Medical Training (Prioritisation) Bill

Lord Winston Excerpts

Committee stage
Thursday 12th February 2026 Lords Chamber

[Lord Mohammed of Tinsley (LD)]

My Lords, I want to speak briefly to the amendments proposed by the noble Lord, Lord Patel, and the noble Baroness, Lady Coffey. The noble Lord, Lord Patel, mentioned that 7% of undergraduates who take medical degrees in the UK are from overseas. I briefly mentioned last week my conversations with the head of admissions at a Russell group medical school. An important point that I did not have time to raise then, but is appropriate to raise now, is the significant amount of money that that 7% contribute not only to that medical school but in additional payments to the local trust.

I wanted to make your Lordships’ House aware of that, but I also want the Minister to talk about the consequences if we accepted the amendment of the noble Baroness, Lady Coffey, and just had British citizens as opposed to the British graduates the noble Lord Patel talked about. What impact would there be? We have held our tuition fees static for a while in this country, while those overseas students have been paying a phenomenal amount. I am just worried that we might throw the baby out with the bath water. The unintended consequence of making some of those courses unviable is a serious concern, and I think it appropriate to raise it at this point.

[Lord Winston (Lab)]

My Lords, I too am a little bit concerned about unintended consequences. It is a real pleasure to see my noble friend Lord Darzi in his place, because I hope he will have comments on this issue.

I trained as a clinical academic. Indeed, we know that clinical academics have had a unique value to the health service. They work part-time in the health service with a reduced salary and do research at the same time. I am very concerned that many of the clinical academics we have had at Imperial College, for example, have been from overseas. They were medically qualified elsewhere but had not yet been in Britain and were still junior doctors, in a sense. I am really concerned that there are many such people who come to Britain, do a postdoctoral degree such as a PhD and, in the meantime, keep their medical skills flowing, as I did myself. I was seven years in this situation with the Wellcome Trust. I remember it very well. I was overseas but at least knew that I could come back to Britain. But I was a British subject—that was easy.

There are so many of these people. To give just one example, Professor Jan Brosens at Warwick University is undoubtedly one of the key people who have contributed massively to female health, particularly on implantation of the ovum and in his magnificent work on endometriosis. He came as a junior doctor from Belgium, from Leuven University, to what was then Hammersmith Hospital, which is now, of course, Imperial College. Now, he is a very distinguished professor at Warwick University with a very large team. His recruitment made a very big difference to the whole field. His is not an isolated example; there are many such people I can think of. I hope the noble Baroness can suggest some way of dealing with this problem of unusually good graduates from elsewhere, who may not be British citizens, perhaps, in the current priorities, but who would really be deserving of serious consideration for certain specialty jobs. Not to do that would be a great loss to the health service.

[Lord Darzi of Denham (Non-Afl)]

My Lords, many of you will know that I did my medical training in Ireland. In fact, I exercised some of my skills in this Chamber back in 2007. Irish medical education is excellent, and many of its graduates have gone on to distinguished careers in the NHS. I speak today to ensure we strike the right balance in this Bill, specifically by securing fair treatment for doctors who hold degrees approved by the Irish Medical Council.

As drafted, the Bill would exclude graduates of the Royal College of Surgeons in Ireland at its medical campus in Bahrain, for example—a campus that was established more than 20 years ago. Let me be clear about what that institution delivers: it has the same curriculum, the same examinations and the same quality assurance as Dublin, leading to a single national University of Ireland degree. Its programme and clinical training sites are also accredited under Irish regulatory oversight by the Irish Medical Council. I urge that, on Report, wording be introduced to bring graduates of this institution within the priority group. Such a clarification would sit squarely alongside the amendments from the noble Baroness, Lady Gerada, and the noble Lords, Lord Clement-Jones and Lord Mendelsohn. These seek to ensure that medical graduates of a UK university holding a GMC-approved degree and following the same curriculum and assessment, but studying outside the British Isles, are included in the priority group. It would also be consistent with the similar amendment tabled by the noble Lords, Lord Forbes and Lord Shipley, and the noble Baronesses, Lady Finlay and Lady Hollins.

I draw a further anomaly to your Lordships’ attention. The unamended Bill would place graduates of the Royal College of Surgeons in Ireland’s campus in Penang, Malaysia—a joint programme with University College Dublin—within this priority group. These students study an Irish Medical Council-accredited, GMC-recognised degree, completing half their education in Ireland and half in Malaysia. Yet the well-intentioned clarifying amendment of the noble Baroness, Lady Finlay, requiring at least 60% of the time to be spent in Ireland, would inadvertently exclude them.

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[Lord Clement-Jones (LD)]

My Lords, I strongly support Amendments 15, 16 and 19, tabled by the noble Baroness, Lady Gerada, which I have signed, and which she spoke to so convincingly. These Benches also support Amendment 17 in the name of the noble Lord, Lord Forbes, and signed by my noble friend Lord Shipley, and Amendment 20 in the name of the noble Earl, Lord Howe.

As I said at Second Reading, I am the former chair of the council of Queen Mary University of London and now, for my sins, an honorary professor. Amendments 15, 16 and 19 seek to correct a category error in the Bill: namely, the classification of students holding a UK primary medical qualification from a UK public university as “international”, solely because their classroom is in Malta. I am sure the noble Lord, Lord Forbes, will say the same in respect of Malaysia. The Minister has argued that these students lack “clinical familiarity” with the NHS, but that does not withstand scrutiny. These students follow the exact same curriculum as their peers in London, as the noble Baroness said.

The Bill prioritises EEA nations, because it seems that our trade deal requires us to recognise “comparable” qualifications. It is legally incoherent to accept a “comparable” qualification from Liechtenstein while rejecting an “identical” and “affiliated” qualification from Malta. We are treating a formal UK affiliate worse than a trade partner. These students sit the UK medical licensing assessment and they are taught by UK-trained consultants. As I said at Second Reading, it is a manifest absurdity that, under this Bill, a graduate from Liechtenstein with no UK degree and no UK training is prioritised over a Queen Mary student who holds a UK degree and is specifically prepared for our health service.

I strongly endorse the point made by the noble Baroness, Lady Gerada, regarding our free trade agreements. We are in an absurd position whereby a treaty obligation forces us to prioritise these “comparable” qualifications. This is not workforce planning; it is a diplomatic and regulatory own goal. As the noble Baroness explained, Amendment 19 offers a simple solution by adding Malta to the priority list. This honours the mutual recognition agreement held between the UK and Malta since 2009—an agreement the Department of Health explicitly renewed in 2024.

Amendments 15, 16 and 17 offer a broader solution based on the qualification. If a student holds a UK degree from a UK-registered institution and passes identical UK assessments, they should be treated as a UK graduate. The Minister fears displacement of domestic talent, yet the majority of these Maltese trainees are contractually obliged to return to Malta after their training. They are what can be described as a circulatory workforce: one that supports the NHS during their training years, without permanently blocking the consultant pipeline. They are the ideal workforce partner. As stated by the noble Baroness, Lady Gerada, Maltese surgeons have been licensed by our royal colleges since the 1830s. This is not a new or risky pipeline; it is a two-century year-old bond that the Bill carelessly severs.

Furthermore, we support Amendment 20 in the name of the noble Earl, Lord Howe, regarding people who qualify in the British Islands but who have trained abroad. We are all on the same page in advocating for these well-qualified students, who should be eligible to have the same priority in obtaining training jobs as those currently set out in the Bill. We have received heartbreaking correspondence from British nationals studying in eastern Europe, often because of the cap on places here, who intend to return to the NHS. One correspondent highlighted that we allow British dentists to return without these barriers. Why do we treat our future doctors differently?

[Lord Winston (Lab)]

My Lords, it is an honour to support the noble Baroness, Lady Gerada. The best surgical training I had was with a Maltese surgeon, who was absolutely fantastic and taught me lessons I have never forgotten. One has to see that that cross-fertilisation happens across the NHS very often.

[Lord Mendelsohn (Lab)]

My Lords, I support Amendments 15, 16 and 19, in the name of the noble Baroness, Lady Gerada, and supported by the noble Lord, Lord Clement-Jones. It is my first opportunity to speak in the presence of the noble Baroness, Lady Gerada, in this Chamber. She is one of the more extraordinary and fantastic additions to this House in recent years. She has made a massive contribution to our country in medical expertise. The case that she made for these amendments was utterly compelling. I hope the Minister has felt the same inspiration as I did from her words. I also commend the noble Lord, Lord Clement-Jones, who I realise I have now known for 29 years, for another great speech, which again I think added to the strength of these points.

The amendments address an important omission, which has a couple of concerning issues underlying it. The case for why we should continue with this relationship is compelling. We seek to add Malta to the list of jurisdictions whose primary medical qualifications are recognised for prioritisation. As stated, Malta’s medical education system is not merely comparable to that of the United Kingdom; it is formally and historically integrated, through decades of regulatory alignment, shared training structures and sustained institutional partnerships, including the Queen Mary University of London’s Malta campus.

A substantial proportion of the graduates from this campus are United Kingdom nationals and many others hold UK domicile or indefinite leave to remain status. This is a cohort that can be planned for with confidence and absorbed without difficulty within the normal operation of the system, while making a real and practical contribution to the NHS. As the noble Lord, Lord Clement-Jones, said, they provide a valuable workforce capability that does not undermine the consultant pipeline, which is something we have to manage very well. Excluding this cohort of medical students disrupts an established pipeline, separates training from deployment and leaves capacity unused within a system that is under constant pressure. That is not disciplined workforce policy; it is a misalignment between regulation and operational need.

Medical education is one of the United Kingdom’s most significant strategic assets and a central pillar of our global impact in healthcare. It is very important that we maintain alignments and partnerships where they exist. Undermining them does nothing to enhance our reputation as a stable partner for any form of business, let alone the important thing of building relationships in medical research. I hope the Government reflect very carefully on this. A category error has led to a position where, even as recently as 2024, we undertook another solemn commitment—as you do in contracting—which we have now backed away from. That is a terrible place to be in.

The historic connections we have with countries—where we align these things over years and people invest with confidence—must not be undermined, especially when we, essentially, use a free trade agreement as a mechanism to undermine it. This is the wrong way around. This is not strategic planning; it is dodging and weaving between different and vacillating policies. We cannot be subject to this.

I hope the Minister will encourage the Government to reflect very carefully on this. I hope that there will be some positive news about how we can make sure that the countries we have aligned with most closely and have a formal UK affiliation can be brought into this arrangement and that some form of these amendments can be accepted.

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[Baroness Merron (Lab)]

As I always do, I will seek to engage in sufficient time before Report. I will not promise the beginning of next week, but we all know the deadlines that noble Lords are working to and I am very respectful of that.

Amendment 17 could create the loophole I have referred to and risks existing international overseas campuses expanding their intakes further. I am grateful that noble Lords acknowledge the concern and are considering how to deal with it. That would be outside any UK workforce planning.

Amendment 21 would provide a regulation-making power to limit the number of applicants who could be prioritised from these overseas campuses. Going back to my earlier comments, it is not clear how such a requirement would be implemented effectively and fairly in practice but, in any event, it would not provide an appropriate safeguard for UK workforce planning.

The Bill rightly prioritises those whose education and placements the UK taxpayer has supported, who are most likely to work in the NHS in the long term—I emphasise this point—and are better equipped to deliver healthcare tailored to the UK’s population because they understand the UK’s epidemiology. However, I hope my noble friend Lord Forbes and the noble Lord, Lord Mohammed, will take back to the university that graduates from international overseas campuses are not excluded and will continue to be able to apply to the foundation programme and specialty training.

Amendment 18 tabled by the noble Baroness, Lady Finlay, relates to the prioritisation of medical graduates from institutions in Ireland. The Government cannot accept this amendment, and I thought her own assessment of it was most honest and helpful. Throughout the development of this Bill, we have been clear that graduates from the Republic of Ireland are prioritised on the same basis as UK medical graduates. This reflects the long-standing and unique relationship between our countries, including the arrangements under the common travel area, which supports reciprocal rights of movement and employment. It also ensures coherence in workforce planning across both jurisdictions, where medical education and training pathways have been closely aligned for many years.

Introducing different criteria for graduates from the Republic of Ireland, as this amendment proposes, would risk disrupting those shared arrangements. It could also create an uncertainty in the provision of postgraduate training in Ireland.

Amendment 19, tabled by the noble Baroness, Lady Gerada, seeks to add Malta to the list of prioritised countries set out in Clause 4. This would require that those who hold a primary medical qualification from any institution in Malta, irrespective of their nationality, are prioritised for foundation and specialty training. I address this particularly to my noble friend Lord Mendelsohn, to whom I listened closely, as I did to the noble Baroness, but we cannot accept this amendment.

I refer particularly to the European Free Trade Association countries, as they have been mentioned a number of times, including by my noble friend Lord Mendelsohn, the noble Lord, Lord Clement-Jones, and others. Those countries listed in Clause 4 are those with which the UK has signed agreements that include offering parity of access to the workforce. I have looked back at when those agreements were made: for the EFTA countries of Iceland, Norway and Liechtenstein, the agreement was made in July 2021, and Switzerland was in 2019. I make these points because they certainly precede this Government. In practice, as I have said before, not all these countries will have eligible applicants in any case.

The 1975 UK-Malta reciprocal healthcare convention will continue and is not affected by the Bill. I emphasise that that agreement is wholly related to reciprocal access to healthcare, not access to training or employment related to medical training. I hope it is helpful to say that the Bill includes a power to amend the list of countries in Clause 4 to reflect any future international agreements that the UK may enter into. As I have also stated previously, the Government set UK medical school places based on future health system needs. I emphasise that there is no disrespect intended here and we very much value the long-standing partnership with Malta on healthcare, and that will continue to be valued. However, prioritising international graduates would undermine our ability to keep foundation training numbers aligned with the NHS workforce that we are planning for and manage those bottlenecks in specialty training, about which there is concern across the Committee. This is about focusing on patient care and ensuring that those whose education and experience best prepares them to practice safely and effectively in the NHS are the ones who are prioritised.

For specialty training, prioritising these individuals would not support our aim to prioritise doctors with significant NHS experience who understand how the health service works and how to meet the needs of the UK population. I reassure the Committee that this Bill will not affect existing fellowship arrangements with Malta, and the affiliation of the UK foundation programme and Malta foundation programme, to which the noble Baroness, Lady Gerada, referred, will still stand. Senior officials in my department have met with the high commissioner of Malta to the United Kingdom to assure him of this and last week I received a positive letter of acknowledgement from the Health Minister in Malta.

To be absolutely clear, individuals with a primary medical qualification from Malta will still be able to apply for foundation and specialty training places, and they will be considered for any places that are left after prioritisation. But it would still be the case that it would be at odds with the aim of the Bill for them to be prioritised for these places. For the reasons I have set out, I hope the noble Baroness will feel able to withdraw her amendment.

[Lord Winston (Lab)]

The NHS is a complex organisation which is going to be rapidly changing, with increasing issues regarding its employees and all sorts of new technologies that will develop in a way we have never seen before. In view of that, does the Minister think there might be some reason for the Government to consider looking at this situation in, say, five years’ time to see the effect of the Bill on the health service?

Terminally Ill Adults (End of Life) Bill

Lord Winston Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

[Lord Shamash (Lab)]

Thank you. I apologise to the Front Bench about that.

The problem was, in the later part of his life, his lungs began to give way. I remember him saying to me, in the last two or three months of his life, “I just wish somebody could help me so that I could end my life”. Watching a member of your close family die from a horrendous disease is something I hope the House will take into account. I am very concerned about Amendment 105 because I think is very tough indeed, and I sincerely hope that the House will reject it.

[Lord Winston (Lab)]

Would the noble Lord agree that the word is “suffocated”, rather than “die”?

[Lord Shamash (Lab)]

I apologise. Yes, the word is “suffocated”—he was suffocating as his lungs began to fade.

Baby Milk Powder: Cereulide

Lord Winston Excerpts

Wednesday 4th February 2026 Lords Chamber

[Baroness Merron (Lab)]

I am certainly convinced that more than a decent job has been done on this occasion. I know that the FSA, along with the department and the UK Health Security Agency, have, as was said to me, been working non-stop since the incident was notified, and I am genuinely reassured by that. What I would say is that alternatives are available, there is no problem with the supply of alternatives and if anybody—grandmothers, mothers, parents, friends, or whoever—has concerns, they should check the NHS website and the FSA website and, if they remain concerned, they should seek guidance from a medical professional. There are people who are potentially affected, but, as I said, this is a live incident and it is being monitored.

[Lord Winston (Lab)]

My Lords, I have in the past given notice to the Minister about this, with regard not to milk but to other issues: for example, where small humans, such as embryos or babies, come in contact with fluids or chemicals that might be dangerous. It is not only milk that may need better observation. Does she agree that we should look rather carefully at how we regulate the fluids used for culture of human tissues, in particular embryos, where there may be some risks of not getting better results, or possibly even of danger to the embryo?

[Baroness Merron (Lab)]

Safety is paramount, whether we are talking about embryos, adults or children. I would be pleased to hear from my noble friend if there are particular areas on which he would like to be reassured, or at least responded to. But I hope that, in respect of food safety, in this situation, your Lordships’ House will see that all actions have been taken by the relevant authorities, with speed and in line with the laws available.

Terminally Ill Adults (End of Life) Bill

Lord Winston Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Lord Winston (Lab)]

My Lords, I wonder whether I could briefly come back to something that the noble Lord, Lord Deben, said. I have a great deal of respect for him, and I agree with a great deal of what he said in his speech just now, but I suggest that, when it comes to medical practitioners and the medical and caring profession, the word “concerns” does not mean that they are against the Bill. It is very important to understand that.

As a member or fellow of a number of these different organisations, what surprises me is how little of the correspondence from them is actually against the Bill. Sometimes there is some concern—of course, this needs reasonable regulation and proper agreement— but, overall, we must be very careful about how we understand their words. I have certainly not heard from my colleagues in many conversations over these past months that the Bill should be stopped. On the contrary; they are interested to see how it goes. I certainly think that many of them would say that they feel that this is a good Bill to look at.

[Lord Deben (Con)]

May I interrupt? I did not for one moment suggest that I was concerned about this because people were opposed to the Bill. What I said—indeed, I said this specifically—was that I was not thinking of those who were in principle opposed to the Bill. What I wanted to say was that specific concerns had been expressed, and that some of these amendments seek to meet the concerns of the very people who are going to carry this Bill through. I was not proposing this to stop the Bill; I was saying that even those of us who do not like the Bill want to do our job, which is to produce a Bill that will be at least, in the proper terms, workable. That is the only point I made.

[Lord Winston (Lab)]

I thank the noble Lord for this conversation. I am glad to hear him say that but, unfortunately, the word “concerns” is often bandied about by people who just say, “Well, of course, the doctors are against this Bill”. That is not a fair assumption; it is certainly clear from the Select Committee evidence we heard that there are various opinions.

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I hope that the Bill’s proponents and the sponsor might be open to some reflection on this point and, specifically, to considering whether it would be better to use clearer language; language that is used elsewhere on the statute book; language that could help deal with the points I have touched on and some of the other concerns that we have had about the way the Bill will be implemented in practice.

[Lord Winston (Lab)]

Forgive me for interrupting; I do not want to take up time. The noble Lord is now giving us a lesson in Anglo-Saxon, Celtic, Latin and indeed Old German, as well as Middle English. We are missing the point. We need to move on, surely. He has been over 12 minutes on this speech, and it is beyond what we would accept at this stage of the day.

[Lord Frost (Non-Afl)]

I think I am allowed 15 minutes, actually. I do not think I mentioned Celtic either, just on a point of detail.

That aside, I was reaching—in fact, had already delivered—my peroration. I hope, as I said, the proponents might be open to some reflection on this point. Meanwhile, I beg to move.

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[Lord Moore of Etchingham (Non-Afl)]

My Lords, I find it strange that the noble Baroness, Lady Royall, should be making the argument that the word “dying” tells us all that we need to know. If that were so, we would not need the Bill. The Bill is about a very specific thing, which is choosing to end your own life and getting help with it. The importance of clarity and frankness in language in the making of law is very great. It must be distinguished from perfectly legitimate what I shall call political language.

Take, for example, the right to life, which is one side of the argument in another matter, and the right to choice. Those are both perfectly good phrases about the subject of abortion, but they were not suitable phrases for law. When you talk about law, the word that should be used is “abortion”. That is what is actually happening. I am not saying that there is any dishonesty here, but it is inappropriate for the making of law.

I strongly support what the noble Lord, Lord Frost, said about possible ambiguities and misunderstandings. I give an example, which is nothing whatever to do with assisted dying, but it just illustrates the point. As we ran up to the 1983 general election, Labour had a policy of unilateral disarmament. The Tories were against unilateral nuclear disarmament and attacked it. Somebody wrote a letter to the Daily Telegraph saying, “I do not think people know what the word ‘unilateral’ means, and if you call it ‘one-sided disarmament’, people will understand what this is about”. The Tories seized that, suddenly changed all their propaganda to talk about one-sided disarmament and the polls shifted very dramatically against one-sided disarmament. The importance of normal English is very significant. Again and again, we can see public confusion, which must be avoided, about what is actually proposed in the Bill.

Finally, there is a contradiction in the arguments made by supporters of the Bill—I think that the noble Baroness, Lady Royall, was in this situation. Since the greatest thing that is being argued for by supporters of the Bill is autonomy, it is important to have a word or phrase that embodies that autonomy and shows who is making this decision and whose agency it is. The phrase “committing suicide” exactly establishes the agency and exactly shows the autonomy. It is contradictory to advocate for autonomy and then to take refuge in euphemism.

[Lord Winston (Lab)]

Many years ago, the noble and learned Lord, Lord Falconer of Thoroton, introduced a similar Bill. I, very misguidedly, introduced an amendment to the title of the Bill; I suggested that the word “euthanasia” should be in the Bill. I did this without believing either that the Bill should pass or that it should fail—I was genuinely uncertain—but, earlier that week, I had talked to a 16 year-old schoolgirl in a school. In the short conversation we had, she asked, “Do you think we always feel that we have to go for and strive for perfection?” I found that very difficult to answer, so I pondered on it.

One of the issues here is exactly what the noble Lord, Lord Frost, has just shown. He tried to demonstrate that there are no absolute meanings of words. In that case, I used Greek, but this is something that we need to go beyond now. These words will mean different things to different people. We waste a lot of time doing this sort of meddling with language when it is unnecessary and when there is no issue with the legal quality of the Bill, which, of course, must be paramount. It is clear that the language we have at the moment is undoubtedly intelligible and largely workable.

[Lord Harper (Con)]

My Lords, let my start by picking up the point that was just made by the noble Lord, Lord Winston. We should be plain and simple in saying what is going on. In effect, the Bill’s central purposes are to amend the Suicide Act and to legalise somebody’s ability to assist someone else in killing themselves. We should be frank about that; that is what we are doing. If people find us being clear and speaking plainly about what we are doing either uncomfortable or distressing, that should make us pause and ask ourselves whether what we are doing is the right thing. We should not change the language to make the thing that we are doing more palatable. We should speak plainly about it then judge accordingly.

There are some real consequences. One of them was set out by my noble friend Lord Shinkwin when he referred to people with learning disabilities. The noble and learned Lord, Lord Falconer, will correct me if I have got this wrong, but I think that, when he gave evidence to the committee, he was clear that he wanted someone with a learning disability to have the same ability to access assisted suicide as anybody else, assuming that they meet the other eligibility criteria. My noble friend Lord Shinkwin put it very well when he said that people with learning disabilities need to have things explained in clear and straightforward language. That is really important.

In an earlier debate, my noble friend Lord Markham talked about relying on the experts, but we cannot do that because we know that they do not always make the right decision. We know that, during the Covid pandemic, many people with learning disabilities were given “Do not resuscitate” notices because some people had made the decision that their lives were not as worthwhile as others. People made decisions about them that they would not have made about somebody who did not have a learning disability. It is important that we make sure that the language we use about this decision, which could not be more important, is understandable and that the consequences are understandable for everybody who will be impacted by such a decision. My noble friend Lord Shinkwin made that point well.

My noble friend Lord Frost has already made the point about the use of the phrase “committing suicide”; I reflected on it before I signed his amendment. Personally, I do not like using that phrase—the “commit” piece, not the “suicide” piece—so I paused before I signed his amendment. However, I thought that having a debate and pressing on clarity was important. Obviously, we are in Committee. If my noble friend were to bring forward these amendments on Report, I would want to work with him on the language. I think that removing “commit” would be better because, as my noble friend correctly said, the Suicide Act has removed that vocabulary.

But using the word “suicide” is accurate. Just because somebody has a terminal illness, that does not mean that in taking their own life they are not committing suicide. It is important because it gets through to people the consequence of what we are doing here and the fundamental reshaping we are doing to the way in which society looks at this. That is why so many of us are concerned about it.

Rare Cancers Bill

Lord Winston Excerpts

2nd reading
Friday 16th January 2026 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I am delighted to pledge the Government’s full support for this Bill. It is very much aligned with our commitments, it strengthens the research ecosystem and, most importantly—I agree with many comments today—it gives hope to patients and families affected by rare cancers. I am glad that the Bill has the support of the noble Lords, Lord Kamall and Lord Palmer, on behalf of their Benches.

I am most grateful to noble Lords for their points and proposals today. I will be reflecting on them after this debate with the Minister in this area, Ashley Dalton MP, and also Zubir Ahmed MP. I was very touched that so many Peers shared their personal experiences, whether their own or those of their loved ones. I feel that the Bill stands in tribute to the memory of so many, including the late Baronesses, Lady McDonagh and Lady Jowell. It also stands in tribute to the memory of so many who I believe have been brought into the Chamber today by the very touching words and reflections of so many noble Lords. I realise how difficult that is.

I congratulate my noble friend Lady Elliott on her tenacity and clarity in bringing forward this important Bill before the House. I associate myself with the thanks to the many campaigners and charities who have worked on this for so many years, and I know they will continue to do so. My noble friend Lady Morgan made that point particularly clearly. I say to the House, and particularly to the noble Lord, Lord Kamall, that the Government are quite clear that no patient should be left behind simply because their cancer is less common.

The national cancer plan is soon to be published— I heard what the noble Lord, Lord Polak, hopes will be in there, and he will not have to wait too long for it—and it will build on the progress of this Bill. They work very well together, because they both seek to improve outcomes for cancer patients across the country, including those with rare cancers. It is by fighting cancer on all fronts—prevention, diagnosis, treatment and research—that we will make that change.

Much has been said today, and rightly so, about a number of cancers, but I want to say a particular word on how little is currently known about the prevention, diagnosis and management of brain tumours. They remain one of the hardest cancers to treat, and we also know how crucial early diagnosis is for improving survival rates for all cancers, including brain tumours. That is why we have committed to an additional £6 billion capital investment on new diagnostic, elective and urgent care capacity. The noble Lord, Lord Patel, called for genome sequencing for brain tumours. I can say to him that the national cancer plan will include detail on how we ensure that patients have access to the latest treatments and technology, including genetic treatments.

Important points were raised by the noble Baroness, Lady Grey-Thompson, and the noble Lord, Lord O’Shaughnessy, among others, about how the £40 million commitment to NIHR funding for brain tumour research will be met. That commitment absolutely remains in place, but there is no upper limit to our funding of high-quality brain tumour research and we are committed to exceeding the £40 million target. I should also add that there is no limit to our funding of high-quality childhood cancer research.

Clinical research, rightly, is at the core of this Bill. It is one of the most powerful tools that we have. I believe that the Bill will complement the ambitions in our 10-year health plan and the forthcoming national cancer plan to embed that research across the NHS and give patients greater control. It will make it much easier for researchers to connect with patients with rare cancers and streamline the recruitment for clinical trials and will ensure our regulatory framework delivers for those who need it most.

The noble Lord, Lord O’Shaughnessy, and the noble Baronesses, Lady Finlay and Lady Browning, raised the database. The database is live across the UK; it is a UK-wide registry. I urge everyone to sign up to be part of research in order to connect with trials. The noble Baroness, Lady Browning, also asked about strengthening the orphan drug regulations. We must ensure that there is a detailed review before any decisions are made on the regulations.

I say to the noble Lord, Lord Polak, that we will ensure that we do all we can to improve how we use data for research and raise public awareness of consent. I certainly fully support the digitisation of advance consent, which he referred to.

It is key that we incentivise research and continue to support and develop cutting-edge research for rare cancers and other rare diseases through the NIHR. For example, in December, we launched a pioneering new brain tumour research consortium to accelerate research into new treatments through the NIHR, which is investing an initial £13.7 million, with significant further funding expected to be announced shortly. We are also ensuring the effective co-ordination of research from other funders and charities through the Office for Strategic Coordination of Health Research, which is chaired by the noble Lord, Lord Kakkar.

We published Transforming the UK clinical research system: August 2025 update outlining how we fully delivered against all the recommendations in the review conducted by the noble Lord, Lord O’Shaughnessy, who I thank for his work on commercial clinical trials. We will go still further to deliver on our 10-year health plan and cut clinical trial set-up times to under 150 days by March—a target driven by the Prime Minister. We are taking forward the most significant reform of clinical trials regulations in more than 20 years. We need a more efficient and adaptable regulatory framework, and that is what we will deliver.

Concerns were raised about timings of implementation and market authorisation of clinical trials. The timeframe in the Bill is a legal boundary, and we certainly expect to publish the report rather sooner. The noble Lord, Lord Mott, asked about the UK’s ranking for approving orphan drugs. The lessons learned from the review of the regulations will inform how we best approach the regulation of UK orphan medicines.

On the abolition of NHSE, work is under way on primary legislation. That will enable its functions, powers and responsibilities to transfer formally to the department. That will include responsibility for this Bill. I heard loud and clear from a number of noble Lords the wish to see a speciality lead for rare cancers in post and getting to work as soon as possible. I certainly agree on their importance. I heard what the noble Lord, Lord Blencathra, said, but this is the way we will go forward. We will ensure that that appointment is made as soon as possible.

As I said at the outset, many useful points have been made. They will be part of our consideration, but the main thing I want to say is how glad we are to fully support this Bill and how we will do all we can to help progress it. It reflects ambition and our support for the goal for the UK to be the global leader in clinical research, which noble Lords called for. This is about patients, particularly those facing rare cancers. They deserve and need greater choice, speed and opportunity to participate in vital studies. Every breakthrough is key because it means that we can maximise people’s access to the benefits. I thank my noble friend for bringing the Bill forward, all noble Lords who have contributed and all those who continue to champion its cause.

[Lord Winston (Lab)]

I apologise for keeping the House waiting a moment longer, but I want to ask the noble Baroness something very important. This has been a fantastic debate of a high standard, in the best interests of the House of Lords. There was a great focus on focused research on rare cancers, but does she agree that continued basic research on cell biology, embryology and a whole range of things about cell development, which has contributed so much to cancer research and to rare cancer research, is also important?

[Baroness Merron (Lab)]

As my noble friend said, this has been an extremely valuable, well-informed and moving debate. At present, we are focusing on rare cancers because of the nature of the Bill, but I absolutely take his point about the importance of work outside rare cancers and the overlap with that. I thank him for it.

Emergency Adrenaline

Lord Winston Excerpts

Monday 15th December 2025 Lords Chamber

[Baroness Merron (Lab)]

I know that the noble Lord always seeks to be helpful. That is indeed a helpful suggestion, which I will gladly take away, but I will not be able to give a commitment, as the noble Lord is aware.

[Lord Winston (Lab)]

My Lords, I was a little unhappy with the answer to the question from the noble Lord, Lord Patel. My understanding, having seen medical students being given injections of adrenaline during a physiology class to see what would happen—in larger doses than you would probably need in this case—is that they might feel a bit faint. I would have thought that giving a non-injection method is even safer and that the likelihood of side-effects is much lower. Is that not fair?

[Baroness Merron (Lab)]

I am sure that is fair and I certainly bow to my noble friend’s expertise in this regard. I thank him for that, and I thank the noble Lord, Lord Patel, for his question. However, I feel a little inadequate on the medical front here.

Terminally Ill Adults (End of Life) Bill

Lord Winston Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Lord Winston (Lab)]

I am grateful to the noble Lord for giving way. I just wonder what he feels a GP should do in the circumstance in which he does not approve of assisted dying? Does the noble Lord feel that that is a problem?

[Lord Rook (Lab)]

With the greatest respect, that is not the conversation I am trying to have here. The conversation is about the necessity that someone who is going through the process has continuity of care and a relationship with that GP. We are suggesting that someone who is after a state-assisted end-of-life process should have the opportunity to see that GP on a number of occasions so that their judgment can be made in the context of continuity of care, not in one appointment.

To pick up the noble Lord’s questions, this amendment would not block access. It would not frustrate autonomy. It would simply ensure that assisted dying does not begin from nowhere. It grounds a grave decision in a minimal but essential relationship with the health service that is charged with safeguarding the person in question. Supporting autonomy requires a supportive context. It requires knowing whether a request reflects a settled conviction, a moment of despair, untreated depression or pressure that the patient feels unable to articulate. These things cannot be reliably assessed in isolation. Above all, care is relational. If Parliament is to contemplate legislation under which the state may participate in deliberately ending life, the very least we must insist on is that such decisions take place within the context of real and primary medical relationships, not on the periphery of the system.

This amendment would strengthen residency safeguards, improve the evidential foundation for clinicians, reduce the risk of doctor shopping and respect the seriousness of what the Bill proposes by rooting it in genuine and consistent care. I commend the amendment to the Committee.

--- Later in debate ---

[Baroness Butler-Sloss (CB)]

Yes, I entirely agree. That is the basis of what I am saying. I think it would be admirable if anyone who was seeking assisted dying in fact had the opportunity to be known by the local GP. All I am saying is that, yes, I am lucky, but I do not actually know my GPs. Of course, I accept what the noble Baroness, Lady O’Loan, says: there are many people who never meet their GPs and never have access. That is why it seems to me that what is required cannot be achieved. That is all I am saying.

[Lord Winston (Lab)]

My Lords—

[Baroness Coffey (Con)]

My Lords, should we not hear from the noble Lords who have tabled the amendments before we—

[Baroness in Waiting/Government Whip (Baroness Anderson of Stoke-on-Trent) (Lab)]

My Lords, can we follow the normal courtesies of the House, please? As the noble Baroness was not here at the beginning of this group of amendments, she cannot participate on this group of amendments. I urge noble Lords to take note of where we were and move forward.

[Lord Winston (Lab)]

My Lords, the noble Baroness, Lady O’Loan, in fact destroys her own argument, because access to GPs, unfortunately, is still a major problem. In that respect, I greatly congratulate the noble Baroness, Lady Gerada, who gave a fantastic maiden speech yesterday explaining the role of the GP and the ideal situation. The fact is, in this Chamber, there will be a number of people who, quite rightly, absolutely deplore or disagree with assisted dying, as they have every right to do.

It is also true that, in my practice many years ago, I saw patients who had requested termination of pregnancy—certainly, in more than one case. However, there is one particular patient who I remember very clearly. Several years after the Abortion Act had been agreed to and had started, I saw a patient who came into the hospital having been refused referral by a GP because he disapproved, as he was entitled to do, of abortion. She did not get a further referral. She went to an illegal practitioner in the East End of London and ended up with infection of the uterus and was in bed for several weeks with septicaemia. She did not die, but her laparotomy required her uterus, tubes and most of her pelvis to be removed. That is the risk. It is always going to be the case that individual GPs have the absolute right to decide how they might handle a particular difficult ethical issue. Of course, the problem here is that these vary from patient to patient; we have to understand that, and simply relying on the GP in this way seems to me to be deeply flawed.

[Baroness O’Loan (CB)]

My Lords, it is very regrettable that the noble Lord had a patient in an abortion situation. We are not, in this group, discussing the doctor’s wishes or otherwise and his views about abortion. I ask the Minister, because I can hear mutterings here, what provision says that you cannot intervene in a debate where you have not been present, perhaps, at the very first moment of the debate? What is the section in the Companion that provides for that?

--- Later in debate ---

[Lord Winston (Lab)]

Forgive me. What the noble Lord is saying is very interesting, but could he possibly keep to the amendment? The amendments are quite tricky and really do need discussion.

--- Later in debate ---

[Lord Mackinlay of Richborough (Con)]

My Lords, I will speak for just a couple of seconds as I am very mindful of time. I support Amendments 24 and 458 in the name of the noble Baroness, Lady Grey-Thompson. We have had very little debate about the issue of pregnancy. I am quite shocked by that, given that there are administrations around the world with many years of experience, such as Oregon, which had similar legislation in 1997, and Belgium, which had it in 2002. They considered the issue of pregnancy during these very delicate discussions on assisted dying.

I am somewhat disappointed and concerned that the noble and learned Lord, Lord Falconer, has not addressed this, and I really hope that this can be addressed on Report. There is a world of difference between a very early pregnancy and a baby close to full term, which is reflected in our Abortion Act. May I therefore give the noble and learned Lord some advice? When this does come back on Report, the issue of pregnancy should be addressed, as it has been in other jurisdictions.

[Lord Winston (Lab)]

My Lords, as Amendment 24 has been tabled and pregnancy has been spoken about, I now feel that I ought to just make one point very quickly. The noble Baroness, Lady Grey-Thompson, quite rightly presented a lot of statistics about cancer, but that she did not address the issue of cancers of the pregnancy itself. That is a serious issue. Choriocarcinoma, for example, is a fatal disease; it is rapidly metastatic, can cause issues all over the body and is not easily treatable. It could easily be that somebody who was pregnant with that, who would test pregnant with that condition, would be eligible. I therefore ask the noble Baroness to consider not pressing her amendment and to reconsider the wording of it, because I do not think that it would be an acceptable amendment later on. Both early in pregnancy and in late pregnancy, this would be a real risk.

[Lord Mackinlay of Richborough (Con)]

I will just come back on that, if I may. I would also say that the wording in the amendments in the name of the noble Baroness, Lady Grey-Thompson, is insufficient, because it is a far more complex issue than that. As I said, there is a world of difference between a very early embryo in the first few weeks and a close to full-term pregnancy. I certainly hope that this Committee would agree that point.

--- Later in debate ---

[Baroness Grey-Thompson (CB)]

My Lords, I thank all noble Lords for this thoughtful and considered debate. As ever in your Lordships’ Chamber, the debate did not go quite the way I was expecting. This has been quite a catch-all group trying to cover a number of very complicated issues. I thank the noble Lord, Lord Kamall, for summing up. I will not seek to sum up all the contributions, but I will pick up a few points.

The noble Baroness, Lady Berridge, asked me about pregnancy. There is very little data on the numbers and one of the challenges is that recording and reporting are very different in different jurisdictions. In somewhere such as Oregon, where the data is destroyed a year after death, it is hard to follow up and interrogate the information. Many jurisdictions around the world do not require a pregnancy test, but that puts a lot more pressure on doctors as it is then up to them to assume or guess whether or not a woman is pregnant. Whether she is showing or not, do they accept the request for assisted dying? It is really worrying for those doctors, because if it is later found out that the woman was pregnant in jurisdictions where there is a penalty for the doctors, they might find themselves less likely to want to carry out an assisted death.

[Lord Winston (Lab)]

Does the noble Baroness not accept that there are certain cancers that will give a positive pregnancy test and also be killing the patient, in a very serious condition?

[Baroness Grey-Thompson (CB)]

I thank the noble Lord; I will cover that later in my summing up, if that is okay, but I will come to back it. What happens in other jurisdictions makes it really difficult for doctors, which means that we need clarity in this Bill about what would happen in those situations.

Many noble Lords discussed the vulnerability of prisoners. This debate has shown that it is not that simple. I have visited many prisons and young offender institutions over the years and they are all very different places. I have met many people who have hope and some who do not. The noble Lord, Lord Deben, articulated my thoughts on the circumstances in which prisoners find themselves very well.

I debated long and hard whether to use this example. The noble Lord, Lord Farmer, talked about moral hazard. There is the case in Australia of Daniel Hume, who was six years into a 30-year sentence for paedophilia. He had a terminal condition and exercised his right to die. His daughter said that she and other victims felt robbed by him being able to access assisted dying. This highlights the complexity of the issues we are dealing with. I hope I am a kind person—I believe in rehabilitation for prisoners—but these are not easy things that we are trying to sort out or get to the bottom of. I have very complicated views on all these issues, as I know many noble Lords do. It is absolutely something that we have to come back to.

I was probably expecting the answer from the Minister on Articles 8 and 14. I am not convinced that we have Article 2 quite right. I thank the noble Lord, Lord Winston, for his intervention and I would be very happy to take his advice. I tried to keep my opening speech very close to 10 minutes, rather than the 15 minutes I am allowed, so there are lots of areas I was unable to discuss in my opening speech. I accept what the noble Lord said—he has far more experience of pregnancy than I do—but that just throws another complication into the mix in respect of what we are trying to sort out. I will welcome his advice on rewording my amendments, should I choose to come back with them.

I would like to thank the noble and learned Lord, as well as the honourable Member for Batley and Spen, who I am meeting next week to discuss some of my amendments. I hope that we can get a bit more clarity in that meeting on the amendments we are discussing. I thank the noble Lord, Lord Mackinlay, for his intervention. I think there is a line—I am sorry, I am jumping back to pregnancy—when it comes to what we do and at what point we do it. I believe that the noble and learned Lord and I have agreed to disagree on the safeguards in the Bill.

I would like to make a correction. I am serious about my amendments, although I could have worded them better. I did not intend for men to have a pregnancy test, and I did not intend to get into a debate about age and the pregnancy test. The reason why I tabled the amendment on a pregnancy test was to allow women to understand all the implications of what they are getting into and to be able to make a choice. They may or may not choose to do something differently with that information.

I thank all noble Lords who have contributed to the debate this afternoon. With that in mind, I beg leave to withdraw my amendment.

Terminally Ill Adults (End of Life) Bill

Lord Winston Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Winston (Lab)]

My Lords, I suggest that the noble Baroness, meaning absolutely well in a clearly very emotional area, has forgotten the real science. She is not a neuroscientist; indeed, I do not think that the commissioner is a neuroscientist. The greatest expert in the United Kingdom on teenage neuroscience is almost unquestionably Sarah-Jayne Blakemore, who works partly in London, partly in Cambridge and of course has been working extensively at UCL for a long time. She has studied teenagers in great detail, and it is very clear from her work on teenagers making decisions that they can make decisions in the right environment and in the right circumstances. I think one has to be very, very careful about making assertions about teenagers. There are many people well over the age of 25 who cannot make these decisions either. I think we have to be quite clear that we may need to take this sort of thing into consideration, but I do not think it is necessarily relevant to this amendment.

[Baroness Stroud (Con)]

My Lords, I want to speak in support of the noble Baroness, Lady Berger. I will limit my remarks because some of them have already been made by previous speakers. I think the reality is that maturity is a scale and choosing to proceed with assisted dying at the age of 18 poses difficult questions, which we must grapple with, about the neurological maturity required for true, settled and informed consent on a matter of such gravity, and not just particular circumstances. I intend to speak in a subsequent group to Amendment 22 in the name of the noble Baroness, Lady Grey-Thompson, but some of the points I will make then are also relevant to this group.

I note that research undertaken by the Sentencing Council in 2024, which focused on aggravating and mitigating factors in sentencing guidelines, has this to say about age and maturity:

“Age and/or lack of maturity can affect … the offender’s responsibility for the offence and … the effect of the sentence on the offender. Either or both of these considerations may justify a reduction in the sentence”.


The report goes on to note:

“In particular young adults (typically aged 18-25) are still developing neurologically and consequently may be less able to: … evaluate the consequences of their actions … limit impulsivity … limit risk-taking … Young adults are likely to be susceptible to peer pressure and are more likely to take risks or behave impulsively when in company with their peers”.


I do not want to cross over into debate on the subsequent group, but this seems highly relevant to our deliberations on the appropriate age for assisted dying. Of course, age and maturity are mitigating factors only, and therefore discretionary, but it seems extraordinary to me that the principle of maturity is one which is accepted in a legal context, and there remain calls for dedicated sentencing guidelines for 18 to 25 year-olds in recognition of this, yet the Bill as drafted does not seem adequately to account for this in a similar manner with regard to the permanent decision to end one’s own life. I would be grateful if the noble and learned Lord, Lord Falconer, could comment on this when he responds to the debate.

The autonomy on which the Bill is purportedly built must be grounded in safeguards commensurate with the irreversible nature of the proposed act. With regards to the age of eligibility, I do not believe the Bill as drafted meets this standard. For these reasons and more, I support the amendments in the names of the noble Baronesses, Lady Berger and Lady Lawlor, as well as those in the name of the noble Baroness, Lady Goudie, and the noble Lord, Lord Moylan.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

The issue with the Mental Capacity Act is that each assessment must be done individually. It relates to the decision that is to be made, the size of the decision, the time and the personal characteristics. There is no absolute. If we are talking about safety in relation to the Bill and avoiding abuse, I am simply trying to suggest that one way forward may be to ensure that the assessment of young people’s eligibility is particularly thorough. That may mean having different criteria and looking at whether they have pain or suffering.

[Lord Winston (Lab)]

I wonder whether the noble Baroness might be kind enough to clarify. She is, after all, a hugely respected individual in the field, of which she is such an expert—I do not doubt that for a moment. Sarah-Jayne Blakemore, a fellow of the Royal Society, has been spending her time looking at peer pressure. That is what her publications have largely been about. Is the noble Baroness really suggesting that a young person of, say, 18, dying of a horrible and painful cancer, would be subject to peer pressure? They might be subject to pressure from doctors but I doubt that they would be subject to peer pressure.

[Baroness Finlay of Llandaff (CB)]

I was simply relating what I found when I was in the Netherlands relating to peer pressure on young people because of the normalisation of euthanasia across that society.

Brain Tumours: Causes and Treatment

Lord Winston Excerpts

Monday 24th November 2025 Lords Chamber

[Baroness Merron (Lab)]

It is an important point, as the noble Lord, Lord Sharpe, raised. As I said, the national cancer plan will give that opportunity to address challenges and needs such as those the noble Lord raised. We are also establishing a brain tumour research consortium through the NIHR, which will bring together researchers from different disciplines. The scientific advancements it will drive will be how to prevent, detect—to the point raised by the noble Lords—manage and treat brain tumours. That will also be of great assistance.

[Lord Winston (Lab)]

My Lords, the Government should be congratulated on trying to improve their work on brain cancer. Talking about treatment, one of the issues is that one of the greatest advances and most important areas is brain imaging using magnetic resonance imaging, PET scanning and even electrical recording in a sophisticated way, but access to these important technologies still seems somewhat deficient. Will the Minister say whether the NHS has plans to increase access to brain imaging? It seems a very important area in treatment.

[Baroness Merron (Lab)]

We certainly want to see services properly available across the country and people not being disadvantaged because of where they live or what the services are. Again, from what I know of it—we will soon see it—the national cancer plan will improve every aspect of cancer care, including outcomes for those with brain tumours and access to the services my noble friend outlines.

Terminally Ill Adults (End of Life) Bill

Lord Winston Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Baroness Hollins (CB)]

I thank the noble Baroness. I thought about that, and it could indeed be brought back in a different way later in the debate, but I feel that the prevention of coercion is really important, so thinking about it at this stage is really helpful.

[Lord Winston (Lab)]

My Lords, I want to ask this question of the noble Baroness, Lady Hollins, but it applies also to the noble Baroness, Lady Berridge: she mentioned various things that are cited as causing pressure, but does she not agree that being in palliative care also causes pressure?

[Baroness Hollins (CB)]

There is no suggestion in anything that I have said of imposing palliative care—none at all. I have listened to the debate, and I was not going to speak personally but I will now, since the noble Lord has challenged me on that. My husband was dying with motor neurone disease last year. He felt under immense pressure from this debate in the House of Commons, the other place. He found it very difficult. It made him ask questions, such as, “Am I still entitled to palliative care? Am I really entitled at a time when the NHS is so short of staff and short of time?” He worried about that, and I had to offer him a lot of reassurance so that he could make his own decision. He was not ready to die. The idea that offering palliative care applies pressure is really not to understand the whole nature of the dying process and the way in which, as we come to realise that our life is coming to an end, we need time to understand, reflect, heal and make sense. The pressure not to be a burden is huge, and the pressure of not having access to services that are in short supply is much worse.

[Lord Winston (Lab)]

I do not wish to extend this conversation but, given what the noble Baroness has said, can she explain why in Australia—I am sorry, in New Zealand—where there is very good palliative care, three-quarters of the people requesting assisted dying, something like 2,000 patients, had been in palliative care at the time of the request?