Terminally Ill Adults (End of Life) Bill

Baroness Winterton of Doncaster Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Baroness Winterton of Doncaster (Lab)]

My Lords, the noble Lord and I go back a long way. I certainly appreciate what he just said, but I ask him whether he agrees with the noble and learned Baroness, Lady Butler-Sloss, that it is important that the Bill gets to Report and that the House has the time to consider it then and not only in Committee.

[Lord Harper (Con)]

I am trying to make some comments on the amendments. Let me do that and then, if I have time—I am very careful to keep my remarks to less than 10 minutes, which is the guidance in the Companion—I will address the noble Baroness’s points. She is right that, when I was Government Chief Whip, she was my opposition and we had a very good working relationship, which I want to continue in this House.

What has come out of the debate is a general view from everybody, whatever their view on the Bill, about the importance of the relationship that people have with their general practitioner, whether it is an individual or, as the noble Baroness, Lady Gerada, said, a multidisciplinary practice. That is a very important point. The amendments that have been tabled to Clause 1 are about the eligibility criteria for whether someone is able to make a request for an assisted death.

The flaw in the amendments—I support the idea behind them, but I do not support them—is that they do not make an appreciable difference to the safeguards in the Bill. When the noble and learned Lord, Lord Falconer of Thoroton, made some remarks in this debate, he put his finger on it: there is no requirement in the Bill for the GP or the team at the GP practice to be the doctor who makes the assessment about whether the person has the capability to make this decision or not. That, as was said by the noble Lord, Lord Scriven, is the role of the co-ordinating doctor, who does not need to have any relationship with the patient at all.

When the noble and learned Lord, Lord Falconer, looked at this issue before, there was a report from the Demos assisted dying commission, which the noble and learned Lord chaired. Its recommendations recognised the need for

“a doctor who … knows the person well and supports the person and their family”.

The report also said that that doctor who knows the person can better assess whether the request to die is a cry for help, a sign of poor care or a result of coercion, and that

“if an assisted death was to go ahead, the first doctor should be responsible for arranging support for the patient and their family during and after the assisted death”.

It envisaged that

“the first doctor would have a greater level of involvement”

and

“an established relationship with the person requesting this assistance, and be familiar with their personal history and family context”.

That seemed to be the general view of all of the noble Lords who have spoken.

The problem is that there is no requirement in the Bill before us for the GP or multidisciplinary practice to be the co-ordinating doctor or even to be consulted before the co-ordinating doctor makes the first assessment. It is absolutely true, as the noble Lord, Lord Scriven, said, that, when the co-ordinating doctor has made the assessment, he or she has to send that to the GP practice. However, as the Bill is drafted at the moment, the role of the GP practice is to act as a postbox, log the report—I see the noble and learned Lord, Lord Falconer of Thoroton, nodding—and pop it on somebody’s medical records. There is no requirement or duty on that GP practice to read the report, to make an assessment of the decision of the person with whom they have a relationship to die or to do anything about it at all. That is the flaw in this.

The problem with the amendments on the eligibility criteria that we are considering is that, if they were all adopted—this is an administrative point—they would not ensure that that knowledgeable individual or practice with whom the patient has a relationship has any role whatever in making this important decision, involving the family or consulting anybody at all. That is the flaw.

This has been a valuable debate because I think it has demonstrated—and I think the noble and learned Lord, Lord Falconer, recognised in his earlier comments —that there was value in that relationship, and I am not surprised by that, given the conclusions that the commission he chaired came to, but the problem is that that is not reflected in the Bill at all.

If I may, I will conclude on this point before I address the remarks of the noble Baroness, Lady Winterton. Why we have these debates, and the reason for hearing from noble Lords with opinions, is because it highlights the flaws that exist in the Bill. The point of this process is that that then enables the sponsor of the Bill and all noble Lords to listen carefully to the debate and to bring forward improvements on Report.

I hope that, in his response, the noble and learned Lord, Lord Falconer, will draw on the concerns that have been highlighted and can indicate his approach. If he is minded to bring forward amendments that deal with some of these things, that clearly means that other people do not need to. If he indicates he is not minded to do that, then other noble Lords can bring forward amendments to deal with it, which can then be debated and voted on at Report stage. That is the point of our process and why we debate these things in the Chamber: so that everybody can hear the debate and the points. It is a better way of improving the legislation than having lots of private discussions to which most of us are not party.

What I would say to the noble Baroness, Lady Winterton—

Cardiovascular Illnesses

Baroness Winterton of Doncaster Excerpts

Thursday 12th June 2025 Grand Committee

[Baroness Winterton of Doncaster (Lab)]

I congratulate the noble Lord, Lord Booth, on securing this debate, on his very personal account of what he went through and on sharing with us his experiences and what we can learn from them.

As a former Health Minister who had some responsibility in this area, I know that cardiovascular illness can be particularly prevalent in areas of high deprivation. NHS figures show that, in 2023, the most deprived 10% of the population were almost twice as likely to die of cardiovascular disease compared to the least deprived. An NAO report published in 2024 said that, in 2020, deaths in those aged under 75 due to cardiovascular disease were four times higher in the most deprived areas compared to the least.

I recently attended an event organised in Parliament by the All-Party Parliamentary Group on Vascular and Venous Disease, where I was particularly struck by the points made about those regional variations—not just in death rates but in treatment and prevention. In the South Yorkshire ICB area, only 3.1% of the population received a health check in 2023-24, despite 32% of adults being obese and 23.5% being physically inactive. There are also worrying disparities in amputation rates. In Yorkshire and Humber, there are 12.6 amputations per 100,000 people, which is almost double that of London; only the north-west and north-east of England have higher amputation rates.

I know that the British Heart Foundation has welcomed the Government’s recognition of CVD as one of the UK’s biggest killers and their ambition to reduce premature deaths from heart disease and stroke by 25% in the next decade. The foundation has also called for a national cardiovascular disease plan. I wonder if, in her closing remarks, the Minister might address whether the Government are looking at that idea to bring together areas that need to be tackled, such as obesity, smoking, air pollution and increased research.

In the time I have available to me, I want to make a few practical points that could address some of these disparities. Health checks are so important, but the 2024 NAO report said that there was “no systematic” way of

“targeting … those most in need of”

health checks, as well as little incentive for primary care providers to provide them. It also said that

“DHSC and local authorities cannot … access data … so cannot assess the impact”

that health checks are having. Perhaps my noble friend could address this or write to me if she does not have the information to hand.

The all-party group has made a number of points. For example, appointing more nurse practitioners would enable what it called hot clinics. In many ways, this would help to reduce the length of waiting times. At present, there are patients who are at risk of amputation of their legs. Obviously, they need to be prioritised. A hot clinic could do this by having nurse practitioners who could assess the patients, compare their blood pressure on the arm and on the leg, see how bad their condition is, then fast-track them through the system. That is one suggestion from the APPG. Also, appointing multidisciplinary team co-ordinators could greatly assist in keeping track of patients, moving them through the system and reducing the time that consultants have to spend on doing this.

Co-locating services is also vital. For example, if there were ultrasound scanners and access to sonographers in out-patient departments, they could increase the number of out-patients because patients would not have to go back and forth to and from hospital. This would improve the patient journey. Hybrid theatre facilities would allow consultants to do a range of services in the same space, again, without having to duplicate services and the patient having to go backwards and forwards for different appointments.

That brings me nicely on to the fact that, as my noble friend the Minister knows, the Doncaster Royal Infirmary is greatly in need of some investment. The recent announcements of an increase in NHS capital spending are very welcome. Part of the plans would be to help in this important area, so I hope that she might cast a sympathetic eye over the points that I have made.

Doncaster Royal Infirmary

Baroness Winterton of Doncaster Excerpts

Monday 12th May 2025 Lords Chamber

[Baroness Merron (Lab)]

I can tell your Lordships’ House that we have inherited an undercapitalisation over the past few years, and it is essential—including to cut waiting lists and provide proper care—that we provide resources. However, the noble Lord is very aware of the extent of the backlog; it stands, according to the latest NHSE figures for 2022-23, at £13.8 billion. Even more worryingly, the critical infrastructure risk within that, which the highest-tier hospitals are wrestling with, is £7.6 billion. We have had to find the best route forward to be fair and efficient. Is it a major mountain to climb? Yes, it is. Are there various options for doing it? Yes, there are, but we believe that we have been as transparent and fair as we can be.

[Baroness Winterton of Doncaster (Lab)]

My Lords, I know that Secretary of State Wes Streeting is determined to increase NHS productivity. DRI’s bid for urgent work to the tower block would do just that; for example, by stroke services having a same-day emergency care centre linked to the in-patient ward with a knock-on effect on vascular services. That is all impossible with the current state of the hospital. Will my noble friend the Minister ensure that Ministers, officials and, crucially, the Treasury not only are aware of the patient safety concerns raised by the right reverend Prelate, but know that the DRI bid will increase productivity and efficiency, as well as improve patient care?

Primary Healthcare Facilities

Baroness Winterton of Doncaster Excerpts

Monday 17th March 2025 Lords Chamber

[Baroness Merron (Lab)]

Although I cannot give a specific answer to the noble Lord on that point, I will be happy to look into it. As I mentioned earlier, in our discussions with the Ministry of Housing, Communities and Local Government we are, for example, looking at how we can lever greater contributions from developers who are working on new developments, where they will be providing much-needed health services and infrastructure. So we are taking a creative approach because we recognise the need to do more.

[Baroness Winterton of Doncaster (Lab)]

My Lords, my noble friend referred to creativity and the noble Baroness on the Lib Dem Benches talked about facilities in the community. Well, in Doncaster, we are already ahead of the game, as Mayor Ros Jones has worked with the local health community to provide a “health on the high street” facility, which will not only reduce pressure on the hospital but make it easier for patients to access services and, crucially, help regenerate the city centre. Will my noble friend join me in congratulating Mayor Ros Jones on this initiative, but also work with the local community to address the issue of urgent repairs that are still needed at the hospital?

[Baroness Merron (Lab)]

I am very pleased to congratulate Mayor Ros Jones on this initiative, as I would be pleased to congratulate such initiatives up and down the country. My noble friend is right to talk about the great benefits to local communities, which I myself remember, as will my noble friend, from the previous Government, in terms of walk-in health centres, which made a huge difference. To the point about repairs to the local hospital, it is vital, if we are to create the right NHS going forward through the 10-year plan, that we repair and rebuild the healthcare estate, which has a very considerable backlog maintenance bill after years of underinvestment. That is why the Chancellor confirmed extra investment for the backlog of critical NHS maintenance and repair upgrades.

Musculoskeletal Health: Chiropractors

Baroness Winterton of Doncaster Excerpts

Wednesday 26th February 2025 Lords Chamber

[Baroness Merron (Lab)]

I am glad that the noble Lord acknowledges the ongoing work, because we are indeed exploring how best to support dealing with MSK conditions—not least to encourage and provide greater parity in the support that is given. That will be alongside the 10-year plan and the long-term workforce plan. Of course, we keep all evidence continually under review.

[Baroness Winterton of Doncaster (Lab)]

My Lords, I take the point my noble friend the Minister makes about national commissioning and the ability of integrated care boards to do some commissioning, but would not the answer be for the integrated care boards to get all preventative healthcare practitioners to sit down together and work out local strategies? It may well be that one condition can have an effect on another, and perhaps that would make the commissioning of chiropractors easier and fit in with a local preventative healthcare strategy.

[Baroness Merron (Lab)]

My noble friend helpfully emphasises the point about the need to provide for local populations, and ICBs are in the pole position to do that. I am sure that noble Lords will recall that we recently announced changes in the NHS operating model to move power from the centre to local leaders. I particularly refer to the NHS planning guidance, whereby we follow the recommendations of the noble Lord, Lord Darzi, to take a whole new approach and reduce the number of national targets from 32 to 18. The reason for that is to give the local systems my noble friend refers to greater control and flexibility on how local funding is deployed. Indeed, one such model could be the one my noble friend referred to.

Mental Health Treatment: Waiting Times

Baroness Winterton of Doncaster Excerpts

Monday 3rd February 2025 Lords Chamber

[Baroness Merron (Lab)]

I certainly do, and with the NHS being such a large employer, that is one of the areas that we will be attending to. The long-term workforce plan will provide its report around the summer of this year and there will be much detail on how the workforce will be but also on the ways that we can improve its health and retention as well as recruitment.

[Baroness Winterton of Doncaster (Lab)]

My Lords, my noble friend Lady Warwick spoke particularly about young people and provision in schools. Does my noble friend the Minister agree that there is a key role for educational psychologists and school nurses in ensuring that diagnosis can take place early? Does she believe there could be a greater role for academies and schools working together at local level to provide that type of provision?

[Baroness Merron (Lab)]

I agree with my noble friend’s suggestions. Of course it is a team that provides the mental health support that is necessary, but I am particularly pleased that we are working to deliver a mental health professional in every school. That is a starting point, not necessarily the end point, so my noble friend makes some very helpful suggestions.

Community Pharmacy Closures

Baroness Winterton of Doncaster Excerpts

Tuesday 28th January 2025 Lords Chamber

[Baroness Merron (Lab)]

Commercial over the counter products will have a part to play. However, I take the point that the noble Lord makes. I am sure it is true that their vital role, and the opportunities that they offer, were not exploited as much as they could have been—when I say “exploited”, I mean that in a positive way. The Minister for Care, Stephen Kinnock, issued a press release today. In his last point he says:

“I am committed to working closely with Community Pharmacy England to agree a package of funding that is reflective of the important support that they provide to patients up and down the country. I am confident that together we can get the sector back on its feet and fit for pharmacies and patients long into the future”.

[Baroness Winterton of Doncaster (Lab)]

My Lords, the Government are on the right track in recognising the role that community pharmacists can play in public health by preventing illness and reducing the number of people turning up at A&E. However, is my noble friend the Minister aware of reports that some GPs have been unwilling to direct patients to community pharmacists, even under the Pharmacy First programme? Will she look at whether further action is needed to ensure that GPs work with community pharmacists to deliver services to patients?

[Baroness Merron (Lab)]

I am aware of the reports that my noble friend refers to. This is a new service; it needs to bed in. NHSE is working closely with ICBs, GPs and the community pharmacy sector to improve referrals. Funding has also been provided to ICBs for primary care network engagement leads, who should be well placed to support GP teams to refer into the service. We are aware of my noble friend’s point; we are acting on it and we will continue to keep it under review.

Health and Social Care: Winter Update

Baroness Winterton of Doncaster Excerpts

Tuesday 21st January 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord is right to remind us of the challenge of having people in the right place, rather than in hospital when they do not need to be there. We have already taken action, so I am pleased to be able to reassure him that, while the noble Baroness, Lady Casey, will look at long-term solutions for social care, she will present a report within a year from her commencement, which will add to the actions that we have already taken.

The noble Lord talked about unpaid carers—and I certainly share the respect that he holds for unpaid carers, so I am very pleased that we have given the biggest boost in income to family carers through eligibility for the carer’s allowance. That has meant an additional —on average, of course—£2,300 a year. That is the biggest boost since carer’s allowance was introduced in the 1970s. We are also legislating for a fair pay agreement, for the first time ever, which will help to tackle the number of vacancies, now standing at 131,000. There will be immediate action, because discharge requires being able to be in the right environment, which might be home but it might need an adaptation. Through the disabled facilities grant there will be a further 7,800 adaptations to homes both this year and next year. So we have taken the immediate action—and, yes, there is a lot more to do.

[Baroness Winterton of Doncaster (Lab)]

My Lords, my noble friend the Minister has just reiterated what the Statement said—that one of the key levers for easing winter pressures is NHS reform, particularly moving some hospital services into the community, which could deal with some of the issues raised by the noble Baroness, Lady Brinton, including X-rays, scans, tests and so on. Does she agree that this will require close collaboration between NHS trusts, hospital trusts, local authorities, ICBs and, sometimes, the private sector? Will she work with Ministers in other departments, not only to remove any obstacles there might be to this but to actively encourage it to happen at the local level? By the way, there are some good examples in South Yorkshire of this happening, and proposals for it to happen.

[Baroness Merron (Lab)]

My noble friend is quite right to highlight the good examples in South Yorkshire. There are good examples across the country and one of our challenges, as the Secretary of State has said, is taking the best to the rest. This is a very good example of that. I certainly agree with her observations. This requires joined-up working locally and nationally, which is why we work closely with other departments in both the immediate term and the longer term as we seek to reform health and social care.

Hospice Funding

Baroness Winterton of Doncaster Excerpts

Monday 6th January 2025 Lords Chamber

[Baroness Merron (Lab)]

As I mentioned, it has been confirmed that there will be funding for children and young people’s hospices for the forthcoming year, which I know had been hoped for but not actually delivered. I am very glad that the Secretary of State was able to confirm that. On long-term sustainability, Minister Kinnock is very much looking forward to meeting major stakeholders and is working with NHS England to find the best funding mechanism, in respect of the £100 million capital grant and more generally.

[Baroness Winterton of Doncaster (Lab)]

My Lords, it is very good news that the commission is in the safe hands of Sir Mike Richards, who I worked very closely with when I was a Health Minister. Could my noble friend set out the ways in which the Government might assist the hospice sector with training, because there must be a crossover in the different tasks undertaken? In particular, could some of the changes announced for social care workers be transferred to the hospice movement?

[Baroness Merron (Lab)]

My noble friend makes a very helpful point that I will certainly follow up. The fact that the majority of hospice care is provided through the NHS suggests that there is room for further co-operation between the independent hospice sector and the NHS. I am grateful for her comments and will follow that up.

NHS Plan: Consultation

Baroness Winterton of Doncaster Excerpts

Monday 2nd December 2024 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Lord. Yesterday, I was at an in-person event in Folkestone, and as with all such events up and down the country, it had used systems to find a wide range of people, including young people, who, as he rightly says, are often unlinked with the health service. I emphasise our continued monitoring and our efforts to reach the groups he speaks of. So far, we know that men, those aged under 35, and black Asian and black British people have engaged least with Change NHS. We are now stepping up our efforts.

[Baroness Winterton of Doncaster (Lab)]

My Lords, will my noble friend the Minister look at the role that pharmacists might play in any consultation? While they may not be an obvious source of reaching out, they are embedded in communities and talk to patients and users frequently. If they could be harnessed, it would much improve the consultation.

[Baroness Merron (Lab)]

I am very grateful to all those, including pharmacists, who have used all their networks and contacts to spread the word. That is why we have had over 60,000 responses and more than 1 million visits in what is the largest ever consultation in the history of the NHS. I call on all groups to continue their efforts to ensure that voices across all communities are heard loud and clear.