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

Lewis Atkinson Excerpts

Committee stage
Tuesday 25th March 2025 Public Bill Committees

[Daniel Francis]

The annual reporting does give us some reassurance, but when we accepted some of Mencap’s recommendations last week, I said that I would welcome it if the entirety of its recommendations were accepted—and it wanted an overall review at an early stage in the process.

Amendment 493 to 495, in my name, address those concerns. A consistent concern of mine is how we address issues that come to light from specific communities, particularly those with learning difficulties, and amend the legislation at a reasonable stage in the process.

[Lewis Atkinson (Sunderland Central) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Roger. I will be brief.

I am in favour of retaining the Bill as it stands. The key thing is the interplay between this clause and clause 42, on commencement. I would have been minded to support changes to the reporting period had the Bill been commencing within two years, as clause 42 as drafted sets out, but my hon. Friend the Member for Spen Valley has tabled an amendment that will change the backstop of the commencement period to four years. The timescales set out in this clause are from the day on which the Bill is passed. It makes no sense to carry out a formal review of the operation of the legislation before the services have come into being. We will have a four-year timetable, potentially, for the backstop of the commencement. Throughout that time, the annual reporting requirement of the commissioner, who will undoubtedly have been appointed in advance, will kick in.

I also draw the Committee’s attention to new clause 35, tabled by my hon. Friend the Member for Penistone and Stocksbridge, which speaks to some of the concerns raised by my hon. Friend the Member for Bexleyheath and Crayford. I strongly support the new clause, and the establishment of a disability advisory board to report annually on the effect on disabled people of not just the Act but the implementation. Picking up any concerns or views about its effect on people with disabilities would happen in a timely manner under new clause 35.

[Kim Leadbeater]

My hon. Friend makes a really important point, which I will come to in due course, but the thing that we need to analyse is the operation of the Bill. That will not start with the passing of the Bill; it will start with its commencement. It is important that we join the dots between the relevant clauses.

[Lewis Atkinson]

That is exactly right. For those reasons, I think we need to retain the full five-year review period. As my hon. Friend the Member for Rother Valley outlined, the review of the Act by the Secretary of State will be in addition to the annual reporting from the commissioner and, if we accept new clause 35, in addition to annual reports from the disability advisory board. Clearly, over the course of multiple amendments, we will have strengthened the reporting requirements both in advance of and post implementation.

[Stephen Kinnock]

It is a pleasure to serve under your chairship, Sir Roger. Amendments 452 and 453 would amend the review provisions in clause 35. As the Bill stands, clause 35(1) provides that the Secretary of State must undertake a review of the operation of the Bill and lay a report before Parliament. This is a one-off obligation that must take place after a period of five years, beginning from the date the Bill is passed. Amendment 452 would amend that requirement, and instead require the Secretary of State to undertake a review, and prepare and publish a report every 12 months after the passing of the Bill. Amendment 453 would remove the definition of the initial five-year period and is consequential on amendment 452.

That increased frequency of reporting would naturally increase the administrative burden and cost of the Bill. It is also noted that there will be an implementation period following Royal Assent. It is unclear if the intention is to require the Secretary of State to undertake a review of the operation of the Bill and prepare a report during this implementation period.

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[Lewis Atkinson]

I rise to speak in support of new clause 40. Given the implementation period that we are talking about, the repeated and routine reporting to Parliament on progress is essential, especially for those who want to see this Bill implemented safely and properly. Nevertheless, there are people—some of whom have joined us in the Public Gallery in recent weeks—for whom that needs to be done with deliberate speed, but without any compromise on the safety and thoroughness of implementation. New clause 40 achieves that, and I commend it.

In a different world there would have been a way of us compositing new clause 28 with new clause 40, and I regret that the two are not compatible. My hon. Friend the Member for Bexleyheath and Crayford makes good points around the earlier assessment of palliative care; I do not think that is something that divides the Committee. There have been amendments tabled by many Members over the course of the Committee that have sought to improve and strengthen palliative care as part of a holistic package at the end of life. I wonder if that is something that I could work on with my hon. Friend on Report, even if it is not possible to agree to new clause 28 tonight.

[Stephen Kinnock]

The Government have worked with my hon. Friend the Member for Spen Valley on amendment 546 and new clause 40, which are consequential and linked to other amendments to clause 42, relating to the commencement of the legislation.

New clause 40 would require the Secretary of State to prepare, publish and lay before Parliament a report about progress made towards implementing the Bill, and the Secretary of State’s plans for implementation in subsequent reporting periods. The reporting periods are one year after Royal Assent, and every six months thereafter, until the sixth and final reporting period. Amendment 546 provides that new clause 40 will come into force on the day the Bill is passed.

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[Lewis Atkinson]

I understand somewhat where the hon. Member for East Wiltshire is coming from, but as a fundamental matter, people have to be paid for time worked. I feel that an interpretation of his amendment is that people would not be able to be paid for time worked. This is not about performance-related pay, as he suggests in that continuation of his—I suggest—scaremongering theme from before, but about remuneration for time worked. For example, if someone is referred for an additional capacity assessment, it is right that the person doing the assessment is paid for their time worked, not as an incentive, but as a normal payment for time worked. I think that the amendment is poorly drafted and not workable. I will therefore vote no.

[Stephen Kinnock]

The amendment is linked to clauses 5 and 8, which define who can and cannot be a co-ordinating or independent doctor. According to the clauses, a person who benefits financially from the death of the person cannot be a co-ordinating or independent doctor. As the Bill stands, clause 40(4) provides 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 in accordance with the Bill.

The amendment may broaden what is meant by “benefiting financially”, so that its effect may be to prohibit a person from being a co-ordinating or independent doctor if their remuneration is greater for applications that are accepted than for ones that are rejected. However, as drafted, it is not possible to determine the effect of the amendment with certainty, so further amending is likely to be required at a later stage should the Committee accept the amendment.

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[Danny Kruger]

I imagine that a doctor who works for the non-profit service I am envisioning would be paid a salary and do their work, but would not be paid on a per-client basis—they would not be paid a tariff for the number of people they passed through the system, let alone for the different chunks of the process. People need to be paid, but they should not be paid on a per-client basis, because that would introduce dangerous incentives into the system.

[Lewis Atkinson]

The hon. Member is making an interesting point, particularly in relation to the commissioning of the service. In the NHS, we generally commission on a block basis and a fee-per-activity basis. I can entirely see that that block basis would be appropriate for this commission, and I am happy to work with him on Report to make that the case. That is not what this amendment says, though. It talks about payment for individual doctors, which gets into the issue of people being fairly paid for their time, which he referenced. I invite him to collaborate on the commissioning arrangements on Report, rather than pressing this amendment.

[Danny Kruger]

We can distinguish between the organisational income and the specific doctor’s income, but the same applies in both cases. Explicitly, the doctor who is making the decisions should not feel the pressure or the temptation of financial reward to expedite or approve applications for assisted dying. I am grateful for the hon. Gentleman’s invitation. By all means, let us try to make sure that, should the Bill reach Report stage, we remove the danger of perverse incentives in the way that the service is commissioned.

Question put, That the amendment be made.

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[Rebecca Paul]

I completely agree. That is exactly what the amendment is intended to do. We are trying to prevent advertising of an inappropriate service to inappropriate groups. It makes sense, therefore, to effectively ban advertising. I think most people would agree that it would be distasteful and inappropriate to have adverts for assisted dying everywhere people look. I hope that hon. Members will consider supporting the amendment, even if that is in an amended form.

[Lewis Atkinson]

I have great sympathy with the intent behind the amendment, and I would like us to get it into a workable form. The hon. Member for Reigate may wish to confirm this, but there is a similar offence in the Surrogacy Arrangements Act 1985—the advertising of surrogacy arrangements is an offence. The important difference in the Surrogacy Act is that there are some further caveats beyond those in the draft amendment— for example, to ensure that there is not inadvertent creation of offences of the type that the hon. Member for Solihull West and Shirley mentioned. The Surrogacy Act sets out that resulting prosecutions would be carried out only with the approval of the Director of Public Prosecutions, to ensure that such safeguards were in place. Although I await the Minister’s comments, I do not think it is possible to support new clause 9 in its current form, for the reasons that the hon. Gentleman lays out.

We have set out that there will potentially be a small number of doctors providing these services. A GP—not a member of the public—would need to know where to direct their patient. I cannot see how, other than by having some form of electronic directory or email correspondence, it would be possible for such people to become available.

I am not able to vote for the new clause at this stage, but I will put it on my notepad of things on which I am keen to work with colleagues on Report, perhaps by learning the lessons from the surrogacy advice and taking advice from Minister. I think we all agree that we should not be advertising to the general public and encouraging these services.

[Stephen Kinnock]

Thank you, Sir Roger, for giving me permission to remove my jacket. It is greatly appreciated. I assume that other hon. Gentlemen in the room are also able to do the same, should they wish to do so.

New clause 9 would make it a criminal offence for a person to advertise their services as a co-ordinating doctor or an independent doctor under the Bill. The offence would apply to a person who, in the course of a business, publishes or causes publication of an advertisement for the services of acting as a co-ordinating doctor or an independent doctor under the Bill, or who prints, devises or distributes an advertisement or causes that for the promotion of such services. The offence is wide-ranging and could include, for example, a person who unknowingly transmitted such advertising via electronic communications or social media.

Should the new clause be passed, further work may be needed to determine how the offence would be enforced. I also note that there is no provision for any defence in relation to the offences—for example, where a person responds to inquiries.

Restrictions on advertising always need careful consideration and drafting, given the potential unintended consequences and European convention on human rights impacts—particularly in relation to article 10, on freedom of speech. That is particularly so when breaches of the restrictions are made a criminal offence, as is the case here. However, article 10 is a qualified right, which means that interference can be justified provided that it is in accordance with the law, pursuant of a legitimate aim and necessary in a democratic society, so although the new clause could engage article 10, it may not violate it.