Terminally Ill Adults (End of Life) Bill

Lord Stevens of Birmingham Excerpts

Friday 13th March 2026 Lords Chamber

[Lord Stevens of Birmingham (CB)]

My Lords, I will speak briefly to two amendments in this group, the first being Amendment 334. In particular, I hope to draw the attention of the noble and learned Lord, Lord Falconer, the sponsor of the Bill, to subsection (6)(m) of the proposed new clause and ask him whether he might be inclined to look sympathetically at the proposal there, which relates to palliative care.

We have had the discussion many times in Committee about the importance of palliative care, which is a shared sense from all sides of this wider debate. Proposed new subsection (6)(m) would require that the assisted dying panel in its assessment must ascertain whether a person considering seeking an assisted death

“has experienced the involvement of a specialist palliative care team and, if not, whether this was because of availability, unsatisfactory care or patient choice”.

I would have thought that this should be acceptable to the sponsor of the Bill. Why would you not want to know whether somebody coming before an assessment panel has had access to specialist palliative care, and, if they have not, whether it is because of the concern that a lot of us have, that palliative care gaps exist right across the country? That will bring about a degree of transparency as to what is actually going on.

In a sense, the difference perhaps between those who are more optimistic and those of us who are less sanguine about the availability of palliative care just comes from the lack of transparency and the lack of a firm government commitment at this stage to funding unmet need in palliative care. Perhaps by way of analogy, we should look at what is happening in mental health services and the health professionals within it, some of whom are going to be required to support the processes set out in the Bill. We have line of sight as to what is happening on mental health spending only because of an amendment that the House of Lords inserted into the Health and Care Act 2022, which requires the Secretary of State to declare his or her hand for the upcoming year, as to what they plan on doing about the share of NHS funding going to mental health.

We found out yesterday from a Written Statement by the Health and Social Care Secretary that his plan is that the share of NHS funding going to mental health services next year should be cut, which is a pretty significant departure from the arrangement that had existed since 2015 onwards. Obviously, that has provoked a degree of concern across the NHS. We have that degree of transparency on mental health but we do not have it in respect of palliative care, and proposed new subsection (6)(m) just provides one little ray of light as to what would actually be going on in this scheme, were it to come into effect.

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[Lord Falconer of Thoroton (Lab)]

May I just finish? The noble Lord, Lord Stevens, refers to proposed new paragraph (m) in the scheme. Under the scheme proposal, the panel of up to seven persons has to be satisfied, or the “assessment must ascertain”, that the person

“has experienced the involvement of a specialist palliative care team and, if not, whether this was because of availability, unsatisfactory care or patient choice”.

I am very supportive of the idea—and I think this was in the noble Lord’s mind—that as much information is available as possible. As I understood the noble Lord, the more we know about the shortcomings of palliative care, the better.

However, I wonder whether the best way to deal with that is not to make a requirement in proposed new paragraph (m) for what a seven-person panel must investigate but to make that the sort of issue that the voluntary assisted dying commissioner should be looking at in his monitoring, which is required specifically by the statute. That is just the sort of thing that might help him.

We all support the point that the noble Lord, Lord Stevens, made that the more we know about palliative care—its funding, where it is good and where it is bad—the better. But is the assisted dying Bill the right place to try to lever in a whole range of informational requirements, of the sort that he referred to from the Mental Health Act, which we would all support?

[Lord Stevens of Birmingham (CB)]

Even if the noble and learned Lord does not adopt the scheme put forward by the noble Baroness, Lady Finlay, would he nevertheless accept that, for the co-ordinating doctors, it would be valuable to ascertain the information contained in proposed new paragraph (m) in this amendment? We would therefore be accumulating real-world evidence from every case and not looking at just the aggregate national position that the voluntary assisted dying commissioner might be able to adduce.

[Lord Falconer of Thoroton (Lab)]

Yes, and I cannot imagine a situation, in particular because it is specifically required under the Bill, in which the co-ordinating doctor does not raise the question of what palliative care the patient has had and what is available. Indeed, the Bill requires him or her to do that. Whether the co-ordinating doctor should then provide that information to the voluntary assisted dying commissioner is a matter for the commissioner, as it is up to him or her to decide what information to collect. In principle, it seems a good thing, but the noble Lord has referred to vastly bigger issues that we might need to consider, not in the context of the assisted dying Bill but in relation to how proper information is available about the availability of palliative care. We are all supportive of that.