesitation; they observe the environment and see who else is present. They pick up the small, telling signs of distress or coercion that a screen can hide: a hand hovering off the camera, a whispered instruction, a look that does not match the words. Remote consultations blunt those senses. If we are serious about preventing coercion, the law should make face to face the default, not the exception.

Secondly, this is a narrow safeguard, not a prohibition. The amendment allows remote assessment where it is genuinely impossible for medical reasons. It recognises that there will be rare cases where a patient is too frail to be seen in person; in those cases, the co-ordinating doctor must set out the reasons. That requirement creates an audit trail and accountability. It deters the normalisation of remote practice for administrative convenience and gives panels, the commissioner and, if necessary, later reviewers, a clear record of why the presumption was set aside.

Thirdly, the evidence is clear: leading geriatricians and psychiatrists have told committees that assessing capacity remotely for complex patients is nigh on impossible. Telemedicine studies and the experience of courts show the limits of video for detecting vulnerability. We should legislate to reflect clinical reality, not hope that guidance will be followed uniformly across hundreds of clinicians and thousands of cases. Some will say that this amendment would delay access or over-engineer the process, but I disagree. A single in-person assessment at the outset is a modest investment of time that dramatically reduces the risk of error. If the system is robust, it will absorb that step without undue delay. If the system cannot, then speed is being prioritised over safety, and that would be a real problem.

Finally on this amendment, will the noble and learned Lord, Lord Falconer of Thoroton, accept that a life-ending pathway should begin with human contact, with a clinician who has seen the person in the flesh—smelled the room, so to speak—and observed the context in which that wish has arisen, or does he prefer a default of pixels on a screen? When the outcome is death, convenience must never trump clinical rigour. I urge the Committee to support my Amendment 320B.

My Amendment 347A would ensure that the second assessment—the final medical safeguard—is conducted in person. The Bill currently allows the independent doctor to assess the patient entirely by video. That is extraordinary for a life-ending decision. Experts told the House of Lords Select Committee that assessing capacity remotely is, as I said, nigh on impossible for complex patients. The subtle signs of confusion, fear, coercion or cognitive impairment are often visible only in person. Remote assessment hides the environment. Who is in the room? Who is influencing the patient? What pressure are they under? Kim Leadbeater MP herself said she was uncomfortable watching Oregon’s remote assessments, describing them as “tick-box”. If the sponsor is uncomfortable with death by Zoom, Parliament should not legislate for it. This amendment of mine is modest, proportionate and essential for safeguarding.

If remote assessments are permitted at all, my Amendment 406A would introduce the bare minimum safeguards: the doctor must verify that the patient is alone and speaking freely. Coercion, as we know, is often silent. Abusers can sit off-camera, and patients are coached. A Michigan prosecutor famously spotted a domestic abuse victim being coerced during a Zoom hearing. If trained lawyers and judges can miss coercion on video, how can a doctor reliably detect it in a single remote consultation? My amendment would not ban remote assessment but simply prevent the most obvious and dangerous form of abuse. Without it, the Bill’s coercion safeguards are meaningless.

My Amendment 415B would ensure that remote assessments are tightly controlled, used only when appropriate and subject to independent oversight. The Bill currently allows remote and even pre-recorded assessments without any statutory framework. A protocol approved by the commissioner would ensure consistency, transparency and accountability. It would prevent remote assessment becoming the default due to NHS pressures or simple convenience. Without this amendment, I suggest, the Bill creates a system where lethal decisions can be made based on pre-recorded video clips. That is indefensible.

In summary, my four amendments form a single, focused package of safeguards to ensure that human judgment, not administrative convenience, governs a life-ending pathway. Amendment 320B would make the first assessment face to face by default—the minimum human contact needed to test capacity and spot coercion. Amendment 347A would extend that presumption to the independent second assessment so that the final clinical check is equally robust. Amendment 406A would require a simple verification when assessments are remote—a recorded confirmation that the patient is alone and speaking freely. Amendment 415B demands a statutory protocol for remote or pre-recorded assessments so that exceptions are tightly controlled and independently verified.

These are modest, proportionate measures. They do not block access where an in-person assessment is genuinely impossible, but they stop convenience becoming the norm when the consequence is irreversible. If this Bill is to be the safest system in the world, will the noble and learned Lord, Lord Falconer of Thoroton, accept these targeted protections so that speed and convenience never replace clinical judgment and human scrutiny? I urge the Committee to support my amendments.

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[Lord Falconer of Thoroton (Lab)]

Obviously, you cannot ask questions under subsection (6), so it is exactly the same point. The point being made in subsections (5) and (6) is that the panel recognises that there are circumstances in which questioning is not possible. I do not know what additional point the noble Lord was making.

[Lord Blencathra (Con)]

I am grateful to the noble and learned Lord. I acknowledge that he has accepted that something else needs to be added to the Bill, possibly along the lines that I was suggesting. That comes on top of the dozen new clauses that he is already planning to add to the Bill, so I ask him to help me understand something. If the noble and learned Lord is therefore admitting that the Bill is fundamentally flawed, to a greater or lesser extent, and that it needs to be amended, how on earth can he reconcile that with what he said a couple of days ago? He said that he would seek to drive the Bill through, unamended from the House of Commons—the Bill that is so fundamentally flawed that he is now trying to move amendments to correct it. That said, I am grateful for his concession this morning.

[Lord Falconer of Thoroton (Lab)]

I would not look a gift horse in the mouth if I were the noble Lord. First, I do not regard accepting amendments in Committee of the House of Lords as indicating that a Bill is fundamentally flawed; I regard it as listening and making appropriate changes. Secondly, in relation to the question of the Parliament Act, the last thing I want is for this to happen through the Parliament Act. I want this House to do the job that it is supposed to do, which is do scrutiny and then send it back to the Commons.

In the debate on 8 January 2026, I gave in detail the reasons why I thought we were not going about it properly, and I thought that the House agreed with me when it said that we needed to move quicker. The problem is not that everybody does not have good ideas; the problem is that it is taking not just far too long but disproportionately long. My experience of the Lords is that we can do this, and we can do it much quicker than we are doing it and there still be quality. That was the point I made on 8 January and that I understood the House to have accepted.

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[Lord Jackson of Peterborough (Con)]

My Lords, I beg the indulgence of the Committee to raise what I think is an important point; I hope the Committee does not think it pedantic. I had not intended to speak but was prompted to by the excellent speech of the noble Baroness, Lady Falkner, and by my noble friend Lady Coffey’s reference to the lack of insight provided by the Government—I will not criticise the sponsor, the noble and learned Lord, Lord Falconer of Thoroton. This—our deliberations, scrutiny and oversight of the Bill—is a moveable feast, so we need information in real time.

My specific point is not just about freedom of information but about Written Questions that the Government have received and not answered. On 1 December 2025 my noble friend Lord Kempsell asked His Majesty’s Government a very reasonable Question. He asked, with regard to the Bill and its impact assessment,

“what assessment they have made of the effectiveness of judicial approval as a safeguard in countries with assisted suicide regimes, including the proportion of applications refused in those countries and the reasons for refusal”.

Two months on, that Question has not been answered. That is unacceptable, because scrutiny and oversight require us to have all the information in our hands, including comparative legal, regulatory and medical regimes.

By comparison, the very sensible Question from the noble Viscount, Lord Stansgate—I do not want to embarrass him because he is in the Chair—about the use of the Parliament Act was asked on 26 January and answered promptly on 29 January. The point is that there should be equality and a level playing field on Questions asked, irrespective of the position on the Bill of the noble Lord asking it.

[Lord Blencathra (Con)]

I am another Member who had not intended to say a single word on whether the clause should stand part; I am rather relaxed about it. The Government Whips must blame their noble friend Lord Rooker, who provoked me into commenting because I agree, once again, with every single wise word he said.

The noble Lord referenced the Delegated Powers Committee, of which he was a distinguished member at one point. I was the chair of the committee when we produced the Democracy Denied? report. It highlighted the fact that every Government over the past 30 years—Tory, Labour, Conservative-Lib Dem and Conservative again—took more and more powers away from Parliament via delegated powers. The delegated powers in the Bill are excessive and have rightly been criticised.

The noble Baroness is also right that no Government in any democracy in the world can function unless there are delegated powers; not everything can be in Bills. The questions here are: how many delegated powers are appropriate; and what will they contain? The trouble is that we have more than 40—48, I think—possible delegated powers, including Henry VIII powers. That seems excessive.

I pay tribute to the noble and learned Lord, Lord Falconer, for producing some amendments that would implement the delegated powers recommendations, but I think he knows that if he did not produce them, this House, on Report, would implement every single one of the delegated powers recommendations; we would gut those bits of the Bill that did not implement them. So, although he has generously provided some amendments regarding the delegated powers recommendations, he knows full well that this House will implement all of them in any case.

That is all I want to say on the Bill. Delegated powers under all Governments have been increasing and ought to be diminished. Although I have some concerns about the contents of the Bill, I have many more concerns about the 48 powers that will be written by civil servants in the Department of Health. At the moment, they are unable to tell the difference between a man and a woman; I do not want them writing up how I will die in future.

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[Lord Hendy (Lab)]

My Lords, it is a pleasure to follow the noble Lord, Lord Sandhurst, and I am particularly grateful to the noble Lord, Lord Harper, for advancing Amendments 70 and 78, which I drafted. Unfortunately, I was unable to be here last week when I thought they would be debated. I disagree with nothing that the noble Lords, Lord Harper and Lord Sandhurst, said.

The purpose of Amendments 70 and 78 was to broaden the definition of “disease” to include “injuries”. It is completely illogical that people who are facing death within six months because of some untoward event, such as contracting an illness, being hit by a car or suffering an injury at work, should not be in the same position. One thinks about injuries at work, in particular: if inhalation of asbestos fibre, silica or cotton results in asbestosis, silicosis, byssinosis or mesothelioma, they would be covered by the legislation currently proposed. But inhalation of a poisonous gas at work, causing an injury that is likely to result in death within six months, would not be covered. There does not seem to be a logical distinction there.

The law also does not regard there being a distinction. The common law of negligence requires one not to harm someone else, whether by an injury or causing that person to contract an illness. That is particularly evident in the field that the noble Lord, Lord Harper, developed; namely, injury at work. The Health and Safety at Work etc. Act 1974, the Workplace (Health, Safety and Welfare) Regulations 1992 and the common law of workplace negligence all require that the employer keeps the workplace safe and they make no distinction between whether the danger arises from a risk of injury, such as getting an arm mangled in a machine, or the risk of disease, by the inhalation of noxious particles causing lung disease. There is no logical distinction to me and it would be right for the Bill to extend the scope of “disease”—illness and disease are not defined in the Bill—to cover “illness” as well.

I turn to the main point that the noble Lords, Lord Harper and Lord Sandhurst, developed. The risk, as the noble Lords, Lord Sandhurst and Lord Carlile, put in their explanatory statement and which the noble Lord, Lord Sandhurst, developed, is that the dependants

“will probably lose their right under the Fatal Accidents Act 1976 to sue the alleged tortfeasor said to have caused the disease, unless the Bill specifically provides otherwise (which currently it does not)”.

I agree with his legal analysis. It is likely that insurers will say, “No, the cause of death here was not the underlying mesothelioma. It was the fact that this person opted for an assisted death”.

The noble Lord developed the consequences for the family. I just want to add: what about the consequences for the injured person? Are they going to think to themselves, “Well, if I opt for an assisted death, I’m going to deprive my family of extensive damages that they will not enjoy”? Of course there will be considerable pressure on that person to say, “I’m going to put up with the suffering as long as I can until I die to make sure that my family get the money”. I do not want to be rude to insurance companies, but they have to do what they can to safeguard their assets and avoid paying out what they do not need to pay out; they will fight these cases. Therefore, it seems important that the Bill, to quote those words, “specifically provides otherwise”, which it does not currently.

I am very grateful for the interview that I had with my noble and learned friend Lord Falconer and the noble Lord, Lord Sandhurst, to discuss these matters a week or so ago. I had mistakenly thought that the power of my oratory was such that my noble friend was convinced by my argument, but he was not. It is quite clear from his Amendment 718C, which he has tabled today, that he does not accept that the Bill should provide a measure that would protect the victim in the circumstances that we are discussing.

The noble Baroness, Lady Finlay of Llandaff, and I tabled Amendment 717, which is obviously not before the Committee today, which seeks to redress this by requiring that the coroner records that the cause of death was the underlying disease, while noting that the death was one by assisted dying. I do not know whether that would go far enough to protect these victims from the insurers who claim that the death was not caused by the underlying disease, but it goes a bit further than the amendment proposed by the noble Lords, Lord Sandhurst and Lord Carlile. In my view, it is essential that the Bill protects against the danger that I have outlined.

[Lord Blencathra (Con)]

My Lords, I am very concerned by my noble friend Lord Harper’s amendment to extend the Bill’s definition of terminal illness to include simply the one word, “injuries”. I agree entirely with my noble friend Lord Sandhurst and with what the noble and learned Lord, Lord Falconer, may propose to ensure that those who have suffered an industrial injury are not deprived of their rightful compensation. I support entirely what the noble Lord, Lord Hendy, said on that, but I disagreed with his general thesis that the Bill should be extended to include all other injuries, because that could take us in a rather dangerous direction.

We all know that some injuries are awfully catastrophic, relentlessly painful and leave no prospect of meaningful recovery. For those individuals, the desire for control over the timing and manner of their death is understandable and deeply felt. If the law permits assisted death for terminal illness, it is in some ways emotionally coherent to ask why a grievous and irreversible injury that will inevitably lead to death should be treated differently. I think the amendment from my noble friend and the suggestion of the noble Lord, Lord Hendy, is born of a humane impulse: to extend compassion to a group whose suffering can be as severe as that of the terminally ill. However, compassion must be married to clarity and caution when Parliament contemplates measures that permit an irreversible outcome. Extending the definition to “injuries” raises serious legal, clinical and ethical problems. I will set out the principal flaws and risks that I see flowing from the proposed change.

First, the term “injury” is legally and clinically vague. What counts as an “injury”? Does the word encompass acute trauma, chronic sequelae, surgical complications, other serious harm, or the long-term consequences of an earlier wound? Without precise limits, the category could sweep far beyond the narrow cohort the amendment’s proponents intend. Vagueness at this threshold invites inconsistent application and litigation.

Secondly, I suggest that the proposed threshold—that the injury be “reasonably expected to result in death”—is problematic. Prognosis after severe injury is often uncertain, as it is with terminal illnesses, and can change with treatment, rehabilitation and time. Modern trauma care, reconstructive surgery and rehabilitation can alter trajectories in ways that are difficult to predict at the bedside. Using “reasonably expected to result in death” without a clear evidential standard hands clinicians wide discretion and risks premature decisions made on the basis of an evolving clinical picture.

Thirdly, there is a real danger of premature decisions in acute settings. Many catastrophic injuries occur in emergency contexts where prognosis is evolving and where immediate stabilisation, surgery or intensive rehabilitation may change outcomes. Allowing assisted death on the basis of an early prognosis risks decisions taken before full treatment options have been explored and before the patient has had the opportunity to adapt to new circumstances or to benefit from specialist rehabilitation.

I will not talk about civil law and compensation, because that has already been expertly covered by my noble friends and the noble Lord, Lord Hendy. My noble friend also mentioned the coronial and investigatory consequences which arise, so I will not elaborate on those.

There is a “slippery slope” argument here. Once “injuries” are included—just that one, simple word—pressure may grow to widen eligibility further to chronic disability, psychiatric consequences or non-combat trauma. Experience from other jurisdictions shows how initial expansions can lead to broader reinterpretation over time. Parliament must be wary of opening a door that cannot easily be closed.

The clinical complexity of catastrophic injury demands multidisciplinary expertise. This is not one GP giving an opinion here. Assessing such cases properly would require trauma surgeons, rehabilitation specialists, pain teams, psychiatrists and a whole range of different medical specialities. The Bill’s processes must ensure that such expertise is mandatory before any irreversible step is taken, otherwise we risk decisions being made without the full range of clinical knowledge that these cases demand.

In conclusion, if Parliament is to consider injuries within scope, it must do so with surgical precision, so to speak. It needs narrow definitions, higher evidential standards, mandatory specialist review, and explicit protections for families and compensation rights; only then can we balance mercy with the safeguards that such irreversible decisions demand. I urge the House to reflect carefully on the human impulse behind this amendment and on the legal and clinical realities that make adding it to the Bill as currently drafted—with just one word, “injuries”, as my noble friend proposes—deeply problematic.

[Lord Carlile of Berriew (CB)]

My Lords, I return us to Amendment 829, to which I put my name and which was moved by the noble Lord, Lord Sandhurst. I added my name because I share experience with the noble Lords, Lord Hendy and Lord Sandhurst. We have all seen cases in which a potentially huge claim arises under the Fatal Accidents Act which will provide a family with a payment for their dependency on the deceased for many years to come, so these are very substantial claims.

Probably all three of us have done cases for both claimants and trade unions on the one side, and for insurance companies on the other. Insurance companies are very business-like and accurate, but they are not social services organisations. One question they ask their counsel—particularly their leading counsel, their KC—in such cases is, “Are we liable to pay? Is there a point we can make, saying that it does not arise because the death was caused by some other means?” There have been many cases in which novus actus interveniens, which the noble Lord, Lord Harper, referred to earlier, has been cited as a reason for not paying.

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[Lord Carlile of Berriew (CB)]

Well, there we are: we know that the noble Lord adheres to the cab rank rule.

We have heard three very cogent speeches from the noble Lords, Lord Frost, Lord Carter and Lord Taylor, about the suffering point. If we look at the discussion we have had this afternoon, we now have a clear and stark difference between assisted suicide based on suffering and assisted suicide based on choice. I agree entirely with the noble Lords, Lord Frost and Lord Taylor: the public expect this Bill to be dealing with suffering. The public understand this Bill to be dealing with great suffering. They understand that the choice to have one’s life ended is based on great suffering, although it does not say so in the Bill. That must be clarified by the sponsor.

On the other side of the argument, we heard a very eloquent speech from my noble friend Lord Pannick, with whom I have a lot of sympathy. It is not generally known that, as he said, he has very personal experience of the issues arising from this Bill. However, the choice he is suggesting comes very close to being a choice for anyone who is seriously ill, not just someone who is seriously ill with an expectation of death within a certain limited period, whatever that happens to be. I fear that those of us who, like the noble and learned Lord the sponsor, are trying to reach the end of our process in the House of Lords on the basis that there will be a Bill, so it must be the best it can be, are not focusing on what choice really means.

We are talking about informed choice, accurate choice, if we can achieve it. I bear in mind very much what my noble friend Lady Finlay said. We are talking about a protective choice: the duty of the state to protect the citizen, even when they are making a choice. We do not, as citizens, have unlimited free choices in what we do; therefore, protection is important. It must be a morally sound choice, because that is part of our polity. We do things that are morally sound, and the Government protect us from those which may not be. It must be a choice founded on medical and scientific integrity: and there is the rub, going back to the points my noble friend Lady Finlay made about the uncertainty of the scientific and medical integrity of what is proposed.

For those reasons, I support the amendments that are focused on choice. I will mention three other amendments that I also support. The first is Amendment 76, which is not in my name but in that of the noble and learned Lord, Lord Garnier, but he is not able to be here for the latter part of today’s proceedings and I agreed to mention it at his request.

Amendment 76 would do something very simple. In Clause 2(1)(b), it would add one word, “direct”, so that a person is terminally ill if, in the amended paragraph (b), their death as a direct

“consequence of that illness or disease can reasonably be expected within six months”.

It may not be the perfect word, but it is about facts and the consequences of those facts. I agree very strongly with the noble and learned Lord, Lord Garnier, that if there is to be a death of someone through the assistance of a third party, which is what the Bill is fundamentally about, then it cannot be just a consequence, or one of the many consequences, of the illness. It has to be the, or at least a, major consequence of the illness. That is the purpose of that amendment: there has to be a bond, as it were, between the illness or disease and the death which ensues.

The next amendment is Amendment 93. It suggests leaving out Clause 2(3) altogether as it lacks clarity as to when an assisted death would be permitted. The subsection says that

“treatment which only relieves the symptoms of an inevitably progressive illness or disease temporarily is not to be regarded as treatment which can reverse that illness”.

What if the relief that is provided for an inevitably progressive illness provides not only relief from the symptoms but extra time to the person who is suffering from the illness or disease? I argue that if it allows extra time, the individual concerned will be having a new experience: they will be seeing what can happen if their symptoms are relieved. They need to discuss with their medical advisers whether they can have that relief of their symptoms again and whether it will prolong their life if they do. The relief may cause a fundamental change of heart by the individual. Therefore, I do not believe that there should be any possibility of the six-month period being elongated in any way by that relief. Indeed, I believe that the period should start again if such relief is given so that the person concerned can have an informed choice.

The third amendment is Amendment 96, which suggests leaving out Clause 2(4), which says:

“For the avoidance of doubt, a person is not to be considered to be terminally ill only because they are a person with a disability or mental disorder (or both)”,


followed by an important further sentence that I will not read out because of time. This subsection fails to deal with the proportionality between the disease, which is the terminal illness, and the disability or mental disorder, or both, from which that person also suffers. It is a complex little conundrum, but a very important one. I believe that proportionality needs to be clarified so that the Bill can be the best possible Bill we can have.

We have much still to learn about the issues that have been under discussion. I invite the noble and learned Lord, Lord Falconer, to consider these carefully and present some draft amendments to us before we meet again in a week’s time.

[Lord Blencathra (Con)]

My Lords, I seek a cast-iron assurance from the Government Whip that those of us whose speeches will be delayed till next Friday are recorded by the Government and will be allowed to speak. That is all I want to say at this stage. We want an assurance that we will be allowed to speak next Friday if we delay our speeches from today.

[Baroness Wheeler (Lab)]

I will shortly make an announcement to that effect.

Terminally Ill Adults (End of Life) Bill

Lord Blencathra Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Lord Blencathra (Con)]

I want to speak briefly in firm support of this suite of amendments, because they do not obstruct compassion but restore clarity and protect the vulnerable. As many noble Lords have said, the Bill leaves crucial decisions to discretion and delegated guidance. As my noble friend Lord Deben said, it is not precise.

Where I slightly disagree with my noble friend Lord Harper is that I am worried not about the judges moving the goalposts on the main Act of Parliament but because I believe that there will be more than 40 regulations, of which we have seen neither hide nor hare. We will not even see a draft before the Bill becomes law, and every single one of those regulations will be wide open to judicial review. That is where the judges will not have to move goalposts but have to fill in gaps on issues that neither House of Parliament has considered. They will have to decide whether the goalposts are for rugby or football, which neither House will have determined. I am deeply concerned that the Bill is not precise enough on the details that noble Lords have specified.

That imprecision leaves a big legal vacuum, where the most sensitive judgments about life and death can be initiated or driven by others, where serious mental illness can be overlooked and where people in care homes or in poverty can be pushed towards an irrevocable choice without robust, statutory safeguards. The amendments in this group are practical, proportionate and targeted fixes to those gaps.

First, the amendments make it clear that only the person themselves may initiate a request and that lasting powers of attorney cannot be used to start the process. That is essential, and I believe the noble and learned Lord, Lord Falconer of Thoroton, agrees. If he does, let us put it in the Bill. The law must not be ambiguous about agency of any sort. Where the law is silent, pressure and expediency will fill the silence. We have seen in other jurisdictions how a third party can accelerate a fatal outcome; the Bill must not replicate that risk.

Secondly, the amendments addressing severe mental health are not an attack on autonomy; they are recognition of clinical reality. A person can meet the narrow legal test of capacity while still having a treatable or episodic mental disorder that drives suicidal ideation. Excluding those with a history or pattern of suicidality from eligibility, or at least requiring a specialist psychiatric assessment, protects people whose wish to die is a symptom rather than a settled, autonomous decision.

Thirdly, the Bill must provide an independent, neutral route for information. Many doctors will rightly decline to participate. Patients must not be left to navigate a black box where the only signpost is a clinician who may be unwilling or conflicted. An independent local service or register would ensure that information was unbiased and accessible, and that the pathway into assessment was not covertly steered by those with other motives.

Fourthly, care home residents deserve heightened safeguards. Undiagnosed dementia and fluctuating capacity are common in residential settings. A single visiting doctor cannot reliably detect these risks in one brief encounter. Requiring a specialist assessment for care home residents is a modest, necessary step to prevent tragic mistakes.

These amendments would not create delay for those who are clearly eligible. They would create clear, statutory thresholds and processes so that clinicians, patients and families knew where they stood. They would reduce litigation risk, prevent inconsistent local practice, and ensure that the law aligned with the seriousness of the act that it permitted. If this House is to legislate for assisted dying, we must do so with precision. These amendments are not obstructionist; they are the scaffolding of a safe, humane system. I urge noble Lords to support them so that the Bill protects autonomy while safeguarding those most at risk of being failed by ambiguity, poverty or untreated mental illness.

I conclude in a more inadequate way than my noble friend Lord Deben did, on the point that he also made to the noble and learned Lord, Lord Falconer. If he cannot produce an assurance of amendments on the Bill that will implement some of the concerns of the royal colleges and of the three Select Committees of this House, some will be left with the impression that his strategy is not to accept amendments but to beg for more time and drive through the Bill, line by line unamended. That would be unacceptable. I hope that that is not the noble and learned Lord’s intention, but he could reassure us all by coming forward with revisions to the Bill and amendments that seek to implement the safeguards for which many organisations outside the House have been calling.

[Baroness Grey-Thompson (CB)]

My Lords, I shall speak to three amendments in this group—Amendment 38, in the name of my noble friend Lady O’Loan, to which my name is attached, and Amendments 39 and 68. Amendment 38 seeks to address the challenges of those who have bipolar disorder, borderline personality disorder or other conditions associated with episodic suicide ideation, who face a higher baseline risk of self-harm and suicide. Research indicates that suicidal thoughts and behaviours are significantly more prevalent among people with these diagnoses, even without terminal illness, as reported by NICE in 2022 and Public Health England in 2021. Critically, evidence also shows that suicidal ideation tends to increase following a terminal diagnosis, so without the safeguard of this amendment, the Bill risks enabling assisted dying decisions to be influenced by pre-existing mental health vulnerabilities exacerbated by the receipt of a terminal diagnosis.

I support calls in the Chamber today to look at the benefits system. It is a really complicated process, whether you have a terminal diagnosis or not. It is important to learn from other jurisdictions. The 2024 Oregon official report cited that 9% of those who requested to end their lives did so for financial reasons and 42% requested it because they were felt a burden. I think it has already been quoted that in 2011, the noble and learned Lord, Lord Falconer, with the Demos report, said that no remedial mental health condition should be eligible for assisted suicide. I do not expect an answer in the Chamber on this question this afternoon because it might take a long time—I am very happy to meet outside—but I am interested to understand what has changed from his view in 2011 to thinking that this would work in the Bill now.

Many of the amendments talk about a settled wish. I could almost see how somebody could try to justify that, for someone with a terminal condition and suicide ideation, requesting assisted dying might be a form of suicide prevention. I feel like I am tying myself in knots with this argument, but I think when we hear the argument that people are already dying, we need protection for those groups of individuals. The noble Baroness, Lady Jay, who I do not think is in her place—I am sorry, I do not have my glasses on—raised evidence given in the Select Committee and talked about paternalism. My personal experience is that I do not see much paternalism in the health service. What I do see is an awful lot of ableism, and I think that if we are talking about paternalism, we should be talking about ableism as well. From a disabled person’s perspective, this recognises the intersection between disability, chronic illness and mental health vulnerability.

The panel has already been raised in the Chamber this afternoon. The panel is a really important part of the eligibility determination and deciding whether somebody can go forward. I think that one of the only things that the noble Lord, Lord Winston, and I could agree on today is that words are important. This relates to the place of the panel. I draw your Lordships’ attention to the clarification statement that was issued by the Association for Palliative Medicine this week. Because words are important, I am going to read it. It states:

“In Friday’s … debate (9/1/26), Lord Falconer cited, and misrepresented, expert evidence presented to the Terminals Ill Adults committee last year by the Association for Palliative Medicine … Crucially, panel members would not be required to meet the patient. They would, therefore, have no individual clinical perspective to bring to bear on the person applying for an assisted death. This renders the panel a mere administrative review, stripping it of the very nuance and human understanding that defines robust, compassionate decision-making at the end of life”.


This is why these amendments are even more important in terms of what we are trying to do.

I have previously discussed suicide among unpaid carers and the pressure on them. In Canada, there is a case of a man who had carer burnout and arranged for an urgent assessment for his wife. She died that day. That is listed in the Ontario coroner’s report. There is also written evidence to show that two men who had caring responsibilities for their partners ended up doing a mercy killing, which is often, strangely, very sympathetically portrayed in the media.

Amendment 39, in my name, is about recognising where an assisted death could take place and who will be most directly affected. The settings that could be affected include care homes or nursing homes—communities that care for those living with dementia, frailty, disability or advanced illness, where dependency is a condition of daily life rather than an exception.

It is important to recognise that a significant proportion of people living with dementia or cognitive impairment remain undiagnosed until the later stages of the disease. On average, people with dementia live with symptoms for three and a half years before receiving a diagnosis. Current NHS England and Alzheimer’s Society data show that only about two-thirds of those with dementia receive a formal diagnosis. The diagnosis rate in Wales is even lower. This further underscores the need for a specialist clinical assessment before any conclusion about capacity is reached. If one in three people with dementia are never diagnosed, one in three potential applicants under the Bill may have an unrecognised impairment in capacity. This is not a margin of error that any legislator can reasonably accept.

A recent report by the whistleblower charity Compassion in Care further illustrates the heightened vulnerability of care home residents. Based on evidence submitted by over 1,000 care workers who called the charity’s helpline to express their concerns about the Terminally Ill Adults (End of Life) Bill, the most predominant issue raised in 97% of cases was that of fluctuating capacity, which is common among those residing in care homes. The British Geriatrics Society, which gave evidence during the Select Committee, estimates the prevalence of delirium among care and nursing home residents to be as high as 60%.

Amendment 68 is about protecting autonomy. It would ensure that the right to request assistance to end one’s life remains solely with the individual who is terminally ill. It would prevent any surrogate, family member or medical professional making that decision on their behalf. By explicitly prohibiting third-party decisions, we safeguard vulnerable individuals from coercion or misinterpretation of their wishes.

Finally, I would like to ask the noble and learned Lord a few questions. How will he specifically seek to protect those who are in care homes or who may be vulnerable? How will the Bill protect those individuals who have had previous suicide ideation? Where does the Bill seek to understand the intersection of those with suicide ideation who then receive a terminal diagnosis and whether this is a genuine, settled wish? How, through the Bill, will we be able to offer protection to those who have a previous history of self-harm?

Rare Cancers Bill

Lord Blencathra Excerpts

2nd reading
Friday 16th January 2026 Lords Chamber

[Lord Blencathra (Con)]

My Lords, it is a bit frightening for me, as a layman, to follow the noble Lord, Lord Kakkar, one of Britain’s top professors of surgery. I congratulate the noble Baroness, Lady Elliott of Whitburn Bay, on introducing this small but important Bill. I support it since I have had a couple of run-ins with cancer in the past—but, so far, I am outrunning it.

I had my first cancer at the age of 32, just two years after being elected to the House of Commons. That was a bit scary, but the excellent doctors at the then Westminster Hospital, just round the corner, fixed that. My Yorkshire Whip visited me and said, in that proper style I admire in Whips, “Eh, lad, you’d better not die on us—we can’t afford another by-election”. However, I am particularly grateful to the brilliant men and women of the Royal Marsden, who chopped out some nasty bits a six years ago. It was not a rare cancer, and in fact it was quite common, but it kills 18,000 people per annum in the UK.

Before looking at the Bill properly I had assumed that there would be a dozen or so rare cancers, but I am shocked to discover there are more than 230 different ones, affecting all ages and every part of the body. Diagnosis of rare cancers can be very difficult, leading to delays, and a lot of research information is often limited to common cancers.

In the time available, I will concentrate on Clause 2. Science is moving at breathtaking speed, and one of the fastest innovative cancer centres in the world is the Royal Marsden Hospital in Fulham. The Marsden and its partner, the Institute of Cancer Research, are translating precision diagnostics, early phase drug development, immunotherapeutics, advanced cellular and gene therapies and AI-driven imaging and data science into patient care—techniques that redefine what “radical” treatment for rare cancer means today.

The Royal Marsden NHS Foundation Trust, in partnership with the Institute of Cancer Research, is widely recognised as a leading expert, one of the top specialist cancer centres in the UK, and in the top four worldwide, for the diagnosis, treatment and research of rare cancers. When we get to Committee, I would like to amend Clause 2 to say that we do not want to appoint a person to be known as,

“the National Specialty Lead for Rare Cancers”,

since I do not think there is a single person capable of undertaking that task. However, the Royal Marsden’s record makes it uniquely qualified to lead this national effort.

It is astonishing what breakthroughs the Royal Marsden is making. There are active programmes at its National Institute for Health and Care Research centre—the Marsden has the only one in the country and has been nominated for it—which translates discoveries from the test bench to bedside care, right across eight translational themes.

The Royal Marsden is noted as Europe’s largest cancer centre, whose expertise is enhanced by more than 2,500 cancer specialists who collaborate in weekly multidisciplinary team meetings to develop personalised treatment plans. It was the first hospital in the UK to use the amazing Da Vinci robot with four arms that have microsurgical tools at the end that can get to the small cancer bits that surgeons’ big hands cannot. If your Lordships want to see something amazing, Google search “Da Vinci robot” and look at the demo. A grape is cut in half, and this robot stitches it together again without tearing the skin. That is why, when they gave me a choice, I said, “I’ll have the robot operating on me, please”, and it did it quite successfully. The Marsden’s Sarcoma Unit is one of the largest in Europe and a world leader in sarcoma research and treatment; as noble Lords present who are surgeons will say, that is one of the many rare cancers the Marsden specialises in.

In closing, the Bill’s measures—especially the careful review of orphan medicinal product authorisations in Clause 1—will protect the incentives that turn radical science into real cures. Putting it simply, if we want the Bill to work, appointing the Royal Marsden as the specialty lead will give the UK the leadership, infrastructure and reach required to make the aims of the Bill a reality.

Terminally Ill Adults (End of Life) Bill

Lord Blencathra Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Baroness Falkner of Margravine (CB)]

My Lords, I wonder whether the Minister in winding up could advise us what the Companion says about Peers making speeches on the same amendment over several points of the passage of that amendment.

It is a pleasure to follow the noble Lord, Lord Deben, speaking to the amendment from the noble Lord, Lord Rook. There is a lacuna in Clause 1(1)(d), which, by requiring registration with a GP, does not cover the practical point of what happens to people who have lost contact with their GP. They may have lost contact for no other reason than being so ill, perhaps with cancer as that is the main illness that people who might be seeking assisted dying have, that they have been taken into private care—those who are lucky enough.

An increasing proportion of the population of the United Kingdom now uses private care, not least because employers provide it as part of a package. So, coming to continuity of care, if we must have the light-touch amendment of the noble Lord, Lord Rook, in the Bill, to clarify and strengthen Clause 1(1)(d), I will share with the Committee very briefly a practical experience of what it means to have advanced cancer and the interaction with the GP. My GP practice, having failed to diagnose me over six months, as I mentioned in my Second Reading speech, slipped away the moment I engaged with private care, although every single consultation with a private practitioner is sent to the GP. Nevertheless, between 30 August 2024, when I was first diagnosed, and late this September, I had no contact whatever with my GP practice. I was finally invited to come in and was told I had fallen between the cracks—it must have been a pretty large crack to have lasted 14 months.

I noticed in the equality impact assessment that 66% of the people who sought assisted dying in the two jurisdictions quoted were people who had cancer. My question to the noble and learned Lord when he winds up on this debate is therefore, what consideration has been given, in having Clause 1(1)(d) in the Bill, as to the relationship of the private oncologist who is treating that patient with the local GP, given that terminally ill people in significant enough numbers that we need to be conscious about them in the Bill may well have been—shall I say—passed on from the GP?

As a final point, once I had the diagnosis, I had the experience of requesting treatment at my local—within a walkable distance—leading cancer teaching hospital in the United Kingdom. When I rang about that after the diagnosis, I was told by my GP, “They won’t take you, because now you’ve gone private”. I leave that for noble Lords to reflect on.

[Lord Blencathra (Con)]

Before we move to the rest of the debate, could we please give way to those noble Lords who have tabled amendments? I would like to hear what they have to say.

[Baroness Grey-Thompson (CB)]

My Lords, I will speak to Amendment 21, tabled in my name, from personal experience. The richness of the debate today shows that, even in your Lordships’ Chamber, we all have completely different experiences of how we access a GP practice.

I tabled this amendment partly from personal experience, trying to look at how we provide continuous care to a patient. As for my own experience, I am disabled, not sick, but I have had some very interesting experiences of interacting with doctors. Fairly recently, I was asked by a doctor how I caught spina bifida and had to explain to him that it was congenital. As for my husband’s experience of the healthcare system, he had a spinal cord injury in 1984 and, at a recent visit, was continually asked whether it was in 1884 that he had his accident—I know he looks good for his age, but not that good. This is not to be flippant, which I have been accused of before. It is actually to try to ensure that we have proper continuity of care for a person who wishes to end their life.

My amendment is also grounded in coercion detection and the limitations of any capacity assessment. When I tabled it, I was thinking that perhaps a GP could provide extra knowledge to contribute to the decision that was made. But then I heard of the experience of my noble friend Lady Falkner, which is absolutely appalling. It shows that there is far more work we need to do, not just on the National Health Service but on making sure we provide the right care. The noble Lord, Lord Deben, talked about the NHS we wish to have. Well, this might be a chance to think about the NHS we wish to have.

I take this opportunity to welcome my new noble friend Lady Gerada and the experience she brings to the Chamber. I have to say that it has left me slightly more confused. I have amendments on data recording, which we will be debating later. Her comments show that data recording and sharing is really important. The part I got a bit confused about was that, if there is a named clinician as part of that process, does that not ultimately feed in to the points that have been made today? I would welcome the chance to discuss that with her outside the Chamber.

Continuity of care is really important, and how it relates to improved patient outcomes. In 2012, 56.7% of patients had a preferred GP, but that is declining. There is a link between your preferred GP and being able to access that GP. The decline has happened regardless of baseline continuity, rural or urban location or level of deprivation. Providing a better experience to patients will make those final weeks and months better for them. The Royal College of General Practitioners published excellent work in 2021 on why the patient’s relationship with their general practitioner is so important. Research on coercion and undue influence demonstrates that standard capacity assessments, while necessary, are not currently sufficient to identify subtle forms of coercion. That is why I tabled an amendment.

In response to the comments of my noble friend Lord Pannick, about what happens if a GP dies, I am happy to be corrected, but I thought the provision in the Bill about your doctor dying would cover a general practitioner as well as any other doctor involved in the process.

What we are talking about here are really complex decisions. Consulting an established GP or GP practice might mean that they possess the nuanced knowledge which would help somebody make a choice. The requirement that GPs confirm that they have a good understanding of the individual’s personal circumstances represents, to me, a better form of safeguard, ensuring that this knowledge actually exists. We cannot assume anything during this process. The assessment should provide abuse detection capacity unavailable in other types of consultations. For individuals whose care is family dependent, the home visit element—which I had, not so long ago—can play an important part in identifying coercion. If the debate has raised nothing else today, it is that this is a really complicated issue which needs much further work.

--- Later in debate ---

This issue illustrates a couple of things. Yes, it is down to safety, but I respectfully suggest that the fact that we are having this discussion today shows the immaturity of the Bill. We should have had a royal commission and a Government Bill, instead of trying to do it this way and negotiate on the hoof.

[Lord Blencathra (Con)]

My Lords, I did not speak last Friday, and this is the only group to which I intend to speak today. I could have spoken to the last group, as my former constituency abutted the Scottish border of Dumfries and Galloway and a mere 85 yards across the River Sark was Gretna. I was aware of our glorious 600-year history of border-raiding for cattle and women—in that order—and now it seems we can add free prescriptions to the list as well.

These amendments would strengthen the safeguards with a demonstrable, ongoing clinical relationship with a GP, reducing risk of error, coercion and administrative confusion, while supporting clinical judgment and the continuity of care. Requiring 12 months’ registration plus a minimum number of in-person contacts gives a straightforward verifiable test of recent clinical involvement. We need robust, practical safeguards and clear eligibility checks. These are essential to protect vulnerable people by evidencing local care and oversight. A sustained relationship with a local GP who has seen the patient helps ensure that the patient is informed and is acting voluntarily and free from subtle pressure. The GP’s direct knowledge of the patient’s circumstances is therefore a critical safeguard rather than a bureaucratic hurdle.

The big issue, which has already been raised today, is: who sees the same GP twice these days? I am very lucky, and perhaps some other noble Lords are as well, in that there are superb multi-disciplinary GP practices in Cumbria. I almost always see the same GP, and we can email as well. In fact, in 40 years of living that constituency, I have only ever had two GPs. However, that is not the national picture. Many patients see a different GP every time they visit. Therefore, for this part of the Bill to work, it cannot be any old GP from a practice; it has to be a GP who has treated the patient personally on a few occasions or over a period of time.

Yesterday, I had the wonderful privilege of hearing in this House from a GP who satisfied all the criteria of these amendments thanks to her deep knowledge of her patients. I was later able to congratulate the noble Baroness, Lady Gerada, a former president of the Royal College of General Practitioners, on her excellent maiden speech. I am delighted to see her here today. I understand that this morning, she was doing the day job, treating her patients in her constituency.

I know that the noble Baroness is in favour of assisted dying, but what she said in one part of her speech yesterday was directly relevant to these amendments. The noble Baroness—I am rather vexed at the right reverend Prelate the Bishop of Norwich, who stole these lines earlier this morning—said:

“I became a GP in Kennington, and I have lived and worked in the community I serve ever since … My very first patient was a young woman who suffered a stillbirth. Decades later, I look after her children and now their children too. That continuity, seeing lives unfold across time, gives general practice its unique moral and social power. It allows us to see people as whole human beings, not as isolated organs or diagnoses. We are interpreters of experience, translators of suffering and witnesses to change”.—[Official Report, 11/12/25; col. 370.]


That is exactly the sort of GP I trust to make a decision on whether a person has a confirmed wish to opt for assisted dying—not just any general practitioner, who may never have met the patient before and has just 10 minutes to form an opinion.

I would love to find a way to include that magnificent sentence about continuity and seeing lives unfold over time giving general practice its unique moral and social power; I would love to see whether we could incorporate it into the Bill, because it sets the right moral climate.

As I say, I have a GP. However, for those millions of people who are not so lucky, these amendments would balance safeguards with practicality. Setting a modest minimum of contacts is proportionate. It is enough to demonstrate an established relationship without imposing unrealistic burdens on patients or practices.

Many noble Lords have spoken of multidisciplinary teams. Can the noble Baroness tell me—indeed, can anyone tell me—how many of all the GPs in this country are still single-practice doctors? A Google search suggests that it is around 63%. That seems terribly high; there must be more multidisciplinary teams than that. There are still an awful lot of single-practice GPs. On the rare occasion when I have not seen my own GP, the other GP has had a look at the computer and read all my clinical notes. However, he does not really know who I am; perhaps that is just his good fortune.

These amendments would support patient safety and public trust in any assisted dying regime. It needs to be visible and enforceable, and it needs to have enforceable safeguards. Clinicians must be able to attest to a patient’s circumstances. I support these amendments.

May I say to the noble and learned Lord, Lord Falconer of Thoroton, that I was dismayed to read some very hostile comments about noble Lords and noble Baronesses in the weekend press? The complaint was that some Peers had tabled a large number of amendments, and that that was somehow wrong. If they were the only Peers who spoke to them, that criticism would be valid, but those noble Lords and noble Baronesses, as professionals and experts, tabled amendments to which many of us wanted to speak. We left them to do it because those Peers have experience; scores of Peers have spoken to their amendments, so they were not abusing the House. I am absolutely certain that the noble and learned Lord was not behind that bad-mouthing, because he is a gentleman as well as a Peer, but some supporters of this Bill are trying to drown out and close down any proper scrutiny in the Lords.

Lastly, I remind the noble and learned Lord and the Committee that Dignity in Dying’s website boasts that the Bill had 29 Committee sittings in the Commons and over 90 hours of consideration. Since the Bill has come to us from the Commons, we have heard devastating criticisms of it from the Constitution Committee, the Delegated Powers Committee and experts giving evidence to the noble Baroness’s Bill Committee. Today, we are on only our fourth sitting, after, I think, 18 hours of debate. So I say this to the noble and learned Lord: please tell some of the others to call off the attack dogs because this House is doing its proper job.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, like many noble Lords, I grew up at a time when the family doctor was looked upon as a family friend who could always be depended on whenever you were ill or in a time of crisis. Unfortunately, that is not the situation today. There is a major problem across the United Kingdom: patients desiring to see a GP find themselves sitting on the telephone and ringing the surgery 120 times, perhaps, but still not getting through to someone and giving up at the end of it. That is the reality of the situation in many places.

I am sorry that the noble Lord, Lord Pannick, is not here. He posed a question to the noble Baroness, Lady Lawlor, concerning what happens if your GP retires. Let me give my small experience. My GP was in his late 50s. He was an excellent GP. During Covid, unlike many other practices, he still allowed patients to come to his surgery. Whenever elderly patients could not come, he went out to their houses and visited them in their own homes—unlike many other practices and GPs. Unfortunately, he got cancer and, in his late 50s, just recently, he passed away.

We were left with a practice in our town with several thousands of patients but nobody to take it over. So what happened to us? Our GP died, and so, without any consultation whatever, we were all farmed out to seven or eight practices around the countryside, some of them not even close—just to whoever would take us. It is unrealistic to imagine that somehow a new doctor would have any knowledge of the pressures, the problems or the complex challenges that his new patient was facing; he would not have any continuity of care whatever.

It was even worse than that, because it was several months before the notes went to the next practice that you were farmed out to. You were allotted a practice but the notes concerning any illnesses of the patients did not immediately follow; it was several months before they arrived. What has been suggested in these amendments today strengthens safeguards. Therefore, they are worthy of the support of noble Lords in this House.

Wheelchair and Community Equipment Strategy

Lord Blencathra Excerpts

Thursday 11th December 2025 Lords Chamber

[Lord Blencathra (Con)]

My Lords, I am delighted to be the first Conservative to congratulate the noble Baroness, Lady Gerada, on an excellent maiden speech, as one would expect from such a distinguished doctor. How wise of her to speak today and not step into the maelstrom of assisted dying tomorrow—although there will be plenty more days and opportunities for her to give a view on that as a distinguished former president of the Royal College of General Practitioners. We shall also expect her to singlehandedly save the NHS and solve the serious problems of general practice moving patients into hospital care. We all look forward to hearing from her again.

I also congratulate the noble Lord, Lord Hunt of Kings Heath, on securing this debate and on his excellent contribution. NHS wheelchair provision has been widely criticised for inconsistency, long delays and poor suitability of equipment. Costs are driven up by inefficiencies and the false economy of supplying inadequate wheelchairs. A cost-effective strategy would focus on standardising services, improving assessments and investing in fit-for-purpose equipment to reduce downstream health and social costs.

What are the key criticisms of NHS wheelchair provision? First, it is a postcode lottery, as services vary significantly across regions, leading to inequitable access. Secondly, there are long waiting times. Delays in assessment and delivery leave users without mobility support for months. Third is the poor suitability of equipment. Many wheelchairs provided are heavy, cumbersome or not tailored to users’ daily lives, forcing some to buy their own. Fourthly, there is limited user involvement. Assessments often fail to consider lifestyle needs, reducing independence and social participation. Fifthly, standards are inconsistent. NHS England acknowledges variation in service quality and outcomes. Putting it simply, NHS wheelchairs are dirt cheap and for that you get big, heavy, ugly things which appal young people who may need to use them. The wheels may not detach. Car transport can be difficult, if not impossible.

Noble Lords have seen my sophisticated wheelchair parked around the corner. It is similar to that of the noble Baroness, Lady Brinton. However, these wheelchairs are of a 10 year-old design. They are on a solid steel frame and very heavy, no doubt designed for 40 to 50 stone Americans. A replacement these days would be lightweight aluminium. Lightweight aluminium wheelchairs have been taking over the scene in the last few years. That is what people want and need, but there is a higher cost.

That cost could be contained if there was a national NHS strategy. First, it would standardise provision nationally, implement the NHS wheelchair quality framework across all ICBs to reduce variation, and appoint a senior NHS England lead to oversee wheelchair services. Secondly, it would improve assessments and user involvement, ensuring that assessments consider lifestyle, employment and education needs rather than just the medical factors, and co-design services with wheelchair users to avoid unsuitable provision. Thirdly, it must invest in fit-for-purpose equipment, providing wheelchairs that meet individual needs, reducing downstream costs from poor health outcomes as they get worse in the future with bad wheelchairs, and expand personal health budgets to allow choice and flexibility. Fourthly, it must streamline procurement and maintenance, centralising purchasing to leverage economies of scale and introducing rapid response maintenance contracts to minimise downtime. Fifthly and finally, it must measure outcomes, not just costs, tracking independence, employment and health outcomes as key performance indicators—the value added—and using data to demonstrate long-term savings from better provision.

While upfront costs of better equipment and services may rise, the long-term savings in health, social care and productivity would make this a cost-effective strategy. Standardisation, user-centred assessments and investment in suitable wheelchairs are the most impactful reforms. I beg your Lordships to support this.

Terminally Ill Adults (End of Life) Bill

Lord Blencathra Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Lord McCrea of Magherafelt and Cookstown (DUP)]

I do not believe that people are tabling amendments simply to wreck the Bill. That may be the noble Lord’s opinion, but he should remember that other people have different opinions. I respect the noble Lord’s opinion, but I hope that he will in turn respect my right to have an opinion. I believe that we must scrutinise this well. I noticed that the noble Baroness, Lady Hayter, objected to the fact that practically no one who supports the Bill has spoken. I know of no one supporting the Bill who has been stopped from speaking. They did not get up to speak, and therefore they were not stopped. If there are those who want to support this Bill and to get up to speak, they are free to do so. I certainly would like to hear their opinions just as well. I believe that I have an opinion that ought to be heard equally, as they have.

I come from a family that knows what the reality of suicide means and the heartbreak of suicide, where we examine and wonder whether something more could have been done before that person ended their own life in suicide. I know the pain of that and the loneliness that they went through. Therefore, I believe we must get this right.

In the domestic abuse and coercive and controlling behaviour context, a victim may, due to intimidation or trauma, deny that their actions are caused by wrongful coercion. Is the doctor supposed to be weighing the patient’s words against the very limited evidence that they can see in an examination room? Professor Jane Monckton-Smith OBE, professor of public protection at the University of Gloucestershire, emphasised in her testimony to the Select Committee the significant difficulties in relying solely on a person’s verbal denial of abuse when assessing coercion:

“I have worked in this area for a very long time. I have seen victims refuse medical help when they have been hit in the head with a hammer through fear. That is not an isolated example. If you speak to the other people here, I think they will probably agree with me. What I am saying is that coercive control is a serious social problem. It will impact on the people who are going to look to this Bill”.


Also in the Lords Select Committee evidence, Cherryl Henry-Leach of Standing Together Against Domestic Abuse warned

“the difficulty is the lack of insight into the impact of coercive control on somebody’s ability to make decisions, even though that has been enshrined in case law”.

I do not want to detain the Committee, but in over 50 years as a minister I have experienced people coming to the end of their life. I have been with them in their moments of their deepest pain, and, as a noble Lord said, was there with the families after the occasion, trying to minister to them. I also know what it is from my 25 years as a constituency Member of Parliament in the other House, and we should not close our minds to the fact that people can be coerced. Sometimes it is done very subtly and gently within family dynamics, and that is difficult for assessing doctors to detect in limited formal settings.

Therefore, I believe it is vital that the words put into this legislation, if it is passed, are the correct ones that cover all these possibilities. Remember, when the person takes that lethal injection or whatever potion they take, there is no return as far as this life is concerned, but they go to another.

[Lord Blencathra (Con)]

My Lords, I had intended to give my strong support to Amendments 3, 45 to 49, 52 and 58—a mere eight amendments out of the 21 in this massive group—but in the interests of time I will dump my notes on all those and speak merely to Amendment 58 in the name of my friend, the noble Baroness, Lady Grey-Thompson, who has made a crucial point with regard to that amendment.

Coercion and pressure do not always manifest themselves as direct, intentional acts by individuals. Instead, they can arise from broader and societal structures and conditions that constrain genuine choice. When a person facing terminal illness is subject to circumstances such as chronic poverty, social isolation or a systemic lack of quality healthcare, their options are severely limited. In such scenarios, the choice to pursue end-of-life options may not be a true expression of free will but rather the result of enduring disadvantage and unmet needs.

At Second Reading, my noble friend Lord Moylan made the telling point that many people contemplating suicide do not want to die; they just want their life circumstances to change for the better. Therefore, “structural disadvantage” refers to the social, economic and institutional barriers that systematically disadvantage certain groups. When terminally ill individuals lack access to palliative care, social support or financial resources, they may feel compelled to consider end-of-life options not out of genuine preference but because their suffering is exacerbated by these systemic failures.

Poverty is a profound social vulnerability. A terminally ill person living in poverty may fear becoming a burden to family or may lack the means to access pain relief, counselling or hospice care. The psychological and practical impact of poverty can create a sense of hopelessness, making the option of hastening death appear more acceptable or even inevitable. When systems persistently fail to address the needs of the most vulnerable, this neglect can be seen as a form of institutional or collective intent. Thus, the responsibility for coercion or pressure extends beyond individual actors to the structures that shape people’s lives and choices.

Many years ago, my illustrious predecessor in my constituency, the great Willie Whitelaw, said to me, “David, I was never interested in pensions until I turned 65”. The wonderful thing about this House of ours is that the average age in here is 71, I understand, and our average death age is 81. That, as we have heard from many noble Peers, gives us a unique insight into the sorts of infirmities that we and our close relatives suffer and the close experience of those near to us who have died from them.

We have heard from many noble Lords, including my noble friend Lord Polak and the noble Lord, Lord Griffiths, their experience of beating the odds because the prognosis was not right. I quoted in my Second Reading speech that Sir William Osler, the father of modern medicine, said, in about the 1890s:

“Medicine is a science of uncertainty and an art of probability”.


Because my noble friend Lady Berridge mentioned NICE, I am tempted to cite an example. I have experience of NICE. I am grateful to it in some ways and hate it in others. One of the side-effects of MS is that one’s feet feel nailed to the ground: they are as heavy as lead and do not move. Fifteen years ago, NICE approved an experimental drug call Fampridine. I was one of about 500 patients put on it at the National Hospital.

Fampridine is an absolutely miraculous drug. What does it do? You saw it in effect this morning. It helped me stagger from my chair to here. With assistance from my noble friends, I can manage to walk—not very fast—to the Dispatch Box. Every six months, I have to do a walking test. If my walking is not fast enough with the drug, they cut it off and I do not get it any more.

Terminally Ill Adults (End of Life) Bill

Lord Blencathra Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord Weir of Ballyholme (DUP)]

My Lords, I rise to support the amendment standing in the name of the noble Baroness, Lady Coffey. Some people may detect from my accent that, although I hail from the great city of Bangor, it is not the great city of Bangor in north Wales but the great city of Bangor in Northern Ireland. I have particular empathy with the amendments that have been put forward by the noble Baroness due to my experience as a Minister in a devolved Administration. The clarity the noble Baroness seeks goes to the heart of the relationship between the devolved Administrations and Westminster, and it is of particular relevance to this Bill.

Generally speaking, a Minister in a devolved institution will face three categories of legislation. First, there will be reserved matters, which are entirely within the purview of Westminster—national issues, which I think everyone would accept. Secondly, there will be a range of issues which, although not strictly reserved, are of such obvious applicability across the United Kingdom that a legislative consent Motion should be applied. I do not see the noble Lord, Lord Foulkes, in his place, but on occasions even the SNP Government in Scotland have been prepared to sign up to legislative consent Motions. The third category—the bulk of legislation—is situations that should be decided locally, where a devolved Government and a devolved Parliament can choose whether to follow what is happening at Westminster and in England, to take a different path in seeking either to virtually replicate or to amend, or to go in a tangentially very different direction. That is at the heart of democratic accountability in devolution.

I believe that this is an issue that should be decided in Wales. It is an issue that should clearly fall into category three. We all know that we have a very unusual constitutional set-up in the United Kingdom, where devolution to Wales, Scotland and Northern Ireland is on a slightly different basis in each case. That can produce some unusual aspects. What we have today is a certain level of anomaly, because this legislation falls into what may be described as a fourth, hybrid category. As the noble Baroness, Lady Coffey, highlighted, the distinction is between the aspects that deal with criminal justice and criminal responsibility, and those that deal with health and social policy, with the former being reserved and the latter being devolved.

It is very clear that the heart of the Bill makes major decisions that impact on health and social policy. However, we are left with a situation for Wales that means, if this goes through unaltered, that the criminal responsibility will be lifted but there will be no regulations coming from this House as to how that will actually be brought about. It is the equivalent of this House saying that we are going to bring in new road safety measures, which will not apply to Wales, but if you are caught speeding on the motorway there could be no criminal sanction against you. What we have potentially arrived at for Wales is the worst of all worlds.

We need to take a step back. We need to ensure that the wishes of the Welsh people, as exercised by the Senedd—they may change over time—are respected. Rather than, in effect, imposing something that then has to be more or less corrected in Wales by way of changes to their health and social policy, we should be allowing the issue of assisted dying to be decided by the Welsh Senedd. If they decide to make those changes, this Parliament should then reflect them by way of changes to the criminal justice system, which I think would be relatively easy to do.

In the absence of that, the importance of these amendments, as outlined by the noble Baroness, Lady Coffey, is that if we cannot get things definitively the right way round, we can at least get a level of clarity over what aspects apply to Wales, rather than a potential wall of obfuscation. This is an ideal opportunity for the Government and the sponsors to highlight where exactly the demarcation is, which will be very helpful as we move through the rest of this Bill.

[Lord Blencathra (Con)]

My Lords, I support my noble friend Lady Coffey’s amendments in this group. As I looked at the title of the Bill, “terminally ill”, and then saw clause after clause talking about the patient and the doctor’s involvement, I was clear that this was a medical Bill. We had the Secretary of State for Health saying that he was in charge of it, and the Department of Health and Social Care, which seconded about 30 officials to help rewrite it, in a way taking ownership of it. Then I asked myself: why on earth are we legislating for Wales when health is a devolved matter in Wales and the Senedd is in charge of health matters? This is where it is really Pythonesque, because although this is a medical Bill in England, it is a criminal Bill in Wales, and criminal matters are not devolved to Wales. How on earth can the same Bill be a health Bill in one country of the union and a criminal Bill in another?

On 23 October last year, Senedd Members, including the First Minister, Eluned Morgan—the noble Baroness, Lady Morgan—and the Health Minister, Jeremy Miles, voted against a Motion calling for a new law to allow assisted dying in Wales and England. Miles had earlier warned of “huge ramifications” for Wales if the law changed. In total, 19 Senedd Members voted in favour of the Motion, with 26 against and nine abstentions. However, the Senedd does not have the power to change the law on assisted dying in Wales, so the vote was symbolic. The Senedd does not have the power to legalise assisted dying, but the Health Minister indicated that it is likely that future legislation will require another vote to give Parliament consent.

The Welsh NHS, which is almost totally devolved and overseen by Cardiff politicians, would be responsible for implementing the law. However, I understand that the Senedd can still vote on whether to implement the legislation, as parts of the Bill touch on devolved areas, so the Welsh Government would need to pass specific regulations and gain an affirmative vote from the Senedd before the Welsh NHS could provide the service. I am not a great fan of the devolved Administrations, but they exist and they have a genuine job to do. In Wales, this would mean that their NHS and its doctors would have implemented all the provisions of an English law, which they had no power to change. That does not seem right. If the Senedd in Wales can be trusted to run the NHS in all medical facilities in Wales, it should be trusted to make its own terminally ill end-of-life Bill.

Next year there will be Senedd elections, and on current polling there may be a large majority of Plaid Cymru and Reform Members elected. It cannot be right that they inherit a Bill relating to the deaths of about 35,000 people in Wales each year and that they have no say over how their constituents die.

Of course, the Senedd could refuse to give consent to the legislation, but I suspect it will be threatened and blackmailed into doing so. It will be told that it is the English Bill or nothing and that Wales has no power to do its own law, so the Senedd had better approve it or else. But the Senedd could do its own law; all we have to do is grant it the constitutional power to do so.

--- Later in debate ---

[Baroness Berridge (Con)]

As people around me are saying, I do not think I said that. They are neutral. The royal colleges have said that they have problems with the Bill, but they have been neutral on the principle, save for the Royal College of General Practitioners. I am sorry; I stand corrected on that. They are neutral, as is the Association for Palliative Medicine, which is not a royal college.

When one looks at the evidence that we took, of course individuals from within that group would come along whom we had to call. It was right that we did that, but one looks at a corporate view. I enormously respect Professor Sir Chris Whitty, but I heard his evidence on this and he was not the highest expert in the land. He was humble enough to write to correct himself, as he had misunderstood the Mental Capacity Act when he gave evidence in the Commons.

[Lord Blencathra (Con)]

My Lords, we should all be grateful to the noble Baroness, Lady Finlay of Llandaff, for bringing this matter before the Committee, but also to my noble friend Lord Harper, who has highlighted some of the deficiencies in in the Mental Capacity Act. Yes, it may be tried and tested in its current usage but, as we heard from many sides of the Committee, it may be inadequate for dealing with death issues.

I was going to speak in support of Amendment 2, but I might also be willing to support the potential oral amendment from my noble friend Lord Deben. When considering important decisions, particularly in the context of healthcare, it is crucial to understand the distinction between capacity and ability. This is especially relevant for terminally ill patients, as questions about decision-making may arise on treatment options, advance directives and legal matters.

I believe that we should change references from “capacity” to “ability” when discussing decision-making for terminally ill patients. The reason for this change is to ensure clarity and accuracy in describing a person’s actual situation. We should not be afraid to bring in a new word if it is more relevant than “capacity”. Although “capacity” is a legal and clinical term for specific criteria, “ability” is a broader term that may better reflect the practical realities and nuances of an individual’s situation. Using “ability” can help to avoid misunderstandings and ensure that patients are supported in ways that are appropriate to their unique circumstances.

Tobacco and Vapes Bill

Lord Blencathra Excerpts

2nd reading
Wednesday 23rd April 2025 Lords Chamber

[Lord Blencathra (Con)]

My Lords, I commend the noble Baroness, Lady Morgan of Drefelin, for the wonderful work she has done as chief executive of the Breast Cancer Campaign, fighting cancer there, and for her wise words in this Chamber of Parliament here today. My concern with the Bill is that we might not hear those wise words—or anyone else’s wise words —in Parliament again, since the Government in this Bill are taking so many powers away and delegating them to Ministers.

Like every other Member who has spoken, I generally support the thrust of the Bill. As we know, the last Conservative Government introduced a similar Bill with these generational restrictions, and which many people thought were possibly unenforceable. The new Government have also reintroduced it with the generational powers, which again may be possibly unenforceable.

My main concern about the Bill are the unacceptable parts with excessive amounts of parliamentary scrutiny being taken away and given to Ministers and others in the delegated powers. As has been said by others, the previous Bill had 33 delegated powers and this one has 66. Some are repeats of the same powers, duplicated for Northern Ireland, Scotland, Wales and England but, nevertheless, the extent of the delegated powers is a slap in the face for the report from the Delegated Powers and Regulatory Reform Committee, Democracy Denied? The urgent need to rebalance power between Parliament and the Executive, which was praised by the current Government.

In that report, we warned about the four major abuses we increasingly see in legislation—but this Bill has every sin we warned against. It has 17 Henry VIII powers, enabling Ministers to change Acts of Parliament, avoiding proper parliamentary scrutiny. It has skeleton clauses saying that Ministers can create offences on a range of topics and set a maximum penalty. That is not good enough. Any and all criminal offences should be set out in detail in primary legislation.

It has subdelegation of powers. It is bad enough that Ministers have been given excessive delegated powers, but some clauses permit subdelegation of these powers to other organisations. Clause 104 simply says:

“Regulations under this Part may confer discretions”.


There is identical wording in paragraph 10 of Schedule 1 and local authorities are given carte blanche to invent their own licensing conditions without Parliament ever looking at one word of them. At least with statutory instruments there is a slim chance that Parliament can debate them, but not when the power to make these laws is delegated to some other body.

The Delegated Powers Committee also slammed the increasing trend for disguised legislation, where the Minister issues guidance which everyone must have regard to. This is a way to get round making a statutory instrument, which of course might get some Parliamentary scrutiny. Technically and legally, the words “must have regard to” are not compulsory, but they can only be disregarded if the target organisation or persons can show exceptionally good reasons not to follow them, which is a heavy bridge to cross. Of course, all government information when the guidance is issued gives the impression that it must be followed on pain of death—we have that here also in Schedule 1.

We have heard from every noble Lord today that there is a justifiable case to add more restrictions to the sale of tobacco and vapes. If that is the case, the myriad offences in the Bill should be set out in detail and not hidden. Let us justify what the Government are doing in legislation.

I leave it to other noble Lords to point out the difficulties of enforcement of the age and generations restrictions, not least the thousands of extra inspectors who may be required and the impossibility of retailers checking the ages of people between their twenties and thirties, thirties and forties, and forties and fifties. Two weeks ago, I was in the Little Waitrose down Victoria Street, and a lady in front of me was stopped at the till because they wanted to check her age for a bottle of Nyetimber champagne that she was buying. She said, “I’m in my forties”, but the assistant said they needed to check her age. The rather elegant lady in her forties had some choice language to give to the Waitrose staff who wanted to check the age of a lady who was obviously older than 21. That is just in a professional Waitrose store; I shudder to think of what will happen in the thousands of little retailers around the country.

I conclude with a word about the illicit market. Illicit is not counterfeit, but real cigarettes made by legitimate companies in Romania, say, and intended for the Romanian market or other eastern European markets—where there may be no duty or taxes—are being brought here illegally. It is massive, and this Bill will add to it. In 2023, one in four cigarettes consumed was illicit—that is 6.7 billion cigarettes—losing HMRC £3 billion per annum. Every single expert, and everyone in the tobacco companies, says that this Bill will further boost this dodgy market. My concern is not around the potential loss of revenue to HMRC but that 25% of cigarettes are able to be sourced illegally in pubs around the country.

We have a Bill with excessive powers and with large parts that are possibly unenforceable; it will lose the Government money and give young people a way to get cigarettes illegally in any case. Although I support the Bill, I hope that we will explore these issues in Committee.

Homecare Medicines Services (Public Services Committee Report)

Lord Blencathra Excerpts

Thursday 2nd May 2024 Lords Chamber

[Lord Blencathra (Con)]

My Lords, I am delighted to participate in this important debate, and I regret that it is tail-end Charlie today when the report deserves much greater prominence. The only credit I can take for this excellent report is that I suggested the topic. I pay tribute to our brilliant chair and her devastating summary today, and to colleagues on the committee and to the officials, who did all the probing and heavy lifting and concluded that this is a major opportunity lost.

My personal interest is that I get two different medicines for multiple sclerosis delivered to my home. The one which sparked this inquiry is called fampridine. Most people with MS cannot lift their feet and they drag on the floor; I can trip over a dead fly on the carpet. Fampridine enables us to lift our feet by as much as 5 millimetres—that is all—but it is the difference between walking and not walking at all. To me and others, that little fact makes it a miracle drug, and I was lucky enough to get in on the trials when they started. As an aside, NICE will no longer approve it for new patients, but all those of us in the trials can keep getting it. That is grossly unjust—like many other NICE decisions.

I had excellent service until 2017, when the delivery contract was allocated to a new company; it is named in the report and I will not name it again, but it began to fail abysmally in getting the deliveries to me before the last pills ran out. I complained on many occasions and it came to a head in July 2021, when I had no delivery and no pills for 10 days. I was unable to walk—or stagger, in my case—from where I park my Ferrari at the Bar of the House even to get to this Front Bench here.

I looked up the company in Companies House, found the names of the main directors, tracked down their addresses and sent them a stinking note with my full rank and titles and a draft of my letter to Sajid Javid, the then Secretary of State, calling for the company’s contract to be terminated. The net result was that, two days later, some poor chap was dispatched on a 500-mile round trip to deliver on a Saturday my fampridine to Penrith in Cumbria.

I looked further into this company and found that the Care Quality Commission—a thoroughly useless body if ever there was one—had just published a report in May 2021 showing that over 9,885 patients had also failed to get deliveries of their drugs, and some had to be hospitalised. The CQC report gave the company an overall rating of “inadequate”. On patient safety it rated it “inadequate”, and on “Are services well led?”, it rated it “inadequate”. Therefore, with all these negative ratings, what did the CQC do? It listed all the regulatory breaches and asked the company to kindly send it a report on how it would behave better in future. As Bob Geldof might have said, “Is that it?”

That is one reason why I say that the CQC is a useless regulator, which our report also suggests—or hints at, in very strong terms. By the way, a month after the scathing CQC report, the company changed its name and pretended to be a completely different supplier altogether.

I wrote to the Secretary of State calling for the contract to be removed, but that did not happen because he was not properly in charge of it and he was not sure quite who was. I now get Rolls-Royce service from this company because of who I am and because I created a big stink, but the other 9,884 victims, who have conditions far worse than mine, might not be so well served.

When I joined the Public Services Committee, colleagues were looking for a short-term inquiry to fill a gap as we looked at suggestions for a longer inquiry. I suggested investigating the delivery of medicines at home and supplied details of my own experience. I think that initially my colleagues thought that I was perhaps exaggerating the shambles I had described, but when our excellent clerk, Samantha Kenny, looked at it, she thought that it deserved a deeper look.

My colleagues thought that there may be a bit of a mess here, and then the evidence started to come in from various patient groups such as Crohn’s & Colitis UK, and the superb report from the British Society for Rheumatology which suggested that the system was a complete shambles and cited countless examples of failure to deliver medicines on time. I think colleagues then concluded that old Blencathra was not so barking after all.

We have called the report An Opportunity Lost and that is true, but we could easily have called it “A Complete Shambles”. Those are not just our words; the Chief Pharmaceutical Officer for England told us that our inquiry had unearthed,

“a complicated picture that is quite hard to understand even when you are working in the area”.

That is a nice way of saying “a complete shambles”.

The then Minister for Health and Secondary Care, Will Quince MP, stated:

“It is certainly complicated. That is an understatement”.


That is, again, a nice euphemism for “a complete shambles”. As the noble Baroness said, the NHS has not a clue how much it costs. The National Clinical Homecare Association told us that the Treasury spends £4.1 billion per annum on homecare medicines, but the NHS told us it is only £3.2 billion. We asked the Minister—he said it was £2.9 billion. As we say, it is utterly shocking that no one in the NHS can give us an accurate figure for the billions spent on home deliveries, but then the NHS does not have a clue about how bad it is and how many patients have suffered. KPIs are a mess, as the noble Baroness explained.

We said in our report:

“Different sets of performance data are available to manufacturers and the NHS. This creates confusion and prevents effective monitoring … NHS England must develop and implement one consistent set of performance metrics”.


Performance data must be published.

The National Clinical Homecare Association told us that

“98.8% of deliveries were delivered on the day they were intended to be delivered on”.

That is a very clever form of words but quite misleading. Yes, 98.8% were delivered on the dates that the delivery company decided they were to be delivered on, but those were not the dates the doctors prescribed, which were always much earlier and before the medication for patients ran out. Part of these failures are delays in the NHS prescribing system and delays by the delivery company.

Chapter after chapter of our report highlights the failings of the system. Thus we say:

“No one—not the Government, not NHS England, not patient groups, not regulators—knows how often, nor how seriously patients suffer harm from service failures in homecare”.


Let no one misconstrue our conclusions as an attack on the private provision in the NHS. While we found myriad flaws in the provision at all levels, God help us if the NHS tried to run a courier delivery service, since that would be infinitely worse. Delivering medicines at home by couriers is eminently sensible but has to be better managed at all levels. The problems that we identified all relate to the fact that there is not one single person or NHS body in charge. Different people and organisations negotiate different contracts. There is no quality control or negotiating competence, there are no consistent KPIs to measure performance and the various regulators are all fairly useless. It seems there is no one with the power to sanction failure or cancel contracts. Worst of all, I got the feeling that the NHS rather likes it this way because when things go wrong there is no one individual or organisation to blame. They can all carry on presiding over a shambles but carry no personal responsibility for it.

I get exceptionally good medical care from the National Hospital for Neurology in Queen Square, the Royal Marsden and the Lakes Medical Practice up in Penrith, but if you want to see the general bureaucratic incompetence of the NHS and why it is failing so badly in so many areas, the bureaucratic shambles that we are reporting on here is a perfect microcosm example.

However, in the report we did not just criticise but offered solutions. Theoretically, there is a Minister in charge, but he or she has no say in the running of the system, which is delegated to the NHS. The Minister should be charge and have a very senior person reporting to them. We say:

“NHS England should designate a senior, named person with responsibility for the homecare system. That person should be given sufficient powers and resources to discharge that responsibility”.


That person’s responsibilities should include:

“Setting clear national KPIs for organisations commissioning and providing homecare medicines services … Collecting data on those KPIs, and publishing data on those KPIs in a way which supports public scrutiny of the homecare medicines system … Holding relevant bodies such as individual providers, Chief Pharmacists, the National Medical Homecare Committee and pharmacy teams to account for work on homecare medicines services … Responsibly using new powers to issue appropriate penalties to under-performing providers”.


That is essential; there must be sanctions.

The fifth recommendation is:

“Ensuring trusts or hubs procuring homecare medicines services have access to sufficient financial and expert procurement advice and information, including template legal agreement frameworks, so they are able to effectively deliver value for money services and influence the homecare medicines services market”.


As in every government department I have served in and witnessed over 40 years in Parliament, the lawyers employed by the outside commercial contractors are infinitely better than government lawyers trying to negotiate contracts; they outwit and outmanoeuvre us every time.

Finally, we said that:

“Achieving value for money and increasing transparency on homecare funding”


should be another part of their individual duties.

As the noble Baroness said, the government response accepted about 90% of what we say—that is jolly good. On that basis, let us have urgent action to implement those proposals and the remaining 10% as well.

[Lord Evans of Rainow (Con)]

My Lords, I remind the House that there is an advisory speaking time of nine minutes.

Health and Care Bill

Lord Blencathra Excerpts

Consideration of Commons amendments
Tuesday 26th April 2022 Lords Chamber

[Lord Blencathra (Con)]

My Lords, I support Amendment 48C in lieu, and what an extraordinary amendment it is. The Government have accepted, for the first time, that they must make—and will make—regulations

“eradicating slavery and human trafficking in supply chains”.

This is an extraordinary turnaround, and I congratulate my noble friend the Minister and the Secretary of State, Sajid Javid, on it.

However, the real hero here is the noble Lord, Lord Alton of Liverpool. In every relevant—or even vaguely relevant—Bill we have considered in this Parliament, he has sought to pass an amendment or new clause tackling genocide or slavery in Xinjiang province. Every time, his amendments have been rejected on the absurd notion that only an international court can decide on genocide. He has articulated again and again the terrible abuses of the Uighurs in China: forced labour camps, sterilisation of women—that is slow-motion genocide—systematic rape, murder and torture. He has called for us not to trade with any company making anything which emanated from such slave labour, either in China or anywhere else in the world. His persistence has paid off and, aided by my right honourable friend Iain Duncan Smith in another place, the Government have now produced this amendment in lieu.

At this moment we have no idea what a change this will bring about. It may seem a small start now but I care to bet that in, say, 20 years’ time, historians will point to this amendment and the campaign of the noble Lord, Lord Alton, and say that it has changed world history. I will press my noble friend the Minister on the timescale here. I hope we will have the regulations on the statute book within about 12 months and will not have to engage in the formerly proposed and rather convoluted 18-month consultation system with everyone under the sun around the world. Indeed, the Secretary of State announced last week that he was banning CCTV cameras from Hikvision, a company with close ties to the Chinese Communist Party. I assume he did that without extensive consultation.

My noble friend the Minister probably cannot answer this, but I hope that the promised procurement Bill will have equally strong provisions. Indeed, it will not get through this House unless it mirrors what the Secretary of State has done here. There can be no back- sliding now.

In conclusion, and in addition to once again congratulating my noble friend Lord Alton, I wish to praise my right honourable friend Secretary of State Javid, who—if I may say so without being patronising—is turning out to be rather good. I tried amendments on single-sex provision in NHS hospitals and the Secretary of State has now urged NHS trusts to do it. I say to him, “Don’t urge them, Secretary of State—make them do it. You must re-write Annexe B and protect women.”

He has also rightly demanded a review of the consequences of children having their sex changed on the basis of inadequate evidence. As he points out, the zealots in the militant trans lobby who are marching children through the sex-change machine could be committing child abuse. That is the real conversion therapy that needs to be banned. It looks like we may have someone sensible in charge of the DHSC. The Motion moved by my noble friend tonight proves that and I commend it once again.