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

Rachel Hopkins Excerpts

Committee stage
Thursday 30th January 2025 Public Bill Committees

[The Chair]

Order. I am sorry, but you are only allowed one question.

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

Q My question, directed at Chloe, is about the practical application of access to doctors for patients, as suggested in the proposed legislation, and how doctors have those conversations with patients—particularly, when it comes to geriatricians, older patients. We heard from somebody yesterday who said that there were concerns around how older people were treated, and the potential risk of elder abuse. I would be interested in the practical application of those conversations, in your experience.

Dr Furst: First up, a patient has to specifically ask me about voluntary assisted dying. They have got to use words that really imply that that is what they want. I will often ask any relatives to leave so that I can have a conversation just with them, to try and reduce the risk of coercion, and then invite the family back.

One of the practical things that I often ask the patient is when they started thinking about this. Is it something that they have always considered should be a right, or is it more of a new-found belief given their current suffering? I want to understand what their current suffering is. I ask specifically whether they feel a burden on their family and friends. It is an hour-plus long conversation to really understand them and their suffering.

Again, I make sure they understand all the other treatment options available to them and what good palliative care looks like. I will often be prescribing other medications as part of that good palliative care—opiates and anxiolytics. As a geriatrician, I am also making sure that their mood is also addressed, and that this is not a reactive depression. I am really doing a holistic and comprehensive geriatric assessment as part of that voluntary assisted dying assessment as well.

[Dr Marie Tidball (Penistone and Stocksbridge) (Lab)]

Q This question is for Dr Furst and Professor Blake. Many of us on the Committee are committed to the need to protect disabled people and to ensuring that the Bill has as many safeguards in as possible. We heard evidence yesterday that anorexia may qualify under assisted dying laws in other jurisdictions. Have there been any cases of people with anorexia accessing assisted dying in Australia, and in your view do the respective laws across Australia allow for that? Secondly, are there any lessons that we can learn on building in safeguards in relation to those with learning disabilities?

Dr Furst: All around Australia, mental health as the primary terminal illness is excluded, so anorexia by definition is excluded. I have had a patient come to me with anorexia as their terminal illness requesting voluntary assisted dying. It is a relatively easy assessment because they do not meet the standard criteria, and I was able to explain to them that they were not eligible. But it opens the opportunity to have good, in-depth conversations with them about what they are going through.

I cannot talk to the learning disabilities question, other than to say that every time a patient comes to me the assessment is directed to the patient. I saw a patient today with motor neurone disease who is on continuous bi-level positive airway pressure and is using Eyegaze. The assessment and conversations I have with her are based around what she can do for me. I have had patients who have been able to put a thumb up and down, and I have had trachy patients. I cannot necessarily talk about learning disabilities, but as a holistic practitioner you are trying to make sure that the patient in front of you understands everything and is given the full opportunity to express their wishes.

Professor Blake: I would just say—

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

Rachel Hopkins Excerpts

Tuesday 28th January 2025 Public Bill Committees

[Lewis Atkinson]

Q I think around 650 people with a terminal illness currently take their own lives a year. If we see a success with the Bill, I wonder whether there would be a reduction of that number going forward. Do you think that could be incorporated in monitoring going forward? Do you think there are opportunities to avoid that suffering? People are clearly experiencing traumatic deaths at the moment.

Dr Cox: It is really difficult to know how many people who die by suicide because of their terminal illness would instead access assisted dying, and it is really difficult to understand the impact of assisted dying legislation on that. If we look at the evidence of suicide, we know that it is increased in people with serious illnesses, but it is actually increased in the first six months after diagnosis, not in the last six months of their lives, so it is about the trauma of the diagnosis. What we need for that is better mental health services, better support around diagnosis and earlier palliative care.

The other piece of evidence that I would offer to you is that the global picture of what happens to suicide rates after assisted dying legislation is introduced is confusing and mixed. But there are jurisdictions, for instance Germany, where after the introduction of assisted dying legislation the incidence of suicide has gone up year on year. I do not think we can say that introducing assisted dying legislation will stop those suicides.

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

Q I want to build on the comments about the multidisciplinary teams that you all work with. The chief medical officer said, in one of the sessions earlier, that discussions about death, dying and end of life are increasing. They are getting better. However, importantly, when we heard from Professor Ranger of the RCN and from the Association of Palliative Care Social Workers, they also talked about the conversations that they have, as part of the wider team. Quite often, it is nurses having those conversations.

I was struck by the way the RCN talked—and you, Dr Clarke, used the word as well—about not being paternalistic, about having the patient at the centre of that conversation, and about ensuring that we listen to the patient and ask them, “What is it that you want?” That, for me, is all about autonomy. Do you agree? The emphasis must be on patient autonomy and their choice at the end of life.

Dr Clarke: One hundred per cent. Sometimes, those of us who work in palliative care almost see the extent to which we try to place the patient at the centre of everything as quite radical, when contrasted with a lot of the other medical specialities. My opinion about what is best for a patient does not matter; their opinion is what counts.

The power of the multidisciplinary team, and the reason for thinking that it may be worth considering amending the Bill so that there is a greater role for a multidisciplinary team, is this: the fact that everybody in that team brings their unique perspective. In my hospital, whenever there is a tricky issue regarding a palliative patient, we will have an MDT. There may be 10 people in the room, all discussing the issues. It might be that someone has decided that they want to withdraw their life-prolonging treatments, or they want to have life-prolonging treatment and, for whatever reason, it is really complicated. We will have the patient, their family, doctors, nurses, social workers and dieticians—a big group of people—in the room because that is the way to make the decision most safely and most effectively, in terms of enabling the patient to have the treatment that they wish to have. It is incredibly important to have that.

[Rachel Hopkins]

Can I ask Mr Sanderson to reflect on that, for the different context, Mr Dowd?

[The Chair]

No. Order. We have two and a half minutes to go. One other hon. Member wants to ask a question. I want them to come in.

Terminally Ill Adults (End of Life) Bill

Rachel Hopkins Excerpts

2nd reading
Friday 29th November 2024 Commons Chamber

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

I am glad to have the opportunity to speak in this hugely significant debate, and as a co-sponsor of the Bill to support my hon. Friend the Member for Spen Valley (Kim Leadbeater) in advocating choice at the end of life. Since I came into this place five years ago I have spoken many times about assisted dying and the desperate need for reform of the law, and I believe this Bill is a landmark opportunity to change the status quo once for all, so that mentally competent terminally ill adults have the right to choose a peaceful, safe and compassionate death.

We hold a responsibility in this place to legislate for all people across the United Kingdom—for society. The overwhelming opinion of the public is clear. A poll conducted earlier this year found that 75% of people would support a change in the law to make it legal for terminally ill adults to access assisted dying in the UK.

The current blanket ban on assisted dying forces terminally ill people to suffer against their will as they near the end of their life, while loved ones watch on helplessly. Some choose to avoid that fate and seek assisted death abroad, but that comes at a substantial cost of around £15,000 to travel to Switzerland for that purpose. That highlights systemic inequality, whereby only those with the necessary financial means have access to a choice over the timing and manner of their death.

[Dr Arthur]

Will the hon. Lady give way?

[Rachel Hopkins]

I will continue, I am afraid.

As a humanist, I believe we have but one life and that we should live it well and make it meaningful. I believe that individuals should have autonomy in life. Similarly, I believe that at the end of life every person should have agency and the right to die with dignity and to a safe and painless death, on their own terms, subject of course to strong safeguards. I believe that the Bill contains stringent safeguards.

Although my humanist beliefs have contributed to my view, personal experience when young sparked my initial questions about the manner in which our lives end. My grandfather, Harold Hopkins, was an optical physicist and is remembered as one of the most innovative scientists of modern times. Many of his inventions are in daily use throughout the world, including zoom lenses, coherent fibre-optics and rod-lens endoscopes, which revolutionised modern keyhole surgery.

Unfortunately, my grandfather was not immune to the grip of a cruel terminal illness, and he sadly suffered greatly in the final weeks of his life, while battling prostate and secondary cancers, rendered blind during his final days, which was a cruel irony for a man who did so much to advance optics. But it was the haunted look on my father’s face when he arrived home having spent the final few days with Harold, who was in terrible pain and suffering before he finally died, that had a lasting impression on me. Surely, in a modern society, if we are able to live a good life, we must be able to have a good death.

My grandfather was just one of many who have faced such a fate. I have heard from many constituents and from other families—many who are here today—who have shared their own stories of watching their loved ones die in unnecessary pain and indignity. While many have raised concerns around the need for better funded and supported palliative care services in our country, I reiterate the point that the Bill does not represent an either/or proposal.

As my hon. Friend the Member for Spen Valley has said over the past few weeks, at its core this legislation is about not ending life, but shortening death. This is fundamentally an issue of dignity, compassion and humanity, and I encourage all Members across the House to use their power as elected representatives to alleviate the needless pain of thousands of individuals and their families by taking the first step towards providing choice at the end of life by legalising assisted dying.

Oral Answers to Questions

Rachel Hopkins Excerpts

Tuesday 14th May 2024 Commons Chamber

[Alex Chalk]

I thank my right hon. Friend for that important point. Fewer than 1% of tenancies required court action in 2019, but for difficult cases that do escalate to the courts, the Government recognise the importance of making sure that the process is smooth and efficient. Nearly 90% of county courts are currently listing possession hearings within four to eight weeks after a claim is received. On bailiff recruitment issues, we are running recruitment campaigns and have reduced administrative burdens to free up resources for bailiffs to focus on enforcement activity.

[Rachel Hopkins (Luton South) (Lab)]

T2. The Government’s latest panic measures to deal with the prison capacity crisis, including expanding the early release scheme to 10 weeks, have simply fuelled the probation crisis instead, with staff warning that many of these releases are unsafe and result in recall in a matter of days. Can the Minister confirm what specific extra resources he has recently put into this struggling service, so that it can cope with the sharp rise in probation workloads?

[The Minister of State, Ministry of Justice (Edward Argar)]

The hon. Lady is right to highlight the work of probation. I put on record—as I know my shadow would and I know she would—our gratitude to all those who work in our probation service. Over the long term, since 2021 we have put an extra £155 million a year into the probation service, and 4,000 more staff in training. She will have also seen the recent announcement made by my right hon. and learned Friend the Lord Chancellor in respect of the probation reset to enable probation officers to focus their time on where it makes the greatest difference and has the greatest impact.

Oral Answers to Questions

Rachel Hopkins Excerpts

Tuesday 22nd November 2022 Commons Chamber

[Kate Hollern (Blackburn) (Lab)]

2. What assessment he has made of the potential impact of the Common Platform on the delivery of justice by HM Courts and Tribunals Service.

[Rachel Hopkins (Luton South) (Lab)]

13. What steps he is taking to improve the performance of the Common Platform.

[The Parliamentary Under-Secretary of State for Justice (Mike Freer)]

We have rolled out the Common Platform at 173 criminal courts in England and Wales and 76% of courts are now live. It has improved the format and timeliness of outcomes of hearings generated and shared with our criminal justice partner agencies and removed the need for staff to re-key information across different IT systems. If we are to reform the criminal justice system, we need to press ahead and reform the IT that underpins it.

[Mike Freer]

The simple answer to that question is no.

[Rachel Hopkins]

Last month, staff at courts across the country, including the magistrates court in Luton, went on strike—not over pay or pensions, but because the Common Platform IT system is so flawed that it is effectively unusable. That should have been enough to make the Government sit up and take notice, but if the Minister will not listen to his own workers and their trade union, the Public and Commercial Services Union, maybe he will listen to the judges who are speaking out? One judge called the Common Platform “completely unsuitable” and “not fit for purpose”. Does the Minister agree?

[Mike Freer]

No, I do not agree. All new IT systems take time to bed down and officials continue to work with user groups, both staff within the criminal justice system and judges. The system replaces eight legacy systems that are at the end of their lives, support for which is being withdrawn. If we do not reform the IT system underpinning the criminal justice system, we will not be able to make the progress we wish.

Assisted Dying

Rachel Hopkins Excerpts

Monday 4th July 2022 Westminster Hall

[Rachel Hopkins (Luton South) (Lab)]

It is a privilege to serve under your chairmanship, Mr McCabe. I thank my hon. Friend the Member for Gower (Tonia Antoniazzi) for leading this debate and for the emotion she put into her speech.

The blanket ban on assisted dying has resulted in unacceptable failings in patient safety. As we have heard, dying people are forced to matters into their own hands without sufficient protection or support for them, their families or the clinicians who care for them. Through the APPG on choice at the end of life, of which I am a member, I have heard from families who have seen family members have a difficult and undignified death not of their choosing. As a humanist, I believe that people are fundamentally good, so I struggle to accept some of the caricatures of people being cynical with their loved ones at the end of life.

Assisted dying reform is a matter of freedom of choice at the end of life. Assisted dying laws can be introduced with robust safeguards. The current system is broken. Research from the Assisted Dying Coalition found that more than one person per week is forced to end their life abroad. This demonstrates an inbuilt inequality in the current system, as only those who can afford the high costs are able to go abroad to do so. If someone is rich, they have a small amount of choice, but if someone is poor and of limited means, they have no choice.

Looking at examples of legislation abroad, we see that all six states in Australia have legalised assisted dying, joining an ever-expanding list of states in the USA, New Zealand, Canada and many countries in Europe that give their dying citizens choice. I want to make one thing very clear: there is no credible evidence from jurisdictions that have legalised assisted dying that vulnerable people will be pressured to end their life.

As has been said, this debate is not about choosing between assisted dying and palliative care. International evidence shows that assisted dying does not harm access to palliative care. A report by Palliative Care Australia concluded that there is no evidence to suggest that the palliative care sectors were adversely impacted by the introduction of the legislation. If anything, in jurisdictions where assisted dying is available, the palliative care sector has further advanced. Evidence shows that the current law is not only cruel but dangerous, as there is little oversight of death by suicide linked to terminal illness or Dignitas deaths, and no formal monitoring. We need transparency and upfront safeguards in legislation, not a continuation of lonely, secretive deaths, with oversight occurring only afterwards.

We have heard how medical opinion supports assisted dying. The British Medical Association decided in 2021 to end its opposition to assisted dying, following a survey of its members. The BMA survey found that half of all doctors personally support legalising a right to die for those who are incurably suffering or are terminally ill.

Thanks to increasing public awareness, the public mood is changing. The petition to legalise assisted dying for terminally ill and mentally competent adults gained more than 100,000 signatures, 120 or so from constituents in Luton South. Public support for assisted dying is unwavering, regardless of age, class, gender or political persuasion.

Whether through an inquiry, a commitment to parliamentary time from Government, or the Government simply recognising that the current law in England and Wales fails dying people and their families, the UK needs to explore whether current laws are fit for purpose. The public need action from the Government and from us, their representatives. It is my opinion that the status quo is failing the public. This is not about either/or. It is about different pathways at the end of life and the right to have a choice.

Ten-Year Drugs Strategy

Rachel Hopkins Excerpts

Monday 6th December 2021 Commons Chamber

[Rachel Hopkins (Luton South) (Lab)]

I welcome the strategy’s holistic approach, but there is an element of irony in it, given that it is the Minister’s party that has cut 60p in every £1 to local authorities over the past decade and has failed to address the structurally flawed police funding model affecting counties such as Bedfordshire, which has contributed to increasing drug-related issues in towns such as Luton. Will the Minister commit to addressing the core funding formula issues affecting forces such as Bedfordshire, to ensure the longer-term resilience of our police to tackle organised crime groups and drug-related crime in Luton?

[Kit Malthouse]

I am hesitant to point out that it was the hon. Lady’s party that crashed the economy, but nevertheless I feel compelled to do so. As she may have heard me say from the Dispatch Box, we have committed to bringing in a new funding formula, and work is under way to devise exactly that.

Prison Officers: Pension Age

Rachel Hopkins Excerpts

Tuesday 16th November 2021 Westminster Hall

[Rachel Hopkins (Luton South) (Lab)]

It is a pleasure to serve under your chairship, Sir Charles. I congratulate the hon. Member for Sittingbourne and Sheppey (Gordon Henderson) on securing this really important debate. Violence in prisons, especially against workers, has increased significantly since the mass cuts to staffing and other budgets from 2013 onwards, with assaults on staff tripling to more than 10,000 a year by 2019. That level of workplace violence should be unacceptable for any employee, but there is increased danger for those over the age of 60. It simply cannot be right to expect officers in their 60s to control and restrain people who are a third their age.

Ministers have not provided any evidence to show that frontline prison officers over 60 can work safely in such a dangerous operational environment. I am aware that the report by Lord Hutton of Furness proposed that some uniformed services—as we have heard, police, firefighters and the armed forces—should be exempt from the rise in the retirement age to 68. The decision excluded prison officers from the “uniformed services” that were spared the retirement age rise. That has never been explained or justified, which has caused anger and despair among prison officers. Expecting officers to manage, care for and control violent, dangerous and difficult people until the age of 68 is quite simply unfair, unsustainable and, as the hon. Member for Sittingbourne and Sheppey said, dangerous.

The Prison Act 1952 gives serving prison officers

“all the powers, authority, protection and privileges”

of police officers. It is quite right that police can retire at 60, given the often violent and volatile nature of their job. Will the Minister explain why prison officers are not afforded the same protection?

Pension age should be negotiated as a stand-alone issue, but it is clear that Ministers see employee contributions as part of the discussion. But those relate directly to pay, and if pay is going to be on the table, the starting point must be the Prison Service Pay Review Body’s recommendation of a £3,000 uplift to entry-level salaries, which the Government deemed unaffordable. According to the Prison Service Pay Review Body, officers

“were said to be leaving the Service for…supermarkets; the Police; Border Force; railway companies; and other security and uniformed services”,

with one prison visited experiencing a turnover rate of almost 25%. Low pay and a high pension age are both reasons why morale is at an all-time low. The current recruitment and retention crisis shows that we need a complete pay overhaul that makes salaries competitive, attractive and fit for purpose.

Lastly, I am concerned about the growing number of female officers who fail their annual fitness test. The Prison Officers Association believes that menopause may be a factor. The situation has caused accusations of unfair and discriminatory treatment of women. Does the Minister agree that the annual prison fitness test is not fit for purpose, and will she commit to replacing it with a system that measures relative fitness, considering factors such as age and sex?

--- Later in debate ---

[Victoria Atkins]

I am conscious that I have only 4 minutes, so I will continue.

My hon. Friend the Member for Sittingbourne and Sheppey has already made the point that we have tried to make change on this before. When the Prison Officers Association membership were balloted eight years ago, they did not accept the package to retire at the lower age of 65 with heavily subsidised additional contributions to the scheme. Although POA members rejected the offer, the Prison Governors Association accepted it and as a result some manager grade staff now have a lower pension age. Another offer was made in 2017, in which prison officers would have incurred no cost to access a pension at the age of 65, but again this was rejected by a union ballot union.

[Rachel Hopkins]

Will the Minister give way?

[Victoria Atkins]

I will finish, if I may, because I want to deal with the points about security and I must finish at 5.48 pm in order to give my hon. Friend the Member for Sittingbourne and Sheppey time to respond.

Any lowering of the pension age for prison officers would invariably mean that their pension contributions would have to increase. Prison officers’ pension contributions are less than half those of schemes for firefighters or police officers.

Oral Answers to Questions

Rachel Hopkins Excerpts

Tuesday 14th September 2021 Commons Chamber

[Rachel Hopkins (Luton South) (Lab)]

8. What discussions he has had with Cabinet colleagues on the effect on the (a) recruitment, (b) retention, (c) safety and (d) morale of prison officers of raising the retirement age for that role to 68.

[The Parliamentary Under-Secretary of State for Justice (Alex Chalk)]

Our prison officers have done a truly remarkable job during the pandemic, and through their decisive actions and rapid contact tracing, literally hundreds if not thousands of prisoners’ lives have been saved. Although there are no plans to revisit the retirement age, we are pursuing a series of initiatives to boost morale, safety and retention, and ensure that prisons are as secure and rehabilitative as possible.

[Rachel Hopkins]

The Government have previously stated that because of the higher potential for serious injury and fatality among firefighters and police, they do not consider prison officers deserving of the same pension age protections and the right to retire at 60. With serious violence against staff still plaguing our prisons, does the Minister accept that the message received by prison officers is that they will have to wait until one of their own is killed in the line of duty before their safety concerns are taken seriously?

[Alex Chalk]

The hon. Lady makes an important point. Mercifully, during the pandemic violence has come down in prisons, which we welcome. It is also important not to make false comparisons. For example, employee contributions for police officers are at 12%, and 14% for fire officers, and 5.45% for prison officers. Of course we keep such matters under review. We made a generous offer in 2017 to bring forward the retirement date when the taxpayer would pay the entirety of employee contributions, but I regret that that was rejected by the POA.

Protecting the Public and Justice for Victims

Rachel Hopkins Excerpts

Wednesday 9th June 2021 Commons Chamber

[Rachel Hopkins (Luton South) (Lab)]

The pandemic has stretched our justice system and created an unprecedented backlog of 57,000 cases in Crown court, but the Government must recognise that the past 10 years of their Conservative mismanagement dismantled the justice system’s ability to respond to increased demand, and is undermining the delivery of justice and the safety of dedicated public sector workers.

The Government cannot blame the case backlog solely on the pandemic. Under the Conservative party’s watch, the backlog was at 39,000 even before the pandemic. As Kevin McGinty, then the chief inspector of HMCTS inspectorate, said to the Attorney General in March, the pre-covid backlog was

“unacceptable”

and was

“due to years of underfunding.”

While we have seen the number of cases soar, the number of staff directly employed by Her Majesty’s Courts and Tribunals Service has fallen by 15% in five years. To plug the gap, the Government have had to rely on agency staff, but the simple fact is there are now fewer staff, working on more cases. During that period of sustained underfunding, the Government had a fire sale of magistrates courts. Between 2010 and 2020, 164 magistrates courts were closed. That amounts to more than half of all the courts in England and Wales, and equates to 27,000 fewer sitting days than in 2016. Even though the Luton and South Bedfordshire magistrates court in my constituency has remained open, since 2010 46% of magistrates courts in the east of England have been closed. This cuts to the heart of the flawed austerity agenda. It is all well and good to stress that £223 million was made from the sale of court buildings, but that has damaged the delivery of justice. The Government seem to know the price of everything but not its value.

Those seeking justice are now looking at waits of up to four years for their court trials. Such a long delay will impact victims’ recovery, as well as all witnesses’ ability to recollect events and give evidence in court. Does the Conservative party now regret the decision to close more than half the courts across England and Wales since 2010? The chief executive of Her Majesty’s Courts and Tribunals Service said that we need 200 Nightingale courts to eliminate the case backlog, but only 25 are up and running. It is not overstating it to say that without urgent action, the Government are losing the public’s confidence in the criminal justice system’s ability to serve the public and uphold the law.

Will the Minister, in his closing remarks, tell the House what assessment he has made of the impact of the backlog on the number of cases that are dropped as victims and witnesses withdraw from the process? What steps are the Government taking to speed up justice for vulnerable people who are victims of crimes such as rape and domestic violence? Finally, the justice system should not be run on the cheap, so has the Minister learned the lesson that drastic austerity cuts inflicted on the Ministry of Justice were a false economy?