Foetal Alcohol Spectrum Disorder

Lord Evans of Rainow Excerpts

Thursday 25th June 2026 Lords Chamber

[Baroness Merron (Lab)]

My noble friend is quite right about the potentially lasting effects of foetal alcohol spectrum disorder on children, which is why the main priority is preventing it. There are three approaches. First, the clear advice—the safest approach, if you are pregnant or could become pregnant—is not to drink alcohol, and that will remain consistent. I have just referred to the legal requirement for alcohol labels. We will of course continue to look at how prevention messaging can best reach people pre conception. The obvious point here is that so many pregnancies are not planned, so there is no neat solution to getting to the right people. We have to get our messaging right, which is why we are taking the approach we are.

[Lord Evans of Rainow (Con)]

My Lords, the Department of Health and Social Care’s own health needs assessment noted that there are still no reliable prevalence studies for foetal alcohol spectrum disorder in England, despite estimates suggesting that the UK may have one of the highest rates in Europe. How can the Government effectively reduce the prevalence of foetal alcohol spectrum disorder when they still do not know with confidence how many children and adults are living with the condition? What steps have the Government taken to improve diagnosis and data collection?

[Baroness Merron (Lab)]

The noble Lord is quite right that we are working on estimates, and there are a number of practical reasons for that. To come to the noble Lord’s real point, the first National Institute for Health and Care Research challenge funding call was launched in 2024, backed by £50 million. That tasked researchers and policymakers with finding new ways to tackle maternity disparities and poor pregnancy outcomes, and clearly that will support further research and policy. So we are looking to the future and I take on that challenge; it is one that we are meeting.

Healthcare Services: Acute, Primary and Community

Lord Evans of Rainow Excerpts

Thursday 25th June 2026 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, I thank the noble Baroness, Lady Janke, for securing this important debate. There is broad agreement across the House on one central point: if we are to build an NHS that is sustainable for the future, we cannot rely solely on treating people once they arrive at hospital. We need strong primary care and early intervention that prevents illness escalating in the first instance.

That principle is not new. Successive Governments, including the Conservatives, have spoken about shifting care closer to home. The current Government have made it one of the central pillars of their health strategy through the proposed neighbourhood health service and the commitment to move from hospital- to community-based care. The question, however, is not whether we support that ambition, but whether the Government are delivering it.

The figures set out in the House of Commons Library briefing are striking. Between 2015-16 and 2023-24, spending on acute services increased by £14.3 billion, while primary medical care increased by only £1.7 billion and community services by £3.1 billion. Those figures illustrate the scale of the challenge in rebalancing the system; they also demonstrate why simply announcing a shift is not enough. Resources must genuinely follow patients into community settings if the policy is to succeed.

These Benches welcome the Government’s stated commitment to shift care out of hospitals into communities. We also recognise the potential benefits of neighbourhood health centres in bringing diagnostics, rehabilitation, mental health services and primary care together and closer to where people live.

However, there are legitimate questions to be asked about pace and delivery. Before the election, Ministers spoke about increasing the proportion of NHS funding allocated to primary and community care by 2029. That objective has now been pushed further back to 2035. For many patients and practitioners, that will feel like a significant delay.

These Benches also have concerns about whether primary care is being given the tools it needs to succeed. The Opposition have consistently raised concerns regarding changes to the GP funding formula and the expectations placed on GPs through the advice and guidance system. Community care cannot become simply a mechanism for managing demand that would previously have gone elsewhere in the system. If primary care is expected to do more, it must be properly resourced to do so.

I turn briefly to mental health, where the relationship between acute and community services is particularly important. Community support and accessible treatment can prevent deterioration early and reduce hospital admissions. It is therefore concerning that the share of NHS spending devoted to mental health has fallen in each of the last three years—from 9% in 2023-24 to a projected 8.4% in 2026-27. At the same time, local systems are no longer required to increase mental health spending in line with overall NHS spending. These developments appear difficult to reconcile with the principle of parity between mental and physical health.

In closing, I therefore have four questions for the Minister. What specific milestones will the Government use to demonstrate that the promised shift from hospital to community care is taking place? What assessment has been made of the impact that recent GP contract changes will have on primary care capacity? How do the Government intend to ensure that mental health services do not lose out as NHS resources are distributed across the system? In the case of eye care, there is already a workforce and infrastructure in the community to treat patients effectively, yet access depends on where you live, which pushes avoidable demand into hospitals. What steps are the Government taking to ensure equitable access across England?

Strong hospitals will always be essential, but an NHS fit for the future also requires strong community services and effective early intervention. The challenge for the Government is not setting out that vision but delivering on it. I look forward to the Minister’s response.

Resistant Hypertension

Lord Evans of Rainow Excerpts

Wednesday 24th June 2026 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord makes a helpful point. Indeed, the modern service framework will soon be published. Of course, as blood pressure is one of the seven risk factors for cardiovascular disease, as the noble Lord referred to, we have to improve detection and management. That is what the modern service framework will drive forward, particularly in local areas. Yes, it will make reference not just to hypertension, which is more widely applicable, but to resistant hypertension, as he suggested.

[Lord Evans of Rainow (Con)]

My Lords, NICE has recognised renal denervation as a potential treatment option for resistant hypertension, yet its use remains limited and subject to special arrangements for governance and research. What assessment have the Government made of the extent to which eligible patients are able to access renal denervation across England? Are Ministers concerned about the emergence of a postcode lottery in access to the treatment?

[Baroness Merron (Lab)]

Looking to the future, obviously, one can only act on clinical guidance. Renal denervation, as I mentioned to my noble friend, is an emerging option for carefully selected patients at the moment, as the noble Lord said. What matters now is that evidence is emerging, and that is why it is being reassessed. We will not have to wait too long to see what the future will bring in this regard, but it certainly has a role to play.

Severe Myalgic Encephalomyelitis

Lord Evans of Rainow Excerpts

Thursday 18th June 2026 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, I thank the noble Baroness, Lady Scott, for securing this important debate. I join others in paying tribute to the patients, families, clinicians, researchers and charities who have worked tirelessly to improve understanding of myalgic encephalomyelitis. For too long, people living with this condition have faced scepticism and inadequate support.

While significant challenges remain, it is right to acknowledge that progress has been made. There is now a much greater recognition that ME is a serious and often profoundly debilitating condition requiring appropriate clinical care and support. We on these Benches welcome the publication of the ME delivery plan in 2025. Many of the origins of that work lie in the commitments made by the previous Conservative Government in 2022 to develop a cross-government approach to ME. It is encouraging that the plan contains a broad range of actions across health services and educational research. We also welcome reports that a substantial number of those actions are complete or in progress.

However, publication of a plan is only the beginning. What matters to patients is whether they experience tangible improvements in their daily lives. The plan contains 44 actions, but patients and charities have raised understandable concerns about how delivery will be monitored in practice, who will ultimately be accountable for implementation, and how responsibilities will be managed as NHS England functions transfer into the Department of Health and Social Care. I therefore hope the Minister can tell the House today when the promised progress report will be published and who will be responsible for ensuring delivery across government and the NHS.

Nowhere are these questions more urgent than for those living with severe and very severe ME. These are often the patients with the greatest needs and the least ability to advocate for themselves. It is therefore concerning that the only delayed action within the delivery plan relates to consideration of specialised services for this group, with the decision now not expected until April 2027. The evidence presented by charities and campaigners illustrates why this matters. Preliminary findings from Action for ME’s recent survey suggest that many people with severe and very severe ME are unable to access existing specialist services because they are simply too unwell to attend them. Large numbers report receiving little or no ongoing support from either specialist services or primary care, while many face serious challenges in meeting basic needs, including nutrition. This matters not only because of the immediate impact on the patient’s quality of life but because early intervention and appropriate support can prevent longer-term deterioration.

If people have access to advice, treatment, system management and practical support at an earlier stage, there is a greater chance of helping them maintain their independence and remain connected to education or employment where appropriate. Delays in accessing support can leave people becoming progressively more unwell, making recovery and participation in everyday life considerably harder. That is why timely and effective services are so important, not only for those who are already severely affected but for those at risk of reaching that point.

It is also important to recognise that ME disproportionately affects women. Evidence consistently suggests that women are significantly more likely to be diagnosed with ME than men. Can the Minister therefore say what assessment the Government have made of the reasons behind this disparity and whether the needs of women living with ME are being specifically considered as the delivery plan is implemented?

Recent prevention of future deaths reports have also highlighted serious concerns regarding the care available to some of the most severely affected patients. The Government have stated that integrated care boards remain responsible for commissioning appropriate services in the meantime. Can the Minister therefore explain what assessment has been made of the current provision for severe and very severe ME, whether significant variation exists across the country, and what interim support will be available before any decision on a nationally commissioned service is reached in 2027?

We must also not lose sight of the critical importance of research. We welcome the support provided for the DecodeME survey. Its early findings identify potential genetic links involving the immune and nervous systems, representing an encouraging step forward in understanding the biological mechanisms underlying this condition. Yet ME remains significantly under-researched relative to its prevalence and impact. The Government have rightly spoken about the UK’s ambition to lead in life sciences and post-infectious disease research. There is a strong case for ensuring that ME forms part of that agenda, including through support for research into diagnostics, biomarkers, treatments and clinical trials.

In closing, I ask the Minister three questions. When will the Government publish their next formal update on the delivery of the ME plan? What interim support will be provided for people with severe and very severe ME before April 2027? Can she assure the House that the decision on specialised services will not be subject to further delay? Those living with ME have waited a long time to be heard. They deserve not only recognition and promises, but delivery.

Cancer Outcomes in the UK

Lord Evans of Rainow Excerpts

Tuesday 21st April 2026 Grand Committee

[Lord Evans of Rainow (Con)]

My Lords, I thank the noble Lord, Lord Patel, for securing this important debate. When I was a Minister, the noble Lord used to stand up and ask me extremely searching questions—well, they were searching questions to me—to which I did not always know the answer. Come to think of it, there are a couple of noble Lords in the House who used to do something similar: the noble Lord, Lord Sikka, and the noble Baroness, Lady Finlay. I used to go back to the department and ask for answers to these legitimate searching questions, but sometimes the answer was not forthcoming. So I used to press and stretch the civil servants to come back, because I had to come back and report to the noble Lord, Lord Patel.

But I started thinking for myself and looking into some of this, and the answer came down to technology. The noble Lord, Lord Drayson, has really made my speech—one of the problems with speaking at the end is that everything has been said. He is right that, two or three years ago, artificial intelligence was just starting to make an impact in certain industries. He made a very powerful point.

Time is short and I have a few things to say. I am speaking as a former Minister who looked into this matter and as a Member of Parliament to whom constituents used to come, pleading for treatment or to get assessment and diagnosis. Not knowing is a problem if you have a lump but you do not know what it is. They used to come to MPs’ surgeries, not just mine, to see if they could cut through the red tape to try to get an answer from the local NHS trust. I used to do my best to help, but it happened frequently.

As I say, I am a family man and have had two experiences of cancer. The first was my late sister, who died of pancreatic cancer. I was listening attentively to the comments of the noble Baroness, Lady Warwick, who mentioned a spray that can detect pancreatic cancer. That was not available until relatively recently. Pancreatic cancer is a terrible disease.

The second was my late mother, who lived to quite a good age. Ovarian cancer is not always easy to detect. I was surprised as a carer that it took a while for the GP to make a referral and, once you got the referral, to secure a scan and get communication from the hospital to the patient—that is, my mother, who had dementia. In a way, she could not understand that; they should talk to the carer. I thought it was old-fashioned to write a letter to someone who could not read it rather than dealing with them directly, perhaps using artificial intelligence, via the NHS app to speed things along.

My contribution to this is that early and timely diagnosis is important to ensure that the right treatment can be given at the right time to get the best possible outcomes, especially for children and young people, whose cancers are often more aggressive and faster growing and require specialist treatment. Despite this, young cancer patients regularly report needing multiple visits to doctors before a cancer diagnosis is given. Data shows that the median time for under-18s to be diagnosed after first symptoms is 4.16 weeks; it takes longer than this for half of them. Teenagers from 15 to 18 years of age have the longest time to diagnosis—a median of 8.7 weeks. Some 60% are diagnosed as an emergency. On average, 14 different healthcare professionals are consulted.

This is further reflected in the NHS cancer patient experience surveys, which show that more than two in five children and young people, 42%, see their GPs three or four times after their cancer symptoms before being told to go to hospital. This compares to the majority of adults, 62%, seeing their GP just once. Not only does this prolong receiving a diagnosis but it can impact trust and relationships with healthcare professionals throughout treatment and after. This experience can be worse for minoritised groups. Data on time to diagnosis is not routinely monitored for children and young people nationally, despite those issues. It is crucial that a diagnostic interval measure is introduced for young cancer patients, as was committed to in the national care plan, to consistently track and improve time to diagnosis.

I have a question for another special person, the Minister, whom we are very lucky to have in your Lordships’ House—she does a fantastic job as Minister. The noble Lord, Lord Stevens, talked about sweating NHS assets, but I am not asking about that. The noble Lord, Lord Patel, and others referred to the Danish model. Denmark has a population of 6 million. In London the figure is 10 million, in Manchester it is 3 million and England as a whole it is 60 million. The noble Lord, Lord Drayson, made a point about artificial intelligence—he talked about economic growth, wealth creation, NHS trusts not talking to one another and scaling up our own domestic industry—and he is exactly right.

My question is not original but is about a pilot scheme to implement artificial intelligence, in order to establish best practice and set international standards of early diagnosis for all cancers but particularly those of low survivability. There are 36 integrated care boards—there were 42 in my day, but I understand that they have been condensed. Not all are the same: we have different populations, rural areas, seaside communities, post-industrial towns and metropolitan areas. We should appoint the best and the brightest from the NHS or industry to implement artificial intelligence throughout the NHS.

What does success look like and how do you measure it? I respectfully say that the best survival rates in the G7 would be a good starter, but artificial intelligence is an opportunity for the NHS to modernise its back-office administrative processes. As noble Lords have pointed out throughout this debate, there is so much good research out there that AI has to have an impact. That is not about sweating the assets but about improving the current workforce, certainly in the back office, so that they can at least communicate with those hard-to-reach populations and communities in the country.

That is my question to the Minister: can we have a pilot scheme of hand-picked individuals and integrated care boards in select areas of the country, to see whether we can introduce this to the NHS to make a difference and the world-beating healthcare system that we all want?

Terminally Ill Adults (End of Life) Bill

Lord Evans of Rainow Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

This Bill poses a very real and present danger for people with lifelong congenital conditions. This amendment is crucial to mitigating that threat. I close with this appeal to the noble and learned Lord, Lord Falconer. Please will he accept this amendment? Will he confirm that he agrees with me that our consideration of this crucial amendment should neither be regarded nor represented as filibustering?

[Lord Evans of Rainow (Con)]

My Lords, the noble Lord, Lord Shamash, mentioned a very moving story from his family regarding Duchenne muscular dystrophy, and I have a similar story but from a slightly different angle. My cousin Stephen was diagnosed with Duchenne muscular dystrophy in the 1960s, when this was a terminal illness without any real idea of a prognosis other than that those with it would die as very young people.

My family were determined to try to make Stephen’s life as comfortable and as long as possible. They campaigned with their local MP, who just so happened to be Alf Morris, Baron Morris of Manchester—an outstanding Member of Parliament, and of service to this House. They worked with him to come up with the Chronically Sick and Disabled Persons Act 1970. They went on to develop therapies for Duchenne muscular dystrophy, including making wheelchair provision compulsory on the NHS. My cousin lived five years longer than the average for Duchenne muscular dystrophy patients. The point I am making to the Committee is that if the assisted dying Bill had been used to that extent, and if we had given up when he was a very young man, that never would have happened.

Stephen had a full life, in so far as he could; he lived till he was 21 years of age, when the average was 14 or 15. It goes to show that, if you give up at a very early stage, you will not know how far you can push this disease. In the 21st century, through medication, Duchenne muscular dystrophy sufferers have an extended lifespan. In offering assisted dying to people with chronic diseases, we do not know the miracles of science and medication that can extend these people’s lives.

[Lord Blencathra (Con)]

My Lords, I am another Peer who sat here for many hours last Friday, desperately keen to speak to this group of amendments. Towards the end, at nearly 5.30 pm, I heard the magnificent speech of the noble Lord, Lord Rook, who is not currently in his place. It really was an incredible speech. I suppose the only benefit of being a sort of carry-over, tail-end Charlie was that I was able to read his speech in Hansard once again. I commend it as superb. I concluded that there was nothing I could usefully add to what the noble Lord had said, so I have decided not to try to add anything more to it, and I conclude my remarks.

Terminally Ill Adults (End of Life) Bill

Lord Evans of Rainow Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

I therefore have to say that I am very unhappy about the proposals in the Bill. I have put my name to some of these amendments and support the comments made by the noble Baroness, Lady Coffey.

[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.

--- Later in debate ---

[Baroness Pidgeon (LD)]

My Lords, it is essential that, as we debate this group of amendments, we keep in mind the fact that the systems that we are creating are for people in the last six months of their lives. We must balance the demands that we place on them at this very vulnerable time with what really matters to them during that time. We should stop talking about microprocess and start really thinking about the individual. In her evidence to the House of Lords inquiry in November, Dr Jessica Young said that

“a system that is too onerous creates stress among the people it aims to serve”.

We must not create a system that is too complex and too protracted for someone who is at the end of their life to deal with.

We have made incredible progress in recent years on facilitating video consultations. That came on hugely in the pandemic. Are we not in danger of taking a retrograde step with these amendments? I fear in particular that we in this House must be careful about standing in the way of technological process. Reading some of these amendments, I wonder whether people might want to add in that we write with feather quills and ink, because it seems that that is what this is really about.

Amendment 65 would mandate a whole range of steps beyond clinical assessments to be undertaken face to face. It also seems to disapply the flexibility provided in the Bill with regards to the person meeting the panel. Is it the intention of this amendment that a person who cannot travel to appointments, whether physically or because of the risk of infection, must be denied a choice over how they die? These amendments will affect hugely those who live in rural areas and far from their GP, let alone a hospital with a relevant specialist. They will affect those whose immune systems have been compromised as a result of extensive chemotherapy and those whose mobility is affected by their terminal illness and who find it impossible to travel. Are we not at risk of denying access to these people when such challenges are not unusual, given the nature of what they are experiencing with their terminal illness? Is it the intention that someone who is, for practical medical reasons, unable to meet the independent advocate or the panel, but is able and willing to do so via video link, will immediately be ineligible even if they fulfil all the other criteria? It is difficult to see a basis on which that can be justified.

[Lord Evans of Rainow (Con)]

Will the noble Baroness give way?

[Baroness Pidgeon (LD)]

I am coming to the end of my speech; I do not think I have to take an intervention, so I would like to finish my point.

It seems to me that this is about making the choice of an assisted death difficult or impossible. We need to think carefully about the checks that we are putting in place for people in the last six months of their lives. We need to make sure that the system really will work for them.

Supply of Blood and Blood Products

Lord Evans of Rainow Excerpts

Wednesday 3rd December 2025 Lords Chamber

[Baroness Merron (Lab)]

I certainly echo the noble Baroness’s comments. It is thanks to the generosity of donors—including the noble Baroness herself, who is I know is approaching her 50th donation—that overall blood stocks are at target levels, but she is right about the extra pressures coming through because of winter. The launch of the national campaign to highlight the constant need for blood in this season and to recruit new donors was set under way last month. We also have targeted media campaigns; for example, in areas of the country with larger black heritage communities to highlight the urgent need for more donors from that group.

[Lord Evans of Rainow (Con)]

My Lords, I confess to 120 donations and thank the Minister for all the work that she is doing on this, particularly for tomorrow’s session, but she is absolutely right that only a tiny proportion of the population are blood donors. Talking personally, it is not always straightforward for working people to get those appointments. The noble Baroness is right that we are very short on black and ethnic-minority donors. With that thought in mind, would it be possible to look at artificial intelligence to make it easier for working people, particularly from ethnic minorities, to make those appointments during the working day?

[Baroness Merron (Lab)]

The noble Lord is also to be congratulated, of course. As he said, despite our having some 790,000 regular donors, only 2% of the population gives blood, so we are not full up and we look forward to more donors. To the point that the noble Lord raises, which is important, we are increasing capacity for appointments to donate, but we are also looking at additional digital and logistical improvements, including in how people can book appointments. We are also piloting a new appointment reminder and better communications. There is room for improvement, and we are taking those steps. The noble Lord makes very good points in this regard.

Terminally Ill Adults (End of Life) Bill

Lord Evans of Rainow Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

I encourage the noble and learned Lord to say early in this debate—we have done it for nearly an hour already—that he is prepared to sit down after this Committee stage with others with the intention, the purpose, of adding the appropriate words to this Bill with the assistance that he has been lucky enough to have. We have had wonderful assistance from the Public Bill Office. He has had much more assistance from even more official channels. We can sit down, we can find the words, we can try to agree on them, and I hope that noble colleagues in this Committee would undertake to act in good faith to try to find those words and to ensure that on Report they were included. Let us not have another three-hour debate in which we feel as though the pin on which we are dancing is melting underneath us.

[Lord Evans of Rainow (Con)]

My Lords, I rise to speak to Amendment 50 in my name and that of my noble friend Lord Goodman. It is a pleasure to follow the noble Lord, Lord Carlile. I would not describe him as a nasty lawyer at all. The noble Lord is a Burnley fan. I do not know any nasty Burnley fans, but I do know a lot of Arsenal fans. There is one thing I would say about some phraseology the noble Lord used early in his speech. He used the words “final solution”. I encourage the noble Lord to think of other phraseology to describe that.

I agree with a lot of what the noble Lord, Lord Carlile, said. I am grateful to my noble friend Lord Deben for following the noble Lord, Lord Pannick, because I, too, am not a lawyer, but like my noble friend, as a former Member of Parliament, I experienced lots of constituents who were under coercive control. Lots of MPs do surgeries for their communities and take on these cases. Not being a lawyer, as a layperson trying to fathom out coercive behaviour is notoriously difficult, and that is why I have come up with Amendment 50.

The existing language limits the coercion pressure bar to cases where it causes the person to make a decision, which creates evidential difficulties. This amendment excludes all cases of coercion and pressure without requiring finding out whether in fact it causes the person to make the decision to end their life. It is easier to see whether someone is being coerced or pressured than to know whether the coercion or pressure is the operable cause that leads a person into making the decision. A doctor should exclude all cases where a person is being coerced or pressured to make a declaration rather than engage in causation analysis. Similarly, offences ought to be focused on the wrongful act of coercing or pressurising regardless of the outcome.

At trial, the Crown, with plenty of resources, would have trouble proving that the coercion or pressure resulted in someone making the decision. How is a doctor on their own supposed to find out? Asking a patient is no help given that the frail or vulnerable person may not even know that they are pressurised or may have been intimidated by coercion. Doctors can see pressure from, say, the person accompanying the patient but cannot read the patient’s mind. This amendment would stop doctors being required to be detectives.

The closest analogy in existing law to this rule against coercion or pressure to do a potentially fatal action is Section 2 of the Suicide Act 1961, “Criminal liability for complicity in another’s suicide”. It does not require any attempt at suicide or even a decision to commit suicide and provides that

“D may commit an offence under this section whether or not a suicide, or an attempt at suicide, occurs”.

Section 184 of the Online Safety Act 2023 titled, “Offence of encouraging or assisting serious self-harm”, provides in subsection (5) that

“D may commit an offence under this section whether or not serious self-harm occurs”.

Compare also Section 65 of the Serious Crime Act 2007, which refers to pressurising someone to commit an offence and does not require the outcome be causative.

In recent years, the Crown Prosecution Service has pursued manslaughter charges against men who subject women to domestic abuse that is believed to have driven their suicide. These are criminal offences where there is a much higher bar to action, given that a person’s liberty is at stake. However, Clause 1 is addressing when civil authorities and doctors should draw the line at a patient’s autonomy. Why does the Bill have a higher standard? There is no statutory precedent for “pressured into making it”. The Government have claimed that the Online Safety Act 2023 and the Serious Crime Act 2007 are analogous, but the distinction is making the pressure all that is needed for an offence. Meanwhile the threshold for excluding a person in Clause 1 requires more than is necessary for a criminal offence under these Acts.

Without this amendment it would be lawful to progress a person towards an assisted death even though the person is living in a household where family members are actively making it difficult to live. All that is needed is to see that the person is not pressured or coerced into making the decision. The leading cause of death in domestic abuse victims is now suicide. We work to stop this, but this Bill is opening a door to help perpetrators. It is estimated that three women a week take their own lives. The Government view addressing this as a priority, and the CPS will now prosecute for manslaughter men whose abuse is seen to have contributed to the suicide of a woman. Those men have not had directly to coerce their partners into death, the facts of the abuse are sufficient pressure, but with assisted deaths there will be no coroner’s inquest to address foul play.

The UK leads the world in now recognising coercive control in law, but a regime of total control is poorly understood and insidious. As Cherryl Henry-Leach of Standing Together Against Domestic Abuse told the Lords Committee:

“Coercion is an incredibly complex phenomenon and by its very nature it is difficult to identify and respond to. A perpetrator of coercion will ensure that a person is dependent on them by isolating them from support, exploiting them and depriving them of their independence and autonomy to make decisions freely. As a result of this, we are extremely concerned ... When I think about pressure, I also am mindful of a pattern of coercive control that can be insidious and subversive. Pressure can be a tactic by a perpetrator to enforce a regime of coercive control. That is very complex and I get that, but it is important to be mindful that pressure can be a tool that indicates a pattern of coercive control”.


Studied neglect and coercion are naturally notoriously difficult to detect, and as it stands now, this Bill is a suicide charter. My amendment is intended to improve the Bill.

[Baroness Hollins (CB)]

My Lords, I have amendments in this group, and I have added my name to other amendments. I start by adding my support to Amendment 460, tabled by my noble friend Lady Finlay. Safeguarding measures are not optional; they are essential. To ensure that each individual requesting assisted dying is properly safeguarded, it is essential that all relevant information is gathered so that a full and thorough picture of their circumstances can be formed. We know that poor mental health, inadequate care support or unaddressed social vulnerabilities can profoundly affect a person’s decision-making and ultimately their capacity and understanding of an assisted death. When safeguarding is insufficient or overlooked, the risks of coercion, subtle pressure or abuse increase, and these are risks that may be difficult to detect or are deliberately concealed. This amendment seeks to ensure that such dangers are neither under-estimated nor ignored.

Dementia and Alzheimer’s Treatments

Lord Evans of Rainow Excerpts

Thursday 1st May 2025 Lords Chamber

Asked by

[Lord Evans of Rainow]

To ask His Majesty’s Government what steps they are taking to advance the development of dementia and Alzheimer’s treatments.

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

My Lords, the Government are committed to advancing the development of dementia treatments having invested £496.4 million over the past five years through the National Institute for Health and Care Research and UK Research and Innovation. Additionally, the Dame Barbara Windsor Dementia Goals programme, with up to £150 million of associated funding, aims to speed up the development of new treatments for dementia by accelerating innovation in biomarkers, clinical trials and implementation.

[Lord Evans of Rainow (Con)]

I thank the Minister for that helpful response. Finding a cure for dementia is the challenge of our time. Some drugs now available delay the onset of dementia. They are available privately, but not on the NHS. The NHS says that the assumed costs of administering the drugs are too high. Can the Minister look into this matter to see whether she can clear any barriers to making the new drug lecanemab accessible to everybody on the NHS?

[Baroness Merron (Lab)]

I understand the point the noble Lord is making; I was glad to have the chance of a discussion with him yesterday. I also thank him for his campaigning on such an important matter. I share his view about the need to ensure speed and efficacy. To that point, I say to him that since March this year, as part of the regulation action plan, NICE and the MHRA have been building on the systems we already have in place to make sure that there is rapid access. To prepare for a new generation of dementia treatments, NHS England is working closely with regulators to ensure that arrangements are in place to support the adoption of any new licensed and NICE-recommended treatments as soon as possible. As the noble Lord will understand, it is important that we have the right treatments that do the job and are available. On some of the more recent ones, I understand the disappointment, but the fact is that no disease-modifying treatments are currently available. However, science is developing, and I am sure we will discuss this further.