Terminally Ill Adults (End of Life) Bill

Lord Bethell Excerpts

Friday 12th September 2025 Lords Chamber

[Lord Bethell (Con)]

My Lords, it is a privilege to follow the noble Baroness, Lady Stuart, who makes a very good point on public opinion. I am persuaded that one of the reasons why the Bill should pass is that the public broadly support it. But they support it only if it works. If it does not work, and if it does not deliver what it has promised, the public will be extremely sceptical and angry that we have allowed this to happen. I have some concerns on the fundamental workability of aspects of the Bill, and in this I shall invoke my noble friend Lord Goodman and the noble Baroness, Lady Cass.

This Bill creates a vast laundry list of new responsibilities without the clarity and consensus on execution that such a Bill requires. I convened a meeting of front-line clinicians downstairs in the Attlee Room on Tuesday to listen to some of these concerns. The feedback echoed what we have been hearing from medics time and again. On testing capacity, which a number of noble Lords have alluded to, the criterion remains contested. On the signing-off of medicines, the process is extremely unclear. Huge palliative care expectations are totally unfunded, which the noble Lord, Lord Stevens, referred to. The expert panels will consume vast amounts of very senior professional time, particularly of psychiatrists. We do not have that many psychiatrists in this country. If they spend all their time on these panels, I am afraid that the rest of us will not get any support at all. There are ambiguous doctor roles, including in the presence of death. The six-month prognosis judgments do not have a very clear methodology. Very importantly, provisions for what I would call the non-NHS sector are completely unstructured and left to civil servants and secondary legislation.

This leads to what the noble Lord, Lord Kakkar, acutely termed over-protocolisation. I think what he meant by that was the sort of bureaucratic complexity without clinical clarity that blows up the intimacy that is needed for the best medical care, without managing down the risks of something going wrong.

I know from my time as a Minister that confusion in the business of health and, for that matter, in the business of death, very quickly wastes vast amounts of resources. It breeds litigation and costs lives. Who will defend these court challenges? The DHSC’s already stretched legal teams? Who will pay compensation if things go wrong? NHS Resolution, which already has a £60 billion liability bill? Sloppy legislation costs an absolute fortune in the business of health.

When we considered IVF, which is different but has some of the same considerations, we had very rigorous preparation, a royal commission, detailed legislation—twice—robust regulation and private sector delivery. Here, we have instead what my friend, the noble Baroness, Lady Murphy, called an “unwieldy if not unworkable” Bill.

I am sorry to say that I am concerned that the role of the commissioner, in particular, needs to be clarified. There is no private sector regulatory capability and there are large, sweeping Henry VIII clauses. I draw noble Lords’ attention to the very important Clause 40, which is particularly weak. The Constitution Committee demanded

“greater detail on the face of the Bill”

regarding the intended guidance and direction of this clause, and I fully support that.

The principle of the Bill is very important and it does have the support of our public. But, without substantial clarification and reform, it could devastate the NHS and our healthcare system. We must address its fundamental flaws, or this legislation should take pause before it irreparably damages our health system.