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

Kim Leadbeater Excerpts

Committee stage
Wednesday 5th March 2025 Public Bill Committees

[Naz Shah]

I rise to speak to amendment 20, which was tabled by my hon. Friend the Member for Lowestoft (Jess Asato).

The key point for me is that doctors are not specialists in coercive control, but this amendment would give them training to spot abusive and coercive relationships, which are difficult to detect. Domestic abuse and coercive control have a disproportionate effect on women and disabled people, and if doctors just rely on their experience to detect coercive control and abuse, they are more likely to miss cases. Some doctors will be more experienced or more perceptive than others. This amendment is not a perfect safeguard, but it will improve the chances of doctors stopping people being coerced.

The amendment would ensure that co-ordinating doctors must have undertaken training on domestic abuse, including coercive control and financial abuse. It is a significant and distinct amendment. In particular, it addresses the issue of repeated coercive control, which so far has been overlooked in the Bill. I believe that amendments seeking to improve safeguards against coercion that do not address the issue of repeated coercive behaviour are inadequate in protecting vulnerable people, particularly women.

It is regrettable that in our witness sessions we did not hear from any experts on repeat coercive control. Such testimony would have been valuable, helping the Committee to understand why this specific environment puts people at risk with regard to the Bill.

We have already spoken a great deal about coercion in this Committee and other Members have referred to that. We have raised concerns about someone coercing another person into the process of assisted dying in a one-off incident. However, we have not yet discussed the very real issue of repeated coercive control and what it means to live in that environment, nor the implications that the Bill may have for people in those situations.

Dr Hannah Denno submitted written evidence to this Committee. She wrote:

“As a doctor I am not trained to detect coercion, and I do not believe that the Bill pays sufficient attention to the detection of those who are under pressure from themselves or others to end their lives. The Bill describes two independent medical assessments, both can be carried out by doctors who have never previously met or cared for the patient.”

[Kim Leadbeater (Spen Valley) (Lab)]

I just want to provide some reassurance to my hon. Friend the Member for Bradford West. I have met my hon. Friend the Member for Lowestoft and today I will support amendment 20, which she has tabled. I hope that provides some reassurance to my hon. Friend the Member for Bradford West.

[Naz Shah]

I am grateful to my hon. Friend for that intervention and I am really grateful that she is supporting the amendment. However, the reason I am making this speech is that I do not think the amendment goes far enough in terms of providing safeguards within the Bill. So, I will make some progress with my speech and then I will address some of the issues that are not addressed in this particular amendment, and set out how we can go further, as well as highlighting some of my concerns.

I return to what Dr Denno wrote in the evidence that she submitted. She wrote that she was:

“not trained to detect coercion”.

And she also wrote that

“Social workers are better placed to screen for coercion but are not mentioned in the Bill.”

Since that submission, my hon. Friend the Member for Spen Valley has tabled an amendment that would mandate a social worker to sit on a panel to consider each application for assisted death. However, I am afraid that I must repeat several points about these panels, points that have already been made frequently. These panels are under no obligation to interview the applicant for assisted death in person. Panel members may do so if they have any concerns, but they may not. That makes it harder for panel members to detect possible coercion.

There is also an absence of any mechanism for people who know assisted dying applicants to report any concerns they have that that person is being coerced into this form of action. The panels are not used in that way, which is the way that multidisciplinary panels are used in the NHS to decide on the pathway for a patient. Instead, the panels introduced by my hon. Friend’s amendment would wait until the two doctors have submitted their statements on the applicant and then the panel members would scrutinise those statements. If they spot problems with the way that the doctors have determined that the patient is not being coerced, then, yes, they would call the patient in for more scrutiny. However, they will first have to come to that conclusion without seeing the patient. That is not a very robust safeguard.

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[Kim Leadbeater]

I am in the process of tabling an amendment that would change the panel to that effect, so that it would speak to the patient. Hopefully, that provides some more reassurance for my hon. Friend. I am sure that we are working very effectively through the Committee process to achieve what we all want to see.

[Naz Shah]

I am pleased to hear that my hon. Friend will table further amendments, but I have not seen that amendment, so I cannot speak to it.

I would slightly beg to differ with my hon. Friend in terms of making progress in the way that I would like to have seen. I would just gently remind her that I am not convinced that we are. I think we are making good progress, but I also voted against one clause stand part and had lots of concerns about another one, so we will agree to disagree on that one.

The non-governmental organisation The Other Half observes in its written evidence to this Committee—TIAB 104—that the Bill makes no provision to identify family members who may benefit financially from the death of a patient, and, therefore, the Bill is unable to protect the vulnerable. That is something that I have said before in this Committee.

This amendment makes training in respect of financial abuse mandatory. It is vital that a medical practitioner is trained on how to identify coercion—we can all agree on that—but coercion is different from domestic abuse. Coercion may be relatively obvious to spot, but, in contrast, coercive and controlling behaviour is much less obvious. It can be subtle. It can be hidden, and unexpected to an outsider. It requires much more sensitive questioning and a degree of a doctor-patient relationship to identify. Multiple people have raised that a patient-doctor relationship is important for spotting that, and, currently, there is nothing in the Bill to say that the two independent doctors have to have met the patient before.

That subtle coercion could have happened over years. We have repeatedly heard from people giving evidence that it is really hard to spot, and the reason it is hard to spot is because it is a matter of trust for a patient to be able to tell somebody—for a victim of coercive control to be able to express that. Even recognising that there is subtle coercion going on is hard for victims of that coercion to understand.

If there is domestic violence—again, I say in this Committee that I first campaigned on domestic abuse in the mid-1990s, and I am not convinced that the stats have changed much. I will refer to some more later on, as I make progress, but it takes women, on average, 40 times to leave an abusive partner—40 times—and it took me a long time to leave my abusive forced marriage when I was very young. The coercion that happens is so subtle and, again, when it is repeated coercion, it is hard to even recognise it as a victim, let alone for a professional to be able to see it. Even when a professional may pick up on it, it is acknowledgment from the victim—that they recognise what is happening—that is important, and that often is not the case.

Again, multiple people have raised that the doctor-patient relationship is important, and there is nothing currently in the Bill to ensure that there is a long-standing relationship between the doctor and the patient. Therefore, it is unreasonable to assume that someone in an abusive relationship, or who experiences coercive and controlling behaviour on top of their terminal illness, would be willing and able to disclose that to a stranger, even if that stranger is a doctor.

On top of that, research suggests that a significant proportion of medical staff in the UK do not feel that they have had adequate training to spot domestic abuse. Research by YouGov and the charity SafeLives in 2018-19 found that half of UK healthcare professionals are untrained to spot domestic abuse.

I understand the current difficulty in ensuring that doctors have a prior relationship with patients; it may not be practically possible. In many cases, where patients will know their doctors, or even know them well, it is even more vital that both doctors have been thoroughly trained in spotting coercive-control behaviour.

Like the other Labour MPs on the Committee, I was elected on a manifesto pledge to halve violence against women and girls within the next 10 years. We must not forget that as we scrutinise this legislation; I want my colleagues and I to remain committed to that in this Bill.

This Bill will have particularly grave consequences for women, since we know that domestic abuse disproportionately affects them. The crime survey for England and Wales estimated that 2.3 million people aged 16 years and over experienced domestic abuse in the year ending March 2024. Of those, 1.6 million were women and 712,000 were men. In the same year, there were only 51,183 domestic abuse-related prosecutions—a very small number compared with the number of people who experienced domestic abuse. That is in addition to the abuse of our elderly, on which Age Concern submitted evidence. Those figures demonstrate that we already frequently struggle with bringing domestic abuse cases to prosecution stage. They show that even the dedicated members of our caring professions have trouble detecting domestic abuse. If something is hard, we need to train our doctors to do it.

Our society already diminishes the status of elderly, infirm women and I have concerns that the Bill will further entrench that. We need to be aware of and ensure that we address the problem of mercy killings in the Bill. That issue is distinctly gendered and the Bill as currently worded will have a distinctly gendered impact if we do not address it. In 2024, The Other Half carried out a review of more than 100 UK cases of so-called mercy killings. It found that

“‘mercy killings’ are not the wanted, ‘hastened’ deaths that need assisted dying.”

Instead, the review found that:

“They are overwhelmingly violent domestic homicides of women, by men: and show that our society is still poor at detecting and responding to domestic abuse.”

Some groups are more vulnerable to domestic abuse than others. A higher proportion of people aged 16 and over with a disability—a group that we know is vulnerable in relation to the Bill—experienced domestic abuse in the last year than those without a disability.

The law and Parliament have, unfortunately, taken a very long time to even start adequately responding to these problems. Coercive control was first recognised as a distinct offence in English law only in the Serious Crime Act 2015. As written, the Bill would not mandate training to the doctors whose role it would be to consider assisted dying cases. Of course, no training can be perfect, but to allow the Bill to go forward without ensuring that doctors have training in this complex matter would be negligent. It would mean that we were failing to even try to carry out our responsibilities to protect people, especially women, in abusive and coercive relationships.

I appreciate that my hon. Friend the Member for Spen Valley has said that she will accept the amendment, but it does not go far enough. The question is: how do we prevent abusers making use of the Bill if it becomes law? The amendment gives us one way of mitigating that risk to a degree. We already have issues recognising domestic abuse. The amendment cannot perfectly solve that problem, but it would take steps to do so.

We must safeguard vulnerable people who live subject to coercive and controlling behaviour on a daily basis from opting for assisted dying as a result of that environment. Thorough and specific training on spotting that is vital for doctors. I am grateful that my hon. Friend, in accepting the amendment, will ensure that some of that training will be forthcoming. Even one abused person being driven by their abuser to use assisted dying is one too many. I am confident that all hon. Members would agree with me on that deeply important point.

In the last few days, I have been looking at suicide, and one of the issues that has come up is that last year, for the first time in our history, suicide by victims of domestic violence overtook deaths from what we would term intimate partner homicide. In the last two weeks, there have been further reports highlighting that the number of women driven to suicide because of the experience of domestic violence has risen. Tomorrow, my hon. Friend the Member for Birmingham Yardley (Jess Phillips) will read the name of every woman who has been killed in the last year, as she does every year. Two of those women were my constituents, and many more kill themselves to get away from their abusers.

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[Stephen Kinnock]

I thank the right hon. Lady for that. We go back to the point about the true significance of the 2011 Welsh Government Measure, which sets a basic foundation for the duty of the Welsh Government to ensure that Welsh language provision is provided through the Welsh NHS. There is absolutely no debate about that point; that is nailed on. The question is simply how we ensure, if we are to amend this Bill along the lines that the right hon. Lady suggests, that that does not create a lacuna or confusion in the system. I think we need to sit down and discuss that, to ensure that whatever we propose is watertight.

It may be helpful to note, as in discussion of amendment 413, that regardless of this amendment, under the Welsh Language Measure of 2011 the NHS in Wales has a statutory duty to deliver its services to the public in both Welsh and English. That legislation gives the Welsh language official status in Wales, and the Measure states that individuals in Wales should be able to conduct their lives through the medium of Welsh if they choose to do so. The Welsh Government’s active offer for health is intended to support all staff across NHS Wales to provide a service in Welsh for patients without their having to ask for it.

Under amendment 20, regulations made by the Secretary of State on the necessary training, qualifications and experience of the co-ordinating doctor would be required to include mandatory training relating to domestic abuse, including coercive control and financial abuse. Amendments 185 and 186, tabled by my hon. Friend the Member for Spen Valley, would require that regulations made by the Secretary of State on the necessary training, qualifications and experience of the co-ordinating doctor covered training related to assessing capacity and whether a person has been coerced or pressured by another person. But I note that, as my hon. Friend the Member for Spen Valley has said, she is minded to support amendment 20, which clearly would ramp up the requirement, as previously discussed.

As I have said, the Government have taken a neutral position on the substantive policy questions relevant to how the law in this area could be changed, but to clarify the intent of the Bill, we have worked with my hon. Friend the Member for Spen Valley in relation to amendments 185 and 186, which would place the Secretary of State under a duty to make regulations regarding the necessary training, qualifications and experience of the co-ordinating doctor. That would include specific training on assessing capacity and assessing whether a person has been subject to coercion or pressure.

I hope that that explanation and those observations have assisted the Committee. I thank hon. Members for their attention.

[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.

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[Liz Saville Roberts]

Diolch, Gadeirydd. As Professor Emyr Lewis of Aberystwyth University told this Committee in oral evidence, because this Bill is a private Member’s Bill it has not gone through the usual process of engagement with devolved Governments. I recognise that there will be amendments and changes and amendments to amendments, but I can speak to the principle here and we will have to adapt as we move ahead, as we are learning to do in this Committee.

The Wales Act 2017 formally acknowledged the Sewel convention by amending section 107 of the Government of Wales Act 2006 with a declaration stating—this is important—that

“it is recognised that the Parliament of the United Kingdom will not normally legislate with regard to devolved matters without the consent of the Senedd.”

It is in that spirit that work needs to be done to ensure that the devolved legislature in Wales and the complexities of legislating across reserved and devolved matters are fully considered and represented in the Bill. That is what these 28 amendments seek to do.

The use of the term “appropriate authority” does two things. First, in the here and now, it recognises the complexity of which competency lies where and with which Minister or Secretary of State. Secondly, it future-proofs the legislation, which we know is important. If and when there are any changes to devolved powers and competencies, the appropriate authority can move with time with the specifics of who is responsible for what.

Amendment 169 would amend clause 40 to include a definition of “appropriate authority”, the term that is used in my other amendments. It would mean the Secretary of State in relation to England and the Welsh Ministers in relation to Wales, where those powers are devolved rather than reserved. The amendment would provide for my other amendments, which would modify each relevant mention of powers provided to the Secretary of State in the Bill, to supply Welsh Ministers with equivalent powers in Wales.

Amendment 144 would amend clause 5 to allow Welsh Ministers the same powers as the Secretary of State in England to specify the training, qualifications and experience of the medical practitioner representing the co-ordinating doctor, because that matter is devolved to Wales. Amendment 145, similarly, would require Welsh Ministers to consult persons they consider appropriate before making the relevant regulations in Wales.

Amendment 146 would amend clause 6 to allow Welsh Government Ministers equivalent powers to make provision around proof of identity. Amendment 147 would similarly amend clause 8 in relation to the training, qualifications and experience of the independent doctor; we are talking, of course, about the co-ordinating doctor.

And so on, and so on. I assume that hon. Members now understand the purpose of my various amendments. I am more than willing to explain them further if necessary, but otherwise I will skip ahead.

Amendments 155 and 156 would modify clause 30 so that the Welsh Government are provided with a power to issue a code of practice over arrangements in relation to this legislation in Wales. That might be a useful route into further discussions on the specifications of the codes of practice; it might also be significant in discussions with the hon. Member for Spen Valley and the Government about how to recognise legislative differences in safeguarding and the Welsh language.

Amendments 157 and 158 are also important. They would provide Welsh Ministers with the power to make regulations under clause 32 to ensure that assistance is available through the health service in Wales. That is the responsibility of Welsh Ministers. As Committee members know, Senedd Cymru voted against a motion to support an assisted dying law by 26 to 19, with nine abstaining. There are a number of issues of which we need to be aware when bringing an England and Wales law into Wales. To ignore them would be irresponsible; we do so at our peril, frankly, especially given that clauses 33 and 34 will place explicit obligations on Welsh Ministers and the chief medical officer for Wales.

I put it on the record that I am disappointed that the Committee was not able to question the chief medical officer for Wales. I understand that he was invited. As there are matters in the Bill that we do not deal with every day in this place, that would have been useful. The Bill is unprecedented, certainly for a private Member’s Bill, in respect of the support, information and advice that the Committee needs, and that would have been an obvious opportunity for us to receive advice. I understand that the chief medical officer has advised on other pieces of legislation, including vaping, although that was Government legislation.

[Kim Leadbeater]

I can confirm that the chief medical officer for Wales was invited to give evidence. I do not know the circumstances of why he did not. If it is helpful for me or other colleagues to meet him, the offer is definitely open.

[Liz Saville Roberts]

I am grateful for the hon. Lady’s intervention.

Amendments 161 to 165 relate to clauses 35, 37 and 38. Amendments 161 to 163 would provide for the Welsh Government to review the operation of the legislation in Wales, which is vital to understand the specifics of the Welsh context and to learn and adapt as appropriate. To not allow Welsh Ministers that power would be to dismiss the particularities of health policy in Wales, as well as the additional implications of contextual differences. I strongly believe that we require an impact assessment to understand those differences properly within the context of health being devolved to Wales, alongside significant population differences in relation to demographics, age and sickness.

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[The Chair]

For clarity, amendments negatived in Committee, if they are pressed today, can be tabled again on Report. I say that in case the right hon. Lady wished to press the amendment and it was defeated. I hope there was clarity from me on that.

[Kim Leadbeater]

I welcome this important debate about the impact of this potential legislation on Wales. I thank the right hon. Member for Dwyfor Meirionnydd for her valuable contributions. I also welcome the Minister’s commitment to meet the right hon. Lady and me for discussions with parliamentary counsel and the relevant authorities.

This is really important. The criminal justice system covers England and Wales, so it is important for the Bill to do the same, given that it disapplies the Suicide Act in certain very carefully defined circumstances. But health is, of course, devolved and the Welsh Government quite rightly make decisions on the Welsh NHS. I want to make it clear that I recognise that reality and its importance, and I am fully committed to observing the same conventions that the Government would if this were a Government Bill.

As has been said, I am working with UK Government officials to ensure that the right steps are taken at the right time, and I would expect to engage colleagues in the Welsh Government as the Bill progresses. Indeed, I really look forward to doing so and would be happy to visit the Senate if appropriate—although, as Members can tell, I need to work on my Welsh a bit. I look forward to continuing these conversations.

[Liz Saville Roberts]

I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendment proposed: 359, in clause 5, page 3, line 18, at end insert—

“(ba) who has conducted the preliminary discussion in accordance with section 4,”—(Danny Kruger.)

This amendment requires that the coordinating doctor has conducted a preliminary discussion prior to witnessing the signing of the first declaration.

Question put, That the amendment be made.

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[Danny Kruger]

The amendment speaks to the general confusion we remain in about how the assisted dying law would be implemented and who would operate it. We are in a great cloud of unknowing about whether we are talking about an NHS service or a private service. If there were to be a private service and people were to be paid to deliver it outside the NHS, the amendment would clarify obligations regarding how their remuneration would be recorded.

There is an established precedent for publishing financial interests where there is a potential for a conflict of interest. Senior officials in NHS England, NHS trusts and the Medicines and Healthcare products Regulatory Agency must declare financial interests—including relationships with pharmaceutical companies—in public registers. Those interests include consultancy fees, gifts, hospitality, shareholdings in pharmaceutical companies or research funding, because there is a concern that those influence drug approvals, procurement and healthcare policy and that there is a risk of bias.

NHS England guidance on managing conflicts of interest encourages the detailed disclosure of significant payments from pharmaceutical companies, often with exact figures or ranges for payments above a £500 threshold. The Association of the British Pharmaceutical Industry runs Disclosure UK, which requires pharmaceutical companies to publicly report payments to healthcare professionals and organisations. It would be appropriate to follow this well-established precedent and ensure that people involved in the administration of assisted dying are accountable for the transparency for their remuneration.

Clause 5(3) recognises that there could be a conflict of interest and that there is a risk that someone who is related or might benefit financially may not be a neutral assessor of someone who wishes to die, but clause 40(4), which comes rather late in the Bill—it should be up front—specifies that

“a registered medical practitioner is not to be regarded as benefiting financially or in any other material way from the death of a person by reason only of the practitioner receiving reasonable remuneration for the provision of services”.

Here is where we discover that the Bill does envisage remuneration, but people being remunerated are excluded from the definition of people who financially benefit from the service. To me, that feels dangerous.

Although it has not resolved the question of whether assisted dying is to be an NHS service, the Bill clearly envisages the establishment of a private market for these services, perhaps with a specialist service like Dignitas. Are we content with the Bill’s assertion that remuneration is not a matter for scrutiny? What level of remuneration would we consider reasonable? What level would we consider excessive—remuneration that is capable of influencing a doctor’s thinking? Would they be paid for administering assisted death on a per patient basis, or as a cumulative practice?

As MPs, should we not have some unease at the idea that this could be a highly profitable specialism for private practice? Transparency on what is being charged and who is profiting from the service would help us to understand what is happening in the system that is being established. I suggest that we bring more sunlight into the system, as we do in many other areas.

It is notable that there is little public data on what is charged, or how much revenue assisted dying generates for medical practices, in other countries where assisted dying is a private service. That is regrettable, and I hope we will not replicate that here. We do know that at Dignitas, which is a not-for-profit, the cost for a single patient is between £5,000 and £8,500 in fees alone. What is reasonable remuneration for a practice that provides assisted dying here in the UK? The term is entirely undefined, and I would be grateful for any clarity.

[Kim Leadbeater]

I understand the hon. Gentleman’s keenness to get to the debate on clause 32, on the provision of the service—we will come to that in due course—but this conversation is about the amendment. To be clear, there is no expectation that assisted dying would be set up as a private enterprise or service. It would be delivered within the provision of the NHS.

[Danny Kruger]

I am glad to have that suggestion. Clause 32 is extremely broad. It basically empowers the Secretary of State to set up a service in any way they choose, potentially including in the private sector. The hon. Lady says it is not envisaged that would happen, as she is suggesting this should be an NHS service. I am grateful for the clarity, but I wish it were clearer in the Bill.

[Kim Leadbeater]

It will be.

[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.

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[Danny Kruger]

I am grateful for that clarity, although we now seem to be less clear than we were. I understood the hon. Member for Spen Valley to be saying that there will not be private provision, but my right hon. Friend is saying that there may be.

[Kim Leadbeater]

Will the hon. Gentleman give way?

[Danny Kruger]

It would be helpful if the hon. Lady clarified whether private provision will be allowed under the Bill, because I think we have a party split. My right hon. Friend the Member for North West Hampshire supports private provision, but the hon. Lady suggests this should be done only on the NHS.

[Kim Leadbeater]

This service, like many others, will be delivered through a range of providers, as alluded to by the right hon. Member for North West Hampshire. I understand the keenness to have this debate now, but we will come on to it further down the line. The hon. Member for East Wiltshire is right that this is really important.

[Danny Kruger]

It certainly is. Okay, so it could be either. This will be an NHS service, with all the implications for general practice, doctor-patient relations and secondary care and social care, but there will also be an opportunity to deliver it privately, without any clarity or transparency on who is being paid and how.

In answer to my right hon. Friend the Member for North West Hampshire, this is different from cosmetic surgery, as even cosmetic surgery is regulated. In many ways, there is more regulation of the administering of Botox than there is in this Bill. The administering of assisted dying is of a significantly different category and gravity. It is appropriate and important that financial interests are clearly revealed and made public, particularly with the new intervention we are creating. If other hon. Members do not support the amendment, what provisions do they propose that would reveal where there may be potential conflicts of interest and how we may regulate this?

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[Stephen Kinnock]

I agree. Like any other aspect of what doctors and general practitioners do, this service is based on remuneration. They are professionals and should be remunerated as such, so the tariff will be important. It is also important that we do not jump ahead into defining the operating model. As I said, officials are working on this with the Bill’s promoter, and it will be made clear when we get to the relevant clauses.

[Kim Leadbeater]

Hopefully the Minister and other colleagues are reassured that, if the Committee agrees to the introduction of the voluntary assisted dying commission, monitoring will be very intense and reporting will be very robust. That might allay some of the fears that have been raised today.

[Stephen Kinnock]

As I have repeatedly said, the Government are neutral on the fundamental question of the Bill, but we are absolutely committed to ensuring it is workable should it receive Royal Assent. The role of the commission will be pivotal in ensuring that the Bill is workable and that all the necessary monitoring and regulation mechanisms are in place.