Access to GPs

Tom Gordon Excerpts

Monday 23rd June 2025 Commons Chamber

[Stephen Kinnock]

I am sure the hon. Gentleman will welcome the fact that we secured a record £889 million increase in the GP contract. That is a first step in digging us out of the very deep hole that the previous Government left for us. When I look across my portfolio, whether it is GPs, mental health, dentistry or pharmacy—you name it—it is a car crash right across the piece. I was frankly shocked by what I saw when I first went into the Department back in July. We are, I hope, beginning to get things back on an even keel. The hon. Gentleman is right, though: we do not have a shortage of people coming through GP training, but supply and demand are not matching up. That has to change.

I am sure that the hon. Member for North Down will welcome the fact that we secured £82 million of additional funding through the additional roles reimbursement scheme, leading to the recruitment of an additional 1,700 GPs. The challenge is more about getting GPs in the places where they are most needed, which is something we need to work on—other colleagues have talked about the geographical imbalance. We need to look at the formula for the way that funding is allocated across the country, as it is an important part of the access issue that the hon. Gentleman raised.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

I have been working with Lib Dem councillor Hannah Gostlow to tackle some of the issues that local health services and GP surgeries in Knaresborough are facing. I recently visited a surgery and was told that it had the staff that it wanted to get in place, but did not have the consulting rooms. The problem that surgery faces is that the money from the community infrastructure levy and other sources of funding will not come until further down the line, so it cannot take on those staff because the consulting rooms cannot be built. Does the Minister agree that we need to get funding into those GP services, so that we can provide the services that local people deserve and need?

[Stephen Kinnock]

The hon. Gentleman is right; one challenge we face is that, where we are developing new centres of housing, we are not getting the social infrastructure wrapping around them. We need to use things such as section 106 agreements and the CIL, as he mentioned. That process is not always working—the developers are not always coming forward with real, concrete commitments—so the integrated care boards do not commission because they are not sure that the infrastructure will be there, and we end up in a chicken-and-egg situation. We are working closely with colleagues in the Ministry of Housing, Communities and Local Government to break through some of that and attach stronger strings to the deals being done with developers. We also have the £102 million capital infrastructure scheme for primary care, which will go some way towards addressing the issue, but this is fundamentally about getting much clearer and stronger commitments from developers.

--- Later in debate ---

[Stephen Kinnock]

If the hon. Member could write to me on that issue, I would be more than happy to look into it. I am always keen to help hon. Members to get their ICBs to move in the right direction.

We have directly provided £61 million to assist the expansion of the multidisciplinary team approach across Northern Ireland, which will help to stabilise primary care, focus on the prevention and management of conditions away from hospital settings, and better utilise the skills of the community and voluntary sector. We will provide additional funding by 2028-29 to bring back the family doctor by supporting the training of thousands more GPs and delivering millions more appointments over the spending review period, and will build further on the 1,700 additional GPs who have already been recruited. Through these improvements, we are making a difference to patient satisfaction: the latest health insight survey shows a sustained improvement in satisfaction, with 72.5% of patients who contacted their general practices in the past 28 days reporting a good overall experience—up from 67.4% in July 2024.

This Government are delivering concrete results, because we believe that everyone deserves access to high-quality care closer to home. I am delighted that general practitioners committee England voted in favour of this year’s GP contract in March. This is the first time the contract has been accepted in four years. The agreement resets our relationship and marks a turning point—a shared commitment to work together on behalf of patients and practitioners alike. The changes in the contract will streamline targets for GPs, incentivise improved continuity of care, 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. Those changes are backed by an extra £889 million, representing cash growth of more than 7% in overall contract investment.

The NHS belongs to the people. Those are not just my words; they are in the NHS constitution. Everything that this Government have done since the election has been geared towards saving the NHS, giving it back to the people and getting it back on its feet. We are putting power back into the hands of patients, where it rightly belongs, because this is their health service and it must work for them. Ensuring that every patient has access to the care that they need is not just a priority, but a promise.

[Tom Gordon]

I thank the Minister for indulging me again. Will he join me in congratulating the many fantastic GPs in my constituency and throughout the country? It is not an easy job; we hear of the flak that they get from patients day in, day out when they are working to tight timeframes. One such GP in my area is Dr Viv Poskitt, who has been elected as a Liberal Democrat town councillor. Will the Minister share my thanks to Viv and to all the GPs across our country?

[Stephen Kinnock]

I will certainly congratulate Dr Viv Poskitt—I think I have got the name right—on being a GP, although I will probably not congratulate her on being a Liberal Democrat town councillor. The hon. Gentleman is right: GPs are the backbone, or the beating heart, of our NHS. They represent the front door, and we must fix that front door, which is currently creaking on its hinges. This Government are absolutely committed to fixing it, and to moving on from there to fix our NHS, get it back on its feet and make it fit for the future.

Question put and agreed to.

Oral Answers to Questions

Tom Gordon Excerpts

Tuesday 17th June 2025 Commons Chamber

[Karin Smyth]

Many hon. Members across the House rightly highlight the actual experience of people throughout the entire pathway. We have heard about the investment we are making in machines and in staff to ensure, on exactly this point, that people get not just that faster diagnosis—that is so important, particularly if cancer is ruled out—but faster care across the entire pathway. The majority of people on waiting lists are on them for diagnostics, which is exactly why we are investing more in capital and investing in staff to ensure that the process is quicker and better for patients. If the hon. Member wants to write to me about any particular issues, I will obviously respond to her.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

Every 17 minutes, someone in Yorkshire is told that they have cancer. Tomorrow, I will be launching a report for Yorkshire Cancer Research, which is based in my constituency, that will set out key recommendations. Will the Minister meet us to talk about how we can feed them into the national cancer plan?

[Karin Smyth]

The work that the hon. Member is doing locally with that group is essential. I will ensure that we have a good response for him, whether it is meeting me or a colleague.

Prostate Cancer Treatment

Tom Gordon Excerpts

Tuesday 17th June 2025 Commons Chamber

[Dr Huq]

The hon. Gentleman makes a powerful point. We are seeing a theme of uneven application. The rule of law means that the law applies to everyone, so it looks like something has gone wrong here.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

I thank the hon. Lady for securing this important Adjournment debate. We have heard from a number of Members who have constituents who are affected or have frustrations with the current system. I met a gentleman called David in the run-up to the general election who has metastatic prostate cancer and is not eligible for abiraterone. He asked me if we would push and do what we could in Parliament to ensure that people such as him could get the drug. He is fortunate and can afford to pay for it privately, but not everyone is in that situation. This is about ensuring that we have equality of access for everyone, regardless of their financial circumstances. Does the hon. Lady agree that we need to have another look at this issue?

[Dr Huq]

I completely agree with the hon. Gentleman that access should be based not on how deep somebody’s pockets are, but on need.

Abiraterone halves the risk of relapse. Each relapse literally costs the NHS millions—the definition of lose-lose. As many Members have pointed out, it is already successfully available on the NHS and routinely funded for use in metastatic cases in England, but sadly there is a catch: abiraterone is not available on the NHS for men with non-metastatic prostate cancer living in England.

Terminally Ill Adults (End of Life) Bill

Tom Gordon Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Adam Jogee]

I thank the right hon. Gentleman for his intervention—it teaches me not to take them. I also thank him for helping my street cred this morning. He raises an important point.

Members of this House have been told that this Bill—it is this Bill we are voting on, not the principle—was rigorously tested and refined in Committee. However, we are now seeing efforts to undermine the decisions of that same Committee. Amendments 94 and 95 serve the singular purpose of undoing amendments introduced in Committee to improve the Bill and make it a safer and more conventional piece of legislation, but their implications go beyond just that: they challenge the basic tenets of our democracy.

One of the key roles at the heart of our democratic system is the role of the or a Minister of the Crown. It is our Ministers who prepare the groundwork for legislation to be enacted successfully, and amendments 94 and 95 would completely do away with that core ministerial function. They would see the responsibility for ensuring the roll-out of assisted dying in Wales—the power that we the people entrust to our Ministers and democracy—taken away from them. [Interruption.]

Conscious of your cough, Madam Deputy Speaker, I shall quickly move towards the end of my remarks—I have taken half of them out already. In my view, Ministers should be able to lead the roll-out of assisted dying in Wales, just as they should in England. It is Ministers, not the supporters of the Bill, who will be responsible for delivering these seismic changes to our health and legal systems, so it is only right that they decide when the provisions become law. Amendment 42 would put England back on an even footing with Wales.

Getting this right is literally a matter of life and death. It makes sense to avoid any possible pressure on decision making and decision makers and, at the very least, allow Ministers to enact legislation with the usual constitutional powers. One death because of a rushed decision would be one too many and should give us all food for thought. I do not want it on my conscience that our collective sticking to an arbitrary deadline led to a death or deaths that may otherwise have not taken place. We must recognise that we can prevent any such situation, and we can prevent that with our vote today. To do so, we must remove the deadline for automatic commencement in England and uphold it in Wales. I urge Members to support my amendment 42 and to vote against amendments 94 and 95.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

I rise to speak to amendment 3 in my name, which would do the exact opposite of the amendments of the hon. Member for Newcastle-under-Lyme (Adam Jogee)—in fact, it would see the commencement period reduced from four years to three years. As a member of the Bill Committee, when we had the initial conversation about increasing the commencement period from two years to four years, I was the only person to speak against it, and I pushed it to a vote.

What frustrates me about the situation we are in is that, in effect, we are acknowledging that the reason we are here and debating this Bill is that the status quo is not acceptable. People are pushed to taking decisions that they should not be and having to go to foreign countries to have opportunities overseas. Those of us who support the Bill are broadly in agreement on those principles. A number of things frustrate me about the four-year period, principally that the people in office—the Government of the day—will not necessarily be here to implement it. I am really hesitant about supporting a Bill when we do not know who would see through those details.

Amendment 3 would reduce the threshold back down to three years, which would still be more than most jurisdictions around the world. Countries have implemented assisted dying legislation after as short a time as six months, 12 months or 18 months, so three years would still be a substantial increase compared with other countries. We are not innovators or leaders in this field: there is no reason why we cannot take best practice and learn from and speak to colleagues around the world. I believe that this Bill has the strongest safeguards of any, which is why I think an implementation period of three years would more than meet the requirements.

[Tony Vaughan (Folkestone and Hythe) (Lab)]

I want to put on record my sincere thanks to my hon. Friend the Member for Spen Valley (Kim Leadbeater) for the way that she has approached this Bill. Her willingness to listen to concerns from across the House has been evident, not least in new clause 14, brought forward in the names of the hon. Members for Reigate (Rebecca Paul) and for West Worcestershire (Dame Harriett Baldwin). That is a testament to how we can work together on these deeply sensitive issues.

I rise to speak in favour of new clause 14 and against amendment (b) to new clause 14. I absolutely understand the intent behind the amendment in the name of my hon. Friend the Member for Rochdale (Paul Waugh). Nobody in this House wants to see voluntary assisted dying services being advertised in a way that is insensitive, inappropriate or exploitative. We all want to protect individuals, particularly those who may be vulnerable or more easily influenced, so I fully share that concern. Although I respect the principle behind the amendment, however, I do not believe it offers the right solution.

New clause 14 rightly prohibits advertising voluntary assisted dying services to the public, while giving Ministers tightly defined powers to create appropriate exceptions through regulations. That is important, because in a healthcare system as complex as ours, we must be able to draw the line between unethical promotion and responsible professional communication. I think the new clause gets that balance right.

--- Later in debate ---

[The Minister for Care (Stephen Kinnock)]

I associate the Government with the words of the Opposition spokesman regarding the tragic incident in India.

As Members will know, the Government remain neutral on the passage of the Bill and on the principle of assisted dying. We have always been clear that this is a decision for Parliament. However, the Government are responsible for ensuring that the Bill, if passed, is effective, legally robust and workable.

Let me start with a brief observation about the process and, in particular, the time made available to Parliament to scrutinise the Bill. The Bill has received over 90 hours of parliamentary time, which is more than most Bills receive. More than 500 amendments were tabled and considered in Committee. I thank Members on all sides of the debate for their contributions during the extensive consideration and scrutiny that the Bill has received.

Given the time, I will confine my remarks on the amendments to those about which the Government have significant legal or operational concerns, and those tabled by my hon. Friend the Member for Spen Valley (Kim Leadbeater) to address significant workability concerns. Before I get into the detail, I remind the House that a full list of amendments tabled by my hon. Friend that the Government deem essential or highly likely to contribute to the workability of the Bill can be found in the letter sent to all Members by me and the Minister of State at the Ministry of Justice, my hon. and learned Friend the Member for Finchley and Golders Green (Sarah Sackman), on 15 May.

Let me start with amendments tabled by my hon. Friend the Member for Spen Valley. New clause 13 and amendments 69, 53 and 72 would allow the Government to create or change legislation to set out the end-to-end process in relation to approved substances to be used for assisted dying. They would allow for monitoring and for a regulatory regime to be designed that will offer robust oversight of approved substances and the devices used to administer them, specifically in the context of assisted dying.

Amendment 54 and new clause 15 would replace clause 35, which is currently unworkable in the wider legal context. They would align the scrutiny and certification of assisted deaths with the existing process for deaths that are not deemed unnatural. That means that assisted deaths would be scrutinised by a medical examiner rather by a coroner unless reported to the coroner by anyone who has concerns about the death.

Amendments 92 to 94 would ensure that the Secretary of State and Welsh Ministers have powers to make necessary regulations to approve assisted dying services in Wales. Amendment 95 would bring the Welsh commencement powers in line with the devolution settlement and remove the requirement in clause 54 for Welsh Ministers to lay commencement regulations before the Senedd for approval, to align with usual procedure.

I now turn to amendments tabled by other Members that the Government assess as creating potentially significant workability challenges. Amendment 97 would require the MHRA to license the approved substances to be used in assisted dying. That may present workability challenges, as licensing is not possible if the approved substances do not meet the definition of “medicinal product” under the current relevant legislation. Furthermore, licensing is reliant on the manufacturer applying to the MHRA for a marketing authorisation for that indication and providing the necessary evidence of safety and efficacy in support. Should the Bill pass, the Government would work to put in place an appropriate regulatory regime for the approval of substances. It may be helpful to note that my hon. Friend the Member for Spen Valley has tabled new clause 13, which recognises the need for a robust regulatory framework and would provide the powers needed to introduce such a framework.

Amendments 105 to 107, amendment (a) to new clause 13 and amendment (a) to new clause 14 would restrict the scope of Henry VIII powers available to the UK and Welsh Governments to make provision about assisted dying services. They would further restrict the use of powers in relation to the regulatory framework for approved substances and the devices used to administer them, and to the prohibition on advertising. I point Members towards the delegated powers memorandum published by the Government, which sets out our consideration of the Henry VIII powers in the Bill. As with legislation more broadly, the Government recognise the need, in appropriate cases, for amendment by Henry VIII powers. Members will be aware that the Delegated Powers and Regulatory Reform Committee will issue its own consideration of the Bill, which will of course be made available to all parliamentarians.

Amendment 3 seeks to shorten the commencement period to three years. Should the Bill pass, an entirely new service with robust safeguards and protections will need to be carefully developed and tested, with input from a range of delivery partners. The Government’s view is that the Bill, as amended in Committee, with a four-year backstop for commencement would be more likely to provide for safe and effective implementation.

[Tom Gordon]

One of the key things that the Bill’s sponsor, the hon. Member for Spen Valley (Kim Leadbeater), has said throughout is that four years, in the Bill as it currently is, would be a backstop. Can that be the case if the Minister is talking about a requirement of four years and that it could not have been delivered sooner?

[Stephen Kinnock]

I can confirm that it is absolutely the policy intent of the sponsor for that to be a backstop. The Government are working on that basis to ensure that it is a backstop and not a target.

Amendment 42 seeks to remove the four-year backstop. Although that is a matter for Members to decide, we note that if both that amendment and amendment 94, tabled by my hon. Friend the Member for Spen Valley, were accepted, nobody would have the power to commence reserve provisions in Wales. That would create major workability concerns for the service in Wales.

Spending Review: Health and Social Care

Tom Gordon Excerpts

Thursday 12th June 2025 Commons Chamber

[Karin Smyth]

My hon. Friend makes an excellent point about bringing down waiting lists for his constituents, and we are so pleased to see that that is continuing, as we were able to announce this morning. He also makes an excellent point about social care providers, which do an amazing job for many of us who have close family members supported by them, and it is important that they are supported and work. I am not sure whether an answer to his question about a meeting needs to be from my Department or from my colleagues in the Ministry of Housing, Communities and Local Government, but I will ensure that he has an answer.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

I welcome the funding announced to repair hospitals with RAAC, which will hopefully include Harrogate district hospital in my constituency. It has already received some money to remove RAAC in one building, which has since been demolished, but it still has a £15 million business case waiting with the Department of Health and Social Care for the next round of RAAC repairs. Will the Minister set out a timetable for repairs to hospitals such as Harrogate’s and for when we should expect to know if we will receive some of that funding?

[Karin Smyth]

We are committed to ensuring that those RAAC hospitals are sorted and fit for purpose, and I was able to visit Airedale myself recently. We are asking people on the ground to do a really difficult job, keeping hospitals going and serving patients while remedying the problem of RAAC. I do not have in front of me the exact timescale for the hon. Gentleman’s hospital, but I encourage it to work very closely with the team at the Department of Health, which I think is working really well. As long as a clear timetable has been put forward, I will ensure that the hon. Gentleman gets a response to his question.

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

Tom Gordon Excerpts

Committee stage
Tuesday 25th March 2025 Public Bill Committees

[Liz Saville Roberts]

I rise to support amendment 535. I do not intend to say much, because the hon. Member for Richmond Park has made many of the points I wished to make. The amendment recognises that an opinion was stated in a debate in the Senedd in October, which dealt in detail with the principles of this Bill, and that Professor Emyr Lewis told us that one way of recognising that would be to consider different commencement provisions in Wales.

Reference has been made to the different criminal law arrangements in England and Wales to do with smacking children, and during covid there were quite definitely different arrangements between England and Wales. After a quarter of a century of devolution, we have devolution divergence, and we are seeing that in action.

We have already accepted the principle that there are aspects of the Bill that are devolved, responsibility for which must be passed to Welsh Ministers. We are still debating the wording of that, but we are working towards it, and I think we have accepted the principle of it. We should also acknowledge that the Senedd and Welsh Ministers may well be able to make a move that would have the same effect of changing the commencement date, but I support the amendment because it shows that we are acknowledging the consequences and implications of a legislative consent motion. Incidentally, I could often stand up here and talk about the fact that legislative consent motions can be overridden by Westminster, but we are working from the point of view of seeking to respect devolved powers alongside the powers that we have here, so I will be supporting amendment 535.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

It is an honour to serve under your chairmanship, Sir Roger. I rise regretfully to speak in opposition to amendment 548, which would extend the implementation period from two to four years. I start by saying that I have had complete and utter admiration for the hon. Member for Spen Valley throughout this process, and I appreciate that she said herself that she had tabled the amendment in disappointment—I will echo a lot of what she said.

We are here today because we acknowledge that there is an injustice—that the current law for assisted dying is failing people. It forces people who are terminally ill and in unbearable pain to make impossible choices; it compels them to travel overseas, away from the comfort of home, to die in unfamiliar surroundings; it punishes grieving families by forcing them to endure police investigations for simply standing by their loved ones; and it denies dignity in death and peace in grief. We have recognised that as unacceptable, and that is why we are here debating the Bill.

The delay brought about by the amendment would tell those same people that they must wait. People have already been waiting far too long. The amendment would tell them that their suffering is not seen as important enough and that their right to a peaceful death has to be postponed. It is not justice, and we must not allow it. We know that the British public overwhelming support a change in the law. People want to see assisted dying laws in place during this Parliament, not in some uncertain future. They will not accept delay, and I do not think they will be particularly forgiving of excuses.

If we allow the implementation period to be extended to four years, we will be seen to be kicking the can down the road. Comments have been made about how the implementation would potentially be before the next general election, but there is no guarantee or certainty of that. It is in the gift of the Prime Minister to decide when the next general election is called. I cannot think of a more worrying instance of a newly elected Government having to implement a big societal change, but the amendment could make that a possibility. No Parliament can bind the next, and legislation that has been passed but not enacted could be quickly abandoned. We cannot allow that to happen; the cost would be too great. For people out there who have been campaigning for years, that would be a catastrophe. This is not an abstract policy debate; it is about real people who are suffering right now and cannot afford to wait.

A number of people have been in touch to make clear their views on the amendment. Tim Wardle, a terminally ill man from Devon with bladder, prostate and lung cancer, said that “even a slight delay beyond the two years currently proposed is not fair or reasonable. I hope the proposal is defeated.” Clare Turner, a mother of two with stage 4 breast cancer, made it even clearer, saying, “This is outrageous for terminally ill people like me. Every delay means more suffering, more people forced to endure unbearable pain against their will. This Government needs to stop dragging its feet and act now.” I appreciate that it is not the Government who are promoting the Bill, but that is the reality for people and, as uncomfortable as it is to hear those stories, we must hear them and we must listen.

It is not just people who are terminally ill who are anxious about a change in the law. Every time that I have spoken to my mum on the phone during this Committee process, she has asked me how it is going, what the process is and what the end date will be. It popped up on Facebook yesterday that it is eight years since she received her all-clear from breast cancer, but it still hangs over her. When she was diagnosed, she had two independent tumours, and her mum and her sister—my gran and my aunt—had both had breast cancer too. While there was no genetic testing to show a link, the doctor said, “This is probably going to come back, and you will probably end up with breast cancer again.”

My mum had post-traumatic stress disorder from that experience of going through cancer treatment—through the mastectomy and the recovery. It was prolonged and, to this day, there are complications as a result of the procedure and the chemotherapy. It was traumatic for the entire family, and my mum has long said that, if she had to go through something like that again, or if she ended up with secondary breast cancer at a later date, she would want this option. Every time I have spoken to her, she has been really heartened to hear the progress that the Committee has been making on the Bill, and when we spoke about this delay, it crushed her heart—and it has mine, too. Just having the option would give her—someone who does not have a terminal diagnosis or anything, necessarily, just yet—peace and comfort.

Supporters of amendment 548 will say that we need four years to get this right, but I want to know where the evidence for that claim is. It has not been clearly set out. Other countries have managed to implement similar laws in far less time. Spain implemented its law in just three months after the passage of a Bill; Jersey and the Isle of Man are aiming for an 18-month implementation period. Indeed, no country has taken longer than two years. The only example of a particularly protracted and prolonged process was in Oregon, and that was because of legal challenges.

The NHS has demonstrated time and again, particularly during covid, that when there is a need, it can act swiftly and decisively. When we set a deadline, civil servants will work towards it. We have some of the best civil servants in the world, and I commend them for their work. Throughout this process, we have examined the Bill line by line to ensure that it is the strongest, most robust assisted dying legislation in the world. We have strengthened its safeguards and refined the eligibility criteria, although I appreciate that I have had different views from some on the Committee about that. We have embedded rigorous oversight mechanisms and ensured that every step is guided by medical expertise. We have drawn from the best of international practices. We have learned from the experience of jurisdictions that have successfully implemented assisted dying laws with compassion and care.

The Bill is not a rushed or reckless piece of legislation; it is carefully crafted, and it balances the right to choose with the need for stringent protections. To delay its implementation from two years to four years, after such thorough debate, scrutiny and refinement, would undermine the very care and diligence that the Bill has been shaped by. Delaying implementation is not simply a neutral decision; it is a decision to prolong the lack of choice for people with terminal illnesses. It is a decision to deny them the ability to die on their own terms. It is a decision to force more families into impossible situations—watching their loved ones suffer, facing investigations for simply accompanying them abroad, being unable to grieve properly because they cannot even bring the body home. That is the reality of such a delay, and we have the power to stop it.

We cannot allow interference from Government, or wherever this has come from, at the last moment. This is my frustration: the amendment was tabled at the very last moment, without an explanation of where it has come from. We must listen to the people who are at the heart of the Bill. We must listen to the public and all the people who have given us input, to make sure that we end up with a Bill that takes into account the need for compassion and does not prolong the timetable for people. It is therefore with regret that I will vote against amendment 548.

[Several hon. Members rose—]

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

Tom Gordon Excerpts

Tuesday 18th March 2025 Public Bill Committees

Division 51

Question accordingly negatived.

Ayes: 3

Noes: 18

[Tom Gordon (Harrogate and Knaresborough) (LD)]

I beg to move amendment 350, in clause 18, page 12, line 34, at end insert—

“(d) subject to subsection (6A), provide additional assistance to administer the substance in the presence of an independent witness.

(6A) The coordinating doctor may provide the additional assistance under subsection (6)(d) when—

(a) the coordinating doctor is satisfied that the person is permanently and irreversibly unable to self-administer the substance due to—

(i) significant risk of choking as a result of dysphagia, or

(ii) the loss of use of the limbs; and

(b) the person has authorised that the additional assistance be provided.”

This amendment would define the eligibility criteria for those who are permanently and irreversibly unable to self-administer the substance and are therefore eligible for additional assistance to administer the substance.

[The Chair]

With this it will be convenient to discuss the following:

Amendment 351, in clause 18, page 12, line 35, after “substance” insert

“or to authorise additional assistance to be provided”.

This amendment would ensure the decision to administer the approved substance remains with the person but would allow those who are unable to self-administer the substance to receive further assistance.

Amendment 352, in clause 18, page 12, line 40, at end insert

“, unless the criteria in subsection (6A) are met.”

This amendment would authorise the coordinating doctor to provide additional support with administration for those who are unable to self-administer the substance.

[Tom Gordon]

It is an honour to serve under your chairmanship, Sir Roger. I speak in support of this group of amendments, which address the issue of fairness and accessibility in the Bill. The amendments seek to ensure that those who are physically unable to self-administer the approved substance due to their condition are not excluded from the choice of an assisted death.

The principle at stake here is equity: making sure that this opportunity would be available to not only those with the physical ability to self-administer but all eligible individuals, regardless of their condition. The Motor Neurone Disease Association made it clear in its written evidence that conditions like motor neurone disease can be cruel, devastating and progressive, locking people inside their own failing bodies. More than 80% of people with MND lose the ability to speak. Many lose all limb function, leaving them unable to lift even a glass of water, let alone self-administer medication.

There is a common theme here that relates to a point I made in an earlier sitting, when we debated the period of time for eligibility. For these individuals, the Bill in its current form creates a barrier. It states that the final act of ingesting or administering an approved substance must be taken by the person themselves. For someone with advanced MND, that may simply not physically be possible. The MND Association’s evidence highlights that in other jurisdictions, such as Queensland in Australia, allowances have been made for people unable to swallow or self-administer. If we fail to include such provision here, we risk excluding some of the most vulnerable people or, even worse, creating a perverse incentive for them to seek an assisted death earlier, possibly abroad, when they may still have physical function.

These amendments are not about lowering safeguards in any way, shape or form. As we know, the Bill has robust safeguards, which these amendments would maintain. It would only be applicable in instances where doctors deem it necessary, and it would not be open to more than those with conditions restricting their ability to self-administer. If the Bill is about compassion, then we must ensure that that compassion extends to everyone; if it is about choice, then we should not deny that choice to those with severe physical limitations; and if it is about justice, then we should not allow injustice to be written into the law.

[Naz Shah (Bradford West) (Lab)]

I rise to oppose amendments 350 to 352, tabled by my hon. Friend the Member for Gedling (Michael Payne). They would allow the co-ordinating doctor to provide additional assistance to administer the substance in the presence of an independent witness, in some circumstances. Those circumstances would be when, as amendment 350 says, the doctor determines that the person is

“permanently and irreversibly unable to self-administer”

the lethal substance because of an inability to swallow or the loss of use of the limbs. The amendments do not spell out what the additional assistance would be, but I think it is reasonable to believe that it refers to the doctor injecting the lethal substance into a person’s circulatory system.

My hon. Friend’s amendments comes from genuine concern about the situation that some people may well find themselves in. Some people who might otherwise qualify for assisted dying under the Bill might be unable to swallow or inject the lethal drugs. We should all respect the feeling that lies behind the amendments, but we should reject them. If we pass them, we will have accepted that doctors can help people who have qualified for assisted dying to prepare to inject themselves with lethal drugs or swallow them. The Bill does not say that doctors can do that. I do not know whether the House would have voted for the Bill on Second Reading if it had, but that is beside the point—it was not part of the Bill. If we were ever to consider taking such a radical step, we should only do so after hearing as much evidence as possible on why and how this might be necessary. I urge the Committee to oppose the amendment.

--- Later in debate ---

[Tom Gordon]

The hon. Member mentioned that down the line the Bill could be changed through guidance. I do not think there would be any scope or ability to do that. Does he agree that that point might be a little bit beyond what we all think might be possible under the terms of guidance?

[Danny Kruger]

I hope the hon. Gentleman is right. Nevertheless, one of my concerns about the Bill is that we are leaving enormous areas of clinical practice, and regulated conduct for the professionals involved in assisted suicide, to be performed under guidance that is still to be set out and that it is the job of future Ministers to determine.

I pay tribute to the hon. Gentleman, because he has correctly identified a group of patients for whom the drafted Bill may present obstacles to the fulfilment of their wish for an assisted death. My belief is that the ability to assist will probably cover almost anybody who wants it and has found a doctor who wants to help them, but the hon. Gentleman is right that there are some groups for whom that might be more of a challenge than others. I think the answer we are going to get—it is one made by hon. Members in the debate already—is that technology will fix it, and I fear it will, because I think we are going to find ourselves in a world in which it is perfectly possible for the administration of death to be enabled through some kind of technological device, which somebody with the most limited physical mobility will nevertheless be able to activate.

I fear the insistence that we have on self-administration. Although we can all acknowledge, as referenced in the previous debate, the conceptual difference between administration and self-administration, we do have this idea that we are individuals cut off from each other and that there is an essential gap between us and other people. At the very end of life, though—in the moments that we are considering and legislating for—that distinction is void, because we are intimately connected with other people, as per the clauses that we are debating. I fear that we are going to find ourselves in a world in which a laptop will be set up and even a movement as small as the blink of an eyelid by the patient will be enough to trigger what will be called “self-administration” of the fatal dose.

I oppose this group of amendments, moved by the hon. Member for Harrogate and Knaresborough, because I do not believe in assisted suicide. I do not understand why other supporters of the Bill are not following the hon. Gentleman’s lead, and acknowledging that if we believe in autonomy and assisted suicide, of course we should enable patients to have the final act performed upon them, rather than insisting on this arbitrary distinction that it is possible to insist on self-administration in all cases.

--- Later in debate ---

[Kim Leadbeater]

I completely understand where these amendments are coming from. In many jurisdictions where assisted dying laws are in place, this would be an accepted part of the process. However, as I have said repeatedly, our Bill stands in its own right, and its safeguards are stronger than those anywhere else in the world. One of those safeguards is that the line cannot be crossed between a person shortening their own death by administering the drugs themselves and by having another person—in this case the doctor—do it for them.

While I am hugely sympathetic to the argument, that is a line that I do not believe the Bill should cross. I concur with the comments of my hon. Friend the Member for Bradford West about Second Reading and what the House voted for, and with those of the hon. Member for Reigate about medical profession levels, which we discussed this morning. I also agree with the Minister’s comments about the concept of an independent witness, and with the comments from the hon. Member for Solihull West and Shirley about the concept of additional assistance. On that basis, I will not be supporting the amendments.

[Tom Gordon]

I will keep it short and sweet. I had not intended to push the amendments to a vote and will not be doing so. A lot of important points have been raised. Irrespective of whether the amendments were going to be pushed to a vote or would have been successful, it is important that we listen to and take into account the voices of people with different diseases who might wish to access an assisted death. We must also take into account the evidence that organisations have submitted, because it is important that those voices are heard too. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

[Danny Kruger]

I beg to move amendment 435, in clause 18, page 13, line 6, at end insert—

“(9A) Where the procedure has failed, the coordinating doctor must escalate the care of the person by making the appropriate referral to emergency medical services.”

This amendment would require the doctor to escalate the care of the person in cases in which the procedure fails.

Terminally Ill Adults (End of Life) Bill (Twenty First sitting)

Tom Gordon Excerpts

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Jake Richards]

My hon. Friend the Member for Sunderland Central has made many of the points that I planned to, so I will be brief. The primacy of patient autonomy when it comes to familial relationships is a principle that should not be interfered with in the medical sphere, which this is—we can call it treatment or something else, but it is undoubtedly a relationship between a doctor and a person.

I agree with my hon. Friend on the term “good faith”. I do not doubt the motives, but it put forwards the proposition that a doctor would act in bad faith and not tell a family member. It is a rather bizarre drafting, and wholly unhelpful for the intent for which it was put forward.

The most alarming is the second part and the issue of “best interests”. I will not labour the point that my hon. Friend has made, but what is a doctor to do? A doctor is not a social worker. A doctor is not a family support worker. What questions are they to ask? If someone says, “Oh, I don’t really want to tell my next of kin, who is my sister. We fell out last year because of tit for tat,” is the doctor going to make a value judgment as to whether that argument is profound enough to stop the notification?

[Tom Gordon (Harrogate and Knaresborough) (LD)]

The point that the hon. Member makes is, I think, exactly the case—raising this conversation and talking about it is probably not in anyone’s best interests in the first instance. I think about my own situation. If I were to find myself terminally ill and falling within the scope of this law, and my mum had passed away, then my dad, who I have not spoken to in over a decade, with whom I have a very difficult and estranged relationship, would have to be notified and we would have to have a conversation about it. On my deathbed, the last thing I want to be thinking about is some childhood trauma being brought back before me in the confines of that terminal illness. Does the hon. Member agree that, while the intention might be good, the consequences could be damaging to the patient and their best interests?

[Jake Richards]

I agree. I think in some of these debates—I am probably guilty of this as well—we forget the context in which we are operating: someone is dying, imminently. Therefore, how we approach these conversations, these assessments and this process must take that into account.

Type 1 Diabetes and Disordered Eating Services

Tom Gordon Excerpts

Wednesday 5th March 2025 Commons Chamber

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

I thank my hon. Friend the Member for Cannock Chase (Josh Newbury) for securing the debate and all hon. Members who have contributed. The hon. Member for Strangford (Jim Shannon), who appears to be quickly making an exit but remains in his place, spoke about mental health. The hon. Member for South Northamptonshire (Sarah Bool) spoke about destigmatisation for disordered eating and for type 1 diabetes. By sharing her diagnosis in this place, she is making a huge contribution towards destigmatisation, and I thank her for that. My hon. Friend the Member for Gloucester (Alex McIntyre) shared his family’s story, which is heartbreaking and shows the impact that these issues have on people. My hon. Friend the Member for Worcester (Tom Collins) talked about technological advancement and support.

As my hon. Friend the Member for Cannock Chase outlined in his remarks, type 1 diabetes and disordered eating—T1DE—is not a widely known condition, yet it potentially affects up to a third of people with type 1 diabetes. People with T1DE find themselves trapped in a battle between needing to control their diabetes with insulin and trying to control their weight in an unhealthy way. It is a vicious cycle. People with T1DE experience increased ill health and, sadly, an increased chance of early death. Studies have shown that people with T1DE who restrict insulin have a mortality rate more than three times higher than those who do not.

We should pay tribute to the diabetes charities that are doing so much for people living with diabetes across the UK and tackling this problem head on, such as Beat, which has dedicated helplines for people struggling with this condition; Breakthrough T1D, which funds international research to cure, treat and prevent type 1 diabetes and its complications; and Diabetes UK, which does a fantastic job of articulating the community’s needs to Government.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

I congratulate my friend, the hon. Member for Cannock Chase (Josh Newbury), on securing this debate. As was mentioned, I used to work for the type 1 diabetes charity JDRF, as it was then—it is now Breakthrough T1D. We used to regularly have meetings with Ministers in the Department of Health and Social Care. One of the key things that I and, I am sure, Members across the House would like to see is the new Government taking up the recommendations of the report by Theresa May and Sir George Howarth. Will the Minister agree to meet the APPG for diabetes to talk about how those recommendations can be implemented?

[Ashley Dalton]

I am more than happy to meet the APPG to discuss those matters.

I was really moved to read Lynsey’s story on the Diabetes UK website. One thing that really stood out to me was her experience of turning 18 and moving to an adult clinic. She said:

“I became a number in a system, rather than a patient. Every time I went, I saw a different team, and would have to explain my entire medical history. It felt like it wasn’t worth my time, and I certainly wasn’t going to have a conversation about what was going on with people I didn’t know.”

After just a few appointments, Lynsey stopped going. T1DE cuts across diabetes and mental healthcare, and Lynsey’s interactions with the NHS show that we must never treat patients like interchangeable statistics, bouncing around a cold system that does not seem to care for them. Instead, each patient should benefit from a unique, joined-up approach.

To its credit, NHS England has recognised that there is an unmet need for better treatment of T1DE. As my hon. Friend the Member for Cannock Chase has recognised, it has begun piloting type 1 diabetes and disordered eating services, two of which came online in 2019. The aim of those pilots was to develop the evidence base around how best to manage T1DE by testing an integrated pathway, which means that patients such as Lynsey would not be obliged to recount their medical history on every visit. In the past five years, NHS England has expanded on the original pilots, with funding extended for five T1DE pilot sites until March 2026 to ensure that there are sufficient patient numbers for us to get a full picture of what is happening on the ground. I thank my hon. Friend for his contribution to those pilots.

While those pilots are gathering evidence, NHS England is looking carefully at the findings, with a view to developing a future national strategy. Each of the five new pilot areas is submitting quarterly data to the evaluation, and it intends to publish its analysis of the data by September.

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

Tom Gordon Excerpts

Committee stage
Wednesday 26th February 2025 Public Bill Committees

[Danny Kruger]

I will decline the hon. Gentleman’s intervention—how about that? I will make his decision for him. Would that be acceptable? I look forward to his speech.

Let me wind up to the general satisfaction of the Committee with a couple of points about some other amendments. On amendment 278, which was moved by the hon. Member for Chesham and Amersham and tabled by the hon. Member for Wells and Mendip Hills—it is a very south and south-west debate—the suggestion is that if somebody has indicated in advance that they do not wish to have a conversation about assisted dying, the doctor will not raise it. That sounds welcome, but I am in fact afraid in practice that I think that this is quite simply an invitation to raise the idea if a declaration has not been made.

The absence of a declaration could well be interpreted as a willingness to have that conversation. Practically, how would it work? Would patients be informed of the need to make a declaration in advance of a doctor’s appointment? Would we all have to think, “Goodness, if I don’t make this declaration, the doctor might be suggesting an assisted death to me”? Should we all do that? Suddenly, we are having discussions about assisted death even before we see a doctor. All over the Mendip hills, people will be worrying that before they see a doctor, they had better sign a declaration.

To make a serious point, although the Bill is frequently framed as a choice only for the people who might take it, with no impact on the rest of society, my great concern is that it will actually impose an obligation on every family with a frail, elderly person in it. It will impose an obligation on all of us as we approach our end to consider whether we should take this option or not. It is not neutral in its effect on everybody. My concern is that amendment 278 will bring that home and make it even more explicitly required that we all consider whether we want to have an assisted death well before the time comes.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

I think there is already broad consensus in this country: people would like the option of assisted dying. Polling shows overwhelming support for it. I accept that there are disagreements about what the option looks like, but this is not something that people have never thought about before and would suddenly pop into their minds; they have been talking about it for decades and decades. What would the hon. Gentleman say to that?

[Danny Kruger]

The hon. Gentleman is right that people are well aware of this topic, and they would be quickly aware of the option if the Bill became law. Without getting into the question of the bogus polling that claims to demonstrate public support, I would simply observe—[Interruption.] Well, it demonstrates support for something called “assisted dying”, but if we drill into the data and ask people explicitly what they mean, we find that they often mean palliative care. The more that people understand what is proposed in this Bill, the less they like it. Actually, other polling shows that there is a majority against the provisions of this Bill, but let us not banter polling around here. We make the law, and we are not responsive to polls, are we?

There is a challenge about making advance notices, and my strong suggestion is that we do not support amendment 278. I had better leave it there; I think we have all had enough of me—me included.