Terminally Ill Adults (End of Life) Bill (Twentieth sitting)

Rachel Hopkins Excerpts

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Rebecca Paul]

I thank the hon. Member for his very good questions. I suggest that it be asked twice, because it makes a lot of sense to ensure that the patient is given the chance to really explain what is driving their decision. It is the simplest of questions, but it is amazing what can sometimes come out of the simplest question.

I return to the safeguard against coercion. In a sense, this is not a new safeguard; rather, it confirms and bolsters the other safeguards in the Bill, which are there to explore the reasons for assisted dying. Asking why will help doctors to better understand what is driving a patient’s decision and to give that patient an opportunity to validate that they are truly eligible. It is the simplest of questions, driving the most significant conversation that a doctor and patient can have. I hope that hon. Members will support my amendment.

[Rachel Hopkins (Luton South and South Bedfordshire) (Lab)]

It is a pleasure to serve under your chairship, Sir Roger. I rise to speak in support of amendments 201, 422 and 423, which stand in the name of my hon. Friend the Member for Spen Valley, and against amendment 468.

On amendment 201, a point was made earlier about the relevance of records. It was mentioned that it might well not be relevant to look at a childhood tonsillectomy. However, I wish to speak in slightly more specific terms, in support of women and their reproductive rights, and to highlight the risk of unconscious bias if all records are to be looked at.

If a woman had a termination in her teenage years, that will be highly irrelevant to her decision, many decades later, whether to choose an assisted death. Relevance is very important, because there will be a high level of record keeping in the process. It is not only the doctors working with the patient on the assessment who will read the records and reports; ultimately, it will also be the panel. I make the point again that so many parts of a patient’s medical records are highly irrelevant to the diagnosis and prognosis of a terminal illness, and to the six months under the eligibility criteria. Indeed, there is a risk of unconscious bias in the judgment. It is about the professionalism of the doctor in respect of understanding the records that are relevant for the process.

[Danny Kruger]

Will the hon. Lady give way?

[Rachel Hopkins]

I will continue, if I may.

I turn to amendments 422 and 423. The importance of a rounded, holistic assessment and discussion with the patient has been pointed out in many of our discussions, as has the importance of the multidisciplinary team and the other health and care professionals who support the patient with health and social care. That would all have to be recorded—the conversations that have been had, and why the assessing doctors and other health and social care professionals were involved. In oral evidence, many doctors in other jurisdictions said that they worked in multidisciplinary teams. The amendment would firm that up. It is about being clearer, because the clarity that the amendments provide would make for a stronger process.

On amendment 468, the hon. Member for Reigate pointed out that it asks a very simple question. However, I return to the point about the professionalism of the doctors involved in the process, who will be working within the legal requirement under the Bill that the individual have a clear, settled and informed wish. The doctors will have to check individuals’ eligibility under the requirements, for example that they are over 18 and have a terminal illness with a six-month prognosis. The doctors will use their expertise and professionalism, and that of the multidisciplinary team, to make assessments about coercion. They have strong rules about assessing for capacity.

The requirement to ask why someone wants an assisted death is a requirement to police the conversation that the doctor has with their patient. Setting it out in primary legislation would lead to a tick-box exercise, with doctors saying, “You’ve told me a number of times already in our conversation that I’ve been having with you, but I’m sorry: I have to officially ask this question and tick the box.” That could lead to an insensitive conversation and relationship between the relevant people in the process.

To a certain degree, the patient may think, “So what? Do I have to tell you why? It is none of your business why I want to pursue this legal course of action down the line.” I appreciate where the hon. Member for Reigate is coming from, but with the best of intentions, her amendment would actually lessen the individual’s autonomy and their right to choose what if the Bill passes will be a legal course of action. I am content that the stringent training that will be required for any of the assessing healthcare professionals will enable a good holistic conversation so that good judgments can be made. Adding this extra sentence would detract from that, so I cannot support the amendment.

--- Later in debate ---

[Naz Shah]

I thank my hon. Friend for his intervention. There is a medical model and a social model of intervention. If I walk into a GP surgery with a really bad headache, I am prescribed paracetamol. If the headache gets worse, I am prescribed something stronger—maybe co-codamol or codeine. Doctors are really busy. We have had to add another 40,000 appointments just for people to get through systems, so we know how hard it is to get a GP appointment.

If the person who turns up at the GP’s with a headache is usually quite healthy, the doctor might not take a minute to ask about what has actually happened. If I say, “I have a headache because I am banging my head against the wall—I have that much stress”, that is a whole different conversation. Having that conversation with the patient—probing a little more—is, for me, very important from a holistic point of view.

[Rachel Hopkins]

I want to check that my hon. Friend was not implying that I had not thought deeply—for more than a minute–in the course of making my comments earlier.

[Naz Shah]

No, that was not my implication. When referring to my hon. Friend’s remarks, I was speaking about a patient perhaps saying “It is none of your business” or that my hon. Friend was talking just about autonomy.

[Rachel Hopkins]

I am grateful to my hon. Friend for reiterating those points. Does she accept that it is a patient’s right to say, “It’s none of your business” in the course of the conversation?

[Naz Shah]

I absolutely accept that it is the patient’s right to say, “It’s none of your business”, with the really clear caveat that they could well be a vulnerable patient. They might say that it was none of the doctor’s business, and that doctor might then not be able to explore the other things going on with that patient. That is why, for me, this does not wash.

The point that I am trying to make is that, in the course of a normal consultation, it is presumed that every doctor will know their patient and be able to have these conversations. In most cases, they probably will because we have amazing doctors; I have amazing relationships with my doctors. But does that mean that the doctors will ask that one question: “Why?” That is the crux of the whole Bill.

[Naz Shah]

That opens up a whole different debate for me. Some clinicians will not sign up to this process and some will. That is a whole different debate, but I take the point that there has to be a reason.

We talk about the option for referral to palliative care. I have previously moved amendments that would have meant a referral, without the option; however, when considering that option, a doctor needs to understand that if a patient says, “I do not have to explain myself—full stop”, or, “I do not want to talk about palliative care”, that should raise alarm bells. If a doctor says, “You’ve got this terminal illness. These are the options—let me spell them out for you. You have the option of referral to palliative care and the option of these drugs, so why do you want to kill yourself?”, and the patient turns around and says, “It’s none of your business”—

[Rachel Hopkins]

Will my hon. Friend give way?

[Naz Shah]

Sorry, I will just finish my point.

From a common sense perspective—I am not medically qualified—that situation should make me, as a human being, want to understand more. As a human being, I would like to understand whether something else was going on, such as anger towards—

[Naz Shah]

Sorry, I will not give way until I have finished my point.

I would like those conversations to be at least explored, which is why I support the amendment.

[Rachel Hopkins]

The Bill already sets out a number of things that a doctor has to assure themselves of, with regard to coercion and capacity. They would do that having had a significant amount of training to establish, in the round, after consulting others, that one way or another the legal requirements have been met. The “Why?” question appears to me to bring in a judgmental element—

[Kit Malthouse (North West Hampshire) (Con)]

Subjective.

[Rachel Hopkins]

Indeed: subjective, as the right hon. Gentleman said. That is the point that I am trying to get at. There is an objective assessment, which is wholly appropriate, but a subjective assessment would lead down a different route and muddy the objective assessment.

[Naz Shah]

I absolutely see where my hon. Friend is coming from and appreciate her concern, but we will have to agree to disagree as we have a difference of opinion. A subjective assessment might reveal that something else is going on for that patient.

I hate to put myself in this position, but imagine I have just received a diagnosis and I am going to die within six months. I could have a whole load of anger about that happening to me and I could say, “I don’t want this. I don’t want to talk about it. It’s none of your business. I’m angry—this is what I want.” At that point, does the doctor stop? In most cases, my hon. Friend the Member for Luton South and South Bedfordshire is absolutely right, but in some cases she might not be. I might want to shut the conversation down because I am angry or because other things are going on in my head and I do not want to explain. Amendment 468 would allow the doctor, from a compassionate point of view, to have another conversation with the patient.

Terminally Ill Adults (End of Life) Bill (Eighteenth sitting)

Rachel Hopkins Excerpts

Committee stage
Wednesday 5th March 2025 Public Bill Committees

[Naz Shah]

Amendment 290 was tabled by my hon. Friend the Member for York Central (Rachael Maskell). Clarity is needed on who a medical practitioner is. With the regulation of physician associates, there was much unease from the British Medical Association and others on the role and function of the new profession. Although I do not want to debate the merit of this today, it is clear that involvement in the assisted dying process requires someone of significant experience to support a patient while undertaking complex assessments and co-ordinating their care between specialists and others.

In some jurisdictions, we have heard that clinicians have extensive clinical experience, whereas they do not in others. Therefore, being able to determine the level of experience and competencies of the medical practitioner is important to ensure that the patient is receiving care from someone who has significant practice expertise. A doctor in training, whether as a specialist or general practitioner, although making very specific clinical decisions, should not be deemed as having the experience, competencies or breath of experience for the purposes of this process. An associate practitioner should also not be deemed to reach these thresholds. Amendment 290 would therefore show the public that the person who would act as the co-ordinating doctor held such experience, and that there was no doubt in their standing to register for such a role. The public can already be confused on the exact status of the clinician they are under or indeed the profession itself. Including this safeguard would ensure that the patient’s interests are upheld.

[Rachel Hopkins (Luton South and South Bedfordshire) (Lab)]

It is a pleasure to serve under your chairship, Mr Dowd.

I rise to speak in support of amendment 185, in the name of the hon. Member for Spen Valley, the Bill’s promoter, regarding training requirements that need to be made by regulation. It would place a duty on the Secretary of State to make regulations about training qualifications and experience required in order to act as a co-ordinating doctor. Similarly, amendment 186 says that the regulations should specifically include training relating to the assessment of capacity and assessing whether a person is being coerced or pressured by any other person. Proposed new subsection (3C), introduced by amendment 186, would make provision that

“the required training, qualifications or experience is to be determined by a person specified in the regulations.”

In making those regulations, reflection of expertise is vital. We heard from many experts who gave us evidence about the importance of training, development and mentorship, which we would expect to see covered in the regulations. Placing those requirements in regulations would mean that they could be developed through consultation with experts and stakeholders, after gaining a wide range of feedback. It would also future-proof the requirement of any training to be developed and strengthened through future experience.

As part of the safeguards in the Bill, the key principles around assessing capacity and potential coercion are really important. I am therefore minded to press the hon. Member for Spen Valley also to support amendment 20, in the name of my hon. Friend the Member for Lowestoft (Jess Asato), which states:

“Regulations under subsection (3)(a) must specify that training in respect of domestic abuse, including coercive control and financial abuse is mandatory.”

That would provide further clarity, and would further strengthen training on assessing coercion in all senses of the word as part of the safeguards, which many Members, even in the earlier debates, have said that it is so important that they see. I agree, and I hope that the promoter of the Bill will support amendment 20.

[Daniel Francis (Bexleyheath and Crayford) (Lab)]

I rise to speak to the amendments in my name—namely, new clause 12 and amendments 336, 337 and 335. Yesterday, we spoke about the evidence we received from the British Medical Association. I accept that there is some crossover between my amendments and the amendments of the Bill’s promoter, my hon. Friend the Member for Spen Valley, on training.

The British Medical Association stated, with regard to my amendments:

“We strongly urge MPs to support these amendments which would define the ‘training’ explicitly in the Bill as specialised training to provide assisted dying, undertaken by those who opt in…We have been vocal that the Bill should be based on an opt-in model…during the Committee’s oral evidence sessions. Reinforcing this, we believe NC12 and Amendments 335-337 would make two important aspects of this provision in the Bill clearer:

1. That providing assisted dying is not, and would not in the future, be expected of all doctors—the Bill’s current all-encompassing reference simply to ‘training’ does not preclude this training being prescribed as standard general medical training via the regulations, in which case it would apply to all doctors and make the opt-in redundant. Specifying that it is ‘specialised’ training on the face of the Bill, and making clear that there is no obligation on doctors to undergo the training, would safeguard the opt-in model in the Bill’s first principles.

2. That only those who undergo specialised, tailored training on assisted dying could provide the service – during the oral evidence sessions, there has been much discussion about the importance of specialised training for those who opt in to carry out the service. Specialised training for those providing the service is essential for doctors and provides additional protection and safeguards for patients—it should be explicitly referenced in the Bill.”

We heard in our oral evidence sessions from others, including Dr Ahmedzai, on the need for training. He said:

“I personally believe that it would be advantageous if there was formal training, as Dr Clarke has mentioned, specifically to have the kinds of conversations that we now talk about, such as about psychological issues and suicidal tendencies.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 69, Q82.]

I now turn to two amendments in my name: amendment 340 and amendment (a) to amendment 186. Both amendments relate to training for those with learning disabilities and autism. We had a similar discussion on a previous clause, and I know that further amendments are likely to be tabled on the matter, but as I said yesterday, they are not currently on the amendment paper.

I heard and welcome what my hon. Friend the Member for Luton South and South Bedfordshire has said about amendment 20. Putting that training in the Bill is hugely important, and I believe the same is true in relation to training for those with learning disabilities and autism, as set out in to amendments 340 and amendment (a) to amendment 186, particularly given my concerns and those of others about whether we end up with clause 3 relating to the Mental Capacity Act 2005.

Terminally Ill Adults (End of Life) Bill (Thirteenth sitting)

Rachel Hopkins Excerpts

Committee stage
Tuesday 25th February 2025 Public Bill Committees

[Tom Gordon]

They would need to come within the definition of a terminal illness. I will come that later in my speech.

We must recognise the reality of neurodegenerative diseases. There are other conditions where prognosis follows a clear trajectory. People with conditions such as MND and Parkinson’s experience a slow but relentless decline. Their suffering can be profound long before they meet the six-month prognosis requirement that is currently in the Bill.

Let us look at some real-life stories. Mary Kelly is a bright and sharp-witted woman from Middlesbrough. Diagnosed with Parkinson’s last year, Mary knows that she faces many years of deterioration. She said:

“It would make the world of difference to know that assisted dying was legal and available. I’d know if I’m not finding joy, I can end it peacefully. It would make the intervening years so much more peaceful, loving, and relaxed.”

Parkinson’s-related dementia affects a third of those with the condition. If Mary loses capacity before a doctor confirms her eligibility, she will be denied the very right that the Bill aims to uphold. If we do not amend the Bill, people like Mary will lose their autonomy precisely when they need it most.

We must also consider the experience of people like Phil Newby, who was diagnosed with MND a decade ago. Phil fought to challenge the UK’s ban on assisted dying, taking a case to the High Court in 2019. He is the last living person who took one of the court cases involving assisted dying. Phil knows that the uncertainty of prognosis leaves too many in limbo. He said:

“People with neurodegenerative diseases often suffer a cognitive decline in the later stages. Twelve months would give a much greater chance for a civilised death to those suffering from the most devastating illnesses.”

We must ensure that those voices are not ignored in this conversation.

Imagine a scenario in which someone with MND applies for an assisted death. They tell their friends, family and loved ones. They begin to make preparations, including signing the written declaration, but they cannot get approval until a doctor says they have six months left. They wait. Their condition gets worse. They suffer choking fits, have feeding tubes fitted, and experience a slow and cruel deterioration. Finally, they receive approval from the first doctor, but before they can get to a second doctor, they begin to lose capacity. They are still suffering. Their family know their clear and settled wish, but they have no chance of a second approval, and especially no chance of approval from a panel. They will be potentially consigned to a death of agony and pain, despite everyone knowing that it is not how they would like to die. Their family must watch on, helpless.

The loss of competency is one of the greatest fears for those with neurodegenerative conditions. The Bill currently states that a person must have full mental capacity at the time of their assisted death, which is an important safeguard. However, people who develop MND can have their decision making impaired, and around 50% experience some form of cognitive decline. In New Zealand, where there is a six-month limit, many people lose their decision-making capacity before they can proceed. By contrast, in Victoria in Australia, where there is a 12-month limit for neurodegenerative conditions, only 7% lose competency. If we do not amend the Bill, we risk condemning those people to a fate they fought to avoid.

We must also recognise the difficulty in predicting life expectancy for those with neurodegenerative conditions. Prognosis is not an exact science. I am fairly sure that everyone agrees on that—people have made those points repeatedly. The Court of Appeal has acknowledged that a six-month prognosis cannot be made with certainty for many terminal illnesses. That is one of the most difficult things that I have had to grasp as part of the Committee. To impose what could seem like an arbitrary threshold on those with unpredictable conditions is unfair and unnecessary.

Moreover, let us look at international examples. Many UK residents who have to travel to Switzerland for an assisted death do not have six months or less to live. If we end up with a six-month limit, we will still see people having to travel to Switzerland or other jurisdictions to ensure that they have access to an assisted death. I worry how people in this country would feel about that —particularly those families who might wish to accompany their loved ones on that journey, with the legal consequences that could follow.

Recent polling shows that two thirds of Brits support an amendment that would allow people with neuro-degenerative diseases access to an assisted death. We know that 85% of people living with multiple system atrophy who gave their views in an MSA Trust survey support such a change in the law. This is not a minor or niche concern. Every year, motor neurone disease alone kills 2,200 people in the UK, which is six people per day. Some 45% of people living with MND say they would consider an assisted death if the law changed. It is not a hypothetical scenario: these are real people, making real choices about how they wish to live and die.

My amendment would not overload the system. Experience from overseas tells us that jurisdictions such as Victoria and other Australian states already have a 12-month system for neurodegenerative conditions, and it works. New Zealand, which maintains a six-month limit, has seen people unable to qualify, and is looking at what it can do to ensure greater access. We must also listen to the written and oral evidence from expert witnesses. Professor Meredith Blake and Chloe Furst testified to the importance of a 12-month eligibility period, not just for fairness but for the practicality of allowing patients to navigate the process in time.

Everyone wants to see a Bill that is about dignity. If it is truly about that, we must ensure that it works for those who need it most. It is not about opening the floodgates or trying to expand the criteria. It is about ensuring equal access. From speaking to colleagues across the Committee, I know that a lot of thought and consideration has gone into this issue. With that in mind, I will not push the amendment to a vote, but it is important that the voices of people with neurodegenerative diseases are considered as part of the process.

[Rachel Hopkins (Luton South and South Bedfordshire) (Lab)]

It is a pleasure to speak under your chairship, Mr Dowd.

I rise in support of amendment 234. I acknowledge the point made by the hon. Member for Harrogate and Knaresborough about not pushing it to a Division, but it is important to hear why it would benefit the Bill if it was agreed to. It would allow a terminally ill person with a neurodegenerative illness, disease or condition who has fewer than 12 months left to live—rather than six—the right to choose an assisted death. I speak as a humanist, because I am very alive to many members of the public, and some MPs, wanting a wider scope of eligibility to cover intolerable suffering. In fact, some want no timescales, and an amendment has been tabled for that. I believe that my hon. Friend the Member for Spen Valley, who introduced the Bill, has had people speak to her and say the Bill needs to go further.

Like all of us, I want to make this a good Act that will have strong safeguards while allowing people choice at the end of life, and I want it to command the support of the House. I reflected on whether we need to have such a wide definition to cover intolerable suffering, and I thought that a change to 12 months for those with neurodegenerative diseases would be a good way to reflect the breadth of voices we have heard in debates on the Bill. It is an appropriate compromise. One of the things we have seen over the course of our Committee debates is the real pulling apart and consideration of what this legislation will mean in practice.

As the hon. Member for Harrogate and Knaresborough set out so well, a 12-month timescale for those with neurodegenerative diseases would mean that people could make decisions while they still have mental capacity. As he rightly said, their condition would so often see a cognitive decline before six months. The Motor Neurone Disease Association—another organisation that supports people living with terminal neurodegenerative diseases—highlighted problems with the six-month criteria and the inequity that arises.

Again, I reference the testimony of medical practitioners from Australia, where some states have eligibility criteria for assisted dying that includes an illness, disease or condition that is expected to cause death within 12 months. It is out there in practice, so it is not a new concept. Professor Meredith Blake said in oral evidence:

“Queensland legislation is different: it sets a 12-month period of expected death, and the reason for that approach was in response to feedback from people living with neurodegenerative disease that they felt that they were being put in a different position to people suffering from, or experiencing, other terminal illnesses.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 211, Q270.]

I will draw my remarks to a close, but there is a personal reason why it is important to me that we reflect on 12-month eligibility: the case of Diane Pretty. Diane Pretty was from Luton, albeit she lived in the neighbouring constituency, and some 25 years ago she was diagnosed with motor neurone disease. She tried to change the law then so that she could access assisted dying, such was the pain and suffering that she endured because of her terminal illness. What she said is fundamental and at the heart of what we are trying to do here, 25 years later:

“I want to have a quick death, without suffering, at home and surrounded by my family.”

In the end, Diane Pretty was not successful, and she died aged 43 on 11 May 2002. She did not have a choice. She could not choose the death she wanted. Much has been said about rushing the Bill, but that was over 20 years ago, so the debate has been going on for many years. That is why I speak in support of amendment 234, so that those with neurodegenerative terminal illnesses, whose death is reasonably expected within 12 months, can access assisted death.

[Rebecca Paul (Reigate) (Con)]

I will speak to amendments 9 and 10, which were tabled by my hon. Friend the Member for South Northamptonshire (Sarah Bool). Members will spot the trend: I have been speaking in favour of a lot of her amendments.

Amendments 9 and 10 would make sure the Bill does what it aims to do: ensure that assisted death is available only to those who are genuinely at the end of life. Under clause 2, a person is terminally ill if they have a prognosis of less than six months and if they have

“an inevitably progressive illness, disease or medical condition which cannot be reversed by treatment”.

That wording gives rise to a risk of unintended cases meeting eligibility criteria.

In Oregon, conditions such as anorexia, diabetes, arthritis, HIV/AIDS and hernias have all qualified for assisted death. That is partly because the Oregon law uses the language of “irreversible”, just as the Bill says

“cannot be reversed by treatment”.

Conditions like diabetes arguably cannot ever be “reversed”, which suggests something more akin to “cured”; they can only be managed. The definition of terminal illness is now broader than it was ever intended to be.

Terminally Ill Adults (End of Life) Bill (Fourth sitting)

Rachel Hopkins Excerpts

Committee stage
Wednesday 29th January 2025 Public Bill Committees

[The Chair]

I mean no discourtesy to the Committee, but we have 20 minutes, and 10 Members wishing to ask questions, so we have to move this on I am afraid.

[Rachel Hopkins (Luton South and South Bedfordshire) (Lab)]

Q Can I ask you, Mr Amin, about your views on coercion, particularly in the light of clause 2 in reference to the Mental Health Act 1983 and the Mental Capacity Act, and any thoughts you have about that in relation to the groups you represent?

Yogi Amin: As I said, I have worked in this area for over 20 years. I represent individuals week to week in this area and safeguarding is all across what is needed for these individuals. The professionals who are involved in their lives are regulated. We are talking about doctors who are meeting individuals, and they understand what it means to identify safeguarding triggers and where referrals are required. That makes it quite strong in this particular Bill.

I am comfortable with the wording as you have it in the Bill, and I say that as someone who has worked in the area for many years. Lawyers will go to court and pick over words, but the way it is drafted, it is understood that there is voluntariness, as described in the Bill, and coercion. I do not think that additional words are necessary to describe what is required here—it is a voluntary, free-will decision, and coercion is defined. When we are talking about a doctor trying to understand that and a court then interpreting it, I think it is pretty clear what that is, so I am comfortable with the way it is drafted.

Generally, from a safeguarding perspective, there are, as Tom said, a number of points at which professionals ask individuals for a decision on this over a number of weeks, and it goes into months. There is quite a robust process. I point also to footnote 3 for paragraph 4 of my written evidence, where I have referred to the current existing law outside the Court of Protection, where it might be thought that the person has capacity but there are concerns about coercion and so on. There is, under section 42 of the Care Act 2014, the provision for safeguarding referrals. There is, under section 222 of the Local Government Act 1972, provision for a local authority where referrals are made to bring the matter before the court under the inherent jurisdiction.

The inherent jurisdiction does not go away; it is here and available where there are concerns over the safeguarding of an individual to allow them to make their own individual, free-will decision. It is not there to do anything other than protect that individual and have a safety net around them to ensure they can make individual, autonomous decisions. Nothing needs to be tinkered with in the current Bill, because that is there—Parliament has already provided for that. Have I answered your question?

[Rachel Hopkins]

You have given clarity. Thank you.

[Juliet Campbell (Broxtowe) (Lab)]

Q My question is for Professor Shakespeare and Dr Griffiths. Clause 4 of the Bill offers the opportunity for clinicians to instigate the discussion on assisted dying. Could you both tell me your view on that, please?

Professor Shakespeare: It is natural and right that somebody should discuss their wishes with a doctor who supports and treats them. I do not think there is a problem there. Marie’s suggestion that there should be a wider body to look at this is very relevant. At the moment, doctors refer women for abortions, and that does not stop them also supporting pregnant women. I do not think that women would distrust their doctor because they are sometimes involved, at some point, with an abortion decision. That is quite obvious. As my colleague Yogi Amin said, the Bill covers what the terminal illness is, and why we should support people to voluntarily exercise their choices. Lots of doctors will not be in favour of this, but they will be clinically professional and they will discuss with the person. I do not have a concern about that. You are more likely to be kept alive against your will than you are to end your life under this Act.

Dr Griffiths: My first point is that, for me, the Bill raises concerns because it relies on doctors’ interpretations of prognosis. If a doctor assumes that you have six months left to live, and is therefore going to start having a conversation with you about the possibility of assisted suicide, that draws into question how we allow assumptions to be made about whether an individual has six months left to live. That is particularly the case given that we have evidence that shows that, with certain interventions or mishaps surrounding prognosis, individuals can live for months, years and decades longer. The idea of bringing in the conversation from the point of view of the medical practitioner could, arguably, accelerate one’s death—if you take into account that their idea of prognosis might be flawed.

It also, I think, raises problems, because we know that many individuals with health conditions and impairments—irrespective of whether we want to create this false line between disabled people and people with terminal illness—do not have access to advocacy or representation in these kinds of processes. Having a conversation where there is extreme credibility and validity that rests on the medical practitioner could exacerbate issues around coercion.

We could take a moment of reflection. When we were going through the pandemic, the Parliamentary and Health Service Ombudsman highlighted how medical practitioners could think about “do not attempt resuscitation” orders and how they were utilised in the disabled people’s community. That has parallels with the issue we have here, where medical practitioners will be making assumptions about whether conversations or applications should be made.

Yogi Amin: Can I just raise one point on representation? I point Members to paragraph 10 in my written submission, which tries to make the important point that if we are involving courts, individuals need access to justice. They need access to advice, and that means legal aid. I point in that paragraph to the provision of non-means-tested legal aid, just like in the case of parents of children and the withdrawal of life-sustaining treatment. Those current rules are in place for parents, and a similar arrangement could be put in place for individuals who are brought before the court in this matter.

Hospice Funding

Rachel Hopkins Excerpts

Thursday 19th December 2024 Commons Chamber

[Karin Smyth]

The hon. Gentleman was a Government Minister, so he had plenty of opportunities to change the system, had he wanted to do so at the time.

[Rachel Hopkins (Luton South and South Bedfordshire) (Lab)]

I thank the Minister for her announcement of a huge funding boost for the hospice sector. Will she join me in thanking all the brilliant staff at Keech hospice, which serves Luton South and South Bedfordshire, and especially all the volunteers who are out fundraising with Smiley Sam and Santa’s train across the streets of Luton, including Farley Hill tomorrow and Wardown Crescent on Saturday?

[Karin Smyth]

I thank my hon. Friend for making that point, and wish the volunteers well in their weekend activities. She is right to highlight not only staff but the hundreds of thousands of volunteers across the country who work to support the hospice sector and others with end of life care. That support is so important for people receiving end of life care and their families. It is something that I have experienced; my father died over the Christmas period a number of years ago. It is a hard time of the year to have a death, and I warmly support what those volunteers are doing this weekend.

Income Tax (Charge)

Rachel Hopkins Excerpts

Tuesday 5th November 2024 Commons Chamber

[Rachel Hopkins (Luton South and South Bedfordshire) (Lab)]

As we all know too well, politics is about choices. The choice in this Budget is clear: five more years of the same failed Conservative policies and more austerity, or change with a Labour Government who will invest in Britain’s future so that we can fix the NHS and rebuild our country.

The Chancellor’s tough but fair choices will benefit so many people across the country, including in my constituency, by delivering on tax commitments to help fund our vital public services. This includes ending both the non-dom tax loophole and VAT tax breaks for private schools so that everyone pays their fair share.

I am pleased to see the £11.2 billion investment in our education system to give every child the best start in life by increasing per-pupil funding in real terms, providing £1 billion in additional support for the SEND system and enabling the roll-out of free breakfast clubs in thousands of primary schools.

For far too long, working people have paid the price for the previous Government’s failures. Whereas the previous Conservative Government focused on funnelling pounds into the pockets of their friends through dodgy covid contracts, this Labour Government have chosen to put pounds in the pockets of working people. The increase in the national living wage to £12.21 is therefore very welcome in my constituency, where over 3,000 people in Luton alone will be better off as a result.

As well as the boost to people’s wages, I am delighted that we will deliver the biggest boost to affordable housing over this Parliament, with a £500 million boost to the affordable homes programme to build up to 5,000 additional affordable homes. Reducing the discounts on the right-to-buy scheme and enabling councils in England to keep all the receipts generated by sales will also deliver on our commitment to protect existing council house stock.

Of course, the NHS is the cornerstone of our public services. Investment in education, jobs and homes will be fruitless if we do not have a healthy population. Our healthcare system was pushed to the brink under the previous Government, with waiting lists for vital scans and operations stretching to months or even years, 24 hour-plus waits in A&E, and the worst staffing crisis in history.

The creation of the NHS was the pride and joy of a post-war Labour Government, and it is a Labour Government who will rebuild it once again by investing an extra £25.6 billion over the next two years. The 40,000 extra elective appointments per week will mean reduced waiting times.

Where previous Budgets felt like reading lines from the same tired script, I can say with pride that this Labour Government’s first Budget really is the start of a new chapter in making Britain better off. It supports better wages, ensures that the NHS is there for people when they need it, and invests in building homes, infrastructure, roads and railways to create wealth and opportunity for all. That is the power of a Labour Government.

NHS: Independent Investigation

Rachel Hopkins Excerpts

Thursday 12th September 2024 Commons Chamber

[Wes Streeting]

I thank the right hon. Gentleman for that question. He is not too far away from me geographically, but he is miles away from me politically, and I always get nervous when he stands up to praise me. We have to keep a sharp eye on value for money. The Darzi report presents some politically challenging messages about NHS management. I could be wildly popular with the country if I stood up and said, “I’m going to take the axe to management across the country and sack loads of managers.” What we need is better management and a sharp eye on value for money. The NHS would not work without good leadership. We have to ensure that we have the right people in the right place, delivering against the public’s expectations, so it is a more nuanced position, but I am sure that what he says will have been heard by his local trust. I will certainly keep an eye on value for money across the country.

[Rachel Hopkins (Luton South and South Bedfordshire) (Lab)]

The Darzi report rightly says that prevention is better than cure, and that public health interventions that protect health are far less costly than tackling the consequences of illness and ill health. Does my right hon. Friend agree that the recklessness and incompetence of the 14 years of Conservative government, stripping millions of pounds from local authorities, which deliver the public health work, has contributed to children being sicker than they were 10 years ago, and adults getting iller sooner?

[Wes Streeting]

My hon. Friend is right, and at some point the Conservatives will have to take responsibility for it. We learned through bitter experience that if we did not change as a party, the country would not choose to change the Government. Long may the Conservatives continue, therefore, with their head in the sand, and long may we continue to get on with the job of clearing up their mess and building an NHS that is fit for the future.

The relationship between the NHS and local government, and between my Department and local government, is of particular importance in relation to social care, which is why I was especially delighted that the Prime Minister chose this week to appoint Tom Riordan, the chief executive of Leeds city council, as second permanent secretary. He is an outstanding public servant with a demonstrable record on health and care integration, public health and prevention. I look forward to having that local government perspective, and local community delivery perspective, at the heart of our Department.

Oral Answers to Questions

Rachel Hopkins Excerpts

Tuesday 23rd April 2024 Commons Chamber

[Kerry McCarthy (Bristol East) (Lab)]

19. What steps she is taking to improve patient access to primary care.

[Rachel Hopkins (Luton South) (Lab)]

21. What steps she is taking to improve patient access to primary care.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dame Andrea Leadsom)]

We are enormously grateful for the work of GPs in delivering 64 million more appointments nationally than in 2019. Our primary care recovery plan enhances GP access by expanding community pharmacy services nationwide. Some 98% of community pharmacies have signed up to the Pharmacy First offer, with over 125,000 consultations claimed in the first month.

--- Later in debate ---

[Dame Andrea Leadsom]

I certainly do not agree. If Labour were in government, we would see significantly worse outcomes. Covid was a once-in-100-years pandemic, and we have pulled out all the stops to recover from that. It is a huge tribute to all those working in primary care that they have done so well. In the hon. Lady’s ICB— Bristol North, North Somerset and South Gloucestershire —38.4% of all appointments were delivered on the same day they were booked in February this year, and 84% were delivered within two weeks of booking, with 66% of them face to face. These are extremely positive numbers for the 482,000 appointments delivered in February 2024. What is really important is that the number of patient care staff has increased by 656 full-time equivalents since 2019.

[Rachel Hopkins]

I have listened to the Minister’s comments, but the number of patients per GP in the Bedfordshire, Luton and Milton Keynes area is nearly 25% higher than the national average. Will the Minister explain why her Government think it is a good idea to cut the proportion of doctors being trained as GPs from around one in three to around one in four?

[Dame Andrea Leadsom]

The hon. Lady is simply wrong. She will be aware that, in fact, our long-term workforce plan is intended to raise the number of training places for GPs to 6,000 by 2031-32. In 2022, we had over 4,000 new GPs apply to take training places—an absolute record. There is much more to do, and I am working with GPs on a future for GP practice taskforce to make sure that we do everything we can, including hiring the 36,000 additional professionals now working in GP practices, in order to relieve the pressure on GPs and deliver much better patient access.

Oral Answers to Questions

Rachel Hopkins Excerpts

Tuesday 5th March 2024 Commons Chamber

[Victoria Atkins]

One of the many ways we have tackled access to dental care is to ensure that those dentists who have a contract to conduct NHS work are using them to the top of their licence. We are encouraging dentists to do that through the new patient premium and a higher rate paid for units of dental activity. There is so much more to the plan. Labour keeps trying to claim credit for our plan, but the truth is that our plan promises 2.5 million appointments while its plan promises a miserly 700,000.

[Rachel Hopkins (Luton South) (Lab)]

It is imperative that we tackle the scourge of mental ill health in children and young people. Labour will ensure access to mental health support in every school and establish an open-access mental health hub in every community, paid for by charging VAT on private school fees. Why will the Government not adopt that plan?

[Maria Caulfield]

I have a news flash for the hon. Lady: we are already doing all that work. Mental health support teams are being rolled out in schools—44% of pupils now have access to a mental health support team, rising to 50% shortly. Over 13,800 schools and colleges now have a trained senior mental health lead. Only last week we announced 24 early support hubs for 11 to 25-year-olds—they will not need a referral; they can drop in. There are 24/7 helplines available that can be accessed through 111. That is what we are doing.

Building an NHS Fit for the Future

Rachel Hopkins Excerpts

Monday 13th November 2023 Commons Chamber

[Rachel Hopkins (Luton South) (Lab)]

It is a pleasure to speak in today’s King’s Speech debate on getting the NHS back on its feet. It is clear that the country is crying out for change. We do not mean bringing back one of the architects of austerity, who started 13 years of failure on his watch, to try to help a Conservative party that is out of ideas and has given up on governing. We are seeing stagnant growth, skyrocketing mortgages, crumbling schools and hospitals, and a cost of living crisis, yet the Government’s agenda includes no meaningful action to deal with the past 13 years of failure.

Only Labour is offering true change—a decade of national renewal to overcome the Conservative party’s national decline—with unshakeable commitments to driving economic growth, safer streets, cheaper home-grown British power, better opportunities for all and a rejuvenated NHS. What working people deserve is a good job, a secure home and a safe community. The cornerstone of a good life is our and our family’s health, and at the heart of that is our NHS. This example of socialism in action is the jewel of the British crown, and a proud creation of the post-war Attlee Labour Government. However, that creation has been pushed to breaking point by the Conservatives as the health service is short of 125,000 staff; patients are waiting longer than ever for operations, in A&E or for an ambulance; and NHS staff are forced to use outdated, creaking equipment, which means longer waits for patients. The answer is not to sack healthcare workers by introducing minimum levels of service on strike days.

It is clear that only Labour can rescue the NHS from the biggest crisis in its history, get it back on its feet and make it fit for the future. We can see that already, with the welcome announcement that the Conservatives are finally adopting our plan to train the doctors and nurses the NHS needs. The Secretary of State could have included a few more of our ideas in the King’s Speech, beginning with our plan to provide 2 million more appointments, to be funded by abolishing the non-dom tax status. We would also arm NHS staff with the latest cutting-edge technology and equipment and support more care in the community so that patients are not stuck in hospital. A Labour Government will ensure that the NHS is there when people need it, from cradle to grave in a fairer Britain, allowing everyone to live well for longer.

The King’s Speech sadly confirmed that the Conservatives have shelved the much-needed reform of the Mental Health Act, breaking their 2019 and 2017 manifesto pledges. Rightly, the absence of Mental Health Act reform has been heavily criticised by social work and health leaders and by mental health campaigners. We need a prevention-based approach whereby people can access mental health support in the community when they first need it, rather than having to wait until they reach crisis point. That is why a Labour Government would recruit 8,500 more staff to expand access to talking therapies and cut waiting times. We would provide mental health support in every school and an open-access mental health hub for children and young people in every community. We would fund that by closing interest-tax loopholes and charging VAT on private schools. Accessible and timely mental healthcare is vital to the creation of a healthy society.

Let me take this opportunity to give credit to Luton Borough Council’s 2040 vision: a plan to create a healthy local community in our town, to improve population wellbeing, and to enable everyone to have a good quality of life and reach their full potential, as part of a commitment to become a Marmot town by tackling health inequalities with action on the social factors that impact health. That means embedding health across all policy areas. The covid-19 pandemic further highlighted and exacerbated many health challenges, and widened inequalities that affect health, such as education, housing and employment.

The Government’s 13 years of failure have had a substantial impact on working people’s lives in Luton. Under this Conservative Government, people are struggling to afford to meet their most basic physical needs—to stay warm, dry, clean and fed. How can the UK have a healthy society when the Conservatives are failing to ensure that people have the basics? People deserve the security and opportunity to get on in life, and a good job is an important part of a healthy life.

The Government need to recognise that they are failing to break down the barriers that prevent people from re-joining the workforce. One in seven people in England are waiting for NHS treatment; unaffordable childcare costs are locking parents out of full-time work; the number of young people out of work due to ill health has nearly doubled in a decade; and only one in 10 older or disabled people has had any support to find work. Labour will tackle the root causes of economic inactivity by driving down NHS waiting lists, reforming social security, making work pay and supporting people into good jobs across every part of the country.

A secure home is essential to a healthy life, but the King’s Speech does nothing to tackle the housing emergency in Luton and across the UK. There is no sign of local housing targets or the reform needed to our planning system. Homeowners face eye-watering mortgage rates, young people are struggling to get on the housing ladder, and the dream of home ownership has been snatched away for so many who are stuck paying unaffordable private rents. Labour’s plan for secure homes, including council housing, will put an end to the Conservatives’ housing emergency.

This is the Prime Minister’s first King’s Speech and, much like his predecessors, he has nothing to offer the country other than division and more of the same. Labour has a plan to rebuild Britain and our public services. We respect and understand the effort that millions of people put in every day. They deserve better from politics and government, and they will get it from the next Labour Government’s King’s Speech.