Terminally Ill Adults (End of Life) Bill

Lord Blencathra Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, the noble Lord, Lord Shamash, mentioned a very moving story from his family regarding Duchenne muscular dystrophy, and I have a similar story but from a slightly different angle. My cousin Stephen was diagnosed with Duchenne muscular dystrophy in the 1960s, when this was a terminal illness without any real idea of a prognosis other than that those with it would die as very young people.

My family were determined to try to make Stephen’s life as comfortable and as long as possible. They campaigned with their local MP, who just so happened to be Alf Morris, Baron Morris of Manchester—an outstanding Member of Parliament, and of service to this House. They worked with him to come up with the Chronically Sick and Disabled Persons Act 1970. They went on to develop therapies for Duchenne muscular dystrophy, including making wheelchair provision compulsory on the NHS. My cousin lived five years longer than the average for Duchenne muscular dystrophy patients. The point I am making to the Committee is that if the assisted dying Bill had been used to that extent, and if we had given up when he was a very young man, that never would have happened.

Stephen had a full life, in so far as he could; he lived till he was 21 years of age, when the average was 14 or 15. It goes to show that, if you give up at a very early stage, you will not know how far you can push this disease. In the 21st century, through medication, Duchenne muscular dystrophy sufferers have an extended lifespan. In offering assisted dying to people with chronic diseases, we do not know the miracles of science and medication that can extend these people’s lives.

[Lord Blencathra (Con)]

My Lords, I am another Peer who sat here for many hours last Friday, desperately keen to speak to this group of amendments. Towards the end, at nearly 5.30 pm, I heard the magnificent speech of the noble Lord, Lord Rook, who is not currently in his place. It really was an incredible speech. I suppose the only benefit of being a sort of carry-over, tail-end Charlie was that I was able to read his speech in Hansard once again. I commend it as superb. I concluded that there was nothing I could usefully add to what the noble Lord had said, so I have decided not to try to add anything more to it, and I conclude my remarks.

[Lord Harper (Con)]

My Lords, I will speak briefly to put on the record one useful piece of information, which is very relevant to the debates that we have had. Somebody previously referred to the welcome cancer plan that the Government published, and I thought it worth sharing with the Committee that there was an important and relevant piece of information in the plan that your Lordships might wish to be aware of.

I think the noble Lord, Lord Stevens of Birmingham, referred to the Government’s plan for palliative care. When we spoke about it, I think just last week, the expectation was that that plan would be published this autumn—I hope the Minister can confirm that I have got that right. The cancer plan makes it clear:

“Next year, we will publish a Modern Service Framework on Palliative and End of Life Care to address these challenges”.


Without being explicit about it, the palliative care plan has now slipped into 2027, with no indication of when in 2027. Given my experience of these things, it could easily be the end of 2027. We are being asked to consider the Bill when the Government are not even going to publish their palliative care plan until some time next year—and it has already slipped twice in a few months.

I draw two lessons from that. First, if we do not have high-quality, universally available palliative care then we are not giving people a genuine choice. As my noble friend Lord Shinkwin said, expectations in society will push people inevitably towards assisted suicide, whether they really want it or not. The second thing that says to me is that palliative care is not really a priority for the Government. If you cannot even produce the plan to improve palliative care, which was originally going to happen this year, until some time next year, with no specific date attached to it, heaven knows what your priority will be when actually delivering the services that people require. My sense is that, if the plan will not come out until next year, we will not see improved services even in this Parliament. In that case, there is no meaningful choice. On that basis, we should not proceed with this Bill.

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Moved by

[Lord Blencathra]

110A: Clause 3, page 2, line 21, at end insert “subject to subsections (2) to (4).
(2) Where the person is ordinarily resident in a registered care home or nursing home, a registered medical practitioner must not certify capacity for the purposes of this Act unless—(a) a specialist clinical review has been completed by a physician with expertise in geriatric medicine or complex care,(b) an independent psychiatric capacity assessment has been carried out by a consultant psychiatrist with expertise in fluctuating or complex capacity within five working days of the specialist clinical review (subject to subsection (4)), and(c) the findings of the review and assessment have been considered by the registered medical practitioner.(3) The specialist clinical review must explicitly record whether any reversible causes of impaired or fluctuating capacity have been identified and treated, including but not limited to delirium, infection, dehydration or medication effects.(4) Where the independent psychiatric capacity assessment is not completed within the period in subsection (2)(b), the registered medical practitioner must record the reasons for the delay.”Member’s explanatory statement
This amendment requires multidisciplinary specialist review before capacity is certified for care home residents, mandates explicit consideration and treatment of reversible causes of impaired capacity, and creates a short statutory timeframe and audit trail for those reviews.

[Lord Blencathra (Con)]

My Lords, I will speak to my Amendment 110A, which seeks to insert into Clause 3 a requirement that, where a person is ordinarily resident in a registered care home or nursing home, a registered medical practitioner must not certify capacity for the purposes of the future Act unless a specialist clinical review and an independent psychiatric capacity assessment have been completed, with their findings considered and any delay recorded.

I will begin with what I hope is a simple, uncontroversial proposition: care home residents are a medically vulnerable group and deserve the highest standards of protection when the law contemplates irreversible outcomes. Many residents experience delirium, acute infection, dehydration, polypharmacy and other reversible conditions that cause fluctuating capacity. An assessment at a single point in time, however carefully performed, can miss those transient but decisive impairments. My amendment recognises that clinical reality and responds with proportionate, targeted safeguards.

My amendment is narrowly drafted and practical. It requires three things before capacity can be certified for a care home resident under the Bill. First, there must be a specialist clinical review by a physician with expertise in geriatric medicine or complex care. Secondly, there must be an independent psychiatric capacity assessment by a consultant psychiatrist with expertise in fluctuating or complex capacity, to be completed within five working days of the specialist review, subject to the limited recording provision where delay occurs. Thirdly, the registered medical practitioner must consider the findings of both reviews before certifying capacity. The specialist review must explicitly record whether any reversible causes of impaired or fluctuating capacity have been identified and treated, including delirium, infection, dehydration or medication effects. If the psychiatric assessment cannot be completed within the five-day window, the practitioner must record the reasons for the delay.

Those are modest, sensible requirements. They would not prevent assessments; they would ensure that they are done properly. They would create a short statutory timeframe, so that the process is not indefinitely protracted, and an audit trail where delays occur. They would also require explicit documentation that reversible causes have been sought and treated. That is clinical best practice, and it should be statutory practice where life-ending decisions are at stake.

We must also place this amendment in the practical context in which the Bill would operate. We all know that care homes are already operating under chronic strain—falling bed capacity, severe workforce shortages and the legacy of Covid pressures—and those realities must shape our debate about assisted dying. Care home capacity in England has fallen relative to the ageing population: places per 100 people aged 75 and over have declined over the past decade and the sector has not kept pace with demographic demand. At the same time, the social care workforce is under sustained pressure: vacancy and turnover rates remain high; recruitment and retention are major challenges; and many areas rely heavily on international recruitment. These shortages reduce clinical time, limit specialist input and make consistent, high-quality capacity assessments harder to deliver at scale.

We all remember Covid-19, which exposed and amplified these pressures. The discharge to assess policy and rapid hospital discharges into care homes in 2020 were possibly a necessary emergency response, but reviews have concluded that some discharges contributed to outbreaks and that operational and clinical oversight was variable. That episode shows how system pressure can degrade safeguards and lead to mistakes, not because clinicians lacked compassion or were uncaring but because the system was overwhelmed. If we accept that as a reality—it was—we must ask whether a new assisted dying pathway could create similar perverse pressures.

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[Lord Hamilton of Epsom (Con)]

This is the second Friday we have had where the target has been 10 groups of amendments and we have come well below half on both those days. If we go on scrutinising the Bill in the way we have been doing, it is inconceivable that it will ever reach the statute book, so is it not time that the noble and learned Lord really considered what he can salvage from the Bill, where there is agreement on both sides of the Committee, so at least something will get through that improves the lots of people in this country?

[Lord Blencathra (Con)]

My Lords, once again, this has been a good little debate, with more noble Lords participating than I expected. The whole Committee admires the noble Baroness, Lady Hayter, for the way she described her husband’s condition and the extreme care, and possibly good luck, she has had in finding an excellent home for her husband. When we were in the House of Commons, we could never tell these personal stories about our disabilities, because we would be regarded as showing a weakness and therefore not suitable to fight for our constituents. The wonderful thing about these debates over the past few weeks is that noble Lords from all sides have been able to relate stories about their own disabilities, afflictions and illnesses and those of their close relatives, which has added a tremendous amount of wisdom and compassion to our debates.

I say to the noble Baroness that my amendment does not seek to throw anyone out; it does not excuse anyone in a care home from getting treatment. We just want extra care for them. As my noble friend Lord Deben and the noble Lord, Lord Carlile, said, there are good care homes, bad care homes and downright ugly care homes. Our amendments are designed to deal with those that are not quite up to scratch.

The noble Baroness, Lady O’Loan, made the point that dementia sufferers are even more vulnerable. The amendments from me and from my noble friends Lady Eaton and Lady Lawlor are different, but the thrust is still the same: we are suggesting that a bit more care is necessary to determine capacity in care homes.

I must come to the important point made by the noble Lord, Lord Carlile, backed up by my noble friend Lord Deben, about the ECHR. I am a member of the Council of Europe. I have been elected to a specialist committee on observing elections in former Soviet Union countries. I was on the committee that elected judges. I am pleased to say that we elected—I was one of those who voted—a superb English KC, who is just retiring this year, to be a judge. I am also a substitute on the election committee. I totally support the ECHR. What I am critical of are some of the judgments we have had in the United Kingdom from some of our immigration judges, who I do not think have properly read the ECHR. I have no problems with the ECHR itself. I am totally in support of it and the principle—I am just worried about some of the judgments.

The other point that the noble and learned Lord made—he ended with this—is that responsibility for this must not rest with care homes alone, and I agree entirely. The noble Baroness, Lady Finlay, made the point that some care home staff are very worried about operating this. The noble Lord, Lord Carlile, made a point about Mission Care and Christians in care homes feeling that they could not work it either. My noble friend Lady Lawlor made the simple point that a higher bar is necessary for care homes. The noble Baroness, Lady Smith of Newnham—to whom we are grateful for revealing her father’s story—stressed that the vagaries of cognitive decline vary depending on the medication that one is on, and I have experience of that.

The noble Baroness, Lady Fox of Buckley, said that she did not want to talk about some of the horror stories in care homes. None of us wants to do that, although every other month we read about some of the appalling treatment that happens, particularly to those suffering from severe dementia. She said that there is a social care home crisis, and that is right. She was spot on about ticking the food boxes.

A few years ago I was in St Thomas’—early on in my MS days, when I had a relapse—and there was an old boy in a bed in the corner, aged 82. At that time we would tick the boxes for what we wanted the next day. Do Members recall that the Government appointed Mr Loyd Grossman to review menus at NHS hospitals? He did review them, but he just wrote them in fancy language. The choice for one morning was ground beef, suffused with basil and scented with carrot juice—or something—and chopped potatoes. This old boy did not have a clue what it meant. I managed to get to him and say, “It’s mince and tatties”, and he was able to understand it. The nurse said, “Oh, you don’t want anything to eat, Mr Smith”. He just said, “Porridge, porridge”. She said, “Oh, we can’t give you porridge. There is only the choice of mueslis”. I will not labour the point any further, but the same thing can happen in care homes, as the noble Baroness, Lady Fox of Buckley, said. She asked, in conclusion, how can one decide capacity between a patient who is on a good day and a patient who is on a bad day? People in care homes need extra special measures to determine capacity.

My noble friend Lord Wolfson of Tredegar made an excellent point about care homes: there are good ones and bad ones. He asked the Government to spell out what the consequences would be of my noble friend’s amendment and my amendment, and what the Government think about it.

I say to the Minister that I am tempted to put down an amendment to the Animal Welfare Act to protect the poor rabbit that has been pulled out of the Government’s hat to say that all our amendments are contrary to the ECHR.

Finally, I say to the noble and learned Lord, Lord Falconer, that our amendments may not be perfect, but the consensus from all noble Lords who have spoken, apart from the noble Baroness, Lady Hayter, was that something more needs to be done for care homes—a little bit of extra protection is necessary. When we were dealing 18, 21 and 25 year-olds, the noble and learned Lord said that we need to think about a bit of extra protection for them. He was right, and I look forward to seeing his amendment on Report on that matter. But the same goes here. We need a bit of extra protection for people in care homes, for the various reasons advanced by noble Lords. Having said that, I look forward to seeing his amendments on Report—and if not, we will table some ourselves. In the meantime, I beg leave to withdraw my amendment.

Amendment 110A withdrawn.