Terminally Ill Adults (End of Life) Bill

Lord Stevens of Birmingham Excerpts

Friday 12th September 2025 Lords Chamber

[Lord Stevens of Birmingham (CB)]

My Lords, palliative care may not be the answer but it has to be part of the answer, and unfortunately that is just not the case across England and Wales as we speak today. It is estimated by my colleagues at King’s College London and the Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care—some of the foremost experts in the country—that over 100,000 people die each year in this country without the palliative and end-of-life care that they would have benefited from. Two-thirds of people report being fearful that they will not have access to palliative care when they need it. So, to the extent that the Bill is about autonomy, you cannot have meaningful choice without having palliative care as part of that choice. By the way, I place high weight on the principle of individual autonomy. My question is, how autonomous can you be when you do not have a meaningful set of choices?

Advocates for the Bill make the point that in some countries that have introduced assisted dying legislation, palliative care services have improved. I have looked at those instances and that is because, when the legislation has been progressing, there has been a matched government effort specifically to increase funding for palliative care. I am not aware of any such effort on offer in this country. Although, as the noble and learned Lord, Lord Falconer said, the assisted dying service will, as per the estimates, be remarkably cheap at only £25 million, the cost of doing something in palliative care would be far greater. Therefore, it makes it far riskier to envisage that this will automatically come about.

Instead, we have in the Bill two reports on offer, in Clauses 47 and 50: one a year after the Bill is passed—if it is—and another, in effect, in nine years’ time. Frankly, those reports on the state of palliative care are not going to be worth the paper they are written on. It would be the Secretary of State at the time marking their own homework. It would be a one-off assessment. In any event, it would have no consequences, because the Act would have automatically commenced within four years anyway.

So, what could be done about this? There are some practical amendments that would improve the prospects. I would like to see a triple lock, as it were, for palliative care. First, I would like to see the attestation that the two doctors are being required to provide attest that there has been a comprehensive offer of palliative care and end-of-life support made available to any applicant to this scheme—not simply that they have had described to them the availability, or lack thereof, of any palliative care in their local area.

Secondly, we should see an attestation from the patient themselves that that genuine offer of palliative care has been made available. Thirdly, it would obviously be entirely perverse if the only way you guaranteed access to palliative care was by going through the assisted dying service. Therefore, we need to see an attestation, periodically independently verified by the Care Quality Commission, that everybody who might benefit from palliative and end-of-life care has access to it across the country. Absent safeguards such as that, we should take very seriously the warning from Hospice UK:

“The introduction of assisted dying, while palliative care is underfunded and inequitably delivered, as is currently the case, therefore brings evident and substantial risk”.