Terminally Ill Adults (End of Life) Bill

Lord Rook Excerpts

Friday 14th November 2025 Lords Chamber

[Lord Ashcombe (Con)]

My Lords, I speak definitely not as a lawyer or as part of the medical profession in any way. It appears to me that the Mental Capacity Act uses the balance of probabilities when making a decision, rather than “beyond reasonable doubt” as, in my understanding, the criminal court does. For such a definite decision as whether to end your life, the balance of probabilities is insufficient. Therefore, is the current definition of capacity in the Act sufficient for this job? I suspect not. Is “ability” the right word? I am not sure. Somewhere along this line, to the point made by my noble friend Lord Deben, there is an answer, and maybe two words is right.

[Lord Rook (Lab)]

My Lords, I will keep this brief. I was not going to share this at this point because it is quite personal and because it takes a lot for me to counter the noble Baroness, Lady Andrews, for whom I have huge respect. She was the first person to invite me to the House of Lords for tea, many years ago. I do not doubt that the Mental Capacity Act has been a huge advance in how we deal with these issues.

I accept that the noble and learned Baroness, Lady Butler-Sloss, is probably one of the few people in this place to make judgments in the courts and the Court of Appeal on mental capacity. I suspect that more of us have had to go through the process of helping a loved one through a mental capacity assessment, although I suspect that number is also still low. My father has dementia. I have had to support him through a mental capacity assessment. No matter how clear the Act or various legislations or definitions may be on paper, it is extremely difficult at times to take someone through that process. All he had to do was prove that he had capacity to instruct a solicitor, a decision far less serious and far less terminal than the one we are discussing today.

If you assessed my father’s capacity, you would find—on the comments made by the noble Baroness, Lady Hollins, about literacy and numeracy—that my father has near-perfect literacy and numeracy. We have had comments about executive function. You would find that he has near-perfect capacity for executive function to make important decisions. You would also find that he has virtually no short-term memory. He is more than capable of making a decision, but that decision is gone in 30 seconds—sometimes sooner. If you apply that to this situation, he would be able to make a decision but would not know about it at the point that decision was acted upon.

Returning to the comment from the noble and learned Baroness, Lady Butler-Sloss, about whether it is capacity or ability, I pick up on the comments from the other side of the Committee recently. There is not enough, in the way we judge capacity at the moment, to make this practicable and desirable. We certainly need more. I am not sure whether it is “ability”, but what we have at the moment is not enough to deal with this in practice.

[Lord Harper (Con)]

My Lords, I have listened carefully to the debate. The noble Baroness, Lady Finlay, has done the Committee a service in tabling this amendment. It has enabled us to think in advance of the debate that we will have when we get to Clause 3 on the existing wording in the Bill about the Mental Capacity Act. Some of those issues came out in the debate that we have just had. It has been helpful to cue that up.

I want to comment on a couple of issues following on from the comments made by the noble Lord, Lord Deben. Two different things are being talked about with capacity and ability. I listened carefully to the comments of the noble Lords, Lord Pannick and Lord Scriven. There is a clear mental capacity test. But as others have said—I will not repeat the quote—experts in assessing capacity from the Royal College of Psychiatrists think that this decision was not thought about when the test was designed and that it is not an adequate test. I will not labour the point now, but we should think about whether we need a new test or, as the noble Lord, Lord Deben, said, an additive process where we take the Mental Capacity Act test and add something to it. There are amendments on both of those—a new test or adding things to it.

That comes to the point that the noble Lord, Lord Scriven, made. Of course, it is true that people make life and death decisions about medical treatment and about whether to refuse medical treatment. But there is a qualitative difference between refusing medical treatment, even if the consequence of refusing that medical treatment will be to hasten the end of your life, and to make a decision for active steps to be taken to administer substances to you which will end your life. They are very different things, and they are treated differently in the law. Perhaps that is the reason why we have had that slight cross-purpose. We need to be very precise about our language when we come to have that debate on capacity. I think that that would be helpful. That is all I will say about that at this point. I suspect that we will have a very extensive debate on Clause 3.

I think that the noble Baroness, Lady Finlay, was getting at something a little wider, which was not just about the capability of the individual to make a decision—that is the capacity piece. It was also about both the information they are furnished with and whether they have all the information at their disposal to be able to exercise their capacity to make a decision. It is not just about whether the information is available but whether the services are available that make that a truly proper, informed decision. Clearly, she has enormous expertise in palliative care.

Whether that palliative care is available in practice is incredibly important. Somebody could have capacity, and we could judge that they do. I listened very carefully to what the noble Baroness, Lady Andrews, said, with her expertise on the Mental Capacity Act, and I listened carefully to my noble friend Lady Browning about the importance of recognising how it works in practice, but it is also about whether those services are available. You could have the capacity and a lot of information provided to you, but if the palliative care services are not available to you, you do not have the ability to make a meaningful choice about whether you wish to end your life. I think that is what the noble Baroness, Lady Finlay, was getting at in that wider use of the word “ability” on top of capacity.

When we get to Clause 3 and the amendments to it, one of the things we should think about is whether we accept that the Mental Capacity Act is a good basis. As people on both sides of the argument have said, it is a tried and tested situation. As we heard earlier, it has been tested in court, up to and including the Supreme Court. We should think about whether we want to replace that with a completely new test or whether we actually stick with the Mental Capacity Act and perhaps have some additions to it, which recognise that it is a qualitatively different decision from whether you are having medical treatment or not. That is the essence of it.

In the place it is in the Bill, just accepting the word “ability” probably is not the right thing to do. We want that wider debate. But the noble Baroness, Lady Finlay, has done us a service in flagging up some of the issues that we can now think about in advance of the debate on Clause 3.

Terminally Ill Adults (End of Life) Bill

Lord Rook Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Lord Rook (Lab)]

My Lords, I am grateful to all noble Lords for the sincerity and seriousness of the debate over these two days. It has been illuminating and moving to hear so many family stories and personal testimonies. I note my interest as a carer for my father, Roy, who suffers with dementia.

This time tomorrow, my dad will knock on the door of the care office in his supported living complex to address an issue of singular importance: whether his choice has been registered for the 4 pm fish supper. Dad will have already made this trip four or five times, and Dawn, his ever-kind and patient carer, will smile and affirm once again that he has chosen haddock and chips and paid his £7 bill. My dad will beam back and say, “Thank you. I’ll see you soon”. This will indeed be true; in the hours that follow he will return many times to ask the same question.

I do not make light of my father’s condition: all carers know that we see many dark moments, and some of the lighter moments give us a degree of hope and happiness. But the truth is that my dad’s life is immeasurably improved by the fact that he lives in a loving environment with tailored medical support, endless activity and entertainment and an astonishing team with almost infinite capacity for kindness and compassion. Despite his diminishing and terminal condition, he has a good standard of living. Why? Because he can afford it.

We have heard a great deal about choice in this debate. I believe choice is a good thing; hence my concern, in assessing this legislation, is for those who have less choice than us—those who, unlike my father, cannot subsidise their own care in the final season of life. The most disadvantaged members of our communities already suffer increased mortality rates and the pronounced effects of health inequalities. They find it hard to see a GP, they wait longer for treatment and they struggle to navigate complex health systems. We have heard it said over and over: the NHS is currently able to support only 30% of the palliative care costs of our country. I simply cannot see how the introduction of this legislation will not pressurise those who, unlike my father, are without access to first-rate care and cannot afford to supplement what the NHS struggles to provide, to turn to assisted dying, not as their first choice but as their last and final option.

Noble Lords sceptical of this point should pay attention to states that have gone this way before. In Canada, increasing numbers of patients, many of them disabled, are being driven in the direction of assisted dying, due to poverty and a lack of ability to fund their own care. In Victoria, Australia, Robert Clark, the former Attorney-General, has said that disadvantaged patients are likely seeking assisted dying precisely because of the problems in accessing adequate care. The same is true in the United States. In Washington, the proportion of people choosing assisted dying because of concerns about their finances has risen fivefold, from 2% to 10% of cases. In Oregon, the percentage of patients choosing this route because they fear becoming a burden to their family has climbed from 13% to 52%.

In scrutinising the Bill, I hope that we will learn from these countries and take a different course. Where my own choice is concerned, I have chosen to support my noble friend Lady Berger’s intervention and her proposal to convene a Select Committee. I hope that this will give us an opportunity to listen carefully to voices that have not been heard as much as they should have in the procedures, processes and legislation before us. I look forward to working with noble Lords in Committee for as long as it takes to ensure that we can give a good end for all.

NHS and Social Care: Joint Working

Lord Rook Excerpts

Thursday 26th June 2025 Lords Chamber

[Baroness Merron (Lab)]

Good—thank you. This derives from the review by Sir Gordon Messenger. The first review was in 2022 and Sir Gordon came up with seven recommendations to strengthen leadership and management. To build on that, in November, Secretary of State Wes Streeting asked Sir Gordon to deliver further recommendations. That is why we now have a new national entry-level induction for new staff. As of 25 April this year, for example, it is being used by nearly 70% of trusts and ICBs to support staff enrolment. That shows how much it was needed and how much change it will make.

[Lord Rook (Lab)]

My Lords, the Archbishops’ Commission on Reimagining Care identified a number of solutions to tackle the workforce challenges in adult social care. These included better pay, improved career progression and role redesign. Could the Minister outline some of the steps that the Government are taking to address low pay, and to develop better training and development programmes and a more strategic approach to career progression in the sector?

[Baroness Merron (Lab)]

I very much welcome that report and am pleased that the Government have been responsive to identifying what we need to do. I never tire of saying that, to support the workforce in the way that my noble friend said, we are introducing a new fair pay agreement for adult social care and implementing the first universal career structure for adult social care. That will—and I know noble Lords are concerned about this—lift the status and attraction of work in social care. I believe that, alongside, for example, the apprenticeships that we are now making available and many other measures, we will get to a place where those in the workforce are doing the job we would like them to do and are being properly recognised on all counts for it.

Tobacco and Vapes Bill

Lord Rook Excerpts

2nd reading
Wednesday 23rd April 2025 Lords Chamber

[Lord Rook (Lab)]

My Lords, I greatly appreciate the comments of my noble friends and noble Lords across the House. I am particularly grateful for the introduction by my noble friend the Minister.

As someone who has spent a good part of my life working with young people, I support the Bill. In contrast to the noble Lord, Lord Strathcarron, I wish to focus my remarks on the measures that protect children from the physical, psychological, social and financial harms of vaping.

I worked for the Salvation Army as a youth worker in the 1990s. At that time, young people seemed to have less to worry about—and I definitely had more hair. That said, even then, I remember thinking that these children were working with greater challenges than I faced in my own childhood. This was well before the invention of social media, the long-term impact of the Covid pandemic, or the current teenage mental health crisis.

At a time when young people are facing unprecedented challenges, I am glad to support the measures in the Bill that reduce vaping. This is just one more thing that our young people simply can do without right now. In 2023, Sarah Griffin was a normal, fun-loving 12 year-old girl. Her bedroom looked no different from those of thousands of her contemporaries, with a dressing table littered with perfume, make-up and hair products. At first sight, there was nothing unusual to see there. However, those bottles and jars were actually the hiding place for Sarah’s vaping materials. In October 2023, Sarah was admitted to hospital after excessive vaping caused her to collapse her own lung. For four days, Sarah’s mother, who had fought hard but unsuccessfully to free her daughter from the addiction, thought she had lost her child. At the time she entered hospital, Sarah had been finishing off a 4,000-puff vape every few days.

The vaping and tobacco industries present multiple dangers to society and subsequent real dilemmas for public policy. I am grateful for the efforts of the Government, as well as the previous Government and Members of your Lordships’ House, and the collective determination to deal with this dilemma and protect young people through this much-needed legislation.

There are some who wish to raise a different dilemma altogether. For some, the Bill represents a dilemma that is less about the tobacco and vaping industry and more concerned with a choice between protecting human freedom and protecting vulnerable groups. With respect, I think that dilemma is false. As a long- time champion of freedom of speech and freedom of religion or belief, I welcome any discussion in your Lordships’ House of the importance of freedom for a healthy society. I, too, prize the long-fought-for freedoms and hard-won liberties that we enjoy today, but the simple fact is that societies that promote freedom are most often the societies that provide the greatest protections for the vulnerable. The inverse is also the case: in societies where freedom is diminished, the vulnerable are often endangered and exploited.

The idea that we in this House must choose between safeguarding freedom and safeguarding children is a fallacy. These measures do not threaten freedom, but they will increase protections for one of the most precious and vulnerable parts of our population. Currently in this country, teenagers and young adults are the group most likely to become addicted to vaping. In 2024, 18% of 11 to 17 year-olds, almost 1 million children in all, tried vaping and nearly 5% of 11 to 15 year-olds admit to being regular vapers today.

While the NHS has said that vapes can be used to help adults quit smoking, there is no long-term research to demonstrate the potentially harmful effects of long-term use. The jury may be out on the negative impact of vaping on child health but the damage done in other areas is clear for all to see. Teachers report a growing number of young people unable to concentrate. Parents fear their children falling into addiction and lack resources to help them quit. Young people find themselves trapped in addiction and go to dangerous lengths to fund and support a habit.

Where the health of our young people is concerned, far from helping teenagers to quit smoking, vapes are providing a gateway to more harmful and addictive behaviours. Recent research indicates that one in six disposable vapes consumed in the UK contains elements of the drug spice. An honourable friend in the other place informed me only yesterday that a vape shop had been closed down in her constituency. On analysis, the police had found that its vapes consistently included the horse tranquiliser ketamine.

As I mentioned before, some believe that the Bill leaves us on the horns of a dilemma between freedom and protection. I believe the Bill is about freedom. In the words of a previous Conservative Health Minister, Andrea Leadsom, only a few months ago, this Bill is about freedom—“freedom from addiction”. After she had spent four days in a medically induced coma, doctors saved Sarah Griffin’s life. I believe we should support the Bill. In doing so, we will give a life of freedom to the next generation and protect our own future.

Funerals: Death Certificate Delays

Lord Rook Excerpts

Thursday 3rd April 2025 Lords Chamber

[Baroness Merron (Lab)]

We are always happy to learn from the practices of other Governments, and we will continue to work on speed and, as I said, to keep distress and delay at a minimum.

[Lord Rook (Lab)]

My Lords, I point to my entry in the register of interests as an Anglican priest. I am particularly glad that my noble friend the Minister mentioned the challenges for faith communities and the important role that ministers of religion have not only in conducting funerals but in supporting families with grief and loss. Obviously, a delay to those things can cause family stress and tension. What are the Government doing to engage Muslim communities, which particularly feel the stress and pressure of this issue given their obligation to have swift funerals?

[Baroness Merron (Lab)]

I pay great attention to this area, as I mentioned in my response to the noble Lord, Lord Polak. I met faith group leaders in December, and we have worked very closely with faith groups to develop the medical examiner system. The faith groups are very supportive of the reforms, have broadly welcomed the implementation and continue to work with us to identify any issues, for which I am very grateful. Data from regional medical examiner offices in England, although unpublished, indicate that 88% of requests for urgent scrutiny—the group we are talking about in the faith communities—were met. Indeed, in Wales the corresponding figure has been assessed to be 99%. I assure all noble Lords that we are working extremely hard to make sure that the system reduces any unnecessary delays, and we will continue to do so.