Terminally Ill Adults (End of Life) Bill

Baroness Hayter of Kentish Town Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

Finally, when the Minister replies, can we please not have the bogus excuse we have heard in almost every single group that the proposed amendments are probably contrary to the ECHR? The Government keep pulling that poor rabbit out of the hat and its ears are getting a bit battered by now. I beg to move.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, I was not able to be here this morning; many noble Lords will know that I spend much of the mornings, most days, in a care home—very often two or three times a day. My husband is being brilliantly looked after in one of the most brilliant care homes. I should have got their names this morning and I could have given them all a shout-out, but I will simply say that Bridgeside Lodge is one of the most amazing places for looking after people.

I must say to the noble Lord who moved this: I do not know whether he spends as much time in care homes as I do, but they do everything possible to keep their residents alive, well, well fed, replenished and amused, and to give them a quality of life that I think would be appreciated by everyone. But, of course, a lot of people in care homes are very ill, and some of them will be exactly the sort of people who may well need this.

It is a bit condescending to think that all those people are vulnerable. Most people in the care home do not know what I do. They think that I am a doctor sometimes, because I am known as Dr Hayter—I have a PhD, but I am not a doctor. But one of them discovered the other day and grabbed hold of me and said, “You won’t let them stop it, will you?” This was a very senior medical physicist, a professor of physics at UCL. I will give a shout-out to him by name: Andrew Todd-Pokropek. These are people in care homes with capacity who know exactly what they are doing and are urging me and others in your Lordships’ House to get this Bill through. Some of them will know that they are exactly the sort of people who may well want to make use of it, although not now.

The idea that the doctors looking after them, who are specialists in geriatric care, are somehow incompetent and that we should somehow need an extra layer of safeguards, is not living in the real world. So many people at the end of their lives will be in care homes, hospitals or hospices, and the idea that we would almost exclude them from the normal way of this Bill seems to me extraordinary. I hope that the noble Lord and others will think very carefully before saying that the exact cohort who are already ill should somehow be excluded from the normal trail of this Bill, because that would really be inappropriate. I urge him to withdraw his amendment and think very carefully before he pushes it again.

[Lord Deben (Con)]

I have some sympathy with the noble Baroness. She is very fortunate with the care home her husband is in, as is he. For many years, I represented the constituency that had perhaps the largest number of care homes in the country. Suffolk Coastal is an elegant area, and with towns such as Southwold, Aldeburgh and Felixstowe, it is a natural place for them. I would, of course, visit them on a regular basis, as indeed did my wife.

I have to say to the noble Baroness that the difference between the best and the worst is very considerable indeed. In grave humour, if I displeased my children, they would mention the worst one as the one where I might be placed. I put it like that because they recognised it, too: the very considerable difference. The reason why I think the amendment from the noble Lord, Lord Blencathra, so important is precisely because it does not exclude people. It says that the conditions of care homes are such that it is important to protect people rather differently, because of our experience. Some of the care homes in my former constituency are absolutely wonderful, with really good care by really good clinicians. However, I cannot say that that is universal, so I think we should have some protection—and this seems to me to be very sensible and it does not exclude anybody.

The noble Baroness suggested that this would exclude people, but this is a proposal that would protect those who are less happily off than the noble Baroness and her husband. It is very generous of her to share her current concerns: mine are not as current, but they are very much wider and from a much longer period. I looked again at the devastating effect of Covid, which came after my membership of the House of Commons, because of connections that one had—and that has made me even stronger in my belief that we should be especially concerned for those in care homes, not because of the best or even the average, but because there are many where people would otherwise be vulnerable.

--- Later in debate ---

[Baroness Smith of Newnham (LD)]

My Lords, like the noble Baroness, Lady Hayter, I have recent experience of visiting care homes. My late father was in a care home from November 2024 until December 2025. Unlike in the noble Baroness’s case, although he was well cared for, there were a range of issues that I was aware of while he was in the nursing home, and in the period before he entered the nursing home, that might be relevant for noble Lords to reflect upon, not least because they also provide a lesson for those the noble Baroness has talked about who are in nursing homes but still have capacity, are able to form a view and would be able to say, “I still want an assisted death”.

The reason why I say that is precisely because of issues of fluctuating capacity, infection, delirium and medication. Before my father went into a nursing home, there was a period when I assumed he had dementia. He was becoming more and more vague. He was on a new medication, and over time the doctors had said, “Double the medication”, then, “Quadruple the medication”, and he became more and more vague and did not seem to know who I was.

Then, for whatever reason, the medication was changed. This was nothing to do with dementia or mental capacity; it was to do with blood pressure. The medicine was taken away and something else was put in its place, and my father returned. It happened to be around Easter, and it was like some Easter resurrection. He was able to function normally, as he had before.

Then my father got pneumonia, went into hospital and was let out into a care home. In the home, they said, “We’re slightly worried about cognitive decline and impairment”. At a review meeting they went through his medications, and I said, “Can you tell me everything he’s on?” They listed the medicines again, including doxazosin. I said, “Why’s he on that? That caused problems before”, and they said, “We don’t know, really. The hospital put him on it”. There had been nothing in his medical notes to say, “Don’t use this medication”.

The new GP, to whom my father had been referred, spoke to me on the phone and was entirely happy to accept my wholly non-medical suggestion that this medication was not appropriate. He was taken off it again, and a mental health practitioner was asked to call me. The suggestion had been that my father should have a capacity test while in the nursing home, but this practitioner said, “To be honest, there is not much point, because if somebody’s been in a care home for more than a few weeks they’re not even going to know what day of the week it is”. So the view was they would not bother testing my father for capacity. He subsequently had on his death certificate that he had vascular dementia. If a full capacity test had been done, maybe that would have been diagnosed at a point before he died rather than after. It was never fully diagnosed while he was alive: there was merely a suggestion that there might be an issue.

The point is that if medication can affect somebody who would otherwise have capacity, it might affect the resident that the noble Baroness, Lady Hayter, referred to. In a nursing home, that person could equally get an infection or be prescribed something for which there were contraindications, but would there be sufficient recognition of that? Although some nursing homes will have brilliant care, not all of them will, and my father was—

[Baroness Hayter of Kentish Town (Lab)]

Would the noble Baroness accept that could have been even more so than if her father, or my husband, were at home all day without any medical or nursing staff around them? These people are more likely to pick up those infections than equivalent people who are living at home.

[Baroness Smith of Newnham (LD)]

I can see a point to that, but the message I was given by the mental health practitioner who rang me from the mental health team—I think he was a psychiatrist—was basically that once somebody is in a home, these tests become much more difficult because of the nature of the environment. That may differ from home to home—and yes, when my father had pneumonia and was clearly delirious, he was at home. If there are concerns, we should surely make sure, if people have a cognitive impairment, that we know that is the case, but if somebody does not—if there are the short-term issues that are being discussed in the amendments, in particular Amendments 111 and 112—then surely those people who want an assisted death would want it ruled out that they had some sort of cognitive impairment if it were temporary and reversible. That is the sort of thing we really need to get right, not only for those people who have an impairment but for those who actually do not have one but would not then be able to have the assisted death that the noble Baroness, Lady Hayter, and others might wish them to be able to avail themselves of.