Eating Disorder Awareness

Stephen Kinnock Excerpts

Tuesday 1st April 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your maiden chairship today, Mr Stuart. I am extremely grateful to the hon. Member for Bath (Wera Hobhouse) for securing the debate and raising this important topic. I know that, as a Member of this House and chair of the APPG on eating disorders, she has been a doughty champion for those living with eating disorders, their families and supporters. I am also grateful to other hon. Members for their valuable contributions, many of which were deeply personal and profoundly moving. I pay tribute to hon. Members for making those contributions.

I share the desire of the hon. Member for Bath to improve the lives of people affected by an eating disorder. Raising awareness of eating disorders and improving treatment services is a key priority for the Government, and a vital part of our work to improve mental health services. We know that living with an eating disorder can be utterly devastating, not just for those battling the condition but their loved ones and those who witness their struggle. We know that eating disorders can affect people of any age, gender, ethnicity or background. However, we also know that recovery is possible, and access to the right treatment and support can be lifechanging, as we have heard today.

Although record investment and progress has improved access to eating disorder services, the reality is clear: demand has surged, especially since the pandemic, outpacing the growth in capacity. We must do more to ensure that everyone who needs support can get it without delay.

[Wera Hobhouse]

The Minister is making a powerful point. Demand is surging, yet it seems that investment from ICBs is going to fall. How can that be possible, and how is it morally acceptable?

[Stephen Kinnock]

National funding has increased over the years, as the hon. Lady will know. The question is whether that funding channels through to ICBs. The Government’s view is that ICBs are best placed to make decisions as close as possible to the communities that they serve and to target and, if necessary, reallocate funding accordingly. As a Government, we are constantly trying to get the balance right between setting frameworks and targets and ensuring that those are being met, while also ensuring that ICBs are not being micromanaged from the centre. We do not think it is right that people sitting in Whitehall or Westminster micromanage what is going on at a local level. We are absolutely clear that every ICB must meet its targets, while also being clear that it is up to the ICB to take decisions as close as possible to the communities that they serve.

Sadly, we have seen the prevalence of eating disorders in children and young people sharply increase since 2017. In 2023, NHS England published follow-up results to its survey on the mental health of children and young people. The report found that the prevalence of eating disorders in 17 to 19-year-olds rose from 0.8% in 2017 to 12.5% in 2023. Unfortunately, we are also seeing the prevalence of eating disorders rising among adults. The 2019 health survey for England showed that 16% of adults over 16 screened positive for a possible eating disorder. The figures do not mean that the individual had a confirmed eating disorder, but they present a worrying situation that we must address by continuing to promote both awareness and early intervention.

The surge in demand has inevitably made meeting our waiting time targets more challenging. However, our services and clinicians, backed by new funding, are supporting more people than ever before. These services are changing and saving lives. As hon. Members will know, we have kept in place the access and waiting time standard for children and young people who are referred with eating disorder issues. This sets a 95% target for children with urgent cases to begin treatment within one week, and for children with routine cases to start treatment within four weeks.

Figures released last month show that although the number of referrals and demand for services has begun to stabilise during the past year, the number of children entering treatment reached a record high of 2,954 last quarter. This shows that the extra funding is enabling services to begin to meet the extra pressures caused by the pandemic. Similarly, the number of children entering treatment within the target time has reached a record high. Of the 2,954 children entering treatment last quarter, 2,414 were able to access that treatment within the one-week urgent target or the four-week routine target—a rate 81.7%. That is the highest figure recorded since NHS England began collecting that data in 2021.

However, we recognise that there is still far more to be done to ensure that patients with eating disorders can access treatment at the right time. The hon. Member for Bath rightly focused the debate on the importance of awareness. Raising awareness of eating disorders is the first step towards early intervention to prevent the devastating impacts that eating disorders can have on people’s lives. To support this, NHS England is currently refreshing guidance on children and young people’s eating disorders.

The refreshed guidance will highlight the importance of awareness and early recognition of eating disorders in schools, colleges, primary care and broader children and young people’s mental health services. A number of colleagues asked when that guidance will be published; my officials are working hard with specialists on that, and it will be published later this year.

The existing mental health support teams, supplemented by the specialist mental health professionals that we will be providing access to in every school in England, will support school staff to raise awareness and identify children and young people showing potential early signs of an eating disorder. Through these interventions, children and young people can be given early support and help to address problems before they escalate.

Community-based early support hubs for children and young people aged 11 to 25 also play a key role in providing early support for young people’s mental health and wellbeing. Early support hubs provide open-access drop-in mental health services that assist children and young people with a range of issues, such as eating disorders, at an early stage without the need for a referral or doctor’s appointment.

I am pleased to say that this year, thousands more young people will receive support with their mental health, thanks to £7 million of new funding for 24 existing community-based early support hubs to expand their current offer. That funding will deliver 10,000 more interventions such as group sessions, counselling therapies and specialist support over the next 12 months. Looking forward, we are also committed to rolling out open-access young futures hubs in communities. This national network is expected to bring local services together and deliver support for young people facing mental health challenges, including support for those with eating disorders.

We should also be concerned about the widespread availability of harmful online material that promotes eating disorders, suicide and self-harm, which can easily be accessed by people who may be vulnerable. We have been clear that the Government’s priority is the effective implementation of the Online Safety Act, so that those who use social media, especially children, can benefit from its wide-reaching protections as soon as possible. Our focus is on keeping young people safe while they benefit from the latest technology. By the summer, robust new protections for children will be enforced through the Act to protect them from harmful content and ensure that they have an age-appropriate experience online.

It is right to focus on awareness and early intervention, but we know that some people simply need access to high-quality treatment in order to get better. A key priority of this Government is therefore to expand community-based services to treat eating disorders, so that people can be treated earlier and closer to home. NHS England is working to increase the capacity of community-based eating disorder services. By improving care in the community, the NHS can improve outcomes and recovery, reduce rates of relapse, prevent children’s eating disorders continuing into adulthood and, if admission is required as a last resort, reduce the length of time that people have to stay in hospital.

I am pleased to say that funding for children and young people’s eating disorder services has increased, rising from £46.7 million in 2017-18 to a planned £101 million in 2024-25. With this extra funding, we can focus on enhancing the capacity of community eating disorder teams across the country. We are also committed to providing an extra 8,500 new mental health workers across child and adult mental health services to cut waiting times and ensure that people can access treatment and support earlier. Through the 10-year health plan, this Government will overhaul the NHS and ensure that those with mental health needs, including those living with eating disorders, are given the support that they need.

I share the concern of the hon. Member for Bath about accurate recording of deaths to understand the extent to which eating disorders and other factors have caused or contributed to deaths. This matter is being explored with the national medical examiner for England and Wales, the Office for National Statistics and the Coroners’ Society of England and Wales.

Hon. Members also raised concerns about BMI. It is not right that any individual is being refused treatment based on their weight or BMI alone. National guidance from the National Institute for Health and Care Excellence is clear that single measures such as BMI or duration of illness should not be used to determine whether to offer treatment for an eating disorder. I am ready to receive any representations from colleagues who have evidence that that is happening, and I would be happy to raise that with the appropriate channels.

[John McDonnell]

I raised with the Minister the reform of disability benefits, which will have implications for sufferers and their carers. My understanding is that the universal credit health element is to be denied to those under the age of 22. In addition, it will be halved and then frozen, and the PIP criteria are changing. As I said, I simply want the Minister to check with his colleagues in the Department for Work and Pensions what the implications are for sufferers of these conditions and their carers. We need specific action to protect them in the consultation; otherwise, people who are already suffering financially as a result of such conditions—particularly when the whole family supports the sufferer—will be further harmed.

[Stephen Kinnock]

I will follow up on those points and write to the right hon. Gentleman. As he knows, the Green Paper is out for consultation. Although the Government have made decisions about some measures, we are consulting and engaging on a number of others. It is very important that we see all the issues that he raises in the round, and I will follow them up with colleagues, particularly in the DWP, and write to him.

I again thank the hon. Member for Bath for raising this important issue and for her tireless efforts in this House to raise awareness of eating disorders. I thank all hon. Members for their thoughtful and moving contributions on behalf of their constituents and, in some cases, their loved ones. One person afflicted by an eating disorder is one too many, so the Government will strain every sinew to combat this profoundly debilitating condition.

Access to Dentistry: Somerset

Stephen Kinnock Excerpts

Tuesday 1st April 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship again this morning, Mr Stuart. I thank the hon. Member for Frome and East Somerset (Anna Sabine) for securing this important debate on access to dentistry in Somerset.

We know that there are challenges in accessing NHS dentistry across the country, with some areas facing acute challenges. Put simply, too many people are struggling to find an NHS appointment. In the two years up to June 2024, just 31% of adults were seen by an NHS dentist in Somerset’s integrated care board, which covers the hon. Lady’s constituency, compared with 40% across England. In the year to June 2024, only 42% of children in Somerset ICB were seen by an NHS dentist, compared with 56% across England. The fact that the number of adults and children in Somerset ICB accessing an NHS dentist is even lower than the already struggling rate across England is concerning.

Somerset is facing significant workforce pressures, and there are not enough NHS dentists available to do the job. As of March 2024, there were 334 vacancies in the south-west for full-time equivalent NHS general dentists. The 29% vacancy rate is the highest of any English region.

It is a shocking fact that the No. 1 reason for children aged five to nine being admitted to hospital in our country is to have their teeth removed, with a primary diagnosis of tooth decay. It is a truly Dickensian state of affairs.

[Chris McDonald (Stockton North) (Lab)]

We have heard about the dental desert in Somerset. Stockton in my constituency has also been branded a dental desert. I welcome the 4,000 new appointments that the Government have granted for Stockton North and the surrounding area. However, given the urgency that he has described, particularly for children’s health, I ask the Minister whether the Government are taking any measures to accelerate the roll-out of those appointments.

[Stephen Kinnock]

We will absolutely ensure that integrated care boards are delivering to the target they have been set. If we see any evidence of slowing down or backsliding, we will certainly intervene to ensure that appointments are accelerated. I would also be more than happy to receive representations from my hon. Friend if he feels that performance in his ICB is not delivering.

The state of NHS dentistry in Somerset, and the nation as a whole, is simply unacceptable and it has to change.

[Olivia Bailey (Reading West and Mid Berkshire) (Lab)]

I welcome the action that the Government are taking to fix our dentistry crisis. In my constituency, only two dental practices accept adult patients, and vast swathes of the rural areas have no practice at all. Will the Minister set out how the Government’s plans will support my constituents to access the dental care that they need?

[Stephen Kinnock]

My hon. Friend puts her finger on the fundamental problem, which is that the NHS dental contract simply does not incentivise dentists to do NHS work. That is the fundamental reason why we are in this bizarre situation where demand for NHS dentistry is going through the roof, yet there is a consistent underspend in the NHS contract. It is a classic example of a false economy. The Conservatives thought they were being terribly clever by structuring a contract in a way they thought would deliver value for money, but in fact, it simply failed to incentivise dentists to do NHS work and they drifted more and more into purely private sector work. That is the very definition of a false economy.

[Anna Sabine]

I just draw the Minister back to my specific point about whether he can confirm that he is having discussions with the British Dental Association. The association agrees that the contract is wrong, and it wants to speak urgently to the Government about how it can be amended.

[Stephen Kinnock]

I am pleased to confirm that I am meeting the BDA in the coming days. The negotiations are moving forward. There is no perfect payment system, and there is a need to get the balance right between ensuring that we have a viable system that does not deliver underspends in the NHS contract, which is absurd, and that we deliver as much NHS dentistry as possible to the communities and people who need it. That is a complex process and it will take some time. The Government have taken intermediate measures, such as the 700,000 urgent appointments and supervised toothbrushing, which we will work on at pace over the course of the coming financial year while also working on a radical overhaul of the contract.

By the time I came into government, the Nuffield Trust was describing the state of NHS dentistry as

“at its most perilous point in its 75-year history.”

As of March 2024, there are over 36,000 dentists registered with the General Dental Council in England, yet there are fewer than 11,000 full-time equivalent dentists working in the NHS.

[Sir Ashley Fox]

I understand that at least 100 Ukrainian dentists in this country are unable to practise with the NHS because they are waiting to take examinations. Can the Minister do anything to expedite their ability to practise in this country?

[Stephen Kinnock]

I absolutely agree. Two big things need to happen. First, the General Dental Council needs to do more to get more exams in place for those very well-qualified dentists. Of course, they have to pass the British exam. We cannot have people practising in Britain who have not passed that exam, but the availability of the exam has been too limited and that needs to change. The other thing is provisional registration. Some work can be done to expedite the registration of an international dentist, but more needs to be done on that as well. I will meet the head of the General Dental Council shortly, and I will convey those messages to him.

Recruitment and retention issues are not limited to dentists; there are difficulties across the whole dental team, including dental nurses, hygienists, therapists and technicians. In the past five years, there has been a 15% reduction in courses of dental treatment being delivered across England, and 28% of adults in England—a staggering 13 million people—have an unmet need for NHS dentistry. As a result, we hear too many stories about people who are unable to access the care they need, and some horrific accounts of DIY dentistry that nobody should have to resort to.

Dentistry rightly receives a lot of attention because of its dismal state, and I am grateful to the National Audit Office and Public Accounts Committee for their interest in the previous Government’s dentistry recovery plan. It is evident that the plan did not go far enough.

[Richard Foord]

The Minister talks about the previous Government’s dental recovery plan, and part of that was to impose a firmer ringfence on dentistry spending so that there was not an underspend that was reallocated elsewhere. The previous Government tasked NHS England with collecting monthly returns from ICBs to establish spending as against the allocation. Now that NHS England is being scrapped, will we still see that monitoring of ICBs to ensure that the spending matches the allocation?

[Stephen Kinnock]

I take the hon. Gentleman’s point about the ringfence, but in a way, ringfencing addresses the symptoms, rather than the cause, of the problem. The fundamental cause of the problem is the amateurish way in which the previous Government set up the NHS dentistry contract so that it does not incentivise dentists to do NHS work. That is what leads them to drift off. In a sense, we can do all the ringfencing we like, but if the workforce that we need is not incentivised to do the work that we need them to do, we are going to have that problem, because they vote with their feet. That is why the radical overhaul of the dentistry contract is the key point. However, I agree with the hon. Gentleman that once we have got a contract that works, we must ensure that every penny that is committed to NHS dentistry is spent on NHS dentistry, rather than the absurd situation that we have now, in which we constantly have underspends in the NHS dentistry contract while demand for NHS dentistry goes through the roof. It is a truly bizarre situation.

I return to the subject of the dentistry recovery plan. The new patient premium, introduced by the previous Government, aimed to increase the number of new patients seen, but that has not happened. In reality, since the introduction of the previous Government’s plan, there has been a 3% reduction in the number of treatments delivered to new patients. It is clear to this Government that stronger action is needed, and we are prepared to act to stop the decay.

[Rachel Gilmour]

In Minehead, in my constituency, a dental surgery responded to the ICB in October and said that it would provide 12 NHS appointments a week for people who currently do not have a dentist. I have chased that ICB on five occasions, but we still do not have a result. That is 48 appointments a month that my constituents are missing out on. Would the Minister please agree to write a letter, on my constituents’ behalf, to the Somerset ICB?

[Stephen Kinnock]

We are very keen to ensure that targets are being met, and the ICB clearly needs to ensure that that is happening, so I would be happy to do that. Perhaps the hon. Lady could write to me so that we can get all the facts on the table, then we can take action accordingly.

We will make the difficult decisions necessary to restore NHS dentistry to ensure that patients can access the care that they need, at the best value for taxpayers. Since coming into office, we have focused on implementing new initiatives and stopping the things that are not working. From today, 1 April 2025, the public will see 700,000 additional urgent dental appointments being delivered every year, as we promised in our manifesto. The urgent appointments will be available to NHS patients who are experiencing painful oral health issues, such as infections, abscesses, or cracked or broken teeth. Somerset integrated care board has been asked to deliver 13,498 of those appointments. That is 13,498 more chances for the hon. Lady’s constituents to get the urgent dental support that they need, every single year.

Across the south-west region, there will be 106,776 extra appointments—that is more chances for patients in urgent need of care. However, to have a truly effective dental system, we cannot focus just on those who are already in pain; we must have a system that prioritises prevention. A cornerstone of the Government’s mission to prevent ill health is supporting children to live healthier lives. We want to ease the strain on the NHS and create the healthiest generation of children ever. As colleagues will be aware, too many children are growing up with tooth decay, which is largely preventable. That is why we have invested £11.4 million to roll out a national supervised toothbrushing programme for three to five-year-olds that will reach up to 600,000 children a year in the most deprived areas of England.

The latest data shows that the rate of tooth decay for five-year-olds in Somerset is 20.2%, which is lower than the 22.4% for England but still far too high. We are taking a targeted approach to support those in the most deprived areas, which is why we have been able to allocate £50,000 of funding to Somerset to support around 2,000 three to five-year-olds. Our additional funding will help to secure and expand supervised toothbrushing based on local needs. This is extra resourcing to support targeted work by the local authority and its partners.

I am determined that we will reduce inequalities faced by children living in the most deprived areas, helping them to brush their teeth daily in the nurseries and schools that they attend. Alongside this, we have launched an innovative partnership with Colgate-Palmolive, which is donating more than 23 million toothbrushes and toothpastes over the next five years. This is of incredible value for the taxpayer, and a fantastic example of how business and Government can work in partnership for the public good.

A strong dentistry system needs a strong workforce. We recognise the incredible work that dentists and dental professionals do, and we know that the current NHS dentistry contract is not fit for purpose. We need to build an NHS system that works for patients and their dentists. A central part of our 10-year plan will be workforce, and we will ensure that we train and provide the staff, technology and infrastructure that the NHS needs to care for patients across our communities. We will publish a refreshed long-term workforce plan to deliver the transformed health service that we will build over the next decade, and to treat patients on time again.

We know that some areas face challenges in recruiting and retaining the dental workforce they need. The golden hello scheme offers 240 dentists a £20,000 joining bonus to work in underserved areas of the country for three years. The recruitment process is well under way, with posts being filled by dentists in these areas as we speak.

[Sir Ashley Fox]

I ask the Minister to reply to my suggestion that students from the University of Bristol Dental Hospital do some part of their training in Somerset, where they can benefit the population.

[Stephen Kinnock]

I thank the hon. Member for that intervention. It is an excellent idea, and it is something that we have seen in other parts of the country. If he would care to write to me about that, I would be more than happy to take that issue up.

In the south-west, the golden hello scheme has already led to seven new dentists on the ground delivering NHS dentistry to patients, and a further six have been recruited and are waiting to start their roles. With 64 live adverts across the region, we are confident that the numbers will grow. And, for the first time in more than a decade, we have increased payments for practices training a foundation dentist. We will not stand idly by while the fundamental reforms to the contract are developed. Where we identify opportunities, we will make improvements to the current system when those can increase access and incentivise the workforce to deliver more NHS care.

I am pleased that work to improve access has also been taking place at the local level, and that Somerset ICB is opening three new practices in Wellington, Crewkerne and Chard. Those services will provide much-needed additional capacity in Somerset. The ICB is committed to delivering additional urgent dental appointments and increasing access for residents facing the greatest health inequalities—although I do recognise what the hon. Member for Tiverton and Minehead (Rachel Gilmour) said about the concerns that she raised.

Fixing our broken dentistry system will not be easy, but I want to reaffirm our commitment to making bold changes and tough decisions to stop the decay and to rebuild the foundations of NHS dentistry. This is an immense challenge—there are no quick fixes and no easy answers—but people in Somerset and across the country deserve better access to dental care, and we are determined to make that a reality. We are committed to rebuilding a system that puts patients first, ensuring that no one is left without the dental care that they need.

Question put and agreed to.

Community Pharmacy Funding 2024-25 and 2025-26

Stephen Kinnock Excerpts

Monday 31st March 2025 Written Statements

[The Minister for Care (Stephen Kinnock)]

I am delighted to announce we have now concluded our consultation on funding for community pharmacy for 2024-25 and 2025-26. We have agreed with Community Pharmacy England that in 2025-26 the funding will increase to £3.073 billion, an increase of £375 million compared to 2024-25. This means, in addition to other changes, that on a like- for-like basis the value of the funding will increase by 15.0% compared to 2024-25, compared to 5.8% growth to the budget of the NHS as a whole. This is on top of a consolidated increase in 2024-25 of 4.1%.

This investment will enable us to embed and build on the range of clinical services that we commission from community pharmacy as we seek to improve access through reform and better use the skills of pharmacy teams to keep people well in their communities.

In addition, we have agreed to allow pharmacies to keep £193 million of funding that was paid to them primarily over the pandemic period to support the vital supply of medicines. This will bring more certainty of funding for contractors and support pharmacies in purchasing the medication prescribed for patients.

We know that community pharmacy has been neglected. We are determined to work with the sector to get it back on its feet and delivering for patients. This agreement with CPE will provide much needed investment and start to stabilise the community pharmacy sector. It marks a show of confidence in this Government to deliver the left shift—moving care from hospital to community, and moving from sickness to prevention.

I would like to pay tribute to CPE’s committee. I am grateful to them for working constructively and at pace with officials to agree how best to use this significant new investment to support the sector, and to continue to provide services to patients across the country. We have prioritised patient access to medication, support and advice. We are also embedding and extending the clinical service offer. We will provide additional support for people newly prescribed medication for depression, as well as offering access to NHS provided emergency hormonal contraception across the country for the first time.

We have also committed £215 million to grow the Pharmacy First service, as we look to build on the over 1.9 million consultations already delivered as of November 2024 and provide a platform for prescribing services in the future.

These services will continue to increase the access and support available for people close to home, in the heart of their communities.

I am therefore very pleased to share this announcement and look forward to continued collaborative working with Community Pharmacy England and the wider sector as we build on what we have announced today and deliver what we all want for community pharmacy, a service fit for the future.

[HCWS570]

Oral Answers to Questions

Stephen Kinnock Excerpts

Tuesday 25th March 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

Rebuilding our broken dentistry system is a priority for this Government. We are already rolling out 700,000 extra urgent dental appointments a year, as promised in our manifesto; we have launched a supervised toothbrushing scheme for three to five-year-olds; and we are committed to reforming the dental contract and making NHS dentistry fit for the future in the long term.

[Rosie Wrighting]

In Kettering, we know the scale of the challenge facing NHS dentistry after 14 years of Tory failure. My constituents regularly tell me how impossible it is to get an appointment. Some are driving tens of miles to see a dentist, and it is simply a scandal how many children are admitted to hospital with tooth decay. While it cannot be rebuilt overnight, in Kettering we welcome the extra 17,000 urgent appointments, which are a vital first step. Can the Minister confirm that it is this Government who will make NHS dentistry fit for the future?

[Stephen Kinnock]

My hon. Friend is absolutely right. After 14 years of Tory neglect and incompetence, far too many people are still struggling to find an NHS appointment. This Government are tackling the challenges for patients trying to access NHS dental care by delivering 700,000 more urgent dental appointments a year and by recruiting new dentists to areas that need them. My hon. Friend’s local integrated care board has been asked to deliver nearly 17,000 of the additional urgent appointments. I am in no doubt that she will continue to campaign tirelessly on behalf of her constituents.

[Anneliese Midgley]

My constituent, Kevin Buckley, had his NHS dentist shut with no notice. NHS dentists in Knowsley are not taking on any new patients and he is stuck. This is not just a local issue, but a national crisis. What action will the Minister take to address the shortage of NHS dentists?

[Stephen Kinnock]

I am sorry to hear of the difficulties faced by Mr Buckley. Sadly, that is a challenge we face nationally after 14 years of abject failure from those now on the Opposition Benches. There are no quick fixes or easy answers, but we are committed to reforming the contract and helping those who need it most. My hon. Friend’s local ICB has been asked to deliver more than 46,000 additional urgent care appointments from April onwards, getting care to those constituents who need it most. The north-west has also been allocated 21 posts in the golden hello scheme to recruit dentists into underserved areas.

[David Williams]

More than one in three five-year-olds in Stoke-on-Trent has tooth decay. That is the worst rate in the west midlands and is 10% above the national average. Children in deprived areas, like much of my constituency of Stoke-on-Trent North and Kidsgrove, are twice as likely to suffer, and that is not acceptable. Can the Minister please outline what steps the Government will take to reduce regional inequalities in NHS dental access for children?

[Stephen Kinnock]

It is shameful that tooth decay is the biggest reason for hospital admissions of children aged between five and nine, and the inequalities surrounding that are stark. On 7 March, we confirmed a £11.4 million investment in supervised toothbrushing for three to-five-year-olds. The scheme is targeted at children in the most deprived areas—those in index of multiple deprivation groups 1 and 2—and will reach up to 600,000 children. Our innovative partnership with Colgate-Palmolive will result in the donation of more than 23 million toothbrushes and toothpastes, providing outstanding value for taxpayers’ money.

[Alex Baker]

Aldershot and Farnborough are dental deserts. My constituent Nick had an infected wisdom tooth and was in agony. He had been registered with a practice in Farnborough, but it kicked him off its patient list. He obtained an emergency appointment through 111, but two weeks later the infection was back. He was left with little choice but to go private, which cost him £700—10 times what the treatment would have cost on the NHS. Can the Minister explain how Labour’s plan for change will help to prevent such cases from being repeated as we end the 14 years of dentistry failure that we saw under the Conservatives?

[Stephen Kinnock]

My hon. Friend has demonstrated again that she is a tireless campaigner for the people of Aldershot, and I am sorry to hear of the challenges faced by her constituents. This Government will deliver 700,000 more urgent dental appointments a year, and will recruit new dentists to the areas that need them most. My hon. Friend’s local ICB has been asked to deliver nearly 7,000 of those additional urgent care appointments in the year from April. In the long term, we will reform the dental contract with the sector, with a shift to focusing on prevention and improving the retention of NHS dentists.

[Melanie Onn]

The Secretary of State and Ministers’ commitment to 700,000 more emergency dental appointments is already taking effect in my NHS area, with an extra 27,000 slots, and the feedback is excellent. However, constituents have told me that some dentists seem to be removing non-emergency patients from their lists. Can the Minister please reassure them that their NHS dentists will be there when they need them?

[Stephen Kinnock]

As my hon. Friend says, we are delivering 700,000 additional urgent appointments. Patients are not limited to a registered practice in England, and practices are required to keep their status up to date on the NHS website. Anyone struggling to find a dentist should go to nhs.uk or call 111. It is also clear that while NHS England is not mandating an approach to the purchasing of these additional appointments, ICBs could consider either buying more appointments through new or recommissioned contracts or modifying existing contracts, and/or using flexible commissioning.

[Sir Roger Gale (Herne Bay and Sandwich) (Con)]

The Minister is aware of my concern about the inability of some 200 fully qualified Ukrainian dentists to practise because of the restrictions placed on them by the General Dental Council. I know that the Minister has written to the GDC about this, but has he received a reply?

[Stephen Kinnock]

I thank the right hon. Gentleman for the constructive meeting and discussion that we had on this matter. As he will know, we are exploring the use of provisional registration for overseas dentists, and we are urging the GDC to arrange more examinations for dentists. I have a meeting set up in short order with the head of the GDC, and I will keep the right hon. Gentleman posted on that conversation.

[Manuela Perteghella (Stratford-on-Avon) (LD)]

My constituents are being forced to travel out of county to Coventry or Evesham to obtain basic NHS dental care. Does the Minister agree that it is a disgrace that access to an NHS dentist has become a postcode lottery? What urgent steps are the Government taking to end this dental desert and restore NHS services to rural communities such as mine?

[Stephen Kinnock]

I absolutely agree. The state of NHS dentistry in our country is shameful. The golden hello scheme enables 240 dentists to receive a £20,000 joining bonus payment to work in dental deserts, and we are negotiating with the British Dental Association the long-term reform of the contract. The issue is not the number of dentists in the country, but the paucity of dentists who are doing NHS work.

[Aphra Brandreth (Chester South and Eddisbury) (Con)]

The north-west has some of the worst levels of children’s oral health in England, with Cheshire and Merseyside falling below the national average. In rural villages in my constituency like Bunbury, where bus services have been cut, and Kelsall, where a dentist is keen to open an NHS practice but faces barriers due to city centre prioritisation, residents are struggling to access NHS dental care. Given the challenges of rural access, what steps is the Minister taking to ensure that NHS dental provision is available in those rural communities?

[Stephen Kinnock]

I find it quite striking when Conservative Members stand up and describe the abysmal state of NHS dentistry. It makes me think, “Well, who created this mess in the first place?” But that is as an aside. The fact is that we have the golden hello scheme for dentists to come and work in so-called dental deserts. We recognise that the fundamental problem is around incentives for dentists to do NHS work. That is why we are doing a long-term contract negotiation to ensure we have an NHS dentistry contract that is fit for purpose and where every penny allocated to NHS dentistry is spent on NHS dentistry.

[James Wild (North West Norfolk) (Con)]

There is an urgent need for dental training in Norfolk, so can the Minister confirm that the Government will enable the Office for Students to allocate new dental training places in the east of England to start in 2026?

[Stephen Kinnock]

I thank the hon. Gentleman for that question. I have met hon. Members from the area and made it clear that in principle we support any creation of new teaching capacity for dentistry. What I have also set out is that, before we can give an instruction to the Office for Students to go ahead with that work, we have to have the settlement of the comprehensive spending review, so we know what our financial envelope is. We will not have that until June, but certainly we will be looking at that as and when we know whether the funding will be available.

[Mr Speaker]

I call Jim Shannon.

[Jim Shannon (Strangford) (DUP)]

There’s only one Jim Shannon, by the way, you know? [Laughter.] Mr Speaker, thank you very much for your birthday wishes. I am terribly embarrassed. I thank right hon. and hon. Members for their kind wishes. As I often say, I don’t count the years, I make the years count. That is the important thing.

Can I ask the Minister a very important question? What discussions has he had with the Education Secretary on providing more financial support to young students who want to study dentistry, to ease the burden of high costs associated with studying dentistry which many young people may find off-putting?

[Stephen Kinnock]

I thank the hon. Gentleman for that question and I congratulate him again on his 60th birthday. [Laughter.] He raises an important point on teaching and training in dentistry. There is not enough capacity in the system. We absolutely want to ensure that we are building that capacity. As I said, a lot of that will depend on the comprehensive spending review settlement in June. I would be more than happy to discuss the issue with him in greater detail once we have a better sense of where we are on the funding.

[Paulette Hamilton (Birmingham Erdington) (Lab)]

3. What assessment he has made of the adequacy of the provision of health services for women.

--- Later in debate ---

[Sarah Hall (Warrington South) (Lab/Co-op)]

8. What recent progress his Department has made on implementing the hub and spoke model for community pharmacy.

[The Minister for Care (Stephen Kinnock)]

This Government recognise the vital role that community pharmacies play as an integral part of our health system and local community. We are working with Community Pharmacy England on the pharmacy contract, which will start to stabilise the sector and make it fit for the future, and we will announce the outcome very shortly. On hub and spoke dispensing, we intend to lay draft secondary legislation in the coming weeks to come into force later this year.

[Sarah Hall]

Community pharmacy funding is at a critical juncture, with many pharmacies in my constituency facing financial challenges. With running costs increasing and uncertainty around the date of the upcoming settlement, community pharmacies are concerned that there may be disruption to their business. What steps is the Department taking to ensure that input from community pharmacies is considered, and prior to any further legislative or regulatory changes relating to the hub and spoke model?

[Stephen Kinnock]

My hon. Friend is right that we inherited a community pharmacy system that had been neglected for far too long, such that over the past two years, on average six pharmacies have been closing every week. A wide range of community pharmacies and representative organisations fed into the public consultation on hub and spoke reform, and I am pleased to confirm that their responses were overwhelmingly positive in support of model 1 of hub and spoke, which we will be going with.

[Rishi Sunak (Richmond and Northallerton) (Con)]

I recently visited Well pharmacy in Northallerton, which, like so many others, plays an important role in providing community health services. One valued service is the provision of free blood pressure checks to those over the age of 40. Will the Minister to join me in urging anyone with health worries or a family history of high blood pressure to take advantage of this fantastic free, pharmacy-led, preventive community health service?

[Stephen Kinnock]

The right hon. Gentleman is right that a big part of the Government’s shift from hospital to community is the pivotal role that community pharmacies will play in that process. We are committed to the Pharmacy First model of enabling community pharmacies to do more clinical work, such as the type that he just described. That is at the heart of our 10-year plan.

[Mr Speaker]

I call the shadow Minister.

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

Now that the Secretary of State is abolishing NHS England, will he listen to the calls from the National Pharmacy Association and the Independent Pharmacies Association, and publish immediately the independent report commissioned by NHS England on pharmacies’ finances?

[Stephen Kinnock]

We will publish the economic analysis imminently. He mentioned the National Pharmacy Association, which gives me the opportunity to say that I think that the collective action that it is taking is premature, unnecessary and detrimental to community pharmacy patients. I urge the NPA to reconsider its position and wait for the outcome of our negotiations with the CPE, which will come very shortly. We will announce that very soon.

[Dr Evans]

The National Pharmacy Association, which has been waiting for months to get the answer, is advising all its 6,000 pharmacy members to reduce services and hours, for the first time in 104 years. That has never happened before under a Labour Government, or under the Lib Dems or the Conservatives, but it is happening under this Government. Its chair said:

“The sense of anger among pharmacy owners has been intensified exponentially by the Budget”,

citing unfunded national insurance contributions and national living wage increases. The Minister acknowledges that there is potential action. What contingency plans does the Department have to ensure that we keep patients safe if pharmacies close their doors in industrial action next week?

[Stephen Kinnock]

On the NPA, it has taken us a while to clean up the utter mess that we inherited in community pharmacy. That involved agreeing financial envelopes and getting into negotiations with CPE. Those negotiations have been constructive, and I am delighted to confirm again that we will soon announce the outcome of those negotiations. What we see here is the shadow Minister apparently taking the side of people taking collective action in a premature way that is detrimental to patients. They would be better off waiting for the outcome. The Government are taking industrial relations into the 21st century, as opposed to the performative nonsense that we saw for 14 years.

[Caroline Voaden (South Devon) (LD)]

11. What steps he is taking to support families of patients who have been sectioned under the Mental Health Act 1983.

[The Minister for Care (Stephen Kinnock)]

When someone is detained, family involvement is extremely valuable, and families should be supported to maintain contact with their loved ones. Our Mental Health Bill will strengthen requirements to involve families in people’s care. We will require clinicians to involve patients and their families where possible when developing new statutory care and treatment plans.

[Caroline Voaden]

I have two ongoing constituency cases with adult men who have serious and long-term mental health issues. One of my constituents believes that her life is in danger because of her son’s threatening behaviour towards her—her own mental health has been seriously affected by the fear and stress. The other case involves a young man causing serious distress to his neighbours with his behaviour, which recently led to an incident where he reportedly threatened a police officer with a knife. Both men are living alone in unsupported accommodation, both are at risk of coercion and abuse because of their mental health problems, and both are causing serious distress to their families and neighbours. Will the Minister tell the House whether he is working with other Departments to ensure the availability of more provision to support people such as my constituents to live safely in the community and not cause harm or distress to those around them?

[Stephen Kinnock]

I know that the hon. Member has met my right hon. Friend the Secretary of State about at least one of those constituency cases. NHS England has asked mental health trusts to review the care of high-risk patients and has published national guidance on the standards of care that are expected. Ultimately, the Mental Health Act is there to protect people and provide the necessary powers to enable clinicians to manage and support such patients—and to do so, where possible, in the community.

[Chris Vince (Harlow) (Lab/Co-op)]

Yesterday I met Essex partnership university NHS foundation trust and spoke to it about the need to support the families of those suffering with mental health issues in Harlow, and particularly those with caring responsibilities. Will the Minister consider how mental health services can better identify and support young carers?

[Stephen Kinnock]

My hon. Friend will be aware that we are bringing forward the Mental Health Bill, and an important part of that legislation will enable family members—when they are chosen as a nominated person—to have powers to request assessment under the Act, challenge decisions and request considerations of discharge in line with the nearest relative powers.

[Sarah Smith (Hyndburn) (Lab)]

13. What steps he is taking to ensure special educational and disability needs are met by the NHS.

--- Later in debate ---

[Patricia Ferguson (Glasgow West) (Lab)]

T5. Since being elected, I have been contacted by a number of constituents registered with a GP in Scotland who find themselves unable to get medication for which they have a prescription while visiting England. Will my hon. Friend take steps to encourage NHS England and NHS Scotland to work together to find a solution that works for patients?

[The Minister for Care (Stephen Kinnock)]

I am very sorry to hear about my hon. Friend’s constituents’ experience. Accessing vital medicines while travelling between nations should be seamless, and I will ask NHS England to work with NHS Scotland to better understand what needs to change to make things easier for patients across the UK.

[Ian Sollom (St Neots and Mid Cambridgeshire) (LD)]

T7.   In the light of the recently announced 50% staffing reductions across integrated care boards, has the Secretary of State made any assessment of how those cuts to the Cambridgeshire and Peterborough ICB will delay the delivery of essential new primary care services for my rapidly growing constituency, particularly in Northstowe, Cambourne and St Neots, where thousands of constituents are already facing unacceptable difficulties in accessing care?

[Jenny Riddell-Carpenter (Suffolk Coastal) (Lab)]

In Saxmundham in my constituency, Dr Havard has led a campaign for 20 years to transform the healthcare centre into a one-stop community healthcare hub. His practice has already expanded services, transforming health locally. Does the Minister agree that the Saxmundham healthcare hub is an excellent example and model for what this Government are trying to do to transform community healthcare?

[Stephen Kinnock]

My hon. Friend is absolutely right that shifting care from hospitals to the community is at the heart of our 10-year plan. I would be happy to meet the doctors leading this pilot to find out more about the excellent work that she describes.

[Christine Jardine (Edinburgh West) (LD)]

For eight years, I have seen how a young constituent has been able to completely control his previously life-threatening seizures with medicinal cannabis, but at huge cost to his family—a cost that is prohibitive for other people. Will the Secretary of State meet me to discuss how we can make access to such treatments more affordable, accessible and safe, so that we can help more people?

[Mohammad Yasin (Bedford) (Lab)]

In the ongoing discussion on assisted dying, one point on which we all agree in this House is the urgent need to improve palliative care. I therefore welcome the Government’s recent £100 million commitment to supporting hospices, including those that help my constituents. Can the Minister confirm whether long-term funding for hospices will be a priority in the upcoming 10-year health service plan?

[Stephen Kinnock]

My hon. Friend is right that the hospice sector has been provided with the largest capital spend in a generation—£100 million. We are also providing £26 million of revenue funding to children and young people’s hospices. I can confirm that hospices will play a key role in our shift from hospitals to the community, as he set out in his question.

[Victoria Collins (Harpenden and Berkhamsted) (LD)]

Tragically, Ed was just 24 years old when he decided to take his own life, and that is why the family have joined us today in the Gallery. What urgent action are the Government taking to improve mental healthcare and suicide prevention for young people like Ed?

[Stephen Kinnock]

The hon. Member raises an important issue. We are investing in 8,500 more mental health specialists, as well as specialists in every school, and in Young Futures hubs across the country, to ensure that we do whatever we can to prevent these tragedies.

[Markus Campbell-Savours (Penrith and Solway) (Lab)]

An early day motion from 2007 noted that women were typically waiting eight years to be diagnosed with endometriosis. Shockingly, nearly 20 years later, that wait has increased to nine years. The Government are right to tackle the appalling waiting lists for surgery, but the one in 10 women who suffer with endometriosis often struggle with years of pain before surgery is even suggested. What plans does the Department have to deal with these delays, and how we can ensure that those working in primary care recognise this debilitating condition earlier?

--- Later in debate ---

[Chris Hinchliff (North East Hertfordshire) (Lab)]

Do Ministers agree that a logical conclusion of the Darzi report is that the national care service that we are committed to creating must be free at the point of use? As Lord Darzi found, as long as the social care system remains means-tested and the NHS is a universally free service, unmet care needs will continue to put unsustainable pressure on our health services.

[Stephen Kinnock]

That is a vital issue. The Casey commission will look at how best to create a fair and affordable adult social care system, and at which structural reforms will be needed where health and social care meet, because reform must always be married with investment.

[Cameron Thomas (Tewkesbury) (LD)]

General practitioners in my constituency have consistently restructured over 10 years of constant systemic and economic pressures. How will the Minister convince the Treasury to exempt GPs from the increase to national insurance contributions, and show my GPs that he has their back?

--- Later in debate ---

[Mr Richard Holden (Basildon and Billericay) (Con)]

Smile Dental Centre is in one of the least affluent parts of my community in Basildon. It is looking to expand and provide more NHS dental services, but it has come up against a few issues. Will the Minister, or one of his officials, meet me and Smile Dental Centre to see what we can unblock to deliver more dental health services for local people?

[Stephen Kinnock]

We are always looking for opportunities to unblock more capacity, and I would be happy to meet the right hon. Gentleman.

[Tom Hayes (Bournemouth East) (Lab)]

Coastal constituencies such as mine in Bournemouth East suffer significant health inequalities. What are the Government doing to address them, and will the Minister meet me and coastal Labour MPs to address the issue?

Male Suicide in Rotherham

Stephen Kinnock Excerpts

Monday 24th March 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I am grateful to my hon. Friend the Member for Rother Valley (Jake Richards) for securing this debate and for raising the extremely serious issue of male suicide. I also congratulate him on obtaining his first Adjournment debate. I am sure that it will not be the last. He is a doughty campaigner for his constituents. I thank other Members for their valuable contributions, particularly my hon. Friend the Member for Portsmouth North (Amanda Martin), who made a powerful speech. I offer my deepest condolences to those who have been tragically bereaved by suicide.

Men tend to seek help for their mental health less than women. As my hon. Friend the Member for Rother Valley said, men are also more likely to die by suicide, accounting for three out of four suicides. Rates in Rother Valley sadly reflect that statistic.

Today, mental ill health is on the rise, and the shocking fact is that suicide is the biggest killer for men under 50. Just as we are determined to end the injustices that women face in healthcare, we will not shy away from the need to focus on men’s health too. That is why the Government will publish a men’s health strategy to tackle those problems head-on.

In November, my right hon. Friend the Secretary of State for Health and Social Care brought together leading campaigners, experts and the Premier League to gather ideas and inform our strategy and our 10-year health plan. We take suicide prevention extremely seriously, because every suicide is a tragedy that has a devastating and enduring impact on families, friends and communities. With that in mind, I would like to express my gratitude for the hard work and dedication of local frontline services, including the voluntary sector, which play such a vital role in supporting people who experience suicidal thoughts or contemplate taking their own lives. Such organisations include Andy’s Man Club, Rotherham Samaritans and James’ Place, to name just a few.

The cross-sector suicide prevention strategy for England, which was published in 2023, has made some progress, and we are working closely with local authorities, health systems and our partners in the voluntary community to see that progress through. The strategy identifies middle-aged men as a priority group for targeted support at a national level. It rightly focuses on key drivers that we know can affect men’s lives, such as gambling, financial difficulties and substance misuse.

Rotherham council has developed a three-year plan for suicide prevention and self-harm, which I understand is currently out for consultation with local partners. I commend the council and all local partners involved in the development of the plan. I hope that it will provide a strong foundation for a new partnership between local government and national Government, because people in my hon. Friend’s constituency deserve backing at every level.

My hon. Friend raised the shocking issue of young men taking their own lives as a result of problem gambling. The NHS has expanded support for those who need help to overcome gambling addictions. Individuals can self-refer to specialist gambling clinics in England, where they can be supported by psychiatrists.

Our suicide prevention strategy for England identifies gambling as a common risk factor and lists actions to reduce suicide as a result of gambling. We will explore opportunities to go further to support people with gambling addictions. It can be hard for a young man in today’s society, particularly for boys in the most deprived areas of England, who are expected to live almost 10 years less than those in the wealthiest areas.

We are committed to improving the nation’s mental health services to ensure that individuals can get the support they need when they need it. We are recruiting 8,500 new mental health workers, who will be trained to support people at risk of suicide. We are also committed to improving the support available to those experiencing a mental health crisis. This year, the Government are providing £26 million in capital investment to open new mental health crisis centres, reducing pressure on busy A&E services and ensuring that people have the support they need when and where they need it. These new centres will include crisis houses, providing overnight accommodation, sanctuaries and safe havens, calm environments for people to visit during the day and mental health-specific spaces in or adjacent to A&E departments.

I am also grateful to my hon. Friend the Member for Rother Valley for raising the important issue of technology, which can have a profoundly damaging effect. We should all be concerned about the widespread availability of harmful content online that promotes suicide and self-harm and can be easily accessed by people who may be vulnerable. The suicide prevention strategy for England identifies online safety as a priority area for action across Government. We are working closely with our colleagues at the Department for Science, Innovation and Technology in this area, including to deliver the commitments in the strategy and to look at what else can be done to address online harms, including harmful content shared on pro-suicide websites and forums.

There is still uncertainty about the relationship between screen time, social media use and child development. However, I look forward to seeing the results of DSIT’s research into the impact of smartphones on children, which is due to be published in May this year. Our current focus is on keeping young people safe while also benefiting from the latest technology. By the summer, robust new protections for children will be in force through the Online Safety Act 2023 to protect them from harmful content and ensure that they have an age-appropriate experience online. Alongside getting those laws in place, we are committed to building the evidence base to inform future action to protect young people online.

It is not only the dangers of technology that are a concern for young people. Young people present unique challenges, and early intervention is vital if we want to stop children and young people from reaching crisis point today or developing mental health issues in the longer term. Schools and colleges play an important role in that early support, which is why we are providing access to a mental health professional for every school. We know that mental health support teams, such as the With Me In Mind team based in Doncaster and Rotherham, help to meet the mental health needs of children and young people in education settings.

We are also committed to rolling out open access Young Futures hubs in communities. This national network is expected to bring local services together and deliver support for young people facing mental health challenges. The Department for Education is also reviewing the relationship, sex and health education statutory guidance, and the Secretary of State for Education is clear that children’s wellbeing should be at the heart of it. The DFE will look carefully at the consultation responses, considering relevant evidence and talking to partners, including on mental wellbeing and suicide prevention, before setting out next steps and engaging with wider experts. As part of this process, the DFE will explore whether additional content is required, including on suicide and self-harm.

Mental health is, and remains, a priority for the NHS. It is backed by the mental health investment standard, which continues in 2025-26 to ensure that mental health funding is ringfenced to support delivery of our commitments, including those outlined in the NHS planning guidance. The Government have a statutory requirement to publish an annual statement setting out expectations for NHS mental health spending before the next financial year begins. My right hon. Friend the Secretary of State will publish that statement in due course.

I will end with a call to action. Suicide is everyone’s business; when we improve men’s health, the benefits can ripple through families, communities, societies and the economy. When we strive to improve men’s health, it will not just transform the lives of boys and men, but those of their wives, mothers, sisters, partners, mates, neighbours, children, teachers and doctors. That is why I strongly encourage all the men listening to this debate to go to the Change NHS online portal, to give their views on how to build an NHS that is fit for the future through our 10-year health plan. Together, we will transform healthcare for men in the Rother valley, in the north of England, and across our country.

Question put and agreed to.

Face-to-face GP Appointments

Stephen Kinnock Excerpts

Thursday 20th March 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I thank the hon. Member for Boston and Skegness (Richard Tice) for raising GP access, which is a vital matter to many of our constituents. I want to start by paying tribute to Laura Barlow’s family, friends and loved ones and to her husband Michael, who is in the Gallery. It is a terrible tragedy that Laura’s cancer was not caught earlier, and I absolutely agree with the hon. Gentleman that the significant number of people who signed the petition shows real strength of feeling on this heartbreaking case.

When people are asked what their top priority for the NHS is, the chances are they will say, “Fix general practice” because GPs are the front door to our national health service. They are the first port of call for millions of people, and they perform a vital service by delivering care in communities across our country. Let me be crystal clear from this Dispatch Box: GPs must provide face-to-face appointments, alongside remote consultations. Online services must always be provided in addition to, rather than as a replacement for, in-person consultations. Patients have a right to request a face-to-face appointment, and practices must make every effort to meet their preference unless there are good clinical reasons to the contrary, such as in cases where the patient tests positive for an infectious disease.

There are clear benefits to attending an appointment in person. GPs pick up cues from body language and foster a more personal relationship with their patients, and that is important if we are to bring back the family doctor. Last year, GPs delivered 380 million appointments throughout England. Two thirds of those were in person, and I can tell the hon. Gentleman that the figures for his integrated care board in Lincolnshire are in line with the national average at 65%. It is possible that, in some practices, defaulting to remote appointments was a temporary and necessary measure during the pandemic, but in some cases, that may have become a habit that has become difficult to shake. Let us be clear that this is not the fault of GPs per se; it is the fault of the last Government, which left them underfunded, understaffed and in crisis. That is why we are doing everything we can to remedy the downward spiral that GP services have found themselves in after 14 years of Tory neglect and failure.

I was absolutely delighted that the general practitioners committee England voted in favour of this year’s GP contract last month. It is the first time that the contract has been accepted in four long years. The reformed contact agreed between the Government and the GPC will improve services for patients, make progress towards our health mission and, crucially, require practices to make it possible for patients to go online to request an appointment throughout the duration of core opening hours. That will free up time for patients who prefer to call or visit in person.

Those changes are backed by an extra £889 million, representing a cash growth of more than 7% in overall contract investment, bringing total spend on the GP contract to £13.2 billion this financial year. That is the largest uplift to GP funding in a generation, and it means we are beginning to reverse a decade of a dwindling share of NHS resources going to general practice.

It is not just about resource and funding, however. We are bulldozing bureaucracy for GPs, so that they spend less time pushing paper and more time seeing patients like Laura. We are training thousands more GPs, modernising the booking system, ending the 8 am scramble and bringing back the family doctor. Those measures should make it possible for GPs to guarantee a face-to-face appointment for all who want one.

The Government are committed to shifting the focus of our NHS from hospital to community. We will move towards a neighbourhood health service, improve continuity of care for those who would benefit from seeing the same clinician regularly, which is associated with better health outcomes and fewer A&E attendances, and we will drive the shift from analogue to digital by ensuring that all practices are employing the full functionality of GP Connect.

Let me turn to cancer. The Government are determined to tackle the biggest killers. My right hon. Friend the Health Secretary has announced that a national cancer plan for England will be published later this year. The plan will put patients at its heart and will cover the entirety of the cancer pathway, from referral and diagnosis to treatment and ongoing care. It will seek to improve every aspect of cancer care and the experience and outcomes for people with cancer. Our goal is to reduce the number of lives lost to cancer over the next 10 years. The plan will spell out how we will improve outcomes for cancer patients, speed up diagnosis and treatment and ensure patients have access to the latest treatments and technology. We will bring this country’s survival rates back up to the best in the world.

Our NHS belongs to the people. Those are not just my words; they are in the NHS constitution. Fourteen years of Tory failure left our NHS broken but not beaten. Everything this Government have done since the election has been geared towards saving the NHS and giving it back to the people. We are putting power back in patient hands, because it is their health service and it must work for them. Last week, my right hon. Friend the Prime Minister announced reforms that will shift power away from the centre. Patient choice is at the heart of this Government’s commitment to build an NHS fit for the future, and all patients should be offered face-to-face appointments when it is in their best interests.

Question put and agreed to.

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

Stephen Kinnock Excerpts

Committee stage
Tuesday 18th March 2025 Public Bill Committees

[Dr Shastri-Hurst]

This gets to the root of how the law has operated in another jurisdiction, Switzerland, where Dignitas has managed this scenario over the past 40 years or so. The key—these are the words that its own guidance uses—is ensuring that the power of control remains with the person seeking the assisted death. That provides the individual who is making the choice with the ultimate autonomy at the end in controlling the circumstances and the manner in which they pass.

I have set out why I feel that although amendment 463 arises from good intentions, it would not achieve what is intended. There is a real risk that the constraints that adopting the amendment would create would lead to the regrettable unintended consequence of individuals being forced to have an assisted death at an earlier stage than they would otherwise have wished.

I can deal with amendments 497 and 498 in short order. They would tighten up the Bill by providing greater clarity around the circumstances in which the substance would be removed from the presence of the individual who had previously indicated a wish to have an assisted death. Amendment 497 specifies that the individual would need to set out to the co-ordinating doctor that they no longer desired to go through with the process. In my view, that is eminently sensible. Amendment 498 elaborates on the Bill to provide greater clarity to those who will be operating it. It will make it a much more workable piece of legislation. I support both amendments.

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Sir Roger. Before I speak to amendments 497 and 498, on which the Government have worked with my hon. Friend the Member for Spen Valley, let me address amendments 462 and 463.

Amendment 462 would amend clause 18 to require the co-ordinating doctor to explain to the person that they do not have to proceed and self-administer the approved substance, and that they may still cancel their declaration. Although it is not specified, it is presumed that the amendment refers to the second declaration that the person will have made. The Committee may wish to note that there is already a requirement in clause 18(4)(b) that,

“at the time the approved substance is provided”,

the co-ordinating doctor must be satisfied that the person

“has a clear, settled and informed wish to end their own life”.

The purpose of amendment 463 is to limit what the co-ordinating doctor is permitted to do in relation to providing the person with an approved substance under clause 18. As the clause stands, subsection (6) sets out the activities that the co-ordinating doctor is permitted to carry out in respect of an approved substance provided to the person under subsection (2). It states that the co-ordinating doctor may

“(a) prepare that substance for self-administration by that person,

(b) prepare a medical device which will enable that person to self-administer the substance, and

(c) assist that person to ingest or otherwise self-administer the substance.”

Additionally, subsection (7) provides that

“the decision to self-administer the approved substance and the final act of doing so must be taken by the person to whom the substance has been provided.”

Amendment 463 would remove subsection (6)(c), which would result in the co-ordinating doctor being unable to assist the person

“to ingest or otherwise self-administer”

the approved substance. The co-ordinating doctor would still be permitted to prepare that substance for self-administration and to prepare a medical device to enable the person to self-administer the substance. This could mean that a co-ordinating doctor may not be able to provide assistance such as helping the person to sit up to help with swallowing, or explaining how the medical device for self-administering the substance works. This could result in practical difficulties in self-administration of the substance and/or place the co-ordinating doctor in a difficult position.

[Sojan Joseph (Ashford) (Lab)]

Does the Minister think that it is confusing for health professionals when we say that they can assist the patient to sit up or hold a cup of water or put the medication into their mouth? Is it not confusing for medical professionals that we are giving contradictory statements?

[Stephen Kinnock]

One of the fundamental principles of the Bill, which my hon. Friend the Member for Spen Valley has prioritised, is self-administration. It is not for me as a Minister to opine on that; it is simply there in the Bill. Once that fundamental principle is established, it is about defining what “assistance” means, compared with what “self-administration” means. As I was setting out, I think “assistance” can mean things like helping the patient to sit up; it does not mean actually administering the substance to the patient. It is about the dividing line between assistance and self-administration—hence the term “assisted dying”, I suppose, which is very different from the doctor actually administering the substance.

[Rebecca Paul (Reigate) (Con)]

I am going to read subsection (6)(c) again. It says:

“assist that person to ingest or otherwise self-administer the substance.”

I would interpret that slightly differently from the Minister. It talks about ingesting, which suggests the substance entering the body, so I would not suggest that sitting someone up would qualify. That in itself shows that perhaps there is some ambiguity here. The Minister has set out something that I had not read into the Bill. Will he comment further on that?

[Stephen Kinnock]

I will pretty much repeat what I have just said to my hon. Friend the Member for Ashford. There is a dividing line, as the Government see it, between assistance and administration. There is a dividing line between making the patient comfortable, enabling the procedure to take place, and the doctor actually putting the substance into the body of the patient. From the Government’s point of view, simply from the position of having a picture of the process in our mind, that dividing line is clear enough in the drafting of the clause.

[Danny Kruger]

I am grateful that the Minister is allowing us to push him on this, because it is crucial. This is the moment beyond which there is no return. He thinks that helping a patient to sit up would be within the scope of the clause. Does he think that holding the patient’s hand and tipping a cup of pills into their mouth would be consistent with the clause?

[Stephen Kinnock]

My interpretation is that it would not be, because if someone were actually tipping the pills into the mouth of the patient, they would be going through the act of putting the substance into the patient. This Bill is founded on the principle of self-administration. However, there are acts such as helping the patient to sit up that are not direct administration but assistance enabling it to take place. That is where the distinction lies.

[Danny Kruger]

That is helpful, but if the patient were holding the cup and the doctor held their hand to help them tip it into their mouth, it is not clear to me at what point assistance would end and self-administration would begin. I would be grateful if the Minister could explain that. What about the scenario in which the patient’s finger is on the plunger of a syringe and the doctor assists by putting their finger on top of the patient’s and assists them to press the button, adding a little force to that being given by the patient? Does he regard that as within the scope of self-administration, or does that cross the line into directly administering the procedure?

[Stephen Kinnock]

I thank the hon. Member for that intervention. The hon. Member for Solihull West and Shirley pointed out earlier that the scenario that he has just described would constitute more than assistance; it would be moving into administration by the doctor, rather than self-administration. I think that that aligns with the Government’s view, so I refer the hon. Member for East Wiltshire to those comments from the hon. Member for Solihull West and Shirley, who has far more clinical experience than I do.

[Danny Kruger]

I am grateful for that, and I will leave it there, but does the Minister agree that it is incredibly difficult to distinguish who is administering the treatment in that scenario? If both their hands are on the instrument, whatever it is—a cup, a syringe or a button on a computer screen—it is very hard to know who has actually delivered the final act.

[Stephen Kinnock]

What is hard to do in this Committee is imagine and agree on how many different scenarios there can be. Every circumstance and every individual experience will be different, so it is difficult for us to envision all the different scenarios. Nothing about this is easy, of course. We would not have been sitting in this Bill Committee for hours on end if it were all easy, but from the Government’s point of view there is a clear enough distinction between assistance and self-administration. As long as we are clear on those basic principles, we feel that that gives enough safety to the Bill and enough clarity around the process.

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

Does the Minister agree that my hon. Friend the Member for East Wiltshire is perhaps unintentionally creating a lack of clarity where there is clarity? Surely there is complete clarity in the distinction between assisting a patient to be in a position to carry out their final desire and act, and performing or even jointly performing that final act with them. Is it not the case that in overseas jurisdictions there is quite a lot of assistance with technology? It needs to be prepared and put in place, but it can put even those who are the least physically able in a position in which the final act of administration can be clearly theirs. In many ways, our life is made easier by modern technology in that regard.

[Stephen Kinnock]

The right hon. Member sets out clearly the difference between self-administration—the concept at the heart of the Bill—and the performance of the act either jointly or by the doctor. The latter is not permitted under the terms of the Bill; the former is. That is where we are.

[Dr Simon Opher (Stroud) (Lab)]

The lack of an ability to assist in the final process would put medical professionals in a very difficult position. Would carrying the medicine to the room where the patient is count as assistance? I think we have to have assistance in the Bill, but I also feel that, as the Minister has outlined clearly, someone can help a person to self-administer but cannot administer. That is quite clear to me.

[Stephen Kinnock]

I thank my hon. Friend, who speaks with considerable clinical expertise. It is about exactly that difference between self-administration and administration. If we cleave to those two principles, that is the basis on which we will achieve the stated aim of my hon. Friend the Member for Spen Valley.

[Sojan Joseph]

Does the Minister agree that assisting a person to ingest is different from assisting a person to self-administer?

[Stephen Kinnock]

In order to ingest, there has to be self-administration. The self-administration is the precondition for ingesting the substance. That is my reading. I hope that that satisfies my hon. Friend.

[Rebecca Paul]

The Minister is being incredibly patient with our questions. The question from the hon. Member for Ashford raises exactly the point with which I am uncomfortable. To me, the phrase

“assist that person to ingest”

means something else. I am really concerned that it could be interpreted differently from how the Minister has laid it out. I want to place that on the record and raise that issue, which I believe the hon. Member was also raising.

[Stephen Kinnock]

The hon. Member’s concerns are absolutely noted. I completely understand that hon. Members are not comfortable with this, but what I am trying to do is set out the Government’s view on the workability of what my hon. Friend the Member for Spen Valley is seeking to achieve and the basic principles on which that is built.

Amendment 497, on which the Government have worked jointly with my hon. Friend, would amend clause 18(11), which states:

“Where the person decides not to self-administer the approved substance, or there is any other reason that the substance is not used, the coordinating doctor must remove it immediately from that person.”

Under the clause as it is currently drafted, there could be difficulties in relation to the duties of the co-ordinating doctor where the co-ordinating doctor does not know what the person has decided. Amendment 497 seeks to resolve that ambiguity by clarifying that the duty on the co-ordinating doctor to remove the approved substance applies where the person

“informs the coordinating doctor that they have decided”

not to self-administer the approved substance.

I turn to amendment 498. At present, clause 18(11) provides that the co-ordinating doctor has the duty to immediately remove the approved substance where the person decides not to self-administer the approved substance, or there is any other reason that the substance is not used. The amendment clarifies that the duty to remove the substance arises when the co-ordinating doctor believes that the substance will not be used. I hope that those observations have been helpful to the Committee.

[Kim Leadbeater (Spen Valley) (Lab)]

The Minister has covered my amendments 497 and 498 very clearly, so I will not speak to them.

I am happy to support amendment 462, tabled by the hon. Member for East Wiltshire, about which we had a conversation this morning. I only make the observation that there is already a requirement in clause 18(4)(b) that, at the time the approved substance is provided, the co-ordinating doctor must be satisfied that the person has

“a clear, settled and informed wish to end their own life”.

Nevertheless, I am happy to support the amendment, because the hon. Member made a very valuable point this morning.

I cannot support amendment 463, however. The Bill states that the patient must self-administer the drugs. Clause 18(7) states that “the final act” of self-administering the substance

“must be taken by the person to whom the substance has been provided.”

That is very clear. The hon. Member for Solihull West and Shirley, with his medical background and expertise, has been clear and helpful on this point: it is a question of passive versus active. We have to be clear that the patient must have an active role in self-administration.

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[Dr Shastri-Hurst]

I am grateful for that helpful and thoughtful intervention.

For the reasons I have set out, I consider that the amendments create unnecessary and highly undesirable legal confusion, so I shall not support them.

[Stephen Kinnock]

Currently, clause 18(6) permits the co-ordinating doctor, in respect of an approved substance provided to the person under subsection (2), to undertake the following activities: prepare the approved substance for self-administration; prepare a medical device to enable self-administration of the approved substance; and assist the person to ingest or otherwise self-administer the substance. Furthermore, subsection (8) expressly provides that subsection (6)

“does not authorise the coordinating doctor to administer an approved substance to another person with the intention of causing that person’s death.”

Amendment 350 seeks to enable the co-ordinating doctor, in the presence of an independent witness, to provide “additional assistance” to the person to administer the approved substance. Such assistance can be provided only where the person has authorised it, and where the person is

“permanently and irreversibly unable to self-administer the substance”

due to a significant risk of choking due to difficulty swallowing—dysphagia—or loss of the use of their limbs. The term “additional assistance” is not defined in these amendments.

Amendment 351 is consequential to amendment 350 and would require any decision to authorise additional assistance for the self-administration of the substance to be made by the person to whom the substance has been provided. Amendment 352 would create an exception to the condition in clause 18(8), and would have the effect of permitting the co-ordinating doctor to administer an approved substance to another person with the intention of causing that person’s death where the criteria introduced in amendment 350 are met—that is, where the co-ordinating doctor is satisfied that the person is permanently and irreversibly unable to self-administer the substance, and that the person has authorised that the additional assistance be provided.

Our assessment is that the amendments would enable the co-ordinating doctor to administer the approved substance to the person, rather than merely assisting the person, in the limited circumstances provided for in clause 18(6), to self-administer. That would be a significant change to one of the fundamental principles of the promoter’s Bill—that the final act of administering the approved substance must be taken by the person themselves, and not by a co-ordinating doctor. That is a policy matter and a decision for the Committee.

However, should the amendments be accepted, further amendments may be needed to ensure that this provision is fully legally coherent and workable in several areas. First, amendment 350 does not define who qualifies as an independent witness—for example, whether this would have to be a health professional or whether it could be a family member. Secondly, it does not address whether anyone would be disqualified from being an independent witness, as provided for through clause 36, which is entitled “Disqualification from being witness or proxy”.

Finally, as drafted, amendment 350 does not detail how authorisation of the additional assistance must be obtained and/or recorded in order to be valid. It also does not require that any details about the independent witness be recorded. This could lead to difficulties in complying with and/or evidencing that the requirements to provide the additional assistance have been met. By extension, there will be a lack of clarity over when and how the criminal provisions are to apply. I hope that those observations were helpful.

--- Later in debate ---

[Lewis Atkinson]

The right hon. Gentleman is absolutely right. Another point we have not yet mentioned is that the Care Quality Commission regulates healthcare on the basis of location of delivery. Hospice services cannot just be provided from a random place: the place has to be registered with the CQC as suitable for the provision. I am sure that regime would continue in this instance.

[Stephen Kinnock]

Amendment 435 would require the co-ordinating doctor to escalate the care of an individual to the appropriate emergency medical services if the assisted dying procedure has failed. Requiring the co-ordinating doctor to make a referral may engage article 8 of the European convention on human rights—the right to family and private life—if the person has indicated that they do not wish to be referred to emergency services or do not wish to be resuscitated. In a situation where the procedure has failed, doctors would, as in their normal duties, support a person in line with their professional obligations and their understanding of the person’s wishes. This could include the involvement of the emergency services, but it would be unusual to specify a particular approach in legislation.

As currently drafted, clause 18(9) provides that:

“The coordinating doctor must remain with the person”

once the approved substance has been provided, until either

“the person has self-administered the approved substance and…the person has died, or…it is determined by the coordinating doctor that the procedure has failed”,

or, alternatively, until

“the person has decided not to self-administer the approved substance.”

Amendment 429 would remove the clarification currently provided for in clause 18(10) that the co-ordinating doctor does not have to be

“in the same room as the person”

once the approved substance has been provided. However, clause 18(9) requires the doctor only to

“remain with the person”.

It may still be possible that the co-ordinating doctor could remain with the person but in a different room if they decide that is more appropriate.

Amendment 436 would increase reporting obligations on the co-ordinating doctor in cases where complications have occurred. It is not clear in the amendment what would be considered a complication and therefore trigger the reporting requirement. It is also not clear what details should be set out in the person’s medical records or in the report to the chief medical officer and voluntary assisted dying commissioner.

[Naz Shah]

I am struggling with this. When amendments were tabled last week, there was a concise direction from the Minister that he understood the intention of the amendments. Could that approach not be applied to these amendments—that there is an understanding of the intention, and they can be tidied up in the wash-up process to make them tight? Could that not happen?

[Stephen Kinnock]

My job and that of my hon. and learned friend the Justice Minister is to defend the integrity and coherence of the statute. The concern that we have with the word “complication” is that it is a wide-ranging term and concept, and its inclusion could potentially undermine the integrity of the legal coherence of the Bill and how it could be interpreted in terms of its implementation. I am simply flagging the risk that if the Committee chooses to accept the amendment, there could be a muddying of the waters in terms of its meaning in law.

[Rebecca Paul]

Following on from the point made by the hon. Member for Bradford West, has the Minister taken into account the guidance on private Members’ Bills? It says exactly what the hon. Member has just set out: the spirit of amendments should be taken, and it is for the Government to ensure that the integrity of the statute is respected with the final version. That is to allow a free-flowing discussion and to ensure that we capture everything we need to in the Bill, in the light of the fact that many of us are not lawyers or experts.

[Stephen Kinnock]

Absolutely, if the Committee chooses to accept the amendment, it goes into the Bill. If the Bill gets Royal Assent, it becomes the responsibility of the Government to ensure that the Bill, as passed by Parliament, is implemented in the best possible way.

The hon. Lady is right that the Government’s responsibility is to take on whatever passes through Parliament and implement it to the best of our ability. My job in this Committee is to raise concerns about risks of amendments that could potentially muddy the waters more than other amendments, or more than the Bill as it currently stands. It is a balanced judgment about whether we are better off with the Bill as it currently stands, whether the amendment would improve the Bill, or whether it could lead to concerns about the integrity of the statute if it were included.

[Rebecca Paul]

I thank the Minister for that explanation. I suggest it would also be appropriate for him to set out the changes that could be put in place in order for the amendment to work in that way. To my mind, that would give the true neutrality that he is seeking to achieve. Rather than set out why something does not work, he could set out how it could work in order to deliver the spirit of the change.

[Stephen Kinnock]

I think what I am saying is that the word “complication” contains a multitude of potential interpretations and meanings. The work that would need to be done by the Government to unpack it and understand what it means certainly could be done if the amendment passes, but the Government are saying that, as it stands, it is not clear. The drafting of the amendment is so ambiguous that it causes the Government concerns about its inclusion.

[Naz Shah]

This is a genuine question because I continue to struggle with this. What kinds of complications would we envisage if a lethal drug is being administered to a patient who has chosen assisted dying? What kinds of examples are there? Can the Minister help me understand?

[Stephen Kinnock]

With all due respect, I think it is more the responsibility of those who draft and table amendments to draft and table them in a way that leaves no room or as little room as possible for ambiguity. I think my hon. Friend would be better off addressing her question about the potential complications to somebody with clinical expertise, who could list off a series of potential physical manifestations. I am not qualified to do that. I do not have a clinical background so I am not able to answer her question.

Amendment 464 would impose a duty on the co-ordinating doctor not to do anything with the intention of causing the person’s death and to seek to revive the person if it appears to them that the procedure is failing. It is unclear what “appears to be failing” would mean, and what criteria would need to be met for the co-ordinating doctor to consider the procedure to be failing. It would be unusual for primary legislation to seek to mandate a clinical course of action in the way proposed by the amendment. In addition, the amendment could potentially create conflict for the co-ordinating doctor if the person has a “do not attempt cardiopulmonary resuscitation” order or a legally effective advance decision is in place, as the doctor would have to resuscitate them even if they had stated wishes to the contrary. That could give rise to engagement of article 8 of the European convention on human rights on respect for private and family life.

Amendment 532 would introduce a new duty on the Secretary of State to make regulations setting out what the co-ordinating doctor is legally permitted to do if they determine that the procedure under clause 18(2) has failed. Under the amendment, the regulations would also include specific actions that the co-ordinating doctor can legally take if there is a greatly prolonged death; if the person is unconscious and unable to make a second attempt at self-administration; or if the person has other complications. If specific actions that the co-ordinating doctor can legally take are set out, there is a risk that, when complications arise, they would be unable to take actions that are not listed. That may lead to uncertainty and restrict what the doctor can do, using their professional judgment, to respond to particular circumstances. It is unusual to set out a particular clinical approach in primary legislation.

Amendment 533 places a duty on the Secretary of State to make regulations specifying where the provision of assistance under the Bill may take place. It sets out a requirement on the Secretary of State to

“consult such persons as the Secretary of State considers appropriate”

prior to making such regulations, including certain specified groups.

I turn to amendment 430, which would broaden the Secretary of State’s power to issue codes of practice under clause 30 of the Bill. It would explicitly enable the Secretary of State to issue a code of practice in connection with

“responding to unexpected complications that arise in relation to the administration of the approved substance under section 18, including when the procedure fails”.

[Naz Shah]

I respectfully point out that the Minister says that it is not for him to make interpretations and that he has not got the clinical expertise. I genuinely appreciate that, but I am also trying to understand why he accepts provisions that are not clear in the Bill. Why is he okay with those but not with the amendments?

[Stephen Kinnock]

My hon. Friend will have noted that a number of amendments have been drafted in collaboration with the Bill’s promoter, my hon. Friend the Member for Spen Valley. I think that demonstrates that when the Government have seen a lacuna, a lack of clarity or ambiguities in the Bill, officials, along with the Justice Minister, my hon. and learned Friend the Member for Finchley and Golders Green, and I, have worked with my hon. Friend to table amendments to tighten up the Bill. We are doing that in areas where we feel that ambiguity exists. However, when we feel that the Bill, as drafted, does not give rise to such concerns, our position on the amendments is according to our position vis-à-vis the current wording of the Bill.

[Danny Kruger]

The Minister said that the Government find it impossible to understand the word “complications” —that it is too complex and full of ambiguity. Yet in clause 9 of the Bill, we have that very word. The suggestion is that the doctor should

“discuss with the person their wishes in the event of complications”.

Is that unclear? If not, what is the difficulty with specifying “complications” in clause 30?

[Stephen Kinnock]

The challenge with amendment 436 is that the policy intent is not as clear as it is in clause 9. That clause is about conversations in advance of decisions about committing to the procedure, whereas when it comes to complications that have arisen in a rapid and fast-moving situation, the view of the Government is that it is adequate to rely on the professional judgment of the medical practitioner to take the decision that best suits that situation.

One is a conversation that can be explored between the clinician and the patient in advance, in a managed environment; the dialogue can take place in a considered manner. The second situation is one in which there is a particular physical manifestation and it is up to the clinician to take a rapid position and to decide, according to all the elements that they usually use, such as the GMC’s “Good medical practice”, other codes of practice and their own professional judgment.

[Danny Kruger]

The Minister suggests that it is appropriate for the patient to give some advance indication of what should be done in the event of complications, but that it would not be right for Parliament, too, to give advance direction of the sorts of responses that would be appropriate in the circumstances.

I am afraid that I do not understand the Minister’s distinction. Either it is possible to set in advance the sorts of responses that would be appropriate in the event of complications—the word “complications” is already in the Bill, so is clearly acceptable—or it is not. In the event of complications arising when the patient has not given clear instructions in advance, surely it is appropriate for the doctor to be able to rely on guidance, whether that is in the Bill or set out by the Secretary of State subsequently.

There needs to be clarity about what to do because, to repeat the point, this is not normal medicine—a fatal drug has been introduced into the body. That is not a normal medical situation in which a doctor just uses their clinical judgment; the only appropriate clinical judgment in such circumstances is to attempt to save the patient’s life, because that is what doctors are supposed to do. But we are telling them that they have been allowed to help a patient to die artificially. In that circumstance, what are they supposed to do when that is clearly not working?

[Stephen Kinnock]

How amendment 436 is drafted makes for a real challenge, because it is not clear what detail should be set out in the person’s medical records or in the report to the chief medical officer and the voluntary assisted dying commissioner. There is ambiguity in the drafting of the amendment.

[Kim Leadbeater]

To try to tie this together, I should say that there seems to be consensus that something has to be recorded in the event of complications. It feels to me as though what the Government are saying is that this is not the best crafted way of doing that—that is the worst sentence ever; I apologise. We have to look at the best way of achieving the intention of a number of amendments. I am looking at amendment 430, which I think achieves the objective. This feels as though it is a drafting issue, rather than necessarily a policy issue. I might be wrong.

[Stephen Kinnock]

Of course, if we can find ways to improve the Bill, we should—that is what this Bill Committee is for. But the input from my officials and parliamentary counsel legal advice have raised red flags about the amendments because of how they are drafted and the ambiguity that they give rise to. Clearly, it is up to the Committee to decide whether it wants to include the amendments or whether those issues could be looked at later—either on Report or when the Bill is going through the other place.

[Naz Shah]

We cannot have things both ways. I have re-read amendment 436 and I am not convinced that the issue is the drafting. It is very clear:

“If complications occur as a result of the provision of assistance the coordinating doctor must…make a detailed record of the complications…make a declaration…and…make a report”.

I am struggling to differentiate between having a conversation about it and it actually happening—it is still a complication, so why the resistance? Can the Minister agree that the Government will look at this and, perhaps in the wash-up, tidy it up—if that is the issue, and they agree in that instance?

[Stephen Kinnock]

Fundamentally, the role of the promoter of the Bill is to decide whether the Bill, as passed through this Committee, meets the policy intent that she wishes to achieve. Our job as Ministers is to work with her to deliver that objective. If the promoter of the Bill comes to the view that any of the amendments should be considered and added to the Bill, we will of course work with her to enable them to be delivered. My job at the moment is simply to say that there are concerns about these amendments due to the issue of ambiguity.

[Kim Leadbeater]

As a matter of clarity, although I appreciate the power that the Minister has just given me, which amendments we vote for is actually the job of the Bill Committee—rather than just my job, I would hope.

[Stephen Kinnock]

Absolutely, it is the job of the Committee to decide which amendments pass, but my hon. Friend’s role as the promoter of the Bill is to define the policy intent of the Bill—its fundamental objectives, the fundamental safeguards issues and its architecture in that sense. It is absolutely the responsibility of the Bill Committee to decide whether to amend the Bill.

[Sarah Olney]

I hope the Minister can answer a question for me. I hear what he is saying about concerns with the amendments themselves, which makes a lot of sense, and the policy objectives of the hon. Member for Spen Valley. What I am concerned about is that in the Bill as drafted, notwithstanding that various amendments have been tabled, it is not clear what the doctor should do in the event of complications. There may well have been an earlier conversation with the patient, but the patient’s request may still leave the doctor in the position of committing a criminal offence.

I would like to know whose responsibility it is to ensure that doctors are not left in that position, which could come about either because the Bill as drafted is not clear or the amendments do not make the appropriate clarification. The hon. Member for Spen Valley has done a marvellous job, but in terms of policy intention the Bill does not cover this aspect. The Minister is saying that it is his job only to ensure that the amendments are appropriate. I am still very concerned that there is a big gap here and that we are potentially leaving doctors in the very difficult position of not knowing whether or not carrying out the patient’s intentions would leave them in the position of breaking the law. I would like to know whose responsibility it is to ensure that doctors are not left in that situation.

[Stephen Kinnock]

The hon. Lady will know that we rely on medical practitioners to make professional judgments all the time. My hon. Friend the Member for Stroud has set out the range of things that medical practitioners can do when they are dealing with end-of-life care. That happens all the time.

In these circumstances, it is the view of the Government that we should continue to rely on the skill, judgment and expertise of medical practitioners, underpinned by the various codes of practice—the GMC, or good medical practice, being probably the most obvious one. There is an understandable desire to use primary legislation to address issues of this kind, but it is important to point out that that could prove to be counterproductive and that we could end up with a Bill that becomes less workable and therefore potentially less safe—what one might call the law of unintended consequences.

[Sarah Olney]

The Minister is talking about somebody making a medical judgment, which would obviously be the right thing to do in the normal course of events, but we are talking about a doctor being left in a position of not knowing whether to take a further step that would end somebody’s life or to take the step that would be natural for a doctor—to try to revive the patient. This is about what the legal position is in that case—it is not a matter for medical judgment.

[Stephen Kinnock]

My response would be to refer the hon. Lady to clause 30(1), which sets out that the Secretary of State will produce a code of practice. Amendment 430, which my hon. Friend the Member for Spen Valley has said she is minded to support, would also ensure that the code of practice includes guidance on the matter that the hon. Lady raises. I think there is a commitment to a code of practice, and if amendment 430 passes then it would be explicitly in the Bill that that code of practice should include the issue that she raises.

Amendment 533 places a duty on the Secretary of State to make regulations specifying where the provision of assistance under the Bill may take place. It sets out a requirement on the Secretary of State to consult such persons as the Secretary of State considers appropriate prior to making such regulations, including certain specified groups.

Amendment 430 would broaden the Secretary of State’s power to issue codes of practice under clause 30. It would explicitly enable the Secretary of State to issue a code of practice in connection with responding to unexpected complications that arise in relation to the administration of the approved substance under section 18, including when the procedure fails.

I understand that amendment 255 is no longer relevant as it relates to schedule 6, which is going to be changed—I think that is right—so, in that sense, the amendment is null and void. I hope that those observations were helpful.

[Kim Leadbeater]

I thank colleagues for a thorough discussion of a group of interesting and important amendments. Amendment 429, tabled by my hon. Friend the Member for Bexleyheath and Crayford, would require the doctor to remain in the same room as the person. I respectfully disagree with my hon. Friend on that point. If a person is literally in the last few minutes and moments of their life, it should be up to them to decide who is in the room with them. In some cases, that might be the doctor, but I suspect that in many cases it would be loved ones and close family members.

We have had a thorough discussion of the range of amendments that look at how we deal with complications. My view is that amendment 430 would do what needs to be done. We need the Bill to show that this has been considered, and the logical place for that would be clause 30, on codes of practice. I am happy to support that amendment when the time comes to vote on it.

--- Later in debate ---

[Naz Shah]

I am grateful for my hon. Friend’s intervention, which will make my speech much shorter—I have repeated it at least three times on all the other amendments. While I welcome the amendment, I hope we can work towards something that strengthens the Bill even further.

Under the amendment, regulations would be made governing the doctors who could fill the role in the clause. Those doctors would have to undergo mandatory training in respect of domestic abuse, including coercive control and financial abuse. Giving doctors that training would not remove the danger that they will overlook evidence of abuse and coercion, but it should decrease it. The doctors we are talking about will spend less time talking to the person seeking assisted death than either the co-ordinating or the independent doctors. None the less, they will spend some time with that person, so I thank my hon. Friend the Member for Batley and Spen—sorry, Spen Valley; I keep going back to Batley and Spen, but we campaigned hard to get her elected there.

[Stephen Kinnock]

There are some amendments in this grouping—namely, amendments 210 and 49—that we worked on with my hon. Friend the Member for Spen Valley, and I will come to them later in my remarks.

If amendment 408 is passed, the person to whom assistance is being provided would have to be consulted before they consent in writing to another medical practitioner being authorised to carry out the co-ordinating doctor’s functions. All registered medical practitioners must uphold the standards set out in the General Medical Council’s “Good medical practice”, which requires registered medical practitioners to support patients to make informed decisions prior to consenting. Therefore, the proposed amendment may have relatively minimal impact.

Turning to amendment 210, clause 19(2)(b) sets out that a registered medical practitioner may be authorised to carry out the co-ordinating doctor’s functions only where they have

“completed such training, and gained such qualifications and experience, as the Secretary of State may specify by regulations.”

The purpose of the amendment is to provide that the required training, qualifications or experience are to be determined by a person or organisation specified in the regulations. An example of such a specified organisation might be the General Medical Council. Allowing for that to be specified in regulations rather than on the face of the Bill ensures flexibility.

Amendment 499 provides that where a registered medical practitioner who is authorised to carry out the functions of the co-ordinating doctor is not satisfied that all matters have been met, they must notify the co-ordinating doctor immediately.

If amendment 22 is made, regulations made by the Secretary of State on the necessary training, qualifications and experience of the named registered medical practitioner who is authorised by the co-ordinating doctor to carry out the co-ordinating doctor’s functions under clause 18 would need to include mandatory training relating to domestic abuse, including coercive control and financial abuse. The Committee has already made equivalent changes to requirements on training for the co-ordinating and independent doctors, so this amendment would bring the clause into line, should the co-ordinating doctor change, for the purposes of clause 18. Should this amendment be accepted, it would require setting up training mechanisms to equip registered medical practitioners with the knowledge and skills needed to identify domestic abuse, including coercive control and financial abuse.

On clause 19—sorry, I was going to refer to clause 19 stand part. That is the end of my observations.

[Kim Leadbeater]

Clause 19 applies when the co-ordinating doctor may not be available to provide assistance. They may be out of the country or unavailable due to other personal circumstances, as the hon. Member for Richmond Park articulated beautifully—I associate myself with her comments. Of course the doctor who steps in has to be trained appropriately, and if they are not satisfied of all the matters mentioned in clause 18(4), they must immediately notify the co-ordinating doctor. That is what my amendments 210 and 499 cover.

On amendment 408 in the name of my hon. Friend the Member for Broxtowe, who sadly is not with us today, it could be argued—and I take on board the comments by the hon. Member for Solihull West and Shirley—that it is unnecessary because it would be common practice by practitioners to consult. However, I also take on board the fact that the word “consultation” does some heavy lifting, and I think that is an important point, so I am happy to support amendment 408.

I have mentioned already in response to my hon. Friend the Member for Bradford West that I am happy to support amendment 22, for the reasons I have given previously in relation to similar amendments.

[The Chair]

Just before we move on to Sarah Olney to wind up the debate, I think I heard the Minister say, “No, that’s stand part.” Stand part is part of this grouping. Did the Minister wish to comment on stand part?

[Stephen Kinnock]

I did not wish to comment. That is why I sat down. I have said quite enough; I am sure everyone would agree.

[The Chair]

It was something else you were pre-empting yourself with—that is fine. I call Sarah Olney.

--- Later in debate ---

[Naz Shah]

I thank the hon. Member for his intervention.

We should be using the world-class pharmaceutical regulator we already have to oversee the drugs that will be used for assisted dying, and I urge all Committee members to support the amendment, which is a very important safeguard.

[Stephen Kinnock]

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

The Government’s assessment of amendment 465 is that it would significantly impact the legal and operational delivery of the Bill. The Government anticipate that all substances used for assisted dying will have existing licences from the Medicines and Healthcare products Regulatory Agency for other indications, but the amendment would require the approved substances to be licensed by the MHRA specifically for the purpose of assisted dying. That would require additional powers or provisions to ensure consistency with the current legal framework. The Bill does not currently provide for that, so the amendment would create significant issues for the Bill’s operability.

Amendment 466 would require there to be scientific consensus regarding the efficacy of the substances to be used in assisted dying under the Bill. The availability of scientific evidence related to the substances used for assisted dying is limited and varied across international jurisdictions. Although expert advice from clinicians and scientists will be fundamental to agreeing a list of approved substances for this purpose, in any area of medicine it would be challenging to achieve consensus on the medicines or substances to be used. The amendment may therefore open up the regulation-making process to legal challenge on the basis that there is not unanimity, and that might extend the implementation process. In addition, there may be variations in product availability and in clinical practice among countries, and that may require different substances or combinations of substances to be used.

Secondly, the amendment would narrow the scope of the duty, focusing on the drug’s efficacy in eliminating pain as a priority impact over other factors that may be considered. Our assessment is that the experience of pain is subjective. The amendment may limit the ability of a doctor to make an appropriate clinical decision on which approved substances to prescribe for their patient. The decision on an appropriate approved substance would be a clinical decision between the doctor and the person seeking assisted dying, having regard to the needs of the relevant person, including that person’s experience of pain.

--- Later in debate ---

[Rebecca Paul]

I will be very brief. I rise to ask a few questions about clause 21 as a whole. Following our debates on various amendments, I am aware that family and those close to the patient could not be involved in the process, although potentially for understandable reasons. I appreciate that we are not here to deal with the whole operational piece, but we should think about it. For example, what happens with notifying next of kin after death, bearing in mind that “next of kin” has a different meaning after death? That is when we start to get into legal considerations, such as who the executor is—and this could be the first time that they are hearing about it. What would be the process for that, given that the person has potentially died on their own at home with the doctor?

What is the process for handling the next stage? Is there anything that we need to include in the Bill to make it a clearer, simpler and easier process? Who will the medical certificate of cause of death be given to for registration of the death? While all that is going on, what will happen to the body? At that point, we may not have family members to take care of that. Those are some questions arising from clause 21 that are worth reflecting on.

[Stephen Kinnock]

The amendments relate to clause 21, which applies where the person has been provided with assistance to end their own life in accordance with the Bill and has died as a result. Throughout this process, we have worked with my hon. Friend the Member for Spen Valley. Amendments 379 and 500 have been mutually agreed on by her and the Government, so I will offer a few technical and factual comments.

Amendment 379 would require that, where a person has been provided with assistance to end their life and has died as a result, the co-ordinating doctor must provide the voluntary assisted dying commissioner with a copy of the final statement under clause 21 as soon as practicable. That links to the commissioner’s role in monitoring the operation of the Bill, as set out in new clause 14. Amendment 500 sets out the information that must be included in the form of a final statement, which is to be set out in regulations in accordance with amendment 214.

The effect of amendment 439 would be to introduce a new requirement for the relevant body, defined as either the co-ordinating doctor or the person’s GP practice, to provide full medical records, court records and all documentation related to assessments and procedures relating to bringing about the death of the person in accordance with the Bill to the chief medical officer and the voluntary assisted dying commissioner. The amendment is broad, and it is not clear whether doctors would be able to comply with the duties fully.

For example, GPs do not normally have access to court records, and would need to request them to provide them to the chief medical officer and the commissioner. Currently, a decision to share court records is made at the discretion of the judiciary in most cases. As such, any statutory burden to disclose court records agreed by both Houses would require consultation with the independent judiciary. Depending on the type of record, there could also be data protection considerations.

[Kim Leadbeater]

I have nothing to add other than to respond to the fair point made by the hon. Member for East Wiltshire about complications. The doctor does have to record the final statement in the medical records, and I am confident that they would also record any complications in the medical records. Similarly, we have talked about the code of practice with regard to complications, so there is scope to include what would happen in those instances there. It is, however, a fair point, and it could be something to look at amending on Report, if the hon. Gentleman wants it to be in the Bill.

Amendment 379 agreed to.

Amendment made: 500, in clause 21, page 14, line 10, at end insert—

“(3A) Regulations under subsection (3)(a) must provide that a final statement contains the following information—

(a) the person’s full name and last permanent address;

(b) the person’s NHS number;

(c) the name and address of the person’s GP practice (at the time of death);

(d) the coordinating doctor’s full name and work address;

(e) the date of each of the following—

(i) the first declaration;

(ii) the report about the first assessment of the person;

(iii) the report about the second assessment of the person;

(iv) the certificate of eligibility;

(v) the second declaration;

(vi) the statement under section 13(5);

(f) details of the illness or disease which caused the person to be terminally ill (within the meaning of this Act);

(g) the approved substance provided;

(h) the date and time of death;

(i) the time between use of the approved substance and death.”—(Kim Leadbeater.)

This amendment provides that regulations about the form of a final statement must make the provision mentioned in paragraphs (a) to (i).

Clause 21, as amended, ordered to stand part of the Bill.

Clause 22

Other matters to be recorded in medical records

--- Later in debate ---

[Danny Kruger]

I rise to speak to amendment 440, which stands in the name of the hon. Member for York Central. I echo the points made by the hon. Member for Banbury. Surely it is the case that the interventions made by a medical practitioner in response to the procedure failing, and the timing of those interventions, must be properly recorded. Should the procedure fail, the need for record keeping is of significant importance, as with all medical record keeping.

The doctor with the patient should write up the notes, including the times at which they reacted negatively to the procedure, the amount of medication that they consumed, any side effects and any action taken. That is good practice. In other jurisdictions there has been poor record keeping, as I mentioned, when things have not gone according to plan. We do not fully understand what happened in those instances or, more generally, the prevalence of complications in those jurisdictions. That information will be vital if further interventions are required, including emergency care.

Clause 22 deals with two situations: if the person decides not to take the substance or if the procedure fails—the phrase “Other matters to be recorded in medical records” seems a rather innocuous title for a clause that deals with such situations. In fact, I think that is the only mention of the procedure failing in the whole Bill. However, the clause, and amendment 380, simply require the co-ordinating doctor to notify the commissioner that it has happened as soon as practicable. Do we have any sense of when the doctor should judge the procedure to have failed? I would be grateful if the Minister or the promoter could offer a definition of procedural failure. What does that actually mean?

That question arises in other jurisdictions that have assisted dying laws. A 2019 paper by the Canadian Association of MAiD Assessors and Providers said:

“There is no clear cut-off for what constitutes ‘delayed time to death’ or ‘failed oral MAID’.”

At what point does a delayed time to death yield to failure? That question is not just abstract for us; it is a philosophical question in other contexts, but we are required to answer it. That paper goes on to suggest that

“clinicians should decide with patients in advance at what point they will consider inserting an IV and completing the provision”,

which is a rather euphemistic term but we know what it means. That is legal in Canada, but it would not be here, so what happens?

In written evidence, Dr Alexandra Mullock, who is a senior lecturer in medical law and co-director of the Centre for Social Ethics and Policy at the University of Manchester, pointed out:

“The Bill is silent on the precise obligations of the doctor if the procedure fails.”

Clause 18(9)(a)(ii) states that the doctor must remain with the person, but what the doctor should be permitted to do, either in relation to aiding recovery or supporting the person to die after the initial attempt has failed, is unclear. She said:

“During my work with the Nuffield Citizen’s Jury, the issue of what happens if the drugs do not end the person’s life was raised within the evidence presented to the jury, and this became a point of concern for several jurors.”

She also said:

“By not addressing this question within the Bill, it allows doctors to exercise clinical discretion, however, it is arguably legally and ethically preferable to clarify the position and address public concern by including a clause that covers this problem.”

I hope that is helpful.

I will end by referencing the hon. Member for York Central, who tabled amendment 440 and made the case very powerfully. She said that should the procedure fail, the need for record keeping is of significant importance, as with all medical record keeping. I have already said that, but we cannot have too much of the hon. Member for York Central.

[Stephen Kinnock]

Amendment 380 is one that the Government have worked on with my hon. Friend the Member for Spen Valley. As the Bill currently stands, clause 22 sets out that where a person decides not to take an approved substance provided under clause 18 or where the procedure fails, the co-ordinating doctor must record that that has happened in the person’s medical record or inform a registered medical practitioner with the person’s GP practice. The amendment would require that in those circumstances, the voluntary assisted dying commissioner must also be notified.

I turn to amendment 440. As I have just mentioned, clause 22 provides that the co-ordinating doctor is required either to record in the person’s medical records or inform a medical practitioner registered at that person’s GP practice if the person has decided not to take the substance or the procedure has failed.

The amendment increases the requirements on the co-ordinating doctor to document in such cases any interventions made by a medical practitioner and the timing of those interventions. The requirement on the co-ordinating doctor to record interventions following a failed procedure is open-ended in time, which could lead to operational challenges. For example, the co-ordinating doctor would remain obliged to record the medical interventions made by others in response to the procedure failing, even if those interventions took place weeks or months after the event itself. I hope that those observations have been helpful to the Committee.

[Kim Leadbeater]

I have nothing to add, other than to say that the complications that have been referred to many times today would be covered by the code of practice that we will introduce by agreeing to amendment 430.

Amendment 380 agreed to.

Amendment proposed: 440, in clause 22, page 14, line 34, at end insert—

“(4) For the purposes of subsections (2) and (3)(b), the information recorded must include—

(a) any interventions made by a medical practitioner in response to the procedure failing, and

(b) the timing of those interventions.” —(Sean Woodcock.)

This amendment would specify certain information to be recorded under section 22 when the procedure fails.

Question put, That the amendment be made.

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

Stephen Kinnock Excerpts

Committee stage
Tuesday 18th March 2025 Public Bill Committees

[Danny Kruger (East Wiltshire) (Con)]

I will speak briefly to amendment 316 in the name of the hon. Member for York Central (Rachael Maskell). She has tabled a sensible suggestion that if a patient makes a statement after the second period of reflection, there should be an automatic referral to palliative care. We have heard how expected and usual that is anyway, and the hon. Member for Spen Valley has frequently made the point that people who are having an assisted death, or going through the process, are likely to be in palliative care anyway—it is not an either/or. It is important that we clarify that expectation.

It will obviously be the case that the patient is not required to take up the referral, and if the referral already exists, that case is dealt with, but let us be absolutely clear that the decision to take an assisted death is not a fork in the road, as would be my concern. If that is not the case and that, in fact, palliative care and the assisted death process go hand in hand and will be seen as part of an integrated package of support for patients, my view is that we should specify clearly that in the event of a decision to proceed down the road to an assisted death, a palliative care referral should be made.

Bluntly, I want to make this as clear as we can, although I am not sure that we will ever be able to do that fully. It really has to be very plain to healthcare commissioners and managers that there is to be no cost saving as a result of an assisted death referral. I very much doubt that a single commissioner or manager would have that at the forefront of their mind; nevertheless, incentives apply in healthcare decisions. Ultimately, we have a ration system, and resource allocation necessarily is the job of commissioners.

If, as we are saying, a decision to proceed with an assisted death will be in parallel with palliative care, let us make that plain, so that if indeed it is the case that the patient requires the investment of palliative care services—hospice treatment or otherwise, even though, as we know, hospice care is inadequately funded through public money—nevertheless, there is a resource requirement. It is important that we specify to everybody in the system that an assisted death is not a way of avoiding the expense of proper end-of-life care.

I hope that Members will recognise that amendment 316 is consistent with the arguments that have been made consistently by advocates of the Bill, which is that there is not an either/or between palliative care and assisted death, and that, in fact, it is appropriate for patients to be on both tracks simultaneously.

[The Minister for Care (Stephen Kinnock)]

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

The purpose of amendment 457 is to exclude a person who has less than one month to live from being eligible for the shorter second period of reflection of 48 hours if that person has voluntarily stopped eating and drinking. That person would instead be required to comply with a second period of reflection of 14 days under clause 13(2)(a). The amendment could create uncertainty as to the required length of the period of reflection. It is unclear, for example, if “voluntarily” would include where someone’s appetite has naturally declined as they approach the end of life, and therefore whose decision to stop eating or drinking may not be deliberate.

As I have said previously, the Government have worked with my hon. Friend the Member for Spen Valley on certain amendments to bolster the legal and workability sides of the Bill, and the purpose of amendment 471 is to clarify that the co-ordinating doctor needs to be satisfied that, immediately before witnessing the second declaration, the criteria set out at subsection (4) are met, and not at any time before. That also ensures consistency with the duty on the co-ordinating doctor in respect of the first declaration.

Amendment 316 would require that where the co-ordinating doctor reasonably believes that the person seeking assistance has less than one month to live from the court declaration, they must refer that person for urgent specialist palliative care. As the referral must be made whether the patient wants that referral or not, this may result in unwanted referrals. The effect of this amendment is unclear.

As drafted, clause 13(2)(b) sets out that where the person’s death is likely to occur within one month, the period of reflection is then 48 hours. Amendment 316 sets out that the referral to urgent palliative care must be made alongside the co-ordinating doctor making the statement, which is the last step to be completed before the provision of assistance under clause 18. That would mean that in some circumstances, there may be insufficient time to make a referral before the person is provided with assistance to end their life.

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

I want to emphasise that at the moment the patient reaches that point, they will have had their palliative care options explained to them extensively, under the Bill, and it is highly unlikely at that point, as my hon. Friend the Member for East Wiltshire said, that anyone would not be in receipt of palliative care, given the very late stage of their disease.

[Stephen Kinnock]

I happened to be at a hospice in Stafford yesterday on a ministerial visit and was extremely impressed by the work that the hospice staff were doing on family counselling, and advice and engagement both with the patient and family and loved ones, so the right hon. Gentleman is right that the hospice sector, among others, plays a vital role in that holistic engagement with patients throughout the process.

Amendment 374 requires that the co-ordinating doctor must notify the voluntary assisted dying commissioner where they witness a second declaration and where they make or refuse to make the supporting statement under clause 13(5), and that the commissioner must be provided with a copy of the second declaration and any statement. I hope that those observations were helpful to the Committee.

[Kim Leadbeater (Spen Valley) (Lab)]

It is a pleasure to serve under you this morning, Ms McVey. My amendments 374 and 471 serve to clarify that the second declaration must be made before it is witnessed—it is a drafting amendment—and to bring clause 13 in line with the reporting requirements elsewhere in the Bill. For the functions of the commissioner to be carried out effectively, including supervising the assisted dying panels and making annual reports on the legislation’s operation, it is essential that all relevant details and reports are made available.

I am unable to support amendment 457, in the name of the hon. Member for Richmond Park. As I said when we started discussing the amendment, I do not fully understand why it has been positioned at this stage in the process. The shorter period of reflection is a recognition that a person’s death is expected within a month, so they literally have a few weeks left of life.

--- Later in debate ---

[Danny Kruger]

The hon. Lady is right, and her point goes to the question that runs through all of these clauses: why? As a Committee, we rejected the obligation on the doctors to ask, “Why are you doing this?” It was suggested by one hon. Member that it was nobody’s business why somebody was trying to take their own life and that if that person qualified, they should be able to summon the agents of the state to provide them with lethal drugs without any question about their motivation.

I agree with the hon. Lady. There is an equal expectation in my mind that doctors should ask the question, “Why are you changing your mind?” I would expect that. The clause could clarify what further referrals would need to be made, if they had not already been; as we have acknowledged, we would expect appropriate care to be provided by doctors anyway.

I conclude with a factual question. Clause 14(1) lets a patient cancel a first or second declaration, but subsection (4) says only that the duties of the doctor stop when a first declaration is cancelled. I would be grateful if the hon. Member for Spen Valley would explain what happens if the patient cancels a second declaration. It strikes me that there would be a need for urgency because if a patient decides to change their mind at that point, that is arguably a more dangerous situation. What would be the obligations on the doctor at that point? Should we read across from subsection (4) that their duties stop in the same way? Perhaps that could be clarified in later drafting, if necessary.

To conclude, my general point is that the issue of a cancelled declaration is about more than the paperwork. Although, of course, we respect the autonomy of a patient to make their own decision to cancel a declaration—obviously, I would insist that that right should be in the Bill—it nevertheless raises a question in my mind: why is that happening, and what should we expect the patient’s medical team, or others, to do in that circumstance?

[Stephen Kinnock]

The Government have worked with my hon. Friend the Member for Spen Valley on amendments 375 and 376. The amendments require that where the co-ordinating doctor, or any registered practitioner from the person’s GP practice, receives a notification or indication from the person seeking assistance under the Bill that the person wishes to cancel their first or second declaration, the doctor or practitioner must inform the voluntary assisted dying commissioner as soon as practicable. Where a registered practitioner from the person’s GP practice has received a notification or indication from the person to cancel their first or second declaration, they must also inform the co-ordinating doctor. I hope those observations are helpful to the Committee.

[Kim Leadbeater]

I repeat what I said earlier about what will happen to the patient if they choose to cancel: their care will continue. From a medical practitioner perspective, it is inconceivable that those patients would be abandoned, as the hon. Member for East Wiltshire is suggesting. That would not happen.

I understand that cancellation of the second declaration does not need to be included in clause 14(4) because of when in the process it would happen. The first declaration comes much earlier, so clauses 7 to 9 would be applicable; the second declaration comes further down the process, so does not need to be included. However, I am happy to look at that in further detail and come back to the hon. Member on that, if necessary.

Amendment 375 agreed to.

Amendment made: 376, in clause 14, page 10, line 12, after “doctor” insert “and the Commissioner”.—(Kim Leadbeater.)

This amendment requires a practitioner other than the coordinating doctor to notify the Commissioner (as well as the coordinating doctor) of a cancellation of a first or second declaration.

Clause 14, as amended, ordered to stand part of the Bill.

Clause 15

Signing by proxy

--- Later in debate ---

[The Chair]

I confirm that amendment 411 has been withdrawn. I see no other Members bobbing; I call the Minister.

[Stephen Kinnock]

Amendment 321 would require a proxy to record, when signing the declaration on behalf of the person, the reason why the person they are acting as a proxy for is unable to sign their own name. The recording of the reason may make the use of a proxy more transparent. It may also assist others involved in the scrutiny of the process to understand why a proxy was used.

Amendment 431 seeks to restrict who can be a proxy under the Bill to attorneys with a lasting power of attorney, or LPA, for health and welfare decisions—that is, those people who are able to consent to or refuse life-sustaining treatment. The amendment raises significant practical issues. First, not everyone has an LPA. Secondly, where a person has made an LPA, they will have decided whether to give the attorney the authority to refuse or consent to life-sustaining treatment. That is not automatic and means that not all attorneys would be able to meet the eligibility requirement of the amendment. Thirdly, the Mental Capacity Act 2005 enables an attorney to exercise power under an LPA only if and when someone has lost capacity.

[Kit Malthouse]

Does the Minister agree that, unfortunately, my hon. Friend the Member for East Wiltshire seems to be labouring under the misapprehension that there is some reputational test in becoming an attorney? In truth, I can appoint anybody I want to be my attorney. There is no verification or otherwise until there is some form of dispute around the exercise of the power of attorney. In fact, the regulations may mean that we have stronger verification of the bona fides of the person who is a proxy than we would have through the LPA route.

Does the Minister not also find it slightly sad that, given the type of Conservative I know my hon. Friend the Member for East Wiltshire is, he thinks the concept of being of good standing in society is somehow meaningless?

[Stephen Kinnock]

I am not a lawyer, but thankfully I am sitting next to a very eminent and distinguished one—my hon. and learned Friend the Member for Finchley and Golders Green—who has confirmed that everything the hon. Member for East Wiltshire said was correct from a legal standpoint, so I shall leave it at that.

Clause 15(5) of the Bill defines a proxy as

“(a) a person who has known the person making the declaration personally for at least 2 years, or

(b) a person who is of good standing in the community.”

Amendment 473 would remove subsection (b) from the definition of proxy, instead introducing a regulation-making power to specify the persons who may act as proxy. That would avoid any ambiguity around the meaning of a person who is of good standing in the community and retain flexibility to amend the specified list in regulations.

[Danny Kruger]

Will the Minister confirm that the Secretary of State could simply reintroduce that ambiguous term at their own discretion? If they are being given the freedom to decide who can be a proxy, they might decide that it should be a term of equal ambiguity. My right hon. Friend the Member for North West Hampshire is absolutely right that I have great respect for the concept of “standing”; nevertheless, I do not believe that the Government have yet been able to define exactly what that means. Does the Minister agree that there is still the opportunity for ambiguity? We are just leaving it completely blank at this stage and hoping that some future Secretary of State will have more clarity than we do.

[Stephen Kinnock]

I would not want to pre-empt the regulations, because clearly that is the point of the process. If this Bill gets Royal Assent, we then move on to making regulations, and I have confidence in the good offices of parliamentary counsel, legal advice and the drafting process. I absolutely agree with the hon. Gentleman, however, that the purpose of those regulations must be to remove ambiguity, not to increase it. I am confident that the system will produce regulations that address his concern.

[Kim Leadbeater]

Does the Minister agree that it will be on the record that we have had this conversation, and that many of us—including myself—have expressed our concerns about the concept of good standing in the community? I would like to think that that will be taken into consideration.

[Stephen Kinnock]

I am acutely conscious that every word we say in this Committee is on the record. My hon. Friend makes a valid point in that context.

The purpose of amendment 253 is to clarify that a person acting as a proxy can both sign and revoke a declaration on behalf of a person seeking assistance under the Bill. This amendment would extend the provisions under clause 15 to a person who is acting as proxy to the person seeking assistance under the Bill, enabling the proxy to act on behalf of the person to cancel their first or second declaration if they are unable to sign their own name by reason of physical impairment, being unable to read or for any other reason. I note that the cancellation of a declaration is governed by clause 14, and the cancellation may be given orally, via writing, or

“in a manner of communication known to be used by the person”.

It does not require the signature of the person seeking assistance under the Bill, so a proxy may not be required for some people in relation to revoking a declaration, even if they have been required under clause 15.

[Naz Shah]

On the point made by the Bill’s promoter, my hon. Friend the Member for Spen Valley, should the issue of proxy end up before a court, what will be relied on—the conversation that we are having here and the intentions stated in Committee, or a future statutory instrument and what the Secretary of State puts in the guidance?

[Stephen Kinnock]

The regulations will have primacy, and will be shaped by a range of inputs, including the conversation we have just had in Committee. The process is that the Bill gets Royal Assent, then the regulations are drawn up based on a range of consultations and inputs—including the Hansard. The regulations then become the basis on which this proxy process is managed, enforced and executed.

[Naz Shah]

I genuinely want to understand this issue. Even though we have had this conversation in Committee, what if the Secretary of State, following those consultations, decides otherwise? What recourse do we as a Committee have to challenge that?

[Stephen Kinnock]

The Bill, once it becomes an Act, places a legal duty on the Secretary of State to produce those regulations. The Secretary of State would be in breach of the law if he were not to enforce the conclusions of the Act.

--- Later in debate ---

[Sojan Joseph (Ashford) (Lab)]

Record keeping is a huge issue in our healthcare system. A huge number of coroners’ reviews have identified that record keeping has been an issue. By specifying only that clinicians need record a “recordable event”, we are leaving it as the responsibility of individual clinicians to decide what a recordable event is.

It is important that a good record be available to prevent future incidents and learn good practice. Leaving it open to a clinician to decide whether something is a recordable event could lead to most issues not getting recorded. For example, if a clinician has identified that there was coercion, it will be for the clinician to decide how much documentation to do. In my view, if they have identified a coercion, that should be recorded as an incident and further investigation should be done, but the Bill leaves it up to the clinician to decide. There is no standard for record keeping across the healthcare system, so a care home’s may be different from an NHS ward’s. I think it is for the Committee to look into what “recordable event” actually means.

[Stephen Kinnock]

The purpose of amendments 474 to 478 is to improve the drafting of the Bill by creating a new definition of “recordable event”. Recordable events are the events set out in clause 16(1) related to the recording of declarations and statements.

The amendments would also make consequential changes to clause 16, which refer to the occurrence of the recordable event, as per the new definition, and include reference to a report in addition to a statement or declaration. The reference to a report is consequential on the amendments already agreed by the Committee to clauses 7 and 8.

[Kim Leadbeater]

I have nothing further to add.

Amendment 474 agreed to.

Amendments made: 475, clause 16, page 11, line 19, leave out from second “the” to “in” in line 21 and insert

“occurrence of the recordable event”.

This amendment is consequential on amendments 209 and 377.

Amendment 476, in clause 16, page 11, line 24, leave out from “the” to “, and” in line 26 and insert

“occurrence of the recordable event”.

This amendment is consequential on amendments 209 and 377.

Amendment 477, in clause 16, page 11, line 27, leave out from “the” to “in” in line 29 and insert

“occurrence of the recordable event”.

This amendment is consequential on amendments 209 and 377.

Amendment 478, in clause 16, page 11, line 30, leave out from second “a” to end of line 32 and insert

“declaration, report or statement within subsection (1) must include the original declaration, report or statement.”—(Kim Leadbeater.)

This amendment is consequential on amendments 209 and 377.

Clause 16, as amended, ordered to stand part of the Bill.

Clause 17

Recording of cancellations

--- Later in debate ---

[Kim Leadbeater]

The amendment, which would clarify the drafting, speaks for itself. The important point is that the record of cancellation be with the GP practice as soon as is practicable. It is not necessary for that to take place physically at the practice, as that could potentially delay its delivery.

[Stephen Kinnock]

Clause 17(2) provides that where a notice or indication regarding a cancellation of a first or second declaration is given to a registered medical practitioner “at” the person’s GP practice, that practitioner must record the cancellation in the person’s medical records as soon as possible. Amendment 479 seeks to clarify that the requirement to record the cancellation applies not just where the cancellation is given to a registered medical practitioner physically at the GP practice, but where the cancellation is given to a registered medical practitioner “with” the person’s GP practice, irrespective of whether the notice was given at the GP practice. I hope that that explanation is helpful.

[Kim Leadbeater]

I commend the amendment to the Committee.

Amendment 479 agreed to.

Clause 17, as amended, ordered to stand part of the Bill.

Clause 18

Provision of assistance

Amendment made: 378, in clause 18, page 12, line 9, leave out paragraph (a) and insert—

“(a) a certificate of eligibility has been granted in respect of a person,”.—(Kim Leadbeater.)

This amendment is consequential on NC21.

Dental Patient Charges Uplift

Stephen Kinnock Excerpts

Tuesday 11th March 2025 Written Statements

[The Minister for Care (Stephen Kinnock)]

The Government ambition is to make sure that everyone who needs a dentist can get one. On Friday 21 February 2025, we launched the roll-out of the extra 700,000 urgent dental appointments promised by the Government in their election manifesto. Integrated care boards have been asked to start making these extra appointments available from April 2025, and they will be available to NHS patients experiencing painful oral health issues, such as infections, abscesses, or cracked or broken teeth. Appointments will be available across the country, with specific targets for each region. These targets are more heavily weighted towards those areas where extra appointments are needed the most.

Through the golden hello scheme, integrated care boards are supporting practices across England in recruiting NHS dentists to posts that they have previously struggled to fill. This recruitment incentive will see up to 240 dentists receiving payments of £20,000 to work in those areas that need them most for three years. As of 10 February 2025, in England, 35 dentists have commenced in post and a further 33 dentists have been recruited but are yet to start in post. A further 249 posts are currently advertised.

To rebuild dentistry in the long term, we will reform the dental contract with the sector, with a shift to focusing on prevention and the retention of NHS dentists. On 7 March 2025, we announced investment of £11.4 million to implement the manifesto commitment of a national, targeted supervised toothbrushing scheme for 3 to 5-year-olds. The investment will be focused on around 505,000 children living in the 20% most deprived communities across England. Following public consultation, we also announced the expansion of community water fluoridation across the north-east of England, reaching an additional 1.6 million people. At the same time, we will not wait to make improvements to the current system where these can increase access and incentivise the workforce to deliver more NHS care. We are continuing to meet the British Dental Association and other representatives of the dental sector to discuss how we can best deliver our shared ambition to improve access for NHS dental patients.

We have launched a 10-year health plan to reform the NHS. A central and core part of the 10-year health plan will be our workforce and how we ensure we train and provide the staff the NHS needs to care for patients across our communities. We have taken necessary decisions to fix the foundations of the public finances at autumn budget. This enabled the spending review settlement of £22.6 billion extra investment in resource spending for the Department of Health and Social Care from 2023-24 out-turn to 2025-26.

On 10 March 2025, the National Health Service (Dental Charges) (Amendment) Regulations 2025 were laid before Parliament to increase national health service dental patient charges in England in line with inflation from 1 April 2025.

NHS dental patient charges provide an important revenue source for NHS dentistry and are typically uplifted on 1 April each financial year. The charges will be uplifted by 2.39% in 2025-26, aligning with the forecast GDP deflator value. Dental patients will benefit from the continued provision that this important revenue supports.

From 1 April 2025, the dental charge payable for a band 1 course of treatment will rise by £0.60, from £26.80 to £27.40. For a band 2 course of treatment, there will be an increase of £1.80 from £73.50 to £75.30. A band 3 course of treatment will increase by £7.60 from £319.10 to £326.70.

Details of the revised charges for 2025-26 can be found in the table below:

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

Stephen Kinnock Excerpts

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Danny Kruger (East Wiltshire) (Con)]

It is a pleasure to serve under your chairmanship once again, Sir Roger. I am looking forward to this week’s debating.

I want to draw the Committee’s attention to further evidence that has come in since the debate got under way. Since we started the Committee, we have had more than 400 pieces of evidence, so I apologise for not having got to this earlier, but it is relevant. I do not want people who have submitted evidence to us to feel that their submissions have fallen into a black hole and are not being considered, and I think this is significant evidence. We are talking about the necessity of a proper period of reflection, which is acknowledged in the Bill—it is understood that it is inappropriate for people to be able to request and receive an assisted death in very short order. The debate is about the extent of that reflection period. I am supporting amendments that suggest that we need slightly longer in some cases.

I want to refer to two pieces of the evidence that has come in. One is from six palliative care doctors who wrote that

“our experience is that many patients experience a period of adjustment to ‘bad news’ and may say that they cannot live under these conditions. However, after a period of reflection and adjustment, the majority come to find peace and value in their altered life circumstance, in a way they would not have believed possible. This may often take many weeks and sometimes short months. It is our profound concern that the two ‘periods of reflection’…would not allow time for this adjustment. This is even more so the case where these periods of reflection are reduced for patients predicted to have an even shorter prognosis. It is thus a reality that patients and their families may miss out on a period of life they would have valued by seeking to end their lives prematurely, and these days, weeks and perhaps even months will never be regained.”

The other piece of evidence is from Tom Pembroke and Clea Atkinson, who are experts in hepatology and palliative care in Cardiff. They raised the problems of the seven-day reflection period where there is alcohol misuse. I do not think this topic came up in last week’s debate, but it is worth acknowledging because liver disease is the most common cause of death for people in middle age. It is also worth noting that liver disease disproportionately affects the people who are most disadvantaged in our society. These experts say:

“Prognostication in advanced liver disease is challenging as management of the underlying causes, including abstinence from alcohol, potentially reverses advanced liver failure…The neurocognitive and depressive effects of alcohol misuse disorder frequently requires more than seven days to resolve following abstinence. Advanced liver disease frequently manifests with hepatic encephalopathy which can affect the ability to make informed decisions.”

Their concern is that

“A seven-day review period is not sufficient to ensure that there is an enduring wish to die which is not influenced by alcohol misuse.”

Considering the prevalence of alcohol misuse in our society, the extent to which so many people tragically die of it and the difficulties in prognostication, I suggest to the Committee that there is a particular argument to be made for extending that short period at the end for the expedited process that is being considered. I beg the Committee to consider accepting the amendment.

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship again, Sir Roger.

Amendment 301 would prolong the first period of reflection, after which point the independent doctor can conduct the second assessment. In the original draft of the Bill, the first period of reflection is seven days, but the amendment would extend that period to 14 days. That means 14 days would have to pass between the time that the co-ordinating doctor has made their statement following the first assessment, and the independent doctor carrying out the second assessment.

Amendment 317 would increase the duration of the period of reflection before a person may make a second declaration from 14 days to 28 days. It relates to cases where a person’s death is not reasonably expected within one month of the date of the court’s declaration.

Amendments 314 and 315 would increase the duration of the second period of reflection before a person may make a second declaration, in cases where a person’s death is reasonably expected within one month of the date of the court’s declaration, from 48 hours to seven days. They would also introduce a requirement for a mandatory immediate referral for urgent specialist palliative care. The requirement would be introduced into the definition of the second period of reflection. It is unclear what impact it would have on the duration of the period of reflection. The amendments do not say who should be responsible for making the referral or where it should be recorded. The drafting is also ambiguous as to what happens if a person does not consent to such a referral or care.

I hope these observations are helpful to the Committee in considering the Bill and the amendments put forward by various Members. Whether these amendments should form part of the Bill is a matter for the Committee to decide.

[Kim Leadbeater (Spen Valley) (Lab)]

I have nothing to add on this group of amendments. I am confident that the Bill as drafted already includes significant periods of reflection. Bearing in mind that we are putting dying people through a very lengthy process already, I remain confident that the periods of reflection are adequate as set out in the Bill.

--- Later in debate ---

[Lewis Atkinson]

Yes, I do. I recognise the importance of independent assessment for prognosis and capacity. However, particularly with the issue of coercion, healthcare is a team sport, as anyone who has worked in healthcare knows. The more information and the more viewpoints we can get in those instances, the better. One of the strengths of the Bill is the team sense around it, which we will further in the amendments to clause 12 that we will come on to in due course.

I will finish briefly on amendment 460. I do not see the loophole that has been described. I think we would all want someone to be able to cancel their first declaration, and they are more likely to do so if they feel they have the option of going back and making a future first declaration. My worry with amendment 460 is that, by removing the word “particular”, it suggests that people are only able to make one first declaration in the course of their life. With the periods of reflection built into the Bill, which Members spoke about earlier, if someone changes their mind, they should cancel their first declaration. They are absolutely free to do so and the Bill, as currently drafted, makes good provision for that. To me, amendment 460 would remove the ability for that person to come back to that decision at a later point and go through the assessment process again. While I understand the motivations behind amendment 460, I am cautious about it for those reasons.

[Stephen Kinnock]

Amendment 348 seeks to add an additional requirement to clause 8(5). This would mean that, where the independent doctor is satisfied that the requirements under clause 8(2) have been met, they must

“inform the person’s usual or treating doctor and, where relevant, the doctor who referred the person to the independent doctor, of the outcome of the assessment.”

Some elements of amendment 348 duplicate requirements that already appear in the Bill, such as the requirement in clause 8(5)(b) for the doctor to inform the co-ordinating doctor of the outcome, including providing a copy of the statement.

The amendment would also overlap with the requirements in clause 16 for the co-ordinating doctor to make entries in the person’s medical record that must include the original statement or declaration. Where the co-ordinating doctor is not with the person’s GP practice, they must also give notice to a registered medical practitioner with the person’s GP practice of the outcome of the assessments.

Amendment 303 seeks to prevent a person from seeking multiple second assessments from different independent doctors. It places a requirement on the independent doctor to confirm

“that no other practitioner has undertaken a second assessment for the same person.”

This amendment creates the risk of a medical practitioner inadvertently committing an offence if there is no centralised record-keeping. It may also have the impact of preventing the person seeking assistance from obtaining a second opinion, as provided for in clause 10. Under the amendment, as drafted, it is unclear how this is intended to interact with the possibility of an independent doctor’s becoming unable or unwilling to continue to act as the independent doctor following the second assessment, when an alternative independent doctor may therefore be required.

On amendment 458, as the Bill stands, clause 10 provides that if, following the second assessment, the independent doctor refuses to make the statement confirming that they are satisfied that matters in clause 8(2)(a) to (e) are met, the co-ordinating doctor may refer the person to a different registered medical practitioner who meets the requirements of clause 8(6), and is able and willing to carry out an assessment mentioning clause 8(2). The effect of the amendment is to restrict the circumstances in which the co-ordinating doctor can make a referral under clause 10(1) to a different registered medical practitioner to only when there has been a material change of circumstances. It is not clear from the amendment who is required to establish that there has been a material change in circumstances and/or how that will be proved. That may cause some uncertainty for the co-ordinating doctor.

I now turn to amendment 459. Clause 10 provides that if, following the second assessment, the independent doctor refuses to make the statement that they are satisfied that the person meets the criteria in clause 8(2)(a) to 8(2)(e) when conducting the second assessment, the co-ordinating doctor may, if requested to do so by the person who made the first declaration, refer that person to a different registered medical practitioner who meets the requirements of clause 8(6) and is able and willing to carry out an assessment of the kind mentioned in clause 8(2).

The effect of the amendment is that, where such a referral is made to the registered medical practitioner under clause 10(1), the co-ordinating doctor is required to provide them with the report by the independent doctor setting out their reasons for refusal. If the new registered medical practitioner reaches a different conclusion from the original independent doctor, they must produce a report setting out why they disagree. The two reports must be made available to any subsequent decision maker under the Bill, and to the commissioner. This additional requirement for reports on the reasons for refusal or differences in opinion may make the process of seeking assistance longer and add to capacity demands on co-ordinating and independent doctors.

Turning to amendment 460, clause 10(3) provides that if, following the second assessment, the independent doctor refuses to make the statement mentioned in clause 8(5), the co-ordinating doctor may make one referral for a second opinion. The effect of the amendment is to remove the word “particular” from clause 10(3), which says that only one second opinion may be sought

“In consequence of a particular first declaration made by a person.”

The amendment is unclear and could have several possible effects in practice. For example, it could have the effect of limiting the circumstances in which a referral can be made under clause 10(1) to the first time a person makes a first declaration.

I hope that these observations were helpful to the Committee.

[Kim Leadbeater]

I associate myself with the Minister’s comments regarding the other amendments in the group; however, I listened carefully to the debate on amendment 459 and the points made by the hon. Member for Richmond Park, my hon. Friend the Member for Stroud and the Minister. My view on that amendment has changed: I do think independence is really important in the doctor’s opinions during the normal process that the Bill sets out. However, it is a really fair point to make that if the independent doctor refuses the patient, there needs to be transparency about that, and it is important that everybody involved in the process can see how that decision has been made. That is a really valid point. It is a good example of how this Bill Committee is operating, and should be operating, in that we have been listening to different views and opinions.

I take on board the Minister’s point on capacity. We need to be aware of that. We will hopefully debate the third layer later today. That layer may be a panel of experts who are there to oversee the full picture of the patient journey. For them to see what has happened with the doctors that they have interacted with is very important. Therefore, I am minded to support amendment 459.

--- Later in debate ---

[Naz Shah]

The hon. Member for East Wiltshire makes an important point. Where are the opportunities? When doctors are doing the assessment.

The other issue that speaks to me is the question of internalised bias. We will have professionals with subconscious bias or affirmed bias. They will be clinicians who have chosen or agreed to take part in the process; fundamentally, the majority of clinicians will not take part in this process because of their beliefs. It changes the relationship between doctor and patient from a societal perspective.

I know that a number of times I have been stopped during a process and asked a different question, and at times that opportunity for reflection—even without the pressure of knowing I have only six months to live—is of benefit to me. I am sure that others would benefit from it, too, particularly because the decision is so momentous. For that reason, I will certainly support amendment 468.

I thank my hon. Friend the Member for Spen Valley for tabling amendment 201. I have mixed views on it. I appreciate what my hon. Friend the Member for Luton South and South Bedfordshire said about medical records, especially when it comes to women and their past, but I also appreciated what my hon. Friend the Member for Ashford said about his experience from a mental health perspective.

I am still thinking about the amendment and I am not sure whether I will support it or not, but further thought needs to be given to the subject. There are the issues of mental health and women’s rights, but another issue applies, too. If someone has experienced trauma in childhood but that trauma has come out much more recently, even though it does not necessarily affect the decision at hand—whether to choose an assisted death—is there some kind of historical post-traumatic stress disorder that would then need to be explored? I do not have the answer, but I look forward to hearing the comments of my hon. Friend the Member for Spen Valley on that point. I would value hearing whether she has thought about that and what her understanding of it is.

[Stephen Kinnock]

As I have mentioned before, the Government have worked closely with my hon. Friend the Member for Spen Valley on some mutually agreed amendments, including amendments 201, 422 and 433. The amendments that the Government support aim to ensure the legal robustness and operability of the legislation, should it pass, and I will offer a technical explanation for them.

Amendment 201 will clarify the wording in clause 9 on the doctor’s assessment. It provides that the duty on an assessing doctor to examine a person’s medical records applies only to records that appear relevant to the doctor. The effect of the amendment is to make clear as part of the assessment process that the assessing doctor is required only to review medical records that are considered by the doctor to be relevant to the person’s request to seek an assisted death.

Amendment 422 would add an additional requirement on an assessing doctor to make inquiries of professionals who are providing or who have recently provided health or social care to the person and make such other inquiries as the assessing doctor considers appropriate. This applies to—

[The Chair]

Order.