Terminally Ill Adults (End of Life) Bill

Lord Shinkwin Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I rise to speak to Amendments 17 and 309A in the name of the noble Lord, Lord Beith, which I have supported. The noble Lord sends his sincere apologies that he cannot be here today. I will also speak to Amendment 62 in my name. I thank the noble and learned Lord, Lord Falconer, for his discussions with both the noble Lord and me on how this Bill affects Scotland.

These are probing amendments. They seek to establish the scope of the Bill, firstly with regard to residents of England who may find themselves availing of Scottish health services. Amendments 17 and 309A remove an anomaly in the Bill under which some residents in England close to the Scottish border will be excluded from its scope because they are registered with a Scottish GP. This is relatively common in border areas, as it may be that a Scottish GP is closer than the nearest English practice, or it may reflect a desire to stay with the same practice after moving house. The BMA has identified cross-jurisdiction protection for doctors supporting their patients in shared-care arrangements across borders as a gap in this Bill that it would like to see addressed in Committee. The Scottish Ambulance Service has also requested further clarity on what paramedics should do or not do across border areas. How does the noble and learned Lord plan to address these issues?

My Amendment 62 is about whether the remit of the Bill extends, perhaps unwittingly, to Scottish doctors, as it probes whether any Scottish GP, whether or not you are registered with them, can undertake preliminary discussions. The Amendment refers to Clause 3, referred to on page 1 of the Bill, and the steps taken under Clauses 8, 10, 11 and 19. Clause 8 refers to the preliminary discussion, the initial request for assistance and the first declaration that is done by the terminally ill person who, under subsection (3)(a), must be in England and Wales, but Clauses 10 and 11 are about the role of doctors. My reading of Clause 1(3), which was inserted in the other place, is that the steps in Clauses 8, 10, 11 and 19 must be taken when the terminally ill person is in England or Wales, but the steps in Clauses 10 and 11 are to be taken only by doctors in England and Wales—not Clause 8, the initial request for assistance, or Clause 19, the confirmation of the request for assistance, or second declaration. They could be undertaken by any GP and, as such, the Bill as it stands would permit discussions to be undertaken by GPs in Scotland even though they would not be regulated under the Bill. Is this what the sponsors of the Bill intended?

I believe there would be a number of consequential issues that might need to be addressed, depending on the territorial extent of the Bill. For example, can the noble and learned Lord say whether the recording required of the preliminary discussion in Clause 7 would work for Scottish GPs? Given the very separate record keeping of NHS Scotland and NHS England, which he and I have discussed, the considerable challenges of cross-border data sharing in the context of health, particularly in primary care, and the separate Scottish legal context, where does that leave the offence of destruction of documentation in Clauses 35 and 36 if the preliminary discussion is undertaken by a Scottish GP? If the intention is that Scottish GPs can undertake these discussions, can I ask the sponsors to clarify this for the record? If this is not the intention, can the noble and learned Lord consider whether the territorial extent needs to be clarified in other areas of the Bill? If it is not the intention, does the noble and learned Lord consider that further amendments need to be tabled to ensure that this loophole is closed? Perhaps he could take us through the provisions relating to Scotland in this response and clarify.

I believe that, when parts of the Bill were extended to Scotland on Report, the sponsor did not have time to explain why they were needed or what they did. The honourable Member for Glasgow West asked whether the Bill’s sponsors had had any conversations with Scotland’s Lord Advocate and the Scottish Government, and the honourable Member for Spen Valley was only able to confirm that she had taken legal advice from government officials to ensure that devolution is respected. She stated that conversations had already started and would continue where legislation that affects other jurisdictions needs to be amended. Could the Minister confirm for us what guidance the Government have provided regarding the provisions relating to Scotland and their necessity?

As this House is well aware, the Scottish Parliament is currently going through its own stages on an assisted dying Private Member’s Bill in Holyrood, so we are facing the very real possibility of a two-tier system in Britain, which the former Prime Minister Gordon Brown has highlighted as being extremely concerning. There is currently a sharp divide between what has been proposed for Scotland and what we have before us here. The amendments in this group do not affect in any way what happens in Scotland, but, like the former Prime Minister, I am very concerned that we could find ourselves in a situation where people are moving between the two jurisdictions. At the very least, I would have expected there to be intensive consultation between the two Parliaments.

The Scottish Cabinet Secretary for Health has written a number of letters to the lead committee on assisted dying in the Scottish Parliament, in which he acknowledges that the Scottish and UK Government officials must continue to hold discussions on the legislative competence issues. Is the Minister able to say more about these discussions? Are they confined to legislative competence or do they extend to issues such as delivery timescales, the regulatory framework of medical practitioners across the UK and the intention to give Scottish Ministers the authority to determine approved substances to use, all of which Mr Gray has highlighted as concerns and are indicative of the problems of having potentially different systems north and south of the border?

In conclusion, it seems to me that matters are moving and changing at pace, both with additions to this Bill and the Scottish Bill. If things are done piecemeal or with haste, we are in danger of assisted dying becoming another deposit return scheme—although you cannot return from being dead. The deposit return scheme was an example of the two Parliaments wanting to implement something that needed careful consultation and co-operation across the UK, legislating separately, both totally within their devolved areas but, in the case of Scotland, ending up with a Bill that could not be implemented because of the cross-border issues that had not been fully acknowledged and addressed. Addressing these issues and getting clear answers from the Bill’s sponsors and the Minister are what this group of amendments is about, and I believe they are essential. I beg to move.

[Lord Shinkwin (Con)]

My Lords, I rise to speak to Amendment 17, particularly in relation to the Scottish Ambulance Service, which my noble friend Lady Fraser of Craigmaddie mentioned briefly in her speech. I do so as someone who can remember just about all my journeys in ambulances—some in agony after a fracture, some with the blue light flashing, others more sedate. What marked them all was a sense that, however much pain I was in, I was none the less safe. The ambulance crew were in control of the situation, caring, competent and consistently professional. That is my abiding memory based on first-hand experience.

I am concerned, as I understand the Scottish Ambulance Service is, that there is currently no guidance on this specific issue even though its absence has significant practical implications. Simply put, from a frequent ambulance traveller’s perspective, without this amendment ambulance crews and other healthcare professionals might well not feel fully in control of the situation. That is just not where you want to be as a potential patient needing urgent emergency care.

Surely, emergency services operating across the Scotland-England boundary not only need but deserve clear guidance. For example, what exactly is a paramedic meant to do if they are called out because an assisted death has gone badly wrong, leaving the individual seriously injured but very much alive, which of course can happen and indeed has happened on occasion in other jurisdictions where such legislation has been implemented? It does happen, yet the Bill, as far as I can see, is silent on this point, which is not much use to a paramedic desperately wanting to provide care when an emergency response is requested due to complications such as choking or vomiting.

I am not aware of this having been covered in the impact assessment, or of John Grady having received an answer when he raised this very issue on Report in the other place. So, I would be very grateful if the Minister could share with the House in her closing remarks what work has been done by the Government to evaluate and address such an important cross-border issue.

[The Lord Bishop of Norwich]

My Lords, I support Amendments 17 and 309A, proposed by the noble Lord, Lord Beith, and so ably explained by the noble Baroness, Lady Fraser. I declare an interest, in that my wife is a GP and a medical examiner—so the Bill has had much discussion at home.

Having spent 10 years living in Northumberland, and having friends who live along the Scottish border, I know that many of those living sufficiently close to the border have chosen very deliberately to be registered with a Scottish GP because they then receive free prescriptions. This raises a number of questions for the noble and learned Lord.

Let us say that you live on the English side of the border, at Cornhill-on-Tweed, and your GP is in Coldstream. The sense of continuity of care that GPs give to their patients is vital to that GP-patient relationship. Indeed, this House was reminded of that yesterday in the excellent maiden speech of the noble Baroness, Lady Gerada:

“That continuity, seeing lives unfold across time, gives general practice its unique moral and social power. It allows us to see people as whole human beings, not as isolated organs or diagnoses”.—[Official Report, 11/12/25; col. 370.]


In supporting this probing amendment, I am interested to discover more about how that continuity of care that is so essential in primary health care can be continued.

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[Baroness Butler-Sloss (CB)]

My Lords, I want to make a practical point. It is obvious that this will be the first Act in relation to assisted dying. Clearly, it is unjust because it does not deal with people with motor neurone disease and so on. Why does the House not accept that the issue of prisoners should be in the next Bill and not the present one?

[Lord Shinkwin (Con)]

My Lords, I will keep my remarks very brief. I rise to speak in support of Amendments 30A and 119A in the name of my noble friend Lady Berridge. I thank her most sincerely for tabling them and thank my noble friend Lady Monckton for her supportive remarks. Disabled people and people with Down’s syndrome should know that this House would never treat them as bottom of the heap.

Given the evidence provided to the Select Committee by the National Down Syndrome Policy Group, the question to my mind is not so much why we would want, but why would we not want to support the provisions in these amendments? We are talking about vulnerable young adults who deserve and need extra protection on account of their disability. I say that as a disabled person who has been involved in championing disability rights for almost 30 years. Such protection as would be afforded by these amendments is neither patronising nor discriminatory. On the contrary, it is our duty to strike the correct balance between rights and protection. I believe these amendments do so.

Wheelchair and Community Equipment Strategy

Lord Shinkwin Excerpts

Thursday 11th December 2025 Lords Chamber

[Lord Shinkwin (Con)]

My Lords, it is a great pleasure to follow the noble Lord, Lord Hunt of Kings Heath. I thank him, first, for securing this important debate; secondly, for his work on improving health outcomes, which he has been involved in for probably far longer than he cares to remember; and, thirdly, for choosing to champion wheelchair services, of which I should declare an interest as a user.

I trust his noble friend the Minister will bear in mind the noble Lord’s tenacity in her response, which we look forward to hearing, as we do the maiden speech of the noble Baroness, Lady Gerada. None of us will ever forget the trepidation with which we each faced the prospect of addressing your Lordships’ House for the first time. There may be issues which divide us, but the nerve-wracking experience of making our maiden speech, seared into each Member’s memory, surely unites us. I have no doubt that we will all be rooting for her.

I referred to the noble Lord’s tenacity. It is much needed, not least because, as he very helpfully outlined, the absence of a strategic approach on wheelchair services will be costing the NHS an awful lot of money—money it cannot afford to waste. So, in the little time I have, may I put three questions to the Minister?

The Minister will no doubt be familiar with the finding of the APPG for Access to Disability Equipment’s report that the community and medical equipment system is “in crisis” and with the Wheelchair Alliance’s recent report Wheelchair Provision: How to Drive Effective Change, which details the costly consequences of inadequate and inconsistent provision, as the noble Lord, Lord Hunt, mentioned. These include delays in hospital discharge, loss of independence, social isolation, with the inevitable impact on mental health, and, of course, avoidable deterioration in health and well-being—a point that the noble Lord made in his excellent speech. Would the Minister agree with me that “avoidable” is the key word here? Would she further agree that, if it is avoidable, then we are cutting our nose to spite our face if we allow ICBs to misrepresent as a saving what is actually in the strategic big picture a completely false economy, which is costing the NHS and indeed the taxpayer far too much money?

My third and last question is this. The second of three reports by Frontier Economics, The Value of a Wheelchair, estimated the potential value—I would say saving—that high-quality wheelchair provision could provide to wheelchair users and, crucially, society. Will the Minister undertake to put that thinking at the heart of any strategy? The current situation is untenable because it does not make economic sense. That is why the noble Lord’s call for a strategy deserves to be heard and acted upon urgently.

Terminally Ill Adults (End of Life) Bill

Lord Shinkwin Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I will speak briefly to Amendment 405 because the Equality Act is relevant to it. It provides a legal duty to provide reasonable adjustments for disabled people, which is defined quite broadly and I think would include a person who was terminally ill. The amendment is currently worded that the doctor must

“take all reasonable steps to ensure that there is effective communication”.

Will the noble and learned Lord consider changing his drafting to say that the doctor must “ensure reasonable adjustments are provided to ensure effective communication”?

[Lord Shinkwin (Con)]

My Lords, I rise to speak on Amendment 405. It is a pleasure to follow the noble Baroness, Lady Hollins, and to echo some of the points she touched on. I clarify that of course the amendment is in the name of the noble and learned Lord, Lord Falconer of Thoroton. I do so because, as a disabled person who was on the National Disability Council in the late 1990s developing codes of practice and advising the then Government on the importance of language—a point that the noble Baroness has just mentioned—I fail to see how changing the Bill’s wording from

“must first ensure the provision of adjustments for language and literacy barriers”,

which was the language of the amendment adopted by the other place, to “take all reasonable steps” can do anything other than weaken this Bill.

The noble and learned Lord would have us believe that this is just a drafting change; indeed, he said in his opening remarks that it makes it “clearer”. I contend that this is no drafting change because, yes, it changes the sense of meaning. The amendment would take us backwards because it would fundamentally weaken one of the Bill’s safeguards, such as they are, which was inserted as a result of Jack Abbott’s Committee amendment in the other place, and which the Bill’s sponsor in the other place described as “very sensible”—she was happy to support it.

I have a few questions for the noble and learned Lord that I would be grateful if he could answer in his closing remarks. Is this Committee being asked to believe that today the Bill’s sponsor in the other place is happy for the noble and learned Lord, in effect, to overrule her? Can he confirm in his closing remarks that she and Mr Abbott have been consulted, or is it that, together, the noble and learned Lord and Ms Leadbeater have decided to water down one of the few safeguards in the Bill because, well, it is only the House of Lords so no one is going to notice? The whole point of the Bill is to make it as easy as possible for people to have assisted dying, so let us minimise the constraints.

I began my career at the Royal National Institute for Deaf People during the first Blair Government. It was an exciting time. To the credit of Tony Blair and the noble Lord, Lord Hutton, who was Health Secretary, digital hearing aids were introduced on the NHS. The RNID, when I worked there, was listened to, and it should be now. So could the noble and learned Lord explain why this amendment implicitly ignores the finding made this year by the RNID and SignHealth in their report that some patients did not understand their diagnosis or treatment?

As a disabled person, I thank our Labour colleagues most sincerely. I know that I owe a debt to the Labour Party’s long-standing and noble—in the true sense of the word—commitment to advancing disability rights. However, this amendment underlines an inescapable but painful truth. The Bill makes a mockery of that fine, noble and honourable tradition. It shreds a tradition that deserves to be preserved, not sacrificed in such a profoundly cynical and misleading way as to make out, as the amendment does, that this is somehow only a drafting change.

There is a reason why not one organisation of or for disabled people supports the Bill; they know that disabled people need the Bill like a hole in the head. I marvel that the noble and learned Lord does not seem to realise that the Bill is dangerous enough already without the removal of provisions that would at least acknowledge the obligation to first ensure that communication adjustments were made; for example, for people with learning disabilities or users of British Sign Language.

The last thing that we as a House should be doing is endorsing an attempt to make the Bill an even poorer piece of proposed legislation than it already is. Noble Lords could be forgiven for thinking that that was not possible, but, as the noble and learned Lord’s Amendment 405 clearly states, he is perfectly capable of making his poorly drafted Bill even worse.

[Baroness O’Loan (CB)]

My Lords, could the noble and learned Lord, Lord Falconer, clarify for me the impact of Amendment 290 and whether it deals with matters of coercive control and economic abuse effectively for the purposes of the legislation? I ask this because Amendment 290 would remove

“including coercive control and financial abuse”

from the Bill. The same principle applies to Amendment 366, while Amendment 931 would remove the requirement for members of a panel to receive training on coercive control and financial abuse.

Even taking into account the Domestic Abuse Act, which I will come back to in a moment, there is a difference between coercion and pressure and coercive control and abuse. It is for that reason that I support the comments previously made about, for example, Kim Leadbeater in the Commons being pleased to support mandated training on domestic abuse, including coercive control and financial abuse, and the Health Minister in the Commons Committee noting that the amendment would require training regulations to include

“mandatory training relating to domestic abuse, including coercive control and financial abuse”,—[Official Report, Commons, 18/3/25; col. 1212.]

which clearly would ramp up the requirement.

However, the definition of domestic abuse in Section 1 of the Domestic Abuse Act 2021 refers to behaviour in the context of personal relationships—persons who are connected—and there is a list of the persons who are connected. Section 1(4) of the Act does not cover those who are not personally connected but who may be capable of having enormous influence upon people on behalf of those who are. I think, for example, of financial advisers, lawyers and even doctors, people like that, who may be able to put pressure on people, and we have seen situations in which such pressure has been brought to bear. Does the noble and learned Lord consider that the situations in which pressure may be brought to bear by someone not personally connected should be otherwise provided for?

This group also contains amendments to Clauses 10 and 13, the provisions in relation to the situation in which a doctor is unable or unwilling to act as the independent doctor. There are provisions in Amendments 332, 418 and 419 for a further referral if a doctor is unable or unwilling to continue. His reasons for unwillingness could include ethical concerns or suspicions of undue influence on the patient. Despite the fact that there is a provision that he can seek specialist advice on this issue, there may be a situation in which the doctor will simply withdraw from the process. The single additional referral was approved in the other place to protect the patient, but these amendments would enable doctor shopping to occur. We will come back to that in group 44. Moreover, if a doctor withdraws from completing the process because of suspicions of possible or undue influence, the reason must surely be recorded.

Amendment 405 would remove from the Bill the requirement to have regard to “language and literacy barriers”, replacing it with the new more general requirement to

“take all reasonable steps to ensure … effective communication”.

The noble Baroness, Lady Hollins, explained during the previous debate the extent to which people with a disability have complex needs, which must be satisfied to enable understanding. The inclusion of “all reasonable steps” et cetera introduces a far less specific test, and consideration must be given to setting standards for the level of communication which is required. I have to ask the noble and learned Lord: does this amendment inadvertently disadvantage those with specific learning difficulties and similar vulnerable groups?

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[Lord Falconer of Thoroton (Lab)]

I do not accept that it is not a drafting point, but that may be dancing on the head of a pin. The point that both the noble Baroness, Lady Fox, and the noble Lord, Lord Deben, are making concerns making sure that if you are leaving for a reason that will give rise to problems, it is properly recorded. I completely accept that and we will make sure that that is the position, because it is a valid point.

In relation to Amendment 405, the noble Lord, Lord Shinkwin, said that it is a watering down. It is not a watering down at all, with respect. The current draft says:

“When carrying out an assessment in accordance with subsection (2), the assessing doctor must first ensure the provision of adjustments for language and literacy barriers, including the use of interpreters”.


The new draft says that the relevant doctor must

“take all reasonable steps to ensure that there is effective communication between the assessing doctor and the person being assessed (including, where appropriate, using an interpreter)”.

The noble Lord, Lord Shinkwin, is shaking his head; I am more than happy to talk to him about how that could be a change, and if there is some change that he would like in relation to it, let us put it in. But it is, in legal terms, to my eye, wider. It covers a much wider ambit without providing any inadequate protection. Maybe the right course is for me and the noble Lord, Lord Shinkwin, to sit down and for him to identify the changes that he would like. At the moment, I cannot see them.

[Lord Shinkwin (Con)]

I thank the noble and learned Lord, and I will be very brief. Would he consider withdrawing his amendment? The change I would simply write, and I imagine the House would find acceptable, is what the sponsor of the Bill in the other place also found acceptable, which is to accept Mr Abbott’s amendments.

[Lord Falconer of Thoroton (Lab)]

I do not need to withdraw the amendment, because if the noble Lord objects to it, I will not press it in Committee. It depends on what we get to when we get to Report. What I am saying is that, at the moment, I cannot see the difference. I am more than happy to talk to him before Report. If there are valid points, let us put them in. However, at the moment, it looks to me to offer just as good, if not better, protection.

Terminally Ill Adults (End of Life) Bill

Lord Shinkwin Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Baroness Blackstone (Lab)]

My Lords—

[Lord Shinkwin (Con)]

My Lords—

[Baroness Blackstone (Lab)]

We have given an enormous amount of time to looking at safeguards. The noble Lord just totally denied that and said that we have to begin all over again. We do not. This debate has regrettably been characterised by too few of the speakers giving any consideration at all to the important, tough safeguards already decided in the House of Commons. I will not go through them now, in the interests of time, because I that know my noble and learned friend Lord Falconer will, when he responds to this debate.

[Lord Shinkwin (Con)]

My Lords—

[Baroness Cass (CB)]

My Lords—

[Captain of the King’s Bodyguard of the Yeomen of the Guard and Deputy Chief Whip (Baroness Wheeler) (Lab)]

My Lords, we will hear from the noble Lord, Lord Shinkwin, and then the noble Baroness, Lady Cass.

[Lord Shinkwin (Con)]

My Lords, an enormous amount of time was given in the other place to blocking safeguards. I support the vital amendments in this group and thank all those who tabled them. It is a pleasure to follow the noble Lord, Lord Dodds of Duncairn, who made some incredibly important points about vulnerability. Some of us have been there. This is proper scrutiny; it is the House of Lords at its best. On whichever side of the divide we find ourselves on this Bill, we should all be very proud of that.

As someone who speaks from one patient’s perspective, I would never presume to know exactly how the pain another person experiences might feel to them as an individual. But I think that the sense of incredible loneliness, compounded by a sense of disorientation, are both parts of total pain, as defined by the pioneer of specialist palliative care, whom the noble Baroness, Lady Finlay of Llandaff, mentioned—Dame Cicely Saunders. That makes these amendments dealing with coercion and pressure crucial.

When I have been drowning in a pool of pain, the sides of which, in that moment, seemed so steep and slippery, I would have clutched at almost anything in an attempt to pull myself out. I appreciate how coercion and pressure are so nuanced and subtle and how much each of us in this House, at some point in our lives, may need to be protected from them. My noble friend Lady Coffey is absolutely right, in speaking to her Amendment 47, to mention the Royal College of Psychiatrists and, in her explanatory notes, its reference to the sense of being a burden as an internal coercion. I can testify from personal experience that in some cases the sense of being a burden, or the burden of pain, whether physical and or emotional, can be simply too great to bear on your own. This can be the most powerful and damaging form of coercion and perhaps the one from which we most need protection. We need to recognise that in the Bill.

I note that the Bill does not require any questions to be asked about why a person may wish to die. It is because Rebecca Paul’s Amendment 468 on precisely this issue was rejected in Committee in the other place that Amendment 3, moved by the noble Baroness, Lady Finlay of Llandaff, and Amendment 181, in the names of the noble Baronesses, Lady Grey-Thompson and Lady O’Loan, are so important. As the noble Baroness, Lady Ritchie, and the other sponsors of Amendment 48 have argued, we cannot divorce this internal coercion from the circumstances in which, for example, a disabled or older person might find themselves. We have to factor those in. It is not just coercion or pressure by any other person that may prove the tipping point.

I hope that your Lordships’ House will give very careful consideration to the amendments on financial pressures, such as Amendment 462, which I thank the noble Lord, Lord Hunt of Kings Heath, for tabling so ably. As we know, these pressures are exacerbated when a person is living with a disability.

In closing, I particularly welcome Amendment 846, tabled by my noble friend Lady Berridge, and Amendment 58, tabled by the noble Baroness, Lady Grey-Thompson, because the subtlety of pressure, particularly as it relates to disability, can definitely stem from cultural attitudes, whether institutional—for example, in terms of access to appropriate care—or societal. I give one example. I was laughed at in the street outside my home as recently as last weekend because of how I look as a result of my disability. That is not good for morale, to put it mildly.

It could be argued that mockery goes with the territory of being disabled, particularly when the anonymised vitriol on social media encourages teenagers, for example, to view disabled people as fair game. My question in relation to the Bill, and specifically Amendment 58, is, how can being subject to such prejudice not affect a person’s mental well-being or their sense of self-worth? How could such a structural disadvantage, in terms of the cumulative effect of being constantly exposed to such negative and discriminatory attitudes, not affect a person in a vulnerable situation who is considering assisted dying? It is inevitable, but how many non-disabled people factor that in?

Terminally Ill Adults (End of Life) Bill

Lord Shinkwin Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord Falconer of Thoroton]

That the House do now resolve itself into Committee.

[Lord Shinkwin (Con)]

My Lords, I apologise, but I rise to raise a procedural issue crucial to the reputation of your Lordships’ House. When I blocked out my diary for the Fridays scheduled for Committee on this Bill, I did so in good faith. I assumed not only that your Lordships’ House would recognise the value of the views of Members with lifelong lived experience of disability, but that steps would be taken to ensure that those views were heard on an equal and non-discriminatory basis. That would be entirely in keeping with the Equality Act 2010, which placed on organisations a legal duty to make reasonable adjustments on account of disability in, among other things, the way in which they work.

In the belief that your Lordships’ House and the Government will appreciate the crucial importance of our being seen to set an example and uphold the law, which we passed and which we expect others to abide by, I emailed the Government Chief Whip and wrote to the Prime Minister to explain that, because of my disability, I need to leave by 3 pm in order to catch my flight home. I requested an assurance that the House would not sit beyond 3 pm, which is of course the time by when the House normally rises on a sitting Friday. Regrettably, I have been given no such assurance. Instead, the Government are using a procedural technicality as a feeble fig leaf for discrimination against me as one of the House’s Members—one of its few Members—with lifelong disability. I do not believe it is beyond the wit or the will of the Government, or indeed your Lordships’ House, to ensure that we rise by 3 pm so that I can participate today and on other sitting Fridays on an equal and non-discriminatory basis. Given that not one organisation of or for disabled people supports this Bill, surely it is right that all of us—every one of us—are enabled to do our duty of subjecting this monumentally significant Bill to the forensic scrutiny it requires.

In conclusion, do we really want to send the message to those who are following our proceedings today, “Do as we say, not as we do”? That would be shameful and it would be unworthy of your Lordships’ House. For our own sake, I urge the House not to discriminate against me as one of the very few Members born disabled. I therefore ask that the House rises by 3pm.

[Lord Polak (Con)]

My Lords, I have every sympathy with the noble Lord, but I would like to thank the Chief Whip, the noble Lord, Lord Kennedy, for his willingness to listen and to be flexible, especially when I, together with a number of colleagues, asked for the Second Reading to be split into two days. In the Chief Whip’s remarks yesterday, he talked about convention and tradition, and so we are to rise at 3 pm or thereabouts. I place on record that, as a modern Orthodox Jewish Member of your Lordships’ House, sitting on Fridays in the winter is deeply problematic. Shabbat begins today at 3.54 pm; on 5 December, it will begin at 3.35 pm and on 12 December at 3.33 pm. Your Lordships will know that, by 3.54 pm today, I and others will need to be ready for Shabbat, and I will be in synagogue.

Keeping with my tradition, as the House will follow its tradition, there will be times, therefore, over the coming weeks that I and some others will be absent— I hope that that does not occur when I have an amendment in my name to speak to. I am grateful for the indulgence of the House, but I felt it really important to place this matter on the record as we begin Committee, which will take place only on Fridays.

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[Baroness Andrews (Lab)]

The noble Baroness is quite right, and it is a very important part of mental capacity decisions that the families are involved, supportive and completely understand the implications of what it means to have either incomplete capacity or capacity that varies from time to time. There is no reason— I will leave my noble and learned friend Lord Falconer to answer this point—why this should not be a better Bill, and maybe it can be better if we address these particular questions.

[Lord Shinkwin (Con)]

My Lords, I thank the noble Baroness, Lady Finlay of Llandaff, for her amazing dedication to her patients. That is beyond question. I hope we are united as a House in paying due respect to that fact and also to the fact that her professional experience is a tremendous asset to this House.

The noble Baroness, Lady Finlay, spoke of her professional experience, and I will speak very briefly of my lived experience on the other side of the table—or the bedside—as a patient. She mentioned Dame Cicely Saunders and the reference to total pain. I simply say that I have been there. My disability has taken me there far more times than I would like to remember. It is awful. The bottom falls out of your world, and your capacity to think clearly, rationally and normally evaporates. So I simply say that it is crucial that patients have the ability to choose: the choice between assisted death and specialist palliative care—a choice that they do not currently have.

I simply finish on this point. Other noble Lords have mentioned the Royal College of Psychiatrists. I ask the Committee to take note of the fact that the Royal College of Psychiatrists states that applying the Mental Capacity Act to the decision to end one’s life is an entirely novel test—in “uncharted territory”, with “no experience or precedent”.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, earlier on in the debate, there was a discussion concerning members of the committee, on who was or was not called, or who was denied the right to be called to it. I suggest that the straitjacket of the time this House allocated probably did not allow the relevant committee the appropriate time to call everyone that it thought was appropriate. It ought to have been given more time, but it seems that it had to be rushed.

Concerning the Mental Capacity Act, Margaret Flynn, chair of the National Mental Capacity Forum, said it was designed to protect us

“when others start to make decisions about our lives … Assisted dying was not on the table during the Law Commission’s consultation which resulted in the MCA”.

Therefore, the suitability of the Mental Capacity Act 2005 as a test for a decision to end one’s life is a major source of debate. I believe the many experts and professionals arguing that it is insufficient for this specific irreversible decision.

The MCA was not designed for assisted dying. It was created to safeguard people who lack capacity in decisions about their care, treatment or finances. Assisted dying was not on the table during the Law Commission’s consultation. The Royal College of Physicians, as the noble Lord said a moment ago, said that applying the MCA to the decision to end one’s life is an entirely novel test in uncharted territory with no experience or precedent. It is a very low threshold. The Royal College of Physicians argues that assessing a person’s mental capacity to decide to end their life is an entirely different and more complex determination, requiring a higher level of understanding than assessing capacity for treatment decisions.

Terminally Ill Adults (End of Life) Bill

Lord Shinkwin Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Lord Shinkwin (Con) [V]]

My Lords, it was a day much like any other when I was diagnosed. A busy day at the office was followed by a hospital appointment to find out why, within months, my face had, in effect, shut down on the left side. Nothing prepared me for what came next: an MRI scan showed that a succession of mini-strokes was killing me, and I had six months left to live. The only hope was neurosurgery.

I asked the neurosurgeon my odds on making a full recovery. Her reply was direct. She said, “I can’t give you odds on survival”. What she did not say was, “I can help you to die”. This Bill would fundamentally alter the conversation that a patient has with the doctor whom they trust to do no harm, as the noble Lord, Lord Truscott, and others have highlighted.

Notwithstanding an excruciating and painful long recovery, the surgery was a success, although I have to speak slowly to be understood, and I am grateful for noble Lords’ patience and understanding. Ironically, my shock then and my shock subsequently at becoming, 20 years later, a Member of your Lordships’ House have something in common: they were both unforeseen.

That brings me to some wise words from Hansard on 12 March 2007:

“Our role in scrutiny is vital … we are a legislative Chamber … There will no doubt be … unforeseen consequences, but they would all need to be considered”.—[Official Report, 12/3/07; cols. 451-56.]


I thank the noble and learned Lord, Lord Falconer of Thoroton, as the words are his. It is indeed our duty to scrutinise the Bill and consider all its unforeseen consequences, for they are legion.

I wonder whether we have any idea of the Pandora’s box that the Bill will prise open. Many noble Lords have referred to jurisdictions where assisted dying has already been introduced. The precedents that those jurisdictions provide clearly show the chain of events that the Bill would set off, not just for disabled people but for older people, young people with mental health issues, and young women with eating disorders. It is the stuff of nightmares.

My noble friend Lady May of Maidenhead told us how her friend referred to the Bill as a “licence to kill Bill”. She is right: it gives the state a licence to kill the wrong type of people. I am the wrong type. As the noble and learned Lord, Lord Falconer, pointed out in his speech, there are savings to be made should assisted dying be introduced. This Bill effectively puts a price on my head. Indeed, should it become law and precedents set elsewhere apply in the UK over time, I face the realistic possibility, as a severely disabled person, of being killed as a result of legislation passed by this House. As my noble friend Lord Harper reminded us, no organisation of or for disabled people supports the Bill.

I close with a plea that we do not allow anything to deter us from doing our duty and subjecting this Bill, with all its unforeseen and irreversible consequences, to the scrutiny it not only deserves but so desperately needs. I support the Motion in the name of the noble Baroness, Lady Berger.

Prosthetics for Amputees

Lord Shinkwin Excerpts

Thursday 1st May 2025 Grand Committee

[Lord Shinkwin (Con)]

My Lords, it is an honour to follow my noble friend Lord Mackinlay of Richborough. I thank him for securing this important debate and draw courage from the example that he sets, as someone who also lives with a disability.

As he may know, non-disabled people often use the term “inspirational” to express their admiration of disabled people. Unwittingly, they thereby place us on a pedestal. The inadvertent implication—subliminal message, even—is that they could never countenance being disabled or, indeed, think of anything worse. Apart from the fact that being placed on a pedestal, however well intentioned, can compound the sense of isolation caused by living with a disability, surely my noble friend’s experience demonstrates that disability—in his case, specifically limb loss as a result of sepsis, as he explained—can affect any of us without warning.

Being placed on a pedestal does not lessen the daily grind of living with a disability, particularly the reliance on prosthetics or, as in my case, orthotics, which I have had to wear on my legs since I was a child. As my noble friend rightly argues, that challenge should not be exacerbated by the system, yet, as he highlighted so graphically, it unfortunately often is.

This seems to be an endemic, even cultural, problem in the NHS, which, to be fair, excels at acute care, as my noble friend and I know from direct experience. The quality of acute care in wonderful NHS hospitals such as St Thomas’, where both of us have been treated, is phenomenal. Yet the failure to follow through with what my noble friend euphemistically termed in his Question “appropriate” care—in his case, prosthetics—at “an appropriate time” perversely undermines the sometimes huge investment made in one individual by inadequate and delayed follow-up care. I hate to think of how much I have cost the NHS over the years. My noble friend is more diplomatic than I am in his use of the term “inappropriate”; what a multitude of sins that word covers.

I should make clear that I do not mean to imply that our highly skilled and dedicated NHS rehabilitation teams, incorporating both prosthetists and orthotists among other relevant healthcare professionals, are at fault—on the contrary. I can speak only as someone who has benefited from the care provided by orthotists, another branch of that rehabilitation family, but I am immensely grateful for the crucial part that they have played in enabling me to keep the show on the road. By that, I mean that, after every fracture—I have had countless fractures—it has only been because of them and the callipers I wear, which they have tailored to support the very broken body in which I live, that I am here today, on my feet, speaking in your Lordships’ Committee.

So I am delighted to have this opportunity to put on the record my sincere thanks to Chris Cody and his brilliant team at the Guy’s and St Thomas’s regional specialist rehabilitation centre for their professionalism, compassion and empathy as I pick myself up, dust myself down and damn well get on with it. I am sure that the same can be said by my noble friend in terms of the pivotal role that NHS prosthetists have played in enabling him to continue both to live a full life and to perform his crucial role as a Member of your Lordships’ House.

In advance of today’s debate, I consulted a few people on the front line of the NHS rehabilitation sector. First, I will give the good news. Technological advancements such as microprocessor knees, which my noble friend mentioned, and the integration of 3D printing are making a difference, although the latter is in its infancy. Such innovations are undoubtedly welcome but—it is a big “but”—they are overshadowed, again, as my noble friend said, by workforce shortages. Indeed, one of the rehabilitation experts said:

“We are a profession at risk”,


such are the workforce constraints. Coupled with funding constraints, which have led to disparities in access to and quality of care, this is a really worrying situation for anyone who cares about value for money in the NHS. As my noble friend explained, demand is outstripping supply. There are not enough prosthetists or orthotists, which has an inevitable effect on waiting times and—quite apart from the low pay for technicians, as has been mentioned, and for prosthetists and orthotists—their morale.

So I would welcome any reassurance the Minister can give that the refreshed NHS long-term workforce plan, which I think is due in the summer, will address the critical shortage of qualified prosthetic and orthotic professionals. In case the Minister assumes that I am asking for the NHS pot as a whole to be increased, let me say that I am not. This is a question not necessarily of increasing the NHS budget as a whole so much as one of reprioritising existing resources to safeguard the cost-effectiveness of the NHS’s investment in people like my noble friend and me, precisely in order to get bigger bangs for bucks.

In conclusion, I go back to the positives and front-line suggestions on improving patient outcomes. As we know, this means greater independence, fewer hospital admissions, better mental health—my noble friend mentioned this—and more disabled people in employment and thus paying into the system. I have three suggestions. First, strengthen workforce development by investing in education and training programmes. Expanding apprenticeship opportunities and providing financial incentives offer exciting potential to attract new talent to the profession.

Secondly, enhance funding and commissioning. For example, a standardised approach to commissioning prosthetic and orthotic services could potentially mitigate regional disparities and promote consistent access to high-quality care. There are lots of amazing products and components out there, but access is limited by financial constraints.

Thirdly, we must embrace technological innovations. This is where investment in research and development and the adoption of emerging technologies are so important. If that means greater collaboration with private sector firms such as the ones that my noble friend mentioned, in the interests of patient outcomes and consistent with NHS values, that is fine.

In closing, I hope that the Minister has found or will find this discussion useful in deepening her appreciation of just how important prosthetic, orthotic and other rehabilitation services are. Neither my noble friend nor I would be here without them; they need to be nurtured, and that requires a shift in priorities. I would love to think that my noble friend might be asked to help effect that change to the culture and priority that the NHS attaches to what are, sadly, Cinderella services.

Fracture Liaison Services

Lord Shinkwin Excerpts

Wednesday 4th December 2024 Lords Chamber

[Lord Shinkwin (Con)]

My Lords, earlier on today, I googled the meaning of the phrase, “It’s a no brainer”. Apparently, it applies to a question that is very easy to answer and, although it did not give an example, I suspect we could all think of one. As my noble friend Lord Black of Brentwood said, there is unanimity across your Lordships’ House on this.

As someone who lives with a bone condition, I am something of a reluctant expert on fractures, or at least on the excruciating pain they cause. The crunch as the bone fractures is immediately followed by the weird sensation of there being a void, because suddenly the broken bone cannot bear any weight. There is literally nothing there, and into that vacuum comes this all-consuming shockwave of pain. I make this point because some may assume that rollout is not urgent because, as my noble friend Lord Black of Brentwood mentioned with regard to hip fractures, it is not normally life-threatening. But this ignores the unnecessary human, as well as financial, cost.

I think of Stephen Robinson, a forklift truck operator, who suffered chronic, agonising back pain, dismissed for years as muscular by his GP. The doctor insisted that he should leave his manual job if he wanted his pain to improve. Eventually, the choice was taken away because the pain was so severe that Mr Robinson had to leave work altogether at 61. He remembers “living in the chair, drugged up to the eyeballs, counting the minutes until I could take the next painkiller”. My Lords, I have been there. It is not nice. A private DEXA scan is not easy to afford when you are unemployed, but it showed that Mr Robinson had 10 undiagnosed spinal fractures. An early assessment through a fracture liaison service would have given him back years of his life and saved him so much unnecessary pain.

In contrast, Alison Smith retired at 60, feeling fit, healthy and ready to embrace her new-found freedom. But nine months later a fall left her with fractured ribs and an alarming sense that something was wrong. Seen quickly by medics, she was referred to a fracture liaison service, which identified severe osteoporosis and started her on treatment. With the support of the fracture liaison service team, Alison received lifestyle advice and ongoing care, which prevented any further fractures happening and saved the NHS and the taxpayer money.

In conclusion, any further delay in the rollout of these vital services would represent an inexplicable, unjustifiable false economy, because it is actually costing money not to proceed with universal provision. I look forward to the noble Baroness the Minister giving us reason to hope.