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

Sean Woodcock Excerpts

Committee stage
Tuesday 25th March 2025 Public Bill Committees

[Danny Kruger]

No, I fundamentally disagree: end-of-life care is healthcare. It is addresses symptoms and conditions, and it is designed in a way that is completely compatible with the founding principle of the NHS, whereas the Bill—I appreciate the honesty of the drafters in recognising this, even if they do not quite spell it out—and its proposal of an assisted suicide service is not compatible with the founding principle of the NHS. That is why adapting that founding subsection as in the original NHS Act is required. Of course I recognise that end-of-life care is healthcare and completely compatible with what the NHS does. I wish it were more part of the NHS—that is another debate. Palliative care should have been more closely integrated into NHS provision, and it still should be.

I want to tease out a tension among the drafters and advocates of the Bill about exactly how the assisted suicide service will be facilitated and provided. We have got a bit closer to it, but some questions remain, which is regrettable when here we are on the very last day of the Committee’s debate. Last month, the hon. Member for Spen Valley told the Committee:

“This is not assisted suicide by the state. The state is not involved.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 11 February 2025; c. 318.]

I am perplexed by that. I think many members of the public would not agree with that analysis of how the Bill has evolved in Committee. If involving the state in the provision of this service was not intended, then that is not the Bill we have.

In contradiction to that, and I think more accurately, the Minister for Care told us that the promoter’s intent—speaking for the hon. Member for Spen Valley—is

“to ensure that the assisted dying service is available as an integral part of the NHS. Officials are working on amendments to later clauses to establish the operating model for her consideration.” —[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 5 March 2025; c. 802.]

That is clearly what has happened, and it is where we are now. However, I am sorry to say that I do not feel that the operating model is now clear. We still do not have an impact assessment, we do not know how the Government envisage it working in practice, and important information is still lacking for the debate today. We do not know the possible impact on general practice or medical specialists, nor how it might impact money that is available for palliative care. I hope the Minister can tell us more today about how he envisages the service being implemented, especially in the light of the British Medical Association conference earlier this month, which supported the motion that

“Assisted dying is not a health activity and it must not take place in NHS or other health facilities”.

That is a principle I agree with.

On 5 March, the hon. Member for Spen Valley said:

“there is no expectation that assisted dying would be set up as a private enterprise or service. It would be delivered within the provision of the NHS.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 5 March 2025; c. 799.]

That now agrees with the Minister—fine, interesting; it is to be an NHS service not to be provided privately. But the new clauses do not rule out private provision, nor any profit making by providers or remuneration of people outside the NHS. Indeed, the new clauses refer to “voluntary assisted dying services”, which suggests the hon. Member for Spen Valley is supportive of services outside those that are NHS commissioned, which will be possible under subsections (1), (3) and (7)(a). That will be in line with comments made by my right hon. Friend the Member for North West Hampshire, who made a very coherent case for private provision of assisted suicide if that is what Parliament chooses to legalise; he said that nothing should prevent someone from opting for private provision. In response, the hon. Member for Spen Valley said:

“This service, like many others, will be delivered through a range of providers”.––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 5 March 2025; c. 800.]

I remain unclear about the extent to which this is an NHS monopoly, as it were, or whether there will be private provision that is privately paid for, or private provision that is publicly paid for. I would be grateful for the hon. Member’s clarification.

Lastly, on the question of profit, in an article in The Times that appeared to have some briefing behind it, there was a suggestion that there would be a cap on the profit of private companies providing the service, limiting them to “making a reasonable profit”. Again, there is nothing in the new clauses about limitations on providers’ profits. If the hon. Member could clarify how she envisages the private provision of the service, I would be grateful.

[Sean Woodcock (Banbury) (Lab)]

It is a pleasure to serve under your chairship, Ms McVey. I rise to speak to amendment (b) to new clause 36, which was tabled by my hon. Friend the Member for Shipley (Anna Dixon). The amendment states:

“Regulations under subsection (1) may not amend, modify or repeal section 1 of the National Health Service Act 2006.”

For clarity, I will read out the relevant part of section 1 of the 2006 Act:

“The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement—

(a)in the physical and mental health of the people of England, and

(b)in the prevention, diagnosis and treatment of physical and mental illness.”

Those core principles have remained the same since the National Health Service Act 1946. As the hon. Member for East Wiltshire stated, in a Britian that was devasted by war, Clement Attlee and Nye Bevan together promised a better future, one where healthcare should be available to all, regardless of wealth. It enshrined a principle that as a society we will care for the ill and we will do that together. No one’s health should be left behind, especially that of the vulnerable.

The NHS stands as the greatest legacy of a Labour Government—despite the input of Opposition parties referred to by the hon. Member for East Wiltshire—and perhaps of any Government since the second world war. The establishment of the NHS lives on in section 1 of the NHS Act. It is why at the height of the pandemic NHS staff courageously put themselves on the frontline to protect us. It is their mission to secure improvement in the physical and mental health of all, free at the point of service. As we consider assisted dying, we must not lose the values at the heart of the NHS.

Section 1 of the 2006 Act has changed little from the corresponding first section of the 1946 Act. It is not just a line in legislation; it has become part of our national story and our national identity, and amendment (b) to new clause 36 is about continuing that. It seeks to preserve the legacy of Attlee and Bevan, and that of Labour Governments committed to the betterment of the people.

Twenty-five senior doctors and pharmacists from Shetland and Orkney spoke of that legacy in their written evidence:

“We note with pride the founding principles of the NHS, with the 1946 National Health Service Act stating, ‘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.’ We believe that Parliament must reflect the lasting ethos of our founding document.”

There are very few lines in legislation that come to represent an institution in this way. It is a testament to the ideal of those founding principles in section 1 that they guide doctors to this very day. This is the thread that runs through the 1946 Act to the 2006 Act—two Labour Governments, 60 years apart, united by this mission to improve the physical and mental health of the people. This Committee should continue the thread of those principles.

Of course, I understand that previous legislation may need to be amended to provide assisted dying services, and that may include the 2006 Act. New clause 36(4) clarifies that specified references to commission voluntary dying services may be included in that Act. I note with regret that the new clause gives us so little information elsewhere about the use of these powers, which are commonly known as Henry VIII powers or clauses. This is not a term that I was familiar with until very recently. I am sure other Members are much more familiar with it than I am, but on the off-chance that there are one or two Members who need a reminder, I will read Parliament’s own official definition of the term:

“‘Henry VIII clauses’ are clauses in a bill that enable ministers to amend or repeal provisions in an Act of Parliament using secondary legislation, which is subject to varying degrees of parliamentary scrutiny.”

Helpfully, it adds:

“The expression is a reference to King Henry VIII’s supposed preference for legislating directly by proclamation rather than through Parliament.”

I accept that it might be rather odd to talk about Henry VIII in this debate, but we should not let that distract us from the serious question of this new clause, which could result in a significant transfer of power from Members of this House to the Secretary of State, and it is not clear what that power will be used for.

The Hansard Society has noted that there is little indication about what role or nature these powers will take, saying:

“A key principle that the House of Lords Constitution Committee has applied to delegated powers is that they ‘should not be framed in such a way that gives little indication of how they should be used.’ The Delegated Powers and Regulatory Reform Committee’s guidance to Departments states that the Delegated Powers Memorandum should set out how it is proposed that a power should be exercised.”

I would be grateful if my hon. Friend the Member for Spen Valley and Ministers could provide clarity on those questions. New clause 36(1) does not specify that voluntary assisted dying be provided on the NHS, but subsection (4) allows for the National Health Service Act 2006 to be amended. What is the intention of these powers? What will the structure of the voluntary assisted dying service be? How will it be funded and who will be responsible for the provision of the services? The answer to those questions will inform which legislation needs to be amended, and that information should be in the Bill.

To be clear, as I have said, I accept that changes to previous legislation may be required. However, the provision of assisted dying should not amend the foundational principles of the national health service. It should not break with the legacy of Attlee, of Bevan and of Labour. That is why I support amendment (b) to new clause 36.

--- Later in debate ---

[Dr Opher]

My hon. Friend is making a reasoned speech. The thing is that the way the NHS is delivered is already very complex: for example, GPs are private providers who are on a contract with the NHS. Amending the Bill to completely ban private providers will not in any way enhance it; it will create a situation in which almost no doctors can get involved. We need to keep the private aspect simply so that the NHS can control what is going on, albeit the providers can be from independent organisations.

[Sean Woodcock]

I am afraid I just do not agree. My view is that if we are going to do this, it should be done via the NHS. As somebody who stood on a Labour election platform not too long ago, that is something I stand by.

We know that geography and socioeconomic factors render access to healthcare, especially private healthcare, unequal. In oral evidence, Baroness Kishwer Falkner, head of the Equalities and Human Rights Commission, and Fazilet Hadi of Disability Rights UK both explained how the impact of the Bill on an unequal society might cause problems. Baroness Falkner said that

“from what one understands, GP provision and general access to healthcare are poorer where demographics are poorer than it is in the better performing parts of the country. One other factor to consider in terms of a postcode lottery is that people in wealthier parts of the country tend to be more highly represented in private healthcare than in public healthcare and use of the NHS. That also impacts their choices and the care they get.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 181, Q235.]

The system must not only be fair, but be seen to be fair. If we had such a system of private provision in place, public trust would almost certainly fall. We do not have to look far to see what happens if these matters go unaddressed. When we have a lack of oversight and accountability, it is the public who suffer. There have been too many scandals in recent history for us not to recognise that reality.

One of the big factors in the Post Office Horizon scandal was that Fujitsu, the supplier of specialist computer software, did not admit when it knew that things were going wrong. I have spent much of my working life in the public sector and I am not saying it is perfect—far from it—but the Horizon scandal is an example that teaches an important lesson. Sometimes private companies will not share information that could mean they lose a lucrative contract. They do not have the same oversight as public authorities, which are ultimately accountable to the Government, to Parliament and, through them, to the public.

We must give the public reason to trust that assisted dying services will have proper oversight; otherwise, the consequences will be felt not just in the provision of assisted dying but in healthcare more generally. Amendment (c) to new clause 36 addresses some of the risks by establishing that voluntary assisted dying services must be provided by a public authority. Furthermore, a body contracted by a public authority to provide the service must be a public authority.

A public authority is defined as:

“A body substantially publicly funded which performs statutory duties, objectives and other activities consistent with central or local governmental functions.”

It is clear that public authorities have stronger mechanisms for transparency and reporting. Requiring assisted dying provision to be through such authorities also places the responsibility firmly with the state. It allows the direct implementation of regulations and guidelines on the provision of assisted dying. Best practice is easier to establish when the regulations apply to the same types of organisations.

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

It is a pleasure to serve under your chairship, Ms McVey. In similar circumstances, with the provision of intense personal services such as in vitro fertilisation, there are a range of providers, some in the private sector and some in the public sector—in fact, most are in the private sector even if they deliver under NHS funding or an NHS contract—but they are all subject to the same rules, inspection and regulations. Does my hon. Friend not accept that if it can work in an intense, personal and sometimes ethically complex situation like that, it could equally work here, because there is experience in that sort of environment?

[Sean Woodcock]

I accept that it could work, but my view is that it is far less likely to work and that it is more likely to be successful if it is wholly the responsibility of public authorities.

I will vote in favour of amendment (d) to new clause 36. It would remove subsection (6), which says:

“Regulations under this section may make any provision that could be made by an Act of Parliament; but they may not amend this Act.”

It strikes me as dangerous to provide in the Bill for the Secretary of State to amend primary legislation, and we should vote to remove that power. It is surely a weakening of the Bill’s safeguards. Assisted dying must remain firmly in the control of the democratically elected Parliament. I urge Members to join me in voting to remove subsection (6).

If we fail to rule out the possibility of private provision and allow the Secretary of State the power to amend primary legislation, we will fail to implement the necessary safeguards. Amendments (c) and (d) to new clause 36 would go some way to addressing that, by ensuring that the state that sanctions assisted dying is also the body that provides it. Assisted dying services need strong reporting and accountability; otherwise, we risk inequality, or the abuse of assisted dying going unchecked. The provision of assisted dying through public authorities is essential to proper accountability, reporting and best practice, so I urge the Committee to support the amendments.

[Sarah Olney (Richmond Park) (LD)]

It is a pleasure to serve under your chairmanship, Ms McVey.

In Richmond Park, a Henry VIII power has traditionally meant the right of the monarch to hunt the deer in the large open space that gives my constituency its name—something that I am sorry to say he has in common with the dog of the hon. Member for East Wiltshire—