Naz Shah MP: speeches 2025

Speeches

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  Does my right hon. Friend share my concern that there will only be three hours for a panel, and that the first and second doctors might not actually know the patient or have met them? Their ability to spot coercion will be very limited.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  Will the hon. Gentleman give way?

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  No, I will make progress. I am very conscious that lots of colleagues are here. I remember that we were all sitting here in November the first time that we debated this Bill; more than 100 Members did not get to speak in that debate, and many people might not get to speak today. I feel really disheartened. As other Members who were on the Committee have pointed out, we have spent so much time rehashing these arguments. There were opportunities to fix this Bill rather than me and others having to put down amendments, taking up time and not giving those who would otherwise have spoken the opportunity to speak.

• 14 May 2025 · Gaza: UK Assessment · Hansard source

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  Seventy-seven years since the Nakba, Israel’s illegal occupation eats away at the land. We now have—I will repeat these words loud and clear—“plausible genocide” according to the International Court of Justice, the International Criminal Court, Amnesty International and the United Nations. Given this week’s news, what new assessments have been made, and how often, to determine what other actions we can take to stop what is happening to the Gazans—the children, the civilians, and the aid workers—and to make sure that we can get aid in? What other pressures and levers can the Government use, including as part of a bloc, together with international partners and others, in addition to recognising Palestine? Surely that recognition is long overdue.

• 7 May 2025 · India-Pakistan: Escalation · Hansard source

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  Twenty six people lost their lives in the Pahalgam terrorist attack, and now 26 people lost their lives in yesterday’s attack. The truth remains that no evidence has been presented to anybody—any national or international partners—to say that Pakistan was, indeed, responsible for the attack on Pahalgam. I thank the Minister for coming so soon to the House and for all his efforts in trying to de-escalate. But to actually get de-escalation, and if India is so certain, does he agree that India should share that evidence with the world to justify this barbaric attack killing 26 people and attacking mosques in the middle of the night?

• 29 Apr 2025 · Palestinian Authority Prime Minister Visit · Hansard source

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  May I place on record my thanks to the Minister for all the work that he and the Secretary of State are doing on the MOU, which is very welcome? On the question asked by my right hon. Friend the Member for Islington South and Finsbury (Emily Thornberry), the Chair of the Foreign Affairs Committee, I appreciate that we stood on that manifesto, and rightly so, but things have since changed. The Government’s position was that we would continue recognition as part of the peace process, but Israel has been blocking aid to Gaza for 50 days now, people are starting to die of starvation, settler violence is increasing in the west bank and we now have an MOU, so is this not the right time to review our position? Will the Minister at least commit to going away and reviewing the decision and give the Palestinians the state recognition that they are way overdue?

• 29 Apr 2025 · Kashmir: Increasing Tension · Hansard source

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  May I first send my condolences, thoughts and prayers to all the victims of this heinous terrorist attack in occupied Kashmir? There is a large Kashmiri diaspora in my constituency, and many of my constituents have reached out to me expressing deep concerns. A number of them have mentioned the Indus waters treaty. Pakistan has already been suffering from the effects of floods in past years, from which it has not recovered. At times of escalation and troubles such as this it seems to be communities at large, be they in India or Pakistan, who suffer. What message can the Minister give my constituents to reassure them that the UK is doing all it can to de-escalate, bring things back to normal and hold the perpetrators to account?

• 25 Mar 2025 · Topical Questions · Hansard source

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  The former chair of my local trust, Bradford teaching hospitals NHS foundation trust, Dr Max Mclean, has today secured whistleblowing protection for himself in a landmark victory. Last week marked a year since a non-exec director at the trust was suspended, and a third non-exec director has put in an ET1 form to the employment tribunal. There appears to be a clear culture of targeting and witch-hunting whistleblowers at Bradford teaching hospitals trust. I appreciate the Secretary of State’s team supporting me, but given these recent developments, will he meet me?

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-eighth sitting) · Hansard source

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  Absolutely. As a former commissioner, I am very familiar with commissioning; I commissioned millions of pounds’ worth of services across Bradford when I was in the NHS. The difference is that that was under Government Bills that had pre-consultation, impact assessments and a model that was debated. None of that has happened with this Bill. I agree that in an ideal world the process set out in new clauses 36 and 37 would be the right one, but without an impact assessment and a consultation, I am afraid that I have been left really disheartened. I am disheartened about something else, too. I thank all Committee members, regardless of the points that they have or have not made, for the way in which the debate has been conducted, both before and during our sittings. On a few occasions, hon. Members have questioned other Members’ reasons for tabling amendments—but to suggest, as has been suggested today, that we are scaremongering, when we are actually going through the detail, is something else. I am afraid. This is not me scaremongering; this is me being afraid for women who are anorexic. This is a gendered Bill. There are amendments that I support because I want to strengthen the Bill. I genuinely do not think that the Bill, as it stands, has that strength. I feel disheartened that we are talking about what is going to happen on Third Reading and potential votes, when we should be concentrating on the amendments on the selection list. I oppose the new clauses tabled by my hon. Friend the Member for Spen Valley, which would replace clause 32. As my hon. Friend explained, new clause 36 outlines the powers that the Secretary of State for Health would have over voluntary assisted dying services in England. New clause 37 does the same for Wales, but makes changes that are necessary because health is a devolved power. I will concentrate on new clause 36, as I represent a constituency in England. Put very simply, if new clause 36 is agreed to, it will give the Secretary of State three sorts of power. First, it will give the Health Secretary powers under subsection (4) to, effectively, change the National Health Service Act 2006. Secondly, it will give the Health Secretary powers to set out regulations about how any service, whether public or private, carries out assisted dying services. Thirdly, the Health Secretary will have powers under subsection (1) to commission assisted dying services. As I understand it, the wording means that assisted dying services could be provided directly by the NHS or by private firms working on contract for the NHS. I will discuss those powers in the order in which I mentioned them. Subsection (4) of new clause 36 says that the Health Secretary may pass regulations that “may for example provide that specified references in the National Health Service Act 2006 to the health service continued under section 1(1) of that Act include references to commissioned VAD services.” To make it clear how the new clause works, I will quote from the subsection of the National Health Service Act 2006 that it would affect. It states: “The Secretary of State must continue the promotion in England of a comprehensive health service designed to secure improvement— (a) in the physical and mental health of the people of England, and (b) in the prevention, diagnosis and treatment of physical and mental illness.” That Act is an adaptation of the original National Health Service Act 1946, section 1(1) of which states: “It shall be the duty of the Minister of Health…to promote the establishment in England and Wales of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness”. The 1946 and 2006 Acts both give the Health Secretary a very clear set of duties that I think we can all support. Those duties have been the basis of how the NHS has been run for the nearly eight decades for which it has existed. My hon. Friend’s Bill would give the Secretary of State powers to change the duties set out in section 1(1) of the 2006 Act. I ask my hon. Friend and both Ministers why the Bill needs to give the Secretary of State those powers. The only reason I can think of is that someone who was part of the drafting process has pointed out that the Health Secretary’s current duties might be incompatible with assisted dying. The Health Secretary has duties to secure improvement in the people’s physical and mental health and in the prevention, diagnosis and treatment of physical and mental illness. Someone could bring a legal challenge on the basis that assisted dying does not fit with that duty, and that challenge might well succeed. I think that, to prevent that happening, my hon. Friend has proposed subsection (1) of new clause 36. If there is any other reason why she has suggested that we should give those powers to the Secretary of State, it is important that the Committee understands and hears it. What is proposed underlines just how major a change the Bill would make. Since the NHS started operations in 1948, we have had a clear understanding of what it is there for. The 2006 Act is little different from the 1946 Act in that respect. For nearly 80 years, we have had an NHS that is there to improve health and to improve the prevention, diagnosis and treatment of illnesses. The fact that we may have to change that shows us that we are taking a very big step indeed. To make such a fundamental change to the NHS, we should have had the best possible evidence and proper consultation, not three days of witness hearings and then hundreds of pieces of written evidence, often published after we had finished discussing the topics to which they relate. That is nowhere near good enough. The next set of powers that I want to talk about is mentioned in subsection (3) of new clause 36, which says that the Health Secretary “may by regulations make other provision about voluntary assisted dying services in England (whether or not the services are commissioned VAD services).” I absolutely accept that if we have assisted dying services in England, the Health Secretary should ensure that they are properly regulated. That will have to include privately provided services as well as those offered on the NHS. However, I must ask: why does the Bill say that the Secretary of State “may” pass such regulations? The best interpretation I can think of is that a future Health Secretary might decide that private firms should provide assisted dying services directly to paying customers rather than via outsourced NHS contracts. In that case, the Health Secretary would need to provide regulations for those private sector services. If that interpretation is correct, surely we could have tighter wording. For example, the new clause could say that if the Secretary of State decides to allow private firms to provide assisted dying to paying customers, the Secretary of State must make regulations to govern that. I would welcome clarification on the point, because I know that my hon. Friend the Member for Spen Valley previously accepted an amendment—I think it was amendment 477—

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-eighth sitting) · Hansard source

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  I stopped myself intervening on my hon. Friend the Member for Sunderland Central; I had lots of questions, and he has confused me even more. He referred to the provision in clause 8(6)(d) about the doctors being different. If I am right, healthcare providers such as Aspire or Ramsay Health Care could be commissioned to deliver the services. If so, does that mean, as the hon. Member for East Wiltshire suggested, that we will need two separate doctors or providers because the co-ordinating doctor and the second doctor cannot be linked? That confuses me even further. After what we have heard this morning, it strikes me that we do not have any proposed model and the measure has not been thought through. It speaks to the idea that this is not right. We are spending hours and hours going through hypotheticals and possibilities—this could happen, that could happen—but there is nothing actually before us.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-eighth sitting) · Hansard source

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  I thank the hon. Member for his intervention. I have observed two things this morning. First, the reality has really hit home. Are we going to look at the amendment regarding local authorities providing the service? Are we excluding private providers? Are we excluding big firms? A new service has to be designed. Will it be two organisations or one? How will the Bill be delivered? We do not even have that before us, and that concerns me deeply.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-eighth sitting) · Hansard source

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  My hon. Friend says that this will be explicitly commissioned. I completely agree with everything he has said, but this will be a newly designed service by definition, so will that not leave the door open for new providers, such as Serco or G4S, to come in, design a new service and bring in the expertise to deliver it?

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-eighth sitting) · Hansard source

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  It is interesting to follow the hon. Member for Richmond Park, because I rise to speak to amendment 537, tabled by my hon. Friend the Member for Shipley. The amendment goes further than the hon. Member for Richmond Park would as far as local authorities are concerned. The amendment also concerns both the national health service and the provision of healthcare by charities. My hon. Friend the Member for Shipley knows both fields extremely well. She was the director of quality and strategy and chief analyst at the Department of Health, and then had a senior role at the Centre for Ageing Better. Her amendment would mean that assisted dying services could be provided only by charitable organisations and not by the national health service. I strongly support the general principle that if we do have assisted dying, it should be free at the point of use. If this House decides that people do indeed have the right to an assisted death under the conditions that this Bill sets out, then it should not be something limited to those who can afford private healthcare. There are, however, strong objections among general practitioners to providing assisted dying as part of their services, and I do not think we should plan to have private firms work under contract from the NHS to provide assisted dying either. The Royal College of General Practitioners said in its written evidence that “any assisted dying service should be seen as a standalone specialised service that healthcare professionals may opt to provide with additional training and should not be deemed core GP work.” The royal college’s advice, which is founded on the views of its members, means that we should give very strong consideration to putting assisted dying outside the normal workings of the NHS. If we do that, it seems that there are a few options. One is for the Secretary of State to invite private firms to tender for contracts and administer assisted dying services. As I have said, there are very strong reasons why we should not plan to have private firms work under contract to the NHS to provide assisted dying; for me, that it is one of the worst possible options. Another option is for the NHS to fund a specialised assisted dying service that would be separate from its other functions. That could potentially be feasible, but it could also represent a significant cost for the NHS, because we still have not had the impact assessment from the Government and we have no idea how significant that cost may be. There is also the worry that if assisted dying becomes available on the NHS, some people will become too frightened to access palliative care, as was outlined to the Committee by Dr Jamilla Hussain. I will read a brief part of her written evidence to the Committee. After talking to the patients in ethnic minority and other disadvantaged groups, she said: “Overwhelmingly, racialised communities expressed deep concerns that they would be more likely to be pushed towards AD through systemic biases and societal attitudes about whose lives are valued… While safeguards were acknowledged, many remained sceptical that they would be applied fairly and equitably, fearing that vulnerable individuals, particularly those who lack strong advocates or English proficiency, might be at greater risk of being guided towards AD rather than offered appropriate care options.” I want to share something with the Committee. We often get taxis to and from work and home; I got into a cab yesterday, and the chap who was driving was called Dave. His 84-year-old aunt died on Friday. When we were discussing this option, he told me really clearly that she has opted for a cremation, which would cost less money, just because she internalised that idea of burden and she did not want a cost for those that she left behind. She had not seen a doctor for 40 years. That brought home the idea of internalised coercion, internalised pressure and mistrust, because he also talked about what happened during covid. We had an interesting conversation. I told him that it was interesting that he had said that, and today I am talking about it. That is the reality: it is about how people perceive healthcare provision, the potential inequalities, and what the barriers are to access—all the preconceived ideas that we have about the provision of healthcare. That brings me to a potential third way, which is what amendment 537 is about: charities. Charities are one way of addressing the concerns I and the hon. Member for Richmond Park have outlined about the risk with private companies and the risk of loss of confidence and access to the NHS, as well as the concerns outlined by the Royal College of General Practitioners. They could well be mitigated by ensuring that the lead responsibility for administering assisted dying is given to charities rather than the NHS.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  I thank my hon. Friend for her explanation, which was very good. I do not have time to go away and think more about it from a legal perspective, because I have only just heard her arguments, but at the moment I absolutely agree. As for my hon. Friend the Member for Lowestoft, I thank her for her attempt to explain. She has years of experience of working in the field. She tabled that amendment in response to the amendment from my hon. Friend the Member for Penistone and Stocksbridge, with the best of intentions and to strengthen the legislation. I will look at it, and I may even return to it during the debate.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  Some of them do, or they deliver parts of healthcare. Any company can bid or design a service to recruit doctors, as I said earlier. That is the reason I mention these companies. Big companies already do provide some services to our NHS, albeit that they may be in different areas at the moment.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  May I thank the hon. Member for Harrogate and Knaresborough for sharing something so deeply personal? I am sure I speak on behalf of the whole Committee in wishing his mum well and hoping that she never has that diagnosis. I rise to speak to amendments 489 and 488. Amendment 489, tabled by my hon. Friend the Member for York Central, would prevent the Bill’s provisions from coming into effect automatically after a certain period had elapsed. The Bill in its original form includes a measure to that effect, in clause 42(3): “But if any provision of this Act has not been fully brought into force before the end of the period of 2 years beginning with the day on which this Act is passed, that provision (so far as not already in force) comes into force at the end of that period.”

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  It is a pleasure to serve under your chairmanship, Mrs Harris, for what might be the last time on this Bill Committee. When we adjourned this morning, I was speaking to new clauses 36 and 37. To bring us up to speed, I will repeat my last paragraph. If the interpretation that I suggested this morning is correct, surely we could have tighter wording. For example, the new clause could say that if the Secretary of State decides to allow private firms to provide assisted dying to paying customers, the Secretary of State must make regulations to govern that. I would welcome clarification from my hon. Friend the Member for Spen Valley on whether she would be minded to accept such an amendment, given that she accepted a change from “may” to “must” in previous amendments. Finally, we come to what I think is the most important part of new clause 36: the powers in subsection (1) to commission assisted dying services. How the Secretary of State uses those powers will be crucial to the transparency of the system and to the impact of assisted dying on the NHS. We do not know whether the Health Secretary will contract private firms to provide services to the NHS or whether all assisted dying will be provided under the NHS. We do know, however, that many parts of the medical profession are strongly alarmed by the idea that the NHS would provide assisted dying. For example, the Royal College of General Practitioners said in its written evidence TIAB 108 that it “does not believe that, if assisted dying is legalised, the process should be integrated into existing care pathways as part of the standard care and treatment they provide i.e. assisted dying should not be deemed core GP work…As such, we consider that if assisted dying is legalised the Bill should make provision to establish a separate Assisted Dying service. This may help to ensure that assisted dying was not a core part of GP work and that any doctor who did not want to be involved would not be forced to do so.” There is a problem here. Giving the Health Secretary the power to commission private firms to work as contractors to provide assisted dying would perhaps solve that problem, with skilled healthcare professionals working in the private sector. In an interview with The Guardian on 10 January, the Health Secretary said: “Where there is spare capacity in the independent sector we will use it. We have agreed that we will work with them, and they will work with us to cut NHS waiting times…At the same time the independent sector has to pull its weight. It’s got to be genuinely additional capacity. I’m entirely pragmatic about this”. I agree entirely with my right hon. Friend that where there is genuine capacity in the private sector to help the NHS to complete its tasks, we should of course use that capacity. However, it is not only private sector healthcare firms that are likely to bid for any future assisted dying contract. There are other firms with a good chance of winning those contracts that we should be very concerned about. The Minister for Care has made it clear that the Government are considering using private firms for assisted dying. He gave an important interview on assisted dying to PoliticsHome , which was published on 11 March. He said that my hon. Friend the Member for Spen Valley “has said that she wants this service to be an integral part of the NHS, meaning free at the point of use. Certainly the advice that we as ministers have given her is we’ve clearly understood that that is her wish, and that is a wish that can be delivered and carried out. Now, free at point of use doesn’t preclude the use of independent contractors to deliver the service. So, yeah, we’re comfortable with that.” Unfortunately, we have seen major failings in the way private firms handle important contracts given to them by the Government. Those failings have happened under all three major parties in England and Wales. I want to quote from an excellent book by Sam Freedman, “Failed State”, which is not about some foreign country but about our own. I should say that Sam Freedman was a special adviser to Michael Gove under the Conservative Government, so he is not someone on the far left. Chapter 3 of the book, which concerns outsourcing, is entitled “Contract Killing”. It says that outsourcing contracts can work well if three conditions are met. First, there need to be many firms or public organisations competing to offer a service. Secondly, the regulator needs to be able to measure clearly whether the firms have delivered the service to a good standard. Finally, “government needs to be able to hand over most of the risk of failure—if the taxpayer is still on the hook for picking the costs if things go wrong then the premium paid to private firms is not justified.” There are fields in which Government contracts do meet those criteria and outsourcing works very well—cleaning services, for example. There are some diagnostic or therapeutic services in the NHS for which private firms can make a genuinely competitive offer. A lot of the time, however, that does not happen: “For more complex services, though, often none of these criteria apply. Take a specialist activity like running immigration processing. There is no existing market. That means there are few plausible bidders outside of a handful of huge multinational outsourcing firms.” It means, as Freedman notes, that the UK’s outsourcing market is dominated by the big four: Serco, Capita, Atos and G4S. There must be a very good chance that these companies will end up bidding for assisted dying services. Freedman gives immigration processing as an example of a complex service in which there are not going to be a lot of companies making good, competitive bids. Assisted dying is even more complex than immigration processing, and it is even more important to get it right. To bid for assisted dying services, companies will need experience in securing complex Government contracts. They will need very good legal advice. They will need to hire doctors and other specialist staff. They will need the facilities to transport and store lethal drugs. We are almost certainly going to see the same old big four outsourcing companies bidding for these contracts. That would be a major problem, because the big four have a terrible record. I apologise for not being able to give a complete list of the scandals in which these four firms have been involved while running Government contracts—after all, time is limited—but it is worth mentioning a few. In 2013, both Serco and G4S were found to have spent years keeping inaccurate records on how they tagged and monitored dangerous criminals. As a result, they had overcharged the Government by tens of millions of pounds. Serco was eventually fined £23 million for fraud and false accounting; G4S was fined £44 million for the same scandal, but that only happened in 2020, seven years after its fraud was first revealed. These two companies committed fraud against the taxpayer worth tens of millions of pounds.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  As far as I have seen, no regulatory system has been proposed in regard to the Bill. I am happy to be corrected. Yes, in other instances we have regulators, but in this instance no regulator is specified. That is why I will come back to my argument about the amendment, but I value my hon. Friend’s intervention. This is not how we regulate banks, which are overseen by independent authorities. We have seen what happens when there is light-touch regulation. Banks told us all that they were doing a great job until it turned out that they were not. There is an Independent Police Complaints Commission—I could go on, as the list is very long, but I hope we can all agree on the principle. When we regulate an important system in this country, we should not allow the people who run it to be the only people to tell us whether it is working as it should. Although we respect the highly skilled people who run our schools and police our streets, we have independent people whose job it is to check whether there are any major issues. The assisted dying system created by the Bill is both complicated and, potentially, very dangerous. If the system gets things wrong, it will mean that people will be given lethal drugs who should not have had them. That is why I would strongly support keeping the chief medical officers as the people who run monitoring, investigating and reporting. Perhaps there could be a dual system in which both the CMOs and the VAD commissioner have some kind of role. That would at least be an improvement on allowing the assisted dying commissioner to say, “There’s nothing to see here.” In my view, the best choice would be to retain the system that the Bill started out with and keep the chief medical officers as the people with the main responsibility for oversight. Members disagreed with my comparison of assisted dying with the scandal of what happened to the sub-postmasters and mistresses, but we have to think about what we have learned about the causes of that scandal. Under the law, Ministers had responsibility for the Post Office. Even though it was an arm’s length responsibility, they still had it. When complaints about the Horizon IT system, and then complaints about miscarriages of justice, started to come through to MPs, Ministers asked the experts in the field. Who were those experts? The executives who ran the Post Office and the engineers at Fujitsu who had set up and then run the Horizon system. What did those experts say for about 15 years? That there were no serious problems with Horizon, that the sub-postmasters and mistresses who said otherwise were lying and that all their convictions were safe. We know how that turned out. That surely leads us to a clear lesson: we cannot ask powerful people who have created and are in charge of a system—in this case, the assisted dying system—to be the ones who report on it. I am not saying that we would see a deliberate cover-up, as there seems to have been in the Post Office scandal. What I am saying is that we all have unconscious biases and all of us are biased to think that the work we do is good and that there are no serious problems with it. Amendment 382 significantly weakens the version of the Bill that was presented to the House on Second Reading. We are being asked to let the commissioner report on their own work. That makes it much less likely that we would be able to spot any problems with the assisted dying system at an early stage. I therefore urge Members to vote against the amendment.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  Amendments 450 and 451 were tabled by my hon. Friend the Member for York Central. Let me first set out broadly what the amendments would do. They would mean that the reports of the chief medical officers for England and Wales had to include qualitative as well as quantitative data on assisted deaths. Subsection (2) of clause 34 says that the chief medical officer’s report “must include information about” when four different events happen: if either of the examining doctors refuses to make a statement saying that the person is qualified for assisted dying, meaning they do not pass the tests set by the Bill; if the panel decides that the person does not pass those tests; or if the co-ordinating doctor decides that the person’s final statement does not pass the tests. Amendment 451 would add a requirement that the chief medical officers for England or for Wales would have to report on patients’ diagnosis and prognosis, any concerns expressed about capacity or the patient being coerced, and any concerns expressed by the panel or family members. The CMO’s report would also have to include data on the patients, including socioeconomic information and their protected characteristics under the Equality Act 2010. It would also have to include information that the doctors had gathered during their consultations with people seeking an assisted death. I anticipate Members objecting to “socioeconomic data” as the term is vague. It is important to note that the chief medical officers’ reports on other matters already make considerable use of socioeconomic data. For example, the CMO for England’s 2024 report on health in cities gave detailed information on urban populations’ socioeconomic categories. The report looked at urban populations by indices of multiple deprivation and ethnicity, and how those factors interacted with their health. The CMOs for England and for Wales are used to working with such data. Indeed, they state in reports that using that type of information is vital to understanding the health needs of different parts of the population. We should take this approach to understanding the people who access assisted dying—who they are, where they live and which groups they belong to. [ Interruption. ]

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  I rise to speak to amendment 382. My hon. Friend the Member for Spen Valley may argue that some of my criticisms of the amendment relate in particular to two other amendments she has tabled: amendments 455 and 456. Indeed, I took an intervention on the matter earlier. I have read those amendments and they do not answer my concerns about amendment 382. They were grouped with amendment 382 until this morning, when the grouping was changed, so I will address them in my next speech. This is a good moment to pay tribute to the Committee Clerks for their extremely hard work. I thank them for the way they have coped with the complex groupings and huge numbers of amendments that are unprecedented for a private Member’s Bill in this century. My hon. Friend’s explanatory statement gives a clear explanation about what amendment 382 does. It provides for the monitoring, investigation and reporting functions under clause 34 to be carried out by the voluntary assisted dying commissioner instead of the chief medical officers for England and Wales. I can think of two possible arguments in support of it. I do not know whether either was behind my hon. Friend’s decision to table the amendment, but they are certainly the best to my mind. The first argument in favour is that the chief medical officers for England and Wales already have a great many demands on their time. Members might say that we should not risk overloading them and should instead give another official the responsibility of looking at how assisted dying systems work. The second argument in favour is that the amendments to the Bill create a voluntary assisted dying commissioner, and that person and their officials will build up expertise in that field, so it could be argued that the commissioner would be the best person to lead monitoring, investigation and reporting. Unfortunately I do not think those arguments hold water. On the first, it is true that CMOs have a great deal to do, but if we pass the Bill, it will be one of the biggest changes made to the duties of doctors in this country. For the first time, they will be able to help patients to take lethal drugs solely in order to bring about their death. The chief medical officers for England and Wales are senior doctors who advice Governments on all medical matters; of course they should be centrally involved in seeing whether the system works and whether there are any problems. The second argument—that the commissioner’s office will become assisted dying subject matter experts—does not stand up either. It is true that the commissioner and the officials they recruit will come to know a great deal about the system they set up, but the very fact that they will set up and run the system means they should not take the lead on monitoring, investigating and reporting. That would mean that the commissioner and their staff would be the first people who decide whether they are doing a good job. Asking people to mark their own homework is a really bad way to check that any system is working properly. It is not how we inspect and report on schools; Ofsted has that job, not headteachers or local councils. It is not how we regulate banks, which are overseen by independent authorities.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  Does the hon. Lady agree that banning advertising also mitigates the issue of advertising to young people? She mentioned young people and suicide from a social media perspective. Young people, or anybody else who has an eating disorder, may see that as an option to enable them to qualify for assisted dying. That is because, under the Bill as it stands, they would qualify for it if they were termed terminally ill due to their eating disorder.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  I rise to speak to amendments 455 and 456, tabled by my hon. Friend the Member for Spen Valley. Under the Bill as drafted, an annual report would be issued by the chief medical officers for England and Wales. If the other amendments pass, that report will be issued by the voluntary assisted dying commissioner. Amendment 455 will do two things, broadly speaking. Proposed new subsection (2A) states that the commissioner’s report “must include information about the application of the Act in relation to…persons who have protected characteristics”. Amendment 456 clarifies that the definition of “protected characteristics” is the same as that used in the Equality Act 2010. Proposed new subsection (2A) also provides that the commissioner must report on any other description of persons specified in regulations made by the Secretary of State.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  I was talking about amendments 450 and 451 and explaining why we should take an approach that involves understanding who the people who access assisted dying are, where they live and to which groups they belong. We have heard frequently from some hon. Members that assisted dying in other countries is disproportionately accessed by people with above-average incomes. They have cited data from those countries as a reason why we should be reassured that the Bill will not have harmful effects on people from ethnic minorities, say, or from economically disadvantaged backgrounds. I am sure that hon. Members would want us to gather the same information in England and Wales to ensure that people with protected characteristics or from disadvantaged communities are not harmed or discriminated against. [Sir Roger Gale in the Chair ] Having covered what the amendments would do, I want to explain why they would improve the Bill. They would increase the qualitative and quantitative data in the CMO’s reports. Such data has all kinds of benefits. It can improve the training for healthcare professionals; it can also make it easier for researchers to dig into trends in the data. We can all agree that if we are to have assisted dying in this country, it must be a much more transparent process than the one that we see in Australia, for example. Amendment 455, tabled by my hon. Friend the Member for Spen Valley, would require the reports to include some of the information that amendments 450 and 451 would add. I will speak to amendment 455 in more detail later, but let me say that I am glad that my hon. Friend recognises the importance of reporting on protected characteristics. Amendment 451 would oblige the chief medical officers to report on complications that people may suffer during their assisted death. I am sure all colleagues will agree that that is a vital topic for CMOs to gather data on. If we are to have assisted dying, we need to understand how often complications occur and what factors they are associated with. That information can be used to inform the decision whether to choose an assisted death. Perhaps most importantly, it can be used to reduce the number of assisted deaths in which people suffer painful complications. It will also inform our decisions in this House if we have to amend legislation or vote on regulations. The amendment would require the commissioner to report on the diagnoses of people who apply for assisted death, which is an extremely important provision. The duty will mean that they look for patterns of diagnoses, making it very likely that the CMOs or other researchers using the same data could spot any particular conditions presented or special problems for palliative care. Identifying such problems will give us the impetus needed to look at how the NHS can improve palliative care for those conditions. Similarly, it is important that the CMOs look at cases in which people have raised concerns about a person’s capacity or about coercion. I understand that the voluntary assisted dying commissioner has a duty to report on those and other matters, but surely hon. Members agree that this issue is so serious that we cannot allow just one official to report on possible concerns. That is particularly true because the commissioner is the person who appoints panel members and rules on appeals against decisions. I have said it before and I say it again: it is never a good idea to allow anyone powerful to mark their own homework. This is a clear case in which we need other senior officials looking at the data for signs of things going wrong. I anticipate that the Minister is very likely to say that the Government can see problems with that part of the amendment, because he has given the same response to other amendments that include the word “complications”. He has said that the Government’s view is that it is not clear what the word means, so we cannot use it to impose duties on doctors or others. That troubles me, and I would like to explore it in depth with him. Actually, the Bill uses the word “complications” in the same sense as the amendment. I refer the Minister to clause 9(2)(c), which states that the assessing doctor must “discuss with the person their wishes in the event of complications arising in connection with the self-administration of an approved substance under section 18”. I am sure the Minister will agree that if we can accept the word “complications” in clause 9 to describe unwanted or unpleasant circumstances during and after the self-administration of lethal drugs, we can accept its use in the same sense in amendment 451. If he objects to the word outside clause 9, I would be happy to hear a detailed explanation, because it is important that we understand why. Amendment 450, the other amendment tabled by my hon. Friend the Member for York Central, reads: “The relevant Chief Medical Officer must produce an annual equality impact assessment of access to both palliative care and assisted dying on the basis of— (a) protected characteristics as set out in the section 4 of the Equality Act 2010, (b) socioeconomic status, (c) geographical location.” I understand that my hon. Friend the Member for Spen Valley has tabled an amendment that would require the commissioner to report on people with protected characteristics, but it would only look at how those people were affected by assisted dying. That does not go far enough. Several doctors and experts who gave evidence to this Committee feared that people might be more likely to choose assisted dying if they had no access to good palliative care. Several experts told us that access to good palliative care varies according to where someone lives. We should not just shrug our shoulders and say that it is a terrible shame that palliative care is in bad shape in some parts of the country while it is good in others. Amendment 451 would mean that the chief medical officers and their teams use their ability and knowledge to scrutinise the assisted dying system. Their reports would help us to identify serious problems early and then deal with them. Amendment 450 would give Parliament the regular information that it needs about whether people in this country can access palliative care. If we are serious about improving people’s opportunity to have good-quality care at the end of their life, we should support it. I urge hon. Members to support both amendments.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  I will get back to the point, Mrs Harris. Serco and G4S carried on getting huge public contracts because the Government found it too hard to replace them. Assisted dying would also be a specialised service.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  I beg to move amendment 452, in clause 35, page 21, line 30, leave out from “must” to end of line 31 and insert “every 12 months after the passing of this Act—” This amendment will replace the review conducting after five years of the passing of the Act with an annual review starting 12 months after the passing of the Act.