Terminally Ill Adults (End of Life) Bill

Polly Billington Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Ms Polly Billington (East Thanet) (Lab)]

Will my hon. Friend give way?

[Kim Leadbeater]

I am going to make some progress, I am afraid.

The Secretary of State must also consult providers of health and care services, including palliative and end-of-life care. I am really pleased that Hospice UK is supporting this amendment—it is very important that those voices are heard. The Secretary of State can also consult anyone else they feel to be appropriate, creating a flexible and holistic approach.

Turning to devolution, this long-overdue reform would apply to England and Wales, which share a criminal justice system. Health is a devolved matter, of course, and I have recognised from the outset that the legislation must respect devolution. I am fully committed to observing the same conventions that the Government would if this were a Government Bill. I have worked with UK Government officials to ensure that the right steps are taken at the right time by the right people. I have engaged with colleagues in the Welsh Government—I met the Welsh Health Minister in Cardiff, and there have been ongoing detailed discussions between the two teams of Government officials to ensure the workability of the legislation in both jurisdictions, in line with the devolution settlement.

Amendments 92 to 95 also ensure that the devolution settlement is respected and adhered to. I thank the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) and the hon. Member for Chesham and Amersham (Sarah Green), not only for their diligent work on the Bill Committee but for working with me on the amendments in relation to Wales, and I thank the Welsh Government for their guidance and support. I hope that colleagues across the House can support these new clauses and amendments.

I now turn to new clause 21, which makes specific provision about the use of the Welsh language. The conversations that happen at the end of a person’s life are extremely personal and should be handled with the utmost sensitivity. It is very important that they are conducted in the best interests of the patient, and a big part of that is using clear communication. In this respect, language matters, so if a patient in Wales has Welsh as their first or preferred language, all efforts should be made to ensure they can communicate with voluntary assisted dying services in Welsh. I committed to this in Committee, and have made good on that commitment.

Turning to amendments 76 and 77, as with any Bill, it is important that the amending legislation secures overall coherence with the statute book. As such, the clauses relating to medicines, advertising and employment protections amend, or confer power to amend, other legislation that currently extends to parts of the UK. Of course, this does not mean the provision of assisted dying, but, for example, they extend the prohibition on advertising to the whole of the UK and apply the employment protections in the Bill to Scotland. That is in line with the guidance I have received from legal experts, and as such I hope all colleagues can support these amendments. If the Bill passes, I will, if necessary, work with other devolved Administrations in the same way as I have worked with the Welsh Government to ensure that devolution is respected.

That concludes the explanations of the amendments tabled in my name. Many colleagues are keen to speak, so I am not going to comment on all the amendments in the group; I will just make two comments about amendments that are not in my name, and allow other people plenty of time to speak.

Amendment 42, tabled by my hon. Friend the Member for Newcastle-under-Lyme (Adam Jogee), would not only try to remove the backstop for the provision of assisted dying in England, but create a number of other issues in relation to commencement. If Parliament chooses to give this choice to terminally ill people, there cannot be a clause in the Bill that would prevent that from being available as soon as it was safe and practicable. But the amendment would remove the four-year backstop. It would also prevent the appointment of the voluntary assisted dying commissioner and create a potential commencement gap between England and Wales. Given that, I have been strongly advised that the amendment would create serious workability issues. I urge colleagues who want an operable Bill to join me in rejecting the amendment.

To finish, I am pleased to support amendment 21, tabled by the hon. Member for Twickenham (Munira Wilson). I thank her for her engagement with the Bill and the amendment, which would require the Secretary of State to prepare and publish an assessment of the availability, quality and distribution of palliative and end-of-life care, as part of the first report on the implementation of the Act, mirroring the assessment already required as part of the five-year review.

Although the Bill seeks to address what in some respects is a very specific issue in terms of the failings of the current law, it has become part of a much-needed broader conversation about death, dying and end-of-life care. We all have our own experiences of death, loss and grief, and we do not talk about them enough. I am really pleased that the Bill has led to many conversations up and down the country; whatever our views, that has to be a positive thing.

--- Later in debate ---

[Ellie Chowns (North Herefordshire) (Green)]

I rise to speak in support of new clauses 13 to 15, tabled by the hon. Member for Spen Valley (Kim Leadbeater), to support amendments 94 and 95, and to oppose amendment 42. I pay tribute to the hon. Member for Spen Valley for her compassionate leadership and immense hard work, to the Members of all views who served on the Bill Committee for their thoughtful and hard work, and to those who have worked behind the scenes to scrutinise the Bill and contribute to the debate.

I thank all the constituents who have been in touch with all of us. I am sure that, like me, hon. Members have carefully reflected on those contributions and taken them into account. It is clear that the status quo is not acceptable. That is why it is right that we have this legislation before us, and that we are scrutinising it so carefully and looking at it in such immense detail.

Turning to new clause 13, regarding the regulation of substances for use in assisted dying, those substances obviously have to be properly regulated, although it is equally obvious that they cannot be subject to conventional clinical trials in the same way as other medicines, which is why the proposal to make that process go through the MHRA is inappropriate. The regulations provided for in new clause 13 will ensure that that critical part of the process is carried out with the highest possible level of scrutiny and harm prevention. It is essential that there is transparency and assurance of the process, from manufacture all the way through to administration, which is what new clause 13 does.

[Ms Billington]

I am interested in what the hon. Lady says about the safety of those drugs. Does any adverse event data exist globally to quantify how much harm and suffering could be caused while inducing the dying process?

[Ellie Chowns]

I thank the hon. Member for raising that issue and giving me the opportunity to speak about the detailed evidence given by my constituent Emeritus Professor Sam Ahmedzai, with whom I spoke at length yesterday about precisely this detail. I have reviewed a number of tables of data about this. Any substance has side effects but, as the comments made today have indicated, in reality those substances are being held to a far higher standard than substances routinely used in palliative care.

We have to recognise that there is a huge amount of evidence about the efficacy of the substances that are talked about in relation to assisted dying. There is a huge amount of published, peer-reviewed evidence about the effectiveness of those substances, and people like Professor Ahmedzai, who has 40 years of experience and is a global expert in this area, point out that we know how to assist people to have a peaceful, compassionate death effectively, and that is what the Bill is about: helping people who are terminally ill to die with dignity and to face those final moments with the support, love and care of their family around them; not in agony, but in whatever degree of peace is possible when facing death.

As the hon. Member for West Worcestershire (Dame Harriett Baldwin) said, new clause 14, which relates to advertising, has been developed in consultation, as a result of concerns raised by opponents to the Bill, to try to ensure the crucial fact that assisted dying is not an advertised service. There is a crucial distinction between advertising and information, and this new clause will ensure that assisted dying remains a careful, clinical process and not something that would be promoted commercially. It is a balanced, cross-party safeguard supported by people on all sides of this debate.

--- Later in debate ---

[Dame Siobhain McDonagh]

The power to alter the intentions, as mentioned by my hon. Friend, was not in the Bill we voted for in November. That is why I have tabled my amendment: to prevent anyone from tampering with the NHS as founded by our forefathers.

Let us be clear about what clause 38 would allow. It would allow a Minister, through delegated legislation, to rewrite the very purpose of our NHS; it would let them do so without the full scrutiny that primary legislation demands; and it would mean that Parliament could be denied any real chance to amend or reject that change. These are not abstract constitutional concerns; this is about whether the founding promise of the NHS can be quietly rewritten—not through open debate or an Act of Parliament, but by a handful of MPs behind closed doors in a Committee room. Once that pass is sold, there is no telling what future Governments might do or undo.

That is why this matters so deeply, because the NHS is not just a set of services, but a promise—a promise made right here in this House nearly 80 years ago, on Second Reading of the National Health Service Act 1946.

[Ms Billington]

It is important for my hon. Friend to be able to explain in detail what the philosophical and institutional implications are. But, fundamentally for ordinary patients, what does she think the Bill will do to change the relationship between the patient and the doctor?

[Dame Siobhain McDonagh]

Its potential is to alter everything in a very undemocratic manner. In this very Chamber, Nye Bevan told us that the NHS would

“lift the shadow from millions of homes...keep very many people alive who might otherwise be dead...relieve suffering...produce higher standards for the medical profession”

and

“be a great contribution towards the wellbeing of the common people”.—[Official Report, 30 April 1946; Vol. 422, c. 63.]

We have a duty in this place to defend that promise. We cannot allow the promise to be reworded without the full voice of Parliament. We owe it to the public, to patients and to the NHS staff who dedicate their lives to this service, to stand firm and protect what is sacred.

The amendment is simple but its impact is profound. It would ensure that any future changes to the core principles of the NHS must be debated openly, transparently and with the full consent of every Member—no short cuts, no sidestepping, no ministerial overreach. I urge colleagues across the House to support amendment 12, to stand with our NHS and with the people it serves. I urge my side—the Labour side—not to allow the assisted dying Bill to be the trojan horse that breaks the NHS, the proudest institution and the proudest measure introduced by our party in 120 years.

Oral Answers to Questions

Polly Billington Excerpts

Tuesday 7th January 2025 Commons Chamber

[Wes Streeting]

I thank the right hon. Gentleman for writing to me before Christmas. I recognise the pressures that have been placed on NHS commissioners in recent years and the pressure that that has put on service configurations. I tend to support the devolution of decision making, with decisions about service reconfigurations taken closer to the communities they serve. I recognise also that commissioners do not always get it right, which is why engagement with Members of Parliament and other democratically elected representatives is important. Ministerial oversight is important, too. We will look seriously at the issues he raises and talk to NHS leaders, and I know he will be doing the same. This Government are determined to give NHS leaders the tools to do the job, so that we can get the right care in the right place at the right time, with a better experience for patients and better value for taxpayers.

[Ms Polly Billington (East Thanet) (Lab)]

I am sure my right hon. Friend will share my delight at the fact that in our growing community of Thanet, the NHS is looking to open the Thanet integrated hub in one of the most deprived parts of Kent. However, Tory-run Kent county council has put in spurious objections to the development. Does he share my concern that such unnecessary objections block access to healthcare and make it harder for the Government and the NHS to cut waiting lists?

[Wes Streeting]

I am grateful to my hon. Friend for the work she is doing to improve health and care services for her constituents. The Government are giving health and care providers the tools to do the job. Of course, change will take time, and it is therefore crucial that we all pull together locally and nationally. For the avoidance of doubt, the Government are on the side of the builders, not the blockers.

Income Tax (Charge)

Polly Billington Excerpts

Tuesday 5th November 2024 Commons Chamber

[Edward Argar]

The hon. Gentleman is right to highlight the ill-thought-out consequences of this hike for hospices and general practices, both in Scotland and elsewhere. I would dearly love to be able to respond to his question. Sadly, however, I am on this the side of the House and not the other side, but I am sure that the Chief Secretary will attempt to do so.

The Nuffield Trust has said that without additional financial support, the tax raid is likely to force social care providers to pass higher costs on to people who pay for their own care, or potentially collapse financially. Charities are not exempt either. As a result of the increases in the national living wage and employer’s national insurance contributions, one of the UK’s largest social care charities says it is facing an unfunded increased wage bill of £12 million a year, and Marie Curie has warned that the rises in employer’s NI contributions will only serve to put the services that it delivers on behalf of the NHS under further pressure. Those charities will be looking to the Chief Secretary to say what succour he can offer them in the form of an assurance that they will not be hit.

[Ms Polly Billington (East Thanet) (Lab)]

I welcome the right hon. Gentleman to his place, but before throwing stones, will he just remind the House that under his Government’s plans, there would have been £15 billion less for the NHS, leaving it broken?

[Edward Argar]

I welcome the hon. Lady to her place as well. I think this is the first opportunity I have had to respond to a intervention or question from her.

In fact, we put record funding into the NHS—£164.9 billion per year—and on top of that we recruited more doctors and more nurses. We did not do that by piling tax hikes on hospices and general practices, among others. I am not sure how hitting primary care, social care or charities supporting NHS services will help the Secretary of State to deliver his aim of cutting waiting lists. I hope that the Chief Secretary will tell the House what steps the Treasury is taking to ensure that those organisations are not hit by these changes.

Let me take a moment to consider what was not included in the Budget.

--- Later in debate ---

[Ms Polly Billington (East Thanet) (Lab)]

Even those of us who are new to this place know to expect more communication from our constituents about what is wrong than what is right, so it is notable that I received emails of thanks and congratulations from constituents last week, after the Chancellor delivered her historic Budget. Stability is highly prized by people after so much chaos, and investment, especially in our NHS, is something that people have been crying out for.

However, we must be honest with ourselves about the state of our NHS in east Kent and in coastal communities like mine. East Thanet has been overlooked for far too long. The service has had to endure the chaos and incompetence of the past 14 years, and has not been as resilient as other places to the onslaught. The director of public health in north-east Lincolnshire, Stephen Pintus, has described people living in coastal communities as “old before their time”. We need to reform the way we deliver NHS services in coastal communities. Investment on its own will not be enough. We need to redesign our health service to answer the questions: what care do people need, where do they need it and how do they need it delivered?

My constituents have been suffering with poor NHS services for far too long. East Kent hospitals university NHS foundation trust, which runs the Queen Elizabeth the Queen Mother hospital in Margate, is ranked the third worst in England for its 12-hour waits for emergency services. Its maternity services have been deemed inadequate. When staff were asked, “If a friend or relative needed treatment, would I be happy with their care?”, only 45% of staff said yes. I have people emailing me about their urgent care and essential appointments being delayed by waiting lists. People in dire need of mental healthcare are being told to wait for months to get the help they desperately need. There is denial of continuous care due to costs and a lack of staffing—and, shockingly, poor communication and record keeping resulted in a cancer patient being misdiagnosed.

In a 2021 report by Chris Whitty entitled “Health in Coastal Communities”, he highlighted the problems faced by constituencies such as mine, and found that they had some of the worst health outcomes in England, with low life expectancy and high rates of major diseases. One of the major reasons for that is simply lack of access to healthcare services—both a lack of NHS services in coastal communities and a lack of transport options.

Whatever the reasons for the challenges in coastal communities, we need to see reform. The extra funding the Chancellor announced last week is crucial to bringing down waiting lists and stopping the chaos of 14 years of Tory mismanagement. The British people delivered us a mandate to fix the NHS. If done well, this reform will be transformative for the country, especially in coastal communities like East Thanet.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I am about to call the final Back-Bench Member. No doubt a lot of colleagues who have contributed will be making their way back to the Chamber for the Front-Bench speeches. I call Matt Turmaine.

NHS: Independent Investigation

Polly Billington Excerpts

Thursday 12th September 2024 Commons Chamber

[Madam Deputy Speaker (Judith Cummins)]

Order. I am aiming to end this statement at 1 pm. I remind Members that anyone who was not in for the start of the statement will not be called.

[Ms Polly Billington (East Thanet) (Lab)]

A recent survey of staff at East Kent Hospitals University NHS foundation trust showed that less than half of employees would be happy for their loved ones to be treated at an east Kent hospital. That is a devastating verdict from staff, showing the impact on their morale and on confidence in the community for the care that people need. Does the Secretary of State agree, however, that a broken NHS is not the fault of staff like them, but down to the previous Government’s decade of austerity and top-down reorganisation of the NHS?

[Wes Streeting]

I am delighted to see my hon. Friend in her place. She is absolutely right. I feel really sorry for NHS staff for what they have been put through over more than a decade of mismanagement and political incompetence, and we will work with them to clean up the mess. She establishes exactly the right test, which is whether we would want our loved ones to be treated in our local health and care services, and whether we would have confidence that, in every case, on every occasion and in every interaction, they would have access to the best-quality care. The truth is that we do not have that certainty, and too often it feels like chance. That is why we will always put the patient voice, the patient interest and the patient experience at the heart of our reform and modernisation programme.