Terminally Ill Adults (End of Life) Bill

Baroness Berger Excerpts

Committee stage
Friday 13th March 2026 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

If there are not enough people with the requisite expertise to people the panels then there will not be panels to do the job. That is why the broad categories have been adopted in the Bill. The Royal College of Psychiatrists has expressed views in relation to this, as has the British Association of Social Workers. However, it is necessary for us to find people to do this process, because the workability of the scheme depends on it, and we believe it is possible to do that. We recognise the concerns that have been expressed, including by the noble Baroness, who is right to say that if we do not have people who can people the panels then we cannot do the process.

On the broader issue of what happens if we have people in one part of the country but not another, it will be for the voluntary assisted dying commissioner to ensure that, when a panel is required, it can be provided.

[Baroness Berger (Lab)]

I have listened closely to all of my noble and learned friend’s responses and remarks on this sizeable group of amendments—by my count, there are 105 amendments. While a handful have been presented by the sponsor, my noble and learned friend, the overwhelming majority have been put forward by noble Lords on all sides of the Committee, largely informed by the evidence that we heard at the Select Committee and by representations made by professional bodies and medical colleges outside of this place that wish us to improve the Bill. That is the job we were tasked to do by the other place and by our colleagues.

I have listened closely to every single word of my noble and learned friend’s response and heard every reason why every single one of these amendments should not be accepted. I did not hear what could come forward to make the changes that people think should be made to this Bill to make it safe, particularly for vulnerable groups, and to ensure we do not see coercion. Reflecting on his response, does my noble and learned friend intend at a future moment to come forward with anything that would put in the Bill things that would make the material differences that are the reason and impetus behind noble Lords putting forward these amendments?

[Lord Falconer of Thoroton (Lab)]

I have thought very carefully about the amendments we have gone through. I am sure they are all based on attempts to improve aspects of the process, such as the appointment of the panels, how the panels operate and the privacy issues. I should say that very considerable thought went into those issues before the Bill was drafted and as it went through the other place. I have given detailed reasons as to why I think the amendments we have debated would not really improve the position. For those reasons, after giving it considerable thought, I think that the Bill probably reached a better conclusion on, for example, the “must” and “may” issue that the noble Baroness raised and the need for special extra expertise. I have given it careful thought, but I do not think any of the amendments we have gone through would improve the Bill.

--- Later in debate ---

A multidisciplinary panel would give a clearer view of what the Bill claims to do. We must avoid doctor shopping. I think all of us would agree that palliative care is incredibly important. I wish that that had been part of the Bill, so we could have debated it in more detail. We have to look at the whole person. This is a model that we should at least consider.

[Baroness Berger (Lab)]

The noble Baroness, Lady Grey-Thompson, made some important points, as have been made by other noble Lords, about the drugs. Given the context of this debate, as we deliberate these amendments and later amendments, it is worth sharing that the Delegated Powers and Regulatory Reform Committee of this House, in its important report about the extension of delegated powers in the Bill—of which there are now 48—had specific concerns about substances, drugs and the detail missing from the Bill. In fact, the two specific themes that are relevant are the lack of specification of approved drugs and the lack of regulation of approved substances. The Bill currently uses two delegated powers for something that would usually be described in the Bill, but it is instead in delegated legislation. That perhaps provides some context as to why these amendments have been put forward.

[Lord Empey (UUP)]

My Lords, I want to deal with probing Amendments 887A and 888A, in my name. Throughout the process there has been a potential clash between what decisions might be made here and what decisions might be made in the devolved nations. In the other place, an amendment was introduced by the sponsor of the Bill as it progressed to extend certain parts of it to Northern Ireland and Scotland, as well as England and Wales. My colleagues at the other end tried to put an amendment down to probe why this was done. Unfortunately, it was not taken, so the matter was never really debated.

I remind the House that Clause 37 deals with the regulation of approved substances and devices for self-administration. It says that:

“The Secretary of State must by regulations make provision about approved substances”,


and that has the extent of the entire United Kingdom. These regulations also deal with

“the supply or offer for supply, or administration, of approved substances … the transportation, storage, handling and disposal of approved substances”,

and

“keeping records”.

It says provisions must be made

“about the manufacture, importation, preparation or assembly of approved substances … or in connection with the monitoring of matters”

and so on,

“requiring persons specified in the regulations, in specified cases, to give information to the Secretary of State”.

As things stand at the moment, there is no plan by the Northern Ireland Executive to introduce an assisted dying Bill, and there is no Private Member’s Bill currently in the Chamber. Some of these regulations would, in my view, cut across the role that is currently played by devolved Ministers and devolved departments.

This is what I am trying to get at and to probe. It does not, incidentally, confine the extent to Clause 37. In fact, other clauses extend the Bill’s extent as well—Clauses 43, 54, and 56 all apply to the whole of the United Kingdom. I do not understand that. If the noble and learned Lord could enlighten us, that would be most helpful. As I said, they are probing amendments. The point I am trying to tease out in Committee is why that was introduced if it was not in the original Bill and why that extension was made, because, as things stand, there are no plans for an assisted dying Bill in Northern Ireland—not from the Executive and there is no Private Member’s Bill currently.

I totally accept that this Parliament has the right to legislate for the entire United Kingdom, irrespective of devolution. But, at the end of the day, the Bill says:

“The Secretary of State must by regulations make provision about approved substances”.


There is no argument about it—this has to happen. The extent of those regulations would be the entire United Kingdom. Whether Northern Ireland and Scotland want it, it is going to happen, according to this clause. Why is that the case? If there is no assisted dying available—and in many cases, it would be a devolved matter anyway—why are we regulating for the provision of these substances in all parts of the United Kingdom? That is what I want to know, and I will be grateful for the noble and learned Lord’s contribution in the wind-up.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

When I said that I am really focused on how to provide a proper assisted death and that that is not a technical question about whether the NHS will provide it, I did not mean to say that it is not important for this issue to be resolved. If I did, I misspoke, but please do not read me as saying that. That is an issue on the way to the Bill providing a compassionate and workable way of providing an assisted death to those who want it.

As to the second part of the question asked by the noble Lord, Lord Harper, about my view in relation to it, it is that it is ultimately for the Secretary of State for Health to decide how it is provided. The power is given to the Secretary of State to decide that in Clause 41, with the amendments that I have put down in relation to it. It gives him power to commission it himself or through a variety of other bodies. That might involve some body other than the NHS providing it. Ultimately, it is for the Secretary of State to decide how that is done. I think I have said enough on the scheme proposed by the noble Baroness, Lady Finlay.

I will go on to substances. There is a range of amendments in relation to substances. We shall come back to substances in relation to Clauses 27 and 37. They are in this group because they relate in part to the scheme proposed by the noble Baroness, Lady Finlay. She proposes designated pharmacies so that only particular pharmacies can do it. It is again—this is the wording of the Bill—for the Secretary of State to decide how substances are to be selected, how drugs and devices are to be approved, and then how they are to be dealt with. Subject to my amendments, which give more limitation to Clauses 27 and 37, I think the right principle in relation to that is that it is for the Secretary of State to decide how properly to regulate and choose the substances, and he or she is to do it only after taking proper advice.

[Baroness Berger (Lab)]

On that very point about Clause 37, I am sure my noble and learned friend is aware of the updated Delegated Powers and Regulatory Reform Committee report alluded to by the noble Lord, Lord Stevens, a moment ago. On that clause, it states that there are still “highly inappropriate” provisions in the Bill, particularly on Clause 37, specifically in relation to the substances that would be used for an assisted death. I heard what my noble and learned friend said, but it is the complete opposite of what the report released yesterday says and what remains in the Bill. The amendments that my noble and learned friend has brought forward do not yet address the concerns expressed by that very important committee in its report.

[Lord Falconer of Thoroton (Lab)]

I accept what my noble friend says. I hope she has read my note to the committee, which it published, in which I accept that further work is required, in particular on Clause 37. I accept in principle that I have to come back with further amendments in relation to Clauses 27 and 37.

The noble Baroness, Lady Hollins, has made a series of creative suggestions. She is addressing this in a way that is separate from the proposal from the noble Baroness, Lady Finlay of Llandaff. She says that her proposals on substances should apply irrespective of which scheme it is. I need to consider some of them in detail. My noble friend Lady Blake has indicated why some are difficult to integrate into substances for assisted dying. I am particularly interested in the relationship between the Medicines and Healthcare products Regulatory Agency and the approval of these drugs; that needs further thought on the sponsor’s part. In addition to the amendments that I am proposing to Clauses 27 and 37, I should consider them as I think they are valuable.

For the reasons given by my noble friend Lady Blake, I do not support the amendments proposed by the noble Baroness, Lady Grey-Thompson, in relation to clinical trials. Although the MHRA has a part to play, I also accept the limitations on that put forward by my noble friend Lady Blake.

I have seven amendments in this group: Amendments 624A, 708A, 708B, 710B, 862B, 877B and 878A, all of which relate to limiting the power in Clauses 27 and 37, and include a requirement for consultation in respect of the Minister. I do not think that they are contentious, although I accept that people think that I should go further. In the respect that I have mentioned, I am more than willing to think about going further. If and when we reach those amendments, I expect the Committee to agree to them.

I deal finally with the question from the noble Lord, Lord Empey, in relation to Northern Ireland. He asks why the Bill extends the power of the drug regulator in this respect to Northern Ireland. The noble Lord will know that drug regulation is a matter for the whole of the United Kingdom so must be dealt with by a statute in this House. We are not suggesting that Northern Ireland should change its current law, but if there was a law change then there would be no reason why the drugs authorised in whatever process the Secretary of State agrees to should not apply to Northern Ireland. That is why it refers to Northern Ireland.

--- Later in debate ---

That is true in general, but, as the noble Baroness, Lady Monckton of Dallington Forest, so movingly, passionately and powerfully put it, people who have Down syndrome often want to keep people happy. What if they hear that suggestion? I am putting this very badly, but it is an abomination that it should even be there on the possibility list. I would like to hear the noble and learned Lord at least concede that point, if nothing else today. That would be worth coming for.

[Baroness Berger (Lab)]

It was so moving to hear the contribution from the noble Baroness, Lady Monckton, and the points that others made about the words that people may hear, including people with learning disabilities. I was reflecting on the evidence we heard at the Select Committee from the National Down Syndrome Policy Group. It is not just the words that people may hear; it is also what they see in front of them. In particular, what was really striking—I had not thought about this—was that even the uniform of the doctor who is having that conversation could suggest a position of authority that someone with a learning disability should show acquiescence to. I thought that was something for us to consider in the light of all these important amendments.

[Baroness Fox of Buckley (Non-Afl)]

That is very helpful. When I see a uniform, I get a bit quivery as well—

Terminally Ill Adults (End of Life) Bill

Baroness Berger Excerpts

Committee stage
Friday 27th February 2026 Lords Chamber

[Baroness Lawlor (Con)]

We are proposing and debating a piece of legislation at this moment. We are concerned about the safeguards in the current proposed piece of legislation. The noble Baroness, Lady Gray of Tottenham, has proposed that the reviewing panel must raise with the person considering assisted suicide whether they have discussed it with their nearest and dearest. That is a different matter from what the noble and learned Lord has raised. We are discussing a piece of proposed legislation and I am discussing an amendment proposed by another noble Lord.

It is very important for those on whom we have depended and may still depend that we form a society and, as human beings, give support and love to one another—a mother or father who wishes only to support their child, perhaps terminally ill, to live their life as best they can; a daughter, son or sibling supporting their loved parents, sister or brother; or a spouse or best friend.

I do not agree with the premise of the Bill that we are autonomous human beings to dispose of ourselves just as we wish. Whatever freedom we have as human beings is rooted in a network of social relations and responsibilities, especially to our kith and kin. We therefore need to do whatever is possible to ensure that a person’s ultimate decision to end their own life is taken within a familial and social context. This amendment, which I support, promotes that end.

[Baroness Berger (Lab)]

My Lords, I will speak to my Amendments 466, 471 and 474, as well as to Amendments 472 and 485 in the name of my noble friend Lady Gray of Tottenham; I will make different points on those. These are all forms of amendments that were tabled but not debated in the other place. They all seek to strengthen the effectiveness of the voluntary assisted dying panels as a safeguard, because that is what we have been told they have been put forward to provide.

My first two amendments would mean that questioning both the co-ordinating or independent doctor and the person seeking an assisted death is mandatory and not at the panel’s discretion. It is extraordinary that, in light of all the evidence that we heard across the 13 panel sessions of the Select Committee, the Bill currently does not ensure that the panel asks questions of every person seeking an assisted death.

Noble Lords will be aware that, as we have heard, the panels were added to the Bill in the other place two-thirds of the way through Committee in order to replace the High Court, which we were originally told was part of a judge-led process. The panel process has never been piloted or consulted on, and it appears to have been based on the Spanish system—a system of guarantee and evaluation commissions—but of course the Spanish law is very different from the Bill that we are scrutinising, which we have been assured is narrower and safer. The Spanish system, which allows for both assisted dying and euthanasia, does not require a terminal illness from which a person is likely to die within six months, as the Bill that we are scrutinising does; it requires only—in translation—a serious and incurable illness or a serious chronic and impossible condition. The Spanish legislation provides for considerably wider categories. I am sure that those of us concerned about vulnerable people being made to feel that they are a burden are very glad that the sponsor has not proposed them here.

The requirement for a terminal illness with a six-month diagnosis is a meaningful safeguard only if it is properly tested. How can it be said that a panel has done its job if it has not asked a single question of the doctors? How can it establish that the person has not been pressured or coerced just by passively hearing their prepared statement, which may have been drafted under the eye of their abuser? In what way is any of this a suitable alternative for the rigour set out in the first iteration of the Bill, which included the High Court? That is why I believe that these amendments are necessary.

This concern was expressed very well to the Lords Select Committee by Dr Luke Geoghegan, who represents the British Association of Social Workers. He set out the following about how safeguarding usually works in this country and how it differs from the approach of the panels that is currently set out in the Bill:

“An allegation is made or a concern is raised and that concern is investigated, and then that allegation or concern is either upheld or it is not. The challenge for the panel”—


the voluntary assisted death panel—

“is that here this model is flipped. Can we be sure that this person is not affected by safeguarding or coercion issues? It is often impossible to prove a negative, but we can make reasonable assessments on the balance of probabilities”.

The real issue here is that the panel system means there is no other side seeking to show that the test for eligibility has not been met, and there is no cross-examining of the witnesses who say that it has. In the absence of such a legal process—usually the hallmark of our British system—having the panel at least ask some questions of every applicant for an assisted death is surely the absolute minimum that must happen if we are to have confidence in it as a safeguard.

Amendment 474 would make a more discretionary change. It would add a requirement to “consider hearing from” a person’s family and other treatment and care providers. I reiterate that, in the amendment as set out, it is not mandatory. In advance of explaining the amendment, I will provide a counterview to some of the things that we have heard so far. We have heard the discussion about family members in the context of agency. I will talk about it in the context of the variety of autonomy and the context of establishing coercion.

Family members and those who have provided care for the person are likely to be privy to information that has a significant bearing on the panel’s deliberations and decision. Perhaps a son or daughter knows that someone new has recently entered the life of their vulnerable parent, has slowly taken control of their finances and has encouraged them to cut contact with others.

I set out this point reminded by the evidence that we heard from Age UK and the existence of different types of abuse, but particularly romance fraud. In the Select Committee, we heard that Age UK had been contacted

“by families who say, ‘Hang on, I’m really worried that there is this person in my mother’s or father’s life and I’m not sure what their intentions are’”.

The evidence talked about

“the moral hazard for people who stand to gain from older people after their death”.

An example of this could be a carer who knows that the person has struggled with suicidal feelings long before their illness worsened or knows the reason behind the source of their despair. Perhaps, while quietly attending to the needs of the patients they are responsible for, a carer has overheard a friend or family member suggest to the patient that it really would be easier all round if they were to end things sooner rather than later with the help of trusted professionals. I know that we would like to think that this does not happen, but I have spoken already in this Chamber about the first-hand experience of hearing how that is unfortunately the case in some instances.

I am aware that there is a power in the Bill to hear from “any other person”, but this is left so open as to add little in the way of assistance or direction to the panel. My amendment, therefore, responds to the evidence we heard from the professional bodies and provides an explicit steer while still allowing for the panel to conclude that additional evidence is not likely to be helpful or that the process of seeking it would be too onerous.

I also support Amendments 472 and 485 in the name of my noble friend Lady Gray, who unfortunately is unable to attend today. Amendment 472 would require the panel to ask the person whether they have discussed their requests for an assisted death with their closest relatives and to discuss the reasons if they have not. Amendment 485 would provide that this requirement would not apply in the exceptional circumstances where a panel chooses not to hear from the person. These amendments, like mine, seek to highlight the vital insight that family members may have into the person’s wishes or eligibility. If the panel is able to place the person’s request for an assisted death in the context of their relationships, they are more likely to be able both to understand an undeclared motivation behind the request and to detect any coercion or undue influence.

As the Bill has progressed, it has frequently been noted that doctors rarely make serious decisions on their own. The sponsor, my noble and learned friend Lord Falconer, has acknowledged this, which is why the panel itself is so often referred to as multidisciplinary. Here, I note the expertise of the noble Baronesses, Lady Finlay and Lady Cass, and others, who have rightly pointed out that the medical assessments themselves should also be multidisciplinary. However, it is also true, as we heard at the Lord’s Select Committee, that patients rarely make decisions on their own. We heard from the Royal College of Psychiatrists that there is very pure personal autonomy, where somebody makes a decision uninfluenced by anybody else, but that does not reflect the way that people usually make decisions, which is as part of their relationships with others, and that is very normal.

Professor Charles Foster told us that, in the real world,

“decisions about how we exercise our autonomy are made in the context of our relationality”.

We discuss with our relatives what should happen. If someone chooses not to tell their immediate relatives or loved ones about such a momentous decision as ending their life prematurely, that is noteworthy. There may be good reasons for it, as set out by my noble friend Lady Hayter, but that should be for the panel to establish. These amendments do not offend against autonomy and they would not oblige a person to tell their family or friends anything, but they would enhance the information available to the panel and move it further towards being an effective safeguard against coercion and undue influence or an otherwise unwanted assisted death.

A secondary point to these amendments is to make it at least a little less likely that families will have to go through the trauma of finding out about the death after it has happened. Our Select Committee was told by the Royal College of Pathologists that in cases where death is unexpected, families often find out about the death of a loved one when they receive a call from the medical examiner. If passed, the Bill is likely to increase the number of cases where that happens and will put a great strain not only on families themselves but on the professionals who find themselves in that position. I am conscious of time, but it is worth reflecting on, and I ask noble Lords to look at the comments from the Royal College of Pathologists, as that was explained to us.

Amendments 472 and 485 seek to minimise these impacts as far as possible. They would not create an obligation on the person to involve their next of kin, but they might encourage them to have that conversation if they feel able to do so. Ultimately, the more information that is available to the panel about a patient’s circumstances and relationships, the more confident we can be in the panel’s decisions and the regime it would create.

Terminally Ill Adults (End of Life) Bill

Baroness Berger Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

[Baroness Levitt (Lab)]

I am not going to take any interventions, I am sorry. I am simply giving the Government’s view. We are very short of time. I apologise to the noble Baroness.

[Baroness Berger (Lab)]

Would my noble friend—

[Baroness Levitt (Lab)]

I am not taking any interventions.

These amendments create a further risk of incentivising the use of palliative care when it is not in line with the wishes of the individual. If a patient has relevant and available palliative care options, as with all treatment options, it remains their decision whether to pursue them.

Lastly, I turn to Amendment 832 in the name of the noble Baroness, Lady Hollins. The Government have workability concerns in relation to the amendment, which states that no person may access an assisted death unless a consultant from palliative medicine has

“confirmed in writing that all appropriate specialist palliative and end-of-life care options … have been discussed and, so far as reasonably practicable, tried or considered”.

This appears contrary to usual clinical practice, whereby the involvement of specialist services depends upon an assessment of need and on the wishes and preferences of the patient. As Amendment 832 excludes people from eligibility unless they have tried or considered particular options for care, this could give rise to legal challenge on the basis that it is not justified under Article 2 or 8 or may amount to unjustified discrimination under Article 14.

Crime and Policing Bill

Baroness Berger Excerpts

Committee stage
Tuesday 9th December 2025 Lords Chamber

[Baroness Berger (Lab)]

My Lords, it is a privilege to follow the noble Baronesses, Lady Bertin, Lady Kidron, Lady Benjamin, Lady Kennedy, Lady Boycott and Lady Shawcross-Wolfson, the noble Viscount, Lord Colville, and the noble and learned Baroness, Lady Butler-Sloss, all of whom who have made significant contributions. I do not wish to reiterate what has been said too much, but I want to speak today in support of Amendments 290, 291, 292, 298 and 314 in the name of the noble Baroness, Lady Bertin, concerning sexualising children, pornography that mimics abuse and nudification. I put on record my thanks to the noble Baroness for her important and vital work in this area, and recognise the toll it must have taken.

The consumption of violent pornography is having a devastating effect on adults and on the children being exposed to it. We have heard the research from the Children’s Commissioner that indicates the average age at which children in the UK first see pornography to be around 13, but a substantial minority are encountering it significantly earlier, including in our primary schools. I should declare an interest: I have two primary-aged children. I have a daughter who is eight and a son who is six, and I am terrified at the prospect of either of them being exposed to this type of material. We know that this material is having an adverse effect on the physical, sexual and mental health of hundreds of thousands of people in our country. I want to touch on a couple of particularly concerning areas: pornography that mimics abuse and nudification.

We know that, for too long, companies hosting pornographic content have been allowed to host whatever material they like online, regardless of its harm. I echo some of the comments that have been made; it is extraordinary that we have a situation where it is not allowed offline, but it is allowed online and anyone can reach it from the phone that they hold in their pocket.

Amendment 290 would make it an offence to glorify or advocate for child sexual abuse. I do not know how anyone can question the aims of that amendment; it is critical. We heard about this on the previous day in Committee. It is both repulsive and shameful, but it is worth reiterating, that the UK is the third-largest consumer of child sexual abuse videos that are streamed from the Philippines. We rightly have laws on hate speech in this country. We must equally have laws that deal with this type of heinous advocation of child sexual abuse. This is not something over there; it is happening every single day in our country, and we have to take responsibility for it.

Justice

Baroness Berger Excerpts

Monday 22nd October 2018 Ministerial Corrections

[Edward Argar]

The right hon. Gentleman is right to highlight again the importance of sport. The report published by Professor Meek in the summer, of which we have accepted 11 of the 12 recommendations, sets out a clear direction of travel—that is, alongside education and developing skills, and provisions for mental and physical health, sport plays a key role for prisoners in the rehabilitative process.

Topical Questions

The following is an extract from topical questions to the Secretary of State for Justice on 9 October 2018.

[Luciana Berger (Liverpool, Wavertree) (Lab/ Co-op)]

T3. Over the conference recess, the inspectorate of probation published a report into the Merseyside community rehabilitation company. The report observes that the approach to reviewing risk of harm is limited, putting vulnerable people in danger. Have Ministers read the report, and what will the Department be doing to ensure that vulnerable people in Liverpool are given the protection that they need?

[Rory Stewart]

We take the report very seriously, as we take all reports, including the recent report on domestic violence. It is absolutely right to say that we need to improve the risk assessment, the programme plans and the frequency of meeting. We are doing a consultation at the moment, to which we invite the hon. Lady to make a submission, on exactly what we can do to tighten up procedures for the CRCs. They have reduced reoffending by 2%, but there is much more that we can do on the quality of delivery.

[Official Report, 9 October 2018, Vol. 647, c. 22.]



Letter of correction from the Minister of State, Ministry of Justice, the hon. Member for Penrith and The Border (Rory Stewart):

An error has been identified in the response that I gave to the hon. Member for Liverpool, Wavertree (Luciana Berger).

The correct response should have been:

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 9th October 2018 Commons Chamber

[Rory Stewart]

This morning, we announced that officers will be able to carry pepper spray on their belts. This is to be used as a last resort, in the same way as a baton would be. It means that if, for example, a prisoner was in the process of stamping on another prisoner’s head, an officer could intervene safely from a distance to resolve the incident and potentially save lives. It is only one measure, along with a dozen other measures that we have to take to improve safety in prisons, but it is an important measure to protect the people who protect us.

[Luciana Berger (Liverpool, Wavertree) (Lab/ Co-op)]

T3. Over the conference recess, the inspectorate of probation published a report on the Merseyside community rehabilitation company. The report observes that the approach to reviewing risk of harm is limited, putting vulnerable people in danger. Have Ministers read the report, and what will the Department be doing to ensure that vulnerable people in Liverpool are given the protection that they need?

[Rory Stewart]

We take the report very seriously, as we take all reports, including the recent report on domestic violence. It is absolutely right to say that we need to improve the risk assessment, the programme plans and the frequency of meeting. We are doing a consultation at the moment, to which we invite the hon. Lady to make a submission, on exactly what we can do to tighten up procedures for the CRCs. They have reduced reoffending by 2%, but there is much more that we can do on the quality of delivery.[Official Report, 22 October 2018, Vol. 648, c. 3MC.]

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 6th March 2018 Commons Chamber

[Rory Stewart]

The hon. Lady is absolutely correct that mental health is at the heart of a lot of these issues. On the concrete steps we are taking, one is the training for 14,000 additional officers and the second is the proper use of the ACCT—assessment, care in custody and teamwork—strategy, which is the process for assessing the risk posed to the prisoner and coming up with a plan to deal with it. We have managed to significantly reduce suicide over the past 18 months, but the level is still far too high. Any death is a great tragedy, and we will continue to work very closely to reduce suicide further.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

Sixty-two years ago, Bessie Braddock, the then MP for Liverpool Exchange division, stood in this Chamber and raised concerns about the appalling conditions at Liverpool Prison—then called Walton Prison—and particularly the treatment of prisoners with mental illness. In the past two years at that very same prison, seven inmates have taken their life, including Tony Paine two weeks ago. I note that the Minister said on 22 February that the conditions at the prison were “very disturbing” and “unacceptable”. What action is he going to take today to ensure that all prisoners’ mental health needs are adequately met and that no other prisoner takes their life in one of our prisons?

[Rory Stewart]

As the hon. Lady mentions, the situation at Liverpool Prison was very disturbing. I have visited Liverpool Prison, and mental health provision is now significantly better than it was at the time of the inspection—I spent quite a lot of time with the mental health staff there—but there is a broader issue. Although we are reducing suicide, there is still far too much of it happening. A lot of this will be about making sure not only that we deal with drugs, but that we have the right kind of purposeful activity in prisons, so that prisoners do not feel the temptation to take their own life.

Oral Answers to Questions

Baroness Berger Excerpts

Tuesday 7th March 2017 Commons Chamber

[Dr Lee]

We are working hard on continuity of care in the transmission of notes from the community into the custodial estate, so that we can improve our pick-up of mental health problems when prisoners arrive. There is ongoing training of staff, so that if mental health symptoms develop within prison they can be spotted and the appropriate care provided.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

When inmates become so acutely unwell that the prison is not equipped to care for them, they should receive appropriate treatment under the Mental Health Acts. In the outside world, this happens within 24 hours; in prisons, the guidelines recommend 14 days. An answer I received to a parliamentary question last year showed that, of 1,141 prisoners, three in four waited more than that two-week window. What action is the Secretary of State taking to rectify this urgent situation?

[Dr Lee]

The hon. Lady is right that access to secure accommodation can be challenging—not only within the prison system but within the community for those who have not committed offences, who cannot always access it within 24 hours. We are in lengthy discussions with the Department of Health on this, because access to secure accommodation in the circumstances the hon. Lady outlines is very important.

Suicide and Self-harm in Prison (England)

Baroness Berger Excerpts

Wednesday 1st March 2017 Westminster Hall

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I beg to move,

That this House has considered rates of suicide and self-harm in prisons in England.

It is a privilege to serve under your chairmanship this morning, Mr Chope. I am pleased to have the opportunity to discuss the record levels of suicide and self-harm in our prisons in this timely debate.

Yesterday, it was announced that prison officers planned to strike today. The reasons they cited were:

“More and more members…being assaulted every day”

and

“the increase in self-inflicted deaths and daily security breaches…as a result of staff shortfalls and budget cuts.”

The industrial action has been blocked by the Secretary of State for Justice, who won an injunction in the High Court, but the serious concerns raised by the Prison Officers Association cannot be ignored. Yesterday, a report from the Institute for Government declared that spending decisions have pushed prisons “beyond breaking point”.

Our criminal justice system rests on the idea that a person who has committed a crime should be punished if necessary and, as a last resort, by the removal of their liberty. By removing a criminal’s freedom, we seek to protect the public from the criminal’s activities for the duration of their time in prison. We also aspire to provide meaningful opportunities for rehabilitation so that on release, the prisoner can rejoin society as a law-abiding citizen.

What we do not do in the United Kingdom, and have not done since 1964, is use the removal of a criminal’s life as a punishment, yet within our modern-day prison system an all-time record number of prisoners are paying for their crimes with their lives. Official data published by the Ministry of Justice on 26 January showed that 119 prisoners died by suicide during 2016—the highest number in a calendar year since current recording practices began in 1978.

Inquest, a charity that monitors deaths in prisons, has reported that already there have been eight recorded self-inflicted deaths in 2017, with a further seven deaths awaiting classification. On average, a prisoner dies by suicide every three days, and 12 women lost their lives through suicide in 2016. The Minister might be tempted to say that the increase in deaths by suicide is a reflection of the increase in the prison population as a whole, but that argument does not stack up when we look at the figures. The number of deaths by suicide has doubled in just five years, yet the size of the prison population, currently standing at a little over 85,000, has plainly not doubled since 2010.

The Minister might be further tempted to suggest that a prisoner who takes their own life in prison might have done the same on the outside, but a self-inflicted death is 8.6 times more likely in prison than in the general population, according to the Howard League for Penal Reform.

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate the hon. Lady on securing this important debate. She has made some excellent points, to which I hope to hear the reply later. Does she agree that a suicide in a hospital would be a very serious issue and that a suicide in prison should be taken no less seriously? Urgent action is needed to reduce suicides that take place on prison premises.

[Luciana Berger]

I thank the hon. Gentleman for his intervention and for his commitment to the issue of mental health. Deaths in prison should be treated no differently from those in any other setting. Issues such as ligature points are contended with very differently in inpatient settings and in prisons. We could point to many things that should be treated in the same way as in any other element of life outside prison.

The number of self-harm incidents has also reached a record high of 37,784, which is up nearly 7,000 on the previous year.

One group that has been uniquely failed by the prison system is transgendered prisoners. There have been four deaths by suicide of transgendered people while in prison over a mere matter of months. That is from an estimated prison population of just 85.

We know that the prevalence of mental health conditions is much higher among the prison population. Prisoners are over three times more likely to suffer from depression, 12 times more likely to suffer from a personality disorder and 16 times more likely to suffer from psychosis.

For prisoners who need to be treated in a mental health inpatient unit, departmental guidance states that transfers under the Mental Health Act 1983 should take place within 14 days. I was appalled to learn from the answer to my written parliamentary question that in 2015-16, 1,141 prisoners—three in four—waited longer than that two-week window. Such ubiquitous failure would never be tolerated in the outside world.

With regard to data on mental health in prisons, it feels like a minefield trying to get hold of figures that give a true representation of the scale of the problems. I cannot help but feel that the Minister and his Department are trying to pull the wool over our eyes. When I resubmitted my question to get the most up-to-date figures, I was told that, in the space of just a few months, the data are now

“not held in the requested format”,

despite the wording of my question being identical. I hope the Minister will tell me why the collection of the data has changed.

When I finished drafting my speech shortly before we began this morning, the Department’s answers to four of my named-day questions were long overdue. The answers would have played a key part in my contribution, but, regretfully, I cannot hold the Government to account fully for them today. Just one example is a question I asked about what proportion of people who died by suicide in prisons were not on the assessment, care in custody and teamwork pathway for people who have been identified as being at risk. In 2015, only 35 of 89 people who died by suicide were on the ACCT pathway, suggesting that too many vulnerable inmates are not being identified early enough. I asked the question again on 31 January—over a month ago—and the Minister’s Department has still not come back to me with that vital information.

Prison should offer a unique opportunity to provide mental health treatment in a secure environment, but the Government are betraying the vulnerable people our criminal justice system is supposed to protect. I met representatives of the Prison Officers Association who told me that, despite having worked in the Prison Service for decades, they had never received any mental health training. A recent Royal College of Psychiatrists forensic faculty survey found that service cuts mean most prison psychiatrists do not feel able to deliver a basic level of care. It is clear that the mental health services in our prisons are buckling. On a recent visit to a local prison, I saw at first hand the lack of care and services available to inmates. A recent consultation by the Centre for Mental Health found that a decrease in prison staff meant inmates often missed psychiatric appointments because there was no one available to escort them, and consequently they could not get the treatment they needed.

This is the stark reality that has been created by decimating staffing levels in prisons. There are 7,000 fewer prison officers than when the coalition Government came to power in 2010. The impacts of such drastic cuts are not trivial. Our prison services are out of control. Assaults in prisons rose by a third in the 12 months to September 2016 and are the highest on record. There was a wave of prison riots in the final weeks of last year, including at Birmingham, Bedford, Swaleside and Lewes. The inconvenient truth for the Minister is that, as things stand, he cannot guarantee the security of anyone who sets foot in our prisons.

Her Majesty’s inspectorate of prisons has found that an increasing number of prisoners report feeling unsafe in prison. Yesterday, we heard the conclusions drawn from an unannounced inspection of HMP Featherstone. We heard that some prisoners felt so unsafe in the prison that they resorted to self-isolation, asking to be locked up for nearly 24 hours a day. In some instances, this had lasted for months.

Nationally, there has been a significant increase in the ratio of prisoners to prison staff. It is not only prisoners who do not feel safe, but hard-working staff who brave the frontline every day, aware that there might simply not be anyone there to back them up if an incident becomes unmanageable.

A couple of weeks ago, BBC’s “Panorama” aired an undercover investigation that was filmed inside HMP Northumberland. I am sure anyone who watched it was, like me, appalled to see the truth about prison life laid bare: pervasive violence; widespread drug use; security systems not fit for purpose—put simply, chaos.

During this debate, it is important to remember that part of the reason this dire situation has arisen is that far too many people have been inappropriately put in prison, when they should be receiving mental health treatment in a secure inpatient unit. There is a need to address how the courts treat people with mental health problems, particularly in respect of community sentences and the inclusion of mental health treatment requirements within those.

I have been raising questions about suicide and self-harm in our prisons for many years, but I was compelled to request this debate because of one particular case, the tragic case of Dean Saunders. He was just 25 years old when he died by his own hand at Chelmsford prison in Essex last year. I had the privilege of meeting Dean’s parents, Mark and Donna, to hear about this tragic case in their own words. Dean was suffering from severe mental illness and had harmed himself and his brother and father as they tried to help him during a paranoid episode. He was charged with attempted murder and sent to prison. His family were told that there he would be safe.

The inquest jury unanimously concluded that Care UK, the private company that ran healthcare at the prison, treated “financial considerations” as a significant reason behind the decision to downgrade him from constant watch to half-hourly observations, despite several warnings that he might harm himself. It said that there were “multiple failings”, including a “complacent” approach to Dean’s mental health. The jury found an assessment of his mental health needs was “not adequately conducted” and concluded that the cause of death was “contributed to by neglect”.

The system failed because of financial cuts in the prison budget, and Mr Saunders paid for it with his life. Despite that damning verdict, Care UK continues to provide healthcare, including mental health services, to more than 22,000 prisoners in many prisons across the UK.

I note that the Justice Secretary has met Mr Saunders’ family, and I welcome that, but Mr Saunders presented a high risk of suicide—he should never have been in a prison in the first place. He needed specialist treatment in a secure mental health facility to protect him, but none was made available.

[Dr Poulter]

Does the hon. Lady agree that one of the problems may well be that people are siloed into being under either the care of forensic psychiatry or that of the prison system? There is very little and very poor interaction between the general mental health system and what goes on in prison, particularly in terms of helping people to receive the adequate care in the community that they need when they leave prison on discharge.

[Luciana Berger]

There have been many reports, inquiries and recommendations that highlight the very point the hon. Gentleman made—reports dating back to 10 years ago. I hope the Minister will reflect in his response on the reports, inquiries and recommendations that have already been put forward and outline what he will do to ensure that that current separation is adequately addressed to prevent situations like this case. What are Ministers going to do to ensure that similar situations to what happened to Dean never happen again?

The shocking and shameful rise in suicide and self-harm is happening on this Government’s watch and the Minister must outline his plan of action today. These are not statistics; they are real human beings—somebody’s father, somebody’s mother, somebody’s daughter or somebody’s son. The Government cannot get away with sweeping this issue under the carpet for a second longer. I note that the Joint Committee on Human Rights is also conducting an inquiry on this issue and I hope that today’s debate might be a precursor to the outcomes of that inquiry.

Last month, in Justice questions, I raised Mr Saunders’ case. The Under-Secretary of State for Justice, the hon. Member for Bracknell (Dr Lee) told me that he was

“seeking the details of all those cases to see whether there is a pattern in why they are happening. I hope to come forward later in the year with suggestions for policy change relating to mental health assessments in prisons.”—[Official Report, 24 January 2017; Vol. 620, c. 156.]

An assessment is not, in and of itself, enough. However, when I sought more details in a written parliamentary question, the Secretary of State’s answer exposed a U-turn on any plans for such an investigation. Although another exploration of data would have been wholly inadequate, it would at least have been something. Now it seems that the Government have no plans in place to confront this crisis.

If the Minister thinks that a further review of the evidence is needed, I am here to disabuse him. If he thinks we need more consultation, I am afraid he is mistaken. Countless inquiries and reports have been conducted, which have a plethora of very practical recommendations to their name. There was the review carried out by Baroness Corston on women and, significantly, the Harris review on self-inflicted deaths of young people, which was the most comprehensive review of suicide in prison and heard directly from bereaved families. Many important recommendations on learning and accountability were put forward, which so far have been rejected.

Families tell us time and again that what they want after a tragedy like this is for no one else to go through a similar experience and for concrete changes to be made. Ultimately, we are seeing the same failings repeated time and again in this pattern of preventable deaths. There is currently a significant accountability gap. Deeds, not words, are what are needed now; a concrete plan of action is necessary, not yet another ministerial speech. I say that in memory of all those who have died by suicide in our prisons. It is unacceptable. We abolished the death penalty half a century ago for very good reason. Now we must ensure that in 2017, no prisoner pays the penalty of their life because of the failure in our prison system. I look forward to the Minister’s response.

--- Later in debate ---

[Mr Gyimah]

We are making the training available to all prisons, and we expect prison governors to ensure that as many of their staff as possible can take it—particularly those who are operating on wings and have direct contact with prisoners. The full training package takes about 1.5 days to complete.

[Luciana Berger]

Will the Minister give way?

[Mr Gyimah]

I would like to make some progress and develop these points. I will perhaps take an intervention later.

We are also making improvements to the assessment, care in custody and teamwork process—the case management process in place in our prisons to support and manage prisoners at risk—and identifying opportunities to make it more effective. That includes changes to relevant training and developing a new self-harm diagnostic tool for use by prison governors and staff, which brings together information for each prison about numbers and types of incident, and where and when in the prison they are happening.

We are also improving infrastructure and partnerships. To support governors and prison staff across the estate, we have put in place specialist roles—regional safer custody leads—in every region to provide advice to prisons and to spread good practice on identifying and supporting prisoners at risk. We are also committed to developing partnerships with others who can help us. In addition to the funding already provided to support the prisoner listener scheme, we will be providing extra funding for the Samaritans to provide targeted support for prison staff and to prisoners directly, including by piloting emotional resilience training for new prisoners, delivered by released ex-listeners.

In the immediate term, a national learning day will be held on 14 March for prison staff on suicide and self-harm. We also strive to continue to learn from others and from completed and ongoing reviews. It is critical that we respond to the independent advisory panel’s ongoing review of women’s self-inflicted deaths. We continue to benefit from individual reviews into deaths in custody by the prisons and probation ombudsman. As hon. Members will have seen, we have introduced the Prisons and Courts Bill, which contains measures to put the ombudsman on to a statutory footing, with powers of entry and requirements on the Secretary of State to publish responses to the ombudsman’s reports. It will give those reports real teeth and will introduce an imperative in the system to follow through the recommendations and ensure that they are implemented. The Bill gives effect to long-standing commitments by successive Governments to give the ombudsman permanent status. I hope that hon. Members will welcome and support the Bill as it progresses through the House.

We will also redouble our efforts to support protective and environmental factors, which evidence tells us reduce risk. We know that strengthening family ties and peer support can support prisoners’ wellbeing and make custody safer. Governors will be held to account for the family services in their prison, and from autumn 2017 the family service budgets will be devolved to governors so that they have flexibility over how they resource family services to best meet the needs of their prisoners. We are also supporting digital developments in prisons, including the roll-out of in-cell telephony, to enable prisoners to call their families more easily and at cheaper rates. We will learn from Lord Farmer’s review to investigate how helping prisoners to engage with their families can support their rehabilitation and provide encouragement.

[Luciana Berger]

rose—

[Mr Gyimah]

The hon. Lady is itching to make an intervention, so I will give way.

[Luciana Berger]

I thank the Minister for very kindly giving way. I can see he is about to conclude, and we still have a few minutes left in the debate. Can I bring him back to two points? First, on the training that may or may not be available to prison staff, I urge him to reflect on the fact that there are people who have served in our Prison Service for decades but have never received any mental health training. It is important that every single one of them receives such training. Secondly, is the Minister’s Department looking at how to reduce risk in prisons, in the same way as we reduce the risks from ligature points in mental health settings?

[Mr Gyimah]

On the hon. Lady’s second question, absolutely yes, we are reducing risk in prisons, in terms of the fabric in cells and so on. In addition to the training and opportunities for prison officers to become better skilled and better able to identify suicide risk and to deal with mental health issues, last week, as she will be aware, we announced a promotion for all band 3 officers—they can get promoted to band 4 and get an additional salary at band 4 if they specialise in certain roles in prison. One of them is specifically to do with safer custody. Therefore, a prison officer today can choose to specialise as a safer custody officer and get paid more to do so. Some 2,000 prison officers across the country could benefit from that increase in pay and from the training that I have outlined.

In the light of the disproportionate number of self-harm incidents among female prisoners, we are exploring ways of improving family links, including overnight visits, family days, child-centred visits, homework clubs and the delivery of relationship and parenting programmes. We are also taking account of evidence that shows that prison environments have a direct impact on prisoners’ wellbeing and rehabilitation, as the hon. Lady rightly pointed out. Our plans for estate transformation include ensuring that prison sites are configured to support prisoners’ access to fresh air, exercise and meaningful activity.

Fundamental to supporting that activity and improving the safety of all those living and working in our prisons will be the recruitment of the additional 2,500 frontline staff we are funding. Extra staff will enable prison officers to conduct new ways of working and transform the culture in our prisons, so that every prison officer is responsible for the supervision and support of about six prisoners. The 1:6 model is in part based on the work of Lord Toby Harris on self-inflicted deaths, which particularly focused on the youth estate. That is why we are introducing the important key worker role.

--- Later in debate ---

[Luciana Berger]

I thank the Minister for very kindly giving way again. Does he accept that those are not additional staff, but merely a replacement of the staff that have already been cut? We have lost more than 7,000 prison officers since 2010. We have only to look at the outcome of the inspection at Northumberland prison to see that there is a very significant issue of prisoners feeling so unsafe that they do not feel able to leave their cells.

[Mr Gyimah]

The 2,500 staff are additional to what we have, so at the end of 2018 we will have 2,500 additional officers. The baseline—the comparison with 2010—is not accurate because, although we lost 7,000 prison officers, we closed down 18 prisons. We are looking at a completely new baseline. However, the most important thing is the one-to-one support from a dedicated officer, which is at the heart of our prison reforms, ensuring that prisoners first and foremost are safe to benefit from the help they need to quit drugs, participate in education and skills programmes and acquire the skills to prepare for life after release.

The hon. Lady asked about the 75% of prisoners—she alleged—who face delays in being transferred to NHS hospitals beyond the 14-day deadline. That is obviously a serious concern, and I will work closely with Department of Health partners to look into it. Health partners are obviously important in supporting prisoners and meeting their physical and mental health needs. In 2015, just to put the statistic out there, there were 1,010 transfer admissions to secure hospitals from prison, but I admit that a lot more needs to be done.

I read the inquest report into the incredibly tragic death of Dean Saunders. Like the hon. Lady, I agree that we are a long way short of where we should be in terms of preventing such self-inflicted deaths. The points I have enumerated today show what we are doing now, and we will come forward with even more detail and further reforms to ensure that we bring down the number of these deaths as much as we possibly can. I look forward to working with the hon. Lady—I will be willing to discuss these issues in detail with her—and with the Saunders family and a number of other families who have lost loved ones in this way.

Motion lapsed (Standing Order No. 10(6)).

Prison Officers Association: Withdrawal from Voluntary Tasks

Baroness Berger Excerpts

Tuesday 28th February 2017 Commons Chamber

[Mr Gyimah]

I will certainly bear that in mind, although the pension deal offered to the POA and prison officers would have been fully funded by the Government.

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

Last year 119 prisoners took their own lives in our prisons—the highest level of suicides on record. The POA instruction urges members to withdraw from ACCT—assessment, care in custody and teamwork. While I have every sympathy with the 7,000 POA prison officers who now face these challenges in our prisons, what impact will that withdrawal have on the already dismal mental health support available in our prisons?

[Mr Gyimah]

As I said earlier, involvement in ACCT processes and ceasing suicide and self-harm are fundamental to a prison officer’s duty. I would encourage and urge all prison officers to carry on with their tasks as they should.