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

Sean Woodcock Excerpts

Committee stage
Tuesday 25th February 2025 Public Bill Committees

[Naz Shah]

The crux for me is that at Second Reading, when the Bill was voted on, many Members cited that one of the central planks to that debate at the time was the six-month prognosis. The amendment would increase that to 12 months. As I have said, my concerns are that we are only three months on from that conversation and we are already trying to expand the Bill, which is why I would not support the amendment. I have said quite a bit on amendment 234, so I will leave it.

I will now speak to amendment 48, which I tabled. Under the current wording of the Bill, a person is terminally ill if their death

“can reasonably be expected within 6 months.”

My amendment would change that so that for a person to be considered terminally ill their death would have to be

“expected with reasonable certainty within 6 months, even if the person were to undergo all recommended treatment”.

One of the risks that confronts the Bill is that of misdiagnosis. That is not some remote possibility. Let me go into detail. As hon. Members know from the evidence brought before the Committee, prognosis is not a precise science. Even with physical illnesses, determining life expectancy is highly unreliable. Government data from the Department for Work and Pensions reveals that one in five people given six months to live are still alive after three years. A study spanning 16 years found that doctors wrongly predict how long terminally ill patients will survive in half of cases. Out of 6,495 patients who were predicted to die within six to 12 months, more than half—3,516, to be precise—lived longer than expected. If the Government themselves cannot accurately determine terminal illness for benefits, how can we rely on such predictions to justify ending lives?

Studies cited in written evidence submitted to the Committee have found that clinicians are routinely inconsistent and inaccurate in their prognostic assessments, often underestimating survival. Professor Katherine Sleeman, a palliative care specialist, underlined that point in her evidence to the Committee. Doctors face considerable difficulty in prognosing whether somebody is in the last six months of their life. Professor Sleeman cites studies based on large samples of patients for whom doctors prognosed life expectancy. The studies found that 47% of the patients whom they predicted to have six months to live in fact lived for longer than that—in some cases considerably longer.

I would argue that there is a danger in using the standard of prognosis currently in the Bill. The current research into doctors’ prognoses indicates that almost half of their estimates that a patient has six months to live are incorrect. We do not want people to choose assisted dying on the basis that they have only six months to live when a very high proportion of them will in fact live longer if they are not given assistance to die by taking a lethal drug or drugs.

My amendment would hold doctors to a higher standard of certainty. Under that measure, they would be explicitly held to prognosing that death would occur with “reasonable certainty” within six months, and that that would be true even if the patient underwent all recommended treatment.

[Sean Woodcock (Banbury) (Lab)]

I think we all accept that prognosis is quite difficult, but one reason why I think this is fundamentally important is that a member of my constituency Labour party was given a prognosis of 12 months in 2012. Last year, they were out delivering leaflets for me in the general election. That is why it is so important that we make sure we get this right. I am sure that my hon. Friend has examples of her own. Is that what is guiding her to press this amendment?

[Naz Shah]

It is absolutely what is guiding me. I am sure we all know people who were told that they had six months to live and have lived a lot longer. We have heard stories of people who were told that they had six months to live and lived beyond 20 years more. We have heard lots of tragic cases, for example in the world of Dr Jamilla Hussain, that would really benefit from the Bill’s being available to them. But equally, there are other families whose loved ones have survived—and not just survived, but thrived for years and years. In fact, a close friend of mine, who happens to be a constituent of my hon. Friend the Member for Spen Valley, was diagnosed not to live very long. It was an emotional time for her daughters. Eighteen and a half years later, she is still alive, well and thriving.

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

Sean Woodcock Excerpts

Wednesday 29th January 2025 Public Bill Committees

[Sean Woodcock (Banbury) (Lab)]

Q My question is to Dr Griffiths and Chelsea. We have had almost two days of evidence. Yesterday afternoon, we had practitioners from the States and, this morning, we had practitioners from Australia. The message they gave seemed to be very clear that coercion essentially does not happen in voluntary assisted dying. The message also was that those who went through it were people who wanted to—it was very appropriate for them and there were almost no issues. Can you explain why they are wrong, if you believe they are?

Dr Griffiths: That goes back to my previous point around how coercion can manifest in various different ways. One can be exposed to the societal pressure to feel that your life is no longer tolerable because of the struggles that you have in terms of accessing services, provision and support. We know from data that we have people in the community who are struggling to see their GPs or consultants associated with their conditions and changes in their conditions. The coercion, I feel, will come from how society is organised, and does not respond to the injustices faced by disabled people.

Also, there is a broader, slightly different issue, which is that there is nothing in the Bill, in my view, that satisfies the concern that—if it were to pass—you would create a network of practitioners who are sympathetic to the principles of assisted dying, and therefore, when somebody comes forward to say, “I want to die”, they will be more receptive to those ideas that the individual has. They will therefore facilitate their process through that, which I think undermines any attempts to have objective scrutiny of coercion that may occur. There is nothing that stops you from saying, “I know that there are these certain people I can go to who have either been public or have supported others to have access to this service. Therefore, that is my best chance of gaining access.” That then collapses all attempts to address issues of coercion.

Chelsea Roff: To add to what Miro is saying, we have seen in our study a more subtle form of influence, and sometimes it actually comes, tragically, from the clinicians themselves. We saw 95% of clinicians tell the patient and their family that they had an incurable, irremediable illness with a prognosis of six months or less in some cases. That has an influence on a person and does not cohere with the evidence on eating disorder recovery— in fact, we have no good ways of making prognosis in eating disorders. The only good prognostic indicator we have is weight restoration.

I would also highlight—relevant to here, where we live —that the all-party parliamentary group on eating disorders just put out a brilliant report on huge gaps in the care system. I am working with a person and a family right now, who has been to the Court of Protection, whose eating disorder team presented her and used the term “not treatable” to the judge, as well as the term “in the end stage of her illness”, and predicted that she would die within six months. Eighteen months later, she and her family are still fighting for treatment and are being denied services. That is the kind of coercion I am worried about, which happens within a healthcare system that I know many of you were elected to fix. That is what so many people have called for—to fix a broken NHS. That is not my choice in terminology—I love the NHS, but I think that is what we need to be worried about.

Clause 4(4) especially to me reads like a formula for coercion. A physician could say to a young woman with an eating disorder, “You have a severe and enduring eating disorder”, which you will not find in any diagnostic text, but is used frequently in these cases and in the Court of Protection. They could say, “We have done all we can. The treatment options are exhausted”—again, you will find that in the Court of Protection—and, “Your prognosis is poor”. It leaves you with a feeling that you have nothing left to choose from, especially if you are struggling to access services.

[The Chair]

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

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

Sean Woodcock Excerpts

Committee stage
Wednesday 29th January 2025 Public Bill Committees

[Sean Woodcock (Banbury) (Lab)]

Q My question is to Dr Griffiths and Chelsea. We have had almost two days of evidence. Yesterday afternoon, we had practitioners from the States and, this morning, we had practitioners from Australia. The message they gave seemed to be very clear that coercion essentially does not happen in voluntary assisted dying. The message also was that those who went through it were people who wanted to—it was very appropriate for them and there were almost no issues. Can you explain why they are wrong, if you believe they are?

Dr Griffiths: That goes back to my previous point around how coercion can manifest in various different ways. One can be exposed to the societal pressure to feel that your life is no longer tolerable because of the struggles that you have in terms of accessing services, provision and support. We know from data that we have people in the community who are struggling to see their GPs or consultants associated with their conditions and changes in their conditions. The coercion, I feel, will come from how society is organised, and does not respond to the injustices faced by disabled people.

Also, there is a broader, slightly different issue, which is that there is nothing in the Bill, in my view, that satisfies the concern that—if it were to pass—you would create a network of practitioners who are sympathetic to the principles of assisted dying, and therefore, when somebody comes forward to say, “I want to die”, they will be more receptive to those ideas that the individual has. They will therefore facilitate their process through that, which I think undermines any attempts to have objective scrutiny of coercion that may occur. There is nothing that stops you from saying, “I know that there are these certain people I can go to who have either been public or have supported others to have access to this service. Therefore, that is my best chance of gaining access.” That then collapses all attempts to address issues of coercion.

Chelsea Roff: To add to what Miro is saying, we have seen in our study a more subtle form of influence, and sometimes it actually comes, tragically, from the clinicians themselves. We saw 95% of clinicians tell the patient and their family that they had an incurable, irremediable illness with a prognosis of six months or less in some cases. That has an influence on a person and does not cohere with the evidence on eating disorder recovery— in fact, we have no good ways of making prognosis in eating disorders. The only good prognostic indicator we have is weight restoration.

I would also highlight—relevant to here, where we live —that the all-party parliamentary group on eating disorders just put out a brilliant report on huge gaps in the care system. I am working with a person and a family right now, who has been to the Court of Protection, whose eating disorder team presented her and used the term “not treatable” to the judge, as well as the term “in the end stage of her illness”, and predicted that she would die within six months. Eighteen months later, she and her family are still fighting for treatment and are being denied services. That is the kind of coercion I am worried about, which happens within a healthcare system that I know many of you were elected to fix. That is what so many people have called for—to fix a broken NHS. That is not my choice in terminology—I love the NHS, but I think that is what we need to be worried about.

Clause 4(4) especially to me reads like a formula for coercion. A physician could say to a young woman with an eating disorder, “You have a severe and enduring eating disorder”, which you will not find in any diagnostic text, but is used frequently in these cases and in the Court of Protection. They could say, “We have done all we can. The treatment options are exhausted”—again, you will find that in the Court of Protection—and, “Your prognosis is poor”. It leaves you with a feeling that you have nothing left to choose from, especially if you are struggling to access services.

[The Chair]

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

NHS: Independent Investigation

Sean Woodcock Excerpts

Thursday 12th September 2024 Commons Chamber

[Wes Streeting]

I am not sure that is a fair characterisation of Sir John Bell’s position. I have a huge amount of respect for him. I am grateful to Lord Darzi for writing the diagnosis. Given that the Conservative party was in government for 14 years, repeatedly promised to rebuild Hillingdon hospital and left my Department in a position where the money for the new hospitals programme ran out in March, the hon. Member has some brass neck to point the finger at us while he is in opposition.

[Sean Woodcock (Banbury) (Lab)]

In 2016, the Horton hospital in my constituency lost its consultant-led maternity unit—a temporary downgrade that ended up being made permanent three years later. Is it not about time that someone from the Conservative party apologised for the damage done to Banbury’s hospital, as well as to the NHS as a whole?

[Wes Streeting]

I am delighted to see my hon. Friend here. His constituents can already see that he is not backwards in coming forwards. He will stand up and champion their interests in this House as a great constituency MP. When it comes to the Conservative party, sorry seems to be the hardest word.

Oral Answers to Questions

Sean Woodcock Excerpts

Tuesday 23rd July 2024 Commons Chamber

[Karin Smyth]

The hon. Gentleman makes a really important point about mental health support in that critical period. We will absolutely make sure that is looked at.

[Sean Woodcock (Banbury) (Lab)]

12. Whether he plans to hold discussions with NHS staff and patients on his plans for reforming NHS health and social care services.

[The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)]

I thank my hon. Friend the Member for Banbury—words I did not think I would ever say—and welcome him to his place. The answer to his question is yes. We do not just want to discuss with patients and staff; we want them to help shape the 10-year plan for the next decade of reform, which will take our NHS from the worst crisis in its history and make it fit for the future. Social care also needs to change. We will work with care workers and care users to build consensus for and shape a new national care service.

[Sean Woodcock]

Does the Minister agree that the voices of frontline staff, whether in hospitals such as the Horton general hospital in Banbury or carers like my mum, are still often ignored when it comes to whistleblowing? More worryingly, those voices are silenced by threats to report them to regulatory bodies. Does he agree that we need to level the field of accountability for managers who ignore whistleblowers, and that there should be a regulatory body with oversight of medical managers?

[Andrew Gwynne]

My hon. Friend is absolutely right. We have previously said that bank managers are more regulated than NHS managers. This Labour Government will pursue an agenda of greater accountability, transparency and candour when it comes to those making managerial and executive decisions in our national health service.

--- Later in debate ---

[Wes Streeting]

I warmly welcome the hon. Member to her place. She is absolutely right to raise the plight of unpaid family carers. They are part of the team, as far as this Government are concerned, so as we set out our 10-year plan for social care as part of our ambition to build the national care service, we will make sure that unpaid family carers are very much at the centre of our thinking, in no small part thanks to her representations.

[Sean Woodcock (Banbury) (Lab)]

T4. The Keep the Horton General campaign in my constituency has recently catalogued the poor experiences of tens of Banbury-based mothers who gave birth at the John Radcliffe hospital in Oxford. Will the Secretary of State or a member of his team meet me to discuss these concerning reports of poor maternity care?

[Wes Streeting]

Of all the issues that keep me awake at night, maternity safety is top of the list. We have already heard about the staffing shortages and the actions we will take to address that, but I also want to reassure people that, as we build our 10-year plan for the NHS, patient voices, including those of recent and expectant mothers, will be part of that process.