Terminally Ill Adults (End of Life) Bill

Lord Blencathra Excerpts

Friday 12th December 2025 Lords Chamber

[Baroness Falkner of Margravine (CB)]

My Lords, I wonder whether the Minister in winding up could advise us what the Companion says about Peers making speeches on the same amendment over several points of the passage of that amendment.

It is a pleasure to follow the noble Lord, Lord Deben, speaking to the amendment from the noble Lord, Lord Rook. There is a lacuna in Clause 1(1)(d), which, by requiring registration with a GP, does not cover the practical point of what happens to people who have lost contact with their GP. They may have lost contact for no other reason than being so ill, perhaps with cancer as that is the main illness that people who might be seeking assisted dying have, that they have been taken into private care—those who are lucky enough.

An increasing proportion of the population of the United Kingdom now uses private care, not least because employers provide it as part of a package. So, coming to continuity of care, if we must have the light-touch amendment of the noble Lord, Lord Rook, in the Bill, to clarify and strengthen Clause 1(1)(d), I will share with the Committee very briefly a practical experience of what it means to have advanced cancer and the interaction with the GP. My GP practice, having failed to diagnose me over six months, as I mentioned in my Second Reading speech, slipped away the moment I engaged with private care, although every single consultation with a private practitioner is sent to the GP. Nevertheless, between 30 August 2024, when I was first diagnosed, and late this September, I had no contact whatever with my GP practice. I was finally invited to come in and was told I had fallen between the cracks—it must have been a pretty large crack to have lasted 14 months.

I noticed in the equality impact assessment that 66% of the people who sought assisted dying in the two jurisdictions quoted were people who had cancer. My question to the noble and learned Lord when he winds up on this debate is therefore, what consideration has been given, in having Clause 1(1)(d) in the Bill, as to the relationship of the private oncologist who is treating that patient with the local GP, given that terminally ill people in significant enough numbers that we need to be conscious about them in the Bill may well have been—shall I say—passed on from the GP?

As a final point, once I had the diagnosis, I had the experience of requesting treatment at my local—within a walkable distance—leading cancer teaching hospital in the United Kingdom. When I rang about that after the diagnosis, I was told by my GP, “They won’t take you, because now you’ve gone private”. I leave that for noble Lords to reflect on.

[Lord Blencathra (Con)]

Before we move to the rest of the debate, could we please give way to those noble Lords who have tabled amendments? I would like to hear what they have to say.

[Baroness Grey-Thompson (CB)]

My Lords, I will speak to Amendment 21, tabled in my name, from personal experience. The richness of the debate today shows that, even in your Lordships’ Chamber, we all have completely different experiences of how we access a GP practice.

I tabled this amendment partly from personal experience, trying to look at how we provide continuous care to a patient. As for my own experience, I am disabled, not sick, but I have had some very interesting experiences of interacting with doctors. Fairly recently, I was asked by a doctor how I caught spina bifida and had to explain to him that it was congenital. As for my husband’s experience of the healthcare system, he had a spinal cord injury in 1984 and, at a recent visit, was continually asked whether it was in 1884 that he had his accident—I know he looks good for his age, but not that good. This is not to be flippant, which I have been accused of before. It is actually to try to ensure that we have proper continuity of care for a person who wishes to end their life.

My amendment is also grounded in coercion detection and the limitations of any capacity assessment. When I tabled it, I was thinking that perhaps a GP could provide extra knowledge to contribute to the decision that was made. But then I heard of the experience of my noble friend Lady Falkner, which is absolutely appalling. It shows that there is far more work we need to do, not just on the National Health Service but on making sure we provide the right care. The noble Lord, Lord Deben, talked about the NHS we wish to have. Well, this might be a chance to think about the NHS we wish to have.

I take this opportunity to welcome my new noble friend Lady Gerada and the experience she brings to the Chamber. I have to say that it has left me slightly more confused. I have amendments on data recording, which we will be debating later. Her comments show that data recording and sharing is really important. The part I got a bit confused about was that, if there is a named clinician as part of that process, does that not ultimately feed in to the points that have been made today? I would welcome the chance to discuss that with her outside the Chamber.

Continuity of care is really important, and how it relates to improved patient outcomes. In 2012, 56.7% of patients had a preferred GP, but that is declining. There is a link between your preferred GP and being able to access that GP. The decline has happened regardless of baseline continuity, rural or urban location or level of deprivation. Providing a better experience to patients will make those final weeks and months better for them. The Royal College of General Practitioners published excellent work in 2021 on why the patient’s relationship with their general practitioner is so important. Research on coercion and undue influence demonstrates that standard capacity assessments, while necessary, are not currently sufficient to identify subtle forms of coercion. That is why I tabled an amendment.

In response to the comments of my noble friend Lord Pannick, about what happens if a GP dies, I am happy to be corrected, but I thought the provision in the Bill about your doctor dying would cover a general practitioner as well as any other doctor involved in the process.

What we are talking about here are really complex decisions. Consulting an established GP or GP practice might mean that they possess the nuanced knowledge which would help somebody make a choice. The requirement that GPs confirm that they have a good understanding of the individual’s personal circumstances represents, to me, a better form of safeguard, ensuring that this knowledge actually exists. We cannot assume anything during this process. The assessment should provide abuse detection capacity unavailable in other types of consultations. For individuals whose care is family dependent, the home visit element—which I had, not so long ago—can play an important part in identifying coercion. If the debate has raised nothing else today, it is that this is a really complicated issue which needs much further work.

--- Later in debate ---

This issue illustrates a couple of things. Yes, it is down to safety, but I respectfully suggest that the fact that we are having this discussion today shows the immaturity of the Bill. We should have had a royal commission and a Government Bill, instead of trying to do it this way and negotiate on the hoof.

[Lord Blencathra (Con)]

My Lords, I did not speak last Friday, and this is the only group to which I intend to speak today. I could have spoken to the last group, as my former constituency abutted the Scottish border of Dumfries and Galloway and a mere 85 yards across the River Sark was Gretna. I was aware of our glorious 600-year history of border-raiding for cattle and women—in that order—and now it seems we can add free prescriptions to the list as well.

These amendments would strengthen the safeguards with a demonstrable, ongoing clinical relationship with a GP, reducing risk of error, coercion and administrative confusion, while supporting clinical judgment and the continuity of care. Requiring 12 months’ registration plus a minimum number of in-person contacts gives a straightforward verifiable test of recent clinical involvement. We need robust, practical safeguards and clear eligibility checks. These are essential to protect vulnerable people by evidencing local care and oversight. A sustained relationship with a local GP who has seen the patient helps ensure that the patient is informed and is acting voluntarily and free from subtle pressure. The GP’s direct knowledge of the patient’s circumstances is therefore a critical safeguard rather than a bureaucratic hurdle.

The big issue, which has already been raised today, is: who sees the same GP twice these days? I am very lucky, and perhaps some other noble Lords are as well, in that there are superb multi-disciplinary GP practices in Cumbria. I almost always see the same GP, and we can email as well. In fact, in 40 years of living that constituency, I have only ever had two GPs. However, that is not the national picture. Many patients see a different GP every time they visit. Therefore, for this part of the Bill to work, it cannot be any old GP from a practice; it has to be a GP who has treated the patient personally on a few occasions or over a period of time.

Yesterday, I had the wonderful privilege of hearing in this House from a GP who satisfied all the criteria of these amendments thanks to her deep knowledge of her patients. I was later able to congratulate the noble Baroness, Lady Gerada, a former president of the Royal College of General Practitioners, on her excellent maiden speech. I am delighted to see her here today. I understand that this morning, she was doing the day job, treating her patients in her constituency.

I know that the noble Baroness is in favour of assisted dying, but what she said in one part of her speech yesterday was directly relevant to these amendments. The noble Baroness—I am rather vexed at the right reverend Prelate the Bishop of Norwich, who stole these lines earlier this morning—said:

“I became a GP in Kennington, and I have lived and worked in the community I serve ever since … My very first patient was a young woman who suffered a stillbirth. Decades later, I look after her children and now their children too. That continuity, seeing lives unfold across time, gives general practice its unique moral and social power. It allows us to see people as whole human beings, not as isolated organs or diagnoses. We are interpreters of experience, translators of suffering and witnesses to change”.—[Official Report, 11/12/25; col. 370.]


That is exactly the sort of GP I trust to make a decision on whether a person has a confirmed wish to opt for assisted dying—not just any general practitioner, who may never have met the patient before and has just 10 minutes to form an opinion.

I would love to find a way to include that magnificent sentence about continuity and seeing lives unfold over time giving general practice its unique moral and social power; I would love to see whether we could incorporate it into the Bill, because it sets the right moral climate.

As I say, I have a GP. However, for those millions of people who are not so lucky, these amendments would balance safeguards with practicality. Setting a modest minimum of contacts is proportionate. It is enough to demonstrate an established relationship without imposing unrealistic burdens on patients or practices.

Many noble Lords have spoken of multidisciplinary teams. Can the noble Baroness tell me—indeed, can anyone tell me—how many of all the GPs in this country are still single-practice doctors? A Google search suggests that it is around 63%. That seems terribly high; there must be more multidisciplinary teams than that. There are still an awful lot of single-practice GPs. On the rare occasion when I have not seen my own GP, the other GP has had a look at the computer and read all my clinical notes. However, he does not really know who I am; perhaps that is just his good fortune.

These amendments would support patient safety and public trust in any assisted dying regime. It needs to be visible and enforceable, and it needs to have enforceable safeguards. Clinicians must be able to attest to a patient’s circumstances. I support these amendments.

May I say to the noble and learned Lord, Lord Falconer of Thoroton, that I was dismayed to read some very hostile comments about noble Lords and noble Baronesses in the weekend press? The complaint was that some Peers had tabled a large number of amendments, and that that was somehow wrong. If they were the only Peers who spoke to them, that criticism would be valid, but those noble Lords and noble Baronesses, as professionals and experts, tabled amendments to which many of us wanted to speak. We left them to do it because those Peers have experience; scores of Peers have spoken to their amendments, so they were not abusing the House. I am absolutely certain that the noble and learned Lord was not behind that bad-mouthing, because he is a gentleman as well as a Peer, but some supporters of this Bill are trying to drown out and close down any proper scrutiny in the Lords.

Lastly, I remind the noble and learned Lord and the Committee that Dignity in Dying’s website boasts that the Bill had 29 Committee sittings in the Commons and over 90 hours of consideration. Since the Bill has come to us from the Commons, we have heard devastating criticisms of it from the Constitution Committee, the Delegated Powers Committee and experts giving evidence to the noble Baroness’s Bill Committee. Today, we are on only our fourth sitting, after, I think, 18 hours of debate. So I say this to the noble and learned Lord: please tell some of the others to call off the attack dogs because this House is doing its proper job.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, like many noble Lords, I grew up at a time when the family doctor was looked upon as a family friend who could always be depended on whenever you were ill or in a time of crisis. Unfortunately, that is not the situation today. There is a major problem across the United Kingdom: patients desiring to see a GP find themselves sitting on the telephone and ringing the surgery 120 times, perhaps, but still not getting through to someone and giving up at the end of it. That is the reality of the situation in many places.

I am sorry that the noble Lord, Lord Pannick, is not here. He posed a question to the noble Baroness, Lady Lawlor, concerning what happens if your GP retires. Let me give my small experience. My GP was in his late 50s. He was an excellent GP. During Covid, unlike many other practices, he still allowed patients to come to his surgery. Whenever elderly patients could not come, he went out to their houses and visited them in their own homes—unlike many other practices and GPs. Unfortunately, he got cancer and, in his late 50s, just recently, he passed away.

We were left with a practice in our town with several thousands of patients but nobody to take it over. So what happened to us? Our GP died, and so, without any consultation whatever, we were all farmed out to seven or eight practices around the countryside, some of them not even close—just to whoever would take us. It is unrealistic to imagine that somehow a new doctor would have any knowledge of the pressures, the problems or the complex challenges that his new patient was facing; he would not have any continuity of care whatever.

It was even worse than that, because it was several months before the notes went to the next practice that you were farmed out to. You were allotted a practice but the notes concerning any illnesses of the patients did not immediately follow; it was several months before they arrived. What has been suggested in these amendments today strengthens safeguards. Therefore, they are worthy of the support of noble Lords in this House.