Terminally Ill Adults (End of Life) Bill

Baroness Watkins of Tavistock Excerpts

Friday 19th September 2025 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I thank all those who have sent me opinions and information on this issue. I declare my interests as a registered nurse and a fellow of the Royal College of Nursing, which has adopted a neutral stance on the Bill, recognising the wide disparity of opinion within its membership.

The fury expressed by some people that they will be coerced into asking for assisted dying is real. The concerns are particularly strong among marginalised communities, as so amply demonstrated by the previous speaker.

Many people with severe disabilities who believe that they may become a burden to other family members, as well as those living alone who express fear about the future and the difficulties of living with a progressive condition, do not like the Bill. However, considerable safeguards in the Bill are designed to ensure that undue pressure concerning assisted dying is never placed on individuals. If a patient is given the opportunity to discuss their future options when planning the last months of their life, this should include the right to refuse further treatment and receive compassionate palliative care.

Patients must be given the chance to explore the options available to them. One of the many issues raised in this House, and in correspondence with the public, is that many people fear staying with the uncertainty about dying—not necessarily about when they will die but how their health and bodily functions, including continence and mental capacity, will deteriorate. People report being fearful of incontinence, speech difficulties and losing capacity, so that they are unable to express their wishes as they become increasingly dependent.

Let us encourage society to discuss and complete advance directives relating to future care, in the way that we are encouraged to make wills. This approach would enable those who would never want to discuss or consider assisted dying to make that clear in their personalised advance directive, and vice versa. Nurses and care workers are often those who are asked about assisted dying by patients, frequently during intimate procedures, including, for example, changing soiled bedding and washing.

I recall, when I was a district nurse, a patient saying something similar to me: “My kind husband just can’t cope with washing me, so I wait for you and I do not tell him I am dirty below but just lie here in it. He does not know, nurse, because he does not sleep in the bed with me any more. We were so happy together. We are worn down with it. Can’t you hurry it up for me?” The Royal College of Nursing has published excellent guidance on how to respond to such a request to hasten death. It states that

“nurses should acknowledge and act on all concerns raised”,

investigating and escalating them to the doctor responsible for the patient’s care and treatment.

The Bill is designed to establish a system for terminally ill adults to access assistance, yet no mention is made in it of the responsibility of health professionals to refer patients to an appropriate medical practitioner for preliminary discussion, to be recorded in the person’s notes when such requests are made.

When the process works well and advance directives have been made, agreed active treatments may be stopped and compassionate, excellent palliative care interventions accelerated. Early clarity on the patient’s position on assisted dying would be helpful to everyone. However, if the patient’s wishes have not been recorded, and they choose an assisted dying pathway in the late stages of their illness, should the Bill pass, there could be challenges from relatives who are vehemently against assisted dying for religious and/or ethical reasons.

I am broadly supportive of the Bill, but I would hope that we can consider the two issues I have raised—advance directives and other healthcare professionals’ involvement.

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[Baroness Berger (Lab)]

I am very grateful for the intervention, and I was just about to come on to that, but I will answer that now. The answer is yes, absolutely. The intention is that all the evidence accumulated and amassed during that time will be published for everyone in the House to interrogate and consider in advance of us going into Committee of the whole House. To confirm, this Select Committee cannot take place in parallel in order that we can receive evidence on vital parts of the Bill before we go into debate, so that we are not in the unenviable position of knowing what is wrong with the Bill but being unable to amend it.

My Motion provides that a Select Committee would be intended as a focused piece of work, hearing vital expert oral evidence, as I have just set out, rather than it being a more time-intensive open exercise. It may report by simply publishing that evidence before we go into Committee of the whole House, in order to inform our detailed consideration of the Bill. As I understand it from the clerks, the revised timetable allows the committee to hold six meetings over three weeks, with two panels of witnesses on each of the days, to begin the week commencing 20 October and allowing it to conclude by 7 November. The revised timetable ensures that the Bill can progress to its next stage and maintain the opportunity for four sitting Fridays before Christmas.

We have, over the past two Fridays, shown the determination of your Lordships’ House to discuss the Bill in a considered and constructive way, and it is my strongest hope that we can continue to do that. If my amendment is accepted, I do not intend to speak on the Motion that will follow, which contains the detail that I have just set out. I am grateful to my noble and learned friend Lord Falconer of Thoroton—

[Baroness Watkins of Tavistock (CB)]

Is the list to give evidence that the noble Baroness has detailed finally determined or would it be possible for us to add the Royal College of Nursing with its 500,000 nurses?

[Baroness Berger (Lab)]

I thank the noble Baroness for her intervention. As I understand it, it is within the gift of the Select Committee to determine who will be called for evidence. I have sought to set out the key people, but of course there will be many other suggestions. Obviously, conscious of the tight timetable, we will not be able to have an extensive list, but I am sure that the chair, when appointed, will consider the suggestion that has been made.

I return to expressing my gratitude to my noble and learned friend Lord Falconer of Thoroton for being prepared to work with me to reach an agreement that would allow the House to engage carefully with the substance of what is being proposed and the powers we are being asked to bestow on Ministers. I am grateful to the many noble Lords who have already indicated in their speeches their support for my amendment and my Motion. I beg to move.

Suicide Reduction

Baroness Watkins of Tavistock Excerpts

Monday 8th September 2025 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Lord for his warm welcome back to the Dispatch Box in full health. The noble Lord makes an interesting suggestion. I will be co-ordinating a cross-government suicide prevention approach. It is the case, as the noble Lord alludes to, that this cannot be solved by DHSC alone. However, it is where it is placed presently and I assure him of the cross-government commitment we are making, and also how that will be developed so that it is much more meaningful than it is at present.

[Baroness Watkins of Tavistock (CB)]

My Lords, I too welcome back the Minister. With her leadership in this area, how will she ensure that the e-learning programme, which I am delighted is now ready, will be extended way beyond mental health practitioners? For example, school nurses, health visitors and many community nurses would benefit from undertaking that module. To do so, they would need additional time as part of their continuing professional development. Can the Minister confirm that that will be considered?

[Baroness Merron (Lab)]

I thank the noble Baroness as well for her kind comments. I assure her that the whole point about the e-learning module is that it can extend to people beyond those in mental health services. As I mentioned, only one-third of those who die by suicide are in contact with mental health services. Of the other two-thirds, a number are in contact with other health services, or other services, while some are in contact with none. There is a lot of work to do in this area and I am looking forward to developing it in the way that the noble Baroness referred.

NHS and Social Care: Joint Working

Baroness Watkins of Tavistock Excerpts

Thursday 26th June 2025 Lords Chamber

[Baroness Merron (Lab)]

I very much agree with my noble friend about the importance of integration. As she explained, it is not necessarily about training to be joint, but about the approach. I will feed back her particular suggestion about job rotation to Minister Karin Smyth, who is responsible for developing the workforce plan. I will also share her view—again, I am sure she will see this reflected in the workforce plan when it is published following on from the 10-year plan—on the importance of multidisciplinary teams in many areas. The one that we are talking about, health and social care, is a prime example.

[Baroness Watkins of Tavistock (CB)]

My Lords, I thank the Minister for her previous very positive answers, but one of the biggest barriers to working together is different terms and conditions for care and health workers: in particular, the lack of pay for care workers who have to go between different visits in rural areas and have significant dead time. If we are really to move this forward, should we not put pressure on councils to ensure that the contracts they let allow for the time travelling between people who are being cared for?

[Baroness Merron (Lab)]

The noble Baroness raises a practical and realistic point that many care workers speak about. She will know that we are implementing a new fair pay agreement that, for the first time ever, will reflect what people actually do. Also, for the first time, there will be a universal career structure for adult social care that supports care workers. The approach that the Government are now taking shows a line of movement that takes seriously the pay, terms and conditions of care workers. I should also add that the noble Baroness, Lady Casey, will have free range to decide how she wishes to conduct her review of social care. Perhaps the noble Baroness, Lady Watkins, will ensure that she speaks to the noble Baroness, Lady Casey, about that.

Social Care Reform

Baroness Watkins of Tavistock Excerpts

Thursday 22nd May 2025 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister explain how cross-party consensus will be constructed in relation to local mayors and local authorities? For example, the leadership in Cornwall Council has just changed, and there are huge care needs in Cornwall. How will we ensure that other parties—those underrepresented in this and the other House—are involved?

[Baroness Merron (Lab)]

As I mentioned, the terms of reference for the noble Baroness, Lady Casey, are deliberately broad. She will set out how she will involve all those who are affected and have a voice, because she wants to make sure that it is a thorough report.

NHS Pensions

Baroness Watkins of Tavistock Excerpts

Thursday 3rd April 2025 Lords Chamber

[Baroness Merron (Lab)]

I am very glad that the noble Lord has given me that option, which I will gladly take. Perhaps it would be helpful to your Lordships’ House for me to say that the deadline to issue remedial service statements was 1 April or later. That was not achievable because of the level of technical complexity, capacity, and delays in HMT and HMRC setting out lower-level policy requirements under the previous Government, so Minister Karin Smyth extended this deadline last week and published a new timetable. Separately, 137,000 higher-earning members of the NHS pension scheme require remedial pension savings statements as part of their remedy. The deadline for that was 6 October. HMRC did not allow this to be amended. The current position is that, to date, 94,012 statements of the 137,000 have been issued. These delays are due fundamentally to the annual allowance element of the remedy being poorly designed and, again, late requirements provided by HMT and HMRC. To say that this is a knotty problem would be underestimating it.

[Baroness Watkins of Tavistock (CB)]

I thank the Minister for the assurance in the Statement that no individual member will in the long term suffer financial detriment. However, is she able to explain how the NHS Business Services Authority issued 23,000 inaccurate statements against 57,000, which is over 30%, and what are we doing to get efficiency and effectiveness from this authority?

[Baroness Merron (Lab)]

I appreciate the point that the noble Baroness refers to. The priority is to get this matter resolved, as she will appreciate. With respect to the NHSBSA, we will also be working closely with it to ensure that the correct service is given in future. Obviously, I want to see this put right to assure people as soon as possible.

Mental Health Bill [HL]

Baroness Watkins of Tavistock Excerpts

Report stage
Monday 31st March 2025 Lords Chamber

I am arguing, as much as the Bill does already, for greater patient empowerment and greater transparency around what is done to patients in our mental health hospitals. If the case that I have tried to make resonates at least to some degree with the Minister then I very much hope that she will consider it. I beg to move.

[Baroness Watkins of Tavistock (CB)]

My Lords, I will first reflect on the introduction to this group from the noble Earl, Lord Howe. I found it deeply moving. As many of your Lordships know, I am a mental health nurse. I have worked in locked units and acute units. Some of the things that he just described happened 30 years ago. What is so sad is that they are still happening now.

I will speak to the three amendments in my name, Amendments 14, 42 and 43. I thank other noble Lords who have added their names to them. These amendments have been drafted with help from the Royal College of Psychiatrists and are supported by several mental health patient and user groups and charities that work with the Mental Health All-Party Group in particular.

Amendments 14 and 42 would ensure that advance choice documents within the Mental Health Act are aligned with the existing best practice on providing such documents. Amendment 43 would ensure that clinicians and relevant bodies have a responsibility or duty to consider the information that is provided in the advance choice documents and use it to inform care and treatment orders given under the Mental Health Act. This is important. Clinicians, nurses and social workers need time to undertake the responsibility of sharing what is in those documents and trying—even if they are not always able to—to design care that reflects what people have asked for before. We continue to have a shortage of staff in mental health and very tight budgets compared with some other parts of the health service. If this is put as a duty in the Mental Health Act, it will help to resolve some of those issues.

I hope that the Minister can support the amendments, so that the rights of some of the most vulnerable patients from all ethnic groups in this country are strengthened within the documents, with the right to ensure that staff have enough time to deliver what is in the documents.

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow that short but extremely powerful contribution, informed by so much professional experience. I think that the whole House would like me to acknowledge that.

My Amendment 63 is about the powers of tribunals to determine challenges against treatment decisions. In many ways the argument for this follows on from the noble Baroness, Lady Watkins, just said. Things go wrong. However much we are trying through this Bill to improve the treatment of people with serious mental illness, I am afraid that we all acknowledge that things will continue to go wrong. Again, I have tabled this amendment at the request of Mind, which feels that there should be something like this. The amendment would not create any automatic right. It says that the Secretary of State may, by regulations, make provision about appeals. It would set up the framework to make this possible.

We had extensive discussion on this in Committee. I will not rehash all of that. We are trying to create mechanisms of common justice, ways forward and possibilities. We all acknowledge that so much of what is in this Bill will not be delivered within a month, a year or even two years, but it is trying to create the frame to make that possible. This is a very strong argument for that.

The noble Baroness, Lady Watkins, powerfully made the case for Amendment 14. I added my name to it as it is so important that it should have a full slate.

I will briefly address Amendment 13, in the names of the noble Earl, Lord Howe, and the noble Lord, Lord Kamall, to which I have also added my name. All through Committee, it kept occurring to me, though I never found the place to reflect it, that the word “trauma” does not appear once in the Bill. I was really surprised about that. I thought about several debates that I have had, going back to the Domestic Abuse Act and the Schools Bill under the previous Government that never became an Act. There was a lot of discussion about the need for trauma-informed environments and trauma-informed care. There is a general sense of intention from your Lordships’ House that this is one of the things that we are thinking about, but there is nothing about it in the Bill.

Therefore, this amendment would add the words

“seeks to minimise the patient’s distress”

and promote their

“recovery from any childhood trauma”.

That is possibly a bit narrow. The Minister might take away and think about the fact that nothing in the Bill talks about the fact that so many of the patients we are talking about will have been through hideous traumas: childhood abuse, domestic abuse, war situations, torture—all kinds of circumstances. This is a chance to ensure that we put in the Bill, perhaps even more broadly than in this amendment, an awareness of the need to think about trauma. I think we are all thinking this, but let us ensure that it is written down in law.

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Tabled by

[Baroness Watkins of Tavistock]

14: Clause 11, page 17, leave out line 39 and insert “statements set out in an advance choice document).”
Member's explanatory statement
This amendment seeks to align the Mental Health Act with the existing best practice on providing advance choice documents.

[Baroness Watkins of Tavistock (CB)]

Amendment 14 is not moved, but I express my thanks to the Minister for her work on advance choice documents.

Amendment 14 not moved.

NHS Dentistry

Baroness Watkins of Tavistock Excerpts

Wednesday 19th March 2025 Lords Chamber

[Baroness Merron (Lab)]

As I said, it will be ICBs delivering the extra 700,000 urgent dental appointments each year. They will be best placed locally to decide how to do it. It may well be through the means that my noble friend said, but the duty on them will be to ensure that those are available. The appointments will be most heavily weighted towards the areas where they are needed most, although appointments will be available across the country. I welcome my noble friend’s suggestion but how the extras are provided will be a matter for local decision-making.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister comment on whether serious consideration will be given to debt relief for newly qualified dentists? They could then work as salaried employers for the NHS and deliver more than the 700,000 appointments we are aiming at, because we have such a long backlog. That would really support children’s dental care immediately.

[Baroness Merron (Lab)]

I welcome the suggestion from the noble Baroness, and I will raise that with the Minister, Stephen Kinnock. What I can say is that strengthening the dental workforce is absolutely central, as we have to rebuild NHS dentistry in this country. Integrated care boards have started already to recruit for dental posts through a golden hello scheme. That means that up to 240 dentists will receive payments of £20,000 across three years to work in those areas that need them most. Already, as of 10 February this year, 35 dentists have commenced in post, a further 33 dentists have been recruited, and hundreds of job posts are currently advertised. There is a long way to go, but we have made a very strong start.

Mental Health Bill [HL]

Baroness Watkins of Tavistock Excerpts

Committee stage
Monday 24th February 2025 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I very much support this amendment and do so for an additional reason to those already given, which is that it will reduce the time staff have to spend discussing debt with severely ill people in a time of crisis. One thing we need to do is improve productivity in the health service—I declare my interests in relation to that—and free up clinical staff to really support patients. I believe that this intervention would actually enable that.

[Lord Kamall (Con)]

My Lords, in speaking to this amendment, I pay tribute to the work of the noble Lord, Lord Davies, in raising this issue in this House and through his work with the Money and Mental Health Policy Institute. The noble Lord, Lord Davies, said he hoped that he would get my support; I can assure him of that. Today, and in previous groups of amendments related to advance choice documents, the noble Lord spoke powerfully about the need to understand the link between financial problems and mental health problems. It also reminded us that while this may not be seen as a priority for people detained under the Mental Health Act, it is not difficult to imagine why they might neglect their personal finances—obviously, not their first priority. During this time, their bills will not be paid, debts will grow, and this could lead to debt collectors or bailiffs being called in, making the situation far worse.

I was particularly struck by the personal testimony that the noble Lord, Lord Davies, read out, in the earlier group of amendments, from the person who was helped by the Money and Mental Health Policy Institute, about not being asked whether there was anyone who could open their mail and keep on top of their day-to-day living. For them, as the noble Lord told us, it was a spiral of going in for treatment and coming out to find that their finances were in a bigger mess than before. What would that do to someone who was suffering from mental health issues? It was a bigger mess, leading to terror, shame and guilt, and in fact it undid the work of the treatment that they originally went in for. Also, as the noble Baroness, Lady Bennett, has said, the phrase “breathing space” is very evocative of what we are asking for here.

It is worth repeating that this amendment does not require health and care professionals to offer financial advice. We are not asking them to be financial advisers or to deal with issues that they are not experts in. It is about empowering them to identify people in need and refer them to the appropriate existing support. As the noble Baroness said earlier, this will improve productivity and save all that time that would be wasted. It need not cost much money, or indeed any money in some cases, but could save the patient from financial and mental distress and save taxpayers’ money. For this reason, we are supportive of this amendment.

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[Baroness Fox of Buckley (Non-Afl)]

My Lords, I will speak very briefly and on a slightly related topic. I want to talk about a different group of people who are in long-term segregation who are not sectioned and often do not get mentioned—prisoners. Long-term segregation is used when very mentally ill people in prison are not transferred to hospital and nobody knows what to do with them. They are put into isolation and left there, psychotic, delusional and forgotten—dumped, in effect.

The noble Baroness, Lady Browning, alluded to prisons, but even prisoners should not be treated like prisoners sometimes. The confusion and conflation of punishment and treatment outside prison is no less shocking when it is inside prison. You are not meant to punish somebody doubly because they are in prison and happen to get ill.

The Chief Inspector of Prisons, Charlie Taylor, has made the point that the segregation units are completely unsuitable for people who are severely unwell. They are also a significant drain on the hard-pressed staff, because very often the restraints are of people literally going out of their mind. They are not getting any medical intervention at all. According to the chief inspector, it requires multiple officers to unlock the cells even just to deliver meals.

Is it possible for the Minister to give any thoughts on that? Also, in a way, this is an appeal to the noble Baroness, Lady Hollins—if she takes this amendment forward—to bring that into the situation, even though I know I am slightly squeezing it in because I have Amendment 160A on reviewing prisons.

On Amendment 146 and the use of force, I absolutely agree with the mover of the amendment in relation to the need to keep records. That is obvious. I suppose the nightmare for us all is the misuse of force. It is horrifying—the stuff of nightmares—when people are ill.

I do not want to be naive. I know that when people are very ill and very psychotic, sometimes appropriate force is necessary; I just think it needs to be recorded. When I say force, I obviously do not mean violence or anything not within the realms of professional intervention. Sometimes I think we forget how ill people can be and how violent and how difficult it is for the people who work with them. We should record every instance of the use of force but be wary of demonising or damning every use of it, because it is not quite as simple as that.

[Baroness Watkins of Tavistock (CB)]

My Lords, I support all three amendments in this group but make the point that a lot of NHS care is now commissioned into the independent and charitable sectors. It is vital that records are kept in any care setting that is paid for by the NHS, not just by NHS facilities. I also believe that recording will reduce these kinds of behaviours because it will make people think much more carefully, particularly in long-term segregation. As you get to 10 days, people will be thinking, “How can we change the care we are delivering to avoid that 15-day reporting sanction?”. It really is imperative that we do this. We are treating some of the people who have the greatest needs in our society really badly.

[Baroness Barker (LD)]

My Lords, we on these Benches offer our support to the noble Baroness, Lady Hollins, for her two very thoughtful amendments and the way in which she introduced them. However, I want to turn our attention to Amendment 146, in the name of the noble Earl, Lord Howe.

I was a colleague of Norman Lamb, who was formerly a Minister in the department. He was one of the people who was, as a Minister, most active in addressing the issue of the overuse of force in mental health. This is a campaign that he has continued to develop in his chairmanship of South London and Maudsley NHS Foundation Trust. It is a subject that I am very glad we are focusing on again.

Anybody who has visited a mental health facility in which there are people who are having acute episodes will know that there are times when, for the safety of the person and the safety of others, it is necessary sometimes to use restraint. However, as I think the noble Earl was alluding to in his introduction, the overuse and frequent use of force is often an indicator of substandard care. Therefore, it is very important that incidences of use of force and the reasons for it, as in his carefully crafted amendment, are recorded.

There are two things that I want to pick up with the noble Earl. His amendment is very carefully crafted. In his introduction to it, he referred throughout to children, but his amendment relates not just to children but to all mental health patients. For that reason, I wish to concentrate on proposed new subsection (9). It says:

“In subsection (4)(k) the ‘relevant characteristics’ in relation to a patient mean—”,

and then lists all of the protected characteristics within the Equality Act, with one omission: gender reassignment. I therefore wish to ask him simply why people undergoing gender reassignment do not merit the same protection as everybody else.

National Cancer Plan

Baroness Watkins of Tavistock Excerpts

Monday 10th February 2025 Lords Chamber

[Baroness Merron (Lab)]

The Roy Castle Lung Cancer Foundation does excellent work and keeps our minds very focused. The point raised by the noble Baroness will be considered as part of the cancer plan.

[Baroness Watkins of Tavistock (CB)]

My Lords, the Cancer Research UK website clearly says:

“Drinking less alcohol can prevent”


at least seven types of cancer. The Statement refers to the Tobacco and Vapes Bill. Will the Government seriously consider a minimum unit price for alcohol to further reduce cancers across the board, particularly throat and bowel cancers?

[Baroness Merron (Lab)]

I cannot give that specific commitment to the noble Baroness. However, as I know your Lordships’ House is aware, one of the three major shifts we seek through the 10-year plan—this is very relevant to the noble Baroness’s point—is from sickness to prevention. Improved health absolutely is preventive for a number of conditions, including cancer. We need to get that message across, as well as supporting people to make improvements to their health.

Mental Health Bill [HL]

Baroness Watkins of Tavistock Excerpts

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Baroness Merron (Lab)]

I thank my noble friend for pointing that out. On the points raised about protections for young carers, the code highlights that children who are caring for parents with severe mental illness are entitled to request a young carer’s needs assessment under the Children Act. It goes on to cover the information that young carers should be offered to help navigate such a challenging time.

Returning to the guidance about which I was speaking, as has been identified, it already outlines the responsibility of multiagency safeguarding partners. Protecting children at risk of abuse and stopping vulnerable children falling through the cracks is very much at the heart of the Children’s Wellbeing and Schools Bill, which was introduced to Parliament last month.

[Baroness Watkins of Tavistock (CB)]

I thank the Minister. I want to raise the issue that so many children and adolescents are placed for care out of their area, which makes the subsequent treatment plan hard to manage. Can the Minister at least look at whether the code of conduct needs strengthening on that issue? For example, it could include a recommendation that a local team visits the person in the hospital before they are discharged. Of course, I would like to see more beds closer to home, but we have to face the reality.

[Baroness Merron (Lab)]

I appreciate that point, and I certainly would be happy to have a look at that.