Terminally Ill Adults (End of Life) Bill

Baroness Fraser of Craigmaddie Excerpts

Friday 23rd January 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

I am grateful to the noble Lord for his intervention, but I think we need to stay focused on the amendments in this group and not get diverted. That is what I am trying to do.

In terms of palliative care provision, I am extremely worried that the amendments put down to the amendments tabled by the noble Lord, Lord Birt, had to be limited because palliative care is repeatedly being deemed out of scope of the Bill. That is a major problem. We hear about bad deaths, but we know that actually, if clinicians act with urgency and have a 24 or 48-hour limit before they call for specialist palliative care intervention—so there is rapid intervention, with highly specialised knowledge—all of the outcome measures show an improvement, using things such as the IPOS scale and so on. Family reported outcomes can also improve. To view bad deaths as something that we should just leave and tolerate, and to say the only solution is the proposal in these amendments, does not recognise the reality of the services that are available already.

In introducing his amendments, the noble Lord quoted extensively from Australia and painted it as everything being perfect. I would like to briefly counter that by quoting the honourable Robert Clark, who was Victoria’s Attorney-General from 2010 to 2014. He has written about the Australian experience of assisted suicide. He describes a change in “attitudes”, with the “ethos” of the medical profession moving away from the practitioner’s primary duty to solve the problems the patient has, and a grave risk that this will lead over time to doctors forming views that a patient ought to be opting for assisted suicide and becoming inclined to regard that patients should go down that road.

He also highlights that there are things going wrong. I will not detain the Committee because of time, but I think there are alternatives. He points out that there are some doctors who, when they have resisted going along with a request for an assisted death, have found their whole careers eventually becoming somewhat blighted. Although there is a clause in the Bill which tries to avoid that, there is concern that that clause is incomplete. So, when we quote international evidence, we also have to be quite balanced in it.

The proposal in the amendments from the noble Lord, Lord Mackinlay, do us a favour, because they demonstrate that this cannot be part of the NHS as it is at the moment. It begins to move us towards viewing some kind of proposal like this being completely outside NHS services but not planted in the NHS. Then, of course, the funding question arises. If funding erodes palliative care funding, which has happened in other places, we really have a problem, because recent evidence to the Public Accounts Committee showed that, if you have specialist palliative care in place and available, as it ought to be, the savings to the country would be about £800 million a year.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I was not intending to stand up today, so I apologise, but this group has not gone at all how I thought it would.

When I looked at Amendment 771 and the proposed assisted dying help service, I was confused. I had thought that navigators might take a similar role to that of independent advocates. We have a group about the importance of independent advocacy, which I am a huge supporter of, and about advising people on other care, health or treatments. That is coming up in 19 groups’ time. But it seems that Amendment 771 is illustrating the flaws of the entire Bill, whether that is geographical provision, training and qualifications, the right of practitioners to withdraw and the need to support vulnerable people.

We have also had a debate today about the funding of the proposed assisted dying help service. We have another group—group 30, which I hope we get to—on the provision of an assisted dying service by groups other than the NHS. I suggest that noble Lords opposite take the suggestion of the noble Baroness, Lady Royall, to press the Government to provide clarity, before we get to that group, on the funding of an assisted dying service and—following the point from the noble Baroness, Lady Finlay—the future funding and support for hospice care.

I have an amendment in that 30th group, which I tabled because I think that the proposers of this Bill have missed a bit of a trick. If you want to set up an assisted dying service, you should do so in parity with the current arrangements for the hospice service. If we understand what the funding for the hospice service will be, we can have our debate in group 30 on alternative provisions.

[Baroness Royall of Blaisdon (Lab)]

I mentioned the future of palliative care. I did not mention the costs of an assisted dying service, which I am very willing to ask for as well, but at that stage I was focusing on palliative care.

[Baroness Fraser of Craigmaddie (Con)]

I thank the noble Baroness for her intervention. I think both would help us, because there is confusion about the future of support for palliative care, and confusion as to whether the funding of an assisted dying service will take away from other services within the current NHS provision.

Finally, I just want to say that it is very different from the Scottish Bill, which very specifically does say that it will be within the NHS.

[Baroness Berger (Lab)]

It may aid the Committee to know that, before Christmas, the Minister in the other place indicated via a Statement that the Government were currently developing a palliative and end-of-life care modern service framework for England, and that it is planned publication date was the spring of this year. In that context, I hope that the Government and the Minister here will hear the calls from people—both those who support the Bill and those who do not—that it would be very helpful to us all in the deliberations on this Bill if the framework, its details and funding were provided to this House as soon as possible.