Terminally Ill Adults (End of Life) Bill

Lord Evans of Rainow Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

This Bill poses a very real and present danger for people with lifelong congenital conditions. This amendment is crucial to mitigating that threat. I close with this appeal to the noble and learned Lord, Lord Falconer. Please will he accept this amendment? Will he confirm that he agrees with me that our consideration of this crucial amendment should neither be regarded nor represented as filibustering?

[Lord Evans of Rainow (Con)]

My Lords, the noble Lord, Lord Shamash, mentioned a very moving story from his family regarding Duchenne muscular dystrophy, and I have a similar story but from a slightly different angle. My cousin Stephen was diagnosed with Duchenne muscular dystrophy in the 1960s, when this was a terminal illness without any real idea of a prognosis other than that those with it would die as very young people.

My family were determined to try to make Stephen’s life as comfortable and as long as possible. They campaigned with their local MP, who just so happened to be Alf Morris, Baron Morris of Manchester—an outstanding Member of Parliament, and of service to this House. They worked with him to come up with the Chronically Sick and Disabled Persons Act 1970. They went on to develop therapies for Duchenne muscular dystrophy, including making wheelchair provision compulsory on the NHS. My cousin lived five years longer than the average for Duchenne muscular dystrophy patients. The point I am making to the Committee is that if the assisted dying Bill had been used to that extent, and if we had given up when he was a very young man, that never would have happened.

Stephen had a full life, in so far as he could; he lived till he was 21 years of age, when the average was 14 or 15. It goes to show that, if you give up at a very early stage, you will not know how far you can push this disease. In the 21st century, through medication, Duchenne muscular dystrophy sufferers have an extended lifespan. In offering assisted dying to people with chronic diseases, we do not know the miracles of science and medication that can extend these people’s lives.

[Lord Blencathra (Con)]

My Lords, I am another Peer who sat here for many hours last Friday, desperately keen to speak to this group of amendments. Towards the end, at nearly 5.30 pm, I heard the magnificent speech of the noble Lord, Lord Rook, who is not currently in his place. It really was an incredible speech. I suppose the only benefit of being a sort of carry-over, tail-end Charlie was that I was able to read his speech in Hansard once again. I commend it as superb. I concluded that there was nothing I could usefully add to what the noble Lord had said, so I have decided not to try to add anything more to it, and I conclude my remarks.

Terminally Ill Adults (End of Life) Bill

Lord Evans of Rainow Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

I therefore have to say that I am very unhappy about the proposals in the Bill. I have put my name to some of these amendments and support the comments made by the noble Baroness, Lady Coffey.

[Lord Evans of Rainow (Con)]

My Lords, I will speak to my Amendment 376. It is a pleasure to follow the noble Lord, Lord Empey. Last Friday, like many of your Lordships, I sat here all day and did not say a word. My amendment was in the following group, but sadly we did not get to it. However, there was an excellent discussion, and I want to pay tribute to some of the contributors: my noble friend Lord Deben, the noble Lord, Lord Mawson, and indeed the noble and learned Lord, Lord Falconer.

The noble and learned Lord said something that rang a bell; he referred to studied diligence, and how healthcare professionals and the whole system will study how best to conduct these assessments. When he said “studied diligence”, it reminded me of some experiences that I had as a Member of Parliament in helping people in very distressing circumstances with the healthcare of loved ones and trying to navigate the system. The thing that struck me was studied neglect. Studied neglect is quite difficult to detect, because it is not always obvious.

Many of us in this House have a routine, which is what makes us get up every day, and as you get older, that routine becomes very important. You have a good night’s sleep, you wake up in the morning, you shower, you clean your teeth, you exercise and you go to work, or to functions in the community. You eat well—you eat healthily. You can lead a normal life, as many of us do in this House, but something may happen to you—you may slip, trip and fall, and you may find yourself in hospital. That is when things can go wrong, because you are out of that routine of a good night’s sleep and getting up in the morning. For every week that you lie in bed, you lose 10% of your muscle strength. You do not get up, you do not do your routine, you do not shower and you do not clean your teeth. Things start happening to you, and you can go downhill very quickly.

Those things can happen through daily life—but the thing that really concerns me about this Bill, and the reason why I tabled this particular amendment insisting on face-to-face diagnosis from the healthcare professionals having to make this decision, is based on my experience as an MP. Close family and friends can have a malign influence by slowly but surely—this is why I referred to it as studied neglect—not encouraging a loved one to get out of bed in the morning, so that routine declines. They stop showering in the morning; they do not go for their manicure or pedicure or to get their hair done, and they start to decline. People who we always regard as very smart for their age can decline very quickly. The loved ones around them can engineer that, so that when social workers and healthcare professionals meet those people, it is not obvious what is happening. They are not sleeping properly, not looking after themselves properly and not eating properly, and therefore they decline. Nutrition is very important. You also have medication, and there can be no clear care plan; as one grows older, we take lots more medication, and that medication can be increased when it does not need to be increased or indeed not given at all.

That is why I am using the phrase “studied neglect”, to the “studied diligence” of noble and learned Lord, Lord Falconer. We really have to look very carefully at the malign forces that, I am afraid, are out there in society. They look at granny and, as my noble friend Lord Deben says, the £2 million house sitting there, and can slowly but surely—but still relatively quickly—see the demise of granny and realise those capital assets. That is the reason why I put this amendment forward.

Crucial steps in the assisted dying process should be undertaken with direct, in-person interaction, to increase the likelihood that the individual’s request is truly voluntary, informed and free from coercion. The necessity for direct interaction with a person, particularly through face-to-face contact, is driven by the importance of rigorous safeguards and scrutiny, and of upholding patient autonomy in a process that culminates in an irreversible outcome, called death. I could use many more examples but, in the interests of time, I beg to move this amendment.

[Lord Blencathra (Con)]

My Lords, I will speak to my Amendment 320B and three others in my name in this group. The first clinical gateway in this Bill is the most important moment any of us will ever legislate for: the moment a doctor begins the process that can lead to a life being ended. That gateway must be treated with the utmost care; it should not be reduced to a convenience-driven video call.

My amendment is simple and proportionate: it creates a presumption that the co-ordinating doctor’s first assessment takes place in person, and it asks only that, if the presumption is displaced, the doctor records why an in-person meeting was not possible for medical reasons. That is not micromanagement; it is common sense. It is the minimum standard of human contact that we should expect before opening a pathway that is irreversible.

Why does this matter? First, capacity and voluntariness are relational judgments. Clinicians do not assess capacity from words alone: they read people’s faces; they notice the hesitation; they observe the environment and see who else is present. They pick up the small, telling signs of distress or coercion that a screen can hide: a hand hovering off the camera, a whispered instruction, a look that does not match the words. Remote consultations blunt those senses. If we are serious about preventing coercion, the law should make face to face the default, not the exception.

Secondly, this is a narrow safeguard, not a prohibition. The amendment allows remote assessment where it is genuinely impossible for medical reasons. It recognises that there will be rare cases where a patient is too frail to be seen in person; in those cases, the co-ordinating doctor must set out the reasons. That requirement creates an audit trail and accountability. It deters the normalisation of remote practice for administrative convenience and gives panels, the commissioner and, if necessary, later reviewers, a clear record of why the presumption was set aside.

Thirdly, the evidence is clear: leading geriatricians and psychiatrists have told committees that assessing capacity remotely for complex patients is nigh on impossible. Telemedicine studies and the experience of courts show the limits of video for detecting vulnerability. We should legislate to reflect clinical reality, not hope that guidance will be followed uniformly across hundreds of clinicians and thousands of cases. Some will say that this amendment would delay access or over-engineer the process, but I disagree. A single in-person assessment at the outset is a modest investment of time that dramatically reduces the risk of error. If the system is robust, it will absorb that step without undue delay. If the system cannot, then speed is being prioritised over safety, and that would be a real problem.

Finally on this amendment, will the noble and learned Lord, Lord Falconer of Thoroton, accept that a life-ending pathway should begin with human contact, with a clinician who has seen the person in the flesh—smelled the room, so to speak—and observed the context in which that wish has arisen, or does he prefer a default of pixels on a screen? When the outcome is death, convenience must never trump clinical rigour. I urge the Committee to support my Amendment 320B.

My Amendment 347A would ensure that the second assessment—the final medical safeguard—is conducted in person. The Bill currently allows the independent doctor to assess the patient entirely by video. That is extraordinary for a life-ending decision. Experts told the House of Lords Select Committee that assessing capacity remotely is, as I said, nigh on impossible for complex patients. The subtle signs of confusion, fear, coercion or cognitive impairment are often visible only in person. Remote assessment hides the environment. Who is in the room? Who is influencing the patient? What pressure are they under? Kim Leadbeater MP herself said she was uncomfortable watching Oregon’s remote assessments, describing them as “tick-box”. If the sponsor is uncomfortable with death by Zoom, Parliament should not legislate for it. This amendment of mine is modest, proportionate and essential for safeguarding.

If remote assessments are permitted at all, my Amendment 406A would introduce the bare minimum safeguards: the doctor must verify that the patient is alone and speaking freely. Coercion, as we know, is often silent. Abusers can sit off-camera, and patients are coached. A Michigan prosecutor famously spotted a domestic abuse victim being coerced during a Zoom hearing. If trained lawyers and judges can miss coercion on video, how can a doctor reliably detect it in a single remote consultation? My amendment would not ban remote assessment but simply prevent the most obvious and dangerous form of abuse. Without it, the Bill’s coercion safeguards are meaningless.

My Amendment 415B would ensure that remote assessments are tightly controlled, used only when appropriate and subject to independent oversight. The Bill currently allows remote and even pre-recorded assessments without any statutory framework. A protocol approved by the commissioner would ensure consistency, transparency and accountability. It would prevent remote assessment becoming the default due to NHS pressures or simple convenience. Without this amendment, I suggest, the Bill creates a system where lethal decisions can be made based on pre-recorded video clips. That is indefensible.

In summary, my four amendments form a single, focused package of safeguards to ensure that human judgment, not administrative convenience, governs a life-ending pathway. Amendment 320B would make the first assessment face to face by default—the minimum human contact needed to test capacity and spot coercion. Amendment 347A would extend that presumption to the independent second assessment so that the final clinical check is equally robust. Amendment 406A would require a simple verification when assessments are remote—a recorded confirmation that the patient is alone and speaking freely. Amendment 415B demands a statutory protocol for remote or pre-recorded assessments so that exceptions are tightly controlled and independently verified.

These are modest, proportionate measures. They do not block access where an in-person assessment is genuinely impossible, but they stop convenience becoming the norm when the consequence is irreversible. If this Bill is to be the safest system in the world, will the noble and learned Lord, Lord Falconer of Thoroton, accept these targeted protections so that speed and convenience never replace clinical judgment and human scrutiny? I urge the Committee to support my amendments.

--- Later in debate ---

[Baroness Pidgeon (LD)]

My Lords, it is essential that, as we debate this group of amendments, we keep in mind the fact that the systems that we are creating are for people in the last six months of their lives. We must balance the demands that we place on them at this very vulnerable time with what really matters to them during that time. We should stop talking about microprocess and start really thinking about the individual. In her evidence to the House of Lords inquiry in November, Dr Jessica Young said that

“a system that is too onerous creates stress among the people it aims to serve”.

We must not create a system that is too complex and too protracted for someone who is at the end of their life to deal with.

We have made incredible progress in recent years on facilitating video consultations. That came on hugely in the pandemic. Are we not in danger of taking a retrograde step with these amendments? I fear in particular that we in this House must be careful about standing in the way of technological process. Reading some of these amendments, I wonder whether people might want to add in that we write with feather quills and ink, because it seems that that is what this is really about.

Amendment 65 would mandate a whole range of steps beyond clinical assessments to be undertaken face to face. It also seems to disapply the flexibility provided in the Bill with regards to the person meeting the panel. Is it the intention of this amendment that a person who cannot travel to appointments, whether physically or because of the risk of infection, must be denied a choice over how they die? These amendments will affect hugely those who live in rural areas and far from their GP, let alone a hospital with a relevant specialist. They will affect those whose immune systems have been compromised as a result of extensive chemotherapy and those whose mobility is affected by their terminal illness and who find it impossible to travel. Are we not at risk of denying access to these people when such challenges are not unusual, given the nature of what they are experiencing with their terminal illness? Is it the intention that someone who is, for practical medical reasons, unable to meet the independent advocate or the panel, but is able and willing to do so via video link, will immediately be ineligible even if they fulfil all the other criteria? It is difficult to see a basis on which that can be justified.

[Lord Evans of Rainow (Con)]

Will the noble Baroness give way?

[Baroness Pidgeon (LD)]

I am coming to the end of my speech; I do not think I have to take an intervention, so I would like to finish my point.

It seems to me that this is about making the choice of an assisted death difficult or impossible. We need to think carefully about the checks that we are putting in place for people in the last six months of their lives. We need to make sure that the system really will work for them.

Supply of Blood and Blood Products

Lord Evans of Rainow Excerpts

Wednesday 3rd December 2025 Lords Chamber

[Baroness Merron (Lab)]

I certainly echo the noble Baroness’s comments. It is thanks to the generosity of donors—including the noble Baroness herself, who is I know is approaching her 50th donation—that overall blood stocks are at target levels, but she is right about the extra pressures coming through because of winter. The launch of the national campaign to highlight the constant need for blood in this season and to recruit new donors was set under way last month. We also have targeted media campaigns; for example, in areas of the country with larger black heritage communities to highlight the urgent need for more donors from that group.

[Lord Evans of Rainow (Con)]

My Lords, I confess to 120 donations and thank the Minister for all the work that she is doing on this, particularly for tomorrow’s session, but she is absolutely right that only a tiny proportion of the population are blood donors. Talking personally, it is not always straightforward for working people to get those appointments. The noble Baroness is right that we are very short on black and ethnic-minority donors. With that thought in mind, would it be possible to look at artificial intelligence to make it easier for working people, particularly from ethnic minorities, to make those appointments during the working day?

[Baroness Merron (Lab)]

The noble Lord is also to be congratulated, of course. As he said, despite our having some 790,000 regular donors, only 2% of the population gives blood, so we are not full up and we look forward to more donors. To the point that the noble Lord raises, which is important, we are increasing capacity for appointments to donate, but we are also looking at additional digital and logistical improvements, including in how people can book appointments. We are also piloting a new appointment reminder and better communications. There is room for improvement, and we are taking those steps. The noble Lord makes very good points in this regard.

Terminally Ill Adults (End of Life) Bill

Lord Evans of Rainow Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

I encourage the noble and learned Lord to say early in this debate—we have done it for nearly an hour already—that he is prepared to sit down after this Committee stage with others with the intention, the purpose, of adding the appropriate words to this Bill with the assistance that he has been lucky enough to have. We have had wonderful assistance from the Public Bill Office. He has had much more assistance from even more official channels. We can sit down, we can find the words, we can try to agree on them, and I hope that noble colleagues in this Committee would undertake to act in good faith to try to find those words and to ensure that on Report they were included. Let us not have another three-hour debate in which we feel as though the pin on which we are dancing is melting underneath us.

[Lord Evans of Rainow (Con)]

My Lords, I rise to speak to Amendment 50 in my name and that of my noble friend Lord Goodman. It is a pleasure to follow the noble Lord, Lord Carlile. I would not describe him as a nasty lawyer at all. The noble Lord is a Burnley fan. I do not know any nasty Burnley fans, but I do know a lot of Arsenal fans. There is one thing I would say about some phraseology the noble Lord used early in his speech. He used the words “final solution”. I encourage the noble Lord to think of other phraseology to describe that.

I agree with a lot of what the noble Lord, Lord Carlile, said. I am grateful to my noble friend Lord Deben for following the noble Lord, Lord Pannick, because I, too, am not a lawyer, but like my noble friend, as a former Member of Parliament, I experienced lots of constituents who were under coercive control. Lots of MPs do surgeries for their communities and take on these cases. Not being a lawyer, as a layperson trying to fathom out coercive behaviour is notoriously difficult, and that is why I have come up with Amendment 50.

The existing language limits the coercion pressure bar to cases where it causes the person to make a decision, which creates evidential difficulties. This amendment excludes all cases of coercion and pressure without requiring finding out whether in fact it causes the person to make the decision to end their life. It is easier to see whether someone is being coerced or pressured than to know whether the coercion or pressure is the operable cause that leads a person into making the decision. A doctor should exclude all cases where a person is being coerced or pressured to make a declaration rather than engage in causation analysis. Similarly, offences ought to be focused on the wrongful act of coercing or pressurising regardless of the outcome.

At trial, the Crown, with plenty of resources, would have trouble proving that the coercion or pressure resulted in someone making the decision. How is a doctor on their own supposed to find out? Asking a patient is no help given that the frail or vulnerable person may not even know that they are pressurised or may have been intimidated by coercion. Doctors can see pressure from, say, the person accompanying the patient but cannot read the patient’s mind. This amendment would stop doctors being required to be detectives.

The closest analogy in existing law to this rule against coercion or pressure to do a potentially fatal action is Section 2 of the Suicide Act 1961, “Criminal liability for complicity in another’s suicide”. It does not require any attempt at suicide or even a decision to commit suicide and provides that

“D may commit an offence under this section whether or not a suicide, or an attempt at suicide, occurs”.

Section 184 of the Online Safety Act 2023 titled, “Offence of encouraging or assisting serious self-harm”, provides in subsection (5) that

“D may commit an offence under this section whether or not serious self-harm occurs”.

Compare also Section 65 of the Serious Crime Act 2007, which refers to pressurising someone to commit an offence and does not require the outcome be causative.

In recent years, the Crown Prosecution Service has pursued manslaughter charges against men who subject women to domestic abuse that is believed to have driven their suicide. These are criminal offences where there is a much higher bar to action, given that a person’s liberty is at stake. However, Clause 1 is addressing when civil authorities and doctors should draw the line at a patient’s autonomy. Why does the Bill have a higher standard? There is no statutory precedent for “pressured into making it”. The Government have claimed that the Online Safety Act 2023 and the Serious Crime Act 2007 are analogous, but the distinction is making the pressure all that is needed for an offence. Meanwhile the threshold for excluding a person in Clause 1 requires more than is necessary for a criminal offence under these Acts.

Without this amendment it would be lawful to progress a person towards an assisted death even though the person is living in a household where family members are actively making it difficult to live. All that is needed is to see that the person is not pressured or coerced into making the decision. The leading cause of death in domestic abuse victims is now suicide. We work to stop this, but this Bill is opening a door to help perpetrators. It is estimated that three women a week take their own lives. The Government view addressing this as a priority, and the CPS will now prosecute for manslaughter men whose abuse is seen to have contributed to the suicide of a woman. Those men have not had directly to coerce their partners into death, the facts of the abuse are sufficient pressure, but with assisted deaths there will be no coroner’s inquest to address foul play.

The UK leads the world in now recognising coercive control in law, but a regime of total control is poorly understood and insidious. As Cherryl Henry-Leach of Standing Together Against Domestic Abuse told the Lords Committee:

“Coercion is an incredibly complex phenomenon and by its very nature it is difficult to identify and respond to. A perpetrator of coercion will ensure that a person is dependent on them by isolating them from support, exploiting them and depriving them of their independence and autonomy to make decisions freely. As a result of this, we are extremely concerned ... When I think about pressure, I also am mindful of a pattern of coercive control that can be insidious and subversive. Pressure can be a tactic by a perpetrator to enforce a regime of coercive control. That is very complex and I get that, but it is important to be mindful that pressure can be a tool that indicates a pattern of coercive control”.


Studied neglect and coercion are naturally notoriously difficult to detect, and as it stands now, this Bill is a suicide charter. My amendment is intended to improve the Bill.

[Baroness Hollins (CB)]

My Lords, I have amendments in this group, and I have added my name to other amendments. I start by adding my support to Amendment 460, tabled by my noble friend Lady Finlay. Safeguarding measures are not optional; they are essential. To ensure that each individual requesting assisted dying is properly safeguarded, it is essential that all relevant information is gathered so that a full and thorough picture of their circumstances can be formed. We know that poor mental health, inadequate care support or unaddressed social vulnerabilities can profoundly affect a person’s decision-making and ultimately their capacity and understanding of an assisted death. When safeguarding is insufficient or overlooked, the risks of coercion, subtle pressure or abuse increase, and these are risks that may be difficult to detect or are deliberately concealed. This amendment seeks to ensure that such dangers are neither under-estimated nor ignored.

Dementia and Alzheimer’s Treatments

Lord Evans of Rainow Excerpts

Thursday 1st May 2025 Lords Chamber

Asked by

[Lord Evans of Rainow]

To ask His Majesty’s Government what steps they are taking to advance the development of dementia and Alzheimer’s treatments.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, the Government are committed to advancing the development of dementia treatments having invested £496.4 million over the past five years through the National Institute for Health and Care Research and UK Research and Innovation. Additionally, the Dame Barbara Windsor Dementia Goals programme, with up to £150 million of associated funding, aims to speed up the development of new treatments for dementia by accelerating innovation in biomarkers, clinical trials and implementation.

[Lord Evans of Rainow (Con)]

I thank the Minister for that helpful response. Finding a cure for dementia is the challenge of our time. Some drugs now available delay the onset of dementia. They are available privately, but not on the NHS. The NHS says that the assumed costs of administering the drugs are too high. Can the Minister look into this matter to see whether she can clear any barriers to making the new drug lecanemab accessible to everybody on the NHS?

[Baroness Merron (Lab)]

I understand the point the noble Lord is making; I was glad to have the chance of a discussion with him yesterday. I also thank him for his campaigning on such an important matter. I share his view about the need to ensure speed and efficacy. To that point, I say to him that since March this year, as part of the regulation action plan, NICE and the MHRA have been building on the systems we already have in place to make sure that there is rapid access. To prepare for a new generation of dementia treatments, NHS England is working closely with regulators to ensure that arrangements are in place to support the adoption of any new licensed and NICE-recommended treatments as soon as possible. As the noble Lord will understand, it is important that we have the right treatments that do the job and are available. On some of the more recent ones, I understand the disappointment, but the fact is that no disease-modifying treatments are currently available. However, science is developing, and I am sure we will discuss this further.

Adult Social Care: Long-term Workforce Plan

Lord Evans of Rainow Excerpts

Monday 13th January 2025 Lords Chamber

[Baroness Merron (Lab)]

My noble friend is never boring and certainly does not bore this Minister. I very much take the point about the difference between the social care workforce and the NHS workforce, because the majority of the jobs in social care, as my noble friend says, are in the independent sector and the Department of Health and Social Care does not have the levers to ensure a development pipeline. However, this is a challenge for us to meet, not something to turn away from: it is a matter of working across the whole of the workforce, no matter where they are from.

On professionalisation, I agree that we need to enhance skills, because care needs to be of the right quality. I mentioned earlier the development of the care workforce pathway, which is a new career structure, and also that the level 2 adult social care certificate qualification has been confirmed.

[Lord Evans of Rainow (Con)]

My Lords, will the long-term workforce plan include the voluntary sector and the army of unpaid carers, such as family, friends and neighbours—in other words, care in the community rather than in care homes?

[Baroness Merron (Lab)]

The workforce plan will be about employed members of staff. On unpaid carers, I am glad to remind your Lordships’ House that, from April, we will be increasing the carer’s allowance weekly earnings limit from £151 to £196, which is the largest increase in the earnings limit since the carer’s allowance was introduced in 1976. I hope that gives some indication of the mode of direction of this Government in respect of unpaid carers.

Human Fertilisation and Embryology (Amendment) Regulations 2024

Lord Evans of Rainow Excerpts

Tuesday 22nd October 2024 Grand Committee

[Lord Evans of Rainow (Con)]

My Lords, when I came here today, I did not think I would be hearing about Enoch Powell. I think that, if he were here today, he would be very interested in what we have been debating. Enoch Powell’s consistency was Wolverhampton South West. In the 2010 election, a colleague of mine of Asian background, a Sikh, won by the same majority as Enoch won it by in 1950. I am glad to say that Mrs Enoch said that Enoch would have been delighted by my Conservative colleague Paul Uppal winning that seat. It shows that people change over time. I wish he were here to hear what I am about to say.

I welcome these regulations laid before us by His Majesty’s Government. They bring forward the plans from May this year that were established by the Conservative Government. Now, as then, we believe that equality under the law is a long-established principle in this country and any improvement towards this end is to be lauded. I am sure that can receive support from all noble Lords.

These regulations mark a further step towards ensuring equal access to IVF services for people living with HIV and for female same-sex couples. It is another stage in the process of ensuring that as many people as possible can fulfil their dreams of parenthood, and it builds on the incredible work done to reduce the stigma associated with HIV, which has for so long prevented people getting tested and seeking treatment. With these changes, we will make it clear that people with HIV can live happy and fruitful lives.

The conditions in these regulations limit donation to those with an HIV viral load of no more than 200 copies per millilitre, meaning that the infection is undetectable and therefore non-transmittable. This requires the donor and recipient to have a personal relationship with one another and ensuring that safeguards are in place to minimise any risks associated with partner donation from people diagnosed with HIV. This will benefit hundreds of couples who have been trying in vain to become parents, and it will also reduce costs relating to IVF.

I hope that His Majesty’s Government will continue in the steps of the previous Conservative Government with efforts to help those living with HIV to have equal access to healthcare services.

[Baroness Merron (Lab)]

My Lords, I am glad to sense not just support for this draft statutory instrument but recognition in this debate. Following the comments of the noble Lord, Lord Evans, I acknowledge the contribution of my predecessor as Minister responsible for this area, who pressed on with the SI and ensured that it was laid. I am glad to be speaking to it today, as I know he is. I am also pleased to note that Adam Freedman from the National AIDS Trust is with us today. He is most welcome to the Committee. He has come to see the statutory instrument debated. He and his colleagues have patiently encouraged the previous Government and this Government in the right direction, and I thank him for that.

On the points raised by noble Lords, the noble Lord, Lord Wigley, asked whether the devolved Governments were content. I delighted to tell him that they are. He also asked about additional costs. A de minimis assessment was carried out, and it estimates £46,000 to £92,000 for the impact on the fertility sector. Obviously, as has been evidenced and described in this debate, there is a hugely positive impact from the measures within this draft statutory instrument.

I note what the noble Lord, Lord Wigley, said. I put down that he, along with the noble Lord, Lord Winston, and other parliamentary colleagues past and present, are veterans of change and of the Acts we are talking about. As the noble Lord, Lord Scriven, said, this is a journey—one that I suspect is not at its end, although I am pleased to take us further on that journey today. I also pay tribute to the contribution in this area of the noble Lord, Lord Winston, over many years, and to the contributions of other colleagues, who have given it their support and professionalism.

The noble Lord, Lord Winston, asked what the case would be if a recipient were HIV positive. The answer is that they will be able to get IVF. They are not actually affected by these regulations, which impact donors, not recipients. I assure the noble Lord that he was far from wasting the Committee’s time with his comments. I heard clearly his comments about counselling and the need for support. I will look closely at that with officials, following his remarks. I clarify that the £1,000 I referred to was not for IVF. It was an estimated cost for the additional screening required for female same-sex couples, which we are now seeking to correct.

On funding and the issue of availability on the National Health Service, as noble Lords will know, funding for IVF is devolved to ICBs. I am very well aware of the differential provision to different groups and individuals. I will consider future policy options, having picked up this part of the brief and spoken to a number of people about their concerns.

The noble Lord, Lord Scriven, also asked about access to IVF on the NHS. In addition to the point about consideration of advice that I will be getting about improving the service, I want to share his comment about this being just one more step in a positive direction. It is about supporting the fact that families come in all shapes and sizes. A family or a household is a family or a household, and parents are parents. They are there to support and bring up their child in a positive way, and we want to support that too.

I finish by thanking the noble Lord, Lord Evans, for reminding us that one thing that these regulations will do is take us a step on another journey—that of reducing the stigma for those who live with HIV. There have been so many medical advances, which is why we are able to bring this instrument forward today. But attitudes continue to be something to be challenged at times, and I am glad that noble Lords recognise the contribution of the legislative change we seek to make.

We want to ensure that those who want to start a family do not face barriers where there is no reason for those barriers. I place on record my thanks to the organisations who have pushed for and supported these reforms, particularly the National AIDS Trust, Stonewall, the Elton John AIDS Foundation and the Human Fertilisation and Embryology Authority. As I said earlier to the noble Lord, Lord Wigley, I thank all those parliamentarians and others along the way who have got us to this place today.

Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024

Lord Evans of Rainow Excerpts

Tuesday 22nd October 2024 Grand Committee

[Lord Scriven (LD)]

I thank the Minister for setting out the rationale for this draft statutory instrument so well. I agree that this is a step forward in the ongoing battle against the devastating impacts of opioid overdoses. As she said, opioid overdoses have reached alarming levels, claiming thousands of lives every year. According to the latest statistics, opioid-related deaths have surged alarmingly in most regions. This is not merely a statistic. This is about the loss of lives, families shattered and far too many left to grieve, so it is important to take further action that is effective and wrapped in compassion. The temporary measures taken in Scotland show that the changes outlined in these regulations work and will save lives.

Naloxone, when used in the right place at the right time, is a life-saving medication. This draft statutory instrument will facilitate local supply networks, ensuring a broader distribution system and therefore more effective use of naloxone, empowering, among others, healthcare professionals, the police, prison and probation staff, and people in the youth justice system to facilitate the supply of this life-saving drug.

In response to one of the issues that the noble Baroness raised, a question occurred to me. As this will not be a mandatory provision across the country, how will the Government monitor lives that could be saved but that may not be saved because of a lack of take-up of this in certain towns, cities or regions? It could end up that a life will be saved if one body decides to do this, while a life could be lost in a neighbouring county, city or town if that does not take place.

One of the key provisions in this draft statutory instrument is the move to enable the friends and family of those at risk to administer this drug. Allowing those closest to individuals at risk to carry and administer naloxone creates a lifeline that will, literally, make the difference between life and death.

I listened to what the Minister said about setting up local naloxone providers and supply co-ordinators, and I have read the draft statutory instrument and the explanation—but I am still not clear about what regulatory oversight of these bodies will be in place. Who will be the regulator and what powers will they have to deal with the improvement or, indeed, withdrawal of such a service if it is deemed that the local provider is not carrying out the rules laid down in the draft statutory instrument?

Clearly, the broader implications of these amendments are not merely about the use naloxone but about standing with those who struggle with addiction, and their families. These amendments are an essential evidence-based response to the dramatic increase in opioid use and overdoses. By enabling greater access to naloxone, they will help to save lives.

[Lord Evans of Rainow (Con)]

My Lords, I thank the Minister for setting out the provisions in the regulations before us so well. This debate touches on a vital aspect of this country’s public health. Opioids are a pernicious threat to our society, a destroyer of lives and a menace to our streets. The ONS reported that 2022 was the deadliest year since records began for drug-related deaths in England and Wales. Of those, opioids accounted for the largest number of mortalities, at 46%. That is 2,261 people dying every year from opioid toxicity. In Scotland, the statistics make for even starker reading. According to the National Records of Scotland, in 2023, opioids were implicated in 80% of all drug deaths.

So we have a problem, but we also have a solution. As noble Lords will be aware, naloxone is a highly effective treatment for opioid intoxication and has been successfully deployed to prevent death from opioid overdose. I am immensely proud that it was a Conservative Government who launched the consultation on proposals to expand access to this life-saving medication, which concluded in March. The regulations laid before your Lordships are the outcome of that process, and I welcome their positive measures.

I will take this opportunity to ensure that the Government have taken all the necessary considerations. As the second report of the Secondary Legislation Scrutiny Committee pointed out, there is no indication of the costs associated with the instrument. The Department of Health and Social Care told the scrutiny committee that services that wish to widen the availability of naloxone would have to do so out of their own pocket, which, given the financial pressures already faced by such providers, may limit the efficacy of the provisions laid before us.

For these regulations to have the desired effect—that is, of course, to reduce opioid-related deaths—access to naloxone products must also be expanded. What is the point of increasing the number of people who can administer the drug if they are unable to procure enough of the medication? Furthermore, will service providers be able to afford the necessary training for the administration and storage of the drug? Would this not somewhat undermine the efforts of the regulations? In the light of these concerns, can the Minister confirm that funding will not impact the rollout of these provisions?

Although Regulation 8 does make provision for training, clarification is required. Naloxone can be administered by three different routes: intravenously, intramuscularly and by intranasal spray. Obviously, the first two require injection, which is a medical procedure for which specific training is required. The NHS, rightly, sets stringent guidelines on who is permitted to provide such services, so I think noble Lords could benefit from assurances that the IV and IM methods of administration are permitted only by medical professionals with full phlebotomy training.

Further to this point, I highlight that intranasal spray administration is, of course, the most effective method of widening access to the drug. Intranasal applicators can be used by the full range of providers specified in these regulations and can be easily distributed into the community. They therefore allow for a rapid response to an individual experiencing an opioid overdose and, I hope, should have a greater impact in reducing mortality rates. Can the Minister confirm that the Government will pursue greater distribution of the intranasal spray to complement this regulation?

I conclude by saying that we are pleased that His Majesty’s Government have continued the policy initiated by the previous Conservative Government by laying these regulations before us. I look forward to the Minister’s response to the questions I have laid out.

--- Later in debate ---

[Baroness Merron (Lab)]

That is understood. I am sure that the noble Lord will be delighted to know that this is to be established, but he is certainly quite right to raise that point. I will ensure that, once that detail is established, it is made known.

On the point about a potential additional burden on services, which the noble Lord, Lord Evans, raised, we certainly recognise the fact that there are challenges in the scope of these regulations. Our intention—I stress intention—is not to create any additional burden. I think I was quite clear in mentioning that these are enabling, not compulsory, requirements. That is important, because it means that no service or individual professional will actually be required to give out take-home naloxone as a result of these regulations. That potentially allows a more gradual introduction of this.

For example, I know that the noble Lord, Lord Scriven, mentioned that there may be differences in the level of take-up across the country. I suspect that may well be the case. It will be our job not just to encourage it to be taken up but to work out why it is not being taken up. We will not just bring in this instrument; we will seek to actively promote it. As I said, we are confident that there is a high level of support for these changes and we will continue to work closely with services and professionals to support them with provision.

The noble Lord, Lord Evans, rightly said that the previous Government undertook the consultation. I am most grateful for that because it has informed where we are today. That consultation under the previous Government received significant positive support from the sector, with the overwhelming majority of respondents agreeing with the set-up of the changes.

The noble Lord, Lord Evans, raised a question about costs. There is no direct cost to the Government associated with these changes since, as the noble Lord will understand, this is only an enabling provision. It will be for services to determine whether they use this power and give out take-home naloxone. At the moment, local authorities provide funding for naloxone, which is supplied through drug treatment services based on their assessment of local need. Although local authority public health services will want to support the wider provision of naloxone, I recognise that their resources are limited; I am sure that many of them will tell me that. This will potentially mean that there is an additional call on their resources and they may need to pay for it through their own funding streams. However, we will monitor demand and engage with services and local areas to understand where any pressures may be.

Another point here is that this is not a neutral act. There will be benefits, in relation not just to personal health and saving lives but to costs associated with dealing with overdoses. I hope that will be seen.

The noble Lord, Lord Evans, also asked whether the methods of administration are permitted only by medical professionals. It is already the case under current regulations that naloxone can be administered by anyone. I emphasise the point about high levels of safety and that it can be administered by a lay person.

I think I have picked up most of the points raised, but as I said, if I have not I shall be very pleased to look further into any other points and to write.

To summarise, the changes we are proposing will allow more services and more professionals to give out take-home supplies of naloxone without a prescription. As I said, it can already be administered by anyone but having more services with the ability to supply it will mean easier access for the people who are at risk of overdose. It will support them and those around them, as has been generously welcomed and acknowledged by the noble Lords, Lord Scriven and Lord Evans.

In short, these changes will widen access to a life-saving medicine. I am sure we can all agree that any death from an illicit drug is tragic and preventable, and we should take every step we can to reduce drug-related deaths; that is what we are doing today. On this basis, I hope that noble Lords will join me in supporting these important regulatory changes. I commend these draft regulations to the Committee.

[Lord Evans of Rainow (Con)]

I thank the Minister for her responses. In Australia, Canada and some states in the United States the nasal spray is available over the counter. Does the Minister have any knowledge of any plans to administer it via our pharmacies?

[Baroness Merron (Lab)]

I am waiting for inspiration, as the noble Lord will realise. In fact, I would rather write to him, as he has made an important point and I want to be quite clear on it. I thank him for reiterating the point.

NHS Hospitals: Apheresis

Lord Evans of Rainow Excerpts

Wednesday 9th October 2024 Lords Chamber

[Baroness Merron (Lab)]

I thank my noble friend for raising that important point. I will be very pleased to look into this further, so I can answer him in full.

[Lord Evans of Rainow (Con)]

My Lords, I pay tribute to the noble Baroness, Lady Ritchie, for her work in this area. In England, leukapheresis can be performed only by the NHS Manchester apheresis unit, and the Birmingham unit can carry out only three of the apheresis services. Are His Majesty’s Government committed to expanding the range of apheresis services available at each unit?

[Baroness Merron (Lab)]

Further to my answer to the noble Baroness, NHS Blood and Transplant is seeking to expand capacity in the way I outlined. It is probably worth going back to the point about the apheresis working group. It met for the first time last month to determine the extent of the capacity issues which we know exist. It will also be looking at who delivers what, how and for what uses. It will identify the issues in respect of workforce, machinery, finance and efficiency, and seek to come up with a recommendation. It will report in spring of next year, so we have a route forward.

Support for Infants and Parents etc (Information) Bill [HL]

Lord Evans of Rainow Excerpts

2nd reading
Friday 6th September 2024 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, I begin by congratulating my noble friend Lord Farmer on securing time for his Private Member’s Bill. I also pay tribute to his work over many years on family policy, preventing family breakdown, and on the welfare of children, and especially to his work on creating and growing the family hubs network, supported by Dr Samantha Callan. I also pay tribute to my right honourable friend Dame Andrea Leadsom, who has worked tirelessly on this subject. There is no doubt that my noble friend’s passion and commitment are behind the Bill today, and his belief, shared by many noble Lords, that we need to give all newborn babies the best possible start in life, no matter what their background.

The importance of the Start for Life approach cannot be underestimated. It ensures that there are welcoming family hubs, usually run by local authorities, through which new parents of newborns can access a wide range of family support services such as parenting support, help for relationships between new parents and between parents and new babies, health visitors, breastfeeding and other infant feeding services and mental health services. These services are provided by local authorities, the voluntary sector and private sector partners.

My noble friend Lord Farmer has highlighted how local authorities that receive Start for Life funding are required to publish their offer. Indeed, it is one of the conditions for local authorities receiving transformation fund money. The Bill is in some ways simple in its aim, which is to ensure that they contribute to offer Start for Life beyond the end of that fund. Of course, this will require additional funding, but in the context of some of the larger sums of billions that we debate in this Chamber, we are speaking about only £500,000 per annum across England. As with any taxpayer spending, my noble friend Lord Farmer proposes that there should be a proper procedure in the Commons to make this relatively small sum available.

It may be argued by some noble Lords that, with £500,000 here and another £500,000 there, pretty soon we are talking serious money. However, against this we need to consider the cost of family breakdown in the UK. Aside from the emotional, social, mental health and societal costs of family breakdown, the Centre for Social Justice think tank estimates that the cost to the Government and ultimately the UK taxpayer is at least £51 billion a year.

In terms of societal costs, the Centre for Social Justice also found that those who experience family breakdown when aged 18 or younger are more than twice as likely to experience homelessness, twice as likely to be in trouble with the police or spend time in prison, almost twice as likely to experience educational underachievement, and almost twice as likely when they themselves become parents to break up with the other parent of their children. They are also more likely to experience alcoholism or teenage pregnancy, suffer from mental health issues, fall into debt or experience being on benefits.

Much has been said by my noble friend Lord Farmer and noble Lords on all Benches about the importance of support for newborns and their families to give our nation’s children the very best start in life. My noble friend has committed his political life to founding and growing the network of family hubs to help parents and children of all backgrounds, and for this reason, I commend him for his equally noble work in this area.

Some noble Lords may say that we should leave this to the decisions of integrated care boards and partnerships or health and well-being boards. However, giving the best start in life to children involves far more than just being health focused. From speaking to my noble friend Lord Farmer, I understand that he believes that it is important to keep Start for Life as integrated as it currently is, with a wider remit than just health.

In preparing for this debate, my noble friend Lord Kamall contacted the office of the Minister, asking for an indication of whether the Government are inclined to support the Bill. The Government were not able to tell him whether they will do so. However, that fateful—but we hope not fatal—day for my noble friend Lord Farmer’s Bill has now arrived.

I have a few questions for the Minister. Do the Government intend to support or reject my noble friend Lord Farmer’s Bill? If the Government are not minded to support it, where do they disagree with it? If the Government are not supportive, are they considering introducing their own Bill for Start for Life? If so, what timeframe can we expect for such a government Bill, and in the meantime what will happen to the funding for the Start for Life programme?

My noble friend Lord Farmer has devoted his life to family hubs. He has made a compelling case for the Start for Life programme. I am sure that he and other noble Lords, including the Opposition Front Bench, are looking forward to the Minister’s answers to these questions.