Courts and Tribunals Bill (First sitting)

Rebecca Paul Excerpts

Wednesday 25th March 2026 Public Bill Committees

[Matt Bishop (Forest of Dean) (Lab)]

Good morning, all. I welcome your work and the support that you offer victims—all of you, in what you have been doing. I am sure there is cross-party support for that in the room this morning. Do you think the changes in the Bill will improve the confidence of victims that, when they report crimes, they will receive justice more swiftly than they currently do and, more importantly, that the changes will also encourage more brave victims to come forward and report crimes?

Claire Waxman: There are a lot of good measures in the Bill that, if delivered and implemented well and with important safeguards, should have positive impacts for victims. We are removing appropriate cases from the Crown court, easing the burden there, and limiting the right to elect for a Crown court trial. By the way, victims view that right as an injustice. They feel that power and control is being given to the defendant, knowing full well that there is a chance they will come out of the process or that their evidence will be impacted over the years. That is something that victims regularly talk to me about. The measures around the automatic right to appeal and to make the magistrates a court of record will open up transparency in the courts and hopefully stop victims having to be called back in for a rehearing. That has devastating impacts; you cannot overestimate what it does to a victim when they think that they have gone through the process of giving evidence, and then they have to come in again.

If all those things ease the pressure and burden on the Crown court, that will give reassurance and confidence to victims who are thinking about whether to stay in the process currently. The measures Katrin talked about—putting in important safeguards around the cross-examination of rape victims—are so important. Vera and I have worked on this since 2019, because of section 41, past sexual history, and issues around cross-examination and compensation claims. That is a financial motive used to undermine the credibility of victims. Victims come out of the system and often say, “I will never report again,” but they tell their friends and families about their experiences, and that deters people and erodes public trust and confidence.

[Rebecca Paul (Reigate) (Con)]

Q Thank you for your time, Claire. If I am interpreting your answer correctly, your basis for supporting the removal of jury trials is that it will save time and allow victims to get justice quicker. Would your position change if that is not the case and those time savings do not come through?

Claire Waxman: That is impossible to answer. We need to see it happen. You need to come back to me and say if it is not going to reduce—

[Rebecca Paul]

Q Your letter says that this will result in quicker justice for victims, and that is why you support it. My question is: if that is not the case, would you not support it?

Claire Waxman: It is the case. The Crown court is overburdened. You have heard Sir Brian Leveson’s analysis; it cannot continue in the state it is in. If we do not take appropriate cases out of the Crown court, then what is the answer?

[Rebecca Paul]

Q That suggests to me that if it did not save time, you would not support the proposal.

Claire Waxman: But I cannot imagine it. If you are taking cases out of the Crown court that cannot deal with the pressure, that will save time.

[Rebecca Paul]

That is what we will be analysing over the next few weeks—whether it will or not.

[The Chair]

We will limit ourselves to one question each at this stage so that everyone can get in. If there is more time, I will call people again.

--- Later in debate ---

[Tristan Osborne (Chatham and Aylesford) (Lab)]

Q Thank you for your testimony so far and for your bravery. Morwenna, you mentioned that you waited two and a half years before your court date. My apologies for going into the detail, but can you go through the stresses and strains of that wait and its impacts on your life and possibly on other victims as well?

Morwenna Loughman: Absolutely. One thing that kept me going—I was so close to pulling out multiple times—was that I had this sense that he had done it before. In fact, what I was later told—it was not admissible, but under the Bill it would become admissible—was that he had broken his ex-partner’s leg repeatedly and raped her as well. His defence barrister stood in front of the judge, the jury and me, and said, “This man has never hurt a woman.” Given that this man was out on bail and repeatedly breaching his bail conditions, brutal is the word. I cannot overstate the impact that that has on victims. It was devastating. I did not look people in the eye for two years. I wore a hat everywhere I went so I could hide my face, because he could have been anywhere. I had to move out of my home. My home became a crime scene. I lost my job. It was daily torture. I echo what Natalie Fleet said the other week in the House of Commons: that the one thing worse than being raped is waiting four years or more to hear if people actually believe you.

[Rebecca Paul]

Q I thank you all for being here. I know that this must be incredibly difficult. You are incredibly brave, and it is wonderful to see you channelling something that was so negative for you in a positive way, so thank you for that.

We have focused a lot on jury trials, but there is a real opportunity here to think about what we need to deliver improvements in our judicial system, because the thing we all agree on here is that it is not working as it should. We might disagree on the best way to address that, but we do agree on the fact that change is needed in some form. What would you like to see in this Bill that is not there? What is needed to address some of the issues? Any of you who want to answer, please feel free to take the question.

Jade Blue McCrossen-Nethercott: It is a very big question. It is tricky, because I do not think that we can really ask for perfection; we are very much asking for a system that is bearable and has a bit of credibility about it. That just has to be centred, with lived experience at the forefront. So often, many victims, myself included, have said that it feels like it has gone so far to the defence side that it is no longer a justice balance. It has flipped so much on that side that I really want to urge you to consider that aspect: that it feels like the balance has gone in favour of the defence, essentially. In any decisions that you make about the Bill, just consider rebalancing that and ensuring that victims’ voices are centred in the decision-making process. If increasing magistrates to the three-year limit reduces the delays by even a small percentage, that can only be a positive thing. All those smaller elements will eventually snowball into more meaningful change across the entire sector. I could ramble on, so I will let someone else have a go.

Charlotte Meijer: I guess the other thing to add, which has been discussed a few times already, is the training of judges and magistrates. We have to find a way to do that—you would not let an untrained teacher into a school—because they are making decisions that mean life or death. After my not guilty verdict, I tried to kill myself, because nobody believed me, clearly. There is a huge impact. Things do need to change.

As I mentioned, I was a victim of rape. The rape did not go to court, because of many mistakes. The police offered to reinvestigate and I declined, because I knew what I would be going into and I did not want to go into that again, as it stands. A lot of that is about not just the courts, but the process leading up to it: the police and the CPS, and making sure that the police, the CPS and the courts are working together, which at the moment they are not. I am going through a three-year complaints process with the police, and they just blame each other. There needs to be accountability from start to end, because, while the Government have many different institutions that you deal with as a victim, you do not always understand it. You should not have to. I should not have to know that the CPS needs to do this and the police need to do that. It should be me coming in and other people understanding that journey for me and holding them to account.

There are no consequences if the victims’ rights we have at the moment are not adhered to. I was failed on at least seven points of the victims’ rights, but there is nothing that anyone can do. It has gone up to the ombudsman, and they said, “Yes, they failed”—great.

[Matt Bishop]

Q At the risk of sounding like a broken record, thank you to the panel for coming in. It is very brave of you to come and relive your stories and experiences. Following on from the previous two questions, maybe this is one for Jade, Charlotte and Morwenna: given the delays and uncertainty in the court process and how that affected your recovery, how do you think the changes in the Bill will better protect victims and survivors in future from the impact that you have experienced?

Morwenna Loughman: I did not actually know that it was the defendant’s right to elect where their trial was heard, and that was a real shock to me. I echo what these extraordinary women on my right have said: it feels like a system that has been weighted against you, and there is no doubt that defendants are gaming the system. As it stands, I would absolutely not recommend this system to someone who finds themselves in my position.

I also agree with what Sir Brian Leveson said. A cultural reform needs to take place, because we are way past the mark of funding being enough. It needs a systemic, systematic, fundamental paradigm shift in how the system is run.

Oral Answers to Questions

Rebecca Paul Excerpts

Wednesday 28th January 2026 Commons Chamber

[Olivia Bailey]

I thank my hon. Friend for that important question. I absolutely recognise the anxiety felt by many trans people at the moment. The Government are clear, as was the Supreme Court judgment, that trans people are protected in law from discrimination and harassment. The independent EHRC has submitted a draft updated code of practice to Ministers, which we are reviewing with the care that it deserves. This will provide further guidance to service providers on how to meet their legal obligations.

[Rebecca Paul (Reigate) (Con)]

It has been 146 days since the Equality and Human Rights Commission laid the revised code of practice before Government. Have the Government asked the EHRC to make any changes to the code of practice? If they have, can the Minister tell us what they are?

Jury Trials

Rebecca Paul Excerpts

Wednesday 7th January 2026 Commons Chamber

[Rebecca Paul (Reigate) (Con)]

Plans to restrict access to jury trial take a sledgehammer to one of the most important protections for the people of this country. I would expect any Government suggesting a change of that magnitude to have a strong rationale for doing so. Instead, we hear the nonsensical argument that curtailing jury trials will address the courts backlog, yet the Minister of State for Courts and Legal Services told the House that only 3% of court cases are jury cases. So before we even get into the debate, we need clarity on what this change will mean for the backlog. That means modelling and timescales, not justifications based on religious belief. I suggest that the Government are getting desperate when that is the best they can offer—perhaps next we will hear that the tooth fairy backs digital identification or that Father Christmas supports giving away the Chagos islands.

Back in the real world, in 2024 the Lady Chief Justice gave evidence to the Justice Committee that our courts faced around 100 unplanned closures every week, with 200 near closures per month. That is in line with credible data suggesting that just yesterday, 15% of our Crown courtrooms sat empty, and it is the same today. If the Minister wants to tackle the backlog, might that not be the best place to start?

Let me turn to the key benefit of jury trials: the involvement of our peers in delivering justice. These are people in our own communities with no obvious axe to grind or political motivations. Any justice system that concentrates powers in the hands of a small number of repeat decision makers inevitably risks groupthink and unconscious, or even conscious, bias. A jury is a built-in safeguard: 12 ordinary people drawn at random, bringing different instincts and experiences, and forced to test the prosecution’s case in a way that a single decision maker cannot. Simply put, it is safer to spread human fallibility across 12 people than to concentrate it in one. A system in which liberty hinges solely on inputs from various arms of the state—the police, the CPS and then a judge—cannot be as inherently fair as one in which justice is done with the people’s direct involvement.

The curtailing of jury trials is not the only concern. Ministers want to expand sentencing powers in the magistrates courts by allowing them to hand down sentences of up to two years, while at the same time restricting the ability to appeal decisions taken in those courts. It is extraordinary that this Government think that someone who can sit as a magistrate from the age of 18, with no legal qualifications or experience, should be able to decide whether someone loses their liberty. If you were in the dock, would you be happy with that? Juries may not be perfect, but I know what I would prefer.

If the Government are determined to push ahead with this, they are knowingly increasing the risk of wrongful convictions and excessive sentences. We know that more than 40% of appeals against decisions taken by magistrates courts are upheld. How many miscarriages of justice are this Government willing to accept?

Ministers would be foolish to trade away a centuries-old safeguard for a headline about swift justice, only to discover afterwards that our courts are no speedier, just less just. I believe that the British people must remain participants in their system of justice rather than mere observers. I urge Ministers to think again. Do not curtail jury trials. Do not concentrate yet more power in fewer hands. Fix the courts. Protect our legal heritage.

HMP Downview: Female Prisoners

Rebecca Paul Excerpts

Monday 24th November 2025 Commons Chamber

[Rebecca Paul (Reigate) (Con)]

I am grateful for being granted this debate on the safety and wellbeing of women in HMP Downview. Women prisoners are some of the most vulnerable in our society, yet very few people give much thought to the conditions in which they are being held. Today I want to draw attention to an unacceptable situation, one that not only places these women at risk of harm but that fails to recognise their basic rights. The law is being broken and it is being broken by our public institutions.

It was in 1823 that the Gaols Act was passed, mandating sex-segregated prisons. Before then, women in prison faced sexual assault and exploitation on a daily basis. Elizabeth Fry brought about important reforms that improved conditions for women, but she would be turning in her grave at where we now find ourselves over 200 years later.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for bringing this debate forward; I spoke to her beforehand in relation to it, and I thank her for raising the issue. Reports have shown that there has been a 90% increase in the number of mentally unwell women at Downview, who face extended delays in getting the support they need. The situation is the same back home at Hydebank Wood in Northern Ireland. In addition, prison staff are not trained mental health professionals, so the necessary healthcare support is not in place. Does the hon. Lady agree that there must be provision to properly train prison staff to support them in supporting prisoners who are faced with long delays and deteriorating mental health?

[Rebecca Paul]

That is absolutely right and the situation at HMP Downview is a great source of concern to me, which is why I am raising it with the Minister.

However, I want to move on to another issue. Once again, we have mixed-sex prisons—inclusion trumping safety, ideology winning out over reality, the feelings of a man holding more weight than the fears of many women. HMP Downview is a women’s prison in Banstead, near the Sutton border. It includes a wing, E Wing, specifically for biological males who identify as women. E Wing local policy sets out that it is for transgender women with or without a gender recognition certificate where risk indicates they cannot be safely held in the general women’s estate.

Over the course of the last year, between five and seven males have been housed in this wing. The Minister in the other place has said that these males are vulnerable. Before I look at the facts, I have a warning: some may find the data difficult as it yields an uncomfortable truth, but one that it is incumbent upon this House not to ignore.

In 2024, of the 245 transgender males—biological males with a trans identity—in prison, 151, or 62%, were convicted of a sexual offence. This is a far, far higher rate than that for the overall male prison population, which is only around 17%. And it is not a one-off either: a similar rate can be seen for 2023—a rate of 56%. So sexual offences are massively over-represented in this specific cohort of biological males.

[Rosie Duffield (Canterbury) (Ind)]

Will the hon. Lady make it clear again for anyone watching this debate that what she is saying is that those biological males—fully intact biological males—housed on the women’s estate are overwhelmingly convicted of violent sexual offences?

[Rebecca Paul]

I thank the hon. Lady for making that point. This is the reality of the data; we must not ignore what the data tells us. I did warn that it makes for an uncomfortable truth, but I can verify all of it and provide hon. Members with the data—I would not come to the House and give hon. Members incorrect data. Accordingly, we can conclude that the male transgender prison population poses a much higher risk to women and girls.

When people parrot the line that transwomen are not a threat to women, in the case of the prison population, I am afraid that that statement does not hold up. Zoe Watts, a biological male who identifies as a women, was jailed for eight years and six months after trying to use a 3D printer to make a gun that had the capacity to cause mass casualties. He was arrested by armed officers and a stockpile of weapons and materials was found at his home. There was a disturbing video on social media of him smashing a watermelon with women’s faces on it using a glass shard-encrusted baseball bat. He was put in HMP Downview.

Joanna Rowland-Stuart, a biological male who identifies as a woman, who stabbed his partner to death with a samurai sword, was put in HMP Downview too. John Dixon, now known as Sally, is a paedophile who was found guilty of 30 sexual assault charges involving seven children, some as young as six years old. He may have been held in HMP Downview too.

There are also more well known transwomen prisoners who have hit the headlines, such as Isla Bryson and Karen White, both incarcerated with women. Isla Bryson, from Scotland, was jailed for raping two women, but only after being charged did he come out as transgender. This dangerous rapist was remanded in a women’s prison. Holyrood, it seems, is even worse than Westminster for drinking the gender Kool-Aid. The case of Karen White is even more appalling. A transwoman convicted of rape and a knife attack, he was remanded in HMP New Hall, a women’s and young offenders’ prison, where he sexually assaulted two inmates. Thankfully, this dangerous predator is no longer in the women’s prison estate.

I hope hon. Members understand why I have grave concerns about such violent males continuing to be incarcerated with women. Not only is it against the law, the Supreme Court clarified back in April that single-sex provision must be based on biological sex alone, not anything else, but it is irresponsible and dangerous. Women prisoners deserve better than this. They should feel and be safe.

I now want to get into a bit more detail about E Wing within HMP Downview. Ministers have said many times in response to written questions that E Wing is not part of the general women’s estate, which is an odd statement for them to make. E Wing is a wing within HMP Downview, and HMP Downview is a women’s prison, ergo E Wing is part of the women’s prison estate. I have visited it and seen it with my own eyes.

Why might Ministers be at pains to say that it is not part of the general women’s estate? I believe they are using a play on words to obscure the fact that the single-sex provisions of the Equality Act are being breached. The current policy for managing transgender prisoners, introduced by the former right hon. Member for Esher and Walton when he was Justice Secretary, prohibits male prisoners who retain their birth genitalia or have any history of sexual or violent offences from being held in the general women’s estate, unless an exemption is granted by a Minister. So this ministerial characterisation that E wing is not part of the general women’s estate appears to be a tenuous effort to argue that they have complied with the policy and the Equality Act after all.

E Wing is physically located within a women’s prison. It is subject to the same policies and procedures as the rest of HMP Downview. It has the same Governor. Its funding comes out of the same pots. Its inmates are supported by the same health services. It beggars belief that Ministers think that we will believe that this wing is not part of the women’s estate.

Putting to one side this blatant breach of the Equality Act for now, let us consider whether the males held in E Wing are truly segregated from the rest of the female prison population. Again, Ministers keep saying that they are, but E Wing is like any other wing.

[Emily Darlington (Milton Keynes Central) (Lab)]

On that point, will the hon. Member give way?

[Rebecca Paul]

I will not. E wing has sleeping quarters and bathrooms, along with some living room space. Everything else that these prisoners need, like work, education and health services, are only available in the main estate. They therefore spend their days mixing with the women. So what supervision arrangements are in place to protect the women from these dangerous males?

[Rachel Taylor (North Warwickshire and Bedworth) (Lab)]

Will the hon. Lady give way?

[Rebecca Paul]

I will not.

In September, the independent monitoring board published its report on HMP Downview and shed some light on this matter. The report makes it clear that there had previously been

“a requirement for constant sight and sound supervision of E wing prisoners by a dedicated prison officer on a 1:1 basis whilst in activities…alongside prisoners in the general population.”

However, the report notes that that was changed earlier in the reporting period. It says:

“The previous 1:1 supervision arrangement was replaced”

by staff having

“general oversight of the E wing residents off the wing, as they do for all other prisoners”—

in other words, nothing additional.

To be completely clear, we have violent males housed in a women’s prison, which in itself is against the law. These males are not segregated from the women in the daytime; they use all the same services and communal spaces. These violent males are not supervised any differently from the female prisoners, with the previous one-on-one supervision by a dedicated prison officer being stopped. That is gross negligence and shows a complete disregard for the safety and wellbeing of female prisoners at HMP Downview.

What have been the responses of Ministers to the supervision issue raised in the report? Are they horrified? Have they committed to look into this issue? No, of course not. What they did do was remove the chair of the independent monitoring board the day after publication of the report highlighting the safeguarding failure.

Before I bring my speech to a close, let me comment on assertions that these males have not caused any issues for female prisoners. In reality, I really do not know if that is the case, because my question about how many of the prisoner-on-prisoner assaults at HMP Downview were committed by males has not elicited a response. Ministers simply say that the information could be obtained only at disproportionate cost. Why is that information not being provided? A failure to respond to that straightforward question does not fill me with confidence.

I would be grateful if the Minister could answer the following questions. When are the biological males being moved out of HMP Downview and all other women’s prisons, in accordance with the Equality Act? What immediate action is being taken about the inadequate supervision of these males in HMP Downview and any other women’s prison where it is relevant? How comfortable is the Minister with the removal of the chair of the independent monitoring board the day after the publication of the IMB’s September 2025 report highlighting the changes to supervision of E Wing inmates? How many assaults of female prisoners and prison officers by biological males in the women’s prison estate have taken place since the inclusion of males in women’s prisons? What percentage of total assaults do they make up?

I thank all Members for their participation in the debate this evening. Those who notified me in advance that they would like to make an intervention were granted said intervention—courtesy needs to be paid to these things. I also thank the Minister for listening to what I know is probably a difficult speech to listen to. I hope the issue at hand is now clear.

I urge the Minister finally to grasp the nettle on this shocking scandal and ensure that women’s prisons become single sex once again. We managed to get this right more than 200 years ago. Please restore our faith that this country is not going backwards on basic safeguards and rights for women.

--- Later in debate ---

[Alex Davies-Jones]

My hon. Friend is right, and I hope to put on record some clarity and facts this evening, rather than just fuelling misinformation.

The current policy, which was brought in by the previous Government, is that no transgender woman charged with, or convicted of, either a sexual or a violent offence or who retains birth genitalia can be held in the general women’s estate, unless an exception is granted by a Minister. I would like to state this evening that no such exemptions have been granted under this Government.

[Rebecca Paul]

On a point of order, Madam Deputy Speaker. I have just been accused of misinformation, and I want to make the point that the information and data I cited was obtained through written parliamentary questions. I can provide that data, so it is not misinformation; it is information that has come from the Ministry of Justice.

[Madam Deputy Speaker (Judith Cummins)]

Minister, you may want to clarify that remark.

[Alex Davies-Jones]

I will happily clarify it. I was not accusing the hon. Lady of misinformation; I was saying that there is a lot of misinformation out there regarding this issue, and that it is important that I put on record the facts of the case, which is what I am doing.

I want to reassert my last point: no exemptions have been granted under this Government. Exemptions that allow transgender women to be housed in the general women’s estate are recommended only when there is a compelling reason, such as a suicide or self-harm risk, or a risk to the prisoner from others, and where a specially trained multidisciplinary panel has carried out a comprehensive risk assessment that concludes that it has a high level of confidence that the prisoner poses a low risk to other prisoners. Again, though, no such exemption has been granted under this Government.

[Rebecca Paul]

The Minister mentions risk assessments. The independent monitoring board report seems to suggest that no such risk assessments have been provided. Can she put on the record that those risk assessments for every single biological male in HMP Downview are on file somewhere, and that she is comfortable that they exist?

[Alex Davies-Jones]

I will ensure that the Minister responsible writes to the hon. Lady to inform her of that. In terms of managing the risk posed to biological women, these policies have been a success. There have been zero assaults and zero sexual assaults committed by transgender women in the women’s estate since 2019. To answer her point, there have been zero assaults.

Oral Answers to Questions

Rebecca Paul Excerpts

Tuesday 3rd June 2025 Commons Chamber

[Shabana Mahmood]

I hope that my hon. Friend heard the earlier answer on the unduly lenient sentence scheme and the review by the Law Commission, but if he writes to me with the specifics of that case, I will make sure that we look into it.

[Rebecca Paul (Reigate) (Con)]

As of 1 May this year, there were seven biological males in HMP Downview, a women’s prison in my constituency. Can the Secretary of State confirm when they will be moved out?

[Shabana Mahmood]

The hon. Lady will be aware that those seven biological males are on E wing, which is a transgender-only facility. We will review the recent Supreme Court ruling and make sure that we are compliant in everything we do going forward. We have inherited a policy that we supported in opposition. It was a strong act by the last Government, but we will build on that following the Supreme Court’s recent ruling.

Oral Answers to Questions

Rebecca Paul Excerpts

Tuesday 22nd April 2025 Commons Chamber

[Alex Davies-Jones]

As I have stated, the child’s welfare must be the court’s paramount consideration. The presumption of parental involvement states that a court should

“presume, unless the contrary is shown, that involvement of that parent in the life of the child will further the child’s welfare.”

I take this opportunity to state, however, that that applies only if the parent does not put the child at risk of harm. We will publish our review of the presumption in due course.

[Rebecca Paul (Reigate) (Con)]

14. What recent assessment she has made of the effectiveness of the standard determinate sentences 40% early release scheme.

[The Lord Chancellor and Secretary of State for Justice (Shabana Mahmood)]

The last Government left our prisons in crisis. We came within days of running out of space entirely, and the emergency release programme was designed to stop that crisis happening. Numbers are rising again, which is why this Government are committed to building 14,000 prison places by 2031, compared with the 500 that the last Conservative Government added in 14 years, and to reforming sentencing so that we never run out of prison places again.

[Rebecca Paul]

Last month, the Prisons Minister said that the longest time that an early-released prisoner had been left to wander the streets without an electronic tag was 53 days. However, just over a week ago, it was reported that prisoners have not been tagged for up to 78 days. Can the Secretary of State please clarify this apparent inconsistency?

[Shabana Mahmood]

We were transparent with the House about the problems with tagging during the second tranche of emergency releases last year. I will ensure that we publish the correct information, and I can write to the hon. Lady with the exact figures, but we have been holding Serco to account, because its performance on its contract has been unacceptable. We have levied fines, and we have said that all options are on the table for any further action that we might need to take.

Terminally Ill Adults (End of Life) Bill (Twenty-eighth sitting)

Rebecca Paul Excerpts

Committee stage
Tuesday 25th March 2025 Public Bill Committees

Hon. Members could argue that, if the assisted dying service was turned over to the charitable sector, it would become underfunded in comparison with other NHS services. However, that argument does not wash because, if the Bill passes, I hope it goes without saying that it would be a state-funded service, fully funded through the taxpayer. I look forward to hearing what the Minister has to say on that because, in the absence of an impact assessment and clarity on what model is being proposed, I have not been able to unpick this in its entirety as I would have liked. We should therefore support amendment 537, tabled by my hon. Friend the Member for Shipley.

[Rebecca Paul (Reigate) (Con)]

It is a pleasure to serve under your chairmanship, Ms McVey. I rise to speak on clause stand part and new clause 36, and in support of amendment 525 and amendment (a) to new clause 36, tabled by my hon. Friend the Member for East Wiltshire. This is a really important debate. The NHS is the greatest achievement of any Labour Government, and maybe even of any Government.

[Danny Kruger]

Steady on!

[Rebecca Paul]

It transformed the quality of life of British citizens at a time of mass unemployment and widespread slums, ensuring free healthcare, in the words of Beveridge, from cradle to grave. The provision of healthcare free at the point of delivery was life-changing and life-prolonging. Although it is far from perfect, we have seen time and time again that as a country we can be very proud of the NHS.

The National Health Service Act 1946 came into effect on 5 July 1948, as a direct consequence of the Beveridge report. Section 1 of the Act states:

“It shall be the duty of the Minister of Health…to promote the establishment in England and Wales of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness”.

It was set up to help people to get better and live healthy lives, and to give hope in situations where otherwise there would be despair. It was lifesaving and life-changing. New clause 36 turns all that on its head. Subsection (4) states that:

“Regulations under this section may for example provide that specified references in the National Health Service Act 2006 to the health service continued under section 1(1) of that Act include references to commissioned VAD services.”

If this new clause passes, the founding principles of the NHS will be monumentally changed to include helping eligible people to commit suicide. That is what it does.

I want to be really clear that it is entirely possible to support assisted dying—to want to ensure that a small group of people, whom palliative care cannot help, have that assisted dying option—but not to support this new clause, which forces provision of the service through the same channels as normal healthcare. Assisted dying is not a medical treatment or a healthcare service and accordingly there should be a degree of separation.

We should be incredibly cautious about incorporating the service into the NHS. It will forever change the relationship between doctor and patient, breed mistrust and fear, discourage vulnerable groups from seeking the healthcare they need and fundamentally violate the Hippocratic oath. Dr Catherine Day, a senior partner of a large GP practice in Coventry, states:

“Trust lies at the heart of the doctor patient relationship. I believe this trust will be shattered if patients consider that their GP…may think that they should end their life and stop being a drain on our NHS.”

Siwan Seaman, a palliative care consultant said:

“How could a terminally ill patient trust a doctor if they know that the doctor was prescribing medication to the patient in the next bed in a bay or cubicle with the intention of ending their life. Letting these assessments take place alongside other NHS services will irreversibly impact on patients’ trust in healthcare professionals and negatively impact our therapeutic relationship with patients as doctors.”

[Kim Leadbeater]

If the hon. Lady is saying that she would not want to see assisted dying services within the NHS, then where does she think they would sit? Would she support my hon. Friend the Member for Shipley’s suggestion that this should be done by the voluntary sector and charities, or would she suggest the private sector?

[Rebecca Paul]

It is important that there is a degree of separation, but I would say to the hon. Lady that it would have made more sense for her to put forward a proposal that we could evaluate, assess, and identify the upsides and downsides of. It would be much easier for me to then come up with suggestions. It does not make sense to ask me, “What is the solution and how would you do this?”, and for me to lay out the many different ways that this could be done, without having first laid a proposal in front of me.

[Kim Leadbeater]

There is a clause that I have laid before the hon. Lady—that is what we are discussing. I will come on to that in my comments. Since she is clear that she does not think this sits within the NHS, she must have given consideration to where she thinks it should sit, if it were to come into effect.

[Rebecca Paul]

I will come on to some of that, and it goes back to my belief that there should be a degree of separation. I think it should be separate from normal healthcare services and there are multiple ways that we could do that. I regret that we are not specifically debating the various different options, with a proposal in front of us detailing exactly how it would work. I am assuming, from the new clause put forward, that the proposal is for this to go through the NHS as healthcare; that is the only assumption I can make based on what is in front of me in this Bill, because there is no other detail to give me any other impression.

Sarah Davies, a consultant respiratory physician in north Wales, argues for a separate service so that ordinary NHS care is not associated with assisted dying. She said:

“It is already my experience that patients and their families are anxious about limiting treatment when they are dying. Many people believe that symptom control medication, such as those delivered in a syringe-driver to aid symptom control amount to hastening or bringing on death. This perception can hinder the patient’s acceptance of medications which can afford significant alleviation of distressing symptoms.”

I have raised my concerns about providing an assisted dying service alongside and in conjunction with day-to-day healthcare many times over the last few weeks. I think it is a massive mistake both for patients and healthcare staff. It blurs the lines of what a treatment is, increases the risk of bad decisions and, as we heard so powerfully from Dr Jamilla Hussain, it will discourage some of the most vulnerable groups from seeking essential healthcare. We have received so much evidence and it is really important that we take it on board, so I will be quoting some in my speech.

Dr Green of the BMA said:

“It should be set up through a separate service with a degree of separation. We believe that is important for patients, because it would reassure patients who may be anxious about the service that it would not just be part of their normal care… It would reassure doctors, because doctors who did not want to have any part would not feel that it was part of their normal job, whereas the doctors who wanted to go ahead would be assured of having support, emotional support and proper training.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 45, Q32.]

In oral evidence, Professor Preston argued for a separate system and pointed to the Swiss example. She said:

“In covid, we did research in care homes, and there was real concern about ‘do not resuscitate’ orders and emergency care plans that were blanketed across the care homes. Care home staff were traumatised by that, so there are real issues. We know that there are real issues day to day in how people are treated within the NHS. I think it is unconscious—I do not think people are intending it—but we know that people are treated differently and that different things are done. That is partly why we think a system outside that would protect them, because then you are not within the healthcare team that is treating you and giving you advice about such things”.

She went on to talk about the Swiss system, also being adopted in Germany and Austria, which seeks to

“protect these people by keeping it one step removed”

from normal healthcare. She said:

“Most hospitals in Switzerland will not allow assisted dying to occur, because they do not want a lack of trust in their patient group.” ––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 246, Q317.]

I therefore support amendment 525, tabled by my hon. Friend the Member for East Wiltshire, which would amend clause 32 in order not to allow the provision of the assisted dying service to be done through the health service. That would ensure that much-needed degree of separation. In light of what the Bill’s promoter has said, I recognise that there are different ways to do that; I am very open to those different ways, but I need to see that degree of separation from normal healthcare. I also support new amendment (a) to new clause 36, also tabled by my hon. Friend, which does the same thing.

Let me come to the other amendments in this group. Amendments 537 and 528, tabled by the hon. Members for Shipley and for Richmond Park respectively, are important to debate—we have had some good debate on them this morning—as they raise the different ways of delivering an assisted dying service. I have been listening closely to the points made. Amendment 537 would limit the provision of an assisted death to charities rather than to the NHS, and conversely, amendment 528 would limit provision to public authorities only.

I do not have the answer on the best way to do this, and that is why I regret that a royal commission has not been set up to properly investigate and evaluate all the options and recommend the best way forward. Instead, we are here without all the relevant information and expertise available to us, trying to land on the best way to do it. That is not the way to make such an important decision. I can tell the Committee, however, that—like many others, including my hon. Friend the Member for East Wiltshire—I have huge reservations about delivering such a service through the NHS alongside normal healthcare.

I agree with much of the evidence that has already been cited: there should be a degree of separation. The BMA said that assisted dying could be part of the NHS, but should be outside existing care pathways and separate in some way:

“Our view is that assisted dying should not be part of the standard role of doctors or integrated into existing care pathways—it is not something that a doctor can just add to their usual role… The separate service could take the form of a professional network of specially trained doctors from across the country who have chosen to participate, who come together to receive specialised training, guidance, and both practical and emotional support. They would then provide the service within their own locality—for example, in the patient’s usual hospital, or their home. Or it could be a combination of some specialist centres and an outreach facility.”

In its written evidence, the Royal College of General Practitioners also proposed a separate service:

“The establishment of a separate service which covered every stage of the process would ensure healthcare professionals of multiple disciplines (including GPs) who wanted to do so could still opt in to provide assisted dying, but this would be arranged through a different pathway.”

I agree with both bodies that the service should be separated out in some way. It is now apparent that my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), whose amendments would have created an assisted dying agency, was on the right track. I regret that the Committee did not explore his ideas in any real detail during our proceedings.

We received important written evidence from Robert Twycross, a pioneer of palliative care who sadly died in October, but had given his friend Ariel Dempsey permission to submit it. Dr Dempsey writes:

“Twycross recommends a de-medicalized model in which AD is a separate service, delivered outside of healthcare practice. He argues for a standalone Department for Assisted Dying, separate from the NHS. He writes, ‘Data indicate that the primary reason for a persistent desire for AD is to relieve distress over a perceived loss of autonomy and to experience a sense of personal control over the circumstances of their dying. These are not medical reasons. Thus, for patients fulfilling the legal criteria, a separate AD service should be established. Indeed, this would be the best way to prevent a corrosive effect on medical practice generally.’ ‘Given the widespread disquiet felt by doctors, a law with minimal medical involvement would be the most equitable.’ He suggests, ‘One way to achieve this would be for [AD] to be delegated to a stand-alone Department for Assisted Dying, completely separate from the NHS and with its own budget. Victoria almost achieves this with its combination of Care Navigators, mandatory training for participating doctors, and a separate Voluntary Assisted Dying Statewide Pharmacy Service.’

Twycross emphasizes that hospice and palliative care must be a ‘sanctuary’ for patients – ‘an assisted dying free zone. Even in the absence of AD, some people decline referral to palliative care despite unrelieved pain and/or other distressing symptoms because they fear they will be “drugged to death”…This unfounded fear will most likely be enhanced if AD is legalized, particularly if palliative care is involved’ and result in an overall increase in suffering.”

--- Later in debate ---

[Dr Opher]

Briefly, the hon. Lady says that only 30% of palliative care is funded by the NHS, but that is quite spurious, because everyone who gives palliative care—all doctor time, palliative care consultants, palliative care departments, all GP services, all district nurses—gives it under the NHS. What she must be talking about is social care, which is obviously very different from medical NHS care.

[Rebecca Paul]

I thank the hon. Member for his intervention. I was quoting written evidence, so I just quoted it, of course, as written.

We should be ashamed if what I have set out is where we end up as a result of this Bill. How would it in any way recognise patient autonomy and give them a real choice? Clearly, it would not. We will end up with patients taking an assisted death because there is no alternative to dying well. If as much effort was put into improving palliative care as has been put into legalising assisted dying, a much greater number of people would be given the dignified, comfortable deaths they rightly deserve. It is a travesty that we find ourselves considering the introduction of assisted dying while hospices are on their knees and patients face a postcode lottery when it comes to receiving adequate end-of-life care. Accordingly, I will vote against new clause 36.

[Lewis Atkinson (Sunderland Central) (Lab)]

It is a pleasure to serve under you this this morning, Ms McVey.

I rise in support of new clause 36, which sets out an entirely workable, appropriate and safe set of provisions for the Secretary of State to ensure that these services are provided across England, as well as appropriate powers for Wales, although I am far from being an expert on those matters.

The new clause would convey powers to the Secretary of State to commission services free at the point of use, in a way that is entirely analogous to the commissioning of other health services that are provided, as we know, by a range of providers.

I came to this place having been an NHS manager for nearly 20 years, and I feel that the debate has sometimes slightly confused elements of commissioning, provision and the way in which the NHS commissions and manages services. My hon. Friend the Member for Banbury said that the state must oversee and regulate the service, and I entirely agree. Commissioning powers sitting with the Secretary of State will ensure that that is the case. The hon. Member for Richmond Park said that the issue is who is commissioning. Again, we are clear that the only person doing any commissioning will be the Secretary of State, potentially delegating this to NHS structures at the time.

The NHS and the Secretary of State are not unused to commissioning highly specialised, sensitive services in this way. Indeed, I would be amazed if the Minister and my hon. Friend the Member for Spen Valley do not confirm that the Government were involved in the drafting of this new clause to ensure that it is equivalent to the other powers that the Secretary of State has.

This will clearly be a specialist service. It is a new service. At high levels of NHS England and equivalent bodies, there is significant expertise and practice in commissioning specialised services. The importance of the commencement period, which I hope we will discuss later today, is that engagement around the exact service specification will be drawn up in just the same way that it would be for a new cancer treatment or a treatment for a rare disease. It is right that the time will be taken to engage on that.

Fundamentally, services have to be commissioned. Some suggest that this will be a free-for-all, that anyone can provide this service and that anyone can be paid for it, but that idea is nonsense. There is no obligation for the Secretary of State to reimburse anyone who decides they want to provide this service. The service must be explicitly commissioned.

Terminally Ill Adults (End of Life) Bill (Twenty-seventh sitting)

Rebecca Paul Excerpts

Wednesday 19th March 2025 Public Bill Committees

[Kim Leadbeater]

These amendments relate to criminal liability under the Bill. They get to the heart of why the legislation is needed. Amendment 504 seeks to clarify the language of clause 24 and provide reassurance that it will not be considered an offence to perform a function under the provisions of the Bill or to assist a person seeking to end their own life in connection with anything done under the Bill. It will ensure that those acting within the law, and with compassion, to assist terminally ill individuals who wish to end their suffering and take control at the end of their life are protected under the law.

Amendment 505 ensures that the provisions of the Terminally Ill Adults (End of Life) Act 2025 will supersede the Suicide Act 1961, providing clarity that actions taken under the new Act will not be subject to the outdated legal framework established under the 1961 Act. That is a crucial step in modernising our laws to reflect the values of compassion, dignity and personal autonomy. These amendments bring us closer to a legal framework that is clear and safe.

Our Prime Minister, my right hon. and learned Friend the Member for Holborn and St Pancras (Keir Starmer), the former Director of Public Prosecutions, stated in relation to assisted dying, “The law must reflect the changing moral landscape of society, and in cases such as this, where the individual’s autonomy and suffering are at stake, our legal framework must offer clarity and compassion.” During his tenure as DPP, Sir Keir also emphasised the importance of not criminalising individuals who act out of compassion, particularly in difficult and morally complex situations. He said, “The law must be clear, and it must ensure that those who act with the intention to relieve suffering are not penalised, as long as their actions are in accordance with the law.” That sentiment is echoed in the amendments before us today, which ensure that those who assist individuals under the Bill are protected by law, offering clarity and reassurance to both the public and professionals who may be involved in such decisions.

Sir Max Hill, another former Director of Public Prosecutions, remarked in 2019, “The law around assisted dying is often unclear and creates a great deal of uncertainty for both individuals and healthcare professionals. What we need is a system that balances compassion with protection, ensuring that people who are at their most vulnerable are supported in a way that is both legal and ethical.” Sir Max Hill’s words emphasise the need for clear, compassionate guidance, which these amendments will provide. They will help to eliminate the legal uncertainty that can cause fear and hesitation in those who act in the best interests of individuals facing terminal illness.

The 2010 DPP policy clarified that assisting someone to end their life was not automatically criminal and that each case would be assessed on its individual facts. However, that has not changed the law and many people are still being failed by the law as it stands. These amendments create clarity and prevent ambiguity around what constitutes a criminal act versus an action legally protected by the new law.

I will finish with a very powerful testimony from Louise Shackleton from Scarborough. Louise accompanied her husband to Dignitas last December. I believe she was the first person to make that trip since Second Reading. Louise talks about the trip she made to Switzerland with her husband. She says:

“This is not an easy process as some against Assisted Dying might have you believe, might try and convince you. It is a robust and thorough almost an ordeal in itself. Then there is the cost, not just financially but mentally and physically as he had to be able to get to Zurich and someone had to assist him to do this…My husband did not deserve this to be his end nor did I deserve this to be his end, my last memory of him…I accompanied my husband to Switzerland, where we had 4 wonderful days together, my husband’s mood had lifted, he was at peace, it was as if the weight of the world had been lifted from his shoulders. He was not scared, no anxiety, his emotional suffering had ceased. You cannot imagine unless you see and feel this he was looking forward to his peaceful death, looking forward to leaving his pain, suffering…At the end, my husband was able to die on his own terms, pain-free and peaceful, held in my arms as his heart gently slowed and finally stopped, granting him the dignified and serene farewell that he had wished for. But where was I? alone in a strange country alone, scared, bereft, organising an Uber to take me away from the…Dignitas House, I was vulnerable and in utter shock, now having to leave my dead husband alone, leave his body to be cared for by people I had never met…Due to our draconian laws my husband had to be in a foreign country, had to be cremated to be brought back home. No funeral that he would have chosen, no mourners, no ceremony, cremated with no Reverend to pray for him, returned to me in a cardboard box. The pain is excruciating beyond any other loss I have experienced”.

She then says:

“I have been arrested and spent just under three hours being interviewed by two CID officers. Four days after my husband left my world there I was stuck in a Police station being cautioned, questioned, having to relive my trauma, for my crime, a crime made by love, a crime made by adoration, a crime of compassion and respect of my husband’s last wish.”

She now faces a prolonged police investigation. She tells us,

“My husband was the first British person to go to Dignitas after parliament debated on Friday 29^th Of November 2024. You have the power, the power is yours to be human, to follow Gods wish, to ‘suffer’ choices that other people may make even if its uncomfortable for you. Palliative care I hear you say, My Husband did not want palliative care…Please give others the gift of dignity and a good death in their homes…You have the power to do something amazing, give people the choice.”

I commend these amendments, which will help many people. Sadly, it is too late for Louise, but they will help many other families who will potentially go through what she has been through.

[Rebecca Paul (Reigate) (Con)]

I rise to speak briefly on clause stand part. As I noted a few weeks back—it feels a long time ago—when we debated amendment 82, the clause leaves the law in a strange position. I hope that we will now have the opportunity to explore that and make sure that we are comfortable with the position and have identified whether any changes are needed.

Section 2(1) of the Suicide Act 1961 criminalises both assisting and encouraging suicide:

“A person (‘D’) commits an offence if—

(a) D does an act capable of encouraging or assisting the suicide or attempted suicide of another person, and

(b) D’s act was intended to encourage or assist suicide or an attempt at suicide.”

It is a single offence, but can be committed in two ways: either through assistance or through encouragement.

Clause 24(3), both as drafted and as amended by amendment 505, would make an exception from criminal liability under the Suicide Act, but in respect only of assistance, not of encouragement. It would cover:

“(a) providing assistance to a person to end their own life in accordance with the Terminally Ill Adults (End of Life) Act 2025, or performing any other function under that Act in accordance with that Act, or

(b) assisting a person seeking to end their own life in accordance with that Act, in connection with the doing of anything under that Act.”

In other words, it is strictly limited to assisting suicide. It only covers the actions in the Bill around conducting the preliminary discussion, assessing the applicant, giving the applicant the approved substance and so on. What happens to the other half of section 2 of the Suicide Act: the offence of encouraging suicide? I will not rehash the debates that we had over amendment 82, but I must point out that as that amendment was rejected, the law does not dovetail. Encouragement would still be very much an offence under the Suicide Act, as it has not been excepted under the Bill.

Because my amendment was not agreed to, we will have the absurd situation in which somebody can commit the crime of actively encouraging someone to take their own life, yet that will not be looked for or taken into account when assessing someone’s eligibility for an assisted death. On the flipside, there is a very real risk for families and friends of loved ones who could inadvertently overstep the mark and move from support of a loved one to encouragement. It does not take much imagination to realise that that could lead to accusations and potentially even to prosecution if the law is not sorted and clarified at this stage.

We already know how difficult it has been for family members who want to accompany loved ones to Dignitas but fear that they could face prosecution; the hon. Member for Spen Valley has made that point so eloquently. No one wants that, so it is important that we ensure that the Bill does not create a similar situation in which someone could be unfairly prosecuted for encouragement, which is still very much a crime under the Suicide Act.

--- Later in debate ---

[Sarah Sackman]

Again, it would depend on the actual facts. However, if they were attempting to perform duties under the Bill, it is highly unlikely that, in circumstances where the facts establish and meet the threshold of gross negligence manslaughter, they could be said to have carried out those duties in accordance with the Bill. They might have been carrying out duties that they thought were what the Bill prescribed, but if they have done that in such a way that it amounts to gross negligence manslaughter, then clause 24(1) would not apply.

The hon. Gentleman makes the point about what the pharmacist in that scenario believes they are doing; that belief has to be reasonable, and that is a test that our courts are well used to applying. That is why the amendments introduce the belief that someone is acting in accordance with the Bill. It is not enough that they think they are doing it; it has to be a reasonable belief. That is an objective standard.

[Rebecca Paul]

I thank the Minister for those helpful clarifications. Was any consideration given to also exempting encouragement as an offence under the Suicide Act? I am interested in why it was not exempted in the same way as assistance, particularly given that if it did fall within coercion and pressure—based on what the Minister said—it would get picked up as a criminal offence anyway under the Bill. I appreciate that the Minister will write to me on some of this, but the issue comes back to what is encouragement. As the hon. Member for Spen Valley set out—

[The Chair]

Order. As I have said time after time, if it is a question of receiving clarification, Members should keep their comments short, rather than expanding on them.

[Rebecca Paul]

My apologies, Mr Dowd, but it is a technical point. I think the Minister understands what I am asking.

[Sarah Sackman]

Helpfully, the hon. Member has also set out her questions fully and precisely in a letter to me, so I think I know what she is asking and I will try and answer it as best I can. I reiterate, as I and the Minister for Care have said throughout, that the policy choices have been for the promoter—the Government remain neutral. The offence of encouraging or assisting suicide or attempted suicide in section 2 of the Suicide Act is well established. Encouraging someone to go through the assisted dying process under the Bill with the intention of encouraging suicide or an attempt at suicide would therefore remain a criminal offence under section 2 of the Suicide Act. That is what I made clear earlier.

What we are talking about will always depend on the particular circumstances of the case. It is the Government’s view that in a scenario—I think this is what the hon. Member for Reigate is getting at—where a family member or friend simply suggests to a person with a terminal condition that the option of assisted death under the Bill is something they may wish to consider, and nothing more, it is unlikely—dare I say, inconceivable—that that would amount to an offence under the 1961 Act.

However, if someone encourages a person in a more tangible way, such as encouraging or pressuring them to make the first declaration, that could well amount to an offence under the 1961 Act. Where that encouragement crosses the threshold into what, interpreted in line with their natural meaning, the courts would understand as pressure or coercion, that could amount to an offence under clause 26 of the Bill, which we will come to in due course. I hope that that addresses the hon. Lady’s question. I will set that out to her in writing, and she is welcome to write back if there is any ambiguity.

I hope that that assists the Committee. I am going to sit down before anybody else intervenes.

[The Chair]

May I make an observation? I understand where the hon. Member for Reigate is coming from, but if letters have gone back and forth to the Department and other Committee members are not privy to what they say, the debate gets a little abstract. That is all I am trying to get to—we should not get too abstract, so that everybody knows what is being said.

[Rebecca Paul]

I appreciate that, Mr Dowd, which is why I was elaborating—I wanted to make sure that everyone understood the nature of the question without having seen the letter. In order to summarise, following your instruction, I refer to the letter.

[Kim Leadbeater]

I have nothing further to add.

Amendment 504 agreed to.

Amendment made: 505, in clause 24, page 15, leave out lines 22 and 23 and insert

“—

(a) providing assistance to a person to end their own life in accordance with the Terminally Ill Adults (End of Life) Act 2025, or performing any other function under that Act in accordance with that Act, or

(b) assisting a person seeking to end their own life in accordance with that Act, in connection with the doing of anything under that Act.”.—(Kim Leadbeater.)

This amendment ensures that it is not an offence under the Suicide Act 1961 to perform a function under the Bill, or to assist a person seeking to end their own life, in connection with the doing of anything under the Bill.

Clause 24, as amended, ordered to stand part of the Bill.

Clause 25

Civil liability for providing assistance

--- Later in debate ---

Amendment 509 ensures that prosecution for any offence under this clause can only be initiated by, or with the consent of, the Director of Public Prosecutions. This is an important safeguard, ensuring that prosecutions are handled with the utmost care and consideration. By involving the Director of Public Prosecutions, we make sure that decisions to prosecute are made fairly, consistently and with proper oversight. This also aligns the approach to assisted dying with the principles of prosecutorial discretion seen in the Suicide Act. This will ensure that cases are reviewed for their individual circumstances before a decision to prosecute is made, ensuring that the individual circumstances of the case are assessed based on the case’s merits. The amendments refine and clarify the Bill’s provisions by ensuring that legal terminology is more precise, penalties are more aligned with the seriousness of offences, and stronger oversight mechanisms such as the DPP’s consent for prosecutions are in place. They aim to protect the integrity of the assisted dying system while offering greater accountability, punishment and deterrence against fraudulent or coercive practices.

[Rebecca Paul]

I will be fairly brief. I welcome amendment 508, which would ensure that conviction for the offence leads to a necessarily serious result. However, it is not just the strength of the sentence that we need to think about; there is also a question about how difficult it can be to detect and demonstrate coercion in the first place.

Domestic abuse prosecutions have followed an overall downward trend over the past decade, according to Women’s Aid. A report from the Domestic Abuse Commissioner in January found the criminal justice system unfit to hold abusers to account and safeguard domestic abuse victims. Domestic abuse victims are being failed by the criminal justice system at every stage, from police to probation. Victims seeking safety in justice routinely face a lack of specialist service referrals, poor enforcement of protective orders, court delays and early release of abusers. The commissioner also found that just 5% of police-recorded domestic abuse offences reached conviction and that less than a fifth of victims have the confidence to report to the police in the first place. Within the police workforce itself, only 4% of alleged domestic abuse perpetrators are dismissed.

Women’s Aid says that trust in the criminal justice system is at an all-time low, with domestic abuse survivors not feeling that they will be believed and supported when reporting abuse. That is even more challenging for black and minoritised survivors, who face additional barriers and poor responses when they seek help.

[Kim Leadbeater]

The hon. Lady is making a point that we have already covered several times in the debate. It is an important point, but I hope that she is reassured by the offences to be included in the Bill, which create sentences that do not currently exist.

[Rebecca Paul]

I am absolutely reassured by the hon. Lady’s amendment, and I welcome it, but it is worth drawing attention to the fact that the sentence is important but identifying coercion and pressure can be difficult too.

In written evidence, a social worker called Rose has cast doubt on the workability of the Bill. She was writing when the High Court safeguard was still part of the Bill, so we need to bear that in mind, but what she said applies to the panel too. She wrote that

“based on lived experience…there is no authentic provision mechanism or route that cheaply and swiftly would allow an approved palliative care professional…or social worker to act to protect a vulnerable person under the grounds of coercion….Place yourself in a position of being sick or older, coerced by family for financial gain or by a practitioner wanting to save public costs to pursue assisted suicide, the social worker senses it by body language, a squeezing of their wrist, a sharp silencing look. Can you see a judge saying: ‘the social worker sensed a tension in the air and a look’.

Do you think that would serve to reach the threshold to override a request for assisted suicide in a court of law?

In practice, what would happen would be, the social worker will record her concerns on the system, share them with her manager who will go to her manager who will say we do not have funds to consult legal and your evidence provided does not reach threshold anyway.”

[The Chair]

Order. I am genuinely trying to give as much latitude as possible, but the issue of coercion has come up before. In the context of the offence, I am not sure that this is necessarily pertinent or relevant. Will the hon. Lady bear that in mind during her speech, please?

[Rebecca Paul]

Thank you, Mr Dowd. In that case, I will stop there. I was just making the point that this is important.

Amendment 509 states:

“Proceedings for an offence under this section may be instituted only by or with the consent of the Director of Public Prosecutions.”

I would find it useful to have more clarity around how the offence is used currently, why it is used and why it is appropriate to use it in this instance. Those are all genuine questions. I simply do not know, so I would be grateful for some input. I will leave it there.

[Danny Kruger]

I will be grateful if the Minister or the hon. Member for Spen Valley can explain the situations in which behaviour criminalised by clause 26(2) would not also amount to an offence under section 2 of the Suicide Act, as amended, or indeed to murder. What behaviour would be criminalised here that is not already criminal? Can the hon. Lady think of any instance in which there would be no crime under section 2 of the Suicide Act, but there would be an offence under clause 26(2)? If there is no such instance—I cannot think of one—it strikes me that, at least in respect of coercion and pressure, the offence being created here is redundant and duplicative.

Ministers have rightly stressed the importance of their duty to the statute book. My understanding is that having redundant or duplicative legislation, or indeed duplicative offences, would be inconsistent with our duty to the statute book. One might ask, “What does it matter? Wouldn’t it be helpful to have additional belt-and-braces safeguards in the Bill?” I agree in principle, but I note that when other Members have deployed that argument in relation to adding terms such as “undue influence”, the neutral Ministers have rebuked them by appealing to the duty that we are supposed to have to the statute book. I think the point cuts both ways. Why are we embroidering the statute book with duplicative offences?

Terminally Ill Adults (End of Life) Bill (Twenty-sixth sitting)

Rebecca Paul Excerpts

Committee stage
Wednesday 19th March 2025 Public Bill Committees

[Lewis Atkinson (Sunderland Central) (Lab)]

It is a pleasure to serve under your chairmanship, Ms McVey, fortified as I am now with a touch of breakfast.

I wish to open my comments on this set of amendments by reiterating the importance of respecting people’s beliefs in healthcare and the contribution that people of different faiths, beliefs and positions make, no matter where they come from, in the context of the activities under the Bill.

I accept and recognise that amendment 480, in the name of the hon. Member for East Wiltshire, would do an important job in strengthening the Bill’s provisions. I obviously want to hear what the Minister says, and I note the comments from my hon. Friend the Member for Spen Valley, but I would want to see this sort of expansion in the final Bill when it goes back to the House. If they may not be the exact right words today, I repeat the offer that my hon. Friend has made to work across the divide, as it were, to ensure that such provisions are included in the Bill.

With the benefit of an overnight reflection, I feel that last night we got somewhat muddled around some of the objections on conscience, particularly when we go beyond the individual. Amendment 480 and equivalent amendments deal very clearly with individuals not having an obligation to carry out acts that would offend their conscience in the provision of these services. I think we can broadly agree on that. The remainder of the debate got rather muddled between organisations providing assistance under the Bill and the locations at which the final act of an assisted death may take place. I think those are importantly different.

On organisations providing assistance, I want to reset things with a common-sense approach to how it will work in practice. The hon. Member for Reigate made the point that hospices should be under no obligation as organisations to provide specific services. I agree. The powers set out under clause 32 for the Secretary of State to make arrangements for the provision of these services, which we will come on to debate at some point, will operate as they do elsewhere across the health service. An NHS organisation or another organisation will say, “This is the set of services that we provide as an organisation.” I see nothing in this Bill that will compel them to do anything other than that. Healthcare organisations up and down the land now make decisions about what is appropriate for them to deliver, based on skills, expertise and demand and whether they think they are well placed to provide care.

I agree with the hon. Member for Reigate, but it does not follow that the amendments are required to enforce that principle. As I understand it, because it is permissible, every organisation and every individual practising healthcare professional will be able to say, “On my own bat, I’m not going to participate in this, regardless of what my employer believes,” not least because of clinical governance and regulation. There is already a strong body of healthcare regulation around the acts and services that are provided. It is currently overseen by the Care Quality Commission. We do not need to reinvent that regime.

I reassure Members that I think it entirely appropriate for hospices or other providers of palliative care to consider whether they want to participate, should the Bill become law. I imagine we will get to a situation in which some will and some will not, which is absolutely appropriate. Particularly in end-of-life cases, a patient will make a choice on the back of that. I am aware that some end-of-life care providers in my area are actively considering whether this is something that they will do; I am equally aware that there are others that think it is not for them. We heard in evidence that in Australia some providers of palliative care provide integrated, holistic care in which it is one of a number of options, whereas other providers do not.

Amendment 481 would insert a new subsection (3)(a) into clause 23, which suggests that an employer has the power to veto an employee doing an act on their time. That is moot: it is not necessary. In the healthcare environments in which I have worked, a doctor may practise elsewhere, doing their own thing, but while they are employed in a certain NHS trust to do an NHS service, they cannot suddenly decide to do something else.

[Rebecca Paul (Reigate) (Con)]

The hon. Member is giving a powerful speech. My amendment is only to ensure that if the employee is working in an NHS clinic, they comply with the policy of that clinic. It would not restrict their doing other things in their own time. The wording of the amendment is clear, as I discussed with the hon. Member for Spen Valley yesterday, that it is just while the employee is performing services for the employer.

[Lewis Atkinson]

I agree that that is what the wording says, but my point is that it is moot. The hon. Lady herself states that the amendment is to prevent an employee from going against the policies of the employer. That power already exists. No healthcare professional says, “Even though I’m employed as a doctor today by such and such a trust, I’m going to do a set of procedures or practices that I want to do.” It is moot.

I have no issue with subsection (3)(a) in amendment 481, although I think it is unnecessary. However, I think subsection (3)(b) is deeply problematic. It cuts across employment law protections by referring to selection when hiring employees. There is a reference to the Equality Act, but as others have noted, it is not clear what protected characteristics we are talking about. At a deeper level, if we accept that there is going to be mixed provision, I would argue—and I think this Committee, in a small way, has shown this—that there is some benefit to that. We should not get to a position where every medic of a certain viewpoint on assisted dying works for one organisation and every healthcare professional of a different viewpoint works for another.

That is not to say, by any stretch, that organisations would be forced to offer assisted dying. Clearly they would not. If the Bill becomes law, however, I want a society that is relatively at peace with it in healthcare, recognising people’s ability to conscientiously object as individuals. Setting up a dichotomy from the start, in which where a medic decides to work is determined by their views on such and such a procedure, is not a road that we should go down. I also have serious concerns, in terms of employment law, about subsection (3)(b).

[Rebecca Paul]

The amendment is simply to prevent a discrimination case. Let us take another example. A rape refuge may provide services to women who have suffered sexual abuse; it may be appropriate, in that instance, to hire only women to support those domestic abuse survivors. In order to prevent a discrimination claim when hiring, we have to rely on the Equality Act and the exemptions carved out. All my amendment says is that the same exemption would apply when a hospice or clinic is employing. It is just to avoid those issues down the road.

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[Naz Shah]

I thank my hon. Friend for her intervention, which gives me a lot to think about. That is why I said that I genuinely do not have the answers. I want to have this discussion so that I can make the choice whether to support the amendments. I want to explore this issue further, because it is really important.

[Rebecca Paul]

The conversation has moved on a little, but I was just going to make the point that the amendments that I tabled focus very much on the rights of the employer with respect to what they expect from their staff. I wonder whether it would be helpful to explore that a bit more.

[Naz Shah]

If we are talking about employers and employees, not people who are accessing the service as service users, I hope the scenario to which my hon. Friend the Member for Penistone and Stocksbridge referred would not happen.

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[Kim Leadbeater]

The right hon. Gentleman makes an important point. The word that we have used a lot—maybe not enough in some respects—is choice. That is important for individuals, but it is important for institutions as well. Putting an institutional opt-out in the Bill would risk creating confusion and distress for patients and their loved ones, and indeed for staff and volunteers.

[Rebecca Paul]

Does the hon. Lady have any concerns about what this position would mean for the end of life workforce? I know we are here to make law, but we cannot ignore the practical consequences for end of life care. If we do not have this carve-out, we could lose a lot of wonderful and great people who work in end of life care and who feel that they are not able to participate, if the hospice cannot specify.

[Kim Leadbeater]

The hon. Lady is absolutely right to acknowledge the wonderful workforce working in end of life care, but there is a range of views within that workforce and there is the individual opt-out. No one has to be involved in this process if they do not want to be. That is clear in the Bill as it stands. I hope that, working together, we can make that even clearer if needed.

Under the Bill, doctors and health professionals already have the ability to opt out for any reason, wherever they work.

Terminally Ill Adults (End of Life) Bill (Twenty-third sitting)

Rebecca Paul Excerpts

Wednesday 12th March 2025 Public Bill Committees

[Danny Kruger]

The hon. Lady does always come back to that point, and I respect it. She imagines that the good practice that is prevalent in the system will obtain automatically, in all cases, under the assisted dying regime, even though that regime is completely new. She says that she cannot envisage a scenario in which the doctors would not hear from all the professionals we all think should be consulted at this stage of the process. I have two points to make on that. First, why not make it explicit that that is required? Secondly, I am afraid that I can envisage scenarios in which for doctors—perhaps some years down the line, once this model of death has become normalised, as it has in Canada and elsewhere, with up to 10% of deaths coming through assisted dying—it just becomes a procedure.

Again, we have not ruled out the possibility—the likelihood, in fact—of independent clinics establishing themselves with a business that is about providing the support for people who want to end their life. There will be doctors who are happy to conduct the assessments; to take at face value what they hear from the patient; not to involve a wider multidisciplinary team in their consultations; and to expedite the process as the Bill, as drafted and amended, allows. I am afraid I do foresee a scenario in which the good practice in which all believe does not happen. My concern, and I expect the hon. Lady’s is the same, is to prevent that.

[Rebecca Paul (Reigate) (Con)]

My hon. Friend is making a powerful point. One of my concerns is about what happens if someone seeks assisted dying privately through a clinic. I see risks with multidisciplinary teams involving social workers continuing in that instance. Does my hon. Friend share my concern?

[Danny Kruger]

I certainly do. That is exactly the scenario that I fear, and I fear it within the NHS too. Let us not imagine that every NHS doctor has all the time and the access to the wider specialisms that they would wish. Under the Bill in its current form, there will be a very strong incentive and a very strong personal instinct for compassionate doctors, who believe in the autonomy of patients and in respecting the patient’s wishes, to take at face value what they are told and not to seek the expertise that would happen automatically if there were a proper multidisciplinary team at that stage of the process.

My point is that we do need a multidisciplinary team, but what is in the Bill is not it. At best, it is half a multidisciplinary team. There is no doctor on it. There is a lawyer, pointlessly. There is a sort of quasi-MDT—a duo-disciplinary team—but it is in the wrong place, and it will not assess, which is the job it should do, but judge. It will not diagnose or advise in the way that a clinician should; it will simply decide whether the criteria have been met for an assisted death. That job was rightly given to judges in the Bill that the House of Commons voted for, but this Bill does not have the powers, the safeguards, the accountability or the independence of a tribunal, let alone that of a court.

As the hon. Member for Spen Valley candidly says, the panel is not a judicial entity in any sense. It is a weird creature, neither one thing nor the other: a quasi-multidisciplinary team, at the wrong stage in the process, for the wrong purpose. I have said that it is not a multidisciplinary team, but it is not really a judicial entity either, as the hon. Lady has mentioned. It is certainly not “judge-plus”, as was originally suggested. There is no judge, just a legal member—not a judicial member but a legal member, who might be a lawyer.

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[Sarah Sackman]

I thank hon. Members for their interventions.

In respect of the standard that would be applied in order for the panel to be satisfied, in practice, as I was saying, the panel would establish a case on the balance of probability in those circumstances only on the basis of strong evidence. In other words, the more serious the issue to be determined, the closer the scrutiny and the stronger the evidence required.

Introducing a requirement for the panel to be satisfied beyond all reasonable doubt at this stage would create a difference to, or a divergence from, the standard applied by professionals earlier in the process, such as by the doctors in the first and second assessments, and—I think the hon. Member for Reigate acknowledged this in her speech—to ascertain whether, among other things, the person has capacity to make the decision to end their own life, whether they have a clear, settled and informed wish to do so, and that they have not been pressured or coerced. Such a requirement would create the problem of making the application of the Bill incoherent because, of course, if a civil standard has been applied earlier in the process, the higher, criminal bar could never be satisfied at the panel stage. The principal decision is what standard should be applied and, as I have said, the civil standard is used in other end-of-life decisions, but there is also a question of the internal coherence of the Bill.

[Rebecca Paul]

I thank the Minister for the very clear way in which she is explaining everything. I completely acknowledge what she has just said. As she rightly said, I alluded to the fact that I tried to make the change at an earlier stage, but was unsuccessful, and I am now trying to put it through here. Can the Minister comment on the meaning of “satisfied”? If we are not going to have “beyond reasonable doubt”, can she expand a little on the meaning of “satisfied” and whether she is comfortable that that is clear enough for these purposes?

[Sarah Sackman]

The answer is yes. I, on behalf of the Government, am satisfied that that would be commonly and well understood by those applying it, and any court construing it, that the standard to be applied is the civil standard. That would be understood by not just the commissioner in terms of laying down the rules for the panels, but the panels themselves. It is important to recall that as Lord Bingham, one of the most distinguished judges that this country has ever produced, once said,

“The civil standard is a flexible standard to be applied with greater or lesser strictness according to the seriousness of what has to be proved”,

and there is no doubt, based on what Parliament has debated, about the utmost seriousness of these issues. To answer the hon. Member’s question, the answer is yes, I think it is clear. That is the Government’s position.

Amendment (b) to new clause 21 would give the panel discretion to refuse to grant a certificate of eligibility where the requirements stated in the Bill are met if it believes there are

“particular circumstances which make it inappropriate for the person”

to be provided with assistance. The Government’s view is that this could risk unpredictability and inconsistency in the panel’s decision making and reduce legal certainty for the person seeking assistance, as well as for the panel.

Amendment (c) to new clause 21 concerns three specific requirements under subsection (2):

“(c) that the person has capacity…(h) that the person has a clear, settled and informed wish to end their own life”

and

“(i) that the person made the first declaration voluntarily and was not coerced or pressured by any other person”.

The amendment would mean that despite finding that those criteria had been met on the balance of probabilities, the panel could stay proceedings when it believed there was a real risk that they have not been satisfied. As with amendment (b) to new clause 21, this could result in uncertainty for the applicant and in terms of what is required of the panel in its decision making.

As I referred to earlier, in a lot of these decisions, the question of whether somebody has capacity or is being coerced is ultimately a binary decision for each panel member. The person has capacity or they do not. In applying the civil standard with the rigour that Lord Bingham spoke about in the most serious cases in circumstances when the panel or its members identify that there is a real risk, one would expect them to exercise their discretionary powers to seek more evidence to remove that risk and doubt, and if that persists, to refuse and make the binary choice that the person does not have capacity or is being coerced, or vice versa.

Amendment (d) to new clause 21 would require the panel to hear from and question both assessing doctors, as opposed to the requirement that the person must hear from, and may question, one of the doctors, and may hear from and question both. The amendment would also require the panel to hear from and question the person seeking assistance and the person’s proxy when clause 15 applies. Under new clause 21, the panel must hear from and may question the person seeking assistance and would have the ability to hear from and question their proxy.

The amendment would also make it explicit that the panel must consider hearing from and questioning parties interested in the welfare of the person and those involved in the person’s care. Under new clause 21, the panel would have the ability to hear from any other person, which could include family members, caregivers and whomever else it deems appropriate.