Terminally Ill Adults (End of Life) Bill

Baroness Grey-Thompson Excerpts

Committee stage
Friday 13th March 2026 Lords Chamber

[Baroness Lawlor (Con)]

My Lords, mine is an amendment to Amendment 552A from the noble Baroness, Lady Hollins, which itself is an amendment to Amendment 552 from the noble Baroness, Lady Finlay. I think that this is a very good group of amendments: they avoid the potential conflict of interest about which we have heard and they make things clear in law. To answer the noble Baronesses, Lady Murphy and Lady Jay, I prefer a law made in this House to one made by the gentleman in Whitehall down the line. I shall speak to these two amendments, to which mine is a further amendment.

Amendment 552 would require that the provision of lethal substances through pharmacies is restricted to a limited number of designated pharmacies. The substance is documented, kept under lock and key and, when unused, disposed of safely. Amendment 552A from the noble Baroness, Lady Hollins, which she introduced so well, would restrict the pharmacies further to only dispensing and storing the drug, not preparing it on the premises, under MHRA rules. My amendment would prohibit pharmacies from stockpiling or storing any quantity of lethal substance in the pharmacy: it must be ordered on a case-by-case basis.

At present, the Bill has no chain of custody for the secure storage of these lethal drugs, even though some that we know are used for assisted dying, such as benzodiazepine, have a black-market use. The measures in these three amendments go some way to addressing this problem of secure storage. I draw particular attention to the role of the Medicines and Healthcare products Regulatory Agency, the MHRA, specified by Amendment 552A from the noble Baroness, Lady Hollins. It is the body that regulates, licenses, inspects and enforces the rules for pharmacies and manufacturers, on which I have a later amendment to Clause 37. Under this body, there is an existing legal framework for looking after drugs when they go to pharmacies—the 2012 regulations outlining the legal framework for distribution and storage and the directive to prevent counterfeit medicines from entering the supply chain.

Even the tightest regulatory system is not foolproof, so other safeguards are needed to protect against theft from the premises and to ensure security so that the drug is not counterfeited. The MRHA had a great victory last month in seizing thousands of counterfeit anti-fat drugs, the drugs that people take to help them to slim. That was a very good operation which turned up trumps, linking a Lincolnshire raid on an illicit drug-making factory to one in Nottingham. The MRHA works with the police. It can seize, check and license. However, we need even greater security, because of thefts from pharmacies, a known address, and it would be better to limit the storage of these lethal substances in the pharmacies to those ordered on a case-by-case basis. Do not tell me that this does not happen now: if I have to go to Boots for a prescription, sometimes they have to order it. In the matter of assisted suicide, if there is a delay, that may help the patient to reflect further and perhaps have a second opinion.

[Baroness Grey-Thompson (CB)]

My Lords, I shall speak to two amendments in this group, Amendments 701 and 703. The noble Lord, Lord Murray of Blidworth, raised some very valid points in the earlier group on local variation. The method that my noble friend Lady Finlay has raised seeks to address some of the issues that many of us have with the Bill, in terms of having a centralised process. We need to find a way to avoid doctor shopping. The reality is that medical issues, legal issues, social issues and economic issues are not separate; they all intertwine with each other. What my noble friend has suggested is a clearer process and fills some of the gap, because there are problems with reporting in the Bill as it stands and there needs to be strict data collection. The commissioner cannot report what the commissioner does not know, and Parliament can regulate only through reporting requirements.

The noble Lord, Lord Deben, spoke about palliative care professionals. They are one of the groups that have consistently raised concerns about this Bill. We had an interesting debate about whether we should have a service separate from the NHS. It would be my preference to have something unconnected. That does not mean that doctors caring for patients cannot communicate and still provide care for somebody who wants to enter this process, but we have to think about the possibility that there may be some doctors who, for various conscientious reasons of objection, may not want to have this conversation with a doctor.

My amendments are looking at clinical trials for the drugs and the regulation of approved substances. I would be interested in the noble and learned Lord’s opinion. I recognise why a clinical trial for these drugs would be very difficult, but there may be cases where people who want to request assisted suicide would be willing to have an enhanced level of study to understand how these drugs work on a patient. It is important that we understand what drugs are going to be used. In different jurisdictions around the world, there are very different combinations, often referred to as a cocktail. In effect, the patient is being given a massive overdose, because we do not know enough about how these drugs work.

--- Later in debate ---

Moved by

[Baroness Grey-Thompson]

149: Clause 5, page 3, line 5, at end insert—
“(A1) No registered medical practitioner may raise the subject of provision of assistance—(a) within 48 hours of a terminal diagnosis;(b) until a multi-agency assessment to identify the patient’s current support needs since diagnosis has occurred;(c) unless the necessary steps have been taken to meet the needs of the individual and both the assessment of and support for this is fully funded.”

[Baroness Grey-Thompson (CB)]

My Lords, the purpose of my amendments in this group is to ensure that all patients’ needs are taken into account and support is given so that people have a genuine choice. I am delighted that my noble friend Lady Campbell of Surbiton will speak to this group. Amendment 149 would ensure that the subject of assisted suicide is not raised within 48 hours of a terminal diagnosis. Perhaps this should be considered a cooling-off period. I have been with someone when they received a devastating diagnosis that they were dreading. They had not considered assisted suicide, but neither of us heard much after initially being told.

This is about a timing issue that could be seen to be a power imbalance or an implied endorsement. Options need to be very carefully discussed. If discussed straight away, treatments might seem so awful that assisted suicide is considered the best option. It might be quicker or easier to talk about this than a complex set of treatment options. To give patients choice, a multi-agency team assessment should take place to identify current support needs and ensure that steps are being taken to meet those needs.

This amendment would also offer some protection to doctors. If the conversation is discretionary, there may be a difficult legal dilemma: if it is raised at the initial consultation, it might be seen to be implicit coercion, but if doctors fail to raise it, that might be considered blocking access. There was a case in South Australia, mentioned in the Voluntary Assisted Dying (Voluntary Assisted Dying Board Annual Report 2022-23). Siblings said that, when they were with their relation, who was given VAD, it was the only time that doctors had shown empathy or understanding. The Medical Defence Union, which supports 200,000 healthcare professionals, is deeply concerned about the appropriate time to raise the subject.

This leads us into a grey area of suicide ideation. We fund suicide prevention; we do as much as we can to prevent someone dying by suicide. This Bill could lead to unforeseen consequences. As previously debated, it does not guarantee a quick or painless death, and if this process exists, the rate of suicide may even rise, as has happened in Australia in the over-65 age group.

There is also an assumption that if a terminal diagnosis is given, the process will be entered into, which might not be the case. ONS data from 2022 shows that people with terminal conditions can feel suicidal. One year after diagnosis for low-survival cancers or COPD, the suicide rate for patients was 2.4 times higher than the suicide rate for the matched controls. One year after diagnosis for chronic ischemic heart conditions, the suicide rate for patients was nearly two times higher than for the matched controls.

In oral evidence, Dr Price said that, of those who would qualify under the Bill,

“around 20% will have diagnosable depression, around 10% will have a wish to hasten death, and around 4% will have a more persistent wish to hasten death”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee 30/1/25; col. 270.]

She added:

“Those who had a wish to hasten death were 18 times more likely to also feel suicidal”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee 30/1/25; col. 276.]


The Royal College of Psychiatrists has raised issues, stating that doctors do not know how to assess the presence of depression. In a large-scale survey of professionals in England and Wales, co-authored by Professor Gareth Owen in 2021, only 6.9% of non-psychiatric doctors rated themselves as assessing capacity “very well”. When Fazilet Hadi from Disability Rights UK gave evidence, she said:

“We often find that doctors, because they cannot treat or cure us, do devalue our lives”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee 29/1/25; col. 180.]


She was referring to disabled people.

The VAD review board of the Australian state of Victoria says that doctor initiation might be the reason for increased take-up. Previously, there was a prohibition on doctors raising it, but that gagging clause has now been removed. A JAMA Psychiatry paper from 2019 also highlighted the heightened risk during the first week after diagnosis. It said:

“Clinically, our results identify specific cancers associated with significantly elevated risk of suicide”.


The combined literature suggests that the first week after diagnosis has the highest risk for suicide, and it falls thereafter. It therefore makes sense that those who have received a shock terminal diagnosis are most vulnerable and suggestible and may have low self-worth. Macmillan Cancer Support recommends a holistic needs assessment as part of cancer care. The Bill will be better for having this assessment built in and will lead to more patient-centred care. It is impossible to have true agency when only one realistic choice is offered. That is why it is crucial that the patient’s current support needs are identified after diagnosis.

I strongly support Amendment 155 in the name of the noble Baroness, Lady Keeley. I feel very strongly that patients should be able to discuss their diagnosis and treatment with no fear of potentially being encouraged or having this process suggested to them.

On Amendment 176, we have covered complications before. The noble and learned Lord said in the Chamber that a discussion should take place before the first set of drugs are taken, and, if they do not work, the patient can choose to take a second dose of poison. But what is there to protect the doctor? Will the wishes be written down or witnessed? What should the doctors do if the drugs do not work? Should the doctor have a second dose with them? Will it be a doctor or, perhaps, a physician assistant? Is euthanasia the next step? It could be seen to be the next logical step in expansion. If one or two bad deaths are recorded, we might be told that we need to be more compassionate, and this is the best way to go.

In Hawaii, a doctor allegedly completed the death of a patient after the woman began choking; it was reported in the Honolulu Star-Advertiser. That doctor was charged with second-degree murder. Legally, a patient needs to know the effect of the drugs. Clause 12(2) refers to the need to discuss the complications, but we cannot play down the risks. Data from Oregon from between 2012 and 2022 showed a complication rate of 11%. In the Netherlands, in one-third of cases it takes up to 30 hours for a patient to die. As I have said before, assisted suicide is often represented as painless and quick, allowing for a calm and meaningful goodbye, but the reality from cases around the world shows that it can be far from this. The case of Kurt from Colorado has been raised previously by my noble friend Lady Finlay.

There has been much said in this Chamber about the importance of words, and I strongly believe that the word treatment does not cover what we are talking about. Using “treatment” to mean a lethal mixture of drugs intended to end life is clearly an attempt to soften the blow of reality. That is why people are not aware of the frequency of complications, and of the need to know the wishes of the patient in the event of complications.

My Amendment 200 is very similar to Amendment 149— it just seeks to amend a different part of the Bill. Briefly, I will talk to Amendment 200A and the unique context around the preliminary discussion, because failure to comply with regulations is appropriately treated as misconduct and subject to existing disciplinary procedures. I know that the noble and learned Lord is not keen to ask someone why they would want an assisted suicide, but I think the question should be asked. People do not need to answer, but we need to ask, to understand the process and look at whether there are other ways that we can improve our health service.

In Victoria, in 2023, the reasons for accessing VAD were not recorded, so the nature and source of the suffering—which is a clear criterion for access to VAD—is not known. This information could help us improve legislation in the future, or close gaps. The impact evaluation of VAD is undertaken by researchers funded by time-competitive grants, which means the results can be piecemeal and the data not always accurate. In 2023-24, 10 doctors with the highest VAD caseloads consulted on 55% of all VAD cases. In Australia, the VAD substance is often taken in the absence of a health professional, and there are no specific requirements or procedures for gathering or publishing information, including on whether complications have occurred.

Turning to my Amendments 207 and 207A, I have previously quoted Tommy Jessop and his concerns for people with Down syndrome. People with Down syndrome put great store in people in positions of trust around them, and the Learning From Lives and Deaths report that was published in January 2026 discussed some of the challenges. The proportion of deaths of people with learning disabilities classified as avoidable was 40.2% in 2023; it was 21.8% for the general population in 2022, so the figure is almost double. That demonstrates that there are problems in healthcare for people with learning disabilities. Some 72.7% of adults with learning disabilities who died in 2023 were reported to have received the reasonable adjustments they required when they accessed care, but conversely, 27.3% were reported to have needed at least one reasonable adjustment that they were not provided with.

There are already deficiencies in our system, and disabled people are discouraged by ableist attitudes in our culture. In 2024, Autism Alliance UK reported that 91% of autistic people feel that society does not accept them, or only sometimes accepts them. That is the reason why my amendments would widen the definition, so that we should be looking to support from a “guardian, or independent person”. Many families are loving and caring, but we have to recognise that some are not, and we should ensure that people have the right protection and support around them. I beg to move.

[Lord Weir of Ballyholme (DUP)]

My Lords, I will speak to my amendment in this group, Amendment 200B. It would insert a new clause to say that care professionals are not permitted to raise the subject of assistance. For the avoidance of doubt, the proposed new clause says that anyone who is engaged in patient care may not

“raise, suggest, encourage or initiate consideration of the subject of the provision of assistance under this Act”.

There are four main reasons why I have tabled this amendment. First, it would give clarity and absolute legal certainty to those in the medical profession and to care professionals regarding the initiation of discussion of the subject. We know that other parts of the Bill set out a clear position on what actions will be taken by medical professionals when it comes to the administration of the assisted death, but it is important that we have a clear legal position when it comes to the front end of the process. That is not simply to give assurance that there is clarity in the law; I think it would give comfort and certainty to anyone who is involved in the care profession. If I were a care professional, I would want to know with certainty what I am entitled to do and not entitled to do. My amendment would give a level of support to those people.

Secondly, the amendment is very much in the spirit of trying to create a distinction between healthcare and the provision of assisted death. A concern has been raised on a number of occasions in this Committee about the extent to which assisted death will alter the perception of the National Health Service and its mission statement. This amendment in and of itself would not solve all those problems, but at least it would go some way to having a level of protection for the National Health Service, which is very much the jewel in the crown of this society. It was created through probably the most significant legislation that a Labour Government ever put through, and it is important that we look at the implications of this.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

A whole range of issues is covered to a large extent by the Online Safety Act in relation to the promotion of suicide, particularly to young people. That, in a way, is a separate issue from this issue. I fully encourage and support all attempts to try to reduce the risks to young people, but I am afraid that the Bill cannot take that on, on its own.

[Baroness Grey-Thompson (CB)]

My Lords, I thank all those who have contributed to the debate on this group of amendments on raising AS in conversation and preliminary discussion, including training.

I thank the Minister for her response to my amendments. However, given the government response and the question about funding, it lays open the bigger question of the whole Bill that many of us are grappling with: who pays for this and what that final bill may be.

The debate has gone in a slightly different direction from what I expected. It is interesting that the noble and learned Lord, Lord Falconer, differentiated in his response between non-disabled and disabled people. Independent advocates will come up in a later group, but I think it is really important that it is understood, as part of this group, when we are talking about learning disabilities, that it may be very difficult for someone with a learning disability to understand what an independent advocate is and what their role is. They may say that they do not need it but not really understand what they are saying yes or no to. We will cover that next week.

I am slightly worried that there may or may not be guidance from the GMC and/or the Secretary of State. I will be very interested to discuss that with the noble and learned Lord away from this Chamber. This is where we probably disagree. Those who support this Bill will talk about Victoria and say that it gives greater access; I say it is a slippery slope and that it is making it easier for a wider group of people to enter this process. We have covered in previous amendments the use of language. “Person with a disability” is not used in the Equality Act. I had hoped, through my contributions to previous debates, that there was some understanding of it and why organisations of and for disabled people are worried about this Bill. It is not just about the contents of the Bill; it is about the language of the Bill. Organisations of and for disabled people use the social model. I will not go through that again, but the language they choose to use is “disabled people”.

The noble Lord, Lord Weir, has apologised for having to leave, but he raised the issue of how disabled people are treated. I am going to raise a difficult question, not to anyone in particular but to the whole Chamber. It is rhetorical. How many in your Lordships’ Chamber have ever felt sorry for me because I am a wheelchair user? My previous career as an athlete negated some of that feeling because, if you like sport, competing for Great Britain is a privilege: of course it is. In my second career, however, I consider the way that I am treated every single week. I am a long way from my sporting career now but, if I am rushing to a meeting, I luckily do not hear “It is not a race” too often these days. I know: I am not in my racing chair and I am not wearing Lycra. I am not sure sometimes, when people say this, whether they think they are being kind, sweet or funny. I did not have a traumatic or dramatic accident; I was a wheelchair user from a very young age. There were a few points in my life when I had three spinal surgeries and experienced terrible pain, but I am healthy.

The noble Lord, Lord Weir, raised the different views that doctors have of people. I have said before that my husband had a traumatic accident at 21. He broke his back and spent nine months in hospital. Many people assumed that it irreparably changed his life. It did not. He went on to complete his PhD. He changed sports; he went from cycling to wheelchair racing and he met me. But the way that he was and is treated is very different depending on whether he is walking with his crutches or is occasionally using a wheelchair. If he is walking, people like to think that he has had a skiing accident or something quite cool but, when he is in his wheelchair, people talk down to him. His colleagues have completely forgotten that he has a PhD and have talked to him differently.

He had a stroke in 2020 and I was really worried about him going into hospital because I was not sure of the outcome. I had calls with doctors telling me about the impact of the stroke. The noble and learned Lord talks about doctors needing to know all the information. It was really clear in his patient notes that he had a spinal cord injury, but the doctors rang to tell me that both of his legs were really badly affected, and I was saying, “Well, that would be the spinal cord injury”. They then told me that his grip strength was really good. Well, 30 years of doing wheelchair racing and cycling and walking with crutches would make that happen; they had no idea what his grip strength was like before he had the stroke. So the information they were giving both of us was not very helpful at all.

All our experience of healthcare is very different. I had a doctor in a spinal unit ask me, “How did you catch spina bifida?” I laughed. I have been asked it several times. I think the first time was when I was in my early 20s, and I said I had caught it with a butterfly net—humour does not always go down very well, either in the Chamber or outside. I was really shocked that a doctor in a spinal unit was asking me how I caught a congenital disability. Because of my scoliosis, my internal organs are all in rather strange places in my body. Every time I go to the hospital for a kidney scan, I am asked, “Do you have one kidney?” I say, “I have two kidneys; look at the notes”. “Are you sure?” “Yes. I haven’t had an operation to remove one of my kidneys”. Every time you are measuring what you say because you do not want to offend doctors and you do not want to be rude or flippant. I sit there and say, “I have two kidneys. My right kidney is somewhere up under my arm”. “It can’t be there”. “Look at my notes”. Eventually, they find my kidney somewhere up underneath my right arm.

This is the frustration that disabled people feel. It is lovely to say that doctors will read all the notes and understand them, but actually something as basic as “I have two kidneys” is often misunderstood. So I challenge your Lordships’ Chamber. Have you ever pitied me? Do you think I am brave? Do you ever think, “Well, at least it’s not me?” Am I brave as a wheelchair user or brave because I was an athlete? How many people consider that, because of my impairment, I suffer? I apologise for sighing when the noble and learned Lord talked about the suffering of disabled people. My phone started pinging. I cannot read out any of the responses or the messages I have had on that, as all the language is unparliamentary. This is why disabled people are scared. The assumption is that we suffer. I do not suffer.

Disabled people are worried. That is why they are fighting this Bill. It is not kind, it is not sweet, it is not being understanding, it is not being compassionate. We are constantly having to try to fit into a version, an idea, of what non-disabled people think of us. If we dare challenge that, we have a chip on our shoulder, and we are one of those funny disabled people who just do not understand that we are meant to deal with people being kind to us. We have to deal with being patted on the head, literally and figuratively. It once happened to me in this building. It was a Peer who did it to me. I was with colleague who was a wheelchair user and we were chatting about a Bill that we were working on. The Peer came up to us and said, “Are you having a nice time?”—in that tone. We said, “Yes, actually, we’re debating the Bill that we’re working on at the moment”. The Peer ruffled my hair. This is patronising. This is ableist. It is not kind. How does the noble and learned Lord assume that people like me “suffer”? I am really squeamish about the word. So many people are frightened because of the assumptions that are constantly made. I want to take my challenge further. How do you see disabled people who might be on the streets? Are we deserving and undeserving disabled people? That happens between Paralympians and non-Paralympians.

My noble friend Lady Campbell of Surbiton talked about DNRs being put on healthy disabled people. By virtue of how people who speak remotely are able to contribute, my noble friend and the noble Lord, Lord Shinkwin, were not able to come back into the debate. My noble friend wanted to make it clear that she has to rely on doctors for everything in terms of her well-being. We put huge trust in those people. My noble friend has been in hospital many times, and it is important to listen to her experience of what it is like. I will keep raising this in terms of how I am able to contribute in debates. I can sit in one place—well, three places—in the Chamber. I cannot sit with my colleagues. Those speaking remotely cannot come back and ask questions. There was one time in the time that I have been here when five wheelchair users wanted to speak in a debate. We had to tag-team in and out of the Chamber. How many other noble colleagues have had to do that?

My noble friend Lady Campbell wanted to reiterate the unequal nature of the system. She also wanted to draw attention to a BMA survey looking at doctors and medical students who are disabled or have long-term health conditions. It was published on 3 December 2025. The author, Natasha Wilcock, is deaf. It raised the ableism that exists in that profession. The assumption is that the barriers are from patients, but actually there are deep-rooted issues in the experience of doctors who are disabled. A huge amount of prejudice comes from other doctors.

The noble Lord, Lord Shinkwin, again, was not able to come back in, but he wanted to raise a couple of points. He asked me to say that the noble and learned Lord did not answer any of his questions and that he would be happy if he could write to him.

If you treat your disabled colleagues with prejudice and contempt—sorry, I am again referring to the BMA survey—how do doctors treat disabled patients? The equity of treatment of staff and of patients is inextricably linked.

Crime and Policing Bill

Baroness Grey-Thompson Excerpts

Report stage
Monday 2nd March 2026 Lords Chamber

Moved by

[Baroness Grey-Thompson]

240: Clause 77, page 104, line 13, leave out from first “relevant” to end of line 14 and insert “local authority.”

[Baroness Grey-Thompson (CB)]

My Lords, I have a number of amendments in this group: Amendments 240, 241, 242, 243, 244, 245, 246, 247, 248B, 263 and 265. I have also added my name to Amendments 257 and 264, tabled by the noble Lord, Lord Polak, which I strongly support. Unfortunately, the noble Lord is not able to be in his place today, but I share his concerns about protecting children from harm. These two amendments seek to fill the gap caused by Clause 84, which was raised in Committee, and I believe they are proportionate. The current clause does not cover a multitude of ways in which reports of abuse can be concealed, and it allows many who intentionally conceal to slip through the net.

Clause 84 is triggered only when the person acting to conceal abuse does so by blocking or deterring someone under the new duty from making a report, so the two amendments seek to strengthen what is currently there. It is broader than the current clause, which we believe currently means that it would be a two-tier system. I am not sure how we can justify an offence that would criminalise a teacher but not a religious leader.

Many of the amendments in my name were taken from my Private Member’s Bill on this, but I took some time to consider what should be a priority, and those are Amendments 246 and 248B. For clarity, I will not be seeking to divide on any others in my name in the group, but I would be interested to hear the Minister’s views on Amendments 246 and 248B.

Like others, I have been working on this issue for a number of years. In 2015 the then Sports Minister, Tracey Crouch, asked me to author a report on duty of care in sport. Mandatory reporting was high on the list of issues that needed to be resolved, the other being positions of trust, where the loophole has now partially been closed.

Coaches and volunteers have very positive relationships with young people. These amendments are not to overburden them but to offer protection. Individuals may be worried about reporting so they need more guidance, and a framework of law will do that. No one wants to get it wrong, and we have to be mindful that there may be some malicious reporting.

As a young athlete in my early 20s, I witnessed inappropriate behaviour by a coach—nothing that I could quite put my finger on. You could argue that it was another time when less was known, but we are now seeing a number of historic cases. When I was a young athlete, there was no framework, policy or procedure to be able to raise it. I did not quite have the words to express what I saw, I did not have evidence, I did not witness abuse and there was no direct disclosure, but what I was trying to explain might have triggered greater awareness of this behaviour. I did not know what I now know. Years later, that coach was charged with historic offences in the 1970s and sentenced to seven and a half years in jail.

When the Independent Inquiry into Child Sexual Abuse was announced, I expected much movement. In March 2020 the Office for National Statistics estimated that 3.1 million adults in England and Wales experienced sexual abuse before the age of 16. IICSA concluded that child sexual abuse was endemic and permeated all sections of society, and it estimated that more than one in six girls and one in 20 boys have been sexually abused in the UK every year. On average, it takes victims 26 years to disclose abuse.

The IICSA report is quoted in the equality impact assessment saying that current arrangements are confusing, unfocused and ineffective. The Local Government Association estimates that only one in three children who are sexually abused by an adult tell someone. According to the Centre for Crime and Justice Studies, it is estimated that 85% of child sexual abuse goes undetected and unreported. Our system is failing the victims of child sexual abuse, and changes need to be made.

I do not believe that His Majesty’s Government’s proposals go far enough and may make the public think that the IICSA mandatory reporting recommendations are being acted on. I do not believe it will make enough of a difference. The key item in the equality impact assessment is table 1 in paragraph 31, on page 9. Given that the Children’s Commissioner for England estimated in 2015 that only one in eight cases of abuse comes to the attention of the authorities, an increase in reports of 0.3% would bring the proportion of unreported cases from 87.5% all the way down to 87.46%. An increase of 0.3% in the numbers of reports would bring the proportion of reported abuse up from 12.5% to 12.54%.

I will not attempt to pre-guess what the Minister might say, but I am imagining a response that it might stop adults wanting to work with children. That is why I looked at Amendment 246, which would make non-reporting a criminal offence. This was recommended by IICSA to provide for defences in situations where there is reasonable doubt concerning the grounds for suspicion. There are criminal sanctions in many countries—Australia, Croatia, Canada, France and most US states.

It has been a pleasure to work on this issue with the honourable Member for North West Cambridgeshire, Sam Carling MP, who wrote the brilliant Amendment 248B. He also has an adjournment debate tonight on this very topic, and I look forward to that. I thank him for venturing down to our end of the building to sit and listen to this debate. I think both of us would prefer a criminal offence, but I am trying to be pragmatic. The proposed new clause in Amendment 248B seeks to ensure that civil sanctions can be imposed for failure to comply with the duty to report suspected child sex offences. Sam Carling has met the NSPCC, the Lucy Faithfull Foundation and the Centre of Expertise on Child Sexual Abuse, which all want to see His Majesty’s Government criminalise the intentional concealment of abuse. He has also met a number of other organisations.

The NSPCC is deeply concerned that the professional sanctions proposed by the Government as the only consequence of non-compliance are not enough. While not wanting sanctions that would lead to a criminal record, it very much wants stronger civil sanctions, including potential fines. Based on these conversations, Sam’s amendment, which I have tabled, describes how civil sanctions would work based on Home Office fine-issuing powers in the Immigration, Asylum and Nationality Act.

The NSPCC said:

“The use of civil sanctions for failing to make a report under the mandatory duty is supported by the NSPCC. It is their belief that civil and professional sanctions strike the right balance between giving this duty the teeth it needs to ensure compliance, and also framing it as a tool meant to uplift and empower our child protection workforce and volunteers”.


The NSPCC feels strongly that the mandatory reporting duty should include reasonable suspicion as a trigger.

Further, two of the IICSA panel members, Sir Malcolm Evans and Ivor Frank, wrote to the Home Secretary on Friday urging her to change course on these issues. They are concerned that the only sanction proposed for the failure to report child sexual abuse under the duty in this Bill is a referral to the Disclosure and Barring Service. They said:

“This falls far below what was recommended. Many of the organisations which our report criticised for failing to safeguard children from abuse rely extensively on volunteers who are often not DBS checked or regulated … DBS referral is already a requirement for regulated activity providers when it comes to those believed to pose a risk to children, and it is a criminal offence to fail to do so. We are therefore calling on the Government to, at the very least, implement stronger civil sanctions for failure to comply with the duty”.


They reported no evidence of the “chilling effect” that would discourage people from wanting to work with children. It simply is not there. They go on to urge His Majesty’s Government to strengthen the duty in the Bill to better deliver on the promises they have repeatedly made to implement IICSA.

My final point is about Amendment 262, which is not in my name but in those of the noble Baronesses, Lady Walmsley and Lady Brinton. If they seek to divide the House, I would very strongly support their amendments as well. I beg to move.

[Baroness Walmsley (LD)]

My Lords, I apologise to the noble Baroness, Lady Grey-Thompson, for missing the beginning of her speech on Amendment 240. However, I have checked with the clerk and I believe it is in order that I speak to my amendments in this group.

Since this is Report, I will not repeat the arguments I made on these and similar amendments in Committee. I will describe what each of my four amendments does and pray in aid not only the final report of the Independent Inquiry into Child Sexual Abuse but a letter, which I will quote from, that members of the board of IICSA wrote to the Home Secretary on Friday last. Having spent seven years hearing evidence about CSA and the reasons why it has been hidden, and having reported in 2022, they were very disappointed when this Bill was published, and even more disappointed when they heard the Minister’s rejection of the measures in these amendments in Committee.

--- Later in debate ---

[Lord Hanson of Flint (Lab)]

As I said to noble Lords who raised the issue, we will look at and respond to the letter from the IICSA members, but I have not seen it, I have not got it in front of me and I am not going to respond to it today, even if it is passed to me, because I have to have some collective discussion with colleagues about the points that are raised. I just say to my noble friend that what the Government have tried to do since 4 July 2025—again, I pray in aid the statement, if he has not looked at it, of 9 April 2025 —is to meet the objectives of IICSA as far as we can. We have met an awful lot of the objectives that have been set, and they are before the House in the legislation today.

[Baroness Grey-Thompson (CB)]

I apologise that the Minister has not seen the letter. If I had realised that he had not seen it, I would have made sure he did. I recognise that it is difficult for him to respond to a letter that he has not seen. Will the Minister make a commitment at the Dispatch Box that, if I do not move Amendment 248B, we will be able to have a discussion and I will be able to bring the amendment back at Third Reading, if we are not able to find a suitable route through?

[Lord Hanson of Flint (Lab)]

I always try to be helpful, if I can. I do not want to have amendments at Third Reading, and therefore I cannot help the noble Baroness with that request. As I say, I have not seen the letter. It is in the ether of the Home Office system. It has arrived, so it will be acknowledged and responded to. But it was issued only on Friday, as the noble Baroness mentioned; to be fair to the Home Office, that is an issue that we will have to look at. Obviously, we will respond to that letter. I will make sure that both the noble Baronesses, Lady Walmsley and Lady Grey-Thompson, have the response, if appropriate, because they have raised it today. I will check with IICSA that it is happy for me to do so—that is important.

The further amendments in the names of the noble Lord, Lord Polak, and the noble Baroness, Lady Grey-Thompson, and Amendment 248A in the name of the noble Baroness, Lady Walmsley, also seek to supplement or remove the criminal offence of preventing a reporter carrying out their duty. Amendments 264 and 248A would provide for proposed thresholds that, again, I cannot accept. The proposed thresholds—when a person “suspects” abuse has taken place, even if that suspicion is poorly founded, the alleged offence never occurred or the relevant concealment actions had no actual effect—are far broader, and harder to justify or prosecute, than interference with a well-known statutory duty. The Government’s preferred model for this type of offence is narrowly targeted, purpose driven and clearly aligned.

On Amendment 265 in the name of the noble Baroness, Lady Grey-Thompson, on protection for reporters, the Public Interest Disclosure Act 1998 already provides a legal framework for protecting child abuse whistleblowers from dismissal, victimisation or other workplace detriments. Attempting to legislate against, for example, social shunning, reputational harm or informal exclusion would pose significant legal and practical problems.

This Government have progressed the recommendations on IICSA in a significant way since 4 July 2024 when we took office—the House may disagree; that is a matter for the House to take a view on. Beforehand, there was a significant gap of inactivity for a range of reasons that I will not talk about today. We have put potential measures in the Bill, and we have made, through a range of other measures to which I referred earlier, a significant amount of progress on these issues.

I accept that there may be issues that are still being pressed, but the progress that has been made is significant. Therefore, I ask the noble Baroness, Lady Grey-Thompson, to withdraw her amendment and I invite the House to support the government amendments I introduced earlier.

[Baroness Grey-Thompson (CB)]

My Lords, I thank everyone who has taken part in this short debate. I am glad that the noble Baroness, Lady Walmsley, was able to speak. She has worked extensively in this area for decades, and I have leant heavily on her expertise. The noble Baroness, Lady Brinton, makes the strongest point on the unusual nature of a board writing to the Home Secretary. As I previously said, I am sorry that the Minister has not been able to see that. On page 1 of the letter, paragraph 2 says:

“we are deeply concerned that the mandatory reporting duty, as currently drafted in the Crime and Policing Bill, does not fully reflect our recommendation. In particular, there is: a lack of appropriate sanction for failure to report; an insufficient definition of who should be a mandated reporter; and a narrow trigger for the duty that does not include reasonable suspicion and recognised indicators of abuse”.

I go with the opinion of Sir Malcolm Evans and Ivor Frank and, as much as this Government have moved things on, they have not moved things on far enough. While I am happy not to press my Amendments 240 to 246, when it is called I will seek to divide the House on Amendment 248B.

Amendment 240 withdrawn.

--- Later in debate ---

Moved by

[Baroness Grey-Thompson]

248B: After Clause 77, insert the following new Clause—
“Penalty for failure to uphold duty to report suspected child sex offences(1) The Secretary of State may give a person who acts contrary to section 77 (duty to report suspected child sex offences) a notice requiring them to pay a penalty of a specified amount not exceeding the prescribed maximum.(2) The Secretary of State must issue, and from time to time revise and re-issue, a code of practice specifying factors to be considered by them in determining the amount of a penalty imposed under this section, as well as factors which they will use to assess if the issuance of a penalty would be in the public interest.(3) A penalty notice must—(a) state why the Secretary of State thinks the person is liable to the penalty,(b) state the amount of the penalty,(c) specify a date, at least 28 days after the date specified in the notice as the date on which it is given, before which the penalty must be paid,(d) specify how the penalty must be paid,(e) explain how the person may make an appeal against the penalty, and(f) explain how the Secretary of State may enforce the penalty.(4) Any person in receipt of a penalty notice under this section may appeal to the county court on the ground that they are not liable to the imposition of a penalty because—(a) they are not required to comply with the duty to report child sex offences under section 77,(b) a relevant exemption from that section applies,(c) a report under the duty was made and therefore the penalty was issued in error, or(d) the amount of the penalty is too high.(5) The court may—(a) allow the appeal and cancel the penalty,(b) allow the appeal and reduce the penalty, or(c) dismiss the appeal.(6) An appeal shall be a re-hearing of the Secretary of State's decision to impose a penalty, and shall be determined having regard to— (a) the code of practice under this section that has effect at the time of the appeal, and(b) any other matters which the court thinks relevant (which may include matters of which the Secretary of State was unaware).(7) An appeal must be brought within 28 days of the date the notice was received by the person upon whom it was issued.(8) A penalty under this section is recoverable as if it were payable under an order of the county court. Where action is taken to recovery a penalty under this section, the penalty is to be treated for the purposes of section 98 of the Courts Act 2003 (register of judgments and orders etc) as if it were a judgment entered in the county court.(9) Money paid to the Secretary of State by way of penalty must be paid into the Consolidated Fund.”Member’s explanatory statement
This amendment seeks to ensure that civil sanctions can be imposed for failure to comply with the duty to report suspected child sex offences.

[Baroness Grey-Thompson (CB)]

My Lords, I wish to test the opinion of the House.

Terminally Ill Adults (End of Life) Bill

Baroness Grey-Thompson Excerpts

Committee stage
Friday 27th February 2026 Lords Chamber

[Baroness Lawlor (Con)]

My Lords, I was going to speak to Amendment 146, in the name of my noble friend Lady Eaton, to which I have added my name. It concerns care homes and a duty on the commissioner to identify and monitor emerging risk and report systemic risk to the Secretary of State so that preventive steps can be taken. However, as the noble Baroness, Lady O’Loan, has so ably introduced it, I simply convey the apologies from my noble friend Lady Eaton, who sent them last night.

The other amendments that I support in this group—Amendments 436, 439 and 913—I will not go into, in the interests of parity. The last one is about conflict of interest. The others seek to put a duty on the commissioners to serve as an extra safeguard, so that the exercise of the commissioner will not simply be to tick boxes but to request further paperwork if necessary, or that the families will be notified, as in the amendment tabled by my noble friend Lady Maclean. That can act as a trigger for a discussion with the families and perhaps prevent the coercion which can happen.

Amendment 913 seeks to prevent those involved with organisations promoting assisted dying, whether as volunteers or employees, being a commissioner, a deputy commissioner or on the staff. There is a conflict of interest if those who have a responsibility for seeing that procedures for assisted suicide are not abused should themselves be actively committed to the cause of promoting assisted suicide. The conflict of interest is so self-evident. I imagine that it is an oversight that a clause to this effect was not included in the original Bill. Perhaps the noble and learned Lord, the sponsor, could comment on that and tell us whether he envisages a conflict of interest and how best we can prevent it.

I associate myself with the very strong expression of support for the noble Baroness, Lady Finlay, who tabled Amendment 913. The support was to give sympathy against the attack on one of the leading medical authorities in this country—a specialist in palliative care who has put her knowledge, expertise and time at the service of those most in need of palliative care. She has done so with her time and her knowledge. Not only that but she has served this country in all kinds of ways: teaching students, seeing patients and building up her profession, which is one of the most important specialisms in medicine. She also gives such service to this House, giving her time selflessly, with her knowledgeable contributions and in sitting on the Woolsack, night after night. We owe her an enormous debt of gratitude, not only in this Chamber but in the whole country.

[Baroness Grey-Thompson (CB)]

My Lords, I have two amendments in this group, the first of which is Amendment 125. I am concerned because the Bill as it stands leaves the responsibility of appointing the commissioner to the Prime Minister alone, with no guarantee of the usual safeguards that are applied to public appointments. As a Cross-Bencher and someone who has been through the independent process— I owe my seat in the Chamber to that process— I believe it is vital.

In October 2025, the Cabinet Office released an updated Governance Code on Public Appointments. The first two requirements are for integrity and openness: Ministers must declare and resolve any interests and relationships, and the processes for making public appointments should be open and transparent. My amendment seeks to bring more transparency and openness, but would leave the final decision with the Prime Minister—once, of course, they have consulted with Welsh Ministers.

There are no such requirements in the Bill for this, just that the commissioner must hold, or have held, office as a judge of the Supreme Court, the Court of Appeal or the High Court. That is a reasonable assumption. However, there is no requirement for the commissioner to declare and resolve any interests and relationships or for the appointment process to be open and transparent. We have to declare virtually everything that we do, so it is not inappropriate that the commissioner should have to do so as well.

I strongly agree with the noble Lord, Lord Deben. That person has to command respect. However, the reason I am asking for this is also to safeguard the individual. We see in the amendments today that the Bill is weak on data and reporting provisions.

My noble friend Lady Finlay raised what has happened in New Zealand. Simon O’Connor, a former New Zealand MP, described some troubling incidents there around the two doctors. Dr Dana Wensley resigned due to her concerns regarding serious problems with the committee’s ability to oversee the implementation of assisted suicide and euthanasia. Dr Wensley is an ethicist. Dr Jane Greville, a palliative care specialist, was pushed out, it is thought, because she was raising too many concerns about the operation of the new law. Both Dr Greville and Dr Wensley went public and stated that the committee’s oversight of the law was so limited that wrongful deaths could go undetected. They cited being extremely concerned about how little information they received relating to patient death, leaving them feeling constrained to the point of irrelevance. They both said that the system was so broken that they would not have been able to identify if somebody had wrongly died.

What happens if normal standards are not followed? We can compare it to someone with significant shares in a drug company being able to decide what drugs the National Health Service could use. As others have said, the assisted dying commissioner will have tremendous oversight. They can make appointments to the list of persons eligible to sit on the assisted dying review panels. They can make arrangements in relation to panels, determine applications for reconsideration and monitor the operation of the Act. This role should be defined by Parliament, not by their own ideas. I would like the noble and learned Lord to give assurance that this appointment process will be looked at to see how we can ensure that the Nolan principles for public appointments will be adhered to.

Looking at the possible scenarios, this individual could be called into a meeting with the Chief Medical Officer to discuss the future of palliative care. They will hold a great deal of power in their hands.

At the Lords Select Committee, Justice Minister Sarah Sackman confirmed that there would be no support to engage or challenge the commissioner. I am very interested in the noble and learned Lord’s view on whether legal aid would be possible to do this. In the case of exceptional funding in coroners’ cases, we might have to be in the position where a person is dead before they get any support to challenge the decision that was taken.

--- Later in debate ---

[Baroness Grey-Thompson (CB)]

My Lords, the noble Lord, Lord Moylan, and the noble Baroness, Lady Fraser, raised some interesting points in this group of amendments. I do not have the noble Lord’s experience of local councils—I declare that I am president of the LGA, but that is largely an honorary role—but I have a lot of experience of wheelchair services. I also declare that I am president of the Wheelchair Alliance.

A service that should be incredibly easy to provide has become one of the most complex parts of NHS funding. In the good old days, when I was a child, there were two choices of chair: a small one and a large one. These days, because we want to provide better wheelchairs for people, which is a good thing, the commissioning and provision of those services has become complicated, and in different areas different prices are paid for exactly the same chair. My concern is that, if we cannot do that for something as simple as wheelchair services, how are we going to do it for this process? Many wheelchairs should be provided within 18 weeks, but I know cases where it has taken years to provide a chair for a child. We should learn from previous experience.

Some noble Lords have mentioned the potential competition that could come from funding for this service and the challenges for palliative care. However, the consensus among several professional bodies, including the Royal College of General Practitioners and the Association for Palliative Medicine, is that assisted dying should have distinct funding. Others have mentioned the way that palliative care is currently funded in the UK, but Nancy Preston, who gave oral evidence as well as written evidence co-written with a professor at Lancaster, Suzanne Ost, expressed concern that it would communicate the wrong symbolic message.

I am one of the seven Peers who were in the Observer for my number of amendments. I am receiving lots of emails telling me I need to uphold the will of the people, but I am not sure the people have been asked how they would like to reprioritise the funding of the NHS. I accept that lot of people think the service is needed, but are they being given the choice of what else they might lose? The comments by Stephen Kinnock, who said there needs to be reprioritisation, were interesting. We need to be really clear what we are going to lose out on. The noble Lord, Lord Markham, made some interesting points about savings and cost, but for me that is more about how you schedule the payments and work through it.

I am more concerned about the comments made by the noble Baroness, Lady Finlay, about the incentive to encourage people to go down this route. In Belgium, the service is paid for through the national health and the doctors receive a fee of €180. The cost of the procedure in Canada is $2,327, and it is estimated that they spend about $22.3 million a year to put this service in place. They save $149 million, but for provincial healthcare that is a negligible saving—it is 0.08% of their budget.

Stephen Kinnock talked about doctors receiving a reasonable expense. I have raised the issue of “reasonable” in terms of the Equality Act before. What actually is it reasonable for a doctor to be paid? In Australia, 27% of the doctors were unpaid while 32% got direct state government reimbursement, but a conversation is going on there at the moment about whether clinicians should have to be altruistic to provide this service. Doctors are already talking about having a standardised price for a voluntary assisted dying assessment of $860 as an out-of-pocket expense. That is important because a lot of assumptions are being made about where this service is going to be provided. The reality is that if we are going to give people a choice, we need to give them a real choice.

This is probably going to come up in later groups as well, but I have also noticed a shift in the language, which originally talked about doctors and now we are talking about medical practitioners. Does this mean it could be physician assistants? Could it be nurses? Could someone else be trained to do this? Could there be a career path in this service? Might people think this a good step in their career? The reality is that somebody always pays: the question is just who and when.

[Lord Empey (UUP)]

My Lords, to some extent this group of amendments goes to the core of a lot of the potential downsides of this Bill because, whether we like it or not, it is going to be a source of coercion.

If we go back a few weeks to the issue that was drawn to our attention by the noble Lord, Lord Stevens, concerning the role and the purpose of the National Health Service, clearly, that would need to be changed because we are talking here about a mechanism for ending life rather than a service that does its best to preserve life. To anybody who has had to spend a lot of time around hospitals—be it as a consumer of, or a relative of a consumer of, NHS services; or if you have had any role in government, even at regional level, dealing with health services—it is inconceivable that looking at the balance sheet is not going to be an issue for a clinician and a trust. That is the nature of the beast if you are the finance director of a trust and it is over budget, as they nearly all are. In Canada, we see that some people are boasting about the money they have saved by providing assisted deaths. I do not believe for one moment that that factor can be airbrushed out of this equation as far as this legislation is concerned. While I do not necessarily accept or agree with every amendment in this group, it draws our attention to the principles at stake.

It is in those circumstances that we have got into the habit in this debate of euphemisms. We call one thing by a certain name, but we know it actually means something else. In that regard, I draw the attention of the Committee to a debate on assisted dying that took place during the last iteration of this Bill, proposed by Lady Meacher, on 22 October 2021. This is the point I want to try to get across. Incidentally, that Bill had 13 clauses and 10 pages, compared to the 59 clauses and 51 pages we are looking at today. After Lady Meacher proposed her Bill at Second Reading, the noble Lord, Lord Winston, who I think is not in his place, spoke. He said that the Bill should refer to “euthanasia” rather than “assisted dying” as the Bill’s title did not represent what was intended. He went on to provide the Greek definition of what the word “euthanasia” means.

These amendments go to the core of a couple of issues. The first is the rationale behind the National Health Service in the first place, and how it would be changed and turned if it is carrying out a service which is anything but—

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

I have already spoken to Amendment 459 and am finishing off speaking to it.

I will move on to Amendments 475 and 939 in Schedule 2. There is concern over the operation of the panels and safeguarding responsibilities, just in terms of the information that comes forward. Someone with relevant information would be allowed to come forward to the panel with appropriate evidence and be afforded whistleblower protection, in the type of situation described by the noble Baroness, Lady Berger, where there is a new person on the scene who others may feel has malintent, for one reason or another.

In the Bill’s current model, medical assessments that have previously gone to the panel will not be monitored contemporaneously. They could be poorly reported, they will not be reviewed and this could hide errors, unconscious bias and discrimination. The role of the panel will be to issue a certificate. In Amendment 493, I have suggested that the certificate should have validity for six months and, in the event that the person has a longer prognosis—we have many examples of that—it is renewable rather than having to start the process again because they have outlived their prognosis.

However, the appeal mechanism to a panel seems to be one-sided. The person can appeal against a refusal to give them a certificate, but there does not seem to be a mechanism for appeal. My Amendment 499 seeks to allow information to be brought to the panel that it may not have known about when it gave a certificate. This may relate to domestic abuse that had been hidden, to coercion or pressure, to any information that the diagnosis may have been wrong, to recent emotional or psychological trauma, or to depression or metabolic disturbance which might have impaired capacity.

Amendment 932 is a very practical one concerning the provision and distribution of panels around England and Wales. It has not been made clear how many panels there would be or that there needs to be fair distribution. I have suggested a minimum of three per region in England and a minimum of three in Wales. For the geography, topography and population, I think three would work for Wales. However, areas of England with high population density, or very large rural areas, would probably need more to enable the panel to visit the patient face to face for an assessment. It is completely inappropriate to expect a patient to go to see a panel when they are already ill or to rely on remote consultation rather than having the ability for face-to-face discussion. Those face-to-face discussions must be subject to the confidentiality that you would expect in any medical consultation. I hope that we will not be suggesting that this would be publicly available.

I suggest that, as has been said, these panels came in two-thirds of the way through and a panel can take testimony from others. However, in terms of getting information about the person, as the Minister of State for Courts and Legal Services said in Committee on this Bill:

“It is not a court or a tribunal … They can make the request, but they cannot compel someone to attend”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 12/3/25; col. 1102.]

[Baroness Grey-Thompson (CB)]

My Lords, I want to pick up on a couple of points that have been debated this afternoon, and those raised by the noble Lord, Weir, on the impact on disabled people. I seem to have completely failed in all the debates to get across the fear that disabled people feel with this Bill being debated.

Jennyfer Hatch in Canada had Ehlers-Danlos syndrome, experienced organ failure and was approved for MAID. It made me think of the letter that the Minister, the noble Baroness, Lady Merron, wrote to the noble Lord, Lord Moylan, this week, about the combination of illnesses that would qualify a person for this service. That is why disabled people are so worried. The combination of their disability and other conditions would make them eligible, even though we have been told that there is nothing to worry about. Can the Minister confirm what I understand the noble Baroness, Lady Merron, said when she wrote to us: that a combination of impairments would enable somebody to enter?

I strongly support the amendment from the noble Baroness, Lady Keeley. That is really important because in another case from Oregon, Joan Lucas, who had ALS, was approved for this service; her children filled out the form. There was no question about it; they just took it and she was approved, which is quite worrying.

I thought the debate on somebody dying by suicide was really interesting, and I am going to use “assisted dying” in this context. One of the reasons we are told we cannot use “dying by suicide” is because dying by suicide and this process are completely different. I am not really sure that we can have it both ways. We need to give a little more thought to that.

I get quite upset when we are constantly told that people are dying anyway. I apologise to the noble Baroness, Lady Hayter, but we have to find a better form of words. People may be dying, but the process and the experience they have as they go through that might vary considerably. Sometimes the language that we use in the Chamber can be quite dismissive of the amendments that we are trying to bring to make the Bill safer. We still never seem to hear the word “safe”, we just hear “workable” all the time.

My amendment in this group, Amendment 924, is about protecting older people and being able to make sure that any abuse or risk of coercion can be assessed. It is really about how the panels gather this information. It has already been mentioned that the British Association of Social Workers has said that the safeguarding is not enough. Hourglass has said that one in five of over-65s has experienced abuse, and on 15 June last year, which was World Elder Abuse Awareness Day, there were calls from numerous organisations to do more. The British Psychological Society has said that elder abuse is a “hidden epidemic”, and the scope is huge: it can be physical, emotional, financial or sexual; there is also neglect and self-neglect.

While the Domestic Abuse Act 2021 gives a framework, challenges persist of social isolation, caregiver abuse, power dynamics and, again, financial abuse. The role of professionals and how they report back on this is really important. I absolutely understand what my noble friend Lady Hayman is saying about not making the system overly complicated, but we have to find a holistic way of supporting people.

SafeLives has said that older people experience abuse before seeking help for twice as long as those who are under 61. Last year Age UK reported the fact that older people are overlooked by policymakers, service providers and programmes that are designed to support victims and survivors. Until 2021, people over 75 were not even asked about their experience of domestic abuse, so the lack of data means that there is an assumption about who is being abused. The ONS introduced new survey questions, which render comparison nearly impossible. Of course, the perpetrator of the abuse could be an adult child. What we found out is that women are at higher risk from their partners and men are at higher risk from adult children. Many organisations have talked about the need for professional support, which is really important.

When I am sitting in the Chamber and we talk about people becoming older at the age of 61, I wonder what the average age of the House of Lords is. I believe it is still 71, and everyone is incredibly active, but this is not the real world—on so many levels, it is not.

[Noble Lords]

Oh!

--- Later in debate ---

[Baroness Grey-Thompson (CB)]

Sorry, I did not mean to be funny.

We are using old data or data that is incomplete. The data I found, which is from 2017-18, showed that 139,500 women and 74,300 men aged 60 to 74 experienced domestic abuse. Those are huge numbers. Hourglass estimates that 2.7 million older people experience abuse, and in Australia, the Royal Commission into Aged Care Quality and Safety said that 39.2% of older people experience neglect and emotional and physical abuse.

I am very sorry that my noble friend Lady Hollins is unable to be here today, because her experience of assessing patients—the thousands of patients she has worked with—would be quite important. We were told by the honourable Member for Spen Valley, Ms Leadbeater, that there would be detailed conversations, so not to worry. But I question what those detailed conversations will look like. My husband and I have very different views on what a detailed conversation is.

To cover the issue of panels briefly, I have no experience of such panels; the only experience of panels that I have is for Olympic and Paralympic selection, which is very different. But you are talking about someone’s life in sport, and potentially their career can be ended by a decision—although I am in no way conflating those two things. But in that process an athlete who has not been selected is able to appeal only the process and not the decision. That is a really important thing, because most athletes never understand what they are trying to appeal to get to go to a major Games. So it needs to be very clearly understood what that appeal process should look like.

Terminally Ill Adults (End of Life) Bill

Baroness Grey-Thompson Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

[Lord Empey (UUP)]

My Lords, I am indebted to the noble Lord, Lord Carlile, for bringing to a head one of the critical issues in this legislation. As one of the diminishing number of people in this House who is not a lawyer, I say that we have to find our way through this labyrinthine structure where we have chambers and all sorts of things. Without legal experience, it is difficult even as a legislator to navigate through this.

The point I want to make at the outset is that this significant piece of legislation started off in the other place with the legal process as a fundamental part of the architecture. That was subsequently changed more than half way through its process in the other place, and now we are trying to re-inject it into the system. I would ask the sponsor and indeed the Minister to respond to this. There are so many issues that have been raised already this morning about the consequences of making this change, for which we have absolutely no information whatever.

I remind colleagues that, on our last Friday, there were five separate issues—I repeat, five—to which no response or answer was provided. They were: the issue between England and Wales, the issue between England and Scotland, the issue of pregnant women, the issue of homeless people, and the issue of prisoners. There is no clarity on any of that.

The noble Lord, Lord Carlile, and his co-signatories are attempting in these amendments to at least make the legislation, as the noble Baroness, Lady Finlay, said, less unsafe. The stage we are at in this legislation is probably 75% or 80% of the way through the process and, as with a Meccano set, we are still bolting bits on and taking bits off.

All of this could have been avoided if we had had the proper process of a Royal Commission and a government Bill. This is Heath Robinson-type legislation on such a serious issue. I have to say to the sponsors that, instead of battling this out for the next few months, they would be far better to go to the Government and ask them to appoint a commission and get on with it. Then we would not have to fight our way through this morass.

Not being a legal person myself, I ask the noble Lord, Lord Carlile—given the pressures that we understand are applied to the courts and the Family Division—whether there is a case for the creation of a special chamber for people who are dedicated to this, with the training that would be required. Or, with the pressures that the family court is under, could it be that comparatively junior people end up being designated to hear these cases? Because you are talking about a huge gap in knowledge and experience on a life and death issue.

Maybe these questions cannot be answered now—maybe we will get answers when we come to Report—but the fact is that we are having to ask all these questions and we have no information, no numbers and nothing in front of us. I do not believe that that is a coherent and sensible way to go forward.

The noble and right reverend Lord, Lord Harries of Pentregarth, made a very valid point about the general public’s confidence in who makes such decisions. While I can see the merits, as the noble Lord, Lord Pannick, pointed out, of having a panel with different disciplines, the fact of the matter is that persons who are on that panel have to be appointed by somebody. Is there confidence in the people who appoint them? The court system, however, has a level of public confidence miles above any alternative.

All of these things need to be sorted out. They should have been sorted out before we had this debate today and they have not been. That is where we are. I think that the noble Lord, Lord Carlile, is attempting to put a foundation under this legislation. Leaving issues of principle out of it for the moment—we are legislators and sometimes we have to do things that we do not want to do personally—we are obliged to undertake this process. I assume that he is trying to put a foundation underneath this legislation that would command confidence among the general public, or at least a higher level of confidence than, I suspect, the panel process has. The fact that we have had this change and this flip-flop is very concerning.

I conclude by asking the noble Lord, and indeed, necessarily, the Minister: if these amendments were to be accepted by the sponsor, what would be the Government’s response? The noble Lords, Lord Harper and Lord Gove, have raised this, as have others. I understand that Ministers are in a difficult position. They are technically dealing with a Private Member’s Bill, whatever some of us think about that. Without having knowledge of what the state is going to do, we are legislating for the state to intervene to allow a person to end their life, which is against other legislation that we have already passed. So it is important that the Government should let us know what their responses will be in these various scenarios and I do hope that, when we come to the wind-up of this debate, we will get some clarity.

[Baroness Grey-Thompson (CB)]

My Lords, I speak to Amendment 67 in my name, in which I have sought to bring back the role of the High Court judge. The complexity of this group of amendments is shown here, but I thought that it could be done with one amendment rather than the number of amendments that my noble friend Lord Carlile had to table.

I think that this debate shows many different things. Not least, we have heard quotes about how the noble and learned Lord, Lord Falconer, has changed his mind over time. Others in the Chamber have done so as well, depending on the situation and the specific piece of legislation.

We need to give much more consideration to how this Bill will work in practice; this is one of the fundamental issues. I was disappointed when the High Court judge was removed from the process, because that had given me a level of reassurance. I felt that it gave authority and integrity to the process.

On where we are now, as other noble Lords have said, the toing and froing of this part of the Bill is very difficult. In another place, two-thirds of the debates on the Bill took place with the High Court judge as part of the process. If the noble and learned Lord was minded to bring that back in, it would yet again change a huge part of the Bill.

I thank the noble and learned Lord for meeting me before Christmas, when we had a very interesting discussion on one of the areas I am very concerned about, which is coercion, specifically coercion of disabled people. I am not minded to think that the panel is strong enough to cope with not just the number of cases that they may have to deal with but actually being able to spot some of the things that we have talked about. I have amendments on coercion; I also have amendments on the appointment process of those panel members, which I will not debate now. I know that the noble and learned Lord and I disagree on whether this is the safest Bill in the world. This is not the time for me to ask who has provided independent verification of that, apart from the Bill’s sponsors, but one thing we have to talk about is how we can make the Bill safe.

--- Later in debate ---

[Baroness Berridge (Con)]

The noble Baroness used the phrase “moral pressure”. I mentioned in my speech that this is a fundamental change. If Clause 3 has gone, not by way of clause stand part, then actually, “pressure” has now gone from the test here. We now have “undue influence or coercion”, not “dishonesty, coercion and pressure”. Does she have any view—I mentioned domestic abuse victims—on whether that makes any change to the safety of the Bill for disabled people?

[Baroness Grey-Thompson (CB)]

Oh, absolutely: I think pressure is something incredibly important that we have to assess. Certainly, from the huge number of disabled people I have spoken to, pressure comes in many different ways, and it is very difficult to detect. If we do not take that seriously, I think people will be coerced into thinking that this is their only option, rather than that they have a range of options. That is picked up in some of my other amendments, but I thank the noble Baroness for her intervention.

We talked about the equality impact assessment. We need to look at the impacts on the Crown Court, on health and education committees and on children with SEND, and I think we probably need another version of the equality impact assessment to enable us to make the best decision on the way forward for the Bill. I am minded to support my noble friend Lord Carlile, because I think that what he proposes is much better than the panel currently in the Bill.

Mindful of time, I will leave my last comment to the Medical Defence Union, the leading indemnifiers of UK doctors, which gave evidence to the Commons Bill Committee:

“The involvement of the judiciary is essential. Its absence leaves doctors unduly exposed. Media reports suggest that an alternative safeguard is being mooted”—


noble Lords should understand that this was the context when the evidence was given—

“No ‘independent panel’, however so constituted, can replace the legal authority of a course of action sealed and ratified by a judge. Doctors deserve that certainty when relying upon this Bill to provide the very best for their patients at the most delicate moment of their duty of care”.


This is one group we have not really heard a lot from, and we should be minded of its role in the system as well.

[Earl Howe (Con)]

My Lords, as sizeable as this group of amendments is, the key proposals embodied within it can be described in relatively brief terms. The Committee therefore owes its gratitude to the noble Lord, Lord Carlile, for having given exactly that kind of helpful summary in his opening speech, which set our debate going on a good track. In thanking him for that, what has emerged most clearly to me in this debate is the far-reaching nature of the change to the architecture of the Bill represented by his proposals. In addition, were his proposals to be adopted in their totality, they would, as I read them, have the effect of simplifying very considerably the procedures required to bring about an assisted death.

In combination, those two consequences inevitably open up a range of questions, as we have heard, about how these proposals would work, not just in theory but most particularly in practice. We have, for example, heard questions about the capacity of the family court, about its funding and about the extent of the opportunity costs which the family court would need to sustain. The noble and learned Baroness, Lady Butler-Sloss, and my noble and learned friend Lord Garnier gave us considerable reassurance on some of those issues, as did the noble Lord, Lord Carlile, himself. However, the questions that have been asked are of fundamental significance and I think the Committee should hear from the Minister how the Government view the practical effect of the proposals and their workability.

On the principle of the proposals of the noble Lord, Lord Carlile, we have heard some powerful points in their favour: for example, the established powers vested in the court; the analogous decisions which courts already have to make; the ability of the court to arrive at a reasoned judgment and to be a court of record; the fact that the court-based appeal system is well understood; and indeed the level of public confidence which the court already enjoys.

I would venture to add another, which is that the role for the court envisaged by the noble Lord, Lord Carlile, would be a substantive judicial role, in contrast to the role originally envisaged in the first iteration of the Bill. That came over to me, at least, as more of a tick-box exercise than an exercise of judicial judgment.

However, what I look forward to hearing from the noble and learned Lord, Lord Falconer, are his views on the strand of this debate brought out most ably by the noble Lord, Lord Pannick, my noble friend Lady Berridge and my noble and learned friend Lord Garnier: how he has assessed the merits of the proposals of the noble Lord, Lord Carlile, in comparison to the proposals set out in the Bill. He is on record, some years ago, as having favoured a court-based approach in this area of the law. If his view is that, on balance, he now favours the panel process, as set out in the Bill, what considerations have led him to that conclusion?

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

I do not understand that proposition. It seems to me that the panel is able to take that into account just as well as the court—and, indeed, I think the panel would probably be better able to assess it. I am not sure I accept that proposition.

[Baroness Grey-Thompson (CB)]

My Lords, when this was debated in another place, that argument was made, and the Association for Palliative Medicine wrote formally to correct the record. In the statement, the APM clarified that the Bill does not align with the standard multiprofessional team decision-making process. The noble and learned Lord mentioned Dr Cox, who argued that the Bill’s model of two independent doctors working alone was inadequate, and that assessments should be carried out within the multiprofessional team model to strengthen the Bill. On that discrepancy, the APM and MPs noted that although the Bill introduces a panel of psychiatrists and social workers at the end of the process, that does not equate to multiprofessional assessment at the beginning—the assessment stage that Dr Cox was advocating for. That is really important. The Association for Palliative Medicine wrote formally to correct the record following the debate in the other place. If the noble and learned Lord does not want to respond to that point right now, I am very happy for him to write to me, but I think it is important for that to be on the record in this Chamber, as a by-product of what happened in another place.

[Lord Falconer of Thoroton (Lab)]

The reason why I quoted Dr Cox of the Association for Palliative Medicine was that she specifically said that it is better to approach this issue through a multidisciplinary process rather than by placing it on the shoulders of the two doctors and the High Court judge. The panel approach reflects that approach. That is why I quoted it. I do not think I need to write to say that. It was part of the evidence that was saying, “Have not one pair of eyes to judge, but three pairs of eyes”.

--- Later in debate ---

[Noble Lords]

Front Bench!

[Baroness Grey-Thompson (CB)]

My Lords, I have five amendments in this group and I beg noble Lords’ indulgence—I will get through them as quickly as I possibly can. I have tabled Amendments 179, 182 and 185 and I am a signatory to Amendments 262 and 263. We have talked a lot about choice, and I believe that patients should have real choice, not partial choice, which is why I have tabled amendments that focus on specialist palliative care.

In another place, the Public Bill Committee accepted Amendment 108 in the name of Polly Billington requiring doctors to offer palliative care support, but this could almost be a case of, “This is what you could have won”. Without a guarantee of that support being made accessible, it does not offer patients the choice that they may be expecting. We have seen cases such as Canada, where they are told, “Yes, you can have this, but we’re not going to fund it”. If the Bill is to be the best in the world, we genuinely have to offer patients every choice that is available. On the previous group, we talked about cost. We were not able to cost this up, but if patients feel that they have no choice but to end their life, we are stripping choice away from them.

Amendments 179, 182 and 185 are in my name. The Bill does not require a medical practitioner to ensure the patient has access to specialist care for their consideration. During the conversations, I believe it is important that the patient is automatically referred to specialist care, ensuring that they have a real choice about the treatment that they may choose to have. It is very important that my Amendment 179 goes beyond what the Bill says, which is just offering to refer, and says they must be referred. Until you are in that situation where you have been given a terminal diagnosis, even if you have a family member who is going through it, it can be slightly different when it is you. How does a patient know about all the different treatment options unless they are given them in a way where they have the time to understand them?

Amendment 182 is about needs being assessed by an appropriate health or social care professional, and proposed new subsection (5A)(b) states that patients must

“be provided with palliative and end of life care in line with their assessed needs”.

We should not be doing this as a case of, “This is what you could have won”—I apologise, but I cannot think a better way of saying it—but we see that in other jurisdictions, such as Canada, you are told, “You can have it, but we’re not funding it”. That puts patients in a really difficult and impossible situation. Amendment 185 also refers to the specialist support that I think is important.

My Amendments 262 and 263 are amendments to Amendment 261 in the name of the noble Baroness, Lady Ritchie. They would add the specialist part of it. I am struck by the number of people I have spoken to who say they have had access to palliative care, but when I have interrogated it, it turns out that they have had access to some medical support. It might be a district nurse, but it does not necessarily mean somebody who has had specialist training. That is incredibly important.

I have lost both my parents. I thought my mother had access to good palliative care, and this is a sense of guilt that I and others feel. It was only when my father was dying that I realised what that could and should look like. They died eight years apart in the same hospital. You would have expected a similar level of treatment and support, but it was very far from that. My father was involved. He had a multidisciplinary team. There was lots of information that we were given time to understand. He was given time to understand what the situation might be.

One of my concerns with the Bill, and why it is so important that the specialist element is there, is that when we were having discussions about my father, we were told he was approaching end of life. We were told that it was very serious, we could let him slip away and that was what we should encourage to happen. That is what he was encouraged to think about. This is why I have real concerns with many parts of the Bill. At that point in my father’s life, he had had his foot amputated. He was told that he would not have a normal life and that he would not be able to live in the same house. It was the house I grew up in, and it was vaguely adapted. He was told it would not be possible to get a wheelchair. If there was one thing I could do for my father, it would have been to get him a really good wheelchair.

This comes back to one real issue I have with the substance of the Bill: how it could be misused by families who are not caring, loving or kind, or by doctors under huge pressure who encourage people to consider ending their life. It is important that the full gamut of options is available, so that individuals can make genuinely open choices about how they choose to end their lives.