Terminally Ill Adults (End of Life) Bill

Baroness Andrews Excerpts

Friday 30th January 2026 Lords Chamber

[Lord Harper (Con)]

I have two points to make on that intervention from the noble Baroness. First, on several occasions the noble and learned Lord has made reference to quite a significant number of officials that he has had working with him, helping him draft clauses and so forth. If the argument is that that is still not enough resource, that rather supports my contention—which I have made from the beginning—that the extent and nature of this legislation makes it absolutely not suitable for a Private Member’s Bill, and it should have been a government Bill. As I said, the noble and learned Lord has had extensive support from not just one but a number of government departments in helping him draft it.

My second and final point is on the issues that have arisen so far in Committee, particularly the issues that have arisen on Clause 1, which I think is why it is relevant to bring it up on the Clause 1 stand part debate. The noble and learned Lord referenced them in his letter, but he has not yet been in a position to set out what his amendments are going to be. He said that he will make them available as soon as he possibly can. That is good, and I welcome that, but, until we see them, we are not in a position to know whether further amendments need to be tabled for later in Committee or on Report. I finish by saying that I agree with the noble Lord, Lord Rooker. The extent to which we can now make progress is going to be largely governed by the extent to which the noble and learned Lord the sponsor of the Bill engages with the very fair criticisms that have been made across the Committee. We will listen carefully to what he says in response to this debate and in subsequent groups.

[Baroness Andrews (Lab)]

My Lords, I think it is right, as my noble friend Lord Rooker said, that this clause stand part debate is an opportunity for a reset and a rethink about how we are approaching the Bill and the way we are prioritising the arguments. Where I slightly take issue with my noble friend is that I do not think it is helpful to apportion blame. We are where we are with this Bill now, and we are all under the clear impression and instruction that, if the Committee wants to change the Bill, whether those who oppose it or those who support it, we have to get it to Report so that we can do that and then send it back to the Commons improved and amended.

On the question of delegation, I worked with my noble friend Lord Blencathra—I will call him that—on the reports on delegated legislation, and they were extremely important. What we have discovered in this Bill, as the amendments have been put forward, is that there is a difficult balance to be achieved between what goes into the Bill on the principle and the design—our task in this House is to make every Bill workable—and what has been left to delegation. As a result of the nature of the Bill, the behavioural issues that are raised by it, and the extraordinary personal and exceptional circumstances when we are dealing with people in the last months of their life—which we should never lose sight of, no matter what we are debating and how technical and process-driven it is—we have to think about the balance between what is workable because it is in the Bill and will stand in law and what has to be left to delegation going forward and therefore can be amended as circumstances change. That is the situation the Australians find themselves in. We have a lot to learn, as we have already learned, from Australian medics who have told us how they are managing the Bill and what an extraordinary benefit it has been. That is on the public record.

All I would say, before my noble friend Lord Blencathra possibly opposes me, although I hope not, is that this is an opportunity to look at the amendments that are coming forward and the priorities we are attaching to them and whether we can triage them in some way. My noble friend Lord Rooker is right that a lot of these early amendments can fall away, because we have addressed the principle. Can we focus on what it will now take to agree to improve the Bill, so that we can have shared trust across the Committee that this is about improving the Bill and not delaying it to the point that it will never become law?

[Baroness Falkner of Margravine (CB)]

My Lords, I have a point related to the point made by the noble Lord, Lord Harper, about impact assessments. Noble Lords will be aware that I am a former chair of the Equality and Human Rights Commission. I gave evidence on this Bill when it was being examined in the other place. Once it was introduced in your Lordships’ House, I recused myself from the EHRC’s involvement on the Bill, as I anticipated participating on the basis of being a Member of this House. That is the background, should anyone detect any conflict of interest on my part. A senior EHRC commissioner, Alasdair Henderson, who is a barrister, has since represented the EHRC on this Bill.

On 22 January, nearly 60 Members, including me, wrote to the Minister calling on the Government to update their equality impact assessment. This was to pick up the argument from the EHRC—which was put nearly three months ago, so the Government have had a substantial amount of time to think about it—that the current EIA contains several gaps and focuses primarily on access to an assisted death rather than on safeguarding risks and the potential for coercion. That letter has been circulated to the whole House. Yesterday, I received a reply from the Minister declining the request. Parliament will receive an updated impact assessment and equality impact assessment only

“should the Bill receive Royal Assent”,

and

“once detailed implementation work has been completed”.

In other words, the Committee is being told that it must legislate blind.

Terminally Ill Adults (End of Life) Bill

Baroness Andrews Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Baroness Butler-Sloss (CB)]

I am delighted to hear it in relation to embassies and charities, but the other example given was the person living in Spain who wants to come back to die here. It seems to me that needing to be resident in this country for the last 12 months would not allow that person to do so. The noble and learned Lord might just look again at that particular element of residence.

[Baroness Andrews (Lab)]

My Lords, I hesitate to interrupt this fascinating debate between our lawyers. I have no legal experience, but I have investigated the notion of domiciliary status at some length for different reasons. I absolutely agree with anyone who has tried to work their way through the 93 pages of conditionalities and various different criteria.

I come back to the central point in the excellent contribution by the noble Lord, Lord Lansley, about the need for consistency with the NHS and the implications of not being consistent. The terminology is not just about domiciliary status. What is the notion of permanence? We could have an equally long and problematic debate over that other element of the terminology. I completely respect that this is a probing amendment, but just as we had the beginnings of a debate on mental capacity and the necessity for consistency and trusting that what we already know works, because we see it every day in practice, so the notion of ordinary residence should simply, as far as I am concerned, end the conversation. I think there is a welcome consensus around the Committee that this is the only definition that is going to be practicable, workable, known and acceptable. I hope we can move on with the debate in that context.

[Lord Moylan (Con)]

Does the noble Baroness accept that ordinary residence does not end the debate because the Bill goes on to impose an additional qualification about having lived in this country for 12 months prior to the date of signing the first declaration? If it were just ordinary residence, legally no issues would arise—there might be other issues—but we also have a 12-month requirement, which appears to me to be arbitrary and risky.

--- Later in debate ---

[Baroness Andrews (Lab)]

The noble Lord is right, and there are specific instances. The noble Baroness raised one in relation to the Crown dependencies, where these definitions will have to be tested in some way. But the purpose of the Bill is to ensure that people living in this country have a right to the security that they will be treated within the NHS and that the normal rules and behaviours of the NHS will apply to the conduct of this Bill as they do to everything.

[Lord Lansley (Con)]

My Lords, my amendments would remove the 12 months, because that would enable greater alignment with practice in the NHS. I make a plea to noble Lords that we might hear from those who have tabled amendments so that we complete the group more quickly. I think it is a discourtesy to those who have tabled amendments not to hear their explanation for them.

Terminally Ill Adults (End of Life) Bill

Baroness Andrews Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I am glad to be able to follow the noble Baroness, Lady Monckton. I declare my interests as a past president of the Royal College of Psychiatrists, and I have a parliamentary scholar, a psychiatry trainee who is appointed by the Royal College of Psychiatrists to work one day a week with me. I was a member of the post-legislative scrutiny committee on the Mental Capacity Act. I also founded and chair a visual literacy charity called Books Beyond Words, which is relevant in a way.

I was listening to the noble Baroness, Lady Lawlor, speak about communication. It reminded me that 18% of the adult population in this country are functionally illiterate. This is really important when we think about making decisions of such importance. I have an amendment later proposing a different framework for assessing capacity, and I will obviously talk about that then, but I want to reflect on how the charity Beyond Words creates really difficult stories in pictures, without any words, to try to help people who struggle with words to understand and make decisions about such things as the care and the treatment that they might require. We currently have about 80 stories, all about the whole story that people can discuss with their peers, their healthcare professionals and their families, to help them to understand an issue, so that they will not be left out but will truly understand. It is very easy to think that somebody understands when you have explained something in words, in simple words, and that the person is compliant with it, but when you explain in pictures and enable the person to say what they have read in their own words, then you get an idea of whether they have understood.

I have been trying to think about how I would be able to create a story in pictures to explain this Bill. It would be several stories. It would take an awfully long time and an awful lot of work to be able to do it. I just wanted to respond to what the noble Baroness, Lady Lawlor, said; I thought it was very important.

[Baroness Andrews (Lab)]

My Lords, at the heart of this debate is the question of safety. It is very impressive to hear all the experience around the House and I know that people shared my experience when we took the Mental Capacity Act through the House in 2005. That Act had been years in the making. It had most profound and serious consideration in this House and, most unusually, it then had post-legislative scrutiny, where we went into every aspect of the Act. The noble Baroness, Lady Browning, is quite right; there were many concerns raised about the practice and the absence of proper training, but no one, to my knowledge, challenged the definition of “mental capacity”, recognising the huge complexity of the term, the different circumstances in which it is implemented and people’s responses to it.

The noble Lord, Lord Pannick, said that we have a framework. Safety, I think, relies on and is expressed in the 20 years of practice in the way the Mental Capacity Act has been implemented and has benefitted so many. The assumption that there is mental capacity was in itself a huge and very important statement of a positive right in the law. The Bill before us is another statement of a positive right in the law, where there has not been one, and where so many people are desperate for us to find a route through this urgently.

We have the experience of that Act, the experience and expertise that this House put into reviewing that Act and confirming it with the recommended improvements, and the way the Act is understood—as my noble friend has said, not least by Chris Whitty—as well as its unknown interpretations. We have just heard about the complexity of defining “ability”. We already know of the huge, unframed and unknown complexity of creating another concept in law in the context of a Bill which, itself, has to be so carefully understood, implemented and communicated. We have to stick to what we know, even though it is still a work in progress, because it can still be improved. I hope it will be improved, in the course of this Bill. But it will be immensely dangerous, unless I hear a completely conclusive explanation as to why “ability” is better, if we were to depart from “capacity”.

[Baroness O'Loan (CB)]

My Lords, under the Mental Capacity Act, the decision is not made by one individual; the Mental Capacity Act provides for decision-making, which includes the experiences of families et cetera. It is a profound process. This is not a profound process; it provides for a doctor to make a decision about whether a person has capacity and a second doctor to sign it off. It is not the same thing at all.

I attended a meeting, as did the noble and learned Lord, Lord Falconer, during which a doctor told a story about a patient who had signed up for assisted suicide. When the time came, he took a sip of the medicine and said, “I’m not drinking this”—upon which his family told him, “You decided you would die this day; you must do it”. He would not drink it. It took him seven days to die.

[Baroness Andrews (Lab)]

The noble Baroness is quite right, and it is a very important part of mental capacity decisions that the families are involved, supportive and completely understand the implications of what it means to have either incomplete capacity or capacity that varies from time to time. There is no reason— I will leave my noble and learned friend Lord Falconer to answer this point—why this should not be a better Bill, and maybe it can be better if we address these particular questions.

[Lord Shinkwin (Con)]

My Lords, I thank the noble Baroness, Lady Finlay of Llandaff, for her amazing dedication to her patients. That is beyond question. I hope we are united as a House in paying due respect to that fact and also to the fact that her professional experience is a tremendous asset to this House.

The noble Baroness, Lady Finlay, spoke of her professional experience, and I will speak very briefly of my lived experience on the other side of the table—or the bedside—as a patient. She mentioned Dame Cicely Saunders and the reference to total pain. I simply say that I have been there. My disability has taken me there far more times than I would like to remember. It is awful. The bottom falls out of your world, and your capacity to think clearly, rationally and normally evaporates. So I simply say that it is crucial that patients have the ability to choose: the choice between assisted death and specialist palliative care—a choice that they do not currently have.

I simply finish on this point. Other noble Lords have mentioned the Royal College of Psychiatrists. I ask the Committee to take note of the fact that the Royal College of Psychiatrists states that applying the Mental Capacity Act to the decision to end one’s life is an entirely novel test—in “uncharted territory”, with “no experience or precedent”.

Social Care Reform

Baroness Andrews Excerpts

Thursday 22nd May 2025 Lords Chamber

[Baroness Buscombe (Con)]

My Lords—

[Baroness Andrews (Lab)]

My Lords—

[Captain of the King’s Bodyguard of the Yeomen of the Guard and Deputy Chief Whip (Baroness Wheeler) (Lab)]

My Lords, it is the turn of the Labour Party.

[Baroness Andrews (Lab)]

My Lords, can the Minister tell us what progress has been made on addressing the problem faced by many unpaid carers who have been penalised, through no fault of their own, for having been paid too much because of technical failures in DWP? Are we making progress on addressing those very serious issues?

[Baroness Merron (Lab)]

Yes, the relevant officials and Ministers are working on that. I realise the difficulty it has caused and they, too, are very sensitive to that point. I will reflect my noble friend’s comments to my ministerial colleagues.

Social Care Reform

Baroness Andrews Excerpts

Monday 2nd September 2024 Lords Chamber

[Baroness Merron (Lab)]

I understand that, whenever there is a change in direction, there is concern. I take the noble Lord’s point. The inherited commitment to implement the adult social care charging reforms, which would have been on course for next month, was undeliverable because the previous Government did not guarantee the money to do that. It would have cost nearly £1 billion next year, rising to £4 billion by the end of the decade. There were many false dawns in respect of this long—and repeatedly—promised change. It is also the case that there was not adequate preparation to implement the charging reforms. Councils warned that they were impossible to deliver in full in the previously announced timeframe. With all that in mind, I am sorry to say that we, as the new Government, had little alternative but to say that these were not funded or on course to be delivered. We will have to ensure that we offer a national care service, along with a new deal for care workers. We will continue to consult and listen to those with lived experience in order to get it right.

[Baroness Andrews (Lab)]

My Lords, the noble Lord was kind enough to reference the Select Committee report. I think he would agree with me that the value of that report was that we were able to reveal the extraordinary voices of those with lived experience and the many unpaid carers who live such very hard but dignified lives. I have great confidence from what the Minister has just said that the Government will listen to those voices, because they know that there is no quick fix. This is a hugely complex problem, and the fair pay agreement is a very important first step. I have great ambitions, as we set out in that report, for a coherent and systemic change in the aspirations that we hold for social care, as well as the practical delivery. I hope the Minister shares those.

[Baroness Merron (Lab)]

My noble friend is absolutely right that there is no quick fix, and I think that is understood. The national care service, for example, is a 10-year vision, which will mean long-term reform of the sector, underpinned by national standards, making sure that locally delivered care will be of a high quality and consistent across the country. That is what people will want. As my noble friend said, we will continue to consult those with lived experience as well as engaging with workers, trade unions and the sector to make sure that we offer a new deal for care workers.