Rebecca Paul MP: speeches

Speeches

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

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  The amendment is simply to prevent a discrimination case. Let us take another example. A rape refuge may provide services to women who have suffered sexual abuse; it may be appropriate, in that instance, to hire only women to support those domestic abuse survivors. In order to prevent a discrimination claim when hiring, we have to rely on the Equality Act and the exemptions carved out. All my amendment says is that the same exemption would apply when a hospice or clinic is employing. It is just to avoid those issues down the road.

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

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  Does the hon. Lady have any concerns about what this position would mean for the end of life workforce? I know we are here to make law, but we cannot ignore the practical consequences for end of life care. If we do not have this carve-out, we could lose a lot of wonderful and great people who work in end of life care and who feel that they are not able to participate, if the hospice cannot specify.

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

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  rose—

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

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  It is clear that the hon. Member for Harrogate and Knaresborough is trying to create equity, which we all understand. We need to think about the patient on the one hand, but also the doctors, nurses and medical practitioners involved. Does my hon. Friend agree that we need to think about the obligation and impact of such amendments on them?

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

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  I completely agree. We are giving the same courtesy and rights at organisation level as we do to individuals. I know that the Committee is very supportive of that position for individuals, so I question why it would not be the same for organisations.

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

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  My hon. Friend the Member for East Wiltshire eloquently covered most of the things I would have said. We have probably not spoken enough to date about the impact on pharmacists, but we are getting to the point in the Bill where it is really important that we take on board the written evidence and feedback that we are hearing from them. The Royal Pharmaceutical Society said: “In dispensing a prescription, a pharmacist assumes a proportion of the responsibility for that prescription and therefore must be assured that all legal requirements are in place and that it is entirely appropriate for the patient. The link to the clinical assessment of eligibility criteria is essential and therefore the prescriber should always be one of the assessors. In addition to the usual practice of checking that the prescription fulfils the necessary legal requirement, pharmacists must have full access to the patient’s diagnosis and assisted dying care plan.” That raises a few valid and interesting points that we need to take on board to ensure that pharmacists can do their jobs in line with the regulations and laws they are subject to, which are ultimately there to maintain patient safety. I support amendment 466, tabled by my hon. Friend the Member for East Wiltshire, which would ensure that the Secretary of State must be of the opinion that there is scientific consensus that the drug is effective without causing pain. I am of the view that the Secretary of State is probably the right place for that responsibility to sit. One reason for that, which my hon. Friend spoke about, is that I am not sure that the MHRA is the right regulating body for that. I am no expert on this, and I am open to hearing the debate, but the MHRA’s remit covers medicines and healthcare products, so there is a question about whether legally the responsibility falls to it. If it does not, do we set up another body, or do we adjust its remit so that it is covered? I have reservations about doing anything that would merge assisted dying into normal healthcare, but I have laid that out many times over the weeks, so I will not go over that. My understanding is that, on top of all the things my hon. Friend set out, the MHRA’s role is to give marketing authorisation for the promotion and advertising of medicine. Once that has been given, reams of regulations and compliance must be done, including in respect of the labelling of medicine. I believe it would have to be put on packaging that a medicine could be used for assisted dying. We need to get clarity on that from experts in the field, so that we fully understand it. If that is the case, how do we feel about making it clear that said medicines, potentially out in the market, could be used for assisted dying? I suggest there could be some significant downsides to such clear labelling. That is something for us all to think about. I wanted to raise those important points.

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

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  Before I get into my speech, I thank the hon. Lady for her useful questions, as it is important to explore these issues. I will talk in more detail about new clause 23, but I would happily expand its provision, if that would make her happy. I wish to speak to amendment 481 and new clause 23 in my name. I welcome clause 23, which makes it clear that no registered practitioner or other health professional is under any duty to participate in the provision of an assisted death. I believe, however, that it can be further bolstered by the amendments that my hon. Friend the Member for East Wiltshire has spoken to, including my amendment 481 and new clause 23. The amendments concern a practical issue that would face hospices and care homes from day one of the legislation coming into force—namely, how they can continue to operate effectively with a huge diversity of views among staff members. We will all remember Sarah Cox’s oral evidence to the Committee. She cited a 2023 Royal College of Physicians survey in which 43% of Association for Palliative Medicine members said that “if assisted dying were implemented within their organisation, they would have to leave.” Dr Cox said that if this Bill became law, it would have “a massive impact on palliative care, in terms of its potential to develop both our funding and our workforce, who are really concerned about this.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 70, Q83.] In written evidence, the Association for Palliative Medicine said: “The APM recognises the importance of organisations also being able to conscientiously object to involvement in assisted dying. This is essential for the organisation and also for healthcare professionals choosing where to work with their conscience. By not having robust conscientious objection at all levels, the Bill risks imposing harm on health or social care practitioners, violating their autonomy and risking an exodus of skilled and valuable health and social care practitioners.” There will be many people in the sector who support and want to participate in assisted dying, but it is likely that some institutions and organisations will want to have a clear policy of not providing assisted dying. Some nurses, doctors and other professionals will want to work only in that kind of organisation. Either we carve out a space for them, or we risk losing some very dedicated people from end-of-life care. I am trying, through amendment 481, to carve out that space. It allows an employer—a hospice, for instance—that has a blanket policy of not offering or supporting assisted dying to require their employees to adhere to their policy. My amendment clarifies that clause 23(2) does not make blanket policies impossible to enforce: a care home or hospice can prohibit its employees from participating in the provision of assisted dying. They can still believe whatever they want to believe, but it sets out clearly what is expected if they are employed in those premises.

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

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  I thank my right hon. Friend and am sure I will come to his point. I echo what my hon. Friend the Member for East Wiltshire said about the definition of “assistance” in clause 23. If this legislation is to genuinely respect the preferences of doctors and other professionals, it is essential that “assistance” is read as including the matters in amendment 480 covering non-medical practitioners, too. I support that amendment, and what I am going to say is based on its definition of “assistance”. My amendment, it is important to say, works both ways. A care home or hospice can state that all employees must be willing to assist. We agreed to amendment 341, which allows individuals to opt out on conscience grounds. My amendment 481 gives institutions and organisations the same latitude. It opens the way to three kinds of institution: those that provide assisted dying as a matter of policy, those that will not provide it as a matter of policy, and those with no fixed policy, where some employees will assist and some will not. All those different approaches should be respected and supported. The legal basis for this is found in schedule 9 to the Equality Act 2010, which allows an employer to specify a “genuine occupational requirement”. A company can require a particular protected characteristic, as long as it is a work-related requirement and the requirement is a proportionate means of achieving a legitimate aim. The Equality and Human Rights Commission gives an example: a humanist organisation that promotes humanist philosophy and principles would probably be able to apply an occupational requirement for its chief executive to be a humanist. In this case, an organisation providing end-of-life care and with a blanket policy in either direction would not be found in breach of the Equality Act’s protection of beliefs. In healthcare, there is the obvious precedent of abortion. The British Pregnancy Advisory Service, as an abortion provider, is allowed to specify that employees must support its position. Without this amendment, we are looking at a legal and ethical minefield. If a hospice has a policy of helping with assisted dying requests and a staff member refuses to refer a patient to a doctor, can that staff member be sacked, or are they protected by clause 23? Surely we want to avoid the situation arising in the first place, by ensuring that employers can make clear their requirements on this front at the hiring stage. Conversely, what if a hospice has a policy of not participating in assisted dying? Many hospices may want to have such a policy, to reassure their patients on this front and provide a safe space for those who need it. In written evidence, Rowcroft hospice says: “Some patients may fear discussing pain and suffering in case assisted dying is suggested as an option.” According to an article in Annals of Palliative Medicine , this is a major concern in Oregon. One nurse is quoted as saying: “there’s all this advice about how to get information on Death with Dignity…already there is an attitude among many of our clients that ‘if I go into hospice, they’re going to kill me because that’s what a hospice does’”. Likewise, a healthcare professional in Australia is cited in one study as saying: “It’s affecting us in palliative medicine, more than we would like and more than it should because of the assumption that because we specialise in end-of-life care therefore, this is for us. And so, the general perception amongst medical practitioners, the health community and the general public is that this is our thing. And so, for a lot of us, we’re saying, no, this is not our thing.” Clearly, some hospices will want to have an explicit policy that assisted dying is not their thing, and they should have the right to do that. But what if an employee at that kind of hospice wants to help a patient with the assisted dying process? What if, for instance, a hospice doctor volunteers to do one of the assessments? That will obviously compromise the hospice’s policy, but are they in breach of the Equality Act 2010 if they only hire doctors who share that institution’s view of assisted dying? Again, without my amendment, it is not clear what the law allows. Amendment 441, in the name of the hon. Member for York Central, has a similar aim and would further clarify the legal position for institutions, so I am glad to support that, too. This kind of institutional opt-out is, I believe, standard practice in US states that have adopted assisted dying. California’s law includes the following provision: “a health care entity may prohibit its employees, independent contractors, or other persons or entities, including health care providers, from participating under” this legislation “while on premises owned or under the management or direct control of that health care entity or while acting within the course and scope of any employment by, or contract with, the entity.” There is also a good model in New Zealand, where the High Court has ruled that institutions can opt out. Hospice New Zealand, the organisation representing all hospice services in the country, sought a declaratory judgment because of exactly the kind of confusions that I have described. In its judgment, the High Court of New Zealand agreed that the ambiguity about institutional opt-outs was “causing confusion amongst those involved in palliative care and more generally.” The Court found that New Zealand’s assisted dying law “does not require hospices or other organisations to provide assisted dying services. They are entitled to choose not to provide these services. This does not depend on a hospice or other organisation having a conscientious objection, although that may often be the reason…Hospices or other organisations that choose not to offer assisted dying services may employ or engage health practitioners on the basis that these services are not provided by the hospices or organisations”. As a result, New Zealand hospices can set their own policy on whether to provide assisted dying. Sinéad Donnelly, professor of palliative care at the University of Otago, says that this judgment has proved very helpful to the hospice sector: “this has proven pivotal in retaining staff at hospices, many of whom would no longer be willing to work there if the assisted dying doctor or nurse practitioners were given access to the hospice to end a patient’s life.” Dr Siwan Seaman, a hospice doctor, says in written evidence: “I have liaised with a Medical Director of a hospice in New Zealand…The Medical Director in New Zealand believed that without the organisation-level conscientious objection that the hospice movement in New Zealand would have been under even more strain and look very different now.” Dr Seaman says that if we want the quality of palliative care provision across England and Wales to continue to improve, “the bill has to be amended to allow specialist palliative care services such as hospices to be separated from assisted dying processes.”

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

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  I apologise to my hon. Friend; I probably should not have used him as an example in that way—it is getting late. I actually think that this clause would benefit more those organisations that support assisted dying. It would ensure that they have the right people who support it working in there. We want patients to get the support and everything that they need.

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

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  I will be very brief. I rise to ask a few questions about clause 21 as a whole. Following our debates on various amendments, I am aware that family and those close to the patient could not be involved in the process, although potentially for understandable reasons. I appreciate that we are not here to deal with the whole operational piece, but we should think about it. For example, what happens with notifying next of kin after death, bearing in mind that “next of kin” has a different meaning after death? That is when we start to get into legal considerations, such as who the executor is—and this could be the first time that they are hearing about it. What would be the process for that, given that the person has potentially died on their own at home with the doctor? What is the process for handling the next stage? Is there anything that we need to include in the Bill to make it a clearer, simpler and easier process? Who will the medical certificate of cause of death be given to for registration of the death? While all that is going on, what will happen to the body? At that point, we may not have family members to take care of that. Those are some questions arising from clause 21 that are worth reflecting on.

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

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  Technically, our palliative care can be described as world leading, but we would all agree that much more is needed.

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

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

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

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  I do not think we should make the mistake of thinking belief is necessarily religious. I do not adhere to any faith, but I have beliefs about certain things that are protected—those beliefs are protected, and they do not necessarily have to relate to a religion. We are getting philosophical now!

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

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  I am going to read subsection (6)(c) again. It says: “assist that person to ingest or otherwise self-administer the substance.” I would interpret that slightly differently from the Minister. It talks about ingesting, which suggests the substance entering the body, so I would not suggest that sitting someone up would qualify. That in itself shows that perhaps there is some ambiguity here. The Minister has set out something that I had not read into the Bill. Will he comment further on that?

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

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  The Minister is being incredibly patient with our questions. The question from the hon. Member for Ashford raises exactly the point with which I am uncomfortable. To me, the phrase “assist that person to ingest” means something else. I am really concerned that it could be interpreted differently from how the Minister has laid it out. I want to place that on the record and raise that issue, which I believe the hon. Member was also raising.

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

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  I am just making the point that palliative care has deteriorated in jurisdictions that have introduced assisted dying. Therefore, we need to bear that in mind for this country if assisted dying is introduced. This is also about competition for time and resources. One palliative care provider in Ontario has been cited as saying that “when a patient is requesting MAID [Medical Assistance in Dying], most of the resources have been sucked up by that one case and it’s all everyone’s talking about and they’re rushing to get stuff done…everyone from admin down to the bedside nurse is focusing on MAID…And all of the high-quality palliative care that we do falls by the wayside for the other patients.” One academic study found that “in Ontario, some palliative care nurses were tasked with administration and co-ordination of MAiD which has been taking up an increasing proportion of their roles—to the point that nurses have left their jobs because they were not able to provide palliative care.” In oral evidence, Dr Cox also said: “It is unclear how this is going to be funded. It looks as if it is going to be within healthcare, and if so, there will inevitably be competition with other aspects of healthcare, including palliative care, for those limited resources. There are finite numbers of doctors, nurses and side rooms in hospitals. If palliative care and assisted dying were funded from the same pot, I think there would be a massive detrimental effect on palliative care because we would be in competition for a limited resource.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 70, Q83.] I have outlined this at length—I thank Members for their patience—because how we vote on these amendments could have enormous consequences for the palliative care sector. At the moment, it is world-leading, but that does not mean there is not huge room for improvement or that it will not be affected by the same pressures as in other jurisdictions. Amendment 481 would institute a common-sense change that the British Medical Association has suggested. New clause 23 would protect the sector from unintended consequences and unfair funding cuts. I urge Members to support both. Ordered, That the debate be now adjourned.— (Bambos Charalambous.)

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

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  It is really helpful to have these questions. I would, of course, defer to the Ministers, as they will be best placed to answer that. However, I suspect the characteristic would be belief. We are trying to ensure that if a hospice has a policy of not providing assisted dying, it is not in a situation where it has employees who are not aware of that at the outset and then want to provide it—or conversely, the opposite situation. All we are trying to do is make sure we match the right employees with the right hospices, clinics and services provided, so that we avoid these issues as they come down. It is a well-intended amendment.

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

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  It is in the top quartile. That does not mean it is good enough—not by any stretch—but I would prefer not to see it fall down.

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

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  I go back to my previous comment: I suggest that belief would be the protected characteristic.

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

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  We are just giving clarity; we are making it clear that it is reasonable and legal for an organisation to have a policy to not provide assisted dying and therefore to require its employees to respect that. All we are doing is protecting that employer from cases of discrimination, and so on, and it is really important to give that clarity. Again, I am looking forward to hearing the views of Ministers on the technicalities of this. The aim and the intention of the proposals is to avoid the problems that we will inevitably see if we do not make this clear up front. We are trying to ensure that we match the right people to the right clinics and hospices to avoid these difficulties where an employee wants to provide it but the hospice does not, and vice versa.

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

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  The answer is no, I have not done any research on that, so I cannot comment. Following this sitting, I will look into it, because the hon. Lady raises a very interesting point. This comes back to the eloquent explanation from my hon. Friend the Member for East Wiltshire that, on the one hand, there is the autonomy—we want to make sure the patient has what they need, and we are all sympathetic to that—but we must also recognise that there is an impact on others. It is about trying to weigh that up and get the balance right. I do not think it is reasonable that patients’ autonomy overrides everyone else. We have to think about the impact on everyone else too, and that is what these proposals try to do. I am trying to get the balance right. That is why I welcome the debate, because it is never quite clear where the line should be, so it is good for us to have this conversation. Amendment 481 is intended to answer the BMA’s request for such a carve-out. In written evidence, the BMA says of clause 23 that “there would need to be scope for some exceptions to allow, for example, an assisted dying service to only employ people willing to actively participate in the provision of assisted dying, without falling foul of this provision.” Presumably this freedom would apply in both directions. My amendment allows any institution or organisation, whatever its stance, the scope to set its policy and bind its employees accordingly. This also works in favour of those institutions or organisations that want to offer assisted dying. It ensures that they can make sure that they do not employ a load of people who are against assisted dying. Would you want Danny Kruger working in one of those organisations? Sorry, Mr Dowd— I meant my hon. Friend the Member for East Wiltshire. I am just saying that it benefits both sides.

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

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  I would like to think that that would naturally happen, and we have had lots of conversations where we have said, “In reality, of course this conversation would happen.” But I always like to be belt and braces, and I would like to have these things covered in the Bill. If Committee members are confident that these things would happen anyway, I am not sure there would be any detriment to accepting this amendment. I want to finish with a question for the Ministers. I have been worried—perhaps unnecessarily—about the lack of photographic identification in this process, and I can see a situation where allowing another doctor to provide assistance could create a risk. Although it might be less of a risk in someone’s home, because it would probably be clear who the person is, I am worried about a doctor in a hospital or clinic being substituted in at the final hour with no photographic verification of the person. At the point where they assist the patient to take the approved substance, how can the doctor be sure that it is the appropriate person if they have not had any involvement with the patient before? I accept, given some of the deep sighs I can hear, that that may be a rare occurrence, but it is worth thinking about. The simple inclusion of a photographic ID check would address some of that risk. I will not go over old ground, but I have been worrying about that.

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

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  We are saying that when an employee is employed by the hospice or the clinic, they are employed to deliver services as directed by the employer. I think the answer is that if an employer is really clear that they do not want to offer a service, an employee should not have a right to then offer the service that the employer does not want to offer. It is like saying, “We are a shop that sells sofas, but I have this employee who wants to sell an oven. I’m worried I will end up in court if I do not allow them to sell an oven.” It is a perfectly reasonable ask for employees to respect what the employer wants to do on this matter, and I am trying to put that clarity in the Bill. As I say, we will save no end of issues down the line if we are really clear on this now.

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

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  I thank the hon. Lady for keeping me on track. These points are important because I am setting out the importance of protecting the hospice sector, which is what these amendments seek to do. I am setting out the context that hospices currently face, and the challenges that they will potentially face if assisted dying is implemented, so that the importance of the amendments is clear—I am nearly there, Mr Dowd. When there was an outcry, the Premier of New South Wales told the press that one reason for that cut in spending was assisted dying. His Government had to find 98 million Australian dollars to pay for the voluntary assisted dying regime, because the previous Government had introduced it without funding. In oral evidence, Dr Cox said that “although palliative care services have improved in those countries where assisted dying has been implemented, they have improved three times more in countries where assisted dying has not been implemented. The evidence from that study shows that the implementation of assisted dying is impeding the development of palliative care services.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 70, Q83.]

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

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  I have real sympathy for that situation, because no one wants to see that. That is why it is really important to be clear up front. I would like care homes and hospices to be clear with their policy, so that when people make decisions about where to have their care or where to live, they can take it into account. I totally recognise that in the situation we have, if the Bill went through in two years’ time, there would be some people who were already settled in care homes where they did not know the policy, because it was not relevant at the time they moved in. I totally take the point that there are downsides to the provision, but it is important to include it to get this right in the long run. I hope Members will agree that amendment 481 seeks to make it easier for hospices and other institutions to deliver on their policy, whatever it may be, by ensuring that they can require their employees to comply. It would also leave space for palliative care to flourish by not imposing burdens on people who work in the sector. Let me turn to new clause 23. I have talked about one challenge for the hospice sector, but it is not the only challenge. The past few years have been a challenging time, given the rising cost of living and rising demand for hospice services. Hospices play a vital role in local communities by providing high-quality, compassionate care at the end of life, and I pay tribute to their work. They face huge financial pressures that put their essential work in jeopardy and could lead to unprecedented closures. In oral evidence, Dr Cox said: “The first thing to say is that palliative care is currently inadequate. Not only do we need to ensure that it does not decline, but we need to massively improve it so that this Bill offers patients a real choice. We know that effective palliative care can change a terminally ill person’s point of view from wanting to die to wanting to live. We also know that 25% of people who die in this country do not have the palliative care they need. That is more than 100,000 people a year. Providing palliative care, which might make their lives better, reduce their suffering and even change their perspective on whether they would want assisted dying, should be our priority in reducing suffering in this group.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 70, Q84.] I also remind the Committee of what Dr Clarke said: “There are hospitals, and mine is one currently, where we do not even have a 24/7 palliative care service face to face. Every night in my hospital, and every weekend from Friday to Monday, you cannot see a palliative care nurse or doctor, despite the fact that for a number of years that has been an NHS standard. That is an absolute disgrace and it shows how little people who are dying are truly cared for in a civilised society. It does not necessarily have anything to do with assisted dying, except that if we do not address that simultaneously, some of those people will “choose” to end their life, because we as a society do not care about them enough to give them the care that might make life worth living. Surely that is a travesty for Britain.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 76-77, Q94.] I remember being quite moved when she said that. Although we are limited in what can be done through the Bill to rectify funding for palliative care, we can ensure that it is not further impacted detrimentally by the introduction of assisted dying. New clause 23 seeks to protect hospices from further funding pressures arising specifically from the Bill, because there is a risk that public funding becomes dependent on offering assisted dying. The new clause would ensure that public authorities could not make funding conditional on the provision of assisted dying, and could not subject care homes or hospices to any other detriment merely on the grounds that they do not permit such assistance to take place on their premises. The new clause reflects a serious concern in the hospice sector. St Gemma’s hospice in Leeds warns in written evidence: “If compliance with assisted dying provision becomes a condition for NHS funding, institutions like St. Gemma’s may have no alternative but to cease operations entirely given its reliance on NHS funding for its financial sustainability. Such closures would have devastating consequences for the communities we serve, eliminating high-quality palliative and hospice care options for thousands of terminally ill patients annually. If patients in our catchment area could not be cared for by St Gemma’s, this would, at a minimum, reduce the degree of choice for many and put at risk the availability of palliative care across large parts of the city. Patients would be admitted to hospital or would die at home in a way that is difficult to reconcile with the palliative care ethos of choice, quality of life and quality of dying. This would increase demand on a health and care system that is already under unprecedented pressure, leading to devastating outcomes.” That is a real possibility, as shown by the fate of the Irene Thomas hospice in British Columbia. It was known as a sanctuary for dying people who did not want to be in a setting offering assisted dying, but the province adopted a policy that required hospices to provide assisted dying if they had over 50% funded beds. After the hospice board voted not to offer assisted dying, its 1.5 million Canadian dollars of public funding was cut, its clinical staff were laid off and it was taken over by the regional health authority. We should be honest about the possible threat to palliative care. This is a much-debated subject, so I will lay out in some detail the evidence that assisted dying may be detrimental to palliative care. It is true that the Health and Social Care Committee concluded that palliative care did not deteriorate where assisted dying was introduced, but a recent report by Professor David Jones looked at the issue more forensically and found: “This conclusion, however, was based on the selective evidence that the Committee received from respondents, much of which was irrelevant, outdated, or speculative. In contrast, a more complete review of better and more recent evidence shows ‘clear indications in several jurisdictions of palliative and end-of-life care deteriorating in quality and provision following the introduction of AD / AS, and a negative impact on some healthcare professionals.’” In his study, Professor Jones found that some of the evidence on which that Committee based its conclusions was highly unreliable. For instance, it was partly based on Canada committing to spend 6 billion Canadian dollars on palliative care and home care over 10 years at the time that assisted dying was legalised. The money was not ringfenced, however, so five years later, only 184 million Canadian dollars could be shown to have been allocated to palliative care. Other evidence was also out of date. For instance, Belgium’s spending on palliative care was cited, but that covered only 2002 to 2011, and that spending appears not to have been sustained. In his lengthy analysis, Professor Jones cites a wealth of evidence for his conclusion. He examines the data and finds that, between 2012 and 2019, European countries without assisted dying increased palliative care provision more than three times more than countries with assisted dying. Between 2015 and 2022, Belgium, Canada and the United States fell out of the top quartile in the world ranking for quality of death and dying, while the United Kingdom remains in first place. Between 2015 and 2019, the number of palliative care teams in hospitals increased by 3.2% in US states with assisted dying, but by 9.4% in non-assisted dying states. Clearly, there is a competition for resources between palliative care and assisted dying. In 2023, for instance, New South Wales cut spending plans by 249 million Australian dollars after increasing palliative care spending.