Terminally Ill Adults (End of Life) Bill (Second sitting)

Marie Tidball Excerpts

Committee stage
Tuesday 28th January 2025 Public Bill Committees

[Juliet Campbell]

Q So rather than going straight to “I have made this request, or this has been suggested to me, and this is the path we are going down,” there is something that should happen in between.

Professor Ranger: Well, you would not really want any clinician to push this view on any patient. It has to come from the person themselves. That is the key thing around capacity and autonomy. I do not think that people should ever say to a patient or an individual, “Is this something you have considered?” It has to be led by the patient.

[Dr Marie Tidball (Penistone and Stocksbridge) (Lab)]

Q Professor Ranger, may I pick up on the points that Glyn Berry made about the different circumstances in which patients find themselves? The barriers to healthcare as a result of health inequalities, access to education and disability are well documented. How could your members help to remove the barriers for such groups in access to the provision of assisted dying?

Professor Ranger: It is vital that any of those barriers be removed and that we always maintain outstanding care at the end of someone’s life. The reality is that the majority of palliative care is given by nursing staff, whether it is in the community, in someone’s home, in a hospice or in a hospital. It is key that it be an expertise and a specialist practice in which someone has extra training and extra education. The skills of listening to patients, advocating for them and ensuring that they are pain-free at the end of their life—these are skills that nurses have now, and it is vital that our nursing members maintain them. They are often the one a patient will speak to at 3 in the morning when no one is there.

As Glyn said, it is vital that the wider team be included in the Bill. The Bill talks about the guidance and recommendations being for the chief medical officer, but I think it is absolutely vital that the chief nursing officer be a key part of the guidance and the drawing up of any care, because even in these circumstances it is nursing staff who will give the majority of the care.

[Dr Tidball]

Q To pick up on your important point about advocacy, how would your members detect coercion, undue pressure or dishonesty by family members or other supporting parties on which the patient was relying in relation to seeking assisted dying? At what point would there be a report to the police by your members?

Professor Ranger: Safeguarding is part of our professional responsibility now. Whether it is for a child, an adult or an elderly person, part of our role is to be vigilant against financial misconduct, physical abuse and mental health abuse: any of those things is a responsibility of every nurse now. It is a very good and simple process. You do not have to investigate or give a judgment; you need to refer it to be investigated. That takes the pressure off an individual clinician. Our job is to be vigilant and to refer safeguarding anywhere we think that there is any form of abuse. I think that that process would remain and could be part of how we do things now.

[Dr Tidball]

Q Just to follow up on that, because it is really important: do you think your members would have the ability to pick up on such coercion, dishonesty and pressure from other parties potentially being placed on a patient who is seeking assisted dying? What other training or support would be needed for your members?

Professor Ranger: We would want more support. I am not going to say that we always get it right. Sometimes things happen that we miss and we do not report. I cannot say that we get it right 100% of the time. When the Bill talks about education and training for medical staff, it is absolutely vital that nursing staff are included because we will need to be vigilant around anyone feeling they are a burden.

The Bill would add other skills that we want to make sure that nurses are included in. Education for medical staff is absolutely pertinent for nursing staff, so that nurses build on skills they already have. There will be a difference between the care of someone wanting assisted dying and palliative care. Those are two slightly different skills and it is really important that they are not always lumped together. Being involved in assisted dying will require a specialist skill and specialist training, and we would very much want nursing to be included within that.

[Dr Tidball]

Q But you believe that your members would be able to pick up on and identify issues such as coercion?

Professor Ranger: I do. They are professionals, and I believe they would be able to.

[Jack Abbott]

Q My question, which relates to some of the points made earlier, is for Glyn Berry. Your organisation has recommended a new role: the approved palliative care professional. To go into the detail a bit more, you make a number of recommendations on what that role would include, such as ensuring that the person has the mental capacity to make the decision. First, are you therefore saying that this new role should sit alongside the two-doctor process, which has already been outlined in terms of final decision making? If the approved palliative care professional felt, for example, that this person did not have mental capacity, should they be able to, as it were, stop the process?

Secondly, what level of training would that person need in terms of time? We have, for example, been talking about a two-year process. If this new role came into effect, how long would that person need to be trained for to fulfil it adequately? Thirdly, do you have a sense of how many of these professionals we would need to make this a functioning system? Those are three separate questions.

Glyn Berry: To answer the first question, we feel, for the reasons I outlined earlier, that the role of an approved palliative care professional would sit beside the role of clinicians, balancing clinical and social observation and assessment.

In terms of the training, we, as social workers, already have continuous training opportunities to become best interests assessors, practice educators and approved mental health practitioners, so we envisage that the training would very much be along those lines. Doing those roles currently requires a course of training at university.

Our thoughts, at the moment, are that that would be for palliative care social workers, whether they are in charities, trusts or local authorities, or are independent, because that is where things sit with us at the moment and we know our roles. We like to think that it would roll out to other professionals, however, because assessing capacity is not specifically the role of the social worker; other professionals are able to, and do, complete capacity assessments.

It is quite difficult to answer your question in terms of numbers at the moment. If we were talking specifically about palliative care social workers, we currently have around 200 members in our association, but there will be other people out there who are not members and we do not know who they are. It is a role that could expand.

One of our other recommendations is that palliative and end-of-life care, as an aside to your question, is also brought into qualifying roles for people in training, such as doctors, nurses and allied health professionals, as well as social workers. We could see that happening in the future.

Terminally Ill Adults (End of Life) Bill (Third sitting)

Marie Tidball Excerpts

Tuesday 28th January 2025 Public Bill Committees

[Sean Woodcock (Banbury) (Lab)]

Q Coercion is one of the main issues that people who are concerned about the Bill raise in opposition to it. That would include myself. We had many distinguished witnesses this morning, and the view was that coercion is “rare” in healthcare generally. It was almost given across that we did not need to worry about it, because staff are so well trained in safeguarding and so on, and they have such a level of experience. What are the views of the panel on that? Is coercion something that we should really not be so concerned about?

Dr Clarke: Based on my clinical experience, I would push back on that in the strongest terms. I am the kind of doctor who believes there is nothing to be gained from sugar coating reality. We have to be absolutely honest with patients and the public about shortcomings, failings and areas where my profession and the rest of the NHS are getting things wrong.

It is my clinical experience that not only are the majority of doctors not necessarily trained in spotting coercion explicitly, but they are often not trained explicitly in having so-called advance care planning conversations with patients around the topic of death and dying, and how a patient would like the end of their life to proceed. It is almost impossible for me to overstate how much avoidable suffering occurs right now in the NHS not because of a lack of resources for palliative care—although that is an enormous problem—but because of a lack of confidence, skill and expertise among the medical profession writ large with these very difficult conversations.

We are all familiar with the idea of death and dying being a taboo in society. People are scared of it, and they hesitate to bring it up with their friends and family. In my experience, many medical students and doctors also suffer from that anxiety. They are scared, and they find it a taboo subject. What that means is that sometimes coercion occurs because the doctor—the consultant responsible for this person’s care—will not even bring up the fact that they think the patient is dying, because it is an uncomfortable conversation. Conversely, I have worked with senior hospital consultants in the NHS who have deliberately prevented our team from accessing their patients, because they believe that the hospital palliative care team wants to kill the patients, and that if I go and see the patient, I will give them a lethal dose of drugs.

These are the kinds of extraordinary misunderstandings and failures to prioritise patient autonomy that are happening now. That is even before we get started on conversations around whether someone would like to consider assisted dying, so it is a huge problem.

[Dr Marie Tidball (Penistone and Stocksbridge) (Lab)]

Q My question is for Dr Ahmedzai. The Select Committee inquiry into assisted dying received evidence that there were not any indications of palliative or end-of-life care deteriorating in quality or provision following the introduction of assisted dying. Indeed, the introduction of it has been linked with an improvement in palliative care in several jurisdictions. I have two questions, if I may. What more could the Bill do to strengthen the available choice at the end of life and the regulation of these choices as set out in the codes of practice? If you could answer that one first, I will come back to my second question.

Dr Ahmedzai: I have visited many of the jurisdictions around the world—such as Oregon, where I met the original judge who brought in the law, as well as the doctors, nurses and patients involved—and it was clear to me that if patients had not accessed palliative care, they were pointed towards it. Obviously, you cannot force anybody to go and have palliative care, but they were certainly informed about it.

In the Netherlands, I commend a system for doctors called SCEN—support and consultation on euthanasia in the Netherlands. These are trained doctors working for the equivalent of the BMA, I believe, who, as Dr Clarke has referred to, are going and supporting doctors who are not familiar with things. They often come from a background of palliative care and pain medicine, so they are making options available that other doctors in the process, for instance, have not brought up. In Australia, there is clear evidence that palliative care is becoming more available.

The European Association for Palliative Care produced a report more than 10 years ago in which it examined all the countries in Europe at the time, and it found there was evidence that palliative care was improving in scope and availability alongside the forms of assisted dying that were happening there. I am reassured that bringing in some form of assisted dying, particularly the form proposed here, would be a boost to palliative care.

One of the things I would like to see is that anybody who is involved in the process is constantly asking the patient, “What about palliative care? Have you actually accessed it?” Right now, if they have not raised their hand and asked for assisted dying, no one has that conversation with them. They are in a vacuum and a bubble, and not receiving palliative care, whereas this provision would possibly make it more available.

[Dr Tidball]

I have two follow-up questions on that basis.

[The Chair]

Order. I do not want to squash any discussion, but I ask Members and the panel to bear in mind that we have until 3.15 pm for this session. I will be as lenient as I can with questions.

[Dr Tidball]

Q On the basis of your 39 years of experience and the Select Committee evidence that I mentioned earlier, do you acknowledge that improvements on both assisted dying and palliative care can run in parallel and do not need to be mutually exclusive?

Dr Ahmedzai: In the interests of brevity, yes.

[Dr Tidball]

Q You talked about the role of medical practitioners discussing this issue, which is of course in clause 4(2) of the Bill. Paragraph 4.2 in your own evidence was very helpful in discussing that, as it makes it clear that it is

“entirely consistent with current medical practice and with compassionate care”

to raise assisted dying. You also said that raising the topic did not have adverse effects. How could clause 4 be strengthened to ensure that patients are presented with a range of treatment options at the end of life and relay any concerns that others have raised about suggestibility where this is mentioned in isolation?

Dr Ahmedzai: That is a complicated question. The first point is that right now, as Dr Clarke pointed out, it is scary to patients to be told that they may actually be receiving palliative care. When it has been mentioned—by an oncologist, for example—many patients say, “I do not want that. Don’t let them come anywhere near me or anywhere near my relatives.” It is not unusual that people may have an adverse reaction to just hearing about the service, but here the difference is that the person has actually asked for it.

I personally believe that it would be advantageous if there was formal training, as Dr Clarke has mentioned, specifically to have the kinds of conversations that we now talk about, such as about psychological issues and suicidal tendencies. It used to be thought that if you mentioned suicide to somebody, it would give them the idea, but of course it does not; it saves them, because they say, “Thank you. Yes, I was having those thoughts.” Bringing up assisted dying is never going to be harmful to the person, even if they had not thought of it. They will just say, “Well, it is not for me.”

[Dr Tidball]

That is very helpful; thank you.

[Rebecca Paul (Reigate) (Con)]

Q My question is to Dr Sarah Cox. What do you think will be the impact on palliative care of introducing assisted dying?

Dr Cox: Professor Ahmedzai has talked about the evidence, which was written up to 10 years ago. There is actually more recent evidence, looking at the last 10 years, where European countries and American states have been assessed in terms of the development of palliative care services. That more recent evidence shows that although palliative care services have improved in those countries where assisted dying has been implemented, they have improved three times more in countries where assisted dying has not been implemented. The evidence from that study shows that the implementation of assisted dying is impeding the development of palliative care services.

The other thing we are really concerned about is the impact on funding. It is unclear how this is going to be funded. It looks as if it is going to be within healthcare, and if so, there will inevitably be competition with other aspects of healthcare, including palliative care, for those limited resources. There are finite numbers of doctors, nurses and side rooms in hospitals. If palliative care and assisted dying were funded from the same pot, I think there would be a massive detrimental effect on palliative care because we would be in competition for a limited resource.

I am also concerned about our palliative care workforce, which we know is already in crisis. Eighty-three per cent. of our members told the Royal College of Physicians in 2023 that they had staffing gaps, and more than 50% were unable to take leave because of those staffing gaps. Forty-three per cent. said that if assisted dying were implemented within their organisation, they would have to leave. This has a massive impact on palliative care, in terms of its potential to develop both our funding and our workforce, who are really concerned about this.

--- Later in debate ---

[Naz Shah]

Q Following up on that, in the cases in which you authorised prosecution for murder or manslaughter, were issues of coercion ever involved? What were the bold points—the top lines—of those prosecutions?

Sir Max Hill: That small handful of cases involved an elderly couple where either he—it was usually a he—or she had chosen to bring to an end the life of their lifelong partner and, once that act had been carried out, claimed that it was an assisted suicide in circumstances where the surviving partner was merely carrying out the wish of the person now dead. There are a handful of cases in which that is clearly wrong and should not be accepted and where murder should be the offence brought before the court.

The point, though, is that throughout the time that I served as DPP—and, indeed, the time served by all my predecessors—we did not have the coercion offences created by the Bill, which I suggest would be a significant advance, and nor did we have a legal system in which the investigation was taking place before the death. It was the other way around. In each of the 27 cases I considered, the deceased individual was already dead, and that is when the scrutiny started. The major advantage of the Bill, if I can put it that way, is that that will be reversed, and scrutiny will be before death. In the case of coercion, where it fits the new potential clauses, prosecutions can—and, I am sure, will—be brought.

[Dr Tidball]

Q It is extremely helpful to understand the opportunity for scrutiny before death. Building on that point, are there any safeguards around those practices that are not currently included in the Bill but should be, particularly around detecting coercion and exploring alternative care options? I also have one follow-up question, if I may.

Sir Max Hill: I think that coercion and the coercion clauses in the Bill should be read alongside the capacity clauses. What we are looking for, as required by clause 1(1) and clause 1(2), is a clear, settled and informed wish, voluntarily made without coercion or pressure. Those aspects were taken, at least in part, from the Crown Prosecution Service guidance on 1961 Act cases. Capacity involves understanding information, retaining it, using it and communicating it. If those hallmarks are not there, you may be in a situation where you should be considering coercion. I think you read the two together.

To answer your question directly, the criminal liability clauses—clause 24, and the new offences in clauses 26 and 27—are robust. As a matter for your scrutiny, they are aspects that we do not have in the law at present. There is, of course, the addition of clause 36, under which you cannot be a witness or a proxy to the procedure that is enshrined in the Bill if you are too close to the terminally ill person. That is another hallmark of the Bill that will hedge against coercion.

[Dr Tidball]

Q I want to follow up, because this is really important in strengthening the Bill. Based on your prosecutorial experience, what key elements should be present in the definitions of coercion, pressure and dishonesty? I also have a bit of a technical question, if I may. Do you think they would be better placed in clause 26 or in clause 40, under interpretation? I am asking what more you can say on the key elements of coercion, pressure and dishonesty, and I am asking about their placement in the Bill to make them as accessible as possible to medical practitioners and patients who will want to rely on it.

Sir Max Hill: My inclination is that clause 26, which is part of the full body of the Bill, is the right place for this. As with the interpretation clause, clause 40, and as with the way we interpret statute as a matter of course, there are aspects of other statutory offences or Acts of Parliament that help us when we are seeking to determine what coercion is. The creation of the offence of coercion and control, now very commonly used in domestic abuse investigations and prosecutions, has brought us into this territory. It is not beyond the wit of anybody who seeks to use and interpret this Bill to also look for other parts of statute that deal with coercion.

I make the same point about capacity. What is in the Bill is very slender, one might say, because clause 3 simply invites the reader to look across to the Mental Capacity Act 2005. But that Act is very clear on what mental capacity is and how it is defined. I think what I am saying is that it is a drafting point, and I am not a parliamentary draftsman, but I do not have a problem with the definitions of dishonesty, coercion and pressure being in clause 26, where they are. It is not the only place one would look, though; there are other sources.

[Dr Tidball]

Q You have helpfully acknowledged the link that we need to make on coercion to strengthen this, but on the other two elements—dishonesty and pressure—is there anything else that we need to look to in order to make this more robust?

Sir Max Hill: “Dishonesty” is a term of art in common use, but it is also a term of statute. Anyone investigating or, still more, prosecuting would understand what dishonesty means. I accept that there is a wider point—not so much for interpretation but for understanding—that this Committee may want to consider, of how much of that existing definition needs to be imported into the Bill. As with mental capacity, I would suggest that, beyond perhaps the odd footnote, it is not necessary for you as a Committee to define again what dishonesty means, because we have it elsewhere.

Alex Ruck Keene: On pressure, I think the Committee would be really assisted by having a look at the learning of the High Court judges exercising their jurisdiction under the inherent jurisdiction in relation to people who are said to be vulnerable. They have developed an awful lot of tools, where they are trying to look at people in complicated situations—potentially, but not necessarily, with impairments—who are caught up in what one person brilliantly described as being caught in a spider’s web. Those are the sorts of sets of tools used when judges are trying to work out what is going on, and whether it is the side of the line we consider to be acceptable or the side of the line we consider unacceptable—because “pressure” is doing a lot of work there.

[Jake Richards (Rother Valley) (Lab)]

Q Thank you all for your written evidence. Sir Nicholas, in your helpful written evidence, you adopt Sir James Munby’s criticism of the current proposal for judicial oversight, and you instead recommend what you call a “Spanish-style specialist panel”. Could you set out for the Committee what you see as the benefit of that approach compared to what might be described as the stark judicial oversight of the High Court judge?

Sir Nicholas Mostyn: One per cent would be 6,000 deaths a year. If each took two hours to process in the High Court—you have to read it and hear the evidence; one of them has to be oral and you have to write a judgment—that is 12,000 hours. Each High Court judge does 1,000 hours in court—outside court, they do lots—so you are talking about nearly three quarters of the entire family division doing nothing but this. It is impossible, in my opinion, for this to be done by the High Court. It should be done in the Spanish way by a panel that is set up. In Spain, the chairperson of the regulator sets up a panel for each case—a doctor and a lawyer. They have to agree and they check that everything has been done lawfully. They do not make any value judgment about whether it is in the person’s best interest. They check that it has all been lawfully.

Interestingly, in 2023, 10% extra denials were done by the panel. I do not know whether that was because they were concerned about voluntariness or whether they were concerned about suffering—because the criterion is suffering there—but an extra 10% was done by the panel, so the panel was not just rubber-stamping. They denied an extra 10%. I believe that an ad hoc system like that, with a doctor and a lawyer doing a check, would be the best way of doing it. The High Court—trust me, I’ve just come from there—has not got the capacity to deal with 6,000 cases of this nature.

--- Later in debate ---

[Jake Richards]

Forgive me, Mr Dowd. I meant that, in terms of the assisted dying process in the Bill, there is no automated mechanism for family members, or indeed any third parties, apart from the doctors, to have notice of this intention. Is there a concern, regarding this appeal point, that perhaps interested parties would not know?

Sir Max Hill: I would suggest that the key to this is in clause 12(5), and that is why I have recommended just striking out the words “High Court” and putting in the word “panel”, and then reading the whole of clause 12 as amended, with those situations in which there are steps that “must” be taken—and there are many—and those in which there are steps that “may” be taken.

In clause 12(5), following that logic, we would imagine that a panel, just as the High Court,

“may hear from and question, in person, the person who made the application”

but

“must hear from…the coordinating doctor”.

The appellate mechanism, which I agree there needs to be, will be looking sharply at the operation of that subsection. In other words, when the panel made its decision to refuse, on what basis did it make that decision and from whom had it heard? We can well imagine situations in which a co-ordinating doctor, having taken his or her own steps to ascertain the views of the nearest and dearest, would satisfy the panel as to what the views of the family are. The reverse of that is that there is no indication here that, having gone all the way through the panel, the family would have been made aware or considered at all. I think that that will be a rare scenario, but I am not a medical professional. I think you can cover that, perhaps with some changes here or there on what you impose on the panel as a mandatory duty and what you leave by way of discretion, subject to the rules of procedure that the panel would then adopt.

[Dr Tidball]

Q I have a question for Sir Max Hill and Alex Ruck Keene. Your insight on clause 12 has been helpful. What procedures would you recommend be adopted for testing and, if need be, challenging the evidence as part of an evidentiary process linked to the panel that you set out?

Alex Ruck Keene: This is, for the moment, predicated on the fact that we are still in the High Court, as opposed to slightly making up policy on the fly about a panel. Assuming it is the High Court, it seems to me the Court has to be discharging a properly inquisitorial jurisdiction, which means it has to be armed with the tools to do that, which includes arming it with the tools to call for its own evidence. It also seems to me that the High Court would have to be armed with its own ability to not just receive evidence from one side and have someone testing it. That then brings you to the only player in town who could possibly do that, which would be the Official Solicitor as advocate to the Court.

I do not want to emphasise too much the question of resources, because if Parliament thinks this is sufficiently important, the resources will be voted through. But it is vitally important to note that the Official Solicitor is completely overloaded, and we would be asking the Official Solicitor to act as advocate to the Court in every single one of these cases. You could not have it be optional; you cannot say that it is some and not others. If it is going to be inquisitorial, the High Court has to have the ability to say, “This is one-sided; someone needs to tease it out,” so the Official Solicitor would have to be funded to be advocate to the Court and, if necessary, instruct lawyers in every single case.

Sir Max Hill: The model that I was espousing would not necessarily involve the Official Solicitor at all. It would make no draw on the administration of the Court or any officer of the Court, still less full-time judges. It would allow the appointment of recently retired judges, as we have in a number of scenarios—surveillance commissioners, for example—and a fresh administration. With that, as with the High Court model at the moment, there is the primary set of provisions, which Parliament must impose, and it is important that that is sufficient for what Alex called an inquisitorial function. Those are in part mandatory—those things that the panel must be satisfied about, which are set out in clause 12(3). Then there are those that are discretionary, which are set out in clause 12(5).

What sits between the two is very important. That is currently expressed as “Rules of Court”, but it would be the rules of the panel, or the commission that appoints the panels. In a court scenario, we are all familiar with criminal procedure rules and civil procedure rules; that is the secondary stage that is reached once the primary legislation has been fixed. That, too, would apply to the commission or panel process, but I do not necessarily think that it would involve using existing, paid judicial resources at all.

[The Chair]

Unless there are any more pressing questions—

--- Later in debate ---

[Naz Shah]

I beg to move an amendment to amendment (a), at end insert—

“Richard Robinson, CEO of Hourglass, Cherry Henry-Leach of STADA, Standing Together Against Domestic Abuse ”.

I completely agree with my hon. Friend the Member for Spen Valley and I am grateful to her for adding Professor Jane Monckton-Smith to the witness list. I also absolutely agree that the evidence we receive is really valuable.

This is an amendment tabled yesterday by the Mother of the House, my right hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) yesterday, to which I have added my name.

The reason for the amendment is that Hourglass focuses on domestic abuse of older people and it has particularly noted that the majority of such victims are female. Hourglass estimates that one in six elderly people are victims of coercion in the UK. This raises serious concerns that such people could be pushed into ending their lives if the Bill is enacted. Hourglass has not published a public opinion on the Bill.

Standing Together Against Domestic Abuse has said that

“We must echo concerns raised by the VAWG sector”—

the violence against women and girls sector—

“and disability activists about the bill’s current safeguards. There is insufficient clarity on what constitutes coercion and limited reflection on carer capacity to support someone terminally ill. Without robust measures, there is a real risk that assisted dying could be exploited as a tool for coercion or even femicide.

Statistics show that over 88% of unlawful ‘mercy killings’ are perpetrated by men towards women, often involving violent means. These troubling realities demand urgent consideration in shaping this legislation.

We also highlight the health sector’s role in identifying domestic abuse. With 80% of victim-survivors having their first or only point of contact in healthcare, it is critical that health professionals are equipped to identify and respond to abuse.

We call on the Government to ensure the proposed bill includes stringent safeguards and that healthcare systems are equipped to recognise and prevent the potential misuse of assisted dying. Femicide is already a crisis in the UK, and no law should inadvertently contribute to its escalation.”

All my adult life, I have had experience of dealing with domestic abuse and coercion, and I draw on that experience to speak to these amendments. Although Professor Jane Monckton-Smith is an expert, she is an academic. These two organisations work with people who have been victims of abuse.

In addition, we had an official meeting with the Clerk to discuss the proposals for Committee sittings. It was said at that meeting that we would only have witnesses who would give evidence, particularly in person, that would contribute to the deliverability and the workability of the Bill. Since then, we have had families added to the list of witnesses. That adds weight to the argument that we should have witnesses who are providing a service to victims directly.

[Dr Tidball]

I, too, support my hon. Friend the Member for Spen Valley and in particular I want to highlight the helpful addition of Kamran Mallick of Disability Rights UK. That augments an already comprehensive list of expert disabled people, which includes: Professor Tom Shakespeare, an internationally renowned disability rights academic; Dr Miro Griffiths, a Disability Studies scholar at the University of Leeds; and Chelsea Roff, the founder of Eat Breathe Thrive. On the panel, we will also have a representative of the Equality and Human Rights Commission, who will be able to give a good overview on the intersection between protected characteristics. Finally, there will be Jon Sparkes, the representative of Mencap.

I am really pleased that my hon. Friend has worked so hard to ensure that the voices of disabled people are integrated across a number of the panels that we will see over the next two days, and the addition in her amendment is really helpful. I commend her for it.

[Kit Malthouse]

I, too, support the amendment proposed by the hon. Member for Spen Valley, and in particular the addition of Jane Monckton-Smith. I have read her book; it is definitely worth a read and is pretty alarming. I will address why I do not think the Committee should support the amendment to the amendment tabled to add other witnesses.

Jane Monckton-Smith has done a huge amount of research in the area, and as well as being an academic who specialises in coercion and femicide—and the impact that coercion has on femicide—she is a former police officer, so has significant frontline experience. As part of her research she will have spoken with and interacted with many of the groups that the hon. Member for Bradford West is proposing to include—although maybe not specifically. I would prefer it if we stuck with the list that the hon. Member for Spen Valley has put forward, and not add the additional witnesses proposed.

[Naz Shah]

There is nothing in my amendment that suggests Professor Monckton-Smith is not capable in her expertise. I am asking for other expertise to be brought to the table. Yes, there is the argument that people can submit written evidence—but so could every witness we have heard from today, and that we will hear from tomorrow and the day after. If that is the yardstick, is this just a tokenistic exercise? I would argue that for women in particular, who are the victims of domestic abuse—

[Dr Tidball]

I note that Laura Hoyano, who is giving evidence on Thursday, is a domestic abuse barrister. She has also been involved in inquiries on child sexual abuse, and has a great range of experience in that area. She will bring that to the table as a practising barrister working closely on such cases.

Child Arrangements: Presumption of Parental Involvement

Marie Tidball Excerpts

Wednesday 22nd January 2025 Westminster Hall

[Matt Western (in the Chair)]

I will call Dr Marie Tidball to move the motion, and I will then call the Minister to respond. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates.

[Dr Marie Tidball (Penistone and Stocksbridge) (Lab)]

I beg to move,

That this House has considered the presumption of parental involvement in child arrangements.

It is a pleasure to serve under your chairship, Mr Western. There must be urgent reform of the presumption of parental involvement in child arrangements, known in law as presumption of contact, on the basis of evidence and principle, and to ensure that children’s voices are at the heart of our family courts.

The de facto common law principle of presumption of contact was legislated for in the Children and Families Act 2014, which inserted sections 1(2A) and (2B) into the Children Act 1989. That legal principle means that parents should always be given contact with their children, even in circumstances where there is a known domestic abuser.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady for raising this massive issue—well done for bringing it forward. In the world we live in, it is always the most innocent—the children—who suffer the greatest in a family breakdown. Does she agree that we must do more to ensure that, where there are doubts about safety, we should utilise supervised parental visits? Getting this right is an essential part of the battle against violence against women and children.

[Dr Tidball]

I certainly agree. To illustrate why, I want hon. Members to imagine a school night with a child being repeatedly asked by his father if he had completed his homework. The child replied in an exasperated tone, “Yes.” His dad stepped towards him with his fists ready to punch him. The boy’s mum stepped into the space between the fist and her son, and pushed him out of its way. The full force of that fist hit her so hard that she was spun round and fell down the stairs, bruising her arms, legs and back. From the top of the stairs, the child’s father shouted to his son, “Look what you made me do.” Imagine the same boy being driven to tears after his father made his brother eat peas until he was sick. The boy’s mother left her husband, taking the children with her.

Imagine a scene, six months later, where the father barricaded a Children and Family Court Advisory and Support Service officer in her office for 15 minutes. Social services were aware that that same father had made statements that he was capable of killing. Then imagine that, despite knowing all that, a family court permitted the father of those two boys five hours’ unsupervised contact per week. Claire Throssell, my constituent, does not need to imagine that nightmare. She and her two sons, Jack and Paul Sykes, lived it.

[Steve Witherden (Montgomeryshire and Glyndŵr) (Lab)]

Women’s Aid highlights that the pro-contact culture in family courts can force children into contact with abusive parents, sometimes against their will. Does my hon. Friend agree that it is crucial that family justice agencies recognise children as victims in their own right, as outlined in the Domestic Abuse Act 2021, to prioritise their welfare and, most importantly, save lives?

[Dr Tidball]

I do indeed, and I will return to that point later, not least because Jack and Paul Sykes told their social workers that they were scared of their dad. The youngest told them that he was “pure nasty”. Their secondary school was so concerned about the domestic abuse at home that it also alerted social services. Yet, on a two-hour contact visit permitted by a family court and allowed to go ahead by that same CAFCASS officer, Jack and Paul were locked in the attic by their father. Using gasoline, their dad then set multiple fires alight across their home. Paul, aged nine, died at the scene after his elder brother tried to save him. Jack, aged just 12, died later in hospital. The father also killed himself in the blaze.

Jack and Paul Sykes were supposed to return to their mother Claire that night. Instead, the boys died at the hands of a known domestic abuser. Their voices were not heard by social services, nor by the court. CAFCASS never heard their voices either. In fact, the day that Jack was supposed to speak to CAFCASS for a welfare assessment was the same day Claire cradled him in her arms as he died. The only time Jack’s voice was heard was when he was held in the fireman’s arms as he used the last of his strength to say, “My dad did this and he did it on purpose.”

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC)]

The hon. Member is making an immensely powerful argument; that is a tragic tale. Does she agree that, as well as domestic abuse being taken into account, perpetrators of child sexual abuse should be taken into account in relation to parental involvement? I support the campaign of my constituent, Bethan Parkinson. Amending Jade’s law to that effect, to include domestic abuse and child sexual abuse, would be a useful step forward.

[Dr Tidball]

I do agree. I will discuss further proposals later in my speech. Jack and Paul would never have been in the reach of a known domestic abuser, were it not for the presumption of contact. Although schools have a statutory responsibility to report suspected incidents of domestic abuse, in contrast the presumption does not put the children of known domestic abusers first.

Ten years on, this place must hear Jack’s and Paul’s voices reverberate loud and clear, because tragically their voices are not alone. Women’s Aid found evidence of 48 child deaths at the hands of a known domestic abuser that took place following a permitted contact visit between 1994 and 2015. The Domestic Abuse Act, as my hon. Friend the Member for Montgomeryshire and Glyndŵr (Steve Witherden) mentioned, recognises that children are victims of domestic abuse in their own right. Child contact is a known risk indicator for domestic homicide, yet we still do not know the true scale of the problem.

The vast majority of court reports are not published, with only 10% of rulings coming to light. Only last month, the sentencing of Sara Sharif’s known domestically abusive father and stepmother for her murder showed all of us that action is urgently needed to change the law. Her life must not be forgotten.

[Mr Will Forster (Woking) (LD)]

As the MP for Sara Sharif, I am very thankful that the hon. Lady has raised her case. As she knows, I called for an immediate safeguarding review, to understand the reasoning. However, it appears that the perverse incentive for parental contact, with Sara’s father being given custody, contributed to her death. Does the hon. Lady agree that family courts and that perverse incentive need to be changed?

[Dr Tidball]

I absolutely do agree and will return to my proposals for reform later.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

My hon. Friend is making an immensely powerful speech. It was extremely moving yesterday for the Education Committee to hear directly from my hon. Friend’s constituent, Claire Throssell. Claire’s work, in the context of her unbearably painful experience, is deeply inspiring, and I pay tribute to her.

We heard from her how problems in the family courts, including but not limited to the presumption of contact, have knock-on consequences for the wider work of child protection. Will my hon. Friend join me in calling on the Minister to ensure that there is strong, joined-up and effective working between her Department and the Department for Education so that we make sure that everyone who has a role in the protection of children is doing the most effective work possible?

[Dr Tidball]

I agree. We have said that we will take a mission-centred approach in Government, particularly to halve violence against women and girls, and I will return to that point. As a reference for Hansard, I mention that Claire Throssell MBE is with us in this Chamber today.

[Rachael Maskell (York Central) (Lab/Co-op)]

My hon. Friend is making the most powerful of speeches. We need joining up with the police service. My constituent fears every day that her children are in contact with their father. It is really important that we look at the thresholds, particularly with the Crown Prosecution Service, for prosecuting cases.

[Dr Tidball]

I agree. As someone who has worked in criminology and criminal justice for over a decade, I think the need for us to move beyond siloed working can be no more important than it is in these sorts of cases.

Just yesterday, we learned that the man Kiena Dawes named as her killer when she committed suicide wants to launch a custody battle over their daughter, saying that

“I’m coming to get you baby girl”.

This man has been jailed for six and a half years for assault of and controlling behaviour towards Kiena. Our current law would allow this person to have unsupervised contact with their child.

[Emily Darlington (Milton Keynes Central) (Lab)]

I thank my hon. Friend for securing such an important debate and for making such a powerful speech. Does she agree that the visitation presumption, custody presumption and all these sorts of things that happen in family law courts are a continuing perpetration of the domestic abuse that the women and mothers were fleeing in the first place? I will keep this case anonymous, but in my constituency I was meant to meet a woman on Saturday. The handling of the handover of the children on Friday had been so abusive and painful for her that she had to cancel her appointment with me because she was in hospital with heart palpitations. Can my hon. Friend address how we can ensure in the future that the presumption in the court service takes into account that this is continuing domestic abuse for both the mother and the children?

[Dr Tidball]

Absolutely. I will return to this later, but the harm report makes quite clear the re-traumatisation of both children and parental victims of domestic abuse that comes with repeated attempts at contact and the presumption that is currently in place. The consequence of that is a generation of lost voices like Jack and Paul Sykes and Sara Sharif, but there is no definitive way of knowing how many parents whose partner or spouse is a known domestic abuser have been persuaded into some form of shared care because of the presumption.

The harm report, published in 2020 by the Ministry of Justice’s expert panel on harm, found that presumption of contact must be reviewed urgently, because the principle

“put a misplaced emphasis on the child’s right to a relationship with both parents…above the child’s welfare and right to be safe from abuse and its effects”.

[Alison Hume (Scarborough and Whitby) (Lab)]

I congratulate my hon. Friend on securing this important debate. I pay tribute to the incredible campaigning work of Claire Throssell MBE in the face of unimaginable grief. My hon. Friend mentioned the Ministry of Justice report, which highlighted that the culture of the family courts and professionals involved in cases showed a systematic disbelief of abuse and the acceptance of counter-allegations—for example, parental alienation—without robust scrutiny. Does she agree that the report, which was left to gather dust, must be dusted down and put into immediate effect?

[Dr Tidball]

I absolutely do. Furthermore, in response to my hon. Friend’s important point, the report specifically stated:

“To the extent that the courts’ pro-contact culture operates as a barrier to addressing domestic abuse, it serves to reinforce that culture.”

Indeed, section 6 of the report laid bare that children’s voices are being “muted or unheard” in domestic abuse cases because of the pro-contact culture.

[Jess Asato]

One of my constituents, a domestic abuse survivor, has had all contact with her children removed, as well as her domestic abuse claim rejected without evidence. She has now had to pay not just for contact visits but monthly drug tests, when her drug use was not proven at all, making it completely unaffordable for her to see her children. Does my hon. Friend agree that it is past time that we stopped our family courts from being used as a tool of abuse against survivors of domestic abuse and sexual violence?

--- Later in debate ---

[Dr Tidball]

I do agree. Our court system should be one where justice is achieved for vulnerable victims of abuse, rather than an additional and secondary means of victimising them.

[Alison Bennett (Mid Sussex) (LD)]

I thank the hon. Member for giving way—she has been very generous in doing so in this short but important debate. A constituent of mine, who will remain anonymous, has undergone domestic abuse that the family courts process not only allowed to continue as economic abuse, but facilitated. With family courts still failing to ensure the safety of child victims, and given that around 60% of cases in the family courts involve domestic abuse, does the hon. Member agree that much more needs to be done to protect families from being re-victimised and traumatised via the very process that should be delivering them justice?

[Dr Tidball]

I agree, and nowhere is that clearer than in the cases of my constituent’s sons, Jack and Paul. Not only was their father known to be abusive, but the boys did not want to see him—all while he was demanding 50:50 contact in the family courts. Claire promised her sons that she would not rest until the law was changed to prevent more children from dying like they did. When I was elected last year, I promised to help her.

Labour’s important mission to halve violence against women and girls in a decade will require a national effort, and require us to use every tool available to target perpetrators and address the root causes of abuse and violence. Last week’s Second Reading of the landmark Children’s Wellbeing and Schools Bill marked a transformative change to child protection in education, and now we need to hold family courts to the same standard by repealing section 1(2A) of the Children Act 1989.

[Dr Lauren Sullivan (Gravesham) (Lab)]

I thank my hon. Friend for securing this incredibly important debate, and I second many of the comments she has made in her incredible speech. Does she agree that the cases of children with special educational needs who cannot express their feelings and fears must be taken into account, and that the presumption of contact must be stopped in those cases where there is live domestic abuse?

[Dr Tidball]

I do agree, and those factors have a cumulative, additive effect on those young people, silencing their voices even more so than those of other victims. That is one of the reasons why the harm report was clear that

“the presumption should not remain in its present form”

and recommended that it be reviewed

“urgently in order to address its detrimental effects.”

Today we are focusing on presumption of contact, but there is much more that could be done to make the family court system child-centric. We can be bolder by changing the language in the Children Act 1989 to say explicitly that a presumption of contact should not be given to a known domestically abusive parent. Further, protections could be strengthened by incorporating practice direction 12J in primary legislation. We also need to ensure that no interim contact takes place before assessments are fully completed by CAFCASS. Additionally, we must legally recognise children as victims of financial abuse under the Domestic Abuse Act 2021. Shockingly, there is currently no definition of rape or consent in the family court system.

[Natalie Fleet (Bolsover) (Lab)]

I thank my hon. Friend for raising this very important issue. Everybody in this room wants children to be born with two loving parents, but that is not possible for everybody, and it is definitely not a luxury that every child enjoys. Currently, when a woman is raped in this country, and she gives birth as a result, the rapist can apply for access to the child throughout their life. A woman in my constituency, and women beyond, talked to me about the trauma inflicted on them not only at the point of the attack but as they raise their child. The law now acknowledges that children born from rape are victims of crime, but it is vital that perpetrators are not given access to those children, continuing their unwanted presence in the victim’s life. The harm that that access can cause must be recognised to protect the young people and their mothers from violent offenders. Does my hon. Friend agree that we need a change to the law?

[Dr Tidball]

I do agree, and I thank my hon. Friend for her powerful statement. That is why we must urgently spell this issue out in primary legislation, alongside having a more tightly drawn definition of domestic abuse towards children in section 3 of the 2021 Act.

Over four years have passed since the UK Government launched a review of the presumption, as recommended by the harm report. The Conservative Government made no response, but now there is an opportunity for our new Government to take action, look at what other countries are doing and embed child-centred approaches in the family courts. Australia has repealed a similar piece of legislation, and the US is rolling out a law to incentivise states to ensure that their child custody laws properly protect children.

We must show leadership and be a beacon of light for children’s rights around the world by changing the law so that family courts prioritise children’s welfare and safety over the privilege of parental contact rights. Our Government must do what the previous Conservative Government failed to do, by taking a child-centred approach and changing the law on presumption of contact.

No more towns such as mine should be left to grieve. No more parents should have to make the ultimate sacrifice of the life sentence of losing a child at the hands of an abusive spouse or partner. No more parents should ever have to send their child on a court-ordered visit and hold them tightly in their arms hours later as they die. This Government must now act to save lives for generations to come by ending contact at any cost.

Let us not just imagine a world where the voices of children are put at the heart of our family court system, where children such as Jack and Paul are listened to, not ignored, where children have a childhood free of fear and oppression, and where children such as Jack and Paul live the lives they deserved to live. Minister, I urge you to do all you can to make that world a reality.

Terminally Ill Adults (End of Life) Bill

Marie Tidball Excerpts

2nd reading
Friday 29th November 2024 Commons Chamber

[Dr Marie Tidball (Penistone and Stocksbridge) (Lab)]

Today’s decision has been one of the hardest that I have had to make. In my career in disability law and policy, I chose not to focus on debates about whether disabled people should be born or whether we should die. Instead, I focused on enabling disabled people to live better, more fulfilling lives.

Today, I find myself voting in a way that I thought I never would. I will vote in favour of moving the Bill to the next stage of the legislative process. That has been a difficult journey for me. I have arrived here by looking at the evidence, reflecting on my own lived experience and listening to the many, many constituents who have written to me in support of the Bill, sharing their compelling and tragic stories of death—death which did not come with dignity or respect.

In reflecting on my own life, one moment from my childhood stood out. When I was six years old, I had major surgery on my hips. I was in body plaster from my chest to my ankles, and in so much pain and requiring so much morphine that my skin began to itch. I remember vividly laying in a hospital bed in Sheffield Children’s hospital and saying to my parents, “I want to die. Please let me die.” I needed to escape from the body I was inhabiting. That moment has come back to me all these years later. That moment made it clear to me that if the Bill was about intolerable suffering, I would not vote for it.

I have subsequently had a good life, a fulfilling life, a life where I have worked towards ensuring disabled people are valued by our society. But that moment also gave me a glimpse of how I would want to live my death: just as I have lived my life, empowered by choices available to me; living that death with dignity and respect, and having the comfort of knowing that I might have control over that very difficult time. For so often, control is taken away from disabled people in all sorts of circumstances.

In order to ensure that there is compassionate choice at the end of life, it is right that the Bill is tightly drawn around the final stage of terminal illness for adults and includes the strongest safeguards. The choice of assisted dying as one option for adults when facing six months’ terminal illness must be set alongside the choice of receiving the best possible palliative and end of life care, or it is no choice at all.

Having analysed the Bill closely, therefore, there are changes I would want to see in Committee to strengthen those options and ensure the way that choice is presented by medical practitioners is always in the round. People deserve dignity in death, and for those who do not choose to end their lives in this way, they and their loved ones should feel reassured and safe in the knowledge they will receive the very best of care. I would also want to ensure that the final stages of the Bill properly define “dishonesty”, “coercion” and “pressure”. I think it is necessary to embed mandatory language in the Bill around the need for a code of practice on palliative care, as well as improving the regulations on training for medical practitioners. I trust my hon. Friend the Member for Spen Valley (Kim Leadbeater) to champion those amendments and to continue to diligently listen to Members, as she has throughout this process.

However people vote today in this House—a decision of conscience—it is incumbent on all of us to commit to improve palliative, end of life and adult social care. It must be the start of the work that we do in this place to ensure the very highest standards in these areas. That will be a very great legacy indeed: giving people the dignity they need in the moment of death. For many of us across the Chamber, considering these issues has been extremely hard and upsetting. We have had to go to the very depths of our selves to understand what choice we will make today. While we may enter different voting Lobbies, we leave this Chamber shoulder to shoulder. I know we will all work in our own ways to make systemic change to improve the lives of our constituents, and people up and down this country.

[Several hon. Members rose—]

Oral Answers to Questions

Marie Tidball Excerpts

Tuesday 10th September 2024 Commons Chamber

[Dan Aldridge (Weston-super-Mare) (Lab)]

7. What steps her Department is taking to support victims of rape and sexual violence.

[Dr Marie Tidball (Penistone and Stocksbridge) (Lab)]

21. What steps her Department is taking to support victims of rape and sexual violence.

[Anna Dixon (Shipley) (Lab)]

23. What steps her Department is taking to support victims of rape and sexual violence.

--- Later in debate ---

[Alex Davies-Jones]

The case in France is truly shocking, and we have all looked on in horror as the details have unfolded. I commend the victim for her bravery in coming forward and making it public so that we can see the full aspects of the trial. Spiking is a despicable crime. We have committed to introduce a new criminal offence of spiking and we are considering how best to implement it. To be clear, in England and Wales, having sex with a person who cannot consent is rape, and spiking with intent to engage in sexual activity is a specific offence, with a maximum penalty of 10 years in prison.

[Dr Tidball]

Ten years ago, Jack and Paul Sykes, aged 12 and nine respectively, tragically lost their lives at the hands of their abusive father, who set their house on fire. Their mother, my constituent Claire Throssell, is a powerful campaigner against presumptive contact—a legal principle that allowed a known domestic abuser to access Jack and Paul. Will the Minister meet Claire and me to discuss how we can properly protect children from domestic abuse in our family court system?

[Alex Davies-Jones]

I thank my hon. Friend for that really important question. Claire’s tireless campaigning for families and children experiencing domestic abuse is inspirational, and my thoughts are with her and the whole community as the anniversary comes closer next month.

Both the criminal and family justice systems will play an essential role in delivering our commitment to halve violence against women and girls. The family court system must protect child victims of domestic abuse, and the new pathfinder courts provide more support for domestic abuse agencies and ensure that the child’s welfare and voice is at the centre of proceedings from the outset. The Government and I take the need to respond robustly to perpetrators within the family courts very seriously. The previous Government were reviewing the presumption of parental involvement. We are considering the findings and will respond in due course.