Terminally Ill Adults (End of Life) Bill

Lord Watts Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, I support the amendments in this group. They are important because, unlike the noble Baroness, Lady Hayter, I do not know what the outcome of this debate will be at the end. She might have some other knowledge of how this House will vote, but I certainly do not know the answer. Therefore, it is vital that we spend the time and debate these amendments, because words are important. If anyone ought to know the value of individual words, it is noble and learned Lords in this House, because many of them spend their lives arguing on the edge of a pin about particular words. As a matter of fact, they make a considerable amount of money out of arguing about single words. Words are important, so let us not try to pretend that words do not matter. Therefore, on “coercion”, “influenced” and “encouraged”, I believe that we need to get this right, because the Bill could pass this House.

I know that there are those who do want to shut down debate. I sat in the House of Commons on Wednesday at Prime Minister’s Questions. I noticed earlier today that for a considerable amount of this debate the person who raised it at Prime Minister’s Questions was sitting here. He is the right honourable Member for North West Hampshire. He has left his position on the Steps of the Throne, but he was here for a considerable amount of the debate. He was indignant and incensed that this House wants to look at and scrutinise this Bill because it was passed by the Commons. I was in the other House for 25 years, and I know that in those 25 years, under successive Governments, the other House got Bills wrong and had to change those Bills. I do not believe it is correct to suggest that just because the other Members have passed the Bill, somehow we must bow and surrender to their superior knowledge, and therefore I believe that we ought to spend time—

[Lord Watts (Lab)]

From the number of amendments here it is clear that this is about wrecking the Bill. It is not about improvements, it is about wrecking the Bill. I went through this with my late wife, who suffered a very long and painful death and wanted to have the opportunity of ending her life. If they wreck the Bill, Members should think about the thousands of other people who will go through that same process.

[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.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

Of course, and I apologise for not answering it.

[Lord Watts (Lab)]

Can we perhaps shoot just one fox? There was a suggestion that there are not enough non-Anglo-Saxon GPs available to do this. I have just looked at the facts: 46% of GPs were born outside the UK and 25% of them are from Asia.

[Lord Falconer of Thoroton (Lab)]

I am very grateful to my noble friend for mentioning that, because that is what was being whispered to me but I did not have the statistics. I am very grateful to him for providing them.

--- Later in debate ---

On the claim that people who die with specialist palliative care input—of whom there are thousands every year—do not die with dignity, I have to defend my professional colleagues and the hospice services. Dignity-enhancing therapy has been developed within the palliative care community to demonstrate how other services may have failed and how you can enhance dignity, and if—

[Lord Watts (Lab)]

Would the noble Baroness agree for one second that, even if someone has good hospice care and the best medications that they can, there are still patients who suffer and have pain before death, despite all the actions of the people who are trying to alleviate that?

[Baroness Finlay of Llandaff (CB)]

I thank the noble Lord for the intervention. Perhaps it might be helpful for us to have a conversation outside this Chamber. But I would just say that pain is complex. It is not only physical; it has multiple components. Of the patients I have had the most difficulty looking after, we discovered that there were very many issues in the psychosocial and emotional domain: things that had happened in the past, some of which we did not know about at the time. But I do not want to go off message from these amendments, which are really important.

These amendments were put down in good faith to address the concerns expressed all around the Committee. I am disappointed that we have not got to the point of saying that we will all sit down together. I think that those of us who have drafted amendments will sit down together and discuss how we should bring something back on Report to manage the situation that we highlighted today, which is a very profound concern over coercion, abuse and all the other factors that go along with that. Apart from that, I beg leave to withdraw the amendment.

Learning Disabilities Nursing

Lord Watts Excerpts

Tuesday 17th June 2025 Lords Chamber

[Baroness Merron (Lab)]

It is probably helpful to say to your Lordships’ House that there have been significant changes to how we respond to care for individuals with learning disabilities within the UK. Like in other specialist areas, there is a move towards multidisciplinary teams, which I certainly welcome. I also emphasise the role of learning disability nurses, who are absolutely key, as is the training of all staff. That is why we are so committed to rolling out the Oliver McGowan training, which I know is highly regarded by all staff.

[Lord Watts (Lab)]

My Lords, we inherited a shortage of nurses and doctors, and it is important that we train and recruit new nurses. But does the Minister agree that, in the meantime, we have some marvellous people from the Philippines who are acting as our nurses and supporting our health service, and that it is important that we do not cut them off while we train our own people?

[Baroness Merron (Lab)]

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

Community Pharmacy Closures

Lord Watts Excerpts

Tuesday 28th January 2025 Lords Chamber

[Baroness Merron (Lab)]

I recognise that, as the noble Baroness says, there are some difficulties with the supplies of certain medicines. That has been going on for some time. We are therefore working to ensure that the supply chain is secure and robust and can meet the demands on it, which requires a detailed look. Work will continue, and I look forward to continuing to update your Lordships’ House about that.

[Lord Watts (Lab)]

My Lords, is it not the case that the present health structures are not suitable for purpose? Do we not need to look at providing health centres that include a pharmacy, dentists, doctors and all other services in one place to get the maximum resources to the public?

[Baroness Merron (Lab)]

My noble friend will be glad to know that bringing services together under one roof and designing them around the patient is exactly where this Government are going. I ask him to keep an eye out for the 10-year plan, which will address many of the points that he is making.

Inflammatory Bowel Disease

Lord Watts Excerpts

Monday 20th May 2024 Lords Chamber

[Lord Markham (Con)]

We had a very good debate on this a couple of weeks ago. All noble Lords accepted that it was a bit of a Cinderella service at the moment, but vitally important to a lot of people’s everyday well-being, so I am happy to do that.

[Lord Watts (Lab)]

My Lords, is the Minister monitoring what is happening in Europe and the US to see whether we can learn any new lessons from the research programmes that are being carried out there?

[Lord Markham (Con)]

The Getting It Right pathway was very much informed from that best practice around the world and, in the last year, NICE has approved four new drug treatments. We are trying to look at the best medicines around the world. One of them, risankizumab, has resulted in a 44% reduction in the disease—so, yes, we are trying to learn from the best in the world.

Immunisation: Children

Lord Watts Excerpts

Wednesday 8th May 2024 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend for the question. Actually, it is not just asylum seekers; it is often migrant groups full stop. Their communities or the countries they have come from often do not have the same level of vaccination programmes. It is part of the check we try to give people as they come into the country, and something we ask GPs to look out for, so that we can get them in a catch-up programme. A lot of the work we are doing on outreach is also particularly focused on those communities.

[Lord Watts (Lab)]

My Lords, is it not the case that we need to make the case for public health, and that our public health policy is determined by parents getting their children vaccinated? Do we not need to make the case that they put their own and other people’s children in danger unless they comply with vaccination?

[Lord Markham (Con)]

Yes, absolutely. Unfortunately, we are all aware of the Wakefield effect on the MMR vaccine. That knock of confidence was completely unjustified and irresponsible, but we know the impact it had. Clearly, a lot of the anti-vax sentiment around Covid has not helped either. We need to overcome all these messages.

International Health Regulations: Amendments

Lord Watts Excerpts

Tuesday 7th May 2024 Lords Chamber

[Lord Markham (Con)]

I am not sure in what year that policy was published. However, I can talk about how, when we were president of the G7 in 2021, we led the calls to donate vaccines on a worldwide basis, which led to 1.2 billion doses being donated to countries all around the world, led by Britain’s initiative with AstraZeneca. That was great global co-operation and we can feel very proud of it.

[Lord Watts (Lab)]

My Lords, the Government said that they would learn the lessons from the Covid problems. How have they tackled the issue of production of equipment that was needed for Covid but which we did not have? The Government promised to make sure that we will have it next time. Can he give us an update on that?

[Lord Markham (Con)]

Of course, we covered much of this when we had a Question on 15 April around this. This is about making sure that we have the diagnostic capability—which we have—and the ability to scale up. We have made a £125 million-fund available for precisely the issue that the noble Lord mentions, so we have the mothballed capacity ready to operate at quick notice.

Covid-19 Vaccination: Coronary Disease

Lord Watts Excerpts

Tuesday 23rd April 2024 Lords Chamber

[Lord Markham (Con)]

The noble Lord is absolutely correct. The MHRA study on heart inflammation, which he mentioned, said that there is that side-effect for one to two people per 100,000—unfortunately, the noble Lord seems to have been one of them. However, if you get Covid it affects 150 people per 100,000. On balance, if you have not had the vaccination, your risk is 22 per 100,000. The statistics are very clear.

[Lord Watts (Lab)]

My Lords, does the Minister think that we need to do far more on public awareness of vaccines and their benefits? All sorts of people out there are spreading malicious tales about the implications of taking them, whether for mumps or Covid.

[Lord Markham (Con)]

Absolutely. We are all very aware of the damage done by all the myths around the MMR vaccine 20 to 30 years ago and the impact that has had on people. The more we can get the message out, the better. As the noble Baroness, Lady Merron, asked me yesterday, we have learned that it is about making sure that we communicate to all groups so that we can make sure that ethnic minorities and other minority groups get that information.

Care of Critically Ill Children

Lord Watts Excerpts

Monday 29th January 2024 Lords Chamber

[Lord Markham (Con)]

Yes, the noble Lord is quite correct. We know that, in many walks of life, so to speak, there are certain sectors of society that do not get the same level of provision and sometimes miss out. We had the debate last week on maternity provision and saw instances in relation to ethnic minorities as well as people with learning difficulties. We need to make sure that all the communications are there and that everyone is armed to provide the right levels of interface and communication in what are some really difficult cases.

[Lord Watts (Lab)]

My Lords, many families with critically ill children find it very difficult to access treatment because often specialist treatment is only available hundreds of miles away from where they live. That puts tremendous pressure on the family financially. Do the Government intend to do any more to help those families?

[Lord Markham (Con)]

Clearly, we would all agree that the families need to be the priority in these terrible cases. What we have tried to do—and I have also done my own research into this—is make available what I call independent funding requests for when there is a new course of treatment which might not be allowed generally by NICE to give opportunities in those instances as well. I will come back to the noble Lord on things such as travel support and other expenses.

Care Home Staffing

Lord Watts Excerpts

Thursday 18th January 2024 Lords Chamber

[Lord Markham (Con)]

Yes. I have seen a number of really good examples of the kind of step-down care that my noble friend is talking about, or intermediate care that can be used as interim measures. We are trying to bring more of them on board, as well as the very good virtual wards. We have set up 11,000 virtual wards, and they are making a difference as well.

[Lord Watts (Lab)]

My Lords, the Government say that they have done an assessment on the effects of the visa changes. Can he tell us how that was done if the Government did not discuss it or consult with the sector?

[Lord Markham (Con)]

It was a Home Office impact assessment, so I freely admit that I do not know exactly who was consulted; I will happily get back to the noble Lord on that. I know that the assessment looked at all the different parts, including the salary cap and the impact on dependants. For instance, it was not thought that the restriction would have much impact on dependants because not many people come with dependants in the care sector. It looked into each bit, but I will happily let the noble Lord know more in writing.

Adult Social Care

Lord Watts Excerpts

Wednesday 22nd November 2023 Lords Chamber

[Lord Markham (Con)]

As I say, we are seeing staff increases. I accept that there is a lot to do in this space, but there has been a 1% increase this year, so we have turned things round quite substantially. Overall, the number of patients being cared for in this way went up by 15,000 in the last year. As the ADASS survey showed, there has been a decrease in the waiting lists, down 13% from the peak, so we have turned a corner and we will see further improvements.

[Lord Watts (Lab)]

My Lords, the Minister said that waiting lists have gone down by 13%. Can he tell us by how much they went up over the previous 12 years?

[Lord Markham (Con)]

I do not have the figures for those 12 years, but I will happily send them to the noble Lord.