Terminally Ill Adults (End of Life) Bill

Debate between Lord Evans of Rainow and Lord Blencathra

Committee stage
Friday 30th January 2026 Lords Chamber

[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.

Holocaust Memorial Bill

Debate between Lord Evans of Rainow and Lord Blencathra

Committee stage
Tuesday 11th March 2025 Grand Committee

[Lord Blencathra (Con)]

The noble Lord referred to me in his remarks and I wish to respond. It is a matter of numbers. I came through the park today, as I do every day, and there were a few people out exercising their little doggies and picking up their mess, and kiddies having little picnics, but if we are going to have these 40 busloads of people eating their sandwiches, the park will be absolutely overwhelmed by excessive numbers and all those other activities will be frozen out, because of the dominance of numbers of those visiting the centre.

If I may say so, the noble Lord was absolutely wrong. I need to open my laptop and find the report. He may have talked to an expert who said that the Holocaust will be the only thing commemorated, but that is not what the official report says. The official report mentions other genocides that will also be commemorated. Of course, it does not refer to them as a Holocaust, because they are not, but it refers to the commemoration of other genocides. That was mentioned in the official Holocaust Commission report and it is referred to in the report published by the department, so it is incorrect to say that the centre will purely be for the Holocaust. I wish it were and I would like to see amendments saying that it should be devoted to the Holocaust only.

The other point about the size is also utterly wrong. As the noble Lord, Lord Carlile, said, it will be four pokey little rooms underground and 48% of the construction underground will not be available to the public: it is ducts, stairways and non-usable space. So we will have an inadequate learning centre far too small for the purpose but far too large for the park, visited, if the Government are right, by tens of thousands of people who will inevitably, in the nicest possible way, with their picnics and so on, squeeze out the other users of that park whom I see every single day.

[Lord Evans of Rainow (Con)]

My Lords, before I support my noble friend Lord Pickles, I should say that I voted for this back in 2013 when I was a Member of Parliament under David Cameron. Since then, every Prime Minister—May, Johnson, Truss, Sunak and indeed Keir Starmer, the current Prime Minister—supported this. All Prime Ministers will support this application. Why is it that Prime Ministers support it? Because they are global leaders. Go around the globe or around Europe, to Berlin, for example, or to America. The Holocaust memorial in Berlin is its centrepiece; you cannot visit Berlin without seeing the Holocaust memorial.

In my view—I am biased, I admit—London is the greatest global city, so therefore to have this memorial as close to the British Parliament, the mother of all Parliaments, is exactly the right place. I say to some noble Lords—many of them are my friends—that this is starting to sound like a local authority council chamber. This is not a local government council chamber. This is the mother of all Parliaments. I believe that this is the right memorial in the right place in this great city.

Homecare Medicines Services (Public Services Committee Report)

Debate between Lord Evans of Rainow and Lord Blencathra

Thursday 2nd May 2024 Lords Chamber

[Lord Blencathra (Con)]

My Lords, I am delighted to participate in this important debate, and I regret that it is tail-end Charlie today when the report deserves much greater prominence. The only credit I can take for this excellent report is that I suggested the topic. I pay tribute to our brilliant chair and her devastating summary today, and to colleagues on the committee and to the officials, who did all the probing and heavy lifting and concluded that this is a major opportunity lost.

My personal interest is that I get two different medicines for multiple sclerosis delivered to my home. The one which sparked this inquiry is called fampridine. Most people with MS cannot lift their feet and they drag on the floor; I can trip over a dead fly on the carpet. Fampridine enables us to lift our feet by as much as 5 millimetres—that is all—but it is the difference between walking and not walking at all. To me and others, that little fact makes it a miracle drug, and I was lucky enough to get in on the trials when they started. As an aside, NICE will no longer approve it for new patients, but all those of us in the trials can keep getting it. That is grossly unjust—like many other NICE decisions.

I had excellent service until 2017, when the delivery contract was allocated to a new company; it is named in the report and I will not name it again, but it began to fail abysmally in getting the deliveries to me before the last pills ran out. I complained on many occasions and it came to a head in July 2021, when I had no delivery and no pills for 10 days. I was unable to walk—or stagger, in my case—from where I park my Ferrari at the Bar of the House even to get to this Front Bench here.

I looked up the company in Companies House, found the names of the main directors, tracked down their addresses and sent them a stinking note with my full rank and titles and a draft of my letter to Sajid Javid, the then Secretary of State, calling for the company’s contract to be terminated. The net result was that, two days later, some poor chap was dispatched on a 500-mile round trip to deliver on a Saturday my fampridine to Penrith in Cumbria.

I looked further into this company and found that the Care Quality Commission—a thoroughly useless body if ever there was one—had just published a report in May 2021 showing that over 9,885 patients had also failed to get deliveries of their drugs, and some had to be hospitalised. The CQC report gave the company an overall rating of “inadequate”. On patient safety it rated it “inadequate”, and on “Are services well led?”, it rated it “inadequate”. Therefore, with all these negative ratings, what did the CQC do? It listed all the regulatory breaches and asked the company to kindly send it a report on how it would behave better in future. As Bob Geldof might have said, “Is that it?”

That is one reason why I say that the CQC is a useless regulator, which our report also suggests—or hints at, in very strong terms. By the way, a month after the scathing CQC report, the company changed its name and pretended to be a completely different supplier altogether.

I wrote to the Secretary of State calling for the contract to be removed, but that did not happen because he was not properly in charge of it and he was not sure quite who was. I now get Rolls-Royce service from this company because of who I am and because I created a big stink, but the other 9,884 victims, who have conditions far worse than mine, might not be so well served.

When I joined the Public Services Committee, colleagues were looking for a short-term inquiry to fill a gap as we looked at suggestions for a longer inquiry. I suggested investigating the delivery of medicines at home and supplied details of my own experience. I think that initially my colleagues thought that I was perhaps exaggerating the shambles I had described, but when our excellent clerk, Samantha Kenny, looked at it, she thought that it deserved a deeper look.

My colleagues thought that there may be a bit of a mess here, and then the evidence started to come in from various patient groups such as Crohn’s & Colitis UK, and the superb report from the British Society for Rheumatology which suggested that the system was a complete shambles and cited countless examples of failure to deliver medicines on time. I think colleagues then concluded that old Blencathra was not so barking after all.

We have called the report An Opportunity Lost and that is true, but we could easily have called it “A Complete Shambles”. Those are not just our words; the Chief Pharmaceutical Officer for England told us that our inquiry had unearthed,

“a complicated picture that is quite hard to understand even when you are working in the area”.

That is a nice way of saying “a complete shambles”.

The then Minister for Health and Secondary Care, Will Quince MP, stated:

“It is certainly complicated. That is an understatement”.


That is, again, a nice euphemism for “a complete shambles”. As the noble Baroness said, the NHS has not a clue how much it costs. The National Clinical Homecare Association told us that the Treasury spends £4.1 billion per annum on homecare medicines, but the NHS told us it is only £3.2 billion. We asked the Minister—he said it was £2.9 billion. As we say, it is utterly shocking that no one in the NHS can give us an accurate figure for the billions spent on home deliveries, but then the NHS does not have a clue about how bad it is and how many patients have suffered. KPIs are a mess, as the noble Baroness explained.

We said in our report:

“Different sets of performance data are available to manufacturers and the NHS. This creates confusion and prevents effective monitoring … NHS England must develop and implement one consistent set of performance metrics”.


Performance data must be published.

The National Clinical Homecare Association told us that

“98.8% of deliveries were delivered on the day they were intended to be delivered on”.

That is a very clever form of words but quite misleading. Yes, 98.8% were delivered on the dates that the delivery company decided they were to be delivered on, but those were not the dates the doctors prescribed, which were always much earlier and before the medication for patients ran out. Part of these failures are delays in the NHS prescribing system and delays by the delivery company.

Chapter after chapter of our report highlights the failings of the system. Thus we say:

“No one—not the Government, not NHS England, not patient groups, not regulators—knows how often, nor how seriously patients suffer harm from service failures in homecare”.


Let no one misconstrue our conclusions as an attack on the private provision in the NHS. While we found myriad flaws in the provision at all levels, God help us if the NHS tried to run a courier delivery service, since that would be infinitely worse. Delivering medicines at home by couriers is eminently sensible but has to be better managed at all levels. The problems that we identified all relate to the fact that there is not one single person or NHS body in charge. Different people and organisations negotiate different contracts. There is no quality control or negotiating competence, there are no consistent KPIs to measure performance and the various regulators are all fairly useless. It seems there is no one with the power to sanction failure or cancel contracts. Worst of all, I got the feeling that the NHS rather likes it this way because when things go wrong there is no one individual or organisation to blame. They can all carry on presiding over a shambles but carry no personal responsibility for it.

I get exceptionally good medical care from the National Hospital for Neurology in Queen Square, the Royal Marsden and the Lakes Medical Practice up in Penrith, but if you want to see the general bureaucratic incompetence of the NHS and why it is failing so badly in so many areas, the bureaucratic shambles that we are reporting on here is a perfect microcosm example.

However, in the report we did not just criticise but offered solutions. Theoretically, there is a Minister in charge, but he or she has no say in the running of the system, which is delegated to the NHS. The Minister should be charge and have a very senior person reporting to them. We say:

“NHS England should designate a senior, named person with responsibility for the homecare system. That person should be given sufficient powers and resources to discharge that responsibility”.


That person’s responsibilities should include:

“Setting clear national KPIs for organisations commissioning and providing homecare medicines services … Collecting data on those KPIs, and publishing data on those KPIs in a way which supports public scrutiny of the homecare medicines system … Holding relevant bodies such as individual providers, Chief Pharmacists, the National Medical Homecare Committee and pharmacy teams to account for work on homecare medicines services … Responsibly using new powers to issue appropriate penalties to under-performing providers”.


That is essential; there must be sanctions.

The fifth recommendation is:

“Ensuring trusts or hubs procuring homecare medicines services have access to sufficient financial and expert procurement advice and information, including template legal agreement frameworks, so they are able to effectively deliver value for money services and influence the homecare medicines services market”.


As in every government department I have served in and witnessed over 40 years in Parliament, the lawyers employed by the outside commercial contractors are infinitely better than government lawyers trying to negotiate contracts; they outwit and outmanoeuvre us every time.

Finally, we said that:

“Achieving value for money and increasing transparency on homecare funding”


should be another part of their individual duties.

As the noble Baroness said, the government response accepted about 90% of what we say—that is jolly good. On that basis, let us have urgent action to implement those proposals and the remaining 10% as well.

[Lord Evans of Rainow (Con)]

My Lords, I remind the House that there is an advisory speaking time of nine minutes.