Stephen Kinnock MP: speeches

Speeches

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

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  That sounds like a sensible approach. New clause 40 sets out the report about progress made towards implementing the Bill. If I have correctly understood what he is saying, the right hon. Gentleman is looking for more flesh on the bones of what that plan should be and look like.

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

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  Amendment 526 would impose a duty on a Minister to arrange for the report on the review of the operation of the Act to be debated by both the House of Commons and the House of Lords within 14 sitting days, beginning with the day after the laying of the report. That goes further than laying the report before Parliament as currently required under clause 35. I hope those observations were helpful.

• 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 that clarification. It is very helpful, because I perhaps did not quite understand what the hon. Member for East Wiltshire said. My hon. Friend sets out very clearly the optionality represented in new clause 36. The new clause further ensures that voluntary assisted dying services provided as part of the health service must be free of charge, unless charging is expressly provided for. Subsection (6) confirms that regulations made under this new clause can make provisions with the same effect as an Act of Parliament, including amending other primary legislation. However, they cannot amend the provisions in this Bill. The amendment also defines voluntary assisted dying services. Amendment (a) to new clause 36 would prohibit regulations being made that authorise the provision of voluntary assisted dying services by the NHS in England. The Secretary of State would still have a duty to ensure that arrangements are made for the provision of assistance, but not by the NHS. The Secretary of State could, for example, make arrangements for another body to provide assistance, which would mean that the Secretary of State could not ensure that assistance was provided in accordance with the Bill or through the NHS in England. This would apply only to England, not Wales. Welsh Ministers could still make regulations for the provision of voluntary assisted dying services by the NHS in Wales. This could result in a divergence between England and Wales in the provision of assisted dying services.

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

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  Thank you, Sir Roger, for giving me permission to remove my jacket. It is greatly appreciated. I assume that other hon. Gentlemen in the room are also able to do the same, should they wish to do so. New clause 9 would make it a criminal offence for a person to advertise their services as a co-ordinating doctor or an independent doctor under the Bill. The offence would apply to a person who, in the course of a business, publishes or causes publication of an advertisement for the services of acting as a co-ordinating doctor or an independent doctor under the Bill, or who prints, devises or distributes an advertisement or causes that for the promotion of such services. The offence is wide-ranging and could include, for example, a person who unknowingly transmitted such advertising via electronic communications or social media. Should the new clause be passed, further work may be needed to determine how the offence would be enforced. I also note that there is no provision for any defence in relation to the offences—for example, where a person responds to inquiries. Restrictions on advertising always need careful consideration and drafting, given the potential unintended consequences and European convention on human rights impacts—particularly in relation to article 10, on freedom of speech. That is particularly so when breaches of the restrictions are made a criminal offence, as is the case here. However, article 10 is a qualified right, which means that interference can be justified provided that it is in accordance with the law, pursuant of a legitimate aim and necessary in a democratic society, so although the new clause could engage article 10, it may not violate it.

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

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  Yes. I am very happy to take that up with officials and I will come back to the right hon. Gentleman in short order. New clause 20 would introduce a requirement on the Secretary of State to lay an annual report in both Houses of Parliament on the impact of the Bill. The report would include the effect of an assisted dying service on access to healthcare, palliative care and assisted dying, and an analysis in relation to people’s socioeconomic status and protected characteristics. That report would sit alongside the existing requirement in clause 35 for a report five years after the Bill is passed. The new clause would require that the first annual report be laid before each House on its first sitting day after one calendar year from the passing of the Bill. The Committee may wish to note that, given the 12-month timeframe, the reporting requirement may start before implementation is complete. Protected characteristics are defined in section 4 of the Equality Act 2010; however, socioeconomic status is undefined in the new clause, and is not defined elsewhere in the Bill. It is therefore not clear what the assessment of those factors is intended to involve, and it may be difficult in practice for the Secretary of State to determine whether they have fulfilled this duty. New clause 28 would introduce a legal requirement on the Secretary of State to undertake an assessment of the Bill within 12 months of it being passed, and to publish and lay a report of that assessment in both Houses of Parliament. The Committee may wish to note that, given the 12-month timeframe, the reporting requirement may start before implementation is complete. Under the new clause, the assessment must cover the extent to which the Bill is on course to meet its aims; the state of health and care services for persons receiving palliative and end-of-life care; the implications of the Bill on those services; any emerging concerns relating to the operation of the Bill; and any steps the Secretary of State proposes to take in response to those concerns. That requirement is in addition to clause 35, which requires a review by the Secretary of State at the end of the initial five-year period after the Bill is passed. That new requirement is wider in scope, and would be required after one year. Palliative and end-of-life care services are broad, holistic services, provided by a range of professionals and providers—generalist and specialist—across the NHS, social care and voluntary sector organisations. Therefore, measuring the provision is difficult, as relevant consultations and tasks are not always coded as palliative or end-of-life care. Commissioning and contracting processes do not consistently support data collection, with block contracts and grants commonplace. It is also practically difficult to identify the Bill as the catalyst of the implications on those services over the specific period, as they are affected by multiple factors. Question put and agreed to. Clause 35, as amended, accordingly ordered to stand part of the Bill. Clause 36 Disqualification from being witness or proxy

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

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  The Government have been working with my hon. Friend the Member for Spen Valley, and some amendments—including all three in this group—have been mutually agreed by her and the Government with the aim of ensuring the workability of the Bill. I shall provide a brief technical, factual explanation and rationale for the amendments. Amendment 392 would add the meaning of “first assessment” and “first declaration” to the list of definitions in the interpretation provision in clause 40. The effect of the amendment is to ensure that all references to “first assessment” and “first declaration” throughout the Bill are interpreted consistently. Amendment 393 would insert the meaning of “second assessment” and “second declaration” to the list of definitions in the interpretation provision in clause 40. The effect of the amendment is to ensure that all references to “second assessment” and “second declaration” throughout the Bill are interpreted consistently. I turn to amendment 424. Clause 4(3) states: “Where a person indicates to a registered medical practitioner their wish to seek assistance to end their own life in accordance with this Act, the registered medical practitioner may…conduct a preliminary discussion about the requirements that need to be met for such assistance to be provided.” Clause 4(4), as amended, sets out that where a practitioner conducts a preliminary discussion, they must explain and discuss certain matters with the person concerned. These are: “(a) the person’s diagnosis and prognosis; (b) any treatment available and the likely effect of it; (c) all appropriate palliative, hospice or other care, including symptom management and psychological support”. The preliminary discussion may not be conducted in isolation from an explanation of and discussion about these matters. Amendment 424 would add a definition of “preliminary discussion” to the list of definitions in clause 40 to ensure that all references to a “preliminary discussion” in the Bill are interpreted in line with the description of the discussion in clause 4(3). Amendment 392 agreed to. Amendments made: 226, in clause 40, page 23, leave out line 37. The amendment is consequential on Amendment 545. Amendment 424, in clause 40, page 23, line 37, at end insert— “‘preliminary discussion’ means a discussion of a kind mentioned in section 4(3);” This is a drafting change. Amendment 393, in clause 40, page 24, line 5, at end insert— “‘second assessment’ has the same meaning as in section 8; “‘second declaration’ has the same meaning as in section 13;”.— (Kim Leadbeater.) This is a drafting change.

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

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  I get what the right hon. Gentleman is saying now: in essence, there will be different parts of the implementation period that will be done at different times. Data may take so long, training may take so long, and so on. I think what the right hon. Gentleman is asking for is a breakdown of which parts of the Bill could be implemented—

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

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  The hon. Member is absolutely right that it is a different situation from the point of view of devolution. Perhaps my answer was conditioned by the intervention of the right hon. Member for Dwyfor Meirionnydd, so I perhaps jumped to a conclusion.

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

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  I thank the hon. Gentleman for that invitation. Clause 38 is a form of insurance policy that enables the Secretary of State to respond to the evolving landscape and changes that may take place, including in the implementation period—for example, to respond to issues relating to data, substances, training or the setting up of the system. It ensures that there is a safety net or fall-back position to enable the Government to make changes that might be required.

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

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  This group of amendments relates to clause 42, which contains the commencement provisions. Amendment 547, in the name of my hon. Friend the Member for Spen Valley, provides that clauses relating to the office of the voluntary assisted dying commissioner, which will be introduced under her new clause 14 and new schedule 1, would come into force one year after the Act is passed. Subsection (4) of new clause 14, which relates to the functions of the commissioner, including arranging the work of panels and monitoring the operation of the Bill, would not come into force at this point. The amendment would require the process of recruiting the commissioner and their deputy to begin shortly after Royal Assent. Powers to second staff under schedule 1 may be a necessary tool in resourcing the commissioner in the interim period before the wider Bill comes into force. Amendment 531 would require the Secretary of State to lay before Parliament a report before assisted dying can be provided and is decriminalised. That report must contain an analysis of the readiness of services to provide assistance and of the training that has been provided under the Bill. The effect of the amendment might be to delay the commencement of the Bill until the specified reports have been laid before Parliament. Amendment 488 would remove clause 42(3), which provides that any provisions that are not already in force two years after the Act is passed will come into force at that point. That would mean that the Secretary of State will need to make regulations to bring into force all provisions of the Bill except clauses 37 to 41 and clauses 43, which come into force when the Act is passed. In addition, the amendment provides that clause 18 may not be brought into force until a Minister of the Crown has made a statement to both Houses of Parliament that all regulations necessary for the effective provision of assistance have been made. The Minister’s statement must list those regulations. The amendment does not specify which regulations are necessary for the effective provision of assistance, which could create uncertainty. Amendment 489, which is linked to amendment 488, would likewise remove clause 42(3). As the Bill stands, provisions that have not already been brought into force will automatically come into force two years after the date on which the Act passes. Amendment 548, tabled by my hon. Friend the Member for Spen Valley and drafted with the technical support of Government officials and lawyers, would change that provision from two years to four years. We have already discussed the proposition to have regular reports on progress towards implementation, as per amendment 546 and new clause 40. The time required to prepare for the implementation of the Bill is clearly a critical point to be weighed when considering the question of workability. Were Parliament to approve the provision of assisted dying services, it would be the role of Government to ensure that a fully functioning, safe and high-quality service is in place for those who wish to access the assistance provided for under the Bill. The delivery of an entirely new service with robust safeguards will need to be carefully and thoroughly developed and tested. As the Bill has rightly been amended by Members in Committee and several new requirements have been added, the Government now have to assess the critical path to implementation. We will therefore provide clarity to Members, ahead of Report, as to whether any further amendments related to commencement are needed. We will continue to develop our thinking on the matter and will work with my hon. Friend the Member for Spen Valley to explore the potential options for Report, to capture the need both for timely implementation and for ensuring the provision of a high-quality service for people seeking assistance under the Bill. Amendment 536 would increase the length of time specified under clause 42(3) from two years to five years. That would mean that any provisions that had not been commenced five years after the date on which the Act is passed will automatically come into force at that time. I turn to amendment 535. As the Bill stands, the Secretary of State may make regulations to commence the provisions of the Bill for England and Wales. The amendment would, in relation to Wales, require Welsh Ministers instead of the Secretary of State to commence the Bill via regulations. Apart from clauses 37 to 41 and 43, which would come into force on Royal Assent, the provisions of the Bill would come into force in Wales on a date or dates appointed by Welsh Ministers in regulations. There would be no automatic two-year backstop for those provisions to come into force in Wales. The amendment would also require that regulations made by Welsh Ministers be subject to the affirmative resolution procedure in the Senedd. That may have devolution settlement consequences, as the impact could be that the Bill is differentially commenced in England and Wales, potentially creating a disparity, particularly in relation to the introduction of the criminal offences, and a lack of certainty. I turn to amendment 490. As the Bill stands, regulations made under clause 42(2) will be subject to the negative resolution procedure. The amendment would change the regulation-making procedure so that the Secretary of State could not make commencement regulations unless a draft is laid before and approved by each House of Parliament. It would also add a new requirement that the Secretary of State may not lay the draft regulations until they have laid a report before each House that provides an analysis of the expected efficacy of services and functions performed under the Bill. The amendment provides a non-exhaustive list of the information that the report must contain. The amendment could cause delays to the making of commencement regulations under the Bill. Amendment 547 agreed to. Amendment proposed : 531, in clause 42, page 24, line 21, at end insert— “(2A) The Secretary of State may not make a statutory instrument containing (whether alone or with other provision) regulations under subsection (2) bringing sections 1 or 24 into force unless they have previously laid before Parliament a report containing an analysis of— (a) the readiness of services to provide assistance and related functions of this Act, and (b) training that has been provided under the provisions of this Act.”— (Sarah Olney.) Question put, That the amendment be made.

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

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  This group of amendments relates to clause 35, which sets out requirements for review of the Act. Amendments 491 and 492 aim to broaden the scope of the assessment criteria for the review. Amendment 491 would expand the scope of the report that the Secretary of State must prepare at the end of the initial five-year period to include an assessment of the availability, quality and distribution of appropriate care services, as well as health services, to persons with palliative care needs. Care services play an important role in supporting terminally ill individuals with care needs in settings such as care homes and in the community. However, it is not clear what the term “care services” would cover. It could include, for example, unpaid care, private or local authority-funded care, or non-statutory care services such as befriending. Amendment 492 would extend the people the assessment will cover to include those receiving end-of-life care as well as those with palliative care needs. The Committee may find it helpful to note that, while palliative care focuses on improving quality of life for individuals with life-limiting illnesses at any stage, end-of-life care specifically addresses the needs of an individual in their final year. The Committee may also find it helpful to note that, under clause 2(1) as amended by the Committee, a person is considered terminally ill if their death, in consequence of an inevitably progressive illness or disease that cannot be reversed by treatment, can reasonably be expected within six months. Clause 35(1) requires the Secretary of State to undertake a review of the operation of the Act, prepare a report on that review, and publish and lay the report before Parliament. The Secretary of State is required to do that during a period of 12 months beginning after the period of five years from the day on which the Bill is passed. Clause 35(3) provides a non-exhaustive list of what the report must set out. Amendment 397 would require that the report includes an assessment of the impact of the legislation on people with learning disabilities, including any concerns about the operation of the Act in relation to them. The amendment does not include a definition of “learning disabilities” and so may introduce legal uncertainty as to what must be included in the report. However, I note that there is an existing definition of “learning disability” in section 1(4) of the Mental Health Act 1983, which could be considered to mitigate this uncertainty if the amendment were agreed to.

• 24 Mar 2025 · Male Suicide in Rotherham · Hansard source

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  I am grateful to my hon. Friend the Member for Rother Valley (Jake Richards) for securing this debate and for raising the extremely serious issue of male suicide. I also congratulate him on obtaining his first Adjournment debate. I am sure that it will not be the last. He is a doughty campaigner for his constituents. I thank other Members for their valuable contributions, particularly my hon. Friend the Member for Portsmouth North (Amanda Martin), who made a powerful speech. I offer my deepest condolences to those who have been tragically bereaved by suicide. Men tend to seek help for their mental health less than women. As my hon. Friend the Member for Rother Valley said, men are also more likely to die by suicide, accounting for three out of four suicides. Rates in Rother Valley sadly reflect that statistic. Today, mental ill health is on the rise, and the shocking fact is that suicide is the biggest killer for men under 50. Just as we are determined to end the injustices that women face in healthcare, we will not shy away from the need to focus on men’s health too. That is why the Government will publish a men’s health strategy to tackle those problems head-on. In November, my right hon. Friend the Secretary of State for Health and Social Care brought together leading campaigners, experts and the Premier League to gather ideas and inform our strategy and our 10-year health plan. We take suicide prevention extremely seriously, because every suicide is a tragedy that has a devastating and enduring impact on families, friends and communities. With that in mind, I would like to express my gratitude for the hard work and dedication of local frontline services, including the voluntary sector, which play such a vital role in supporting people who experience suicidal thoughts or contemplate taking their own lives. Such organisations include Andy’s Man Club, Rotherham Samaritans and James’ Place, to name just a few. The cross-sector suicide prevention strategy for England, which was published in 2023, has made some progress, and we are working closely with local authorities, health systems and our partners in the voluntary community to see that progress through. The strategy identifies middle-aged men as a priority group for targeted support at a national level. It rightly focuses on key drivers that we know can affect men’s lives, such as gambling, financial difficulties and substance misuse. Rotherham council has developed a three-year plan for suicide prevention and self-harm, which I understand is currently out for consultation with local partners. I commend the council and all local partners involved in the development of the plan. I hope that it will provide a strong foundation for a new partnership between local government and national Government, because people in my hon. Friend’s constituency deserve backing at every level. My hon. Friend raised the shocking issue of young men taking their own lives as a result of problem gambling. The NHS has expanded support for those who need help to overcome gambling addictions. Individuals can self-refer to specialist gambling clinics in England, where they can be supported by psychiatrists. Our suicide prevention strategy for England identifies gambling as a common risk factor and lists actions to reduce suicide as a result of gambling. We will explore opportunities to go further to support people with gambling addictions. It can be hard for a young man in today’s society, particularly for boys in the most deprived areas of England, who are expected to live almost 10 years less than those in the wealthiest areas. We are committed to improving the nation’s mental health services to ensure that individuals can get the support they need when they need it. We are recruiting 8,500 new mental health workers, who will be trained to support people at risk of suicide. We are also committed to improving the support available to those experiencing a mental health crisis. This year, the Government are providing £26 million in capital investment to open new mental health crisis centres, reducing pressure on busy A&E services and ensuring that people have the support they need when and where they need it. These new centres will include crisis houses, providing overnight accommodation, sanctuaries and safe havens, calm environments for people to visit during the day and mental health-specific spaces in or adjacent to A&E departments. I am also grateful to my hon. Friend the Member for Rother Valley for raising the important issue of technology, which can have a profoundly damaging effect. We should all be concerned about the widespread availability of harmful content online that promotes suicide and self-harm and can be easily accessed by people who may be vulnerable. The suicide prevention strategy for England identifies online safety as a priority area for action across Government. We are working closely with our colleagues at the Department for Science, Innovation and Technology in this area, including to deliver the commitments in the strategy and to look at what else can be done to address online harms, including harmful content shared on pro-suicide websites and forums. There is still uncertainty about the relationship between screen time, social media use and child development. However, I look forward to seeing the results of DSIT’s research into the impact of smartphones on children, which is due to be published in May this year. Our current focus is on keeping young people safe while also benefiting from the latest technology. By the summer, robust new protections for children will be in force through the Online Safety Act 2023 to protect them from harmful content and ensure that they have an age-appropriate experience online. Alongside getting those laws in place, we are committed to building the evidence base to inform future action to protect young people online. It is not only the dangers of technology that are a concern for young people. Young people present unique challenges, and early intervention is vital if we want to stop children and young people from reaching crisis point today or developing mental health issues in the longer term. Schools and colleges play an important role in that early support, which is why we are providing access to a mental health professional for every school. We know that mental health support teams, such as the With Me In Mind team based in Doncaster and Rotherham, help to meet the mental health needs of children and young people in education settings. We are also committed to rolling out open access Young Futures hubs in communities. This national network is expected to bring local services together and deliver support for young people facing mental health challenges. The Department for Education is also reviewing the relationship, sex and health education statutory guidance, and the Secretary of State for Education is clear that children’s wellbeing should be at the heart of it. The DFE will look carefully at the consultation responses, considering relevant evidence and talking to partners, including on mental wellbeing and suicide prevention, before setting out next steps and engaging with wider experts. As part of this process, the DFE will explore whether additional content is required, including on suicide and self-harm. Mental health is, and remains, a priority for the NHS. It is backed by the mental health investment standard, which continues in 2025-26 to ensure that mental health funding is ringfenced to support delivery of our commitments, including those outlined in the NHS planning guidance. The Government have a statutory requirement to publish an annual statement setting out expectations for NHS mental health spending before the next financial year begins. My right hon. Friend the Secretary of State will publish that statement in due course. I will end with a call to action. Suicide is everyone’s business; when we improve men’s health, the benefits can ripple through families, communities, societies and the economy. When we strive to improve men’s health, it will not just transform the lives of boys and men, but those of their wives, mothers, sisters, partners, mates, neighbours, children, teachers and doctors. That is why I strongly encourage all the men listening to this debate to go to the Change NHS online portal, to give their views on how to build an NHS that is fit for the future through our 10-year health plan. Together, we will transform healthcare for men in the Rother valley, in the north of England, and across our country. Question put and agreed to.

• 20 Mar 2025 · Face-to-face GP Appointments · Hansard source

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  I thank the hon. Member for Boston and Skegness (Richard Tice) for raising GP access, which is a vital matter to many of our constituents. I want to start by paying tribute to Laura Barlow’s family, friends and loved ones and to her husband Michael, who is in the Gallery. It is a terrible tragedy that Laura’s cancer was not caught earlier, and I absolutely agree with the hon. Gentleman that the significant number of people who signed the petition shows real strength of feeling on this heartbreaking case. When people are asked what their top priority for the NHS is, the chances are they will say, “Fix general practice” because GPs are the front door to our national health service. They are the first port of call for millions of people, and they perform a vital service by delivering care in communities across our country. Let me be crystal clear from this Dispatch Box: GPs must provide face-to-face appointments, alongside remote consultations. Online services must always be provided in addition to, rather than as a replacement for, in-person consultations. Patients have a right to request a face-to-face appointment, and practices must make every effort to meet their preference unless there are good clinical reasons to the contrary, such as in cases where the patient tests positive for an infectious disease. There are clear benefits to attending an appointment in person. GPs pick up cues from body language and foster a more personal relationship with their patients, and that is important if we are to bring back the family doctor. Last year, GPs delivered 380 million appointments throughout England. Two thirds of those were in person, and I can tell the hon. Gentleman that the figures for his integrated care board in Lincolnshire are in line with the national average at 65%. It is possible that, in some practices, defaulting to remote appointments was a temporary and necessary measure during the pandemic, but in some cases, that may have become a habit that has become difficult to shake. Let us be clear that this is not the fault of GPs per se; it is the fault of the last Government, which left them underfunded, understaffed and in crisis. That is why we are doing everything we can to remedy the downward spiral that GP services have found themselves in after 14 years of Tory neglect and failure. I was absolutely delighted that the general practitioners committee England voted in favour of this year’s GP contract last month. It is the first time that the contract has been accepted in four long years. The reformed contact agreed between the Government and the GPC will improve services for patients, make progress towards our health mission and, crucially, require practices to make it possible for patients to go online to request an appointment throughout the duration of core opening hours. That will free up time for patients who prefer to call or visit in person. Those changes are backed by an extra £889 million, representing a cash growth of more than 7% in overall contract investment, bringing total spend on the GP contract to £13.2 billion this financial year. That is the largest uplift to GP funding in a generation, and it means we are beginning to reverse a decade of a dwindling share of NHS resources going to general practice. It is not just about resource and funding, however. We are bulldozing bureaucracy for GPs, so that they spend less time pushing paper and more time seeing patients like Laura. We are training thousands more GPs, modernising the booking system, ending the 8 am scramble and bringing back the family doctor. Those measures should make it possible for GPs to guarantee a face-to-face appointment for all who want one. The Government are committed to shifting the focus of our NHS from hospital to community. We will move towards a neighbourhood health service, improve continuity of care for those who would benefit from seeing the same clinician regularly, which is associated with better health outcomes and fewer A&E attendances, and we will drive the shift from analogue to digital by ensuring that all practices are employing the full functionality of GP Connect. Let me turn to cancer. The Government are determined to tackle the biggest killers. My right hon. Friend the Health Secretary has announced that a national cancer plan for England will be published later this year. The plan will put patients at its heart and will cover the entirety of the cancer pathway, from referral and diagnosis to treatment and ongoing care. It will seek to improve every aspect of cancer care and the experience and outcomes for people with cancer. Our goal is to reduce the number of lives lost to cancer over the next 10 years. The plan will spell out how we will improve outcomes for cancer patients, speed up diagnosis and treatment and ensure patients have access to the latest treatments and technology. We will bring this country’s survival rates back up to the best in the world. Our NHS belongs to the people. Those are not just my words; they are in the NHS constitution. Fourteen years of Tory failure left our NHS broken but not beaten. Everything this Government have done since the election has been geared towards saving the NHS and giving it back to the people. We are putting power back in patient hands, because it is their health service and it must work for them. Last week, my right hon. Friend the Prime Minister announced reforms that will shift power away from the centre. Patient choice is at the heart of this Government’s commitment to build an NHS fit for the future, and all patients should be offered face-to-face appointments when it is in their best interests. Question put and agreed to.

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

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  Amendment 445 would require that the Secretary of State make regulations about enforcement, including provision of imposing civil penalties, when making regulations for prescribing, dispensing, transporting, storage, handling and disposal of approved substances, including the keeping of records relating to those activities. That would be a change from the current approach in the Bill, which gives a power to the Secretary of State to make such provisions. In practice, where the Secretary of State makes regulations specifying substances under clause 20, they will necessarily make regulations under clause 28 for the prescribing, dispensing and transporting of said substances, and on enforcement, which would include imposing civil penalties.

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

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  It is a great pleasure to serve under your chairship today, Mrs Harris. Amendment 442 would require the Secretary of State to make regulations for the prescribing, dispensing, transporting, storage, handling and disposal of approved substances, including the keeping of records relating to those activities. That differs from the Bill’s current approach, which enables the exercise of a power by the Secretary of State to make such regulations. In practice, where the Secretary of State makes regulations specifying substances for the purpose of the Bill under clause 20, they will necessarily also make regulations for the prescribing, dispensing and transporting of said substances under clause 28. However, requiring, rather than enabling, the regulations under clause 28 to be made may reduce flexibility in terms of their timing as there is a range of technical issues that may need to be resolved—for example, clinical questions on how an approved substance should be prescribed or dispensed. Amendment 443 would mean that regulations for the prescribing and dispensing of approved substances could be made only in relation to substances that have already been approved by “the Medicines and Healthcare products Regulatory Agency and either the National Institute for Clinical Excellence or the All Wales Medicines Strategy Group”. That may impact the operational delivery of the Bill as the drafting is ambiguous. One possible interpretation is that the amendment may require the approved substances to be licensed by the MHRA specifically for the purpose of assisted dying. That would require additional powers to amend medicines regulations, which are not currently provided for in the Bill. NICE and the All Wales Medicines Strategy Group typically make recommendations only on medicines that have already been proven to be safe and efficacious. They do not approve medicines in the way the amendment implies, and this could infringe upon the role of the MHRA.

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

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  I will speak on amendment 524, in the name of the hon. Member for East Wiltshire. As the Bill stands, a person is required to “have regard to” any codes of practice issued by the Secretary of State when performing a function under the Bill. Amendment 524 would mean that individuals are instead required to “comply with” the codes of practice issued. That could limit someone to doing only what is specified in the code, rather than allowing them to exercise their professional discretion to perform the function in the most appropriate way, having given regard to the code. It is also unclear from the amendment who would monitor or enforce compliance with the codes. Codes of practice are normally detailed practical guidance on how to comply with legal obligations, and are generally not legally binding. I hope those observations are helpful to the Committee.

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

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  This group of amendments relates to clause 30 of the Bill and the codes of practice that may be issued by the Secretary of State. As the Bill is drafted, the Secretary of State may issue one or more codes of practice in connection with arrangements pertinent to the assisted dying process. Amendment 447 requires the Secretary of State to issue such codes, substituting “must” for “may”. As such, codes of practice would need to be issued for all matters listed in clause 30(1). Amendment 394 has the effect of broadening to Secretary of State’s power to issue codes of practice, explicitly enabling the Secretary of State to issue guidance in connection with “information and support to persons with learning disabilities who are eligible to request assistance” under the Bill, including information and support about the role of advocates. I note that under the Equality Act 2010, health providers are already under a duty to make reasonable adjustments in the provision of services, including for persons with a learning disability. That duty includes taking steps to provide information, including on what support services are available. As drafted, clause 30(1)(c) provides that the Secretary of State may issue codes of practice on “the arrangements for ensuring effective communication in connection with the provision of assistance…including the use of interpreters”. Amendment 448 provides that, if the Secretary of State issues codes of practice that include the use of interpreters, those interpreters should be “registered and qualified”. The amendment would limit those who are able to translate to only those who are registered and have a recognised qualification. However, the amendment does not state who or what such a registration would be with, or what would constitute a recognised and appropriate level of qualification. Amendment 534 adds to the list of codes of practice that the Secretary of State may issue. The addition is a code of practice on the acceptable forms of proof of identity when a person makes a first declaration. Clause 6(3) of the Bill already provides a regulation-making power that sets out the acceptable forms of proof of identity. Amendment 534 would give the Secretary of State a power to make codes of practice about how someone can ensure they are compliant with the requirements set out under clause 6(3). The amendment has little practical effect, because clause 30(1)(e) already provides a wide power for issuing codes of practice, providing that the Secretary of State may issue codes of practice on “such other matters relating to the operation of this Act as the Secretary of State considers appropriate.” Amendment 523 allows the Secretary of State to issue further codes of practice at his discretion, should they not be covered by the preceding subsection (1) of this clause. The Bill’s promoter has said she is minded to support amendment 447, and the hon. Member for East Wiltshire asks whether, if amendment 447 is incorporated into the Bill, that renders amendment 523 unnecessary or surplus to requirements. I am not entirely sure, so I will quickly check while the Bill’s promoter is making her remarks and come back to him immediately.

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

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  Thank you, Mrs Harris; you have helped me to answer the hon. Gentleman’s question in a far more pithy and direct way than I could have. I think it is best for us to wait for us to discuss clauses 32 and 39, when we can really get into the meat of the precise issue he raised. Amendment 521 would change the requirements in clause 28 so that regulations governing the prescribing, dispensing, transporting, storage, handling, disposal and records relating to these activities of approved substances under the Bill must be laid in draft form and approved by resolution in each House of Parliament. This is a change from the current requirement in the Bill that the regulations are subject to the negative procedure. Both procedures are subject to Parliamentary scrutiny. However, the requirement for active debate in both Houses of Parliament as a result of the amendment would extend the timeline to make or change regulations. Amendment 485 is similar. It would alter the requirement in clause 28 that regulations governing prescribing, dispensing, transporting, storage, handling, disposal and records relating to these activities of approved substances are subject to the affirmative procedure, instead of the negative procedure as drafted. Similar to the change of procedure proposed by amendment 521, the affirmative procedure would extend the timeline to make or change regulations. That is the end of my observations. I hope they were helpful to the Committee.

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

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  Amendment 517 relates to new clause 25, which I will come to next. The amendment would make provision for the Secretary of State to issue a code of practice regarding arrangements for a qualifying person to receive the support of an independent advocate, as set out under new clause 25. The new clause would require the Secretary of State to make regulations about the appointment of independent advocates. The role of the independent advocate would be to provide support and advocacy to a qualifying person seeking to understand options around end-of-life care, including the possibility of requesting access to assisted dying. A qualifying person is defined in the new clause as someone who has a learning disability, a mental disorder as defined under the Mental Health Act 1983, or autism; or who might experience substantial difficulty in understanding the processes or communicating their views, wishes or feelings; or who meets criteria specified by the Secretary of State in regulations. Although the new clause would require the Secretary of State to make regulations about the appointment of independent advocates, there is discretion as to what those regulations should include. The new clause sets out a non-exhaustive list of the things that the regulations may provide. The effect of this is that the new clause leaves open who would be obliged to ensure that an independent advocate is present and the precise nature of the obligations around their appointment. It is also unclear how a person would be determined to be a qualifying person, as the definition is quite broad and encompasses a wide range of people with varying support and advocacy needs. Finally, although the new clause would enable provisions to be made about payments of independent advocates, it is not clear who would make these payments or how they would be funded. I hope those observations were helpful to the Committee.

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

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  My understanding is that the amendment would place the duty on a medical practitioner. I am speaking to the purpose and effect of the amendment, which is not about a regulator; it is about a medical practitioner. Does that answer my hon. Friend’s question?

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

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  It is a pleasure to serve under your chairship, Mr Dowd. Well done for arriving on time, by the way. These amendments aim to ensure that, if passed, this legislation will be legally and operationally workable. I will offer a technical, factual explanation and rationale for them. Amendments 501, 502 and 503 replace clause 25(1) and instead provide that the provision of assistance in accordance with the Bill will, of itself, not give rise to civil liabilities in certain circumstances. Those circumstances are where an individual provides assistance in accordance with the Bill, where an individual performs any other function under the Bill in accordance with the Bill, and where an individual assists a person seeking to end their life under the Bill, in connection with the doing of anything under the Bill. Proposed new subsection (1A) would create an exception to the exclusion of civil liabilities, providing that civil liabilities can arise in cases when an act is performed dishonestly or otherwise than in good faith, as well as in cases of negligence. Without this amendment, there is the possibility that clause 25(1) could provide blanket immunity to a person from all civil liabilities, even when they may have been negligent in their actions in providing assistance in accordance with the provisions in the Bill.

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

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  We will at some point get to clause 32, which is about the way in which the system will work, specifically with the NHS, and the role of regulation will absolutely be debated in that context. My sense is that it would be best to confront that issue when we debate clauses 32 and 39. Officials are currently working with the promoter of the Bill, my hon. Friend the Member for Spen Valley. We know that her policy intent is for the service to be an integral part of the NHS, but with some flexibility in the way it is delivered; we have briefly touched on that in previous debates. As an integral part of the NHS, it will have to be a regulated service, based on the foundations of the way in which the NHS is regulated more broadly. I think the answer to the hon. Gentleman’s question is basically yes, but the right place to debate it and potentially amend the Bill would be in clauses 32 to 39.

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

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  I can confirm that amendment 523 is a helpful amendment as 447 is incorporated, so that is all fine—we are good with that.

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

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  Clause 31(2) provides that, before preparing guidance under the clause, the relevant CMO must consult such persons as they consider appropriate. Amendment 395 would add a duty for the CMO to consult persons with learning disabilities before preparing such guidance. That may call into question why other specific groups are not expressly listed. Amendment 396 would include persons with learning disabilities as an additional category of people to which the CMOs must have regard in relation to preparing practical and accessible information, advice and guidance under clause 31. The effect would be to include persons with learning disabilities as a specific category of people in addition to the listed categories. This could imply that those with learning disabilities would not already be included in one of the categories already listed, namely “persons requesting or considering requesting assistance to end their own lives…next of kin and families of such persons” and “the general public.” Clause 31 sets out a duty on the chief medical officers for England and Wales to publish public-facing guidance relating to the operation of the legislation. It has rightly been a matter for the Committee to determine amendments to the clause, and the Government will respect the will of Parliament. As Members will know, the Government have been working with the Bill’s promoter, my hon. Friend the Member for Spen Valley, on amendments to ensure that, if passed, the legislation will be legally robust and workable. On this clause, we intend to support the development of further such technical amendments on Report. Where amendments are required to clarify the obligations in relation to the preparation of guidance, we will work with the promoter to ensure that MPs receive good notice to give them adequate time for consideration. I hope those observations were helpful for the Committee.

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

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  As I was saying, the scope of the term “premises” is unclear. Is it residential property, care home, hospice or indeed hospital? That is one of the challenges with the drafting of the amendment: the scope and definition of the term is not clear.