Terminally Ill Adults (End of Life) Bill

Baroness Gerada Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Lord Rook (Lab)]

I absolutely agree with that. The reason why the doctor is able to do that is because he gives consistency and continuity of care. He does not see patients on one occasion on one big issue, but is able to travel with them in a longitudinal relationship, and that gives him the ability to make those decisions.

[Baroness Gerada (CB)]

As a GP, I understand the sentiment behind this amendment and the power of continuity; in fact, it was what my maiden speech was about yesterday. But modern general practice works in multidisciplinary teams. We have nurse prescribers, pharmacists and physician associates. We also work with other team members, especially with those at the end of their life, such as palliative care teams and oncology teams. While I understand the need to have a GP involved, I think it is rather reductive. We deliver continuity in today’s world through our medical record, which is a complete record of the individual from cradle to grave. I would say it is with the primary healthcare team that the individual has a relationship rather than with an individual.

On a point of clarification, the average patient over the age of 75 consults their GP team—the primary healthcare team—around 10 times per year, so I do not recognise the figure that most elderly people at the end of their life have no access to the GP. We reach out to our elderly patients and we try to deliver the best possible care we can to them, especially when they are approaching the end of their life.

--- Later in debate ---

[Lord Deben (Con)]

I agree with that, but the point of the amendment from the noble Lord, Lord Rook, is to tie together a period of someone being in the National Health Service. I agreed with the comments made by the lawyers about “normally resident”, rather than other words. The noble and learned Lord who introduced the Bill might consider that this amendment will give some confidence to those who had a concern because it means that “normally resident” has been underlined by the fact that someone has in fact been in a general practice of the National Health Service. I cannot see that it does any harm, given that there is a year in any case. It underlines what the noble Lord reminded us of: the idea that this should be a part of the normal way in which people are dealt with.

I do not like the Bill very much, but it is our job to make it work. To do that, it is more valuable to fix it within the National Health Service as we have it, rather than trying to invent a service that we might well like to have—and I am old enough to remember when we did have it. Let us not pretend, when things are not as they ought to be.

[Baroness Gerada (CB)]

My Lords, if a patient is at the end of their life in any practice in the NHS, that patient will be discussed at a multidisciplinary team meeting. The patient will be put on an end-of-life pathway and will have a named clinician within the practice to do their care. This would include assisted dying. There is absolutely no way that a patient, unless in an extraordinary situation—and I take the point about Wales, which has a desperate problem with GPs—would not be cared for in that way. That is how our contract is; that is how we want to care for our patients. We would code it on the notes so that every single person consulting with that patient would know that this patient was an assisted dying choice, and they would get the care that I have just described.

With respect to the arbitrary 12 months or 24 months, many patients choose to move at the end of their life. They choose to move to the place where their loved ones are. Many choose to do something such as go abroad to the countries that they may have come from and come back right towards the end of their life. To put in an arbitrary barrier of 12 or 24 months is not putting the patient first; it is putting an arbitrary time limit first.

[Baroness Falkner of Margravine (CB)]

My Lords, I wonder whether the Minister in winding up could advise us what the Companion says about Peers making speeches on the same amendment over several points of the passage of that amendment.

It is a pleasure to follow the noble Lord, Lord Deben, speaking to the amendment from the noble Lord, Lord Rook. There is a lacuna in Clause 1(1)(d), which, by requiring registration with a GP, does not cover the practical point of what happens to people who have lost contact with their GP. They may have lost contact for no other reason than being so ill, perhaps with cancer as that is the main illness that people who might be seeking assisted dying have, that they have been taken into private care—those who are lucky enough.

An increasing proportion of the population of the United Kingdom now uses private care, not least because employers provide it as part of a package. So, coming to continuity of care, if we must have the light-touch amendment of the noble Lord, Lord Rook, in the Bill, to clarify and strengthen Clause 1(1)(d), I will share with the Committee very briefly a practical experience of what it means to have advanced cancer and the interaction with the GP. My GP practice, having failed to diagnose me over six months, as I mentioned in my Second Reading speech, slipped away the moment I engaged with private care, although every single consultation with a private practitioner is sent to the GP. Nevertheless, between 30 August 2024, when I was first diagnosed, and late this September, I had no contact whatever with my GP practice. I was finally invited to come in and was told I had fallen between the cracks—it must have been a pretty large crack to have lasted 14 months.

I noticed in the equality impact assessment that 66% of the people who sought assisted dying in the two jurisdictions quoted were people who had cancer. My question to the noble and learned Lord when he winds up on this debate is therefore, what consideration has been given, in having Clause 1(1)(d) in the Bill, as to the relationship of the private oncologist who is treating that patient with the local GP, given that terminally ill people in significant enough numbers that we need to be conscious about them in the Bill may well have been—shall I say—passed on from the GP?

As a final point, once I had the diagnosis, I had the experience of requesting treatment at my local—within a walkable distance—leading cancer teaching hospital in the United Kingdom. When I rang about that after the diagnosis, I was told by my GP, “They won’t take you, because now you’ve gone private”. I leave that for noble Lords to reflect on.

Wheelchair and Community Equipment Strategy

Baroness Gerada Excerpts

Thursday 11th December 2025 Lords Chamber

[Baroness Gerada (CB) (Maiden Speech)]

My Lords, I rise for the first time with gratitude, humility and, if I am honest, a certain amount of surprise, until I remember how hard it is to see a GP these days—and having me in the House at least solves that problem. It is a great honour to stand here, particularly in such a significant debate that concerns dignity, fairness and independence. I thank the noble Baroness, Lady Kennedy of The Shaws, and the noble Lord, Lord Patel of Bradford, who so kindly introduced me. I also thank the staff of this House for their warm welcome, their patience with my many questions and their kindness.

Here is a little bit about me. I have Maltese heritage and was born in Nigeria, where my father worked as a doctor. My parents arrived in this country in the early 1960s as proud citizens of the Commonwealth. They taught me that success rests on courage, hard work and a commitment to the quiet dignity of public service. My father became a general practitioner in the NHS. His surgery was the front room of our home and patients have therefore been part of my life from a very early age. As a young girl, Dad would take me on home visits in communities still bearing the scars of the Second World War. Through him, I learned what general practice truly involves: not only medicine but community, continuity and compassion, and that the measure of a doctor lies not only in what they know but in how he or she cares.

I have now worked in the NHS for more than 50 years, beginning as a Saturday girl in our local pharmacy. In 1990, after completing my training in psychiatry, I became a GP in Kennington, and I have lived and worked in the community I serve ever since. Being well known in the area has its advantages. I recall my bicycle being stolen during a home visit; the next day, it was returned to the surgery with a note reading, “Sorry, doc. It won’t happen again”. Of course, it can never happen when I visit this House, as my little Brompton has two armed policemen guarding it every day—thank you, officers.

My patients have included the great, the good and, given that I work in the Division Bell zone, occasionally the difficult. My very first patient was a young woman who suffered a stillbirth. Decades later, I look after her children and now their children too. That continuity, seeing lives unfold across time, gives general practice its unique moral and social power. It allows us to see people as whole human beings, not as isolated organs or diagnoses. We are interpreters of experience, translators of suffering and witnesses to change. We observe how illness is linked to housing, poverty, work and the myriad pressures of everyday life. This is not the soft end of medicine; it is its foundation: the undramatic, continuous care that underpins the entire National Health Service. GPs carry out more than 300 million patient consultations every year—80% of all NHS contacts—for less than 10% of its budget. Most of our encounters end without referral, admission or prescription. When general practice thrives, the whole system does. It prevents illness, supports self-care, protects hospitals from becoming overwhelmed and saves money, and it is where the story of our NHS begins anew every day.

It is a privilege to be among the very few GPs admitted to this noble House, and now that I have completed my maiden speech, my first surgery is tomorrow—10 minutes only and only one problem allowed. Thank you very much.