Terminally Ill Adults (End of Life) Bill

Rebecca Smith Excerpts

Friday 13th June 2025 Commons Chamber

[Dr Sandher]

I will make a bit more progress.

This has been a heated debate, and hon. Members on both sides of the House feel strongly about it. I am grateful to Members who came before me, who made my place here possible and who have spoken so powerfully and movingly in this debate, but I believe—and the evidence shows—that the colour of my skin does not belong in discussion of the Bill.

[Rebecca Smith (South West Devon) (Con)]

I rise to speak to amendment (a) to new clause 15, tabled in my name, which I hope hon. Members will support. Although it may seem technical, it is in fact a simple amendment with a significant impact. It will ensure that there is genuine protection against abuse, proper detection of coercion, and effective scrutiny of how the law works in practice. Simply put, it will ensure that deaths from assisted dying under the Bill will still fall within the coroner’s duty to investigate deaths under section 1 of the Coroners and Justice Act 2009. I will explain why that is important.

Like many hon. Members, I have been deeply concerned from the outset about how the Bill is drafted, its workability, and its impact on the NHS and on the lives of vulnerable people up and down the country. To be clear, my view is that one unintended death as a result of the Bill becoming law is one too many. I humbly ask hon. Members who are still considering their position, or who are minded to support the Bill, to consider this point about my amendment carefully: what is an acceptable error rate?

Based on the figures in the Government’s impact assessment, which I think underestimates the impact, even a 1% error rate would see a minimum of 13 wrongful deaths in year 1, with 45 per year by year 10. A 5% error rate would see 65 deaths in year 1 and 227 in year 10. A 10% error rate would see 131 deaths in year 1 and 455 in year 10. As I say, I think those are low-ball estimates, but they are nevertheless chilling. If this law is passed, it will be exceptionally difficult to say whether there have been errors or instances of abuse; or, at the very least, any errors picked up will be but a fraction of the true picture, as tragically those who would testify to the fact will already be dead. My amendment (a) to new clause 15 directly addresses that issue.

In England and Wales, a coroner will investigate a death when certain legal conditions are met. This duty is primarily governed by section 1 of the Coroners and Justice Act 2009. Judge Thomas Teague KC, who served until 2024 as the chief coroner of England and Wales, notes:

“any death arising as a consequence of the ingestion or administration of a lethal substance constitutes an unnatural death which the local coroner is under a statutory duty to investigate”.

Clearly, assisted dying meets that definition, and it is right that such deaths be afforded the best possible posthumous judicial scrutiny.

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

Does the hon. Lady not feel that the provisions in the Bill already have safeguards? Also, and most importantly, does she not feel that putting a family through a coronial process when the death is expected is unfair, unjust and completely beyond the bounds of what coroners are meant to do?

[Rebecca Smith]

On the first point, I do not believe that the Bill is strong enough as it stands. On the second point, we are already dealing with the fact that families are not even guaranteed knowledge of their loved one having an assisted death, so I do not think the hon. Lady’s point is entirely to be considered.

As it stands, the Bill would disapply the duty of the coroner to investigate in the case of an assisted death that has been carried out in accordance with the Bill’s provisions. New clause 15, specifically, would amend the Coroners and Justice Act to clarify that assisted death does not constitute “unnatural death” for the purposes of the Act. I think it takes an extraordinary leap of imagination not to conceive of deliberately self-administering lethal drugs as anything but an unnatural death.

[Tim Farron (Westmorland and Lonsdale) (LD)]

I am grateful to the hon. Lady for giving way; I want to support her in what she is saying. We are going through a process, as we consider the appalling situation of coercive control in domestic abuse cases, where a person who is a victim may not realise they have been a victim until years later. Obviously, a person who has gone through an assisted death will have no years later. Is the amendment not a way of making sure that we guard against the evil of coercive control?

[Rebecca Smith]

I thank the hon. Member for his intervention and I completely agree with him. These are the sorts of safeguards that even the promoter of the Bill is saying should be there. I do not think that they are in the Bill and my amendment to new clause 15 would make them much stronger.

[Simon Hoare]

My hon. Friend is right in what she says. Those of us who are opposed to the death penalty, for example, are against it because we do not believe in the infallibility of the state. The state can get things wrong; professionals can get things wrong—and when they do, there should be a proven, clear path as to how that wrongdoing can be identified, to try to ensure that it does not occur again.

[Rebecca Smith]

I thank my hon. Friend. The statistics I quoted earlier are pretty clear on the point he makes. Let me make some progress.

The work undertaken by the coroner is not a box-ticking exercise or a bureaucratic hurdle. In the context of assisted dying, it is an extremely powerful deterrent against abuse and malpractice. Again, to quote Judge Thomas Teague KC, in a letter to The Times on 7 May this year, he said that the removal of

“any realistic prospect of an effective inquest...would magnify, rather than diminish, the obvious risks of deception and undue influence”.

[Naz Shah]

I thank the hon. Member; she is making a very powerful speech. Does she share my concern about the removal of the coroner, as stated clearly by the Royal College of Pathologists, which speaks to her amendment?

[Rebecca Smith]

I thank the hon. Member and I will come to that point very soon. I will now make some progress; I will not take any further interventions.

I struggle to see how removing automatic oversight of assisted deaths squares with a commitment to enact legislation with the “strongest safeguards in the world”. By doing so, the Bill sets a lower bar for scrutiny and review, and creates an information deficit. Put another way, we simply do not know what we do not know. Implementing a novel piece of legislation such as this without ensuring the most robust possible scrutiny of deaths taking place under the Act is astonishing. Under the Bill, assisted deaths would be the outlier, as any other intentionally procured death would automatically be reviewed by a coroner. Why should deaths under this legislation be any different?

Requiring automatic scrutiny from a coroner for assisted deaths should not be viewed as an add-on at the end of the process or perhaps just a safety net, although it is that.

[Dr Simon Opher (Stroud) (Lab)]

Will the hon. Lady give way?

[Rebecca Smith]

No, I have already said that I am not going take any further interventions. I have been very generous with my time.

It is imperative to consider the whole picture, particularly regarding malpractice or coercion—whether that be on the part of medical professionals, families or third parties. In written evidence to the Committee, Dr Rees Johnson, a legal expert from Essex Law School, highlights that, in some cultures,

“decision-making is a collective process involving family and community members.”

--- Later in debate ---

[Dr Opher]

Will the hon. Lady give way?

[Rebecca Smith]

No.

Beyond coercion, automatic inquests provide vital opportunities to identify other critical issues that may not otherwise be picked up. Without a coroner’s inquest, there would be no post-mortem examination. This is not merely an academic point; studies have shown that autopsy reveals that one in four cases have been misdiagnosed. Without this oversight, as His Honour Judge Thomas Teague KC, the former chief coroner, notes, there is

“no certain means of knowing whether the approved substance has led to a quick and painless death, or a lingering and distressing one, or even whether it had failed to cause death altogether and the deceased had been dispatched by manual asphyxiation or some other unlawful means.”

I am not sure whether that could be more clear. The view of experts in this area—both the Royal College of Pathologists and the former chief coroner of England and Wales—is that this Bill’s proposals, as drafted, are not fit for purpose. I strongly urge hon. Members to support my amendment (a) to new clause 15.

[Several hon. Members rose—]

NHS Funding: South-west

Rebecca Smith Excerpts

Wednesday 11th June 2025 Westminster Hall

[Rebecca Smith (South West Devon) (Con)]

It is a pleasure to serve under your chairmanship, Dr Huq. I thank the hon. Member for Torbay (Steve Darling) for securing this debate.

I am here to focus specifically on fertility treatment in Devon, which is one of the costs we have because of the atrocious funding situation to which the hon. Member referred. The Devon integrated care board is not currently funding fertility care for local patients in line with Department of Health and Social Care expectations, and is not following National Institute for Health and Care Excellence guidelines in their entirety. Its policy is not based entirely on the clinical factors recommended by NICE, but is based instead on previous clinical commissioning group policy, economic factors and additional non-clinical factors, which are all understandable, but that is not good enough for local patients.

NICE states:

“Commissioners…should commission sufficient capacity within specialist fertility services to provide 3 full cycles…for women aged under 40 years who meet the criteria for IVF…A full cycle should include 1 episode of ovarian stimulation and the transfer of any resultant fresh and frozen embryo(s)”,

and that any previous cycle counts towards that total. NICE guidelines also state that women under 40 who meet the criteria for IVF treatment

“should be offered 3 full cycles of IVF”

with a cycle defined as including one episode, as I have said. A full cycle ends either when every available but viable embryo has been transferred, or when one results in a pregnancy.

Devon ICB incompletely funds only a portion of one cycle. It has made up a different definition of a cycle, and, in the commissioning policy, defines a cycle as

“one…fresh and one…frozen implantation of embryos. A frozen embryo transfer episode will only be available if there are embryos generated from the fresh cycle suitable for freezing.”

That does not include any remaining embryos from the first cycle of stimulation, nor the remaining two cycles recommended by NICE. Devon should be funding three full cycles, and it is not.

That means that we are living in a legitimate postcode lottery: people with a PL, TQ or EX postcode are being completely sold short. I believe we need to treat this, and we need to see what the Government can do to mitigate the problem and to encourage ICBs such as Devon to ensure that just living within their health authority should not mean that people cannot access the treatment that others in other parts of the country can access, particularly those under 40 years old.

Dementia Care

Rebecca Smith Excerpts

Tuesday 3rd June 2025 Commons Chamber

[Caroline Voaden (South Devon) (LD)]

I beg to move,

That this House has considered dementia care.

I thank the Backbench Business Committee for granting time for this important debate and Members for supporting it, as well as the charities and organisations that have provided material. Dementia is undoubtedly one of the most urgent health and care challenges facing our society, and I know that most of us in this Chamber will know someone affected by it. My family is currently battling it on two fronts. My confident, witty, generous father-in-law is now almost unrecognisable as the man he used to be. He is lucky to be living in a lovely care home where he receives the best care possible, but the decision to move him there was heartbreaking. My brilliant, funny cousin, always the life and soul of family parties, was diagnosed far too early with frontotemporal dementia, which is likely to affect her ability to communicate over time—a particularly cruel diagnosis for someone so young. Watching people we love become confused by the world around them, unable to communicate and fading away from us while so physically present is heart-wrenching. Dementia has to be one of the cruellest conditions for those afflicted and for those supporting them.

As we are neatly placed between Dementia Week and Carers Week, it is fitting that we should discuss this condition with which 900,000 people in the UK are living, most over the age of 65. Dementia is now the leading cause of death in the UK, and while its scale is national, its impact is deeply local and personal. It is already widespread as our population ages, and that number is expected to rise sharply. According to NHS England, one in 11 people over the age of 65 has dementia, and that rises to one in six for those over 80. In Devon, which has one of the oldest populations in England, this issue is not just coming; it is already here. Unless we act now to improve diagnosis, care and support, we will fail tens of thousands of families in our communities.

A timely diagnosis is not just about putting a name to a condition; it is also the essential first step towards accessing care, planning for the future and, increasingly, receiving treatment. New disease-modifying drugs for Alzheimer’s offer real hope, but only if the disease is caught early and diagnosed accurately. In October 2023, the all-party parliamentary group on dementia published a report highlighting the significant regional disparities in dementia diagnosis across England. The findings were stark. While Stoke-on-Trent had the highest diagnosis rate, at 90%, the South Hams—much of which lies in my constituency of South Devon—had the lowest rate nationally, at just 44%.

[Rebecca Smith (South West Devon) (Con)]

As a fellow South Hams representative, I wonder whether the hon. Lady would agree that the Government’s lack of focus and targets for dementia diagnosis is having a particular impact on rural constituencies such as ours, given that treatment is so dependent on diagnosis. Does she also agree that the work of local groups such as the Dementia Friendly Parishes around the Yealm is going to be vital to increasing diagnosis in our communities in Devon?

[Caroline Voaden]

I thank the hon. Member for her contribution, and I agree that community groups such as the one around the Yealm are vital in caring for people with dementia.

Devon as a whole is falling worryingly behind. As of March 2025, our county’s dementia diagnosis rate stands well below the national average, placing Devon 39th out of 42 NHS systems in England. At the same time, demand for services is increasing sharply. Referrals to the Devon memory service have surged by 94% of the past five years, yet no additional investment has been made to meet this rising need. In Torbay the pressure is especially acute, with some individuals now waiting up to 20 weeks for an assessment.

A diagnosis can change lives. It provides clarity, access to support and the opportunity to plan for the future. It has proven to help people live well with dementia, but without investment people are being locked out of vital services, including support groups. One local dementia charity told me:

“Until there is a formal diagnosis, patients and their families cannot access our Memory Cafes, as our funding requires a confirmed diagnosis to provide support.”

I know from family members that this kind of support can make a world of difference, giving carers contact with others who truly understand the pressures and strain of caring for a much-loved relative who is slowly but surely losing themselves to this awful condition.

Oral Answers to Questions

Rebecca Smith Excerpts

Tuesday 6th May 2025 Commons Chamber

[Stephen Kinnock]

I absolutely share the frustrations of my hon. Friend and his constituents. The investment made today was in response to GPs telling us that they needed more space; the investment will lead to more capacity and better access and outcomes for his constituents. Today’s announcement was only possible thanks to the decisions made in the October Budget, which were opposed by every party opposite. The choice is clear: investment in our NHS with Labour, or cuts with the Tories and Reform.

[Rebecca Smith (South West Devon) (Con)]

My constituent Dr Toby Nelson, an NHS consultant dermatologist, has started a business that seeks to address the heavy demand on primary care for skin health screening. His business Map My Mole sends an image capture kit to patients to attach to their smartphones. The patients then send a high-resolution image remotely to be reviewed by a specialist consultant, bypassing the need for a GP appointment and freeing up time and resources for both doctor and patient. It has already resulted in a significant drop in skin cancer referrals in pilot GP surgeries. Will the Minister agree to meet Dr Nelson and me to discuss this revolutionary proposal?

[Stephen Kinnock]

The hon. Lady raises what sounds like an extremely interesting scheme. She will know that we have a strong commitment in our 10-year plan to shift from hospital to community, and indeed from analogue to digital. The digital aspects of that scheme sound very interesting, so I would be more than happy to take further representations from her.

Health and Adult Social Care Reform

Rebecca Smith Excerpts

Monday 6th January 2025 Commons Chamber

[Wes Streeting]

My hon. Friend is absolutely right about that. If we improve the service at Whipps Cross hospital for his constituents, it will have the added benefit of improving the service at Whipps Cross Hospital for my constituents, too.

[Rebecca Smith (South West Devon) (Con)]

What is missing from today’s announcement is any sort of update on the new hospitals programme review, which is vital in my constituency of South West Devon, because Derriford hospital needs its urgent and emergency care centre to bring down ambulance waiting times before it can even start to tackle its general waiting list issues. When will Derriford hospital hear whether it has been successful in the new hospitals programme review?

NHS Dentistry: South-west

Rebecca Smith Excerpts

Tuesday 12th November 2024 Westminster Hall

[Rebecca Smith (South West Devon) (Con)]

It is a pleasure to serve under your chairmanship, Mr Vickers. I congratulate the hon. Member for Honiton and Sidmouth (Richard Foord) on securing this vital debate about NHS dentistry in the south-west.

My constituents know the issues with access to NHS dentists only too well. Since 2020, the number of dentists in the county has fallen from 549 to 497. That means that each remaining dentist must see almost 300 additional patients a year. It is clear that we have a significant shortage of dentists in Devon. Only 34.7% of adults in the county have seen a dentist in the past year, compared with 55% 10 years ago. As we also heard from the hon. Member for Exeter (Steve Race), very few children are seeing dentists: 46.6% of children in Devon in the past year, compared with 61% in 2016.

For those who live in or around Ivybridge in my constituency, there are currently only two dental practices within a 10-mile radius accepting new patients. That only gets worse for the more rural and coastal communities, and the statistics are not good for the communities within the Plymouth boundary. I am aware that an anomaly in Devon is that there is actually a waiting list for NHS dentists.

At one recent meeting with local senior health officials, it was pointed out that Devon’s waiting list is unusual, perhaps even unique. We have 60,000 people on that list, believing they are entitled to an NHS dentist, when, as was discussed at the same meeting and I was led to believe on the day, the existing NHS contract was designed to serve only 55% of the adult population. The assumption was that others would access dental care privately.

I am not making a judgment about whether that is right or wrong; I am just stating the fact that most people do not understand that. The dental system was set up to be more like that for opticians than GPs at the time. The issues we currently face in Devon have in many ways gone beyond those points’ being particularly relevant, but it is worth reflecting how important it is to be honest with people, as we make changes, to ensure they understand what the impact of those changes might be for them.

Before I reach the main point I wish to make today, I will briefly mention two challenges we face in Devon: how we train dentists and how NHS contracts are awarded. Devon is fortunate to have an outstanding dental school at the University of Plymouth. When it opened, many believed it would provide the city and the region beyond with a ready supply of new dentists to help us tackle our dental shortage. The school, however, is so successful that it is incredibly difficult to secure a place to study there, which has an impact on local people’s being able to study at home and perhaps stay after graduation.

Equally, I have been informed by an expert on dental training that the way we train dentists makes it very difficult for people to stay where they have studied. Currently, the system almost forces the non-local dentists—the ones that might be coming down from the midlands —to go back to where they came from, rather than staying in the south-west if they want to. I urge the Minister to look into what more can be done to ensure that students can more easily stay where they have studied; at the moment, even if a dental student falls in love with Devon, it is very difficult for them to stay and help us to solve our problems.

Secondly, I am concerned about the lack of flexibility in the awarding of new NHS contracts at a time when we are in desperate need of more dentists. I was contacted about a year ago by a dentist seeking to open a practice in my constituency, who was told by the ICB that the window for applications had closed. That may have been the case but, given that we are in such dire need of dentists, perhaps an exception could have been made.

That leads me, finally, to my main point. In the last 12 months, 876 people attended the emergency department at Derriford hospital for a dental reason. Of those, 18% were under the age of 20 and 82% were over 20. That is an average of 2.4 people per day having to resort to using the emergency department to access dental care. Of these patients, 77 were then admitted for treatment. That is why we need to see the stalled review into funding for Derriford hospital’s urgent and emergency care facility, because it is part of the bigger picture of how we provide dental care across the south-west. If we free up emergency, we have more capacity to look after the region more fully.