Maternity Commissioner

Lizzi Collinge Excerpts

Monday 20th April 2026 Westminster Hall

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

It is a pleasure to serve under your chairship, Sir Alec. I thank my hon. and learned Friend the Member for Folkestone and Hythe (Tony Vaughan) for introducing this important debate.

It is hard to fathom but, over the course of this speech, at least four babies will be born in England—they will come into the world, their tiny hands stretching out and a whole future beginning for them with their first breath. The births of my children were among the most significant moments of my life, as is the case for most parents, but alongside the joy comes something that I think every birthing parent will recognise: just how vulnerable you are in that situation and how frightening childbirth can be. You are placing your life and your baby’s life in the hands of others, in the hands of chance and in the hands of the brutal reality of natural processes.

I first became involved in maternity advocacy after the frankly quite awful birth of my first child in 2014. Only when that happened did I realise how much harm had been done to someone close to me when she gave birth in 2011. I remember apologising to her with a newborn in my arms: “I’m so sorry; I had no idea how bad it is.” This has happened to women up and down the country. Today, I represent Morecambe Bay, where both those births took place, and where baby Ida Lock was born and died in 2019. Ida and her parents are always on my mind when we talk about issues such as this.

I feel obliged to say that the vast majority of maternity care is safe. We talk about all the failings and all the horrors that women have seen, but I do not want that to frighten families. We have to accept that the worst tragedies are exceptions, but the experience of parents who have seen avoidable harm to themselves and their babies is the reason we are here today debating the pros and cons of a maternity commissioner.

I will be honest: I do not necessarily have fixed views on this. It has been really interesting to hear colleagues speak, and I look forward to hearing more. I am also very interested in the outcome of Baroness Amos’s investigation. But we cannot just keep trying to learn lessons; we need to take action right now. We have had review after review and inquiry after inquiry, and yet here we are.

[Jess Brown-Fuller]

The hon. Member is making a powerful speech, and she is absolutely right. We had the Bill Kirkup review, which made multiple recommendations; across all parties, the House said, “Now we need to implement those recommendations,” but that never happened. Then we had the Donna Ockenden review, which contained immediate and essential actions; we need to implement those, but the Government have not come forward and said that they will make them mandatory. Now we have Baroness Amos’s review. Does the hon. Lady agree that this must be the last review, for the sake of every single mother who has come and every single mother who is to come, so that they know that they are being well supported when they go into hospital settings?

[Lizzi Collinge]

I absolutely agree. There is work to do to prioritise the actions that have come out of all those inquiries, because trying to do too much will lead to it all being done badly. There must be a real focus on what will make the difference to women’s safety and experience.

Countless national and local maternity reports have revealed persistent issues with care, a failure to listen to expectant mothers, staffing pressures, a lack of transparency and institutional cultures that have encouraged cover-up. That is against the background of increased medical complexity in pregnancy and birth, wider aspects of public health having worsened, and the racism and misogyny that still permeates our society.

These failures are a long time in the making. Failed regulation contributed to the historic problems at Morecambe Bay—and that was under a Labour Government. Structural changes to our care system and wider society under successive Conservative Governments have impacted care. Due to austerity, we had a £37 billion capital investment shortfall in the 2020s compared with our peer countries. We know that increased poverty affects maternal and neonatal mortality, and as a nation we have become more poorly over the past 15 years. It is now on us and the Government to fix the problem.

As a member of the patient safety all-party parliamentary group, as well as through my own work as a constituency MP, I have seen that tragedies are often partly or completely avoidable, whether through effective diagnostics, timely or better treatment, or simply listening to women when they say that something is wrong. The consequences of these failures are devastating. A study by the Royal College of Obstetricians and Gynaecologists showed that up to 75% of pre-term babies who died could potentially have been saved with different care. Even when the worst is avoided, bad experiences can leave lasting damage. They can erode trust in services and make families more anxious about seeking care in the future.

I want to touch on a couple of aspects of this issue that have not had the concerted operational effort put into them that they ought to have had. The first is the conditions that midwifery and obstetric staff work in, including the wider picture of the health of the nation. Most midwives, doctors and support staff are doing their absolute best in challenging circumstances, and most people go into maternity care because they want to deliver babies safely into this world and support families. They often go above and beyond, but they are being stretched too thin by the demands of their jobs. They are looking after ever more complex cases on every shift, and in 2023 alone, midwives and support workers put in over 100,000 hours of overtime. Even hospitals that are rated highly for maternity care feel the strain, with staffing gaps leading to interrupted handovers, missed checks and limited time for training. Over time, that pressure leads to burnout, staff leaving, and the loss of the experience that the system depends on. When the system is stretched like that, it is staff and patients who feel the consequences. I hope that the Minister will ensure that while we drive down waiting lists in elective care, we support maternity staff, improve their work environment and do not lose sight of the wider improvements to public health that we need to make to reduce complexity and comorbidities.

The second thing I want to talk about is culture, particularly the ability of staff to speak up, the need for brave and open leadership, and the need for lessons truly to be learned. I am not saying that is easy to do—it is quite tricky, and it takes concerted effort and skilful leadership—but culture simply means, “The way we do things around here.” It can be a tangible thing that we can affect. Unfortunately, long-term failures and the spotlight that comes with them can cause staff to feel under attack, defensive and unsupported. Even where they have not been part of any particular case, staff groups can become entrenched. During the problems at Morecambe Bay and since, we have found that people working in opposition to each other in entrenched staff groups has caused huge amounts of harm.

Poor leadership compounds the effect. I have spoken many times about the harm caused by cultures of silence, where staff do not feel able to come forward to raise concerns, problems are not addressed head on, and families are left without proper answers when things go wrong. We need to create environments where people are able to speak up, raise concerns early and be open when mistakes happen, because if staff do not feel safe to tell the truth and fear being blamed or punished, problems are hidden instead of being fixed. More than that, staff need to be supported when they raise a concern or even when they cause harm, because staff do not listen to what the leadership say; they see what they do, look at their actions and behave accordingly.

To be clear, human beings will make mistakes, and patients will be harmed by those mistakes. That is inevitable. Not all cases of harm can be prevented, but they can always be learned from. In any organisation, culture is set from the top. The leadership have to show through actions that concerns are taken seriously and that no one will be penalised for speaking honestly. Working as a maternity advocate, I was shocked that organisations that are meant to be care organisations would respond to a bereaved family not by reaching out, caring for them and holding them, but by keep them at arm’s length, lying to them and even, when it came to coroner’s inquests, being adversarial. It beggars belief.

Linked to that is the fact that families often feel the need to take legal action simply to get answers. That costs huge amounts of money, still sometimes does not get them answers, and sets up an adversarial approach that can cause further harm to families. I hope that the Public Office (Accountability) Bill, also known as the Hillsborough law, will shift the legal risk for organisations. The current legal risk to many hospital trusts appears to be telling the truth—that seems to be how they see it. I hope that the new law will shift the legal risk so that it is far riskier to obfuscate than to be candid.

There are so many different aspects of maternity safety that I could talk about all day, such as the way that “normal” birth culture still permeates the education of our midwives and some practice, despite having been shown to be harmful. The wider culture around birth seems to say that it must be a joyful, wonderful experience at all times, when in reality it is messy, brutal and quite often unpleasant, even when it all goes well.

We should be learning from other countries. For example, Japan has no-fault compensation for profound cerebral palsy. That separates the process of giving compensation from the process of investigating what happened and what went wrong. It appears to have lowered the legal costs associated with maternity care, but more importantly, it seems to have reduced the number of babies born with profound cerebral palsy.

We all know that maternity care needs to be improved in this country, whether through the appointment of a maternity commissioner or actions such as implementation of recommendations in the Amos review. I thank my colleagues for their contributions, and their constituents for sharing their stories. To make maternity care safe, we need to ensure that services are properly staffed, creating the conditions for safe care, where handovers can be done properly and staff have time to do their jobs well and are supported to rest and recover. That also means making sure that women are listened to, that concerns are taken seriously and that, when things go wrong, they are handled with honesty and care. It means accountability for leaders as well as frontline staff. I urge the Minister to consider whether the leadership of a maternity commissioner can give us the change that our constituents deserve.

Healthcare in Rural Areas

Lizzi Collinge Excerpts

Wednesday 4th March 2026 Westminster Hall

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

It is a pleasure to serve under your chairship, Dr Huq. I thank the hon. Member for Mid Bedfordshire (Blake Stephenson) for securing this important debate.

I represent a semi-urban, semi-coastal, semi-rural constituency, and I know that delivering healthcare across a wide and dispersed population brings very real and practical challenges. I want to speak briefly about three things: hospital trust funding, staff recruitment and transport.

Unfortunately, our funding formulas do not fully recognise the additional costs of providing services over a larger geographical area. Major cities can rely on one large hospital with everything in one place, covering a range of specialities. My local trust serves a similar population size, but it goes from the south of Lancaster all the way to Barrow, around the beautiful Morecambe bay. It is not safe or practical for one hospital to try to do the whole job, yet the funding arrangements do not fully recognise those costs and tend to treat them as inefficiency, rather than as an inherent part of delivering over that geography.

Although funding rightly takes into account deprivation, deprivation can look different in different areas of the country. In my constituency, we have a mix of wealthy and low-income households in the same larger geographical area, and that often determines the funding. Pockets of deprivation get diluted and sometimes miss out on vital funding pots or targeted interventions that would really help. At the same time, my population is older, with higher rates of dementia, which is caused not only by ageing, but by poor cardiovascular health and inequalities.

Hospitals in coastal and rural areas often have persistent issues with staff retention. Professional development opportunities are often focused on the big cities, so services such as major trauma, where people need to go to do their training, are more likely to be there.

For patients living in rural areas, the cost of and lack of access to transport place huge burdens on their time and finances. I do a lot of work with Lancaster Bus Users’ Group and Sedbergh and District Public Transport Users. We all know the challenges facing rural bus services. One of my constituents was waiting in A&E with her sick child, but they had to leave the hospital before they were seen, because they simply could not afford a nighttime taxi journey.

Progress has been made; I really welcome the 10-year health plan, particularly the shift from hospital community care, which will ensure people are seen closer to home. However, I urge the Minister to consider the points I have made today about recognising the true scale of the real and unavoidable costs of serving dispersed rural communities.

Oral Answers to Questions

Lizzi Collinge Excerpts

Tuesday 24th February 2026 Commons Chamber

[Karin Smyth]

I commend the hon. Member for going out with her crews. One of the reasons we have been so successful this year in improving the services is by looking at things such as where ambulances are located and how they operationalise their services. We will continue to work with NHS England on the best model for local constituencies.

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

9. What assessment his Department has made of the adequacy of access to NHS dental services in Morecambe and Lunesdale constituency.

[The Minister for Care (Stephen Kinnock)]

We inherited a broken NHS dental system in which many people were unable to access a dentist when they need one, including in my hon. Friend’s constituency, but we are making real progress, having increased the number of NHS treatments by 1.8 million between April and October 2025 compared with the same period before the general election. As a result of this nationwide increase, I am pleased to report that 89,000 more NHS dental treatments were delivered between April and October last year in the Lancashire and South Cumbria integrated care board area, which of course includes my hon. Friend’s constituency.

[Lizzi Collinge]

One of my constituents contacted me because their spouse is bedbound and cannot get dental care at home, so he gets no routine care. He recently waited three months for an emergency extraction—something he could have had on the same day if he was not disabled. What work is going on to help my constituents access the care they need?

[Stephen Kinnock]

I am sorry to hear about the plight of my hon. Friend’s constituent. I will, of course, be more than happy to meet her and look into the specifics of the case. Specialised dental services have a vital role to play in providing dental treatment to vulnerable people in settings such as care homes. In many cases, this is about teamwork and integration, ensuring that primary dental care is working in lockstep with adult social care. There is clearly some room for improvement in some areas. I would be happy to work with her to ensure that this issue gets resolved.

Hughes Report: Second Anniversary

Lizzi Collinge Excerpts

Wednesday 11th February 2026 Westminster Hall

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

It is a pleasure to serve here today under your chairship, Ms Allin-Khan. I thank the hon. Member for Chesham and Amersham (Sarah Green) for securing this important debate.

I am going to focus on sodium valproate, which was prescribed for decades without proper warnings about the effect on unborn children. As a result, those children were harmed and, despite multiple Government-commissioned reports, families are still waiting for accountability and redress. Two years on from the Hughes report, that delay can no longer be justified.

Sodium valproate is a medicine used to treat epilepsy and bipolar disorder. It is a very effective medicine for many but, if taken while pregnant, it can cause serious harm. Those harms include major physical birth defects, developmental delays, learning disabilities and a significantly increased risk of autism. Many of the children affected will need lifelong care.

For years, despite those risks being known, women and prescribers were not given clear or adequate information about them. Even after the effects were more widely known, prescriptions continued without proper safeguards in place. At least 7,000 children have been affected by this medicine since it came on to the market in 1973, but the real number is quite likely very much higher because of the lack of awareness around foetal valproate spectrum disorder.

My constituent Nicola was one of the many women affected. Her children were profoundly harmed by exposure during pregnancy. Like so many others, Nicola trusted her doctor and followed proper medical advice. She was badly let down. She has explained to me just how immense the impact has been on her and her children and, of course, what a difference compensation would make to her kids’ lives.

[Luke Myer (Middlesbrough South and East Cleveland) (Lab)]

My hon. Friend is making a passionate case for her constituent. My constituent Gill has told me how she has suffered for around 11 years as a result of the pelvic mesh scandal. She is a member of the Sling the Mesh group. Does my hon. Friend agree that, whether on sodium valproate or pelvic mesh, such groups deserve to be listened to, and that we should pay tribute to them for campaigning for these courageous women?

[Lizzi Collinge]

My hon. Friend is absolutely right. This scandal follows a pattern that we have seen far too many times before: early warnings ignored, information withheld or downplayed, measures to protect people not effectively enacted, and public bodies closing ranks rather than being open and honest when things go wrong. I have done a lot of work on maternity safety, and I have seen those patterns again and again; the parallels are really clear. Had concerns been properly addressed at the outset, so much harm could have been avoided, and so many more children would not have been born with lifelong, preventable conditions.

Their families have been waiting for far too long. There were initial recommendations for redress six years ago in the Cumberlege review, but the previous Government failed to act. Through the Hughes report, we have an even more comprehensive examination of what needs to be done to support those families, but they are no closer to getting even a formal response to that. That constant delay increases the cost, delays support and builds up ill-will with affected families, who have already spent their lives fighting for their kids.

I urge the Government to provide an interim payment for those families. We know that that is possible; Dr Hughes has outlined how to do it in this case, and we have seen it in the infected blood scandal. The main question for the Minister is this: when will we get a full response to the Hughes report? When will we actually see some action?

Like so many of my colleagues, I pay tribute to Emma and Janet from the Independent Fetal Anti-convulsant Trust, who are here today. Their children were affected by sodium valproate, and they have been tireless campaigners for compensation for affected families—I have known them for many years now. They have been invaluable in raising awareness about foetal valproate spectrum disorder. I also thank my hon. Friend the Member for Lancaster and Wyre (Cat Smith), who has worked with In-FACT for many years on this and has been a staunch advocate for their campaign.

Despite all their hard work, progress from the Government’s side seems to have stalled yet again, and families are left waiting. We know that things go wrong in medicine, and that all drugs have side effects, but when a harm that is caused was preventable, and when the state fails to act on warnings, the Government must step up. We should do what we should have done years ago, and give justice and support to the families who have already paid a heavy price for our failings.

[Dr Rosena Allin-Khan (in the Chair)]

I remind Members that it is discourteous not to attend for the opening speeches and then to make interventions. As a result, those Members who have been here from the start and will be here until the end will now have a shorter time limit imposed on them. Because of the number of Members who have indicated that they wish to speak, with the authority of the Chairman of Ways and Means, I am imposing a time limit on Back-Bench speeches of three and a half minutes.

Medical Training (Prioritisation) Bill

Lizzi Collinge Excerpts

2nd reading
Tuesday 27th January 2026 Commons Chamber

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

It is a pleasure to speak in support of the Medical Training (Prioritisation) Bill. We all know that our NHS faces workforce shortages in many specialties. In my constituency of Morecambe and Lunesdale, the workforce problem, combined with other factors, means that my constituents are not seeing the improvement in waiting times that other parts of the country have seen. The progress that has been made nationally is astounding, and we Government Members should be proud of that, but there are pockets where that progress has not been made, and that is unacceptable. I would welcome more conversations with Ministers about how we can tackle that, and I will continue to raise the matter with the local NHS.

Alongside the workforce shortages, we have the bizarre situation that doctors who need training places are struggling to get them, particularly those who are UK graduates. Competition for foundation and specialty training places has grown, partly because of a 2020 change to visas that lifted restrictions on overseas applicants applying for those training places. I would like to believe that that was done in good faith to try to increase the NHS workforce and to plug specialty gaps, but because of how it was done, UK graduates ended up competing, not with perhaps one other person, but with six other people for a training place. That is clearly unhelpful, particularly when we have already invested so much in their education.

Doctors have taken on a lot of debt to go through their initial training. Faced with this level of competition, and unable to continue their training in the UK, many medical graduates are being pushed to seek employment abroad or, even worse, to leave medicine altogether. Pressure is uneven across the system; some specialties are heavily oversubscribed, while some are left with unfilled posts. For example, there is a 15% staffing shortfall in oncology. For many years, I was the deputy chair of the Lancashire health scrutiny committee, so I saw Tory incompetence in the health service in real time. That particular example adds to the litany of their failures in health. Over 14 years, they made us poorer, sicker and less able to get early help.

This Bill addresses the failure to provide training places for doctors, in order to ensure that UK graduates can continue to train in the UK. It introduces a system of prioritisation for UK medical graduates, and will deliver this Labour Government’s commitment to a more sustainable medical workforce. It protects public investment, reduces excessive competition and ensures that our home-grown talent can become the next generation of NHS doctors. No disrespect to the fantastic medics who come from abroad to work here—they do such a fantastic job, and our NHS would not have survived without that immigrant workforce—but prioritising UK-trained graduates would bring us into line with international norms. Favouring domestically trained clinicians helps countries to ensure that they have a stable workforce. To be honest, we should not be nicking other countries’ doctors, particularly doctors from countries with underdeveloped health systems. I do not believe that is in line with our values.

UK taxpayers invest around £4 billion every year in training doctors, so the aim of any sustainable workforce policy should be to see all UK graduates in training posts. A fifth-year medical student who wrote to me aptly described this Bill as essential to safeguarding what he calls

“fair access to training opportunities amongst UK graduates”,

and to ensure that the NHS workforce pipeline survives in the long term.

I am glad to see the Government addressing this issue with the urgency it deserves. Doctors, of course, are only one part of the health service. Many professions work together to care for patients, but doctors are a vital part of the NHS, and we need to ensure that UK medical graduates can progress their careers. This goes alongside all the other work that the Labour Government are doing to make us healthier as a nation, whether on controlling tobacco and vapes, helping people to afford healthy food, or enabling earlier access to primary care. I urge colleagues across the House to support this Bill.

Puberty Suppressants Trial

Lizzi Collinge Excerpts

Wednesday 17th December 2025 Commons Chamber

[Wes Streeting]

I will take the hon. Member’s question in three parts. First, the opinion polling that she mentions shows that people in this country are overwhelmingly kind, and they want to ensure that trans people, and LGBT people more broadly, are treated with kindness, compassion and inclusion. Secondly, I do not dismiss the opinion polling that shows that a majority are against this kind of trial. Thirdly, the reason I am doing this is that I have to think about this extremely small group of people. I do not know what it is like to walk in their shoes and I have to think very carefully about what is in their best interests. The best way to do that is to build the evidence base that we need to provide high-quality healthcare. I strongly, strongly do not agree with her characterisation of this study, which is in itself irresponsible.

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

Some of the political debate around this subject has saddened me, not least the way that trans people’s reality and experience has been denied. We even have evidence of British trans people from the 4th century—they have existed forever. Will the Secretary of State confirm that the trial is a real attempt to get a proper evidence base for treatment for young people that is really needed?

[Wes Streeting]

My hon. Friend is correct that the study is about building the right evidence so that we get high-quality, safe healthcare for this vulnerable group of children and young people.

Resident Doctors: Industrial Action

Lizzi Collinge Excerpts

Wednesday 10th December 2025 Commons Chamber

[Wes Streeting]

I completely agree with my hon. Friend. The BMA has put the offer to its members in neutral terms, but the fact is that it is now going to run a hasty survey over the next few days in order to give us what will still be less than 48 hours’ notice of whether or not these strikes will go ahead. If it took up the mandate extension, it could run a referendum properly and give its members more time to consider and discuss the offer in the workplace and with their families and reps. I do not see how more participation in the conversation and in the ballot could possibly be a bad thing.

As I have made clear to resident doctors, there are no downsides for the BMA in this. In fact, the only person who risks having a downside is me if, even after accepting the mandate extension, the deal is rejected and the doctors go out on strike again in January. This is not even a win-win scenario; this is a potential win-lose scenario, so I do not know why the BMA would not take it up.

This is a great offer for doctors. I know there will still be more to do, whether that is the implementation of the 10-point plan that Jim Mackey has come up with, my offer to work with the BMA trust by trust and employer by employer to see progress, or any of the other things we can do together. If we work together, we can get more done together. If we are working as partners rather than adversaries, we will all enjoy it a lot more and we will make more progress, and that is the opportunity that is available.

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

I am very concerned that flu has hit hard and hit early this year. Hospital bed occupancy for flu is more than 50% higher than it was this time last year and resident doctors are central to tackling that. I have to admit to being very shocked that the BMA turned down an offer that would allow it to postpone next week’s strike. Does the Secretary of State share my worry that any strike action would make tackling this flu crisis much harder?

[Wes Streeting]

My hon. Friend is absolutely right. It also costs us roughly a quarter of a million pounds each time the BMA does this, and we cannot afford to keep paying that. It may say, “Well, then just do a deal with us and you will not have to fork out,” but then why would the rest of the NHS workforce, or the entire public sector or the entire economy, not go on strike? That is not constructive, and it is not going to get the NHS or Britain out of the enormous hole it was left in by the Conservatives. We are making real progress together, and I thank resident doctors for that. We will make more if we work together.

Jhoots Pharmacy

Lizzi Collinge Excerpts

Wednesday 15th October 2025 Commons Chamber

[Stephen Kinnock]

I do not think that is an accurate characterisation of what I am saying. I am saying that we are taking action against Jhoots from the regulatory point of view, and there is clearly a glaring issue with the payment of staff. That needs to be taken forward through the industrial relations process, both through ACAS and the PDA. We will give all the support we can to both those organisations to ensure that Jhoots is held to account.

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

My constituents in Sedbergh, a rural market town, have suffered greatly from the terrible pharmacy provision by Jhoots. Medicines have been unavailable, the pharmacy has often been closed, and staff and locum pharmacists are going unpaid, yet pay slips are being issued, so it is very hard for them to claim benefits. I have written to the Minister and met with the integrated care board. Doctors and neighbouring pharmacists—I say neighbouring, but this is in Westmorland, which is a 40-minute drive away—have stepped in to help, as has the parish council. Can the Minister outline what action he is taking nationally to force Jhoots to provide a better service for my constituents?

[Stephen Kinnock]

We are actively working with integrated care boards, NHS England, the General Pharmaceutical Council and, indeed, trade unions to ensure that all of these issues are being taken forward and given the urgency that they require. Sadly, as I have pointed out, the regulatory framework is not adequate. It is very focused on pharmacists and pharmacy premises, and inadequately and insufficiently focused on business owners. That is something that must be addressed as a matter of urgency, and we are working on it at pace.

Baby Loss

Lizzi Collinge Excerpts

Monday 13th October 2025 Commons Chamber

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

I speak with a number of hats on: as the MP for Morecambe and Lunesdale, representing all my constituents who have lost babies in pregnancy; as a mum of two children; and as a woman who has lost two much-wanted pregnancies. I want to use my place here to shine a light on the pain that families are feeling due to baby loss, and the steps that the Government can take and are taking to help them, from enforcing a duty of candour on public bodies to giving bereavement leave to parents who have lost a baby before 24 weeks of pregnancy.

First, I welcome the national maternity investigation. I thank the Secretary of State for his attention to it, and for listening to harmed families. I want to emphasise that, on the whole, maternity care in this country is safe, but where it is not, strong action must be taken. I was relieved to see that my local trust, Morecambe Bay, will be part of the national investigation, not least because of the experiences of my constituents Ryan and Sarah, whose baby Ida was born in 2019 and died seven days after. Ida died because of failings in her care. I know, as Ryan and Sarah do, that mistakes happen—healthcare workers are human—but they have had to fight every step of the way to get the truth about their daughter’s death, which feels so inhumane. After the hospital trust’s completely inadequate internal investigation declared there to be no care issues and Ida’s death was graded as “moderate harm”, Ryan and Sarah had to approach a senior coroner to get a full inquest. It was only at that inquest, five and a half years later, that the trust accepted that its failings had led to Ida’s death.

The thing that breaks my heart is that those failings had already been identified: the Kirkup report identified major failings, which were meant to have been fixed. I first became involved in maternity advocacy in Morecambe Bay after the pretty awful birth of my first child. There was a lot of activity in the trust in response to the Kirkup findings, and I do believe that improvements were made, but two things never went away, and I think they are still harming families to this day.

The first thing that I want to highlight is the ideological belief that certain types of birth are superior to others. We hear talk of “normal” or “physiological” birth. The belief that that is somehow superior to a birth with intervention still harms people today. The second thing is the organisational culture that led to a care organisation responding to a baby’s death not with care, respect and humility, but with a gross failure to investigate, a gross failure to act with decency and kindness, and a gross lack of transparency.

Finally, I want to mention a constituent who came to my surgery a few weeks ago. Her stepdaughter was born sleeping many years ago, and she and her husband recently found out that she was buried in a mass public grave. They know the location where she was put to rest, and they really want to put a marker directly on the grave site, but apparently that is not allowed under local council rules. They are puzzled, as am I, as to why marking one baby’s death is somehow disrespectful to the other babies who lie in that mass public grave. I am working with my constituent to try to address that.

I am glad that the pain that families feel across our country is being recognised in this place today. We cannot let more babies die preventable deaths. We cannot let those losses go unacknowledged. I thank Members in the Chamber today for their work.

Terminally Ill Adults (End of Life) Bill

Lizzi Collinge Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Rebecca Smith (South West Devon) (Con)]

I rise to speak to amendment (a) to new clause 15, tabled in my name, which I hope hon. Members will support. Although it may seem technical, it is in fact a simple amendment with a significant impact. It will ensure that there is genuine protection against abuse, proper detection of coercion, and effective scrutiny of how the law works in practice. Simply put, it will ensure that deaths from assisted dying under the Bill will still fall within the coroner’s duty to investigate deaths under section 1 of the Coroners and Justice Act 2009. I will explain why that is important.

Like many hon. Members, I have been deeply concerned from the outset about how the Bill is drafted, its workability, and its impact on the NHS and on the lives of vulnerable people up and down the country. To be clear, my view is that one unintended death as a result of the Bill becoming law is one too many. I humbly ask hon. Members who are still considering their position, or who are minded to support the Bill, to consider this point about my amendment carefully: what is an acceptable error rate?

Based on the figures in the Government’s impact assessment, which I think underestimates the impact, even a 1% error rate would see a minimum of 13 wrongful deaths in year 1, with 45 per year by year 10. A 5% error rate would see 65 deaths in year 1 and 227 in year 10. A 10% error rate would see 131 deaths in year 1 and 455 in year 10. As I say, I think those are low-ball estimates, but they are nevertheless chilling. If this law is passed, it will be exceptionally difficult to say whether there have been errors or instances of abuse; or, at the very least, any errors picked up will be but a fraction of the true picture, as tragically those who would testify to the fact will already be dead. My amendment (a) to new clause 15 directly addresses that issue.

In England and Wales, a coroner will investigate a death when certain legal conditions are met. This duty is primarily governed by section 1 of the Coroners and Justice Act 2009. Judge Thomas Teague KC, who served until 2024 as the chief coroner of England and Wales, notes:

“any death arising as a consequence of the ingestion or administration of a lethal substance constitutes an unnatural death which the local coroner is under a statutory duty to investigate”.

Clearly, assisted dying meets that definition, and it is right that such deaths be afforded the best possible posthumous judicial scrutiny.

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

Does the hon. Lady not feel that the provisions in the Bill already have safeguards? Also, and most importantly, does she not feel that putting a family through a coronial process when the death is expected is unfair, unjust and completely beyond the bounds of what coroners are meant to do?

[Rebecca Smith]

On the first point, I do not believe that the Bill is strong enough as it stands. On the second point, we are already dealing with the fact that families are not even guaranteed knowledge of their loved one having an assisted death, so I do not think the hon. Lady’s point is entirely to be considered.

As it stands, the Bill would disapply the duty of the coroner to investigate in the case of an assisted death that has been carried out in accordance with the Bill’s provisions. New clause 15, specifically, would amend the Coroners and Justice Act to clarify that assisted death does not constitute “unnatural death” for the purposes of the Act. I think it takes an extraordinary leap of imagination not to conceive of deliberately self-administering lethal drugs as anything but an unnatural death.

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[Sadik Al-Hassan]

Will the hon. Lady give way?

[Lizzi Collinge]

Will the hon. Lady give way?

[Dr Johnson]

I do not have much time and I do not want Madam Deputy Speaker’s cough to return. [Laughter.]

If one examines the litany of drugs involved in other jurisdictions where assisted dying is legal, it makes for troubling reading. It is often an ad hoc cocktail of lethal substances, including sedatives, analgesics, cardiotoxic agents, neuromuscular blockers and antiemetics. There is no internationally agreed drug regime. Jurisdictions such as Oregon, Canada and the Netherlands use varying combinations of barbiturates, sedatives, opioids and antiemetics. In 2020, the official Oregon report stated that, compared with single barbiturates,

“All drug combinations have shown longer median times until death”.

As the Bill currently stands, doctors will have to consider prescribing untested drugs or drug combinations, which could potentially breach the General Medical Council prescribing guidance that a doctor must be satisfied that the drug serves the patient’s needs. To address some of those concerns, I have tabled several amendments.

Amendments 96 and 97 ensure that no drug can be approved under the Act unless there is a scientific consensus that it is effective and does not cause undue pain or side effects, and that it has been specifically licensed for that purpose by the MHRA. I cannot really understand why anyone would disagree with that.

Amendment 98 clarifies that the Secretary of State is not compelled to approve any drug if, after consultation, it is concluded that no substance is appropriate or safe enough to meet the standard.

Amendment 99, alongside amendment 100, mandates that before any regulations are laid before Parliament, a comprehensive report must be provided. That report must include time to death, possible complications including pain, and any likely side effect of the proposed substances. Again, I cannot see why that would be controversial, because surely we all want everybody to be fully informed and make fully informed decisions, and that is part of making an informed decision.

Amendment (b) to new clause 13 requires any medical devices for self-administration be approved by the MHRA and that the Secretary of State consult the MHRA before making any regulations. That is a basic safeguard that we would expect in any medical intervention, and it should be a non-negotiable condition here.

Finally, amendment 42 removes a time limit and therefore the pressure on the Secretary of State. I understand other people’s concerns about that. There is often a narrative that it will lead to patients being able to die at a time and in a place of their choosing. However, the regulations in the Bill require the doctor to stay with the patient from the moment the drug is given until they are dead. We have heard that that could take quite a long time. Do we really have enough doctors to do this at people’s homes at a time of their choosing? At the moment, I do not think we do, and I do not see how, in a short period of time, that will be achievable either.

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[Dr Huq]

I totally agree. We know that Esther Rantzen and Jonathan Dimbleby want the Bill to be implemented, but our role is to be voices for the voiceless, so I totally agree with her.

As opposed to the vague, ever-changing qualifying criteria that are held up as safeguards, at least these amendments would put ethnic minority people on the board: new clause 6 says that if they are on the ward, they should be on the board as well. The Bill seems to have neglected them altogether, so the new clause would provide real protections.

We know that in a cost of living crisis, assisted dying could be quite attractive. BAME communities have lower disposable household incomes than standard households, and during a cost of living and housing crisis, it is possible to imagine relatives wanting to speed up granny or grandad’s probate—or naani maa or dadima, even—to get a foot on the ladder.

[Lizzi Collinge]

On that point, will my hon. Friend give way?

[Dr Huq]

No, because I will not get any more time.

Given the cost of care, people could convince themselves that elderly relatives would be better off out of the way, in order to get the younger generation on the ladder.

We know from the experience of other places that once assisted dying is allowed, the scope broadens—depressed 12-year-olds in Holland can get it—and the incentive to fix palliative care will lessen. Why now, with the state of the NHS? What of Suicide Prevention Week? Yes, we know that public opinion is in favour of assisted dying, but public opinion also supports bringing back hanging.

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[Carla Lockhart]

My hon. Friend is absolutely right. On a constitutional basis alone, amendment (a) to amendment 77 is necessary, and I hope that hon. Members will feel they can support it.

Moving on to factors beyond the constitution, I am concerned that there is a dangerous absence of an adequate regulatory framework for lethal drugs under the Bill. At present, clause 25 gives the Secretary of State powers to approve lethal drugs, while clause 34 mandates the Secretary of State to make provision for prescribing, dispensing, transportation, storage, handling, disposal and record keeping, as well as enforcement and civil penalties. However, the fundamental issue of how these approved substances are actually approved remains alarmingly weak. The Bill defines “approved substances” simply as

“a drug or other substance specified”

by the Secretary of State in regulations. There is no explicit requirement for those substances to undergo specific, rigorous testing for their use in assisted dying.

When this issue was debated in Committee, I was disappointed to see good-faith amendments to engage, such as amendment 443, being dismissed.

[Lizzi Collinge]

Will the hon. Lady give way?

[Carla Lockhart]

No, I will not.

Amendment 443 sought to mandate that those substances be approved through the Medicines and Healthcare products Regulatory Agency and either the National Institute for Health and Care Excellence or the All Wales Medicines Strategy Group processes. I therefore strongly support amendment 96, tabled by the hon. Member for Sleaford and North Hykeham (Dr Johnson), which

“ensures that drugs can only be approved if the Secretary of State is reasonably of the opinion that there is a scientific consensus that the drug is effective at ending someone’s life without causing pain or other significant adverse side effects.”

That is a common-sense approach that should attract support from across the House.

This week, more than 1,000 doctors wrote a powerful letter to all MPs to outline their deep concerns about this Bill, calling it a

“real threat to both patients and the medical workforce”.

I strongly urge this House and colleagues to read that letter before Third Reading. The Government’s own impact assessment does not provide any comfort with regard to the use of lethal drugs under the terms of the Bill, which the doctors’ letter picks up on, saying that

“there is no requirement for…[the drugs]…to undergo rigorous testing and approval that would be required of any other prescribed medication, nor indeed for them to be regulated by the Medicines and Healthcare products Regulatory Agency”.

They go on to say that that is

“contrary to all good medical practice”.

This matters not just for regulation, but with regard to patient safety and complications. There is no requirement in the Bill to inform patients about how risks—including a prolonged death, rather than the promised peaceful and dignified death—will be managed. Complications do occur, and this is not scaremongering. In Oregon, when complications have been recorded, patients have experienced difficulty swallowing, drug regurgitation and seizures, and they have even regained consciousness. In Canada, a Canadian association has noted that patients have experienced regurgitation, burning and vomiting.

I draw Members’ attention to the written evidence submitted to the Bill Committee by a group of expert senior pharmacists and pharmacologists. In their submission, they warn that the approach of the Bill puts the cart before the horse. Specifically, they caution against proceeding without

“a comprehensive review of the evidence for efficacy and safety”,

and note that that review

“should be scrutinised by MPs before…consideration of legalising assisted suicide”.

These are not small details or incidental matters, yet, even at this late stage in the Bill’s passage through the Commons, we are still being asked to pass legislation without satisfactory answers to basic questions from experts in the field. That is simply not good enough.

I am grateful to have had the opportunity to speak, and I will close by saying simply that whatever mitigating amendments may be passed, this Bill remains morally and ethically wrong. It is flawed and should not be passed.

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[Rachael Maskell]

I rise to speak to my amendment 27. The insufficiencies of clause 25 and new clause 13, and the mechanisms for substance approval, have attracted much criticism as they defy safe process. I have therefore undertaken extensive research with leading academics, toxicologists, anaesthetists, pharmacists and others to understand the safety concerns over pharmacology, prescribing and dispensing.

Normally, the MHRA would undertake research and trials to secure safety, quality and licensing. The British National Formulary focuses on dosage and side effects, and NICE or the All Wales Medicines Strategy Group focuses on showing that drugs work and are cost-effective. That safety regime underpins the reputation of UK pharmacology. So can this House assure itself that without due process, someone will have a safe and peaceful death? Let us look at the evidence.

First, the data is poor. The Health and Social Care Committee visited Oregon. We know there are varying times for how long it takes for someone to die—up to 137 hours. The research cites nausea and vomiting in 10% of cases, seizure, oral muscular burning, regurgitation and regaining consciousness.

[Lizzi Collinge]

Will my hon. Friend give way?

[Rachael Maskell]

No time.

There is a lack of consistency of approach and data across jurisdictions on the substances used, how they are titrated and the dosages administered. While ingestion can be a factor, absorption varies according to frailty, metabolism, diagnosis, body mass index and drug reactions. Pharmacokinetics and pharmacodynamics are complex.

However, it has been my discussions with toxicologists that have been most alarming. They highlight the high risk of acute pulmonary oedema. This is backed by research showing that 84% of cases using pentobarbital on death row have flash pulmonary oedema. The drug disintegrates the membranes in the lung tissue, filling them with fluid, causing shortness of breath and a sense of drowning. As a clinician, I have supported many people on intensive therapy units with such a diagnosis. High concentrations of the drug cause an acute assault to the cardiopulmonary function. If paralysed and conscious, a patient may look peaceful but is anything but.

Such physiological distress needs research. It is unclear how the Government will identify data, process and safety. The risk to those handling toxic substances also needs to be examined, and in the light of the Government identifying that a pregnant woman could opt for an assisted death, that clearly needs examination.

There is no formulation for safe titration or dosage. If pentobarbital is to be used, as it is in Australia, the Government’s impact assessment did not examine it, so it needs revision. Also, the drug is not an approved substance for humans in the UK, licensed or unlicensed. The MHRA and NICE have a role to play. We are increasingly hearing that professional bodies are withdrawing their support from the Bill, because they know that the regimes that have been set out are just not safe, so it is our duty to examine the evidence.