Terminally Ill Adults (End of Life) Bill

Lord Hamilton of Epsom Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Baroness Berger (Lab)]

My Lords, very briefly, I support the amendment that is calling for face-to-face consultations to take place, rather than only in exceptional cases. I want to reflect on why this matters. We know from other jurisdictions that many of these assessments are being done online. It is a really important question for us to consider whether we would want that in our country—and if not, it should be in the Bill. In addition, my comments are informed by the evidence that we were presented with in the Select Committee and drawn from my experience of meeting a number of elderly constituents over the course of nearly a decade as a Member of Parliament.

I reflect particularly on the women I met in their 70s, 80s and 90s who shared their experiences of domestic abuse. This conversation and these amendments matter because this legislation does not happen in a vacuum. The Labour Government today are rightly concerned with addressing the public health emergency of violence against women and girls in our country and has an important landmark mission and goal of halving violence against women and girls over the next decades. The NHS is playing its part and enhancing its efforts in tackling and violence against women and girls, focusing particularly on early identification. There is a lot of other very important work going on via training and investment, and I commend the work of many colleagues who are dealing with this on a daily basis. It was the experts that told us that to identify coercion, undue influence and pressure, doctors and other professionals need to look at someone’s body language. It is not just the words we say, how we say them, the volume or the tone—it is our non-verbal cues and what our body says. It is what we do not say that often shares an important message.

I listened very carefully to the counterchallenge of noble Lords so far. I do not think there is anything to stop the Bill from stipulating that, in exceptional circumstances, the doctors, or the independent advocates or panel members can visit an individual. But I would much rather that we had legislation that supports the Government’s important aim to reduce violence against women and girls, rather than something that will exacerbate the very serious problem that we know that too many women in our country face, particularly at their most vulnerable moments, which includes the end of life.

[Lord Hamilton of Epsom (Con)]

Can the noble Baroness recall that last week she told the House that 23% of six-months-to-live diagnoses turned out to be wrong and that people lived longer? Does that not make the whole position of face-to-face diagnosis much more important when doctors so often get it wrong?

[Baroness Grey-Thompson (CB)]

My Lords, technology has gone a long way to helping disabled people to lead inclusive and integrated lives in British society, and I generally support the use of it. But for many of us who worked on the coronavirus legislation, where we had to make very quick decisions, the speed with which we went online made it seem as if, as a society, we had moved decades forward from having to meet only in person. Even your Lordships’ Chamber managed to meet and vote online. But that comes with a set of challenges.

We have to look at what happened during Covid and the huge increase in domestic abuse. It was not just because we did not have to ask people to turn their cameras on. It was deemed that would be upsetting, so we could not see if somebody had been domestically abused. The impact of increasing domestic abuse was also because there was more recording. Even when you look at the technology that we have in your Lordships’ Chamber, it is not foolproof. I was on a call yesterday in my office. The system crashed twice, and the people I was speaking to on Teams did not even realise and carried on talking. We have to think very carefully about how we would use technology.

Age UK said that about 2.4 million older people do not have access to technology in this country and just under 2 million do not have a mobile phone, let alone a smartphone, so if we are going to do this, we need to think carefully about what other provisions will be in place. I agree with the noble Baroness, Lady Berger; why can the panel not go and visit the individual? I think there is something about being in their own home. The noble Baroness, Lady Pidgeon, raised rural areas. What if people do not have the technology? What will be put in place to ensure that there is a suitable online option?

--- Later in debate ---

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the Government’s 10-year health plan for England seeks to

“make the NHS the most AI-enabled health system in the world”.

Like others, I think that is an incredibly exciting prospect. I do not want it to be dystopian. I think that the right reverend Prelate the Bishop of Hereford makes an important point in warning us against going completely over the top. I think it is important that this amendment has been tabled, because it makes us think about what the possible problems are, which have been well expressed by others. Despite my excitement about what AI might do, even in terms of treatments—there are wonderful possibilities in terms of helping people to walk, what is happening with the brain, and so on—we do not want to be naive.

The question for the noble and learned Lord, Lord Falconer, is: as the NHS digitises and doctors become increasingly reliant on AI for notes and diagnostics, given that the diagnosis is so important in a life-or-death situation in this instance, how can we ensure that a time-poor doctor does not use AI as an assessment tool or a shortcut? We would be naive to imagine that that does not happen elsewhere; we would only have to think of politics. People now use AI to avoid doing research, in a wide range of instances, and I do not want that to be translated over.

As for the patients, algorithms are supremely impressive and can take things that have happened on Facebook or TikTok, from when you have been on a Teams meeting or Zoom—all sorts of indications—and detect chronic illness conversations. The algorithms can then push pro-assisted dying content such as the Switzerland adverts or positive end-of-life options. Interestingly, when discussing banning social media for under-16s, which I completely disapprove of, or bringing in the Online Safety Act, which I argued against, everybody kept saying, “Algorithms, oh my goodness, they can do all these things”. We should consider not that chatbots are malevolent but that AI tends to agree with people via the algorithms; to quote the title of a piece in Psychology Today, “When Everyone Has a Yes-Man in Their Pocket”. If you say that you are interested in something, they will just say, “Yes, here are your options”. That is something to be concerned about, and it will come up when we discuss advertising.

I finish with that BBC story from August of a Californian couple suing OpenAI over the death of their teenage son. They allege that ChatGPT encouraged him to take his own life, and they have produced the chat logs between Adam, who died last April, and ChatGPT that show him explaining his suicidal thoughts. They argue that the programme validated his most harmful and self-destructive thoughts. I am just saying that AI is a wonderful, man-made solution to many problems, but if we pass a Bill such as this without considering the potential negative possible outcomes, we would be being irresponsible.

[Lord Hamilton of Epsom (Con)]

My Lords, I have supported AI for as long as I can remember, and I think it is the future for this country. If we are looking for improvements in productivity, there is no doubt that we should look to the National Health Service and the public sector, where we can see AI having its greatest effect and improving the health of the economy of this country.

However, we are in early days with AI, although it has been with us for some time. We must be very careful not to rely on it for too many things which should be done by human beings. The noble Lord, Lord Stevens, has already referred to the appalling rate of misdiagnosis. We can look at these statistics and say, “Well, it is only a small number who are misdiagnosed”. Yes, but my noble friend Lord Polack was misdiagnosed as only having six months to live and he is still with us 32 years later. You must think about this, because if you get the situation with misdiagnosis badly wrong, it undermines the basis of this Bill. Therefore, we must be very careful that AI does not contribute to that as well.

I pay tribute to the right reverend Prelate. AI is having a tremendous effect in the health service and helping a large number of people to get better, and it may well be that AI introduces cures for people who are being written off by their doctors—perhaps wrongly. We must not dismiss AI, but we must be very wary about where it leads us. There will be an awful lot of bumps in the road before AI is something in which we can all have complete confidence and believe will deliver better outcomes than human beings.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, there are just a few remarks I would like to make. We live in an age where it is hard to get a human to interact with any more. We lift the phone and speak to a voice that says that if you want one thing, press 1, and if you want something else, press 2. I fear that this is what we are heading for: if you want death, just press a button.

I have no doubt that if this legislation is passed as it is, in the near future we will be heading towards AI assessment procedures. My concern is not where we start in this process, but where it leads to and where it ends.

I am informed that, in the Netherlands, it has been proposed to use AI to kill patients in cases where doctors are unwilling to participate. Indeed, it is suggested that AI could be less prone to human error. Surely, in crucial assessments and decision-making processes for a person seeking assisted suicide, AI could not identify subtle coercion and assess nuanced capacity, bearing in mind the irreversible nature of the outcome. There are concerns about the risk of coercion or encouragement by AI. It should be noted that, with the newly developed AI functions and chatbots, there are already cases globally of individuals being coerced into all sorts of different behaviours, practices and decision-making.

Clause 5 allows doctors to direct the person

“to where they can obtain information and have the preliminary discussion”.

That source of information could be AI or a chatbot. Is there anything in the Bill that will prevent this?

AI undermines accountability. If the technology fails, who bears responsibility? Traditionally in the health service, the doctor bears responsibility. If AI is used, who bears responsibility?

Terminally Ill Adults (End of Life) Bill

Lord Hamilton of Epsom Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Lord Hamilton of Epsom (Con)]

Does the noble Baroness not share my concerns about the misdiagnosis of six months, when you think of all the people who live for much longer afterwards?

[Baroness Hayter of Kentish Town (Lab)]

While that is absolutely a legitimate thing to discuss, and I would always defer to doctors on that, it makes no difference to this part of the argument of whether we call it dying. The noble Lord may well want to raise the question of whether we can ever be sure that someone is dying, although I have to say that I cannot be the only one who has been with someone where it is jolly clear that they are not going to live till the end of the week. There are times when you absolutely know that someone is going to die. While he may well be right that there are other cases, that is not the issue of this word. This word in the Bill is to give to the public the understanding that we are talking about whether there is a way of helping either the final timing or the way of those final days. We are not talking about someone who just decides to commit suicide for some other reason; we are talking about people who are dying from some sort of terminal illness.

Childbirth: Black Women

Lord Hamilton of Epsom Excerpts

Wednesday 3rd May 2023 Lords Chamber

[Lord Markham (Con)]

I do not think I would categorise this in any way in terms of institutionalised racism, and I do not believe that noble Lords would think that of the NHS. Clearly, work needs to be done on helping all ethnic minorities to access health services and on education, because there are many underlying conditions. That is what we are doing now. A few years ago, the numbers were quite a lot worse; black women were five times more likely to die in childbirth, but that figure is now 3.7. A lot more work needs to be done, but we are improving.

[Lord Hamilton of Epsom (Con)]

Does my noble friend accept that the term “institutionalised” is, in the words of the Metropolitan Police Commissioner, “ambiguous”, in that it means different things to different people? Can he define “institutionalised”?

[Lord Markham (Con)]

The point I was trying to make is that I think all noble Lords would agree that the NHS does a fantastic job in addressing and reaching people of all ethnic minorities. That is something we can all support.

Coronavirus: New Cases

Lord Hamilton of Epsom Excerpts

Monday 11th July 2022 Lords Chamber

[Lord Kamall (Con)]

We are finding that vaccination is clearly the best way to break the link between catching Covid and hospitalisation. Sadly, a large part of our population still has not been vaccinated. Even with the third booster, 80% of that age group have come forward but 20% of the older age group still have not done so. We are trying to target groups that have not yet been vaccinated to make sure that we offer them the best protection possible.

[Lord Hamilton of Epsom (Con)]

My Lords, does my noble friend think that an inquiry will be carried out into the Covid pandemic, and if there is one, does he think that it will prove that every mutation has made this virus more transmissible but less lethal?

[Lord Kamall (Con)]

Undoubtedly there will be an inquiry; in fact, the Government announced that there would be one. There will also be lots of independent inquiries and academics writing about what different countries got right and got wrong. When speaking to my friends who are Health Ministers in other countries, we all say that, looking back, there are things that we could have done differently, in various ways, if we had had that knowledge. But we also have to be very careful about the fallacy of hindsight, and of saying that we would have acted differently had we been in that situation. We can learn from hindsight, and we need to make sure that we do so for future pandemics.

Diabetic Prevention Programme

Lord Hamilton of Epsom Excerpts

Thursday 23rd June 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for the question and pay tribute to him for his work in this area over many years. He is absolutely right. One of the challenges of this programme is that it is a nine-month course. Clearly, like many things, it was impacted by Covid, with a lack of in-person consultations and appointments. However, the silver lining to the cloud was the digital service. The course was able to move some patients on to digital services and to self-referring. One impact of that has been more people signing up to this programme.

[Lord Hamilton of Epsom (Con)]

My Lords, is it possible that it is not the course that is at fault but the people who go on it? Has the department not considered charging people a refundable attendance fee to ensure that they roll up?

[Lord Kamall (Con)]

I thank the noble Lord for his question but what is more important is that we get people who have diabetes on to the programme in the first place. As we adjust the programme to take account of the pandemic, for example, and digital offers, we are also looking at different ways to work with different communities. For example, I was talking to a young girl of Bengali origin in my department the other day. I said, “What do we do about getting to the heart of the communities, given that we are in Westminster and Whitehall?” She said that one of the problems in her community is that, “We love ghee—we love clarified butter, in our curries and our rotis.” We are looking at alternative recipes and menus so that people can still have the same food but it can be healthier.

International Healthcare Outcomes

Lord Hamilton of Epsom Excerpts

Thursday 19th May 2022 Lords Chamber

[Lord Kamall (Con)]

I appreciate the fact that the noble Lord has had his spring booster. I would love to take some credit for it, but that must go to our wonderful health and care staff and how they deal with these issues.

The noble Lord is absolutely right: the waiting list, however big, is too big. However, when we analyse the waiting list on the backlog, we see that 80% of people on it are waiting for diagnosis, not surgery. Of those waiting for surgery, 80% can be seen within a day and do not need to stay overnight. We understand the granularity of the waiting list and are taking targeted action to ensure that it is focused on needs.

[Lord Hamilton of Epsom (Con)]

Does my noble friend the Minister accept that, last year, the United Kingdom spent, as a percentage of GDP, a higher amount than any other country in the EU? Does he, therefore, also accept that all these internationally poor comparisons cannot be attributed to a lack of money?

[Lord Kamall (Con)]

My noble friend makes an important point. When you look at the Civitas report, there are a number of statistics where the UK does quite well, but they were not always highlighted. This comes back to the point that this is not only about money; it is about how you spend that money and ensure that you focus on outcomes. One thing we are looking at is better use of the money, for example by using new technology to identify the waiting list and prioritise based on need, as opposed to waiting time.

NHS: Abuse of Nurses

Lord Hamilton of Epsom Excerpts

Tuesday 5th April 2022 Lords Chamber

[Lord Hamilton of Epsom (Con)]

My Lords, does my noble friend have any idea who the people are who are abusing nurses, how many of them are drunk and how many of them are mentally ill?

[Lord Kamall (Con)]

I thank my noble friend for his question. When the NHS started investigating and digging deeper into this issue, the assumption was that it was often just members of the public. It is finding that it is individuals who have had a mental health crisis or are suffering from dementia or another neurological condition, rather than the classic perception of members of staff being abused by the public.

Elderly Social Care (Insurance) Bill [HL]

Lord Hamilton of Epsom Excerpts

3rd reading
Friday 4th March 2022 Lords Chamber

Moved by

[Lord Hamilton of Epsom]

That the Bill do now pass.

[Lord Hamilton of Epsom (Con)]

My Lords, on behalf of my noble friend Lord Lilley, who is suffering from Covid, I beg to move that this Bill do now pass.

[Baroness Penn (Con)]

My Lords, noble Lords may wish to have a short debate before we pass the Bill.

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, I begin by thanking the noble Baroness, and the Lord Speaker for allowing us time for this debate. I congratulate my noble friend Lord Lilley on securing the time for Third Reading of the Bill, which proposes a state-backed insurance company for social care. I am sure noble Lords across the House will wish my noble friend a speedy recovery. I thank him for his thoughtful proposal to address the long-standing issue of unpredictable social care costs. As many noble Lords will recognise, there have been many reports over the last few decades and they have just sat there gathering dust on shelves: to date, we still do not have a proper system. The Government wholeheartedly agree with much of the analysis underpinning the Bill and I shall mention but a few of the ideas that stood out for us.

First, we are well aware of the challenges around the private market delivering insurance for social care costs, so we recognise the benefits of delivering insurance through a public not-for-profit company owned and guaranteed by government. I also particularly admired how the proposal addresses affordability by allowing people to pay for the insurance premium through equity on their home. Lastly—this is probably the Bill’s strongest selling point—it would be cost-neutral to the Exchequer. I recognise the opportunity this presents for the savings to be invested in financial support for those not able to access the insurance offer—for example, people who do not own a home.

I reassure my noble friend that his proposal has been carefully considered in the lead up to the announcement of our reform package from October 2023, but I point out that one of the key benefits of the cap and extended means test is that it is a universal offer—universal for everyone, irrespective of age or home ownership. We believe that a universal cap means people can plan ahead for their care from the outset. Knowing that the cap is there will benefit everyone, not just those who own a home. The home ownership landscape is changing over time, and within that context the Government have developed a package of reforms which is future-proof and gives support and certainty to the current generation, as well as future generations.

In addition to the cap, from October 2023, anyone with assets of less than £20,000 will not have to make any contribution for their care from their savings or the value of their home, ensuring that those with the least are protected. Anyone with assets below £100,000 will be eligible for some means-tested support, helping people without substantial assets and ensuring that many more people benefit from funded support earlier in their care journey. We believe that our reforms significantly improve the current system. In developing the reforms, we had to make tough choices, balancing the generosity of the reforms with how much extra we ask taxpayers to contribute and pay for them. My noble friend may disagree with our current formulation of the cap, but we believe the plan is credible, deliverable and affordable. Therefore, while the Government are not convinced that the Bill is the right course of action, we agree with his intelligent analysis that underpins it and, as the noble Baroness, Lady Merron, said, we will debate this further.

I again thank my noble friend Lord Lilley for putting forward this proposed Bill, and for his engagement in discussing our reforms after this debate.

[Lord Hamilton of Epsom (Con)]

My Lords, I know that my noble friend Lord Lilley will be very grateful for the compliments from both Front Benches and he will be glad that he stimulated so much thought in the minds of the Government, judging by the remarks of my noble friend the Minister. He will probably be watching this from his sick bed but if not, I am sure he will read it tomorrow in the Official Report.

Bill passed and sent to the Commons.

NHS: Nurse Recruitment

Lord Hamilton of Epsom Excerpts

Thursday 27th January 2022 Lords Chamber

[Lord Kamall (Con)]

We do not think we should just have a protectionist view on staff. It is important that we recruit British staff from the UK, but we should not have a policy of British jobs for British workers. There are very good staff across the world. Indeed, in some countries they train more staff than they have places for in their health system so that they become a foreign revenue earner. Many people who have looked at the statistics say that remittances quite often are more effective than foreign aid.

[Lord Hamilton of Epsom (Con)]

Could the Minister say how many agency nurses are being employed by the NHS? Is he not concerned that so many are being employed when they are so much more expensive?

[Lord Kamall (Con)]

My noble friend makes a valuable point about the cost of agency nurses, which is why we have the goal of recruiting 50,000 nurses. We are looking at completely different pathways to ensure that we can encourage people into nursing. I do not have the statistics with me, but I will write to my noble friend.

Care Workers: Professional Register

Lord Hamilton of Epsom Excerpts

Monday 10th January 2022 Lords Chamber

[Lord Kamall (Con)]

Issues such as the way private care home owners treat their staff are all part of the consultation that we launched on 6 January. We are working across government and with the devolved Administrations to seek views on the proposed criteria on which the profession should be regulated, whether there are regulated professions that no longer require statutory regulation, and whether there are unregulated professions that should be brought into statutory regulation. The consultation will run for 12 weeks until 31 March, when we will look at the results before taking further action.

[Lord Hamilton of Epsom (Con)]

My Lords, was the Spectator right when it said that 25% of people over 65 were worth more than £1 million, and is it right that these people should have capped care costs of £86,000, which means that taxpayers on much lower incomes have to pitch in and support them?

[Lord Kamall (Con)]

As my noble friend will appreciate and probably anticipate, there will be debate on the Health and Care Bill for the next few weeks. I am sure that that is one of the issues that will come up.