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

Liz Saville Roberts Excerpts

Committee stage
Tuesday 25th March 2025 Public Bill Committees

[Stephen Kinnock]

I thank my hon. Friend for that clarification. It is very helpful, because I perhaps did not quite understand what the hon. Member for East Wiltshire said. My hon. Friend sets out very clearly the optionality represented in new clause 36.

The new clause further ensures that voluntary assisted dying services provided as part of the health service must be free of charge, unless charging is expressly provided for. Subsection (6) confirms that regulations made under this new clause can make provisions with the same effect as an Act of Parliament, including amending other primary legislation. However, they cannot amend the provisions in this Bill. The amendment also defines voluntary assisted dying services.

Amendment (a) to new clause 36 would prohibit regulations being made that authorise the provision of voluntary assisted dying services by the NHS in England. The Secretary of State would still have a duty to ensure that arrangements are made for the provision of assistance, but not by the NHS. The Secretary of State could, for example, make arrangements for another body to provide assistance, which would mean that the Secretary of State could not ensure that assistance was provided in accordance with the Bill or through the NHS in England. This would apply only to England, not Wales. Welsh Ministers could still make regulations for the provision of voluntary assisted dying services by the NHS in Wales. This could result in a divergence between England and Wales in the provision of assisted dying services.

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC)]

The Committee should be aware that the Isle of Man has today passed an assisted dying Act, and we already have divergence between the different jurisdictions of the United Kingdom.

[Stephen Kinnock]

I think we are all moving in a direction where, if this Bill passes, we would like its delivery in England and Wales to be compatible, based on full respect for the devolution settlement and for the legislative consent motions. Divergence in the context of the devolution settlement is what the right hon. Lady is keen to achieve, and I think she is working with my hon. Friend the Member for Spen Valley to achieve that aim.

Amendment (b) to new clause 36 would provide that the Secretary of State must, by regulations, make arrangements for the provision of assisted dying services in England. The amendment would remove the provision that regulations under new clause 36 may provide that specified references to the health service in the NHS Act include reference to commissioned assisted dying services. Secondly, it removes subsection (5), which states that regulations under new clause 36

“must provide that section 1(4) of”

the NHS Act

“applies in relation to commissioned VAD services”,

which provides that health services must be free of charge unless exceptions apply. Finally, amendment (b) to new clause 36 explicitly provides that regulations made under subsection (1)

“may not amend, modify or repeal section 1 of the National Health Service Act 2006.”

If accepted, the proposed amendment may impact the provision of assisted dying services through the health service in England. The effect would be that section 1 of the NHS Act could not be amended, modified or repealed via regulations under new clause 36(1). The proposed amendment applies only to England, and the restriction does not apply to Welsh Ministers. This could result in a divergence between England and Wales in the provision of assisted dying services, as Welsh Ministers could amend section 1 of the National Health Service (Wales) Act 2006.

Amendment (c) to new clause 36 would limit the scope of the Secretary of State’s power in subsection (1) of new clause 36 to make regulations that secure arrangements for the provision of voluntary assisted dying services in England. Under this amendment, such regulations cannot authorise the provision of assistance by a body other than a public authority, even if that body is contracted by a public authority to do so. That would effectively prevent the NHS from contracting with private providers to provide assistance. The NHS regularly contracts private providers to provide NHS services. It is possible that being unable to do so here may present operational challenges. The amendment applies only to England, and the restriction does not apply to Welsh Ministers. That could result in a divergence between England and Wales in the provision of voluntary assisted dying services.

Amendment (d) to new clause 36 seeks to limit the Secretary of State’s power to amend, revoke or repeal other legislation for the purpose of making provision for assisted dying services.

[Stephen Kinnock]

The hon. Member is absolutely right that it is a different situation from the point of view of devolution. Perhaps my answer was conditioned by the intervention of the right hon. Member for Dwyfor Meirionnydd, so I perhaps jumped to a conclusion.

[Liz Saville Roberts]

On that point, we are also expecting a decision in Holyrood in Scotland, which I think the Committee will agree is part of the United Kingdom. These jurisdictions influence our discussions in this place.

[Stephen Kinnock]

The right hon. Lady makes a valid point, although Scotland has a different legal system from the one that governs England and Wales. That takes us back to the legal jurisdiction question versus the devolution of health service delivery. How to make those two work compatibly is a key challenge that the Committee is seeking to address.

Amendment (d) to new clause 36 could limit the Secretary of State’s ability to make provision for assisted dying services via the health service in England. For example, it could limit who can commission and regulate assisted dying services, as the Secretary of State will not have the power to amend primary legislation. If the amendment were agreed, the Secretary of State would not be able to make, via regulation, the required amendments to relevant legislation for the purpose of enabling the provision of assisted dying services in England. The Committee may wish to note that the amendment would apply only to England, which could lead to a divergence in provision between England and Wales.

Amendment (e) to new clause 36 would add two requirements. First, it would provide that the Secretary of State could not lay regulations concerning the provision of voluntary assisted dying services in England unless an impact assessment of the regulations is also laid before both Houses of Parliament. Secondly, the impact assessment would need to include

“an assessment of the impact of such regulations on the workforce of health professionals and on the National Health Service.”

An impact assessment is routinely prepared to accompany secondary legislation. The amendment would impose a legal requirement on the Secretary of State to prepare an impact assessment that must be laid before both Houses to assess the impact on the workforce of health professionals and on the NHS in England. Practically, this could cause delays in making regulations under the Bill, by requiring a duplicative impact assessment to accompany each set of regulations, including regulations that make minor or consequential amendments. [Interruption.]

--- Later in debate ---

[Jake Richards]

I rise to speak briefly in support of amendment 548, tabled by my hon. Friend the Member for Spen Valley. I do so fundamentally for two reasons.

First, there may be a lot of support for the principle of assisted dying among members of the Committee and, indeed, Members of the House, but there are also understandable concerns about its implementation. We have been debating all the aspects of that over a lengthy period in Committee, and it is undoubtedly complex. Although my hon. Friend is disappointed that she has had to table the amendment, I commend her for doing so, because it is important to get this right and to be brave by setting longer time limits if necessary. I think that can be reassuring to Members who, while supporting the principle, want to make sure that we get this right. I hope that the amendment will do that.

Secondly, for those people—including those who have been in the Public Gallery today, Committee members and, indeed, other Members of the House—who might be disappointed about the delay, in my mind the amendment is not an obstacle to change. In fact, what we have seen here is the Bill’s promoter working with the Government, who remain neutral on the principle but want to make the Bill deliverable, to come up with a sensible, pragmatic proposal for how and at what speed this profound change is to be implemented. In my mind, that gives a sense of the Executive and the promoter thinking about the practicalities.

I urge those who are desperately seeking this change and have fought for decades to secure it to approach this measure with a sense of optimism. This is serious. This is a once-in-a-generation opportunity to deliver that change. I hope that, both in the Committee and outside it, they will support my hon. Friend the Member for Spen Valley, who has gone to great lengths to build support and to make sure that the Bill is workable. I will be voting for amendment 548 with a great sense of reassurance, but also a great sense of optimism that one day this country will see this change, which is so desperately needed.

[Liz Saville Roberts]

I rise to support amendment 535. I do not intend to say much, because the hon. Member for Richmond Park has made many of the points I wished to make. The amendment recognises that an opinion was stated in a debate in the Senedd in October, which dealt in detail with the principles of this Bill, and that Professor Emyr Lewis told us that one way of recognising that would be to consider different commencement provisions in Wales.

Reference has been made to the different criminal law arrangements in England and Wales to do with smacking children, and during covid there were quite definitely different arrangements between England and Wales. After a quarter of a century of devolution, we have devolution divergence, and we are seeing that in action.

We have already accepted the principle that there are aspects of the Bill that are devolved, responsibility for which must be passed to Welsh Ministers. We are still debating the wording of that, but we are working towards it, and I think we have accepted the principle of it. We should also acknowledge that the Senedd and Welsh Ministers may well be able to make a move that would have the same effect of changing the commencement date, but I support the amendment because it shows that we are acknowledging the consequences and implications of a legislative consent motion. Incidentally, I could often stand up here and talk about the fact that legislative consent motions can be overridden by Westminster, but we are working from the point of view of seeking to respect devolved powers alongside the powers that we have here, so I will be supporting amendment 535.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

It is an honour to serve under your chairmanship, Sir Roger. I rise regretfully to speak in opposition to amendment 548, which would extend the implementation period from two to four years. I start by saying that I have had complete and utter admiration for the hon. Member for Spen Valley throughout this process, and I appreciate that she said herself that she had tabled the amendment in disappointment—I will echo a lot of what she said.

We are here today because we acknowledge that there is an injustice—that the current law for assisted dying is failing people. It forces people who are terminally ill and in unbearable pain to make impossible choices; it compels them to travel overseas, away from the comfort of home, to die in unfamiliar surroundings; it punishes grieving families by forcing them to endure police investigations for simply standing by their loved ones; and it denies dignity in death and peace in grief. We have recognised that as unacceptable, and that is why we are here debating the Bill.

The delay brought about by the amendment would tell those same people that they must wait. People have already been waiting far too long. The amendment would tell them that their suffering is not seen as important enough and that their right to a peaceful death has to be postponed. It is not justice, and we must not allow it. We know that the British public overwhelming support a change in the law. People want to see assisted dying laws in place during this Parliament, not in some uncertain future. They will not accept delay, and I do not think they will be particularly forgiving of excuses.

If we allow the implementation period to be extended to four years, we will be seen to be kicking the can down the road. Comments have been made about how the implementation would potentially be before the next general election, but there is no guarantee or certainty of that. It is in the gift of the Prime Minister to decide when the next general election is called. I cannot think of a more worrying instance of a newly elected Government having to implement a big societal change, but the amendment could make that a possibility. No Parliament can bind the next, and legislation that has been passed but not enacted could be quickly abandoned. We cannot allow that to happen; the cost would be too great. For people out there who have been campaigning for years, that would be a catastrophe. This is not an abstract policy debate; it is about real people who are suffering right now and cannot afford to wait.

A number of people have been in touch to make clear their views on the amendment. Tim Wardle, a terminally ill man from Devon with bladder, prostate and lung cancer, said that “even a slight delay beyond the two years currently proposed is not fair or reasonable. I hope the proposal is defeated.” Clare Turner, a mother of two with stage 4 breast cancer, made it even clearer, saying, “This is outrageous for terminally ill people like me. Every delay means more suffering, more people forced to endure unbearable pain against their will. This Government needs to stop dragging its feet and act now.” I appreciate that it is not the Government who are promoting the Bill, but that is the reality for people and, as uncomfortable as it is to hear those stories, we must hear them and we must listen.

It is not just people who are terminally ill who are anxious about a change in the law. Every time that I have spoken to my mum on the phone during this Committee process, she has asked me how it is going, what the process is and what the end date will be. It popped up on Facebook yesterday that it is eight years since she received her all-clear from breast cancer, but it still hangs over her. When she was diagnosed, she had two independent tumours, and her mum and her sister—my gran and my aunt—had both had breast cancer too. While there was no genetic testing to show a link, the doctor said, “This is probably going to come back, and you will probably end up with breast cancer again.”

My mum had post-traumatic stress disorder from that experience of going through cancer treatment—through the mastectomy and the recovery. It was prolonged and, to this day, there are complications as a result of the procedure and the chemotherapy. It was traumatic for the entire family, and my mum has long said that, if she had to go through something like that again, or if she ended up with secondary breast cancer at a later date, she would want this option. Every time I have spoken to her, she has been really heartened to hear the progress that the Committee has been making on the Bill, and when we spoke about this delay, it crushed her heart—and it has mine, too. Just having the option would give her—someone who does not have a terminal diagnosis or anything, necessarily, just yet—peace and comfort.

Supporters of amendment 548 will say that we need four years to get this right, but I want to know where the evidence for that claim is. It has not been clearly set out. Other countries have managed to implement similar laws in far less time. Spain implemented its law in just three months after the passage of a Bill; Jersey and the Isle of Man are aiming for an 18-month implementation period. Indeed, no country has taken longer than two years. The only example of a particularly protracted and prolonged process was in Oregon, and that was because of legal challenges.

The NHS has demonstrated time and again, particularly during covid, that when there is a need, it can act swiftly and decisively. When we set a deadline, civil servants will work towards it. We have some of the best civil servants in the world, and I commend them for their work. Throughout this process, we have examined the Bill line by line to ensure that it is the strongest, most robust assisted dying legislation in the world. We have strengthened its safeguards and refined the eligibility criteria, although I appreciate that I have had different views from some on the Committee about that. We have embedded rigorous oversight mechanisms and ensured that every step is guided by medical expertise. We have drawn from the best of international practices. We have learned from the experience of jurisdictions that have successfully implemented assisted dying laws with compassion and care.

The Bill is not a rushed or reckless piece of legislation; it is carefully crafted, and it balances the right to choose with the need for stringent protections. To delay its implementation from two years to four years, after such thorough debate, scrutiny and refinement, would undermine the very care and diligence that the Bill has been shaped by. Delaying implementation is not simply a neutral decision; it is a decision to prolong the lack of choice for people with terminal illnesses. It is a decision to deny them the ability to die on their own terms. It is a decision to force more families into impossible situations—watching their loved ones suffer, facing investigations for simply accompanying them abroad, being unable to grieve properly because they cannot even bring the body home. That is the reality of such a delay, and we have the power to stop it.

We cannot allow interference from Government, or wherever this has come from, at the last moment. This is my frustration: the amendment was tabled at the very last moment, without an explanation of where it has come from. We must listen to the people who are at the heart of the Bill. We must listen to the public and all the people who have given us input, to make sure that we end up with a Bill that takes into account the need for compassion and does not prolong the timetable for people. It is therefore with regret that I will vote against amendment 548.

--- Later in debate ---

Brought up, and read the First time.

[Liz Saville Roberts]

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

We have received additional evidence from the Welsh Language Commissioner that bears on this new clause quite considerably. The comments result from our discussions of amendments 413, 427 and 428, and amendment (a) to new schedule 2, and it is worth having an interpretation of them on record.

The safeguarding process is a matter of Welsh language legal rights and a clear communicative necessity. The Welsh Language Commissioner says that

“it is essential that Welsh speakers can discuss the decision to end their own life through the medium of Welsh if they so wish.”

The key word here is “discuss”. We are very used in Wales to the convention of documentation and information being available in bilingual forms., However, in previous amendments on the Welsh language, I have endeavoured to make sure that those involved in the process are—to the degree that all reasonable steps have been taken—able to converse with fluent proficiency in the preferred language of the person who comes before them seeking their support and their judgment in relation to capacity and coercion.

Therefore, all reasonable steps should be taken to ensure that the key human aspect of this discussion—the conversations between the person and the co-ordinating doctor, the independent doctor and the panel—should be conducted in Welsh, where that is the preferred language. Welsh speakers should not have to request to be able to use Welsh every time the process moves from one person to another; that should be recognised at the beginning of the process. Again, all reasonable steps should be taken to ensure that people are able to communicate in the language with which they are most naturally comfortable—the language that comes to them when they express perhaps their deepest fears and greatest emotions. On occasion, it will be difficult to find people in a reasonable timespan, and we will need to train people in certain roles, but that is where the “all reasonable steps” requirement comes in.

Forgive me, it is late, but it is important for me to take a little time, because the commissioner notes that there has already been some discussion in Committee about whether provisions are necessary in the Bill. The commissioner goes on to say:

“The Welsh Language Standards (No.7) Regulations 2018 are the relevant standards which apply to health boards and NHS trusts in Wales. Although the standards place duties to provide a range of services through the medium of Welsh (such as correspondence, case conferences, documents and forms), they do not go as far as to place duties on health boards to ensure that Welsh speakers can receive clinical services through the medium of Welsh.”

That is why we need my new clause in the Bill. Legislation as it stands in relation to Wales is not sufficient even to give us the “reasonable steps” provision.

The commissioner says that although in Wales

“Welsh Language standards apply to NHS primary care services that are contracted by the health boards, Welsh language standards currently don’t apply to independent providers. However, a limited number of Welsh language duties have been placed on independent primary care providers”—

that is GPs, of course. The commissioner continues:

“As is the case with respect to the Welsh language standards, these duties do not go as far as ensuring that Welsh speakers can receive clinical primary care services through the medium of Welsh.”

That again is why “all reasonable steps” is about doing the best we can to ensure that people are able to communicate in the language that comes most naturally to them.

The commissioner also says:

“It is important to note that the standards set out duties relating to health services in general, while the Bill in question relates to a much more specific and specialised service. It also relates to a highly sensitive issue where being able to provide in an individual’s first language is essential. The key point here is that stronger provisions could be made in an area such as assisted dying compared to that which would be practically possible in standards relating to health services more generally. As such, if there is an opportunity to make specific provisions in legislation regarding ensuring clinical services through the medium of Welsh then it should be done.”

I know that there are two concerns, and I have already mentioned the phrase “all reasonable steps”. I want us to have a decision in this place, here and now, and to hear back from the promoter and Ministers that there is an appreciation that we need something in the Bill. The Welsh Language Act 1993, as it applies to the judiciary, gives the individual only the right to speak Welsh; it does not give them the right to discuss or to be understood. Through the written evidence I have quoted, I hope I have been able to show that the Welsh language standards in Wales do not go as far as we need them to in this legislation.

The other point—again, this is part of our finding our way with amendments—is that my understanding is that the new clause would apply to the geographic area of Wales only; it would not apply in England, as is normal with other legislation in this respect.

I want to hear the response from the promoter and Ministers before I decide whether to press my new clause to a vote. However, I do feel, on this final day, that we need to have something on record that says we respect the use of the Welsh language and we will do our best to ensure that the provisions act effectively in that respect.

[Stephen Kinnock]

The new clause would ensure that anyone seeking assistance under the Bill in England or Wales receives any services, reports, declarations or certificates of eligibility in Welsh if that is their first or preferred language. It is linked to the amendments tabled by the promoter to ensure that the form and content of any statement or declaration be set out in regulations, rather in the schedules to the Bill.

The new clause would require any regulations made specifying the form and content of declarations or statements required in relation to the first declaration, the co-ordinating and independent doctors’ assessments, the second declaration and the final statement to make provision for those to be provided in both English and Welsh.

A legal requirement that all services, as well as reports, declarations or certificates of eligibility, must be provided in Welsh, where an individual’s first or preferred language is Welsh, would go beyond usual practice in England. Such a requirement may lead to operational issues, such as there being a reduced pool of registered medical practitioners or assisted dying panel members who are able to carry out the functions under the Bill.

I want to put on record again the Government’s continued commitment to devolution and to working with the devolved Governments. The Government have taken a neutral position on the Bill and on the matter of assisted dying, but we are committed to working together with the Welsh Government to resolve any legal and technical issues, and to discussing constitutional matters that might arise.

[Kim Leadbeater]

I thank the right hon. Member for Dwyfor Meirionnydd for tabling the new clause. She has made extremely valuable points, as she has throughout the Committee, about the importance of respect for the Welsh language. I think she is absolutely right.

As the Minister said, there are some issues with the drafting, as to what the implications would be, not just in Wales but in England. It is my understanding that Ministers in the Senedd are happy to meet following the Committee’s proceedings, and I am happy to discuss these issues with them as part of our conversations.

It is important that the right hon. Member’s thoughts have been put on record, and we need to look at what we can put in the Bill ahead of Report to address her concerns.

[Liz Saville Roberts]

I honestly feel that the legislation as it stands—the Welsh Language Act 1993, and the 2011 and 2018 standards in relation to health—is not sufficient for what we are endeavouring to do. People have a right to use their first language, and it is of some regret to me that the only two languages protected by law in England and Wales are English and Welsh. I would be happy if there were more, but they are the only two I can discuss, and Welsh is obviously very close to my heart. On this last day, I feel my obligation to push the issue to a vote; otherwise, we will default to legislation that is not sufficient for what we are endeavouring to do.

Question put, That the clause be read a Second time.