Terminally Ill Adults (End of Life) Bill

Debate between Baroness Finlay of Llandaff and Lord Scriven

Committee stage
Friday 23rd January 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, this group of amendments is about the process of information giving. The lead amendment, Amendment 39A, is about the person having an understanding.

In any process of giving information, there is no point just giving the information: broadcasting it, if you like. You have to check that the person has understood it. Usually, in clinical practice, that is done by asking the patient, “Can you tell me what you have understood from what I have just told you?” That allows the patient to repeat back. Sometimes, you find that they have not understood it at all. Sometimes, you find that they have over-understood and brought in other sources of information, and you can then deal with misinformation that comes in and that might be relevant to them. That process is behind consent. The signing of a consent form is simply verification that the process of handing over and receiving information has happened. It is not the signature that matters, it is the process.

I will deal very briefly with something that came up before lunch—

[Lord Scriven (LD)]

The noble Baroness is absolutely correct that it is the process. In the Bill, there would be two doctors who, after sitting down and discussing with the patient their understanding, have to write an independent report that details the very things that the noble Baroness has noted, which are within the provisions of the Bill, and then goes to the independent commissioner. What is missing in the Bill that would describe the process that the noble Baroness has given that would require extra provision to determine that the two doctors have not just understood that the patient has signed the form but have detailed in the report why they think the patient both has capacity and has given consent?

[Baroness Finlay of Llandaff (CB)]

If I may, I would like to come on to the issue of the information around drugs, because that is key. But I did not want people to think that simply signing the form was adequate.

Withdrawing ventilation, which was raised earlier, is a fundamentally different situation from this. If a patient is on a ventilator, they would have died earlier without that intervention. When they withdraw consent for ventilation to continue, you still have a duty of care towards them. You need to go through all the processes as to what you will do when you withdraw the ventilation and how that will be managed, so the patient understands how long you expect it to take and that they will die without the ventilation. They must understand that they are dying of the disease that they would have died from previously. That is quite different from to the proposal in this Bill about lethal drugs. I will come on to those lethal drugs now.

This has been sold out there to the public as if this is a Hollywood death—as if you take one little tablet and that is the end of it. In evidence to the Select Committee on 22 October, the noble and learned Lord, Lord Falconer, stated that the substance used

“will be safe, efficacious and not cause suffering”.

I would like to know the basis on which he can say that with assurance.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Finlay of Llandaff and Lord Scriven

Committee stage
Friday 16th January 2026 Lords Chamber

[Lord Scriven (LD)]

The fact that somebody has a terminal diagnosis of six months automatically triggers SR1, so that part of the amendment is superfluous. There are things in amendments that automatically happen but which they would put in the Bill, but they do not need to be put in the Bill by the amendments because they already happen.

[Baroness Finlay of Llandaff (CB)]

My Lords—

[Lord Scriven (LD)]

You cannot intervene on an intervention.

[Baroness Finlay of Llandaff (CB)]

I beg your pardon; I am sorry.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Finlay of Llandaff and Lord Scriven

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Scriven (LD)]

The noble Baroness will know that, at present, an 18 to 25 year-old with a terminal diagnosis has the legal capacity to withdraw consent to treatment. Do they go through a different capacity assessment from somebody who is over 25?

[Baroness Finlay of Llandaff (CB)]

I am delighted that the noble Lord has asked me that question, because it reminds me of a patient I had. He was a young man with an advanced testicular tumour and had refused treatment. He was referred to me, and I looked after him for a couple of years, during the time that he became more and more ill with his metastatic disease. He consistently refused treatment. However, when he was moribund, and his parents had come in and were sitting at the bedside, he suddenly asked me, “Is it too late to change my mind and have treatment?” At that point, I was indebted to my local oncologist, who I phoned, and we arranged transfer that day to the Royal Marsden Hospital, which then treated him because that was his wish. My assessment every time I saw him was not to persuade him to have treatment but to allow him to talk about his fears and difficulties. That is the role of specialist palliative care when you are looking after these young people who are very vulnerable. I am simply suggesting that, due to the way the Bill is written, the assessments may not be adequate.

[Lord Scriven (LD)]

I listened to the noble Baroness’s individual case. My question was very specific. Is somebody who is 25 or over given a different mental capacity assessment based on their wish to withdraw treatment from somebody who is 18 to 25? That is the specific question based on what the noble Baroness is now suggesting happens in the Bill.

[Baroness Finlay of Llandaff (CB)]

The issue with the Mental Capacity Act is that each assessment must be done individually. It relates to the decision that is to be made, the size of the decision, the time and the personal characteristics. There is no absolute. If we are talking about safety in relation to the Bill and avoiding abuse, I am simply trying to suggest that one way forward may be to ensure that the assessment of young people’s eligibility is particularly thorough. That may mean having different criteria and looking at whether they have pain or suffering.

Human Medicines (Amendments Relating to Hub and Spoke Dispensing etc.) Regulations 2025

Debate between Baroness Finlay of Llandaff and Lord Scriven

Tuesday 17th June 2025 Grand Committee

[Baroness Finlay of Llandaff (CB)]

My Lords, I am most grateful to the Minister for the comprehensive way in which she introduced this instrument, including how it corresponds with all the documentation that we have. I am glad to see that it applies to Wales; we have many small pharmacies with cross-border flow and many roads going across the border, so this SI will make things much easier.

Like the noble Viscount, Lord Stansgate, I have some questions. I hope that at least some of them will be answered; some of them may need time. One of my concerns is about how the finances of this will work, because pharmacies depend on a dispensing fee. Who will get the fee? Will that be down to local negotiation? Will the fee be split?

However, the principle of freeing up time for the pharmacist to undertake more clinical duties is to be welcomed. They are often the first point of call for patients now. They often know the patient. They spot the person who looks less well and can advise them appropriately. They can also advise on drug side-effects, if a person goes into the pharmacist and asks about new symptoms that they might have.

However, I wondered where the liability sits if there is an error. If I understood right, it would sit with the hub if it were in what is dispensed, but there may be a difference in liability for information given to the patient. One hopes this will never happen, but some of those governance issues need to be thought through in detail.

I note that the pharmacists are already taking impressive extended roles in some areas. For example, there is a scheme in Bristol where pharmacists are taking blood for PSA assessment and reaching a population who would not otherwise present for screening for cancers. If we have pharmacists doing more health screening that would certainly free up GP time. Again, pharmacists will need to be remunerated for that.

I was interested to see that the international evidence is a little variable. Germany, Finland, Belgium and Denmark already using a hub-and-spoke dispensing model but the evidence is not overwhelmingly conclusive. In hospitals, where you have a single large building and a large number of prescriptions, automated pharmacy has in many ways revolutionised the administration of medicines.

One of the concerns is the time lag from a dispensed medicine going from the hub out to the spoke. I hope that will be thought through, so that we do not have patients, perhaps with mobility difficulties, having difficulty getting back to collect their prescription, and that those things will be factored into such arrangements.

Another area that I have a slight concern about relates, not surprisingly, to my own area, palliative care. We know that the availability of controlled drugs is poor at times, yet they are often needed urgently. I hope that consideration has been given as to how the dispensing of controlled drugs in particular can be rapid and efficient, especially when the clinical situation has changed and new medications are required at speed for a patient to be able to remain at home, rather than ending up taking an unnecessary or inappropriate voyage to hospital, with possible admission. Those travel systems also come into it.

The last area that I hope this model will tackle is waste, because there are a lot of things that patients are prescribed but never end up taking. Those of us who have been in a house after someone has died will often have been given several supermarket bags—I will not name the supermarket—full of packs of medicines that have been dispensed. They can be extremely expensive but have not been taken. They cannot be taken back in at the moment and cannot be recycled. The schemes that recycled some of the opioids, such as diamorphine, have not continued over the years. This is an enormous financial waste to the NHS, because some of these medicines have been very expensive.

I hope that this model will free up pharmacists and incentivise them to dissuade patients from accepting prescriptions when they are not actually taking those medicines. I could spend hours relating numerous stories of patients who were either not taking their medicines or giving them to somebody else. I have even once been presented with some children trying to sell me grandmother’s pain relief at the foot of the stairs, which helped me understand why I could not get grandmother’s pain under control. There is a real problem of waste in the system. If this instrument will decrease waste without jeopardising pharmacist’ income from prescribing fees, that would be very welcome.

[Lord Scriven (LD)]

My Lords, I thank the Minister for outlining the purpose behind and need for these regulations.

On these Liberal Democrat Benches, we are of course open to innovation and efficiency in our healthcare system. We recognise the potential for modernising practices to streamline operations, to reduce burdens and, ultimately, to try to improve the delivery of medicines to patients. However, for something as sensitive and fundamental as dispensing medicines, the devil, as always, lies in the detail—as the noble Viscount, Lord Stansgate, and the noble Baroness, Lady Finlay of Llandaff, pointed out—so we must scrutinise these proposed changes with the utmost care.