Lord Kamall
Main Page: Lord Kamall (Conservative - Life peer)
Lord Markham (Con)
Let me answer that, then I will be perfectly happy to be intervened on—
Lord Kamall (Con)
I am sorry to interrupt. If I am correct, the noble Lord can speak again, but he cannot intervene on an intervention.
Lord Markham (Con)
I believe I am answering the question. Once I have finished answering, the noble Lord can intervene on me and say what he would like to say. If he is willing to wait a few moments, that would be the appropriate point.
We spoke earlier about how palliative care is a way for people to choose to ease the way they die. I would say that assisted dying is also giving people the choice to die in a way they want to. In birth services, people have a birth plan. I remember going through this recently and there was a midwife who played a role very similar to that of a personal navigator, helping us talk about what sort of birth plan we wanted: whether we wanted a home birth and what we wanted to do about pain relief. It was very similar to many of the things that the noble Lord, Lord Birt, was talking about. The fundamental point here—the noble Lord, Lord Winston, is free to intervene at any point now I have answered that—is that it is giving people choice and autonomy. I believe that choice in the way you wish to die and when you want to die, if it is certain that your diagnosis is that you will die within six months, is a fundamental choice and a health choice.
Lord Kamall (Con)
My Lords, this has been a long and comprehensive debate, and a number of points have been raised. I will try not to hasten it—
Lord Kamall (Con)
Sorry, I will try to hasten it, actually, in many ways. Maybe we should slow down.
I start by thanking the noble Lord, Lord Birt, for the amendments in the group and the whole idea of establishing the assisted dying help service. As the noble Lord said, it is based on well-established experience. It seeks to address a number of important questions that the current draft of the Bill does not address. How will important services, such as care for the families of those who are seeking assistance under the Bill, be provided? Who will publish the appropriate information about the provisions of the Bill in the public domain? How will those seeking assistance be supported throughout the process? These are thoughtful amendments, but a number of noble Lords have quite rightly raised concerns about the potential downside to speed and efficiency in this case.
The amendments in the name of my noble friend Lord Mackinlay seek to ensure that when a personal navigator is allocated to the person seeking assistance—that sounds like a good suggestion—there must not be a presumption that, when they appoint that navigator, the person will necessarily continue with the process to its end. That gives the person who seeks it the option of changing their mind.
A number of the issues that we have discussed today have been discussed throughout the passage of the Bill. I have a number of questions; they are more for the Minister than the Bill’s sponsor, but I think that many noble Lords have questions for the Minister.
On the specific matter of the assisted dying help service, as well as the duty to publish information on the Act’s provisions, what consideration have the Government given to the interaction between the legitimate dissemination of information about assistance with ending one’s life and the encouragement of suicide, as prohibited by law under the Suicide Act 1961? I know that this issue came up very early on but, in this specific context, it is worth repeating.
A number of noble Lords have rightly asked about the workability of the help service, including what the cost of managing the service and the other running costs might be. Do Ministers feel that resourcing the service adequately might undermine the effective delivery of other parts of government? As a number of noble Lords have said, the Government have not really answered those questions about the available resources and where the money will come from. Once again, I am taken back to Second Reading, when the noble Lords, Lord Stevens and Lord Hunt of Kings Heath—the latter being a former Health Minister—both said, “We know how the system works. This money will come from somewhere, and it will be at the expense of palliative care”. We are assured by those who support the Bill that that will not be the case; indeed, Ministers have themselves said that sufficient money will be made available. However, a couple of weeks ago, I asked almost the same question as my noble friend Lord Deben asked—albeit in a less eloquent way—of the Minister from the Ministry of Justice, and, last week, of the Minister from the Department of Health. To be fair to the Government, I received an answer from the Minister; if noble Lords allow me, I will touch on a few extracts from that letter and paraphrase where possible. The Minister’s letter to me said
“you sought confirmation that the Government is confident that palliative care will be sufficiently funded, so that those who may seek assisted dying services are offered a real, as opposed to theoretical, choice on palliative care to support them making a more informed decision”.
So far, so good. As my noble friend Lord Gove said, the letter talks about support for the hospice sector, including £100 million for adults and £80 million for children—I almost sound like a Minister responding here, I know, but we have to be fair when we challenge the Government on this. The Minister also mentioned the all-age palliative care and end-of-life care modern service framework for England to improve the services. The noble Baroness, Lady Berger, said that it would be published in spring 2026, but the letter says that it will be published in autumn 2026—I think the Minister answered that; let us be fair: that is better than the answers that many Ministers from all parties have given over the years, where they often say “at pace” or—what is the other phrase?—“in due course”, but at least this gives us a real timeframe. The Minister also talked about the framework being aligned with the ambitions of the 10-year plan.
Lord Harper (Con)
On that point, I also got a copy of that letter. It is worth saying that, in the 10-year plan, there is no ambition for high-quality, universal palliative care. It is not there. So, if the plan the Government are going to publish in the autumn is aligned with it, I think we can see that they do not plan on making universal, high-quality palliative care available in the next 10 years. That is a real problem for decisions taken under this Bill.
Lord Kamall (Con)
I thank my noble friend for that intervention. Before commenting on the content of the Bill, I was seeking, just to be fair to the Government, to lay out what they have told me.
Lord Stevens of Birmingham (CB)
May I pursue the important point that the noble Lord is making? The Minister for Care, Stephen Kinnock, was before a Commons Select Committee on this very point that the noble Lord, Lord Harper, has discussed. He declined to give any commitments about the content of the modern service framework for palliative care and declined to say that resources would be made available to fill the gap; the only specific commitment he gave was that a new 24/7 phone number would perhaps be put in place in 2027, I believe.
Lord Kamall (Con)
I thank the noble Lord for that intervention, as well. It reinforces the points I am going to come to—if that makes sense.
The Minister, the noble Baroness, Lady Merron, ends the letter by saying:
“Through these actions … we hope to ensure sustainable funding for palliative care and end-of-life care sector in the long term”.
This is the Government’s stated intention. The next bit says:
“I hope this letter has provided clarification on the queries you raised”.
I will let noble Lords be the judge of whether it provides clarification. To be fair, the Minister copied the letter to all Peers who tabled amendments, as my noble friend Lord Harper said, and put a copy in the Library. I urge all noble Lords to read that letter to see whether they believe that it provides the clarification that many are seeking. If we feel that it does not, we should come back to this point in future weeks and raise these issues with the Government again.
I hope the Minister, the noble Baroness, Lady Blake, will take that on board when she answers. If she does not have the answer to many of these questions, we should wait for other noble Lords to read that letter, then maybe raise the questions again and ask whichever noble Baroness is on duty as the Minister in future weeks to answer questions on areas where we still believe there are gaps.
Baroness Finlay of Llandaff (CB)
I am grateful to the noble Lord for referring to that letter and quoting the amounts of money in it. Does he recognise that that is one-off and not recurring funding, and there is no intention for funding to increase as cost of living and so on increase, and to meet the gaps in services that we have been talking about?
Lord Kamall (Con)
I have to be very careful because I am not answering for the Government; I am just trying to reflect that letter. However, the Minister did make it clear that the children’s hospice funding is over the next three years and that it will account for £80 million in total. We all know how Governments work, and I not sure that any Government could give a commitment beyond three or four years or beyond another election. To be fair to the Government, I believe that they have answered the question about how much resource they will be allocating. It is up to noble Lords to decide whether they believe that that is sufficient, but if, whichever side of the debate they are on, they feel that the Government have not answered those questions, it is up to them to come back in future weeks and press the Minister on duty.
Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)
I thank noble Lords for their thoughtful comments, particularly those on the amendments proposing an assisted dying help service and a minimum timeline for the assisted dying process. I thank the noble Lords, Lord Birt and Lord Mackinlay, and the noble Baroness, Lady Coffey, for their amendments in this group.
I also thank the noble Lord, Lord Kamall, for his helpful comments on the detailed letter that has been sent to noble Lords. I hope that noble Lords can therefore accept that that is in train and that they will refer to the letter. Of course, there will be other opportunities to come back on particular details if required.
The amendments tabled by the noble Lord, Lord Birt, aim to set up a new statutory body entitled the assisted dying help service, which would be part of the National Health Service. From a workability perspective, these amendments would create many new concepts and relationships that would conflict with the current provisions of the Bill. I note that considerable further policy development and legal drafting would be required to create a workable system should noble Lords support these amendments.
Amendments 287A and 287B tabled by the noble Baroness, Lady Coffey, would create a new role for the General Medical Council—GMC—to set the requirements for training, qualifications and experience, and introduce new licensing, for assisted dying. Although the GMC has a function to set standards for doctors and recognise specialisms, it does not set requirements for training and qualifications for specific services, or license doctors to provide them. This would be a significant departure from the way that the GMC operates and would require it to identify a new process to identify the doctors on this register who are licensed to provide this service.
Lord Blencathra (Con)
My Lords, I will speak relatively briefly to the amendments in this group. I degrouped them for a technical reason. They are quite narrowly drawn. I know there is a group coming up, led by the noble Baroness, Lady Berger, that is wider ranging and more important than mine. If any noble Lord wishes to speak on the principle of these amendments, they might be better off waiting for the noble Baroness’s group.
The purpose of my Amendment 39B is to ensure that a person who wishes to die is driven by their illness, not by poverty, loneliness, lack of care or other remedial pressures. This would restore the link between the justification for the Bill and its operation. The political case for assisted dying has always been framed around unbearable physical suffering caused by terminal illness, yet the Bill contains no requirement that the person’s motivation must arise from that illness. Without this amendment, the Bill becomes a general choice in adversity scheme, where any reason—financial distress, lack of care, fear of being a burden—can drive the decision.
The noble and learned Lord has now explicitly said:
“I am strongly against saying poor people should not have that choice”.—[Official Report, 16/1/26; col. 2020.]
That is an admission that the Bill permits assisted death for reasons of poverty. My amendment would correct that. It would ensure that the motivation must be principally attributable to the illness itself, not to the state’s failure to provide care, housing or support. This is not about denying autonomy; it is about ensuring that autonomy is real. A decision driven by poverty or abandonment is not a free choice. The amendment would ensure that the Bill remains what the public believe it to be: a response to suffering caused by terminal illness, not a response to social failure.
My Amendment 39C would draw a clear line: financial distress, lack of housing or lack of social support cannot be the primary motivations for an assisted death. Without this safeguard, the Bill risks becoming a mechanism by which poor and unsupported people are offered death instead of help. The Bill is presented to the public as a response to the unbearable physical suffering caused by terminal illness, yet it contains no requirement that the person’s motivation must arise from that illness. Without these amendments, the Bill permits assisted death for a whole host of reasons that Parliament never intended, such as loneliness, poverty, lack of housing, lack of care or feeling like a burden on the state or your dependants.
The noble and learned Lord has now accepted that these motivations are valid choices. That is a dramatic shift from his own 2012 commission, which said that motivations were never legitimate and that safeguards must prevent them. Peers are entitled to ask what has changed other than the political need to keep the Bill workable. International evidence shows that non-medical motivations dominate assisted dying requests. Pain is not the primary driver. We hear that being a burden is a driver, as is the loss of autonomy. Parliament must decide whether it is comfortable legislating for that.
Finally, these amendments ensure that asking “why” has consequences. If the answer is poverty, loneliness or lack of care, the response should be support, not a lethal prescription. These amendments restore coherence, safeguard autonomy and prevent the Bill from becoming a general choice in adversity scheme. I beg to move.
Lord Kamall (Con)
In the interests of being brief, rather than repeating everything that my noble friend said, I look forward to the answers from the sponsor of the Bill and from the Minister.
Lord Kamall (Con)
My Lords, it has been a long day at the end of a long week for many noble Lords, so I do not seek to make a long speech. But before I respond to the debate on this group of amendments, I want to thank all staff from across the House who have worked extra hours to ensure that we could be here today and at this late hour. We really do appreciate it.
I thank the noble Baroness, Lady Berger, for introducing the amendments in such a clear and, more importantly, concise manner. As my noble friend Lord Blencathra said, the principle behind this group is very similar to that behind the last group: what is being sought is that doctors should seek to establish whether those who are terminally ill, and who have been given a prognosis of six months or less to live, are seeking an assisted death for those reasons only—their terminal condition—and not material factors.
My noble friend Lord Markham explained why other motivations are relevant, could be relevant or could be reasons for people wishing to die or seeking an assisted death. Contrary to that, the noble Lords, Lord Mawson and Lord Carlile, referred to misunderstandings and pressures, particularly on people from black, Asian and other minority ethnic communities. It reminds me of a comment that the noble Lord, Lord Rees of Easton, made at Second Reading—a man who spent all his life working with black communities in Bristol—who said he was concerned about the impact of this Bill on black communities.
The noble Baroness, Lady Grey-Thompson, has also spoken of her own very real experience and concern for people in the system, if the motivation is not purely because they are terminally ill but might be because of other factors. I know that my noble friend Lord Deben shares these concerns. I just gently remind him that he is not as unique a Conservative as he believes he is; all Conservatives want a better society. In fact, most politicians from all parties go into politics because they want a better society. We are on different Benches simply because we disagree on how to achieve that. Conservatives would probably say that the state is not the same thing as society.
Lord Deben (Con)
I am sorry if I misled my noble friend. I merely meant that you can believe in the individual but you have to believe in the individual in a society, and you cannot take the extreme view that suggests that the individual is on their own. No man is an island.
Lord Kamall (Con)
Indeed, and in fact many classical liberals and libertarians understand the individual’s role in a wider society. But that is not the basis of this debate, and I digress too much. I will return to the group of amendments.
I know that the noble and learned Lord, Lord Falconer, understands the concerns of those who have raised issues about minority communities and people being stuck in the system. But I also know that he has already made his view clear about the principle of seeking to exclude some of those other principles—if I am incorrect, I am sure he will correct me. So I suspect that, given the strength of feeling, we will return to these amendments on Report.
Given that—I understand that the Minister may not be able to answer all the questions now and we accept that he or one of his colleagues will write to us—we have to understand how the Government envisage how a person’s motivation beyond their terminal condition could be established. That is the crux of the matter. How do you establish that if you can justify it only on the grounds of terminal illness, not other motivating factors?
For example, what work, if any, have the Government or NHS England done to try to understand that? One assumes they may have to draw up guidance for this one day. Have the Government, or anyone in government, looked at how other countries have handled this issue, whether they do handle this issue, and what would have to change? We spoke earlier about the foundations of the National Health Service and what might have to change in guidance for many of the practitioners. Indeed, what training would be required?
As my noble friend Lord Deben has often said, this goes way beyond just the Bill. It will affect the Department of Health, the practitioners and the legal system. These are questions we need the Government to answer. They can still take a neutral position, but they have to understand that noble Lords seek to understand the implications here for government, the costs to government, and how that will change.
I understand these questions are in depth and recognise that the Minister may feel it is slightly unfair. I do not expect all the answers now. But it has been a constant theme throughout the debate and the many days in Committee that we need better answers from the Government. That is not a party-political point; it is purely that we want to see the implications of this on government: what extra costs there will be, what guidance will have to change and, however the Bill finally turns out, and in whatever form it reaches the statute book, how the Government will deal with that. I suspect that, for many noble Lords who are torn the Bill, that might be the deciding factor on how they vote at the end of the day.
Lord Katz (Lab)
I thank noble Lords for their considered contributions on the motivation for assisted dying. Before I go into the meat of my comments, I join the noble Lord, Lord Kamall, in thanking the House clerks and staff for all their efforts and dedication in allowing us to sit for longer on a Friday to consider these weighty issues properly.
I also share the noble Lord’s comments about our wider motivations across the House, and about generally in politics wanting a better society. For what it is worth, I find myself in agreement with the noble Lord, Lord Deben, that, indeed, no man is an island. Whether that makes me a classical liberal or not, I am not sure—probably not.
These amendments seek to amend the eligibility criteria for assisted dying, to require that the person’s wish to end their own life is due to their terminal illness rather than to other reasons. I will keep any detailed comments limited to the amendments on which the Government have major legal, technical or operational workability concerns.
Amendments 320ZA and 332AA, tabled by the noble Lord, Lord Blencathra, seek to prevent people being eligible for an assisted death if they are motivated by non-medical factors such as loneliness, poverty or lack of services. There are various workability issues with these amendments, which I will briefly outline to aid noble Lords’ consideration. First, it could be challenging to establish whether someone is seeking an assisted death as a result of specified factors, given that a person’s motivations could be complex. Furthermore, a wide range of factors could be deemed as non-medical, given that the term is not defined and the list given is non-exhaustive. It is also unclear how the patient or doctor are meant to proceed if these factors are present.
I raise no major workability issues with the other amendments in this group, which are rightly a matter for your Lordships’ House to decide. However, I would like to set out their potential effects, which noble Lords may wish to consider. The amendments would require a person’s terminal illness to be a motivation for them seeking an assisted death, but, as drafted, they do not require it to be the only or primary motivation. It is arguable that every person seeking an assisted death under the Bill would be doing so in some way because of their terminal illness, so it may be that, in practice, the amendments would not impact on who is eligible.
The noble Lord, Lord Kamall, asked me some questions. I would push back on his first question around how the Government envisage a process or system for establishing motivation beyond condition: we genuinely think this is a policy decision, and that is one for my noble and learned friend Lord Falconer, the Bill’s sponsor, and those others who support the Bill. On his question about any work or research that NHS England has undertaken, I do not have that answer at my disposal, but I am very happy to take it back and write to him.
Finally, I would just like to mention that none of the amendments in this group has had technical drafting support from officials, so the way they are currently drafted means that they may not be fully workable, effective or enforceable.