Endometriosis Services

Jack Abbott Excerpts

Tuesday 24th March 2026 Westminster Hall

[Jack Abbott (Ipswich) (Lab/Co-op)]

I beg to move,

That this House has considered access to endometriosis services.

It is a pleasure to serve under your chairmanship, Mr Dowd. I welcome my hon. Friend the Minister to her place. Many people will recognise that she is a long-time champion of women and women’s health, so it is especially fitting that she is responding today. I am particularly grateful to have secured a debate during Endometriosis Awareness Month to discuss, as a matter of deep importance to women in Ipswich and across the country, access to local specialist endometriosis services.

Endometriosis affects one in 10 women. That means that more than 1.5 million women in the UK are living with a condition that causes chronic pain and infertility, and has profound effects on mental health. Yet for women in Ipswich, specialist care is out of reach. There is no specialist endometriosis clinic at Ipswich hospital, so women who are already living with debilitating pain and who have often waited years for a diagnosis, never mind treatment, are forced to travel to access the care that they desperately need. That is clearly wrong on so many levels.

I want to share the story of one of my constituents, Monica Thomas, who is here with us in the Public Gallery—that sounds very formal, but Monica was in the year below me at Earl Soham primary school 25 years ago. She has battled symptoms for nearly that long; it was 17 years before she finally got a diagnosis. She is now waiting for lung surgery due to having thoracic—as well as pelvic—endometriosis. Despite years of chest pain and breathing difficulties, she was refused referrals to a thoracic specialist and ended up seeking a private opinion. She lives in daily pelvic and chest pain, constantly deals with breathlessness and spends many days bedbound—thankfully not today, Monica.

Monica took her suffering and turned it into determination, resilience and strength. She founded Women’s Health Hope, an award-winning charity dedicated to supporting, advocating for and educating people about women’s health. It shines a light on the unique challenges that women face and creates a safe space in which no one feels alone on their journey. Monica really is a powerhouse and we should all be inspired by her, but also by all the women who have come down from Ipswich today, including Faye Ramsey and so many others. They are battling not just for themselves, but for so many of their friends and family members and many women yet to come—thank you for making the journey here today.

An almost unifying experience for women with endometriosis is having their symptoms overlooked, ignored and dismissed. They are told that they are overreacting and that pain is normal for women. A recent survey by Endometriosis UK found that 82% of respondents had been told by a healthcare practitioner that they were making a fuss about nothing, or had heard similar comments. It takes on average 10 visits to a GP before someone mentions endometriosis. In England, the average waiting time from first visiting a GP with symptoms to getting an endometriosis diagnosis is nine years and four months. Let that sink in: it takes nearly a decade just to get a diagnosis, never mind treatment.

Women are waiting to be diagnosed with a relatively common reproductive health condition and are suffering preventable adverse effects. A key reason for that is the normalisation of symptoms of reproductive ill health and particularly of severe period pain, the severity of which is often not believed. From a young age, women are taught to expect painful, heavy periods and that experiencing severe pain is nothing noteworthy and just par for the course—part of being a woman. We live in a society in which women are told to suck it up and endure pain that interferes with every aspect of their daily lives.

Women learn from a young age to hide their pain away because they must be overreacting and to feign headaches and stomach pains, migraines and food poisoning. More than 1 million women mask period pain sick days every year, because they feel unable to tell their boss the true reason. The systemic normalisation of symptoms means that women do not solicit medical help when they need it. Indeed, studies have shown that less than half of women with severe reproductive health conditions seek help.

The lack of specialist endometriosis services at Ipswich hospital is symbolic of how women’s pain has historically been deprioritised. Unsurprisingly, gynaecology has the largest waiting list of any specialty for working-age adults. As of January 2026, more than half a million women were waiting for gynaecological care. When specialist services are left to a postcode lottery, care for women in places such as Ipswich becomes even further out of reach. It deepens health inequalities, delays treatment and adds unnecessary barriers to accessing essential services.

[Alex Easton (North Down) (Ind)]

I thank the hon. Member for securing this debate. An estimated 75,000 women in Northern Ireland are living with endometriosis, with an average wait of seven to eight years for diagnosis. Does the hon. Member agree that it is vital that national clinical guidelines are properly implemented and that every hospital trust should have a designated endometriosis lead clinician?

[Jack Abbott]

I thank the hon. Gentleman for his intervention and completely agree with him. I have focused much of my speech on the lack of specialist care in Ipswich, but the postcode lottery is affecting people and communities across the United Kingdom, including in Northern Ireland.

[Mark Sewards (Leeds South West and Morley) (Lab)]

I commend my hon. Friend on his incredibly powerful argument. I also commend Monica and other women here today. Women in my constituency have told me that the pain they experienced was described as “normal and expected” by health professionals. I welcome the Department of Health and Social Care’s commitment to renew the women’s health strategy to tackle inequalities in care. Does my hon. Friend agree that any such strategy should include a commitment to provide the right resources, training and funding? Although there is no cure, women deserve the best possible care.

--- Later in debate ---

[Jack Abbott]

I thank my hon. Friend and could not agree more.

For women with endometriosis who may have already waited years for a GP even to mention the word, and who have already been utterly failed by institutionalised and deeply structural medical misogyny, this is a complete dereliction of duty. The human cost of inaction is devastating. Untreated endometriosis can have an untold impact on someone’s life, including on their education, career, relationships, fertility and mental health: 98% of respondents to Endometriosis UK’s most recent survey said the condition affected their mental health and 63% that there was a significant impact.

Women’s lives are put on hold and even changed for ever. They are our neighbours, colleagues, friends, families, partners, girlfriends, wives, mothers and daughters. We all know women who are suffering and struggling to access care right now. In Ipswich, those lives are further disrupted by unnecessary travel for specialist services that should be available locally.

When we came into government, we pledged never again to neglect women’s health. Honouring that commitment is a moral necessity. We have made significant strides since coming into office, with waiting lists for gynaecology care falling for the first time in years. The updated women’s health strategy has the capacity to make an enormous difference. The Government are investing in research on diagnosis, treatment and pain management, with a new research programme on pain management for endometriosis starting this month.

Endometriosis will be prioritised under the new virtual hospital NHS Online, meaning women will be able to access specialist expertise online much more quickly. If that commitment is to mean anything to women in Ipswich and across the country, however, it must also include equitable access to specialist endometriosis services. National strategies, research investment and virtual hospitals are all welcome and necessary, but digital access cannot replace talking to a specialist face to face. Women in Ipswich need that local provision of specialists.

We have somehow allowed a culture to develop where women living in pain is seen as acceptable—as something normal to be expected. That should never have been allowed to happen, but we finally have a Government who are taking women’s health seriously and a Minister who has championed this for many years. That should give us all hope, because we owe it to my constituents here today and to all women who have spent years in excruciating, debilitating pain, who have been ignored and belittled, and who have suffered alone. We cannot let the next generation of women with endometriosis be failed in the same way. They all deserve better, but without specialist care in our communities where people live, that would be impossible.

--- Later in debate ---

[Jack Abbott]

I thank the Minister for her detailed speech. I look forward to working with her over the coming months and years on these important issues. I thank everybody who has contributed and shared not just the experiences of their constituents—as awful and harrowing as they often are—but some deeply personal stories. It is not often in this Chamber that we have the time to do so, and it was welcome that we were able to today.

I am grateful to my hon. Friend the Member for Hampstead and Highgate (Tulip Siddiq) for plugging the film showing next door—I was also just about to do that. It is called “This is Endometriosis” and it starts at 4.30 pm. It is free of charge, although I do not know whether the Minister is going to be on the doors herself. I thank my hon. Friend the Member for Erith and Thamesmead (Ms Oppong-Asare) for hosting us there.

I give final thanks to all the women who have joined us today in the Public Gallery. I thank Monica Thomas for her fearless advocacy for so many women locally. Faye Ramsey has collected nearly 100 stories from women who have been badly failed for so long locally, and she is also pushing for greater education in schools and far better practice in the workplace—I thank Faye for all of her work.

I also thank Zoe Wright, Evie Lapworth, Evie Niblock, Siana Lynch, Kelly Harris-Flatt, Sanju, and Monica’s partner, Aaron. They should all be incredibly proud of their advocacy for so many women locally. I know that they, like me, will not be satisfied by just shining a light on the issue; they want to shift the dial too. I will stand side by side with them, as will many other Members, to ensure that every woman has access to the services that they need, ultimately changing lives for the better.

Question put and agreed to.

Resolved,

That this House has considered access to endometriosis services.

Medical Training (Prioritisation) Bill

Jack Abbott Excerpts

2nd reading
Tuesday 27th January 2026 Commons Chamber

[Jack Abbott (Ipswich) (Lab/Co-op)]

It is a pleasure to speak in support of the Medical Training (Prioritisation) Bill. This Bill goes to the very heart of the future of our national health service—the doctors on whom our health service depends. It is about fairness, protecting taxpayers’ money, and building a home-grown NHS workforce that is sustainable in the long term. It is about making sure that those who have trained here have the opportunity to become the next generation of doctors working in our health service.

Every year, it is becoming harder for graduates of UK medical schools to find a place on a foundation or specialty training programme. Since 2019, competition for postgraduate training places has increased by a staggering amount. In 2019, there were about 12,000 applicants for 9,000 places, but in 2025 the situation became even more stark. There are now more than 30,000 applicants, and over 12,000 UK-trained doctors and nearly 21,000 overseas doctors compete for fewer than 10,000 places. That is an enormous and unsustainable change. For some specialties, the competition is much fiercer. Aspiring neurosurgeons, for example, had to compete against 26 others to secure a place, and there were 737 applicants for just 10 cardiothoracic surgery training places.

Those are not abstract statistics, and behind every number is a person who has spent years training, often at great personal and financial cost, only to find their opportunities for career progression drying up. Some take time out, some seek experience abroad and some leave medicine altogether. Many do not have a choice. They are forced by a system that has become so congested that getting a training post in something that they are passionate about and trained in is completely unattainable. Every time a doctor leaves the NHS, there is no guarantee that they will come back.

The Secretary of State is incredibly committed to increasing medical school places, and we desperately need more doctors, but we have to be honest with ourselves: we cannot expand medical school places without addressing the growing crisis of competition for training places. It is within that context that the Medical Training (Prioritisation) Bill must be understood. There has been a direct correlation between the lifting of visa restrictions in 2020 under the Conservatives and the dramatic rise in competition for foundation and specialty training posts. Maybe that was one of the Conservatives’ Brexit bonuses that they so eloquently talked about. This needs to be addressed, because otherwise we risk training doctors for a system that cannot support them. We are recruiting doctors from abroad at a time when there is already a substantial pool of eligible applicants who have trained in the UK or are already working in the NHS. That cannot be right.

General practice is particularly reliant on international doctors, with half of first-year trainees having qualified outside the UK in 2024. Let me be clear, because this point matters enormously: international medical graduates have always played, and will continue to play, a vital role in our NHS. Many of our hospitals and services simply could not function without them. The Bill does not diminish that contribution, and neither does it seek to close the door to international talent, but it does ask fair and reasonable questions. When we are spending almost £4 billion every year to train doctors in the UK, is it right that those doctors are increasingly unable to access the very training posts that they need to progress? Is it right that huge amounts of taxpayers’ money is spent training doctors, only for that investment to be lost when doctors are forced out of the system or choose to go overseas or into the private sector? If we are honest with ourselves, how progressive is it that we poach doctors from countries that desperately need them, while we have our own brilliant and willing recruits who cannot get jobs here?

If we are serious about building an NHS that is stable, resilient and fit for the future, we must also be serious about retention and recruitment, so we must ensure that those we train can stay, specialise and build careers here at home. What is the alternative? We train thousands of talented, hard-working young people at significant public expense, only for them to hit a wall, feel undervalued and leave either the NHS or medicine altogether. Every doctor we train in the UK who chooses to leave is an enormous loss for our health service and our country. It is such a waste of talent and money. We cannot afford to lose our next generation of doctors—the future of the NHS depends on it—yet that is where we are headed unless we do something now. It is urgent.

Prioritisation is not about exclusion; it is about safeguarding public investment and guaranteeing the long-term sustainability of our NHS workforce. It is about ensuring that the NHS remains an attractive place for young doctors to build a career, and that doctors in this country feel valued, which the previous Conservative Government failed miserably on. The Bill sends an important signal to young people in this country considering a career in medicine that we want them to build a long and fruitful career right here in the UK, in our NHS. It says to those currently picking their A-level options or deciding whether a medical degree is right for them that their hard work will be rewarded and we want them to succeed.

The Bill is not a silver bullet. It will not solve every workforce challenge facing our NHS overnight, but it is a sensible and necessary reform that will go a significant way towards dealing with a deeply concerning and growing problem. If we care about the future of our NHS, we must care about the doctors in it and the doctors who will sustain it in the years to come. For the sake of the future health and viability of our NHS, I therefore urge all Members to support the Bill.

ADHD Diagnosis

Jack Abbott Excerpts

Tuesday 20th January 2026 Westminster Hall

[Jack Abbott (Ipswich) (Lab/Co-op)]

Thank you, Ms Vaz. I thank my hon. Friend the Member for Sefton Central (Bill Esterson) for securing this important debate. He spoke powerfully about the long and agonising waits that many people have to endure to get an ADHD diagnosis, but I want to focus on what happens next. For many people, receiving a diagnosis is not the end of the fight; in many cases, it is the start of a new one.

Time and again I hear from people who, after finally securing that elusive diagnosis, encounter a set of new barriers that prevent them from accessing the treatment they are entitled to. In January 2025, local medical committees in Suffolk and Essex advised GPs to stop delivering ADHD treatment under shared care agreements. A survey by Healthwatch Suffolk of people’s experience of the changes to shared care found that only 40% had received prescriptions or monitoring from their GP. Of those, 69% said that their GP had already stopped or would soon stop providing support.

Most received only two or three months’ notice that their shared care agreement was ending; some had no notice at all. Patients are left in limbo: they have been diagnosed, and maybe even stabilised on medication, and they are suddenly told that their shared care agreement is ending. In some instances, people are left with no access to medication whatsoever. I have received letters from terrified parents and families, panic-stricken at the prospect of being left without the medicine that they need to function every day.

I look forward to hearing the Goernment’s response to the ADHD taskforce recommendations and I welcome the launch of the independent review into the prevalence of and support for mental health conditions, ADHD and autism. Reducing waiting times for an assessment and diagnosis is critical, but that work will be rendered futile if we do not also address the crisis of timely access to medication and support. For too many of my constituents—and I am sure for the constituents of many Members across the room—the hardest part of their ADHD journey did not end with diagnosis; it simply began there.

[Valerie Vaz (in the Chair)]

Thank you. All colleagues got in. I call the Liberal Democrat spokesperson, Adam Dance.

Pandemics: Support for People with Autism

Jack Abbott Excerpts

Tuesday 2nd December 2025 Westminster Hall

[Jack Abbott (Ipswich) (Lab/Co-op)]

I beg to move,

That this House has considered support for people with autism during pandemic-type events.

It is a pleasure to serve under your chairship, Mr Vickers. I am grateful for the opportunity to secure this debate, and to discuss a matter of deep importance for one of my Ipswich constituents, Ivan Ambrose, as well as thousands of people across our country who were failed during the pandemic. It is because of Ivan and his tireless campaigning that we are here today. He has given me permission to share his story. It is deeply personal to him, but tragically, it will be recognised and shared by many people.

Ivan is a 41-year-old man who lives in Ipswich and has been housebound for the past four years. He has autism and severe mental health problems. Prior to the pandemic, Ivan had suffered multiple breakdowns, the most recent of which resulted in him being hospitalised for three weeks. However, he had gradually started to reach a more stable place. It had taken a long time, but he had begun to feel somewhat better.

Ivan was on the road to recovery, but then the pandemic hit. Constantly changing rules left him confused and distressed. He was made extremely anxious by rules that were revised on a daily, and sometimes even hourly, basis. The mass bombardment of information in completely unsuitable formats left him overwhelmed and debilitated. His parents could not have the TV on around him, as he was unable to deal with the relentless stream of information about the pandemic, and none of that information was delivered in an autism-friendly way. No consideration was given to making information easier for autistic people to process and understand, and there was no guidance to help autistic people understand why the rules kept changing. Accessibility was simply not a concern.

After the second lockdown, as pubs and restaurants reopened, no thought was given to housebound autistic people such as Ivan. While the relaxation of rules came as a relief to many of us as we enjoyed a greater sense of freedom, Ivan was not allowed to invite anyone home—not even his favourite aunt. Those years were incredibly difficult for many people.

[Chris Vince (Harlow) (Lab/Co-op)]

I thank my hon. Friend for giving a passionate speech. I also thank Ivan for sharing his experiences with the House; they are hugely important. I declare an interest as a trustee of the charity Razed Roof, which provided online sessions during lockdown to support people with autism and other learning difficulties. I am sure that my hon. Friend welcomes charities giving that support, but does he agree that we cannot rely on charities, and that there needs to be state support for people with autism?

[Jack Abbott]

My hon. Friend has done a huge amount of work in this area and he is absolutely right. I pay huge tribute to all the people in our charity sector, and the many organisations that played such a crucial role in supporting people during the pandemic. However, this was a failure of the Government at the time, and we should not just let charities pick up the pieces from that.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Gentleman for bringing this issue forward. I always try to be helpful by mentioning some of the things we have done in Northern Ireland, and the Minister may find it helpful to know that many universities, including Queen’s University Belfast and Ulster University, offer work-based support for students with autism to help them navigate placements and internships in a way that assists them in preparing for future employment. It is really important that there is face-to-face activity. Does the hon. Member agree that, should we experience another pandemic-like event, there must be more focus on ensuring that support is still available and that the employment opportunities and health of people with autism are not hindered because they cannot access the support they need? Queen’s University and Ulster University did that, and they did it well.

[Jack Abbott]

The hon. Gentleman is absolutely right, and I will come to some of that in a moment. I pay huge tribute to those who were working in Northern Ireland at the time. The pandemic was worldwide and the response hit all parts of our communities.

The years of the pandemic were very difficult for many people, but for people like Ivan they were deeply and profoundly traumatic. Ivan still bears the scars of that time. He lives with post-traumatic stress disorder and continues to experience flashbacks. He has not left the house at all in four years, and to this day the TV stays off. I will be really blunt: Ivan and those like him were betrayed by the previous Conservative Government. They utterly failed him, along with so many other autistic and neurodivergent people.

[Carla Lockhart (Upper Bann) (DUP)]

The hon. Member is speaking so eloquently about his constituent Ivan. Does he agree that children with autism were failed by school closures during lockdown? That was particularly difficult for children who rely on structure and routine. Research from Queen’s University Belfast shows that that measure harmed children’s rights to play, rest and leisure, with autistic young people reporting fear, uncertainty and isolation. Does he agree that any future response should avoid school closures?

[Jack Abbott]

The hon. Lady is absolutely right that that had a huge impact on many autistic and vulnerable children, not least because of the lack of clear and consistent communication that I am outlining. I will not go into the issue of school closures—the Minister may touch on that in a moment—but of course they had a profound impact on all children, and we are seeing the effects of it.

[Tim Farron (Westmorland and Lonsdale) (LD)]

I pay tribute to the hon. Member and his marvellous constituent Ivan, who he is speaking about so passionately and affectionately. Does he agree that support for autistic children and their families must be treated as a priority during and in the aftermath of pandemics and other crisis events of that sort? In my constituency, the parent of a three-year-old child who is showing clear signs of autism has been waiting for 18 months for a community paediatric assessment and just as long for dietetic support for suspected avoidant/restrictive food intake disorder. That delay is already affecting his development and nutrition at a critical stage. Does the hon. Member agree that neurodevelopmental and early years services must be properly resourced and protected, and not sidelined, so that such children are not left without support when they need it the most?

[Jack Abbott]

I agree wholeheartedly with the hon. Gentleman.

In February 2021, Ivan’s parents, Jayne and Gary, wrote to the then Prime Minister, Boris Johnson, describing how their son was struggling and pleading with him for help. Ivan sent me a copy of the letter a few months ago, and it is truly heartbreaking; you can hear Jayne and Gary’s desperation, helplessness and heartbreak as they watched their son in immense pain, powerless to help. They did finally receive a response, but it was a full 13 months later. It is not lost on me that illegal parties were likely taking place in No. 10 at the very time the Ambroses’ letter arrived.

I have met Ivan several times and I think he is a hugely inspirational person. He has turned his trauma and suffering into incredible determination, and he has spent the last four years campaigning and fighting to make sure that no one has to go through what he did. He launched an online petition in 2022 calling for autistic people’s needs to be met in a future pandemic response. Although he failed to get the 10,000 signatures for a Government response, he persisted none the less. He has featured across our local media, trying to raise awareness, and over the last few years his campaign has had a real impact. Recently, he was asked to submit evidence to the House of Lords Select Committee on the Autism Act 2009 and his evidence features in the Committee’s report. I know he is very proud of that, as he absolutely should be.

We hope and pray that pandemic-type events never occur again, but hope and prayers alone are not a responsible strategy. If this sort of tragedy should occur again, we need to make sure that autistic people, neurodivergent people and all vulnerable people are properly considered and supported.

The UK covid-19 inquiry recently published its module 2 report of its investigation into the previous Government’s response to the pandemic. The verdict was clear: that Government did not adequately consider the needs of disabled people. Neither the Minister with responsibility for disabled people nor the disability unit played a direct role in the Government’s initial strategy from January to March 2020. Neither had any part in the discussions about whether to implement lockdown, or how the effects of that decision might be mitigated.

It was not until 21 May 2020, two whole months after the country went into lockdown, that the position of disabled people was even considered at interministerial level. Disabled people were an afterthought; their needs and how the Government response to the pandemic might affect them were not considered. Ivan and thousands of other autistic and neurodivergent people across the country bear the consequences of that negligence today.

[Ayoub Khan (Birmingham Perry Barr) (Ind)]

I thank the hon. Member for the powerful and persuasive argument he is making in relation to his constituent, Ivan. Neuro- divergent children who went through the trauma of the pandemic are finding it very difficult to establish themselves in schools. It is already the case in Birmingham, certainly in my constituency of Birmingham Perry Barr, that schools are underfunded when it comes to addressing some of these challenges. Would he ask the Government to provide additional funding for schools that now have these classic symptoms, which are ever-growing?

[Jack Abbott]

I thank the hon. Gentleman for his intervention. We also saw severe cuts to early intervention support during the pandemic in my home area of Ipswich and Suffolk. At the height of the pandemic, children’s centres were closed and the number of visits by health visitors was slashed. I absolutely echo his call for more funding, which is why I am really pleased that the Government provided £1 billion in extra funding for special educational needs and disability in comparison with the previous year. In Suffolk, £10 million of that will be spent on specialist places. I absolutely echo and support what the hon. Gentleman said.

Data reporting on disabled people during the pandemic was also woefully inadequate. In October 2020, it was noted that data on disability across the Government was “fragmented” and did

“not allow comparisons to be made across Departments.”

The information mainly came from anecdotal reports or charity sector surveys.

Departments were tasked with improving the collection of data on disabled people. Needless to say, however, nothing much improved and no preparations were made for communicating properly with disabled people in appropriate formats. For example, for a significant period, there was no British Sign Language interpreter on Government broadcasts. The list of clinically extremely vulnerable groups who received online deliveries in the early stages of the pandemic was entirely medicalised, based on an outdated medical model of disability. Thousands of disabled people with mental distress, mobility challenges, energy limitations, sensory impairments and learning disabilities were not placed on that list for online deliveries, even though many of them could not visit supermarkets or other important outlets in person.

According to the chief executive of Disability UK, that was

“one stark example of the abandonment of the Social Model of Disability.”

That model, which was developed by disabled people, says that people are disabled by barriers in society, rather than by their impairment or condition. It is widely accepted and has been the recommended model for all Government Departments for several years.

The failures that we have heard about in the first two inquiry reports are utterly shameful. Between June and July 2020, the National Autistic Society ran an online survey looking at autistic people’s experience of coronavirus and the lockdown. Autistic people were seven times more likely to be lonely and six times more likely to have low life satisfaction; nine in 10 autistic people worried about their mental health during lockdown; and one in five family members had to reduce work because of caring responsibilities. That is an appalling legacy. It cannot happen again, and our Government must ensure that it does not.

I know that the Government are currently looking at the UK’s pandemic preparedness and recently concluded Exercise Pegasus, a pandemic simulation exercise assessing our ability to respond to another pandemic. One of the core objectives of the exercise was to explore the impact of inequalities and consideration of them during pandemic decision making. I look forward to seeing the results of that work.

As the Government prepare the pandemic response plan, I am very glad that the impact on vulnerable people, including autistic people, and preventing such events from happening again are front and centre in that work; I look forward to the Minister outlining in more detail what steps the Government are taking to ensure that. What happened to Ivan is a tragedy and a gross injustice. He is still suffering today and might suffer for many years into the future. That cannot be undone, and the damage inflicted on him cannot be taken back—but, as we prepare for future pandemics, we must make sure we do better.

I finish by thanking Ivan and his parents Jayne and Gary for their tireless work in raising awareness and campaigning so relentlessly and selflessly. Ivan’s resilience and commitment to fighting so that no one goes through the torment that he did and still suffers from is commendable. We should all be inspired by him. I will be frank, however: warm words of inspiration and thanks are simply not enough. We need to see lasting and permanent change, so that what Ivan went through can never happen again.

Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting)

Jack Abbott Excerpts

Committee stage
Tuesday 25th March 2025 Public Bill Committees

Brought up, and read the First time.

[Jack Abbott (Ipswich) (Lab/Co-op)]

I beg to move, That the clause be read a Second time.

I am minded not to press the new clause to a vote, but I have a few brief remarks to make. The new clause does what it says on the tin. It applies to the rare—I underline the word “rare”—cases in which two family members, particularly a couple, both receive a terminal diagnosis within a relatively short space of time and would therefore qualify under the Bill.

For very many couples, there would be absolutely nothing untoward. Many people will make a decision in their best interests, particularly if they have been married or partners for a significant period. The new clause stipulates that if any medical or healthcare professional receives any indication that a patient is seeking an assisted death at the same time as one of their family members, especially a partner, both the co-ordinating doctor and a registered medical practitioner from the person’s GP practice must be notified and the patient must be referred both for a psychiatric assessment and for an assessment by a social worker. The assessing doctor would then have to take into account any opinion provided by the psychiatrist and social worker and share it with the assessing doctor.

I appreciate that the new clause may be a little too prescriptive at this stage, but I would like the matter to be considered on Report and to be given further deliberation by the Government if the Act is passed and goes into the implementation phase. I think all Committee members can appreciate why such a scenario, rare as it may be, needs to be considered for the reasons we have discussed today in relation to coercion or other sorts of abuse, whether it is obvious or more pernicious. We know that in certain situations there will be people, particularly if they are married or in a long-term partnership, for whom such aspects may be at play. I am sure that they are a rare minority of cases, but I hope that these things are considered. Greater scrutiny is probably needed in these scenarios.

Essentially, the new clause would allow for a more comprehensive and thorough assessment of people’s wellbeing and social context, including their relationship. I am not minded to press it to a vote at this stage.

--- Later in debate ---

[Kim Leadbeater]

I thank my hon. Friend the Member for Ipswich for tabling the new clause. I have some concerns around the broad definition of “family member”. I also feel that it would be potentially excessive if there were a coincidental situation in which, tragically, two members of the same family were terminally ill. I worry about the extra burden it would place on them of going through an even more rigorous process when they had both been assessed under the thorough regime of the Bill, including the multidisciplinary panel. However, the point is worth discussing and I welcome the fact that my hon. Friend has raised it.

[Jack Abbott]

I appreciate the points made by the Minister and by my hon. Friend the Member for Spen Valley. “Family member” is a relatively non-specific description, but I think the thrust of the new clause is clear. Clearly, it is directed particularly at couples.

I fully understand why my hon. Friend does not want people to have to go through a huge number of extra layers; I have said at length several times that I do not want people at the end of their life to go through an awful period of sitting in endless meetings, assessments or courtrooms. However, I reiterate that although they would be relatively exceptional, there will be situations in which coercion and other sorts of pressure are potentially at play. I agree that that may be an incredibly rare scenario and that two people may just want to go through the stages towards the end of life together, but extra checks may need to happen at some point to ensure absolutely that there is nothing untoward such as other sorts of pressure or coercion, rare as that might be.

--- Later in debate ---

[Dr Tidball]

I beg to move, That the clause be read a Second time.

This is the final new clause of the Committee. As I said in support of new clause 25 and associated amendments last week, I want to strengthen the voice of disabled people in the Bill. New clause 35 would require the voluntary assisted dying commissioner to establish a disability advisory board that would report annually on the implementation and impact of the Act on disabled people. The new clause has been designed to ensure that disabled people have a voice at the heart of the Bill and an ongoing role in monitoring its impact.

The disability advisory board model reflects a structure that was used at the Department of Health to implement the Autism Act 2009 and monitor the implementation of its provisions, statutory guidance and strategy. It was a highly effective body. Including a disability advisory board structure on the face of the Bill would entrench the board in the work of the commission, enabling a long-term and iterative structure in which disabled people could report on the reality of the impact of the Bill on disabled people across this country.

This reflects comments made by Dan Scorer of Mencap in oral evidence. He said that if the Bill was passed,

“We would want to see strong representation from patient groups…as well as from people who have been involved in the process, such as family members, advocates and clinicians, to make sure that if serious issues are being raised, they can be picked up early and addressed.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 280-81, Q367.]

The board must therefore consist of

“(a) people who have a disability under the Equality Act 2010,

(b) representatives from disabled people’s organisations, and

(c) other such persons or organisations as the Commissioner considers relevant to the impact of the Act on disabled people.”

The commissioner would, within six months of being appointed, have to appoint a programme board to advise on the implementation of the Bill, and annually thereafter report on the impact of the Bill’s operation on disabled people.

The clause reflects the learning of Dr Greg Mewett, the specialist palliative care physician from Australia who gave oral evidence to the Committee about the Australian implementation taskforce, which includes a strong disability advocate. My new clause would go further, by including a rigorous reporting process that requires the advisory board to report to the Secretary of State and the commissioner within six months of the commissioner being appointed, and annually thereafter. It also provides:

“The Secretary of State must, within three months of receipt of any report under subsection (3), lay the report before both Houses of Parliament.”

In the oral evidence sessions, I asked witnesses for their views on what structures or mechanisms could work to facilitate the opportunity to hear the voices of disabled people in monitoring the implementation and impact of the Bill were it to pass through Parliament. Dr Miro Griffiths said:

“I think there needs to be further robust action around how to collect data and allow it to be analysed, to see the trends that are occurring in why people are pursuing this option and how that may play into broader political and socioeconomic issues, such as a lack of services elsewhere or frustrations for disabled people and their families in trying to access particular services…I would therefore encourage their representation on any form of advisory council. I would also request that disability studies scholars, who are often left out of the discourse around disability policy, are part of any form of mechanism to advise or scrutinise.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 145, Q183.]

Subsection (2)(b) and (c) would provide for this.

Professor Tom Shakespeare corroborated the benefits of such an advisory board, calling it a “very good idea.” Importantly, Fazilet Hadi, from Disability Rights UK, stated:

“Should the Bill go through, it would be good to see a monitoring mechanism. I cannot say what that should be, but it would be good to see disabled people shape it. Some 45% of older people are disabled people, so disabled people are going to be very affected by the Bill.”

Poignantly, she went on:

“It is often our experience that we are the last people who are spoken to; maybe that is what is behind the question. We should of course be at the table now in respect of whatever mechanisms, and in the shaping of any implementation, should the Bill be passed.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 175, Q227.]

There is, and there should be, nothing about us without us.

As a disabled Member of Parliament, I am grateful to my hon. Friend the Member for Spen Valley for inviting me to sit on this Committee. Through this new clause and my earlier new clause 25, I have worked hard to put together a structure that ensures that disabled people are firmly at the table in the process of monitoring the implementation and impact of the Bill. I urge members of the Committee to support new clause 35.

[Jack Abbott]

At this point, I pay tribute to my hon. Friends the Members for Penistone and Stocksbridge and for Bexleyheath and Crayford. They have consistently tabled really important amendments that are very close to my heart, measurably improving the Bill.

I am briefly speaking in favour of new clause 35. We have had a number of good amendments about ensuring proper representation for vulnerable people during the process. We have also had a lot of discussion about the very important need to regularly monitor and report back on the Bill. This new clause brings all this together, ensuring that there is real oversight, with real thrust and a point to it. It is not good enough just to report back some statistics; the question is what we do with them. Having this sort of panel, with expertise and life experience, would be a significant step forward for people with disabilities, learning needs and anything else that might be included.

Once again, I pay tribute to my hon. Friends for this work. I am fully supportive of the new clause.

[Sarah Sackman]

I hope to be brief, given it is the witching hour.

This new clause would require the voluntary assisted dying commissioner to establish within six months of their appointment a disability advisory board. The advisory board must include representation from disabled people and disabled people’s organisations. Within six months of its appointment, the advisory board must report to the Secretary of State and the commissioner to advise on the implementation of the Act for disabled people. We anticipate that the advisory board’s annual report will be separate from the commissioner’s, and that in time this may be subject to a level of integration between the two bodies. Practical arrangements for the advisory board would require further consideration, but the Government can see no workability reason why this should not go ahead.

Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting)

Jack Abbott Excerpts

Tuesday 18th March 2025 Public Bill Committees

[Sarah Olney]

The hon. Gentleman gives me an opportunity to conclude my remarks. I support amendment 429 because it is important to provide clarity that when we say “with the patient,” we mean in the room. However, I invite the Minister to expand further on the resource requirement of assisted dying. I want the doctor to remain with the patient, which I think is critical. That is why I support amendment 429, but the implication of the Bill is a considerable resource requirement, particularly for GPs, and I would like the Minister to respond to that.

[Jack Abbott (Ipswich) (Lab/Co-op)]

I rise to speak to amendments 532 and 533, standing in my name, and in support of amendments 429 and 430, tabled by my hon. Friend the Member for Bexleyheath and Crayford. I appreciate that my amendments are similar to amendment 430. They go a little bit further, but probably not as far as we have previously discussed in the Committee.

I totally understand the concerns about the Bill being overly prescriptive about the regulations that could be passed down to the doctors making such decisions. However, it is important that we enable the Secretary of State to provide guidance, in addition to GMC regulations, on what the co-ordinating doctor must do if the procedure has failed. At the moment, the Bill simply states:

“The coordinating doctor must remain with the person until”

that time. However, I appreciate that amendment 429, if passed, would cover that issue.

Clause 9 states:

“The assessing doctor must…discuss with the person their wishes in the event of complications arising in connection with the self-administration of an approved substance under section 18”.

However, the Bill as drafted is not clear about what a doctor is legally permitted to do in the event of such complications. That is particularly important, as the Bill expressly states that the final act of administration must be taken by the person themselves. Therefore, the Bill as it stands stipulates that the doctor must discuss the patient’s wishes in the event of complications without stipulating what actions the doctor can take in such an event and thus what the patient’s options actually are.

There is a gap in the Bill and a lack of clarity on that critical issue, which has been raised frequently in both written and, to an extent, oral evidence. Dr Alexandra Mullock argued that, as

“the Bill would only permit”

a doctor only to assist in the patient’s self-administering a substance,

“administering drugs to end the life of a patient who might be unconscious (but not dying) is not permitted.”

She also raised the possibility that a patient might regain consciousness, but

“be too ill to make a second attempt”

at self-administration. What should a doctor do if that occurs? Unless the Secretary of State clarifies what a doctor can do in that situation—my amendment would not do that; it would merely give the Secretary of State direction to do so—the co-ordinating director could be placed in a difficult position.

Professor Alex Ruck Keene argued that the Bill as it stands could lead to the potential for medical professionals to be “required to stand by”, yet without being able to take steps to respond to complications so as to ensure that the process is completed. I fully appreciate that all doctors would use their good training, common sense and years of extensive practice to make a best-case judgment, and we would always support them in that, but the Bill has the unintended consequence of not giving doctors true cover in that area.

Dr Mullock also asked what should occur if the patient survives a procedure, “but is badly affected”. What treatment should be provided? Should the patient be moved to hospital? Should the patient be sedated or made comfortable until a natural death occurs, or should the doctor be able to take steps for the patient to die following the initial failed attempt? We need answers to those questions. Amendment 532 does not seek to answer them, but it would stipulate that the Secretary of State must do so at a certain point.

[Danny Kruger]

The hon. Gentleman is making an excellent speech, setting out the gap at the heart of the Bill. Does he agree—I think that he does, as he has just explained it—that there are quite straightforward choices: to expedite a death, which is illegal; to do nothing, which is inhumane; or to treat, revive or resuscitate? Why does he think that should not be clearer in the Bill? Why does he want to leave it for the Secretary of State to determine that in the future? Why do we as Parliament not get to decide what the right options should be?

[Jack Abbott]

I appreciate the hon. Gentleman’s question. In short, the answer is because we are not medical professionals. [Interruption.] Well, some members of the Committee are medical professionals, but not all of us are. I do not think that it is for the Committee to make a judgment on whether to put that in the Bill. I am happy and comfortable to leave such a directive and further recommendations, in addition to the GMC guidance, as further work to do in the coming months and years ahead of the Bill’s implementation. I think that is a healthy and strong thing to do. This is an important compromise to some of the conversations we have had in this Committee over the weeks. The amendment seeks to give a clear direction that these sorts of regulations and procedures should be stipulated at some point down the line.

[Danny Kruger]

The hon. Gentleman suggests that this is something that should be left to the medics. Nevertheless, here we are legislating for medics to be able to administer lethal drugs to people; we are responsible for what happens subsequent to the administration. Let me put this another way: does the hon. Gentleman foresee any scenario in which the guidance from the Secretary of State could be anything other than that the patient should be revived and helped to live in the circumstances where there are clearly complications under way? What else could be the appropriate direction given by the Secretary of State?

[Jack Abbott]

I appreciate the point that the hon. Gentleman is trying to make. We have discussed this point at length, across a range of subject areas, but we cannot legislate for every single permutation that could possibly happen. That could be about the initial conversations, when the patient is given a terminal diagnosis. Where do those conversations leave us? Clearly there will be a number of different scenarios, which could occur to various degrees.

I do not think it is possible to legislate for every single eventuality. I do not believe that whether to revive or not revive will be so black and white; it will completely depend on the scenario at that particular moment in time. Therefore, further work would need to be done over the coming months and years before the final introduction of the Bill. I believe that it is important to allow the time for that work to happen alongside the existing guidance as it stands.

I do not seek in my amendment to stipulate exactly what every single permutation might be—indeed, that could run to many pages and beyond. The amendment seeks to empower the Secretary of State and the Department to make sure that those eventualities, and the concerns that the hon. Member for East Wiltshire has raised, are covered by regulations over time.

In my view, the failure to provide a clear answer to these questions is an oversight. Data from Oregon shows that it is unfortunately not totally uncommon for patients to suffer complications following the administration of a lethal substance. In 2023, of the 102 patients for whom we have data on whether they suffered complications—out of a total of 367 patients who died by assisted death in Oregon in that year—10 suffered complications. That is just under 10% of the patients we have data for.

Of those 10, eight had difficulty ingesting the substance or regurgitated it. One suffered a seizure, and for one we have no data of what complications occurred. If I may say so to the hon. Member for East Wiltshire, that goes back to the variances that I referred to. It is not as simple as whether to resuscitate or otherwise. There are a number of different factors. Although that is a relatively small sample size, it shows the diversity of the challenges ahead.

In Oregon, information about complications is reported only when a physician or another healthcare provider is present at the time of death, which means that we evidently have less data on this issue than is desirable. However, despite the small sample size, that data would put the complication rate at one in 10. It would not be a completely uncommon occurrence for patients to experience complications following the administration of a lethal substance, although it would be rare.

[Kim Leadbeater]

My hon. Friend is referring to Oregon. Obviously every jurisdiction has its own methodology when it comes to assisted dying. Is he reassured somewhat by the evidence from Dignitas that for not one person did the procedure fail? A survey from Victoria in Australia showed that 1,076 deaths from the self-administration process took place, and 86% of patients died within one hour. There are different models, and it is important to look more broadly at this if we can.

[Jack Abbott]

I fully accept my hon. Friend’s points, and I agree. To reiterate, complications are not a regular occurrence by any means. They are relatively uncommon. In saying that, there are still 10% of people who did experience them. As she says, these complications are not huge, but there were issues with being able to ingest the substance or with regurgitating it. The figure of 86% that my hon. Friend refers to is absolutely correct, but that would suggest that for 14% of people it took longer than an hour. In my view, that is a relatively high percentage for what we are talking about here.

As I say, my amendment does not seek to stipulate in the Bill exactly what measures have to be taken in every single scenario. I am not suggesting for a moment that we have to legislate about what we must do in the event that, for instance, someone has difficulty ingesting the substance; I am sure that will come naturally with the GMC regulations. I fully appreciate the points made about how this will probably naturally occur, but it is important to provide a reassurance that we are looking at the long-term effects in such scenarios.

--- Later in debate ---

[Jack Abbott]

I thank my hon. Friend for the question; I agree that 10% is a statistically reasonable figure and should be noted, which is part of the reason for my amendment. However, this is still relatively uncommon from the small sample sizes we have. For example, while it is important to refer to the Oregon example, the sample size is only 100 people, so we should always keep that in context. Will fewer people choose to go down that path because they feel, for example, there is potentially a small chance they might struggle to ingest the substance? To be perfectly honest with my hon. Friend, that will completely be their personal choice, and it is really important that, in every stage of the process, we are very clear with those looking to go down this path about what those eventualities might be.

Everyone will take their own personal opinion about that, but we want to be very clear about any risks that might come about, and we have already stipulated that this will be part of the process. Everyone should be very clear about the process—what it will look like and the associated risks. Many people will look at this and still say, “This is the path for me”, but that of course will be their own judgment.

[Danny Kruger]

I wonder whether, in the hon. Gentleman’s view, it might be appropriate for the Secretary of State, when framing the guidance he requests, to leave it to a doctor’s discretion. Would that be an appropriate outcome that he would be happy with? My concern is that we will end up with a Bill that has a blank space when it comes to what should be done in the event of complications, as it does currently, and that the Secretary of State might find it equally confusing and unclear and might be reluctant to specify too precisely what should be done in the range of different circumstances that the hon. Gentleman has mentioned. Will we not end up with a further passing of the buck to clinicians to make that decision? Given that, is it not even more appropriate at this stage for us to give a direction to the Secretary of State stipulating that, whatever the guidance will be, it is entirely inappropriate for a doctor to expedite the death of the patient in any way?

[Jack Abbott]

In the case of this Secretary of State, he is more than happy, as we have seen in the last week or so, to take decision making back in-house and make them himself as well, although that is perhaps a separate political point.

[Danny Kruger]

I trust this Secretary of State.

[Jack Abbott]

Absolutely, I know. I am sure the Committee supports him as well.

I would also point the hon. Gentleman to proposed new subsection (13), which my amendment 532 would introduce, saying what “specific actions” can legally be taken, for example, if

“there is a greatly prolonged time to death”,

the person has been “rendered unconscious” or

“the person is otherwise undergoing complications.”

That quite clearly states that we expect the Secretary of State, through this amendment, to take specific co-ordination actions on that. Under proposed new subsection (12) alone, the Secretary of State would have to make provision on that, which could lead to what the hon. Gentleman is alluding to. However, what I propose in proposed new subsection is very clear: that we would expect specific actions from the Secretary of State in that area.

[Naz Shah]

My hon. Friend is making an important speech. He talked about percentages earlier. Is he aware of a study in the Netherlands that concluded that 21 people—18% of the cases in the study—were assisted with lethal injection? In five of those cases, that was because the person could not swallow, but in the rest, they were unable to complete.

[Jack Abbott]

I have used the statistic of 10%; we might find additional statistics from different jurisdictions that put that figure slightly higher or slightly lower. The point I am trying to make is that this is a relatively uncommon occurrence; none the less, this is an area of the Bill that we can make stronger with additional provisions.

I will make some progress on amendment 532. I have made the basis of my point and want to get on to amendment 533. As I have said, amendment 532 seeks to provide clarity on what doctors can do if the procedure fails or is failing by stipulating that the Secretary of State must specify in regulations what actions the co-ordinating doctor can legally take if there is a prolonged time to death; if the person has been rendered unconscious or unfit to make a second attempt at self-administration, but has not died; or if the person is undergoing complications following the initial attempt.

While there is existing GMC guidance, if no further guidance comes forward in the coming years, we risk placing some doctors in an incredibly difficult position. We always say that we should abide by good practice and the experience of many doctors, but additional cover is no bad thing. We need to say what doctors are legally permitted to do in the event of a patient undergoing severe complications. Leaving aside the doctors, that presents a risk to the patient, who may suffer needlessly and intolerably because the co-ordinating doctor does not know what they are legally allowed to do and is thus seeking to avoid legal ramifications of actions. We do not want them to take steps to respond to those complications or support the patient to die in a painful manner.

I will speak briefly to my amendment 533, which is about where assisted dying can take place. The Committee has already touched on that, and I do not want the Bill to be too prescriptive, which is why I have not stipulated exactly where the locations should be. However, this question was raised a number of times in the submitted written evidence. It is incredibly important that we address this question to ensure that assisted dying takes place at a certain location and does not have a detrimental effect on that location or community, and that the implementation of assisted dying does not exacerbate existing healthcare inequalities or deepen the mistrust of the healthcare system that exists among some ethnic minority communities in particular.

We have a duty to ensure that anyone seeking an assisted death under the Bill feels that it is safe to do so, is able to experience the positives of assisted dying and is not traumatised or retraumatised by the process. That is not possible if assisted dying takes place in settings in which people feel unsafe, which they feel unable to control or in which they have no agency. The amendment seeks to ensure that the question of where assisted dying can take place is properly addressed and that the possible impacts of assisted dying taking place at any particular location are fully considered. Only then can we address and mitigate its possible detrimental impacts.

That is a particularly important point because the criterion in the Bill that the doctor must remain with the patient until they have died realistically precludes assisted dying taking place at home, as there may be a prolonged time to death. As my hon. Friend the Member for Spen Valley said, 86% of patients in Western Australia died within the hour, but 14% took longer than that. To use another comparison, in Oregon, 87.7% of those who died via an assisted death in 2023 did so at home. If we are essentially precluding assisted dying from taking place at home because of the stipulation that a doctor has to be in attendance, we must answer the question of where it can take place.

In written evidence, Sue Ryder and the National Care Forum cited concerns about the impact on the wellbeing of staff and the other residents of hospices and accommodation-based services, should assisted dying take place within those communities. Dr Jamilla Hussain, in arguing that the question of where assisted dying could take place needed to be addressed, stated that her consultations with

“ethnic minority groups across Bradford highlighted the risk that AD could significantly deepen mistrust in healthcare services, including but not limited to palliative care.”

She argued that that needed to be considered when determining where assisted dying would take place, and because of that it would be preferable to avoid

“healthcare settings that these communities rely on, such as hospitals and hospices.”

Again, amendment 533 does not seek to specify where assisted dying should take place—I think further work is possibly needed over the coming months and years before this policy is potentially implemented—or to prohibit any particular location, I must add. The rationale behind the amendment is to ensure that through extensive consultation with relevant parties, the possible impacts of assisted dying taking place at any particular location are fully and comprehensively considered, and thereby any potential harm is addressed and mitigated against.

[Danny Kruger]

Will the hon. Gentleman give way?

[Jack Abbott]

I was just finishing, but the hon. Gentleman has timed it perfectly, so I will.

[Danny Kruger]

I think the hon. Gentleman is right about this one. Does he agree that the hospices that have written to us have a very valid point of concern that they might be required to facilitate assisted dying on their premises, even if many members of staff or other residents do not wish that to happen? Does he agree that it is important that we protect hospices from having to have anything to do with assisted dying?

--- Later in debate ---

[Jack Abbott]

I appreciate that point. Throughout this process we have spoken about the absolute need to ensure that very good palliative care options are being presented to everybody along this pathway. I do not think you can separate care homes and hospices from the Bill, but I fully appreciate and sympathise with what the hon. Gentleman is saying. As I have said, there may be some hospices that are simply not appropriate for this, so although amendment 533 does not seek to put that on the face of the Bill in terms of precluding any particular areas of our healthcare system, it would require the Secretary of State, through consultation, to make sure that the legislation is used properly, and make suitable recommendations.

[Naz Shah]

I rise to speak to amendment 436, tabled my hon. Friend the Member for York Central. The amendment concerns what would happen after a patient has suffered complications while going through the administration of lethal drugs. Let me stress that we know that people suffer complications when they are undergoing assisted deaths. Unfortunately, one thing we do not know is how common those complications are. Another thing we lack is data that would allow researchers to investigate whether certain drugs, perhaps in combination with certain medical conditions, were more likely to cause complications.

The reason that we do not know those things is because of the many gaps in the data collected in places that have assisted dying laws. It has been mentioned before, but very much bears mentioning again, that the Australian states’ reports on assisted dying do not publish data on complications suffered by patients who self-administer drugs, and that is the overwhelming majority of assisted deaths in Australia.

Western Australia’s most recent report does tell us how frequently there were complications in the cases that involved practitioner administration of lethal drugs—4.3% of those deaths were affected. I understand that the Bill does not allow practitioner administration, but that is not the relevant point. What is relevant is that first, the Australian data shows that some people given lethal drugs suffer complications, and secondly, those complications were ones that we would not wish on someone in their last minutes or hours of life. For example, five out of 198 practitioner administration deaths involved “other complications”, which included people coughing and/or reporting a burning throat after they were helped to swallow drugs,

“hiccups with gastric reflux, involuntary muscular contractions, and delayed loss of consciousness.”

Western Australia could be much better than other states on average in avoiding complications, or it could be worse. I am afraid that we really do not have the robust data that would allow us to make those comparisons. I repeat: the Australian state does not publish data on complications affecting the majority of assisted dying cases. They do not because they cannot, since no one is mandated to stay with the patient and observe their condition. We do not know, therefore, how common those complications are.

Record-keeping in other jurisdictions is also concerning. This House’s Health and Social Care Committee examined the records kept by the state health department in Oregon while inquiring into assisted dying. They found that Oregon authorities kept very poor records into how many patients suffered complications and what those were.

Amendment 436, tabled by my hon. Friend the Member for York Central, would take a very different approach. Under this amendment, the doctor attending the person having an assisted death would have to make “a detailed record” if the person suffered complications. They would then have to declare that the person had suffered complications, on the final statement concerning that case. Finally, they would have to make a report, to both the chief medical officer for either England or Wales and the voluntary assisted dying commissioner.

--- Later in debate ---

[Jack Abbott]

I fully understand and am very sympathetic to my hon. Friend’s point about the family having privacy and space in the last moments. However—this is a genuine question—what happens if things start to go wrong? Although it is uncommon, we know it is possible. Do we expect the family members who are going through the last traumatic moments to have to go out of the room to find the doctor, albeit they might just be behind the door? I do not know that that would necessarily make it less traumatic, and for some people it could make it worse if the doctor is not there and present next to their bed.

[Dr Opher]

I think there is some truth in that, to be fair, but I believe we should leave it open to the family’s discretion, with the proviso that the doctor should be close at hand, whether that means outside the door or whatever. We need Government advice on whether amendment 429 is safe. I have nothing further to say.

--- Later in debate ---

[Jack Abbott]

I appreciate what my hon. Friend is saying about the Secretary of State not stipulating every dot of every i and cross of every t in the regulations, but we are talking about something that has not been practised in this country, so we do not have existing guidance anywhere about what to do in this event. My hon. Friend may correct me, but I think it is really important that the Secretary of State has to give some direction through regulations on what a doctor is able or not able to do in these situations. I appreciate that there must remain room for a doctor’s best-case judgment in certain situations but, from a legal perspective and otherwise, the Secretary of State and the Department will have to give some thought to exactly how the regulations work.

[Lewis Atkinson]

To me, amendment 430, tabled by my hon. Friend the Member for Bexleyheath and Crayford, strikes the right balance. Under clause 30 the Secretary of State “may” make provision for codes of practice on these matters if that is required; I am uncomfortable with saying that the Secretary of State “must” do so, when it is likely that it will be more appropriate for the GMC or some other body to make those regulations. We get into a difficult precedent if the Secretary of State must specify the reaction in certain medical circumstances but we routinely leave that to medical regulation and practice more widely. I think a “may” power, as set out in amendment 430, would allow that backstop provision, but would not get into the issue of “must”. It is also likely to be more respectful of the conversations as outlined in clause 9.

--- Later in debate ---

[Lewis Atkinson]

I am going to finish on this point.

On amendment 533, tabled by my hon. Friend the Member for Ipswich, I suspect that, in dealing with a later clause, we will have a conversation about issues around hospices and care homes, but again I find the requirements under the amendment unduly onerous. As my hon. Friend the Member for Stroud and others have said, often people’s preferred place of death is at home. Are we really saying that the Secretary of State would specify addresses or the nature of places where these procedures should take place?

[Jack Abbott]

No, is the short answer to that question. Because a doctor has to be present, are we saying that doctors have to go to someone’s home to administer this? Would the Secretary State say, for example—this is not my personal view; it is for discussion—that it would have to take place in a medical facility, or could people choose to have an assisted death at home? The amendment stipulates that the Secretary of State would have to give that guidance at the time. I do not see how we can have doctors going out to individuals’ homes to assist the process.

[Lewis Atkinson]

It is by no means clear that doctors would not go out to people’s homes, but my hon. Friend asks whether doctors would have to do that—there are no powers of compulsion anywhere in the Bill, because the entire model is an opt-in model at every stage, including the example he gave in respect of hospices. It is a matter between the resident of the home and the treating medical practitioner.

In reality, healthcare procedures do not happen ubiquitously: they happen in appropriate places with appropriate cultural sensitivity. We do not specify in primary legislation for that to happen. Health professionals, and those involved in the management and commissioning of health services, currently have ample opportunities to co-ordinate and consider such matters.

[Jack Abbott]

I appreciate my hon. Friend giving way again. For people in the Committee and our colleagues across the House, there has to be clarity. Perhaps it is a question for the Bill promoter’s and the Government. As I said, I have no personal problem with it, but is there an expectation that assisted dying will take place at home as well as in medical facilities?

[Lewis Atkinson]

I cannot speak for the Bill’s promoter or for others, but a significant number of people wish to die at home.

--- Later in debate ---

[Kim Leadbeater]

I believe that amendment 447, tabled by my hon. Friend the Member for York Central, would change the “may” to a “must”. I am minded to support it for that very reason.

Amendment 532, tabled by my hon. Friend the Member for Ipswich, comes from a good place as is meant to be a way of trying to help the doctor, but I worry, as medical colleagues have commented during our deliberations, that it could create more of a problem for the doctor in that it would remove flexibility and the use of their clinical judgment and expertise. It always worries me when we are considering putting that level of detail in the Bill.

[Jack Abbott]

I appreciate what my hon. Friend is getting at in terms of what might happen down the line, but the amendment would not restrict any doctor’s flexibility at all or bind them in any way. All it would do is ask the Secretary of State to form a set of regulations.

[Kim Leadbeater]

The challenge would be in whether the co-ordinating doctor would be able to take actions that were not listed. I worry that a list would be quite restrictive. Amendment 430, which would look at the code of practice, would achieve something in a less restrictive way, which is why I am minded to support it.

We have had a really interesting discussion about amendment 533, and we will probably come further down the line to discuss where patients should have the choice to have an assisted death. I am not entirely sure how the amendment would work, which is why I am not minded to support it.

I am slightly concerned about the terminology and am not sure what the definition of “disadvantaged and marginalised communities” would be for the purposes of the amendment. I refer my hon. Friend the Member for Ipswich to new clause 8—the duty to consult—bearing in mind that there will be a long period of consultation before the Bill, if it passes, is enacted.

The Minister referred to amendment 255, which I think will fall as it refers to a schedule that has been removed from the Bill.

Terminally Ill Adults (End of Life) Bill (Twentieth sitting)

Jack Abbott Excerpts

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Jack Abbott (Ipswich) (Lab/Co-op)]

For clarity, at what point in the conversation does the hon. Member expect the question to be raised? In reference to an assessing doctor, do I take it that the question must be asked twice, at different times, by both the co-ordinating and the independent doctor?

[Rebecca Paul]

I thank the hon. Member for his very good questions. I suggest that it be asked twice, because it makes a lot of sense to ensure that the patient is given the chance to really explain what is driving their decision. It is the simplest of questions, but it is amazing what can sometimes come out of the simplest question.

I return to the safeguard against coercion. In a sense, this is not a new safeguard; rather, it confirms and bolsters the other safeguards in the Bill, which are there to explore the reasons for assisted dying. Asking why will help doctors to better understand what is driving a patient’s decision and to give that patient an opportunity to validate that they are truly eligible. It is the simplest of questions, driving the most significant conversation that a doctor and patient can have. I hope that hon. Members will support my amendment.

--- Later in debate ---

[Naz Shah]

I agree. Sometimes it will be the simple thing of asking the question as a human being—among all the conversations that are happening, just stopping and asking why.

[Jack Abbott]

I appreciate that my hon. Friend has given way a number of times, but I gently suggest that we already know the crux of the Bill and what we are debating. The “why” is that people with a terminal diagnosis, with six months to live, would like a course of action to end their lives in a pain-free way and to have the autonomy to do so.

We are in danger of over-legislating for a range of different permutations that could potentially happen in conversations. I agree that these kinds of questions are absolutely crucial, but it may satisfy my hon. Friend that amendment 21, to which we agreed a few moments ago, requires medical practitioners to take training on

“domestic abuse, including coercive control and financial abuse”.

That sort of protection and safeguard has already been agreed to.

We will rely on highly specialised individuals to pick up on these issues. They may want to explore, through further questioning, why people are making these decisions but we cannot legislate for all the different sorts of conversations, and all the emotions that may be going through people’s minds. If someone comes back and says, as my hon. Friend put it, “Well, it’s none of your business,” or whatever the answer may be, we will rely on the specialised professionals to pick up on danger signs. However, that would not necessarily lead them in every single conversation to have a suspicion of the patient’s motives. Life and conversation do not work like that and we cannot legislate in that way.

[Naz Shah]

I absolutely agree that life does not work like that. Life is very complicated and that is why I want the conversation to happen. My hon. Friend referred to amendment 21, which we have just agreed to. I spoke extensively about why that is a brilliant amendment that moves us towards much more safeguarding, but I also think that it does not go far enough for women, marginalised communities and people from ethnic minority backgrounds. I genuinely do not feel that amendment 468 is about over-legislating. It is just stating an obvious fact: sometimes, even in normal life, we go around the houses to get to a conversation and get to the right point. That is what I want to get to.

[Jack Abbott]

To follow up on the example my hon. Friend gave earlier, if—to be glib—someone said, “None of your business”, she would want the doctor to keep probing. At what point does that end? If someone genuinely does not want to have that conversation and says, “I want to end my life because I have a terminal diagnosis. I live in fear of the pain that could await me and I don’t really want to go into much detail,” where does that end? Where does that conversation continue to?

[Naz Shah]

My hon. Friend makes my case for me. If that person says, “It’s none of your business, but I have so much pain,” at that point, automatically, as we naturally do as human beings—

[Jack Abbott]

But this is a pure example.

[Naz Shah]

That example is a good example that strengthens my position.

Terminally Ill Adults (End of Life) Bill (Twenty First sitting)

Jack Abbott Excerpts

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Danny Kruger]

I am afraid to say that the whole debate about assisted dying is replete with scare stories. The hon. Gentleman says that they are descriptions of horrible events, but that is the situation that we are dealing with. We are here to try to pass legislation that is designed to avert horrible deaths. I am absolutely committed to that as well, but the evidence from abroad shows that people can also have a horrible death with assisted dying.

The hon. Gentleman points to Australia, but the evidence from Western Australia in particular is that over 4% of assisted deaths reported complications. He might be right that it is a better regime than that used in the United States, but even there complications occur. We do not know yet what the regime will be here, but I am alerting the Committee to the genuine danger of an assisted dying regime that induces very unpleasant results for patients.

[Jack Abbott (Ipswich) (Lab/Co-op)]

The hon. Member may be surprised to hear that I am inclined to support his amendment 362 and amendment 142 tabled by my hon. Friend the Member for Broxtowe, not because of, in the words of my hon. Friend the Member for Stroud, the scare stories or the examples that the hon. Member has been giving, but predominantly because of what the amendment says on the tin: that a person must be given a full explanation of the risks of complications and how a substance should be administered. As I have said a number of times in Committee—

[The Chair]

Order. Can I just check that this is an intervention?

[Jack Abbott]

It is an intervention, Ms McVey. My plea to the hon. Member is to focus on exactly what the amendment states. I appreciate all the stories and examples that he wishes to make, but it is important to reflect on the words of the amendment. As I said, I am minded to support it.

[Danny Kruger]

I am grateful to the hon. Member for his intervention.

Amendment 306, tabled by the hon. Member for York Central, addresses the question of what to do in the event of complications. I recognise that clause 9 states that that must be discussed, which I welcome. I think, though, that there is a significant absence that this amendment would address, which is what to do in the event of complications—specifically, which intervention would be appropriate.

Here we get into a very difficult area. I personally find it difficult to understand a way out of it, because it is a consequence of the sort of legislation that we are considering: what do we do when complications arise? Specifically, what do we do when the patient does not die and is still alive some hours later, possibly in distress? I have cited evidence about some of the complications that occur and the prevalence—for example, that 10% of such people in Oregon experience complications, including some who simply wake up again. We need to resolve this. On explaining possible side effects and complications, under the Bill as it stands none of the declarations that are signed by the doctors or the person requesting assistance confirm in writing that the criterion has been met for proper communication, so that is one concern.

My more substantial concern—I will finish with this—is that at the moment the doctors have to explain the complications, even though we do not know what the drugs are going to be yet, but they cannot discuss or decide with the patient what they would do in the event of complications. We know that the doctor must be present at the end or in the next room, but can they halt the process if complications arise—if the patient wakes up or is exhibiting signs of distress? That would be against the last known wishes of the patient who had said that they wanted to go ahead with the death. Should the doctor expedite the death knowing that that is what the patient theoretically wanted? Of course not, because that would be euthanasia; it would be the doctor actually killing the patient, which is illegal under the Bill. Do they stand by and do nothing at all, which goes against the doctor’s obligations to address symptoms and illness in a patient? If the patient is fitting or vomiting, the doctor would normally clear their airways. Should they do that, knowing that that might bring the patient back to life—that it might resuscitate them and stop the assisted death?

When we debate clause 18, we will discuss the process of the assistance that the doctor gives, but we are obliged, when we come to debate the Bill fully, to choose between three options. We could allow complications without any guidance, which is what the Bill does; that raises all sorts of challenges, and practical and ethical concerns, for doctors. We could stipulate that the patient should be revived, perhaps if a certain degree of distress is witnessed or if the patient is still alive after a certain period of time. Finally, we could allow euthanasia and say that, in that event, the doctor should be authorised to expedite the death. I do not know what the option should be. That is a question that a doctor would have to face in reality, in the bedroom of a patient who is exhibiting complications. I do not know what to do, but I do not think we should be proceeding with this Bill. Those who do believe in it have to answer this question: what does a doctor do if a patient is exhibiting distress and not dying—do they bring them back to life, expedite their death or do nothing?

--- Later in debate ---

[Naz Shah]

Yes, fortunately not. I am not convinced that the clause covers it. I will go back to that, but I have just read it because the hon. Member for Solihull West and Shirley raised it and I support his amendment, and somebody else raised it earlier.

I am not convinced that the complications are covered, because the clause does not set it out. In the usual sense, complications are side effects from medications. We have research and literature given to us and we understand the potential side effects. In this instance, we do not have a yardstick. I do not know whether the Minister can speak about the Government’s intentions—it would be helpful to have an impact assessment—and whether any research has been done in this area.

I am not convinced that clause 9(2)(c) actually covers this point, and I think the amendment would make the Bill much stronger. Ultimately, these drugs have not been tested—and for a very good reason, because they lead to death. We are in unchartered territory. When we are doing things that we have not done before, we cannot just pick and choose what we apply an analogy to. We need to be careful. We really need to consider the options to make this clause in particular much stronger.

[Jack Abbott]

I completely understand what my hon. Friend is saying about what may need to happen in respect of medical intervention, but I gently point out that the amendment would not cover that. It does not spell out in any way, shape or form what a medical intervention would look like. It says that there needs to be a random discussion, but it does not lay out any sense of the medical intervention. I do not see how the amendment will do what my hon. Friend is looking for.

[Naz Shah]

I thank my hon. Friend for his intervention. As drafted, the Bill does not include effects. All it says is “complications”. It does not include the potential effects of the drugs that will be used. That is how the amendment would strengthen the Bill.

--- Later in debate ---

[Dr Opher]

No, I have not, because that is currently illegal—this Committee is about changing that—but I have sat with patients who have slowly died. It is not about whether we get an ambulance; we know we do not do that. We are allowing the patient to die, and if something happens that involves having to help them, we just do it. We do not need to specify that in the Bill: it is part of normal medical practice.

[Jack Abbott]

I will be brief, as I have already alluded to my support. I put on the record my support for amendment 93. There has not been a lot of debate on it because it is a fairly straightforward proposal.

There has been a lot of discussion. Members on both sides of the Committee have spoken in defence of the medical profession in respect of huge parts of the Bill, although they should not have to. We have of course seen occasional bad practice, as we do in all professions, but we should take a moment to reflect on the dedication, diligence, hard work and expertise of medical professionals in everything they do. This debate has on occasion almost presented this as a 50:50 choice between good doctors and bad doctors. I think we would all agree that although we want to put in the right safeguards, that is not the case at all.

I have made this point a number of times, but I do not want to accept amendments that spell out all the rules and regulations so that every doctor has to go to the nth degree all the time. As my hon. Friend the Member for Stroud has said eloquently on a number of occasions, it is already in their codes of conduct, working practice, training and everything else. However, on occasion we cannot be satisfied that something is a given. For that reason, particularly in respect of amendments 142, 362 and perhaps 305, if we say that

“the nature of the substance that might be provided to assist the person to end their own life (including how it will bring about death)”

must be discussed, it is not a huge leap to say that we should also spell out how it may be administered and the possible risks and complications that come with that. As I have said, I do not think it will create any unintended consequences. I do not think it puts the full rulebook on the face of the Bill. If we are stipulating how it will bring about the death, it is not a huge leap to also talk about the other side effects.

Cutting through some of the stories, and everything else we have heard this afternoon, we should be considering what the amendments seek to do—what they say on the tin, as it were. We should be asking doctors to have the conversations, although I am absolutely sure that, as my hon. Friend the Member for Stroud said, those conversations will happen naturally anyway. I do not think there is anything harmful in the particular amendments, as we have discussed today.

Finally, on amendment 306, I understand the points that my hon. Friend the Member for Bradford West and the hon. Member for East Wiltshire made. To be totally honest, I fail to see how the amendment satisfies the arguments they were trying to make, as powerful as those arguments are. It does not solve the issue they are looking to solve; I do not think it answers any of those questions. For that reason, I will not support amendment 306, but I am minded to support the other amendments in the group.

[Stephen Kinnock]

Amendment 93 relates to the discussion during the assessment that the co-ordinating doctor and the independent doctor are required to have with the person. The amendment would require that each of those doctors, during their assessment, must discuss the nature of the substance that “is to be provided” to the patient to end their life, rather than the substance that “might be provided”.

On amendment 305, clinicians in all areas are expected to work with patients to make decisions about their care and treatment as part of a shared decision-making process, including by discussing the risks, benefits and possible consequences of different options. The Committee may wish to note that the GMC’s “Good medical practice” states that when discussing a patient’s condition doctors must discuss with patients

“the potential benefits, risks of harm, uncertainties about, and likelihood of success for each option.”

--- Later in debate ---

[Naz Shah]

I absolutely agree that we have not thought this through enough, because that process has not been laid out. We really need to think about these potential eventualities.

When such cases happen, the public, including family members of the person who has died, will rightly demand answers, and so will the media. They will want to know who the panel members were and why they made the judgment they did. In such cases, who would investigate whether panel members had got it wrong? The commissioner who had appointed them? The commissioner, or any person, no matter how honest and how learned, would come back to that question with a very strong bias. The commissioner will mark their own homework. That is not a system that anyone can argue will provide proper safeguards.

Hon. Members might object that the voluntary assisted dying commissioner will be a very senior judge. According to the new clause, the commissioner

“must hold or have held office as a judge of—

the Supreme Court

the Court of Appeal, or

the High Court.”

I agree that only people of high intelligence and good standing become judges in those courts, but that does not mean that the very highest judges in the land do not sometimes make mistakes—sometimes very bad ones.

[Jack Abbott]

If we follow that argument, does that mean that we would support the new clauses? If we are moving from that single point of reference—a High Court judge and judicial review—it is surely much safer to move to what is proposed.

[Naz Shah]

The truth is—I said this in my previous speech, which I will not repeat, as instructed by you, Mrs Harris—that neither of the safeguards is strong enough. As it was, the Bill was not strong enough—that has been recognised and changes have been proposed—but neither is the idea of a commissioner.

There is another great problem raised by this set of changes to the Bill: they seem likely to increase the prospect of group-think when it comes to members of the panel. I would argue that that danger has been greatly increased by the move away from the High Court judge model that was originally in the Bill.

When my hon. Friend the Member for Spen Valley introduced the Bill on Second Reading, she reassured the House that all assisted dying applications would have to be examined by a High Court judge. There were problems with that proposal, which is why she abandoned it. But there was one strength in making a High Court judge the arbiter: the Crown does not appoint High Court judges on the basis of whether they agree with assisted dying. We could all reasonably expect High Court judges to have a range of views on assisted dying; there is no reason I can think of that would mean that High Court judges, as a body, were biased in favour of assisted dying.

Something different will happen if a commissioner selects people to serve on these panels. Anyone serving on a panel will know that they will have to approve some applications for assisted death. We do not know how many applications for assisted death the Government expect to have. We also do not know how many social workers, psychiatrists and lawyers would be unwilling to approve any assisted death applications at all—I do not want to repeat myself, but I will be referring back to psychiatrists in another amendment. However, the number of psychiatrists who are strongly opposed to assisted death is very high, according the Royal College of Psychiatrists. We have also heard strong reservations expressed by the Association of Palliative Care Social Workers. Therefore, many professionals will choose not to sit on these panels, because they will not want to approve any cases. That means that some panel members are likely to end up dealing with dozens of cases per year. That poses the danger that some of the people who sit most on these panels will be advocates of assisted dying and will approve applications that other members may not have.

--- Later in debate ---

[Jack Abbott]

My hon. Friend is saying that there is no mechanism to remove the voluntary assisted dying commissioner. Actually, paragraph 4(5) of new schedule 1 says:

“The Secretary of State may by notice in writing remove a person from the office of Commissioner or Deputy Commissioner if satisfied that the person—

(a) has behaved in a way that is not compatible with their continuing in office”—

I think that addresses a lot of the concerns that she has been expressing—

“or

(b) is unfit, unable or unwilling to properly discharge their functions.”

There is a mechanism in the new schedule that would give the Secretary of State the power to remove the commissioner.

[Naz Shah]

I thank my hon. Friend for pointing that out, and I will look at it, but that was not my understanding.

There are multiple reasons to oppose new clause 21. With it, the Bill will reduce the impartiality that would have been provided by having a High Court judge rule on applications. It will increase the risk that a large number of decisions are taken by people who are enthusiastic proponents of assisted dying, which will reduce patient safety. It will also create a powerful new commissioner, who will appoint panel members and will then rule on whether they have made the right decision. That same commissioner will also be able to decide whether to overturn a panel’s decision to reject an assisted death application. That is a huge amount of power to put in one person’s hands and we should not do so. I urge hon. Members to reject the new clause.

Terminally Ill Adults (End of Life) Bill (Eighteenth sitting)

Jack Abbott Excerpts

Committee stage
Wednesday 5th March 2025 Public Bill Committees

[Kim Leadbeater]

I rise to speak first to my amendments 185 and 186, which would make important changes to impose a duty on the Secretary of State to make regulations about the training, qualifications and experience required to act as the co-ordinating doctor, as the Minister says. Moving from “may” to “must” would make it a legal requirement that such training take place and would thereby strengthen the Bill. In its present form, the Bill gives the Secretary of State that power to make such regulations but does not legally require him or her to do so.

Amendment 186 would ensure that regulations must include training about

“(a) assessing capacity;

(b) assessing whether a person has been coerced or pressured by any other person.”

Colleagues will appreciate that it is difficult for me to resist the temptation to put the entire training manual in the Bill—we all want to show the thorough approach that has been taken—but doing so would not make for good, clear legislation and can be limited in terms of flexibility and future-proofing. However, given the importance of the matters of capacity and coercion, I felt that it was important that this level of detail be specified in the Bill, because those issues have been at the heart of so many of our deliberations on this hugely sensitive and important issue.

My hon. Friend the Member for Bexleyheath and Crayford, who tabled amendment (a) to my amendment 186, has made a compelling argument, as always. Like my hon. Friend the Member for Penistone and Stocksbridge, I have some concerns that the amendment would limit the number of disabled people who are covered and that it would not cover people with mental disorders, but I understand the concerns around autistic people and those with learning disabilities.

I am also mindful, given that people with Down’s syndrome will typically have some form of learning disability, that amendment (a) may help to address some of the concerns that were expressed yesterday about ensuring that the Bill meets their needs and takes them into consideration. I take on board the Minister’s comments about the Health and Care Act 2022, but I am minded to support the amendment and work with my hon. Friend the Member for Bexleyheath and Crayford and others as necessary to make any further changes as the Bill progresses.

[Jack Abbott (Ipswich) (Lab/Co-op)]

I am grateful to my hon. Friend for supporting that amendment. We have often debated the level of detail that should be set out in the Bill. I fully appreciate that she does not want to include the whole training manual; I will not discuss my amendment, which concerns culture and trauma-informed care, because I recognise that it is much too detailed in that respect. However, does she agree that where possible, and where it does not create unintended consequences or loopholes, we should reassure not just colleagues across the House but members of the public, who want to see these sorts of thing on the face of the Bill?

[Kim Leadbeater]

My hon. Friend is absolutely right. If the Bill passes, it will be a huge change. We have a duty to the public to show that we are including sufficient detail in the Bill and to provide reassurance in any way we can. To be honest, I would quite like to put the entire training manual in the Bill, but I appreciate that from a legislative perspective that is not possible. However, there are occasions when, for the avoidance of doubt, we should make certain provisions clear on the face of the Bill.

That brings me to amendment 20, which was tabled by my hon. Friend the Member for Lowestoft, who has a huge amount of experience and expertise in the field to which it relates. Her amendment states:

“Regulations under subsection (3)(a) must specify that training in respect of domestic abuse, including coercive control and financial abuse is mandatory.”

At the moment, there are no safeguards for terminally ill victims of domestic abuse, financial abuse or coercive control. That concerns me, and it feeds into the points made by my hon. Friend the Member for Bradford West.

If a victim of domestic abuse or coercive control—it is often a woman, as we know—is also terminally ill, I can only imagine what a lonely place that is. At the moment, that person is under no supervision. Sadly, there have been instances in which those people have taken their own life. They will continue to be the victims of their incredibly difficult personal circumstances on top of having a terminal illness, which is an absolute tragedy. Opening up the conversation with doctors and healthcare professionals about their circumstances has to be a good thing. It will shed light and transparency on what must be an incredibly difficult situation.

--- Later in debate ---

On amendment 427, I think we covered the relevant points yesterday. As I have said, I am very open to continuing the conversations to ensure that the Welsh language is fully respected in the Bill.

[Jack Abbott]

On a point of order, Mr Dowd. I think my hon. Friend the Member for Spen Valley said that if amendment (a) and amendment 186 are agreed to, that will negate the need for amendment 340. I seek clarity on whether that is the case.

[The Chair]

It is not for me to make that decision.

--- Later in debate ---

[Danny Kruger]

I am glad to hear we will have more clarity. Having assisted suicide as an NHS service is fraught with enormous risks, along the lines we have discussed and will no doubt continue to discuss. At least we have that clarity. If the hon. Lady is going to rule out private provision and profit making or remuneration of people outside the NHS, I would be grateful for amendments specifying that. That would help to address this question.

My amendments would mean that if there is private provision of assisted suicide, as the Bill currently allows, the public and Parliament could understand who is being paid what, which I think is very appropriate.

[Jack Abbott]

To give the Committee a sense of clarity, is the hon. Gentleman saying he wants the finances to be in the public domain, so that if provision were to go down a private route, everyone would know what an individual is charging for these services? Or is he suggesting a cap on services? What is the intention of his amendments?

[Danny Kruger]

My amendments state that if a medical professional is paid for delivering assisted suicide, the money they receive should be transparent. The answer is therefore the former.

I do not propose any cap. If we end up with a private service, although the hon. Member for Spen Valley has just told us that we will not, it might be appropriate to create a scale of charges. My suggestion is that we need absolute clarity. I also think we should use the affirmative procedure to approve the regulations on the transparency of finances. This should be something that Parliament expressly approves.

Terminally Ill Adults (End of Life) Bill (Nineteeth sitting)

Jack Abbott Excerpts

Wednesday 5th March 2025 Public Bill Committees

[Jack Abbott (Ipswich) (Lab/Co-op)]

The problem with the amendment, which has been mentioned before—I will not go as far as my hon. Friend the Member for Rother Valley and say that it would essentially nullify the Bill—is that it is entirely subjective. It is not guidance or a clear point of reference; it is entirely subjective to each individual doctor.

[Danny Kruger]

I am afraid that the English language is rather subjective. The service would rely on guidance or case law that had been built up, although one hopes that there would not have to be court cases in respect of it. The interpretation of the language of the Bill would be the duty of clinicians and, ultimately, NHS trusts and their lawyers.

[Jack Abbott]

A lot of the conversations we have had in Committee have been about eliminating the lottery that exists in our healthcare system. What the hon. Gentleman is suggesting will be exactly that: a lottery according to each individual clinician and doctor.

[Danny Kruger]

We cannot have it both ways. We cannot give doctors and clinicians autonomy, which the Committee has repeatedly seen as a ground to reject all sorts of obligations that I and others have proposed to ensure that doctors do the job in a specific way, and then suggest the opposite in this instance. I recognise what the hon. Gentleman says, and he may be right that that is inappropriate.