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Category: Health

  • Andrew Mitchell – 2024 Speech on the Terminally Ill Adults (End of Life) Bill

    Andrew Mitchell – 2024 Speech on the Terminally Ill Adults (End of Life) Bill

    The speech made by Andrew Mitchell, the Conservative MP for Sutton Coldfield, in the House of Commons on 29 November 2024.

    I want to make three brief points. First, I have completely changed by mind on this subject since I entered the House during the last century, because I have sat in my advice surgery with tears pouring down my face listening to constituents who have set out so clearly, speaking with such emotion, about how their mother, brother, father or child had died in great pain and great indignity.

    I strongly support the Bill, and I congratulate the hon. Member for Spen Valley (Kim Leadbeater) on the excellent way in which she has presented it. I believe that we should give our constituents—our fellow citizens—this choice. I want this choice for my constituents; I want it for those whom I love; and I want it, perhaps one day, for myself.

    Dr Scott Arthur (Edinburgh South West) (Lab)

    Will the right hon. Gentleman give way?

    Mr Mitchell

    I will not, I am afraid. The current law forces people to plan their deaths in secret. Their bodies are found by their loved ones. Often, they die in the most horrific circumstances. They have no chance to say goodbye to their loved ones. It is devastating for their families. The former Health Secretary commissioned the Office for National Statistics to try to find out how many people who committed suicide every year were dying people. The figure was between 300 and 650.

    Secondly, in our democracy, the Commons must make this decision. Only we, elected by our constituents, have the legitimacy to do this. It is not the DPP, the Crown Prosecution Service, the police, doctors or even unelected Members of the House of Lords—this House of Commons must make this decision. Let us be clear that all of us on both sides of the debate strongly support an increase in the quality and extent of palliative care. For me, the debate is about extending choice, in very narrow and heavily regulated circumstances under the Bill, as the hon. Lady so clearly set out—the choice not to be forced to end your life in pain and indignity. No element in the Bill talks about intolerable suffering. Many believe that the Bill is too narrowly drawn. I stand by the hon. Lady’s drafting. We should remember that in Oregon there has been no serious attempt to change or amend the law.

    I had the privilege of speaking to an NHS consultant last year, the day before she headed to Dignitas. She said, “I love my country, but I object very strongly to my country forcing me to make this choice, and to having to travel unaccompanied to a foreign country to die.” The status quo is cruel and dangerous. People caught up in these circumstances have no transparency; there is no regulation, safeguards or oversight. The Bill contains a whole series of safeguards that are not present at the moment.

    Thirdly, we are deciding today on a principle. If the Bill is voted down on Second Reading, that will be the end of the matter for many years, and we will do that in the knowledge that Scotland, the Isle of Man, Jersey and many other countries are likely to bring in legislation like this. There are 300 million people in 30 jurisdictions who have secured this ability to choose. There will be numerous safeguards. There will not be a slippery slope unless this Parliament agrees to there being one. If we agree to a Second Reading today it is, in my judgment, inconceivable that the Government Front Bench will not ensure we have the proper time to scrutinise the Bill.

    This Bill goes with the grain of our constituents’ views—about 75%, according to the most recent polling. There is an opportunity and a chance, as the hon. Member for Spen Valley has set out, to consider in detail these matters ahead of Third Reading. As drafted, the Bill seems to me a very modest and controlled proposal. Let us not forget this: Oregon shows us that fewer people take these steps once they know they have this choice as a back-up.

    I end with something I have never forgotten. Some years ago, I was listening in a debate to a young man who had recently lost his father. He had visited his father and seen him in great pain and indignity. He had seen him three days before he died. In the end his father put a bag over his head and used his dressing-gown cord to hang himself. That young man said to all of us: “If you are ever in this position, let’s hope that God will help you, because they certainly won’t.” Today, this House has the opportunity to ensure that they will.

  • Diane Abbott – 2024 Speech on the Terminally Ill Adults (End of Life) Bill

    Diane Abbott – 2024 Speech on the Terminally Ill Adults (End of Life) Bill

    The speech made by Diane Abbott, the Labour MP for Hackney North and Stoke Newington, in the House of Commons on 29 November 2024.

    I congratulate my hon. Friend the Member for Spen Valley (Kim Leadbeater) on bringing forward this Bill, which has been the occasion of a very important national conversation. I recall to the House the fact that, in 1969, Parliament voted to abolish the death penalty for murder. Public opinion was actually against that change, but MPs believed, on a point of principle, that the state should not be involved in taking a life. It was a good principle in 1969 and it remains a good principle today.

    I am not against legalising assisted dying in any circumstance, but I have many reservations about this Bill. In particular, I do not believe that the safeguards are sufficient. They are supposed to be the strongest in the world because of the involvement of a High Court judge, but the divisional courts have said that

    “the intervention of a court would simply interpose an expensive and time-consuming forensic procedure”.

    Sir James Munby, the former president of the family division of the High Court, said recently:

    “Only those who believe implicitly in judicial omniscience and infallibility—and I do not—can possibly have any confidence in the efficacy of what is proposed.”

    Is the judge supposed to second-guess doctors? Will the judge make a decision on the basis of paperwork? Or will there be a hearing in open court? Where will be the capacity in the criminal justice system to deal with all this? Far from being a genuine safeguard, the involvement of a judge could just be a rubber stamp.

    Catherine Atkinson (Derby North) (Lab)

    More than two thirds of care proceedings involving the most vulnerable children in our society cannot be completed within six months. Does my right hon. Friend agree that there is a real concern that the safeguard is not deliverable, or risks being the rubber stamp that I know my hon. Friend the Member for Spen Valley (Kim Leadbeater) does not want it to be?

    Ms Abbott

    I entirely agree with my hon. Friend.

    Robust safeguards for the sick and dying are vital to protect them from predatory relatives, to protect them from the state and, above all, to protect them from themselves. There will be those who say to themselves that they do not want to be a burden; I can imagine myself saying that in particular circumstances. Others will worry about assets they had hoped to leave for their grandchildren being eroded by the cost of care. There will even be a handful who will think they should not be taking up a hospital bed.

    Jake Richards (Rother Valley) (Lab)

    My right hon. Friend makes her case powerfully. Can I ask her to comment on the current situation whereby people ask themselves the question she just asked today? What safeguards are there for those people? What inquiry is made before those people pass away, often having taken the most drastic and horrific action to do so?

    Ms Abbott

    But if the House passes this legislation, the issue that I have raised will become foremost in people’s minds even more so.

    We are told that there is no evidence of coercion in jurisdictions where assisted suicide is possible, but people do not generally write letters to sick relatives urging them to consider assisted suicide and then put those letters on file. Coercion in the family context can be about not what you say but what you do not say—the long, meaningful pause.

    Shockat Adam (Leicester South) (Ind)

    As a medical professional who is surrounded by even more senior medical professionals, I know we can all miss things when there are tangibles in front of us: the shadows on X-rays and the markers on blood tests. As professionals, we miss things that can be seen. What security will we have that we can pick up things that we cannot see, like coercion?

    Ms Abbott

    That is the point: coercion is something that there will be no material evidence of and that we cannot see.

    People keep saying that the Bill cannot be amended, but of course any future Government could bring in new clauses. We can see what has happened in Canada, which introduced assisted dying in 2016 for adults with terminal illnesses. In 2021, it was extended to people with no terminal illness and the disabled. In March 2027, anyone with a serious mental health problem will also be eligible. The House should remember that no single organisation representing the disabled supports the Bill.

    Mary Kelly Foy

    My daughter Maria lived her life with severe disabilities and health conditions. Since her birth, we were told many times that she might have only six months to live. She lived for 27 years. Crucially, Maria was non-verbal. I am filled with dread and fear about what might happen to people like Maria who are non-verbal and do not have that capacity, if they are not loved and cared for and do not have somebody speaking out for them.

    Ms Abbott

    I have heard so many stories like that. The arbitrary cut-off of six months does not necessarily meet with the reality of sick people.

    Graham Stuart (Beverley and Holderness) (Con)

    The case of Maria, and others, should give us all pause. Does the right hon. Lady agree, with two thirds of the Cabinet apparently supporting this measure in principle, that we should reject the Bill today, but that we should as a House commit not to go another 10 years ignoring this topic, but to come forward in a considered way, ensure it is looked at properly, and do everything possible to have a system that is more robust, more caring and ensures good outcomes for people like Maria?

    Mr Speaker

    Order. Let me also say that we must try to keep to the time limits.

    Ms Abbott

    I agree with the right hon. Gentleman. As I said right at the beginning, I am not against assisting dying in any circumstances. If the Bill passes, we will have the NHS as a 100% funded suicide service, but palliative care will be funded only at 30% at best. The former Member for Dunfermline East, Gordon Brown, has said recently:

    “we need to show we can do better at assisted living before deciding whether to legislate on ways to die.”

    I represent very many vulnerable people in marginalised communities. I cannot vote for a Bill when I have doubts about whether they will be protected. We can come back, have a commission and craft a better Bill, but I will not be voting for the Bill today.

  • Danny Kruger – 2024 Speech on the Terminally Ill Adults (End of Life) Bill

    Danny Kruger – 2024 Speech on the Terminally Ill Adults (End of Life) Bill

    The speech made by Danny Kruger, the Conservative MP for East Wiltshire, in the House of Commons on 29 November 2024.

    I think you indicated that I could speak for a little longer than eight minutes, Mr Speaker.

    Mr Speaker

    Yes.

    Danny Kruger

    Thank you very much. I do not want to have too much grumbling at the eight-minute moment. I will take my 15 minutes, with time for interventions.

    I start by paying tribute to the hon. Member for Spen Valley (Kim Leadbeater) for her very powerful speech and the way in which she has led this campaign—with great respect, sensitivity and, to use a contested word, dignity. She and I knew each other before we were MPs, when we both worked in the charity sector. I like and admire her greatly, and I know that we have more in common than might appear today.

    All of us in this House have this in common: we all share a deep concern about the experience of people dying or fearing death, pain and suffering. I bear heavily on my conscience the people whose lives will be prolonged beyond their wishes if I get my way and this Bill is defeated today. I will not disregard those people or minimise their anxiety. We will hear those voices in today’s debate—we have heard many of them already—speaking through hon. Members in what I know will be very moving speeches.

    If I voted for this Bill, I would have on my conscience many more people whose voices we cannot hear—the people who would be vulnerable as a consequence of the huge changes that this Bill would introduce in our society and in the NHS. My view is that if we get our broken palliative care system right and our wonderful hospices properly funded, we can do so much more for all the people who we will hear about today, using modern pain relief and therapies to help everybody die with a minimum of suffering when the time comes. We will not be able to do that if we introduce this new option; instead, we will expose many more people to harm.

    I will go through the Bill in a moment, but first I will say a word about process, in response to the points made by the hon. Member for Spen Valley. This Bill is simply too big for the time that it has been given, and I implore hon. Members not to hide behind the fiction that it can be amended substantially in Committee and in its later stages. The remaining stages of a private Member’s Bill are for minor tweaks, not the kind of wholesale restructuring that we would need if we were ever to make this Bill safe. Members who vote for the Bill today must be prepared to see it become law largely unamended. I suggest that if they have any doubts, the only responsible choice is to vote no, and let the advocates of assisted dying bring back a better Bill at another time.

    Alistair Strathern (Hitchin) (Lab)

    I deeply appreciate the respectful way in which the hon. Gentleman is making his point, but I stand before him not sure of how any colleague in this Chamber cannot have doubts whichever way they are voting today. It feels like there are two necessary harms that we are all forced to weigh up. If the hon. Gentleman is so certain that doubt should push people one way, I am deeply intrigued to hear why that is, when it is very clear that many people will continue to suffer unnecessarily if we reject this Bill.

    Danny Kruger

    I recognise that there are very many doubts on each side, and I fully respect the arguments that have been made by the hon. Member for Spen Valley. Of course this is a finely balanced debate, but the point about process is that this Bill is too flawed; there is too much to do to it to address in Committee. By all means, let us have this debate, but let us have that before a Bill of this magnitude is brought forward, The consideration of the Bill should be much more comprehensive.

    Andrew George (St Ives) (LD)

    Contrary to what the media are saying, today’s decision is not about bringing this Bill into law; it is about allowing it to go to the next stage. People may have misgivings, but the hon. Gentleman is making the assumption that the Bill cannot be corrected or amended in order to make it palatable to people who have doubts. We all have doubts, but surely today’s vote is simply to let it go to the next stage. The final decision on Third Reading is the critical one in deciding whether the Bill goes into law.

    Danny Kruger

    I think I have made the point that this Bill is too comprehensive and there is too much in it to address through the process of a private Member’s Bill. If the hon. Gentleman has serious concerns about aspects of the Bill that he would not be prepared to see come into law, he should not be supporting it today.

    Let me explain the concerns about the Bill that I think are too comprehensive to be dealt with in Committee. I recognise how hard the hon. Member for Spen Valley has worked to try to ensure that it is safe, but I do not believe it is, for the following reasons. Let us start at the beginning. The process starts with a conversation between a patient and a medical practitioner—not necessarily a doctor; just a medic of some sort, unspecified at this stage. If the patient tells their ordinary family doctor that they want an assisted death, the doctor is obliged to either explain how it works or pass them on to someone who will do it—which is probably what will happen, by the way. The likelihood is that we would see a new branch of medicine spring up, like the medics I met in Canada.

    Kevin McKenna

    Will the hon. Member give way?

    Danny Kruger

    I will in a moment.

    These medics I met in Canada are specialists in assisted death and personally kill hundreds of patients a year in their special clinics. [Interruption.] If hon. Members have difficulty with the language, then I wonder what they are doing here. This is what we are talking about. I met doctors for whom this is their profession and their job, and they are proud to do it.

    Lewis Atkinson (Sunderland Central) (Lab)

    Will the hon. Member give way?

    Danny Kruger

    I will give way to the other hon. Gentleman.

    Kevin McKenna

    I want to be very clear that “medical practitioner” is a synonym for doctor—not nurse, pharmacist, dentist or any other practitioner. To be a doctor is to be a practitioner of medicine. We need to be very clear on this. There is lots of law and regulation on this, and I believe that what the hon. Member said is incorrect.

    Danny Kruger

    What the Bill actually says is that a doctor means

    “a registered medical practitioner…who has such training, qualifications and experience as the Secretary of State may specify by regulations”.

    Obviously they are some sort of regulated medic—I recognise that—but they are not necessarily a doctor. We will find out. I recognise that they will have professional qualifications, but it is not clear what those are going to be because it is not in the Bill.

    Gavin Robinson (Belfast East) (DUP)

    I commend the hon. Gentleman for the way in which he is engaging in this discussion, in the same spirit as the hon. Member for Spen Valley (Kim Leadbeater). We often hear that one of the safeguards associated with the Bill is that medical practitioners would be involved and that a diagnosis of a terminal illness, with six months or less to live, would be required. Does the hon. Gentleman accept that medicine is not an exact science? It is the science of uncertainty blended with the art of probability. There is no exactitude in this. No court will second-guess medical opinion; it will simply look at process.

    Danny Kruger

    I entirely agree with the right hon. Gentleman; he is absolutely right. I am afraid that the definition of terminal illness is in a sense the essential flaw in the Bill, but I will come on to that.

    Going back to the conversation that the patient has with the medical practitioner, the crucial point is that the conversation does not need to be started by the patient, according to the Bill. It could be started by the medic—any medic—perhaps in hospital, who could make the suggestion of an assisted death to a patient who has never raised the issue themselves, whose family have never suggested it and whose own doctor does not think it is the right thing to do. And so the idea is planted.

    Then, for whatever reason—and, by the way, there is no need ever to give a reason—the patient says that they want to proceed with an assisted death. They sign a declaration, or rather somebody else can sign it for them. It could be any professional, someone they do not know—maybe a new medical practitioner. A total stranger can do all the paperwork on their behalf. That is what the clause about the proxy entails. Then these two medical practitioners make their assessment.

    Paula Barker (Liverpool Wavertree) (Lab)

    I urge the hon. Member to check the wording of the Bill, because if somebody signs as a proxy, they have to have known the individual for two years, and would simply be signing to say that they agree with the patient who wishes to go forward with assisted dying.

    Danny Kruger

    I do not have time to check the Bill now, but from my memory it refers to someone who has known the patient for two years or someone of good standing in the community, which could be some sort of professional who is not known to them at all. Someone can quickly check the Bill, but my understanding is that it could be a total stranger to them.

    Jim Allister (North Antrim) (TUV)

    Is the matter not very clear? Clause 15(5) states:

    “In this section “proxy” means—

    (a) a person who has known the person making the declaration personally for at least 2 years, or

    (b) a person who is of good standing in the community.”

    So there is no protection such as that which is pretended by the supporters of the Bill.

    Danny Kruger

    I am grateful for that intervention.

    The assessments have to determine whether the patient is terminally ill, whether they have mental capacity to make the decision, and then whether they have been coerced or pressured into the decision. In many ways the whole issue turns on the question of whether someone is terminally ill. I am afraid that it is a term of great elasticity, almost to the point of meaninglessness. It is well known, as the right hon. Member for Belfast East (Gavin Robinson) said earlier, that it is impossible for doctors to predict with any accuracy that somebody will die within six months. It is a purely subjective judgment, made in this case by a doctor whose job will be approving assisted deaths. They simply have to determine not whether it is reasonably certain that death will occur, but that it can be reasonably expected—in other words, that it is possible.

    Simon Hoare

    The thrust of the Bill, as I understand it, is to ease suffering and pain in a patient who has a diagnosis and will die of the condition that has been diagnosed. But that right could only be exercised within a six-month period, and the pain and discomfort could last a lot longer than that. Has my hon. Friend heard—because I have not—what the importance of six months is? Why not eight, 10 or 12? What would stop people challenging it on the grounds that the dam has been breached, the six months is entirely arbitrary and it could, and indeed should, be extended by negative resolution in a statutory instrument?

    Danny Kruger

    My hon. Friend makes the right point, and I am afraid to say that is absolutely the case. The six-month cut-off is completely arbitrary and impossible to determine. It is a line in the sand, and of course it could be challenged, as so much of the Bill could be challenged, on human rights grounds. Every one of the safeguards that has been introduced by the hon. Member for Spen Valley would in fact be a barrier and a discrimination against the new human right that has been awarded to one group but should of course be awarded to all—if the point is conceded in this way.

    Melanie Ward

    Earlier this week, colleagues and I met two eminent doctors who were former presidents of the Association for Palliative Medicine, and they raised serious concerns about the Bill, including that the doctor or medical practitioner who makes the assessment need never have met the person they are assessing, or been involved in their care at all. What does the hon. Gentleman make of that?

    Danny Kruger

    The hon. Lady makes a very important point. I will not get into the question of public opinion and the polling, because it is so contested, but there is clear evidence that the doctors who work with the dying—the palliative care professionals—are opposed to a change in the law by a great majority. They see the damage that it would do to the palliative care profession and services, and they see the danger for vulnerable patients.

    Wera Hobhouse

    I appreciate that the hon. Gentleman talks to us as a medical professional and we need to listen to his views. But is it not true that any medical assessment is an approximation; something that cannot be said for certain? For this decision too, we cannot be 100% certain, but that is life. We cannot make legislation that is 100% good because at some point we have to make a decision, on balance, whether something has merit or not. For that reason, we should vote for the Bill.

    Danny Kruger

    I am grateful to the hon. Lady, especially for promoting me to the status of doctor; I am actually a charity worker and political hack by background. It is good of her to credit me with those skills—perhaps I should set myself up as a medical practitioner. She is right that medics and indeed judges have to make difficult judgments all the time. I think it would be very dangerous and inappropriate to give them the power to do so in this case.

    The whole question of the six-month cut-off is very important. I acknowledge all the points that have been made, but there is another problem with the definition of terminal illness. Almost anybody with a serious illness or disability could fit the definition. I recognise that these are not the cases that the hon. Member for Spen Valley has in mind—of course they are not—but that is the problem with the Bill. All that someone needs to do to qualify for an assisted death—for the definition of terminal illness—is refuse treatment, such as insulin if the person is diabetic. In the case of eating disorders, a topic on which I have worked with the hon. Member for Bath (Wera Hobhouse), a person just needs to refuse food. The evidence from jurisdictions around the world, and our own jurisprudence, shows that that would be enough to qualify someone for an assisted death.

    Lewis Atkinson

    Does the hon. Gentleman accept that every day in the NHS patients refuse treatment, and indeed food, and that there is currently legal oversight in respect of coercion and other such matters? Would the Bill not strengthen protections in those areas?

    Danny Kruger

    I am perplexed by that argument. The suggestion that there may be coercion—of course there will be—and abuse, and all sorts of injustices that take place in the current system, does not strike me as an argument for regulating and licensing assisted suicide. If we have concerns about practice in the NHS, let us deal with that. Let us not license suicide—and, by the way, evidence from around the world shows that that increases suicide in the general population. Suicide is contagious. For instance, Oregon is often pointed to as an example. The incidence of suicide, outside assisted suicide laws, has risen by a third there since it was legalised. There would be enormous contagious effects were we to regulate and license it in this way.

    Richard Tice (Boston and Skegness) (Reform)

    The hon. Gentleman is making an excellent case for the Bill to be passed today. What he is actually saying is that there are specifics that require debate, analysis and discussion in great detail in Committee—that is the whole point of it. If it is not dealt with properly in Committee, it will not pass Third Reading. He is suggesting that because he does not like those specifics, we cannot discuss the Bill in any detail.

    Danny Kruger

    I am sure that the hon. Member for Spen Valley is delighted to have the support of the hon. Gentleman. I refer him to the point that I was making: this is an inappropriate process.

    Sir John Hayes (South Holland and The Deepings) (Con)

    My hon. Friend is making a superb speech, as I expected him to do. On the issue of process, I say this to the hon. Member for Boston and Skegness (Richard Tice), my constituency neighbour: as he will know, I have introduced some very serious Bills, including the one that became the Investigatory Powers Act 2016. It was preceded by three independent reports and pre-legislative cross-party scrutiny by both Houses, which happened before the Committee stage. The point is that that process should take place before Second Reading, not after.

    Danny Kruger

    I am grateful to my right hon. Friend. I will now run through the process before taking any more interventions.

    As I have explained, pretty much anybody with a serious illness or disability could work out how to qualify for an assisted death under the Bill. Members may think that far-fetched, but it is what happens everywhere that assisted suicide is legal, including in Oregon.

    Cat Eccles (Stourbridge) (Lab)

    On a point of order, Mr Speaker. The hon. Gentleman is using incorrect language. It is not suicide. That is offensive. I ask him please to correct his language.

    Mr Speaker

    That is not a point of order.

    Danny Kruger

    I am sorry if offence is given, but the fact is that the value of having a Bill in black and white is seeing what the law really is. What the Bill would do is amend the Suicide Act 1961. It would allow people to assist with a suicide for the first time. I respect the hon. Lady’s concern, but I am afraid we do need to use the proper language here.

    The Bill’s scope is very broad. Members who think that assisted suicide for people with anorexia or other conditions that would not be regarded as terminal could not happen here should consider the young people in the UK today who are given a diagnosis of terminal anorexia and put on a palliative care pathway—essentially, assigned to death. Of course these are extreme cases—

    Wera Hobhouse rose—

    Danny Kruger

    I am not going to give way again.

    There are a great many of these cases, I am afraid, and I mention them to show how wide open the Bill is. [Interruption.]

    Mr Speaker

    Order. May I ask the hon. Member for Bath (Wera Hobhouse) to keep a little calmer? She has intervened twice already, and plenty of other Members who also need to be heard.

    Danny Kruger

    I think particularly of disabled people, many of whom require constant treatment to stay alive. All, immediately and by definition, will be eligible under the terms of the Bill for a state-sponsored death. I refer Members to the Equality and Human Rights Commission, which has made the point that the line between disability and terminal illness is very blurred. That is why the Bill’s title is, in fact, so dangerous.

    Mary Kelly Foy (City of Durham) (Lab) rose—

    Danny Kruger

    I will make a little progress.

    The second question that medical practitioners have to answer is about mental capacity, and here again is a great vagueness. How do they judge if someone is in their right mind when they are asking for help to kill themselves? The Bill says that the definition of capacity is based on the Mental Capacity Act 2005, but that Act is deliberately expansive. It explicitly assumes capacity in the patient, so having acute depression is no bar to being judged to have capacity under the Act. Being suicidal is no bar under the Act, so the capacity test is no bar at all.

    Finally, there is the question of coercion. Is the patient asking for an assisted death because of pressure from someone else? There are two glaring problems here. The first is that the process does not even attempt to answer the question properly. There is no investigation, no requirement for medics to interview friends and family, and no need for a psychiatrist or family doctor to be consulted. The medics just need to satisfy themselves—who knows how?—that, to the best of their knowledge, the person has not been pressured.

    The second problem with the coercion test is that it focuses on only one type of coercion—the less likely type. The bigger danger is not other people pressuring someone to do this; it is that they pressure themselves—hon. Members have made this point. The Bill has nothing to say on that. Internal pressure is absolutely fine. If you feel worthless or a burden to others, if the NHS will not offer you the treatment you need, if the local authority will not make the adjustments you need to your home, if you have to wait too long for a hospital appointment, or if you want to die because you think the system has failed you, that is absolutely fine.

    Several hon. Members rose—

    Danny Kruger

    I will get to the end of my speech.

    That is the medical stage, and I will jump straight to the judicial stage. The medical practitioners sign it off, and then the judge has to confirm all the same tests. Of course, many eminent judges have made the point that it will overwhelm the family courts if the test were applied properly, but it will not be applied properly, because the Bill assumes that judges will fulfil a new inquisitorial role and actually look into cases as investigators, which is entirely unknown in English common law. But the Bill will not require any actual investigation.

    There is no requirement for a judge even to meet the applicant. They simply have to have a phone call, or maybe it will be an email, from one of the medics. That is it. That is the inquiry. On that basis, the judge must decide whether it is more likely than not that there has been external pressure. After the judge approves it—they are required to approve it, unless they can find evidence of external coercion—we go to “the final act”, as the Bill says, where a junior colleague, as a medical practitioner, oversees your death by pills or lethal injection.

    And here is the last thing that the Bill does or does not do. There is no requirement at any stage of the process—at either the medical or the judicial stage—for anyone to tell the patient’s next of kin, their wider family or even their GP that the NHS and the judicial system are working in secret to bring about the death of their loved one, maybe their father or their daughter. I say again that these are not the cases that the Bill was designed for, but they are directly in scope, and it is going to take more than a tweak in Committee to get them out.

    Is this what is meant by having choice at the end of life? Let us talk about choice. I am often accused of wanting to impose my view on others—that point was made earlier. People say, “If you don’t approve of assisted death, don’t have one, but don’t deprive me of the choice.” In fact, the evidence is that, with this new option and the comparative loss of investment and innovation in palliative care, real choice will narrow. There is a broader point to make about choice, which is that no man or woman is an island. Just as every person’s death, even a good death, diminishes us all, so we will all be involved and affected if we make this change.

    The Bill will not just create a new option for a few and leave everyone else unaffected; it will impose this new reality on every person towards the end of their life, on everyone who could be thought to be near death, and on their families—the option of assisted suicide, the obligation to have a conversation around the bedside or whispered in the corridor, “Is it time?” It will change life and death for everyone.

    I am very aware of the terrible plight of the people who are begging us for this new law. I think we can do better for them than they fear, but we also need to think in real human terms about what the effect will be on the choices of other people, and I do not mean the people who are used to getting their way. I am talking about the people who lack agency, the people who know what it is to be excluded from power and to have decisions made for them by bigwigs in distant offices who speak a language they do not understand—the sort of people who the hon. Member for Spen Valley and I both know from our previous charity work, and who we all know from our constituency work. They are not the people who write to us campaigning for a change in the law, but the people who come to our surgeries with their lives in tatters, or who the police or social workers tell us about—the people with complex needs. What are the safeguards for them?

    Let me tell the House: we are the safeguard—this place; this Parliament; you and me. We are the people who protect the most vulnerable in society from harm, yet we stand on the brink of abandoning that role. The Rubicon was a very small stream, but on the other side lies a very different world—a worse world, with a very different idea of human value. The idea that our individual worth lies in our utility, valuable only for so long as we are useful—not a burden, not a cost, not making a mess. Let us not be the Parliament that authorises that idea.

    I mentioned at the start of my speech the voices of those we cannot hear: the frail and elderly and the disabled. As we are surrounded by such a cloud of witnesses, let us do better than this Bill. Let today be not a vote for despair, but the start of a proper debate about dying well, in which we have a better idea than a state suicide service. Let us have a debate in which we remember that we have intrinsic value; that real choice and autonomy means having access to the best care possible and the fullest control over what happens to us while we live; and that true dignity consists in being cared for to the end.

  • Kim Leadbeater – 2024 Speech on the Terminally Ill Adults (End of Life) Bill

    Kim Leadbeater – 2024 Speech on the Terminally Ill Adults (End of Life) Bill

    The speech made by Kim Leadbeater, the Labour MP for Spen Valley, in the House of Commons on 29 November 2024.

    I beg to move, that the Bill be now read a Second time.

    Thank you, Mr Speaker, and thank you to everyone who is attending this hugely significant debate. It is a privilege to open the debate on the Terminally Ill Adults (End of Life) Bill, a piece of legislation that would give dying people, under stringent criteria, choice, autonomy and dignity at the end of their lives. I welcome the debate on this hugely important issue.

    Let me say to colleagues across the House, particularly new colleagues, that I know this is not easy—it certainly has not been easy for me—but if any of us wanted an easy life, I am afraid we are in the wrong place. It is our job to address complex issues and make difficult decisions. I know that for many people this is a very difficult decision, but our job is also to address the issues that matter to people. After nearly a decade since the subject was debated on the Floor of the House, many would say that the debate is long overdue.

    For my part, I have tried incredibly hard to ensure that the tone of the debate has been—and continues to be—robust, of course, but most importantly respectful and compassionate. I am pleased that, for the most part, that has been the case. I can be confident that that same tone of respect and compassion will be adopted by colleagues today, whatever views they hold. That is particularly important as we have people in the Public Gallery who have a strong personal interest in this issue. They hold a range of views. Some of them have lost loved ones in difficult and traumatic circumstances, and others are themselves terminally ill.

    I want to pay a huge and heartfelt tribute to those families and to every single person who has contacted me about this issue, and in many cases shared their own very personal stories of loss and death. I know from my own personal experience of grief that telling your story over and over again takes energy, courage and strength. I am incredibly grateful to them all. It is their voices and their stories that have inspired me.

    Such stories are difficult to hear, but it is vital that they are heard as they are at the heart of the debate. They show that the law is failing people. Where that is the case, we have a duty to do what is right to fix it. Those here today or watching at home are dealing with the real consequences of the failings of the current system. I will start by recounting just a few of their stories.

    Warwick was married to his wife Ann for nearly 40 years. She had terminal peritoneal cancer, which meant that she could not breathe properly. She spent four days gasping and choking, remaining awake throughout despite being given the maximum dose of sedatives. She eventually died of suffocation. She had begged Warwick to end her life, but as he stood over her with a pillow he could not do what she asked as he did not want that to be her final memory of him. Ann had excellent palliative care, but it simply could not ease her suffering.

    Tim fell in love at first sight when he met his wife Louise—he proposed after just three days. But Louise got cancer, twice, and at the end, the morphine simply could not control her pain. In desperation, she managed to smash a small glass bottle and tried to take her own life, not realising that her toddler daughter had got into bed with her. Tim found her. He says,

    “You get to a point where you stop praying for a miracle and start praying for mercy.”

    Former police officer James waved is mum off as she embarked on her final trip, to Dignitas. She had terminal vasculitis. James desperately wanted to accompany his mum and hold her hand during her final moments, but he knew, because of his job as a police officer, that it was just not possible. Indeed, she insisted that he must not go with her, so she went alone—no one to hold her hand, and no proper goodbye or funeral. Those are just a few examples of the heartbreaking reality and human suffering that far too many people experience as a result of the status quo. the public know this.

    I have always been keen to ensure that my politics stays rooted in the world beyond Westminster. It is clear that public opinion is very much in favour of a change in the law. Polling shows consistently that around 75% of people would like to see the legalisation of assisted dying for terminally ill, mentally competent adults. These findings are significant, but it may not be that surprising that most people believe, as I do, that we should all have the right to make the choices and decisions we want about our own bodies. Let us be clear: we are not talking about a choice between life or death; we are talking about giving dying people a choice of how to die.

    Let us examine what that choice currently looks like. I do not have a legal background but I have always been driven by a strong sense of injustice. If I see a problem, I will do everything I can to try to solve it. Indeed, in this job, we all do that every week and every day, whether here in Parliament or in our constituencies. When four former directors of public prosecutions, including the Prime Minister, two former presidents of the Supreme Court and many lawyers all agree that the law needs to change, surely we have a duty to do something about it.

    Intentionally helping another person to end their life is currently illegal under the Suicide Act 1961, and carries a maximum prison sentence of 14 years. This includes family and friends helping someone who is terminally ill to die, both in the UK and overseas. Existing guidance does not stop people from being investigated by the police, adding fear, guilt and further trauma to grieving families. The law is not clear, and it does not protect individuals, families or medical professionals. That drives people to very desperate measures.

    What about coercion? Senior King’s Counsel have said:

    “There is currently no established system for identifying abuse or coercion in advance of a person’s death or for helping vulnerable people to make end of life decisions.”

    Kevin McKenna (Sittingbourne and Sheppey) (Lab)

    I have been a nurse for more than a quarter of a century, and in that time I have worked mostly in intensive care as a specialist. I have worked with compassionate and skilled, well-trained clinicians who have been taught to spot coercion—it is fundamental to our practice. Does my hon. Friend agree that it is wrong to suggest that clinicians cannot spot coercion in these cases?

    Kim Leadbeater

    My hon. Friend makes a very important point. I thank him for it, and for his years of service as a nurse. I have spoken to many medical professionals about this issue, and they say that this is part of their job. They are very skilled and they work closely with patients, particularly dying patients, to assess their needs and to have those difficult and delicate conversations. As the KCs said, at the moment we check for coercion in cases where people have taken their own lives—when someone is dead. The Bill would make coercion a criminal offence with a sentence of up to 14 years.

    Surely, by putting a legal framework around this difficult situation, we will provide an extra level of safeguarding. One psychotherapist, who is terminally ill herself, said to me recently that coercion happens when things are hidden away. The Bill would bring things out into the open. Surely, that must be safer for everyone. Let us look at what the absence of a robust legal framework looks like.

    Simon Hoare (North Dorset) (Con)

    I thank the hon. Lady for giving the House the time to debate the Bill this morning. She references coercion, and I understand her point about the two medics, but medics will not be able to see or hear everything at all times. People will not be put beyond challenge, because subsequent to the death, if a relative claims coercion of another relative, investigation will remain. I am entirely unclear how, without peradventure, two clinicians can claim that there had been no coercion at any point.

    Kim Leadbeater

    The hon. Gentleman has made the point for me: within a robust system, we will check for coercion, but we do not have any of that now. At the moment, the person will be definitely be dead. We have to look at the status quo. Putting in layers of safeguarding and checking for coercion must be better than the system that we have now.

    Alicia Kearns (Rutland and Stamford) (Con)

    Colleagues are right to raise questions around coercion. I hosted a phone-in on LBC where people rang in and said, “I feel like I have to end my life because I recognise how difficult it is for my family to see me suffering.” The limit in the Bill, however, is that someone must have only six months to live according to two doctors and a judge, which I genuinely believe massively reduces the risk of coercion. Are we really saying that people are so desperate to bump off their families that if they were told that they had six months to live, they would escalate the process and do it sooner?

    Kim Leadbeater

    The hon. Lady makes an excellent point—she is absolutely right. The very strict criteria in the Bill add extra layers of safeguarding, which, again, we just do not have at the moment.

    Richard Burgon (Leeds East) (Ind)

    I have the deepest respect for my hon. Friend, but one thing that concerns me is societal or systemic coercion. At the moment, elderly people in our society pay thousands of pounds a month to be in a care home. What reassurances can my hon. Friend give that an elderly person in a care home who has been given six months to live would not think to themselves, “I’m a burden. I have been given six months to live. If I end my life now, I can save my family between £25,000 and £55,000”? That really concerns me.

    Kim Leadbeater

    As I have said, at the moment, we have no idea whether that person would take action because we are not having those conversations. By getting two medical professionals and a High Court judge involved, we would be putting this out in the open. Evidence from other jurisdictions shows clearly that coercion tends to happen the other way; what tends to happen is that families try to prevent the person from making the choice of an assisted death.

    Several hon. Members rose—

    Kim Leadbeater

    I will take one more intervention.

    Wera Hobhouse (Bath) (LD)

    Is it not the case that the conversations that patients will have with doctors will bring out whether they have been coerced or are suffering intolerably? The criteria are about suffering, not whether somebody worries that they are a burden.

    Kim Leadbeater

    I agree absolutely. Those conversations, which are not taking place at the moment, are very important. I will make some progress.

    There has rightly been a lot of discussion about palliative care in recent weeks, and I am convinced that a significant amount of that discussion would not have taken place without the introduction of the Bill. It is a long overdue conversation, and I am very pleased to see it happening.

    I have met with the Association for Palliative Medicine, Hospice UK, Sue Ryder and Marie Curie, and last week I was delighted to attend the inaugural meeting of the all-party parliamentary group for hospices. I also attended the fantastic Kirkwood hospice, which serves my constituency of Spen Valley. I pay tribute to the dedicated staff and volunteers across the country in the palliative care sector, who do some of the most vital work in society. We must do more to support them, and I look forward to working with the Government and colleagues across the House in that important endeavour. That is why I have included in the Bill a requirement for the Secretary of State to report to the House on the availability, quality and distribution of palliative care.

    Of course, assisted dying is not a substitute for palliative care—it is not an either/or. We have some of the best palliative care in the world in this country, and, when it can meet the needs of terminally ill people, it is second to none. However, when it cannot, surely the choice of an assisted death should be one component of a holistic approach to end of life care.

    The comprehensive report by the Health and Social Care Committee, published earlier this year, found no indications of palliative care deteriorating in quality or provision in places where assisted dying had been introduced.

    Jim Shannon (Strangford) (DUP)

    Ever mindful of what the hon. Lady has said about the criteria, I remind her that Belgium started off with a simple project like the one she refers to but it deteriorated and expanded to include sufferers of dementia and under-18s—children. What guarantees do we have that this legislation will not end up with a situation like that in Belgium, in which case anything goes? Is that what the hon. Lady wants? I do not want that. Does she?

    Kim Leadbeater

    I thank the hon. Member for his intervention, but let us be very, very clear. Huge amounts of research has been done by the Health and Social Care Committee, and indeed by myself and others. The model being proposed here is nothing like what happens in Belgium. It is nothing like what happens in Canada. There are strict, stringent criteria, and if the House chooses to pass the Bill, those criteria cannot be changed.

    Mark Pritchard (The Wrekin) (Con)

    I am grateful to the hon. Lady for giving way and congratulate her on the measured way in which she has conducted this debate over the last few weeks. Whatever side of the House and whatever side of the debate, I would like to recognise that—it is not always the case. But is it not the case that the Bill crosses a new and irreversible medical red line for doctors and nurses? Is it not the case that in other Bills we have seen in this House over the years, the safeguards invariably become obsolete over time, and so the safeguards in this Bill, however well meant, should be seen as temporary safeguards and not immutable safeguards?

    Kim Leadbeater

    Absolutely not. I respectfully disagree with the right hon. Gentleman. In countries where a Bill of this nature has been implemented, the safeguards have been in place and the boundaries have never changed. I will come on to talk about that.

    Sir Oliver Dowden (Hertsmere) (Con) rose—

    Kim Leadbeater

    I will take one more intervention and then I must make some progress.

    Sir Oliver Dowden

    I thank the hon. Lady for giving way. I have a great deal of sympathy for the arguments she is making. However, we have seen, time and again, excessive judicial activism taking the words in this House and expanding their meaning into places we had not foreseen. What reassurances can she give that the words in her Bill will be respected by the judiciary and that we will not find ourselves in a decade’s time in a totally different place that this House did not intend?

    Kim Leadbeater

    I thank the right hon. Gentleman for his intervention. The courts have repeatedly put this issue back to Parliament. This is not their domain. This is the legislation. There are strict criteria.

    Coming back to palliative care, in situations where pain simply cannot be managed, the result is deaths that are so horrific that the person themselves can spend hours, and in some cases days, in unimaginable pain as they die. I want to bring the debate back to the issue that we are trying to solve. For their loved ones, no matter how many joyful and happy memories they have, they also have the trauma that comes from watching someone you love die in unbearable agony and fear. That memory stays with them forever.

    Rebecca’s mum Fiona developed metastatic brain cancer at the age of 69. She had very good palliative care, but her pain could not be managed, and she died begging and screaming for assistance to end her suffering. Her family and the medical team treating her cried beside her bedside as it took her 10 days to die.

    Lucy’s husband Tom was 47, a music teacher with a young son. He had bile duct cancer which obstructed his bowel, resulting in an agonising death. Tom vomited faecal matter for five hours before he ultimately inhaled the faeces and died. He was vomiting so violently that he could not be sedated and was conscious throughout. Lucy pleaded with the doctors to help. The doctor treating him said there was nothing he could do. His family say that the look of horror on his face as he died will never leave them. Lucy now has post-traumatic stress disorder, which is quite common for families who lose loved ones in such harrowing circumstances.

    Rachel Taylor (North Warwickshire and Bedworth) (Lab)

    I thank my hon. Friend for the powerful and moving stories she is telling. A constituent of mine watched her mum suffer from pancreatic cancer. Unable to keep any food down, she basically starved to death. Does my hon. Friend agree that that is no way to see a loved one die? Does she also agree that we did not come into this place to shy away from difficult choices, but to listen to our constituents and make better laws for everyone?

    Kim Leadbeater

    I thank my hon. Friend for her intervention, and I am so sorry to hear that story from her constituency. We all have stories from all our constituencies, and she is absolutely right that we are here to make difficult decisions. On her example there, I have been astonished by the number of people who have been in touch with me to tell me about the terminally ill loved ones who have starved themselves to death out of desperation—something that takes far longer than we may imagine and is just horrific for everyone involved. That is currently legal, and doctors are required to assist the patient through this agonising process. How can we allow that, but not a compassionate and humane assisted death?

    Blair McDougall (East Renfrewshire) (Lab)

    I join the right hon. Member for The Wrekin (Mark Pritchard) in commending my hon. Friend for the way she has made sure that this binary debate has not been a polarising one. I started the debate where she is now, but I have moved to opposing the Bill by the stories I have heard of disabled people who have had “do not resuscitate” put on their medical records without their permission, or who have been stopped by strangers in the street and been told, “You would be better off dead.” I know she will say that we are voting on the specifics of her Bill, but we are also voting on a principle. Does she agree that there should be a precautionary approach, and does she honestly believe the legislative process gives us the time to be sure that we are making the right decision?

    Kim Leadbeater

    I thank my hon. Friend for his intervention and I will come on to some of those points later in my speech. Let us be very clear: the title of the Bill refers to terminally ill adults, not disabled people or elderly people, as another hon. Member referred to. The criteria are very clear.

    I come back to the status quo, which is the problem we are trying to address. If people want to avoid the trauma of some of the harrowing circumstances I have described, they can have an assisted death—just not in this country. If they have £10,000 or £15,000, they can make the trip to Switzerland or elsewhere but, because of the current legal position, it is often a deeply distressing and very lonely experience, shrouded in secrecy, with people feeling like criminals as the fear of prosecution hangs over them.

    Ilana’s husband Crispin had late-stage motor neurone disease. He was paralysed, and Ilana is a wheelchair user, but at his request she took him on a traumatic and difficult journey to Switzerland. She describes the intense stress and anxiety she felt due to the total secrecy of their plan—and we can only imagine what the journey home was like, on her own, with an empty seat beside her.

    There are also those terminally ill people who take matters into their own hands. Gareth’s father Norman served in the Welsh Guards. He was a strong man, but his final five years were full of pain and discomfort. He had prostate cancer, which he lived with for 15 years. He was given good initial hormone therapy and chemo, but the cancer spread everywhere and the pain could not be eased. One day, when it all became too much, he went into his garden with the gun he owned and shot himself. Gareth’s sister rushed to his house and found him. Gareth said his father just wanted the pain to stop.

    Then there is Peter, from Mirfield in my own constituency, who stopped me in a car park a couple of weeks ago to tell me the harrowing story of his beloved wife, who was diagnosed with metastatic cancer aged 52. The treatment was ineffective and her symptoms were unbearable. She took an overdose of her medication, and Peter found her and took her to hospital. She recovered and he brought her home, but the following day she made another attempt to take her own life, in a way that is too awful to describe. Peter found her dead, and he spent the next eight hours being questioned by the police.

    It is estimated that more than 600 terminally ill people take their own lives every year. Often patients will store up medication. Josh, a 33-year-old from Huddersfield went to coach his local kids’ rugby team one Saturday and came back to tell his mum all about it. He found her dead. Lisa, who was terminally ill, had stored up her medication and taken her own life.

    Our former colleague Paul Blomfield, the previous MP for Sheffield Central, has campaigned tirelessly on this issue since his dad Harry took his own life in 2014, alone in his garage, after being diagnosed with inoperable lung cancer. Language matters: Harry was not suicidal; he loved life, but he had watched too many of his friends have lingering, degrading deaths and he did not want that for himself. But, like the others, he could not tell Paul and his family of his plan, as they would have been complicit and could have faced prosecution. How many precious days and weeks did Harry miss out on as a result of having to take action while he was still physically able to do so? Hearing these stories is not easy, but it is important.

    Lloyd Hatton (South Dorset) (Lab)

    What I have been struck by in recent weeks as I have listened to Members from across the House is the clear agreement that the current situation is neither sustainable nor dignified. Almost everyone in this House agrees that the status quo is unacceptable in terms of dignity, palliative care and end of life. Given that, does my hon. Friend agree that today’s debate is about how we depart from the unacceptable situation that we currently face? Is today’s vote not the first stage of an important discussion about we improve the end of life for hundreds and hundreds of people across this country?

    Kim Leadbeater

    I wholeheartedly agree. I am setting out what we are dealing with now. This cannot be right, and surely we have a duty to do something about it.

    Wendy Morton (Aldridge-Brownhills) (Con)

    Will the hon. Lady give way?

    Kim Leadbeater

    I am going to make some progress, if that is okay.

    Some of the most important voices in this debate are, of course, those of people currently living with a terminal illness. Having a terminal diagnosis is perhaps one of those situations where it is very hard, if not impossible, to know how we would feel. I have met many terminally ill people over recent weeks and every one of them is in my thoughts today.

    Sophie, who is here today, was diagnosed with stage 4 secondary breast cancer, which has spread to her lungs, liver and pelvis. She is allergic to opioids, so she knows that her pain is very unlikely to be able to be managed. She has a 17-year-old daughter. All she asks is to have the choice to say goodbye to her daughter at a time of her choosing, in circumstances that she can have some control over, and for her daughter to be able to remember her as the vibrant, positive woman she is.

    Nathaniel, who also joins us today, has stage 4 incurable bowel cancer, which is now in his liver and brain. Like many of us, Nat says that he does not know whether he would choose an assisted death or not, but he simply cannot understand why anyone would want to deny him the choice. He says:

    “I wish to live as fully as I can and for as long as possible. But when the time comes”,

    Nat also wants

    “the right to die with dignity and compassion”.

    Another very emotional lady came up to me at a recent interfaith event. She and her husband thanked me for putting the Bill forward. She said, “Kim, I am a proud Christian and I am guided by my faith. But I also have terminal cancer and I want the right to choose a compassionate death.”

    There has been much discussion about the views of people who hold religious beliefs. I fully respect those beliefs and do not intend to say much more about this, other than that I know there are a range of views within faith communities. Indeed, some of the most powerful conversations that I have had have been with people of faith, including in my own constituency. People of different religions have said that although they would not choose an assisted death for themselves or their family, who are they to stop someone else who may want to make that choice?

    Barry Gardiner (Brent West) (Lab)

    Will my hon. Friend give way?

    Kim Leadbeater

    I will make some progress, if I may. I hope that I have set out the problem that clearly exists. Now allow me to set out how the Bill can address that problem and, most importantly, do so safely and effectively.

    If the Bill were to become law, it would contain the most robust and strongest set of safeguards and protections in the world. Very strict eligibility criteria and multiple layers of checks and safeguards are embedded in the Bill, none of which, as we have seen, exist at the moment. I made a conscious decision to name it the Terminally Ill Adults (End of Life) Bill, rather than anything else. That title can never be changed and ensures that only adults who were dying would ever come within its scope. As such, the Bill is not about people choosing between life and death; it is about giving dying people with six months or less to live autonomy about how they die and the choice to shorten their deaths.

    The Bill does not apply to people with mental health conditions. It does not apply to the elderly. It does not apply to people with chronic health conditions, and it does not apply to disabled people, unless, of course, they have a terminal illness, in which case they would and should be entitled to the same rights as anyone else.

    Daisy Cooper (St Albans) (LD)

    One group of people who are not often talked about are the learning disabled. Clause 9(3)(b) says that if an assessing doctor has any doubt as to the capacity of the person, they may refer them for a further psychiatric assessment. If the Bill is voted through today, will the hon. Member engage in a debate about whether that language should be strengthened from “may” to “must” and whether the training and experience required of the assessor should be strengthened as well?

    Kim Leadbeater

    The hon. Lady makes an excellent point and highlights a community who we must consider in light of the Bill. I would absolutely be open to that conversation in Committee; it is a very valid point.

    There are different views within the disabled community. As Professor of Disability Research, Sir Tom Shakespeare says that it is unacceptable that people with disabilities continue to face social stigma and inequalities, but that it would be a mistake to conclude that we should oppose legalising assisted dying for terminally ill people until those wider problems are fixed. He says that it is paternalistic and wrong to imply that inequalities will be resolved by reducing choices, and that a clear, transparent legal framework for end-of-life choice is better for everyone. He is right. There is, of course, still work to do in the fight for equality for people with disabilities, but once again it is not an either/or. I will campaign alongside many others in this place for those rights, but I will also campaign for the rights of terminally ill people, because their rights are as important as anybody else’s rights.

    Barry Gardiner

    I have huge respect for the hon. Lady for the way that she has conducted this debate over the last few weeks. My concern is that she has focused today on the individual and the individual choice, but we are here to legislate for society as a whole. In legislating, what we are saying if we pass the Bill is that it is okay to take that choice—[Interruption]—and there will be some people who have six months of their life to go who will then feel, “Ought I to do this? Is this something that I now should do?” That brings into play a whole set of considerations—“Is it better for my family? Is it financially better for my family?”—in ways that, at the moment, are out of scope. Rather than simply focusing on the individual suffering, which we all recognise is acute, we must broaden the debate to the impact that the legislation will have on society as a whole.

    Kim Leadbeater

    I thank my hon. Friend for his intervention. I suggest that the Bill will give society a much better approach towards end of life. We are already hearing conversations about dying and death which I do not think we have heard enough in this country. We have to take a holistic view. Indeed, that is what happens in other countries and other jurisdictions. Having those deep and meaningful conversations about death and dying is really important. My hon. Friend’s comments bring me on nicely to the protections and safeguards in the Bill.

    Mr Toby Perkins (Chesterfield) (Lab)

    A decade ago, I voted against a similar Bill, because I felt that perhaps it was not perfect and there were more things that I needed to know. My hon. Friend is right that we have not talked about death for the 10 years since or considered any legislation. The truth is that if we vote against her Bill today, it will be the end of the conversation once again for another decade.

    Kim Leadbeater

    My hon. Friend is absolutely right. How many people will go through the situations I have described if it is another 10 years before we address this matter?

    Several hon. Members rose—

    Kim Leadbeater

    I am not going to take any more interventions, I am afraid, because I am conscious that lots of hon. Members want to speak; I know Mr Speaker is conscious of that as well.

    Under the Bill, any terminally ill person who wants to be considered for an assisted death would have to undertake a thorough and robust process involving two doctors and a High Court judge. No other jurisdiction in the world has those layers of safeguarding. The person requesting assistance must have mental capacity and a settled wish at every stage. That means they must repeatedly demonstrate that they understand the information relevant to their decision, the ability to retain that information, and to use or weigh that information as part of the process of making the decision. We know that capacity can fluctuate which is why it is assessed at every step of the process.

    Melanie Ward (Cowdenbeath and Kirkcaldy) (Lab)

    On that point, will my hon. Friend give way?

    Kim Leadbeater

    I am sorry but I am not going to take any interventions, as I need to make progress.

    The court must speak to one of the doctors and can hear from anybody else they deem necessary. If there is any evidence of coercion, the court will not approve the request, and if evidence emerges subsequently, the court order could be revoked. It is also important to note that the person can change their mind at any time, with periods of reflection built in. Having consulted at the highest levels in the judiciary and the medical profession, I know that they can and will fulfil those safeguarding responsibilities and that they have the expertise to do so.

    Let us be clear: as my hon. Friend the Member for Sittingbourne and Sheppey (Kevin McKenna) said earlier, this is not brand new territory for doctors. Doctors, working in partnership with other clinicians, are already required to manage complexity in end-of-life decision making. I followed the request of the British Medical Association that doctors should be under no obligation whatsoever to participate, but if they do participate, they will receive appropriate training and support. Doctors should be able to use their professional judgment when and if a conversation takes place, taking their cue from the patient, as they do for many other issues. I welcome that patient-centred approach. Many doctors feel the change in the law would safeguard clinicians and patients by making everything explicit.

    When it comes to the detail of what assisted dying would look like, we have the benefit of drawing on the experience of 31 jurisdictions around the world. I could talk extensively about the international experience of assisted dying. The Health and Social Care Committee report did a brilliant job of that, and this Bill has looked at best practice as well as models which I and many others would not be comfortable with our having here in England and Wales.

    Reflecting on their experience, clinicians in Australia say:

    “through deep and meaningful conversations between doctors, patients and their loved ones we can dispel fear, reduce suffering, bring death and dying out of the shadows, and so allow patients and their families a better quality of life and quality of death”.

    As one Australian Member of Parliament said:

    “We have brought ‘behind-closed-doors’ practices into the open and given dying people meaningful, transparent choices. Crucially none of the fears that were put forward as reasons not to change the law have been realised. The status quo was broken and assisted dying works.”

    Evidence from around the world shows that the option of having an assisted death actually lifts the fear that terminally ill people have, and that many never actually use it but are able to make the best of the time they have left due to the comfort and reassurance that it provides.

    People talk about a slippery slope, but the Health and Social Care Committee found that not one jurisdiction that has passed laws on the basis of terminal illness has expanded its scope. [Interruption.] That is absolutely true. As the courts here and in Europe have repeatedly made clear, Parliament is sovereign. This Bill could not be made any broader through any judicial process.

    Speaking of process, with reference to the Bill, having listened to what I know are genuine concerns of Members about ensuring that we get this legislation right, I commit to the House that if the Bill passes Second Reading today, which I sincerely hope it does, I am minded to move a motion that gives the Bill Committee the power to take oral and written evidence in order to ensure that a thorough approach continues to be taken. That is not normal procedure for a private Member’s Bill, but I think that that is the right thing to do. I also reassure colleagues that the Bill Committee will meet over a number of weeks, meaning that there is ample time for full consideration of the details of the Bill, including amendments. The Committee will be representative of the views and make-up of the House. Let me be clear: that will mean there will be representatives of different parties with a range of views on the Committee.

    As the Leader of the House said at the Dispatch Box just yesterday, and has said several times, the Government will, of course, work with me to ensure that the Bill is workable and operable. That will quite rightly take time, and I have included in the Bill a commencement period of up to two years—this is not going to happen overnight. That timeframe can be explored in Committee, as it is more important to get this right than to do it quickly.

    In conclusion, for the reasons I have set out, I am very clear that the law needs to change to give terminally ill people choice at the end of life and to protect their loved ones from fear of prosecution. There will be some of us here today who are lucky enough not to have personal experience of this issue, but sadly we know that any one of us could end up in this heartbreaking situation. We are all living longer, which is brilliant, and I have campaigned inside and outside Parliament for a greater focus on prevention and early intervention of illness and disease to keep us fit and healthy for as long as possible, but any one of us or our loved ones could be unfortunate or unlucky enough to receive a terminal diagnosis. I struggle to see how it is fair or just to deny anyone the autonomy, dignity and personal choice of taking control of their final weeks. And the right to choose does not take away the right not to choose. Giving the choice of an assisted death to those who want it would of course not stop anyone who is terminally ill from choosing not to make that choice.

    Whatever happens today, I am incredibly proud of the work that my fantastic team and the many campaigners have done on this hugely significant, emotional and sensitive subject. We need to be clear: a vote to take this Bill forward today is not a vote to implement the law tomorrow. It is a vote to continue the debate. It is a vote to subject the Bill to line-by-line scrutiny in Committee, on Report and on Third Reading. Then, of course, the Bill will go to the Lords for what I have no doubt will be further robust debate and scrutiny. This will be a thorough process, focused on one of the most significant issues of our time—an issue that people across the country clearly want us to address, none more so than the many families who are facing the brutal and cruel reality of the status quo. Today is the beginning, not the end, of that process, but the debate can continue only if colleagues join me in the Aye lobby today. I wholeheartedly encourage them to do so, and I commend the Bill to the House.

  • Wes Streeting – 2024 Comments on Employing Temporary Staff in the NHS

    Wes Streeting – 2024 Comments on Employing Temporary Staff in the NHS

    The comments made by Wes Streeting, the Secretary of State for Health and Social Care, on 11 November 2024.

    For too long desperate hospitals have been forced to pay eye-watering sums of money on temporary staff, costing the taxpayer billions, and pulling experienced staff out of the NHS. We’re not going to let the NHS get ripped off anymore.

    Last month the Chancellor made a historic investment in our health service which must reform or die. I am determined to make sure the money is well spent and delivers for patients.

    These changes could help keep staff in the NHS and make significant savings to reinvest in the frontline.

  • Wes Streeting – 2024 Speech at the Royal College of General Practitioners Conference

    Wes Streeting – 2024 Speech at the Royal College of General Practitioners Conference

    The speech made by Wes Streeting, the Secretary of State for Health and Social Care, in Liverpool on 4 October 2024.

    [We have approached the office of Wes Streeting for the full version of the speech]

    I’d like to begin by saying a public thank you to you, Kamila, and, by extension, to your college. In opposition, we engaged in good-natured but robust debate on the things we disagreed on and, more often than not, found ourselves in violent agreement on the state of general practice today and our responsibility to rebuild general practice for a brighter tomorrow.

    That relationship, based on mutual respect and a spirit of partnership, means I come here today feeling that I am not only among friends, but among teammates – a theme I’ll build upon in my speech this morning.

    In that same spirit, can I also say a special thank you to Sunaina, Paula, Rumshia and Andy for those outstanding presentations.

    You are proof that, while the NHS may be in the midst of the worst crisis in its history, the biggest asset we have are the people who work in it. More than that, you provide hope to a country that is desperately looking for it, because you are showing us not only is reform possible, but it is already happening, and you are showing us what a reformed NHS could look like.

    I’m delighted to be the first Secretary of State personally addressing this conference in 7 years. I can’t imagine what the others were so worried about.

    I imagine some of you were quite happy to not have to hear from my 7 predecessors who held the job in that time. The good news is I’m here this year, the bad news is, whether you cheer or boo, I’ll be back for more next year. For 2 reasons:

    First, I always welcome challenge, and as you might have gathered by now, I love a good argument.

    More seriously, I recognise that the health service is in a deep hole, and it’s only by working together that we’ll get out of it.

    It’s my job to mobilise nearly 2 million people who work across the NHS to be the team that takes the NHS from the worst crisis in its history, gets it back on its feet, and makes it fit for the future.

    I can’t do it on my own. We can only do it as a team.

    The team spirit we need to build together starts with honesty.

    The NHS is broken. That’s what 2 in every 3 patients believe. I suspect a poll of NHS staff would find the same sort of result. I’m yet to speak to a GP who tells me – on many of the visits I’ve done in the last few years – everything going really well, my workload is entirely manageable, this is just what I signed up for.

    And I want to be clear about something else too: the NHS is broken, but GPs didn’t break it.

    [Political content has been removed]

    And that’s not just my view – that’s effectively the conclusion of the Darzi investigation.

    I know he’s a surgeon. Sorry about that.

    But I think that, if you’ve read his report, the analysis is so stark and so clear that you might even forgive him for polyclinics.

    Lord Darzi found, “GPs are expected to manage increasingly complex care, but do not have the resources, infrastructure and authority that this requires.”

    Hospital resources have shot up, while primary care has been neglected. There are 1,500 fewer fully qualified GPs in the NHS today than 7 years ago.

    While hospital productivity has fallen, the reverse is true in general practice. Despite there being fewer of you, you’re delivering more appointments than ever before – squeezing the time you spend with each patient. And as RCGP’s research this week revealed, it’s the poorest areas hit the hardest.

    Cuts to capital investment mean that one in every 5 of you are working in buildings older than the NHS itself.

    [Political content has been removed]

    In Lord Darzi’s words, “GPs were to all intents and purposes set up to fail.”

    We’re left with a status quo that isn’t working for anyone. Not for patients, 2 in 3 of whom aren’t satisfied with the service they receive – a record low.

    Nor does the status quo work for staff – you are working harder than ever before, pushing you to burn out and in too many cases pack it in.

    Patients are frustrated they can’t see you. You’re frustrated you can’t meet their demands. It’s not sustainable.

    The NHS is broken, but not beaten, and I think what unites all of us – staff, patients and, crucially, the evidence – is the shared conviction that continuity of care, what most people would call the ‘family doctor relationship’ really matters. It’s what drives patient satisfaction, your job satisfaction and better outcomes for patients.

    It will be at the heart of this government’s plan to reimagine the NHS as much as a neighbourhood health service as a national health service.

    We’ll shortly be embarking on a wide-ranging and deep engagement exercise to build our 10-year plan.

    That 10-year plan for the NHS will deliver 3 big shifts in the focus of healthcare:

    from hospital to community
    analogue to digital
    sickness to prevention
    And general practice is fundamental to each one.

    Just look at what the GPs who introduced me today are already doing.

    Paula is using basic technology to meet demand for same-day appointments and giving patients a digital front door, leading the way on ending the 8am scramble.

    Advances in big data are going to transform the NHS’s ability to end the cruel postcode lottery of health inequality. Rumshia is already showing us how – by taking screening, checks and care directly to the communities most in need – intervening early and preventing ill health from worsening, what we can already do.

    And as Andy and Sunaina have shown, if we bring GPs together with colleagues from mental health services, community pharmacy and social care, all working in lockstep as one team, more patients can be treated in the comfort of their own home – where they want to be. That’s the neighbourhood health service we want to build. That’s the future of the NHS.

    And I think we’ve seen in the last 3 months we’ve started as we mean to go on.

    [Political content has been removed]

    GPs were left qualifying into unemployment this summer. While patients can’t get a GP appointment, GPs couldn’t get a job.

    You asked us to act, so we did – in what might be the first example in history of someone signing a petition that actually led to action.

    I received RCGP’s petition, we cut red tape, found the funding and we’re recruiting an extra 1,000 GPs this year, our first step to fixing the front door of the NHS.

    In my first week as Health and Social Care Secretary, I pledged to increase the proportion of NHS resources going to primary care. And in our first month, the government made a down payment on that pledge, providing practices with their biggest funding increase in years.

    I’ve never pretended that one measure on GP recruitment or indeed the funding that was announced was a panacea. But given the £22 billion blackhole we inherited, and the painful cuts we’ve had to make and are having to make elsewhere, be in no doubt how hard we had to fight to deliver that extra funding. It was a serious statement of intent. A proof point. An early decision to demonstrate that we’re serious about rebuilding general practice.

    Not everything is about more money. It’s also about less waste.

    When I spend time shadowing GPs, one of the things they are dying to show me is the sheer amount of paperwork you are required to fill in to refer a patient.

    I was genuinely stunned to hear about one practice that has to complete more than 150 different forms to refer patients into secondary care services.

    Practices spend as much as 20% of their time on admin and work created by poor communications with secondary care.

    This is intolerable. That time should be spent with patients.

    That’s why today I can announce that Amanda Pritchard and I will launch a red tape challenge to bulldoze bureaucracy so GPs are freed up to deliver more appointments.

    The challenge will be led by Claire Fuller and Stella Vig, primary and secondary care leaders who have their bulldozers at the ready. Tell them what’s working well, but more importantly what needs to change. We will listen, act and solve this problem together.

    Amanda and I will receive the conclusion of this work in the new year. And NHS England will hold ICBs and trusts to account if they fail to act.

    The other frustration I hear from staff and patients alike are the pointless appointments you’re forced to hold and patients are forced to attend. You didn’t go through 5 years of medical school plus 5 years of training to tick boxes. So where there are appointments that can be cut out, with patients seen by specialists faster and GPs’ time freed up to do what only GPs can do, we will act.

    Starting in November, 111 online, which is available through the NHS app, will pilot directly referring women with a worrying lump to a breast clinic.

    That means faster diagnosis for cancer patients.

    And more GP appointments freed up.

    Better for patients and better for GPs.

    I suspect there are other cases that come across your desks every week, where a patient has been passed to you by someone else in the NHS to refer them on to someone else in the NHS. It is a waste of everyone’s time, including yours, and where you give us examples of patient pathways that can be simplified through appropriate patient self-referral or direct referral by other NHS services to save your time, we will act.

    It’s not just that I value your time, I respect your profession and your expertise.

    General practice is a specialism.

    That’s why I am committed to the creation of a single register of GPs and specialist doctors and this government will legislate to give the GMC the power to do it.

    It’s symbolic, but it’s also meaningful.

    It reflects the partnership I want to build with this profession.

    What I need from you in return, is goodwill and the same team spirit.

    When the BMA’s GPC returned their ballot result on collective action, I wasn’t remotely surprised.

    I know that after years of rising pressures, declining resources and a worsening service for patients, you feel it is your duty to sound the alarm.

    And trust me, you weren’t the only ones who wanted to punish the previous government.

    [Political content has been removed]

    Capping appointments now will only punish patients and make the road to recovery steeper. Be in no doubt – it is shutting the door on patients.

    Their care will suffer, receptionists will bear the brunt of their frustration, and the rest of the NHS will be left to pick up the pieces.

    Worse still, our collective job will be made harder. Collective action really means collective failure.

    Your message has been received. Not from this one vote, but from all the time I’ve spent in general practice in the past 3 years, literally looking over GPs’ shoulders, seeing what you deal with and the state of the crisis for myself.

    There’s a reason that, back in July, I rejected the list of hospitals suggested to me for my first visit as Secretary of State, and instead went to Dr Ellie Cannon’s Abbey Medical Centre in North London.

    I wanted to send a message that I understand how bad things are, and I am determined to fix them. But I can’t do that alone. We can only do this together.

    So I ask GPs to stand down collective action and instead work with a new government that is serious about working with you, to rebuild our NHS together.

    There are some tricky issues we’ll need to navigate together.

    Take data.

    It’s the future of the NHS.

    Advances in genomics and data mean the NHS will be able to do things never before possible.

    From the moment a child is born, we will know their risk of disease, giving you the tools you need to keep them healthy.

    Cancer could be detected from its earliest signs, saving countless lives.

    And the NHS will be able to treat patients with personalised medicine – far more effective, with fewer side effects.

    That’s the prize waiting for us.

    But beyond the day-to-day challenge of whether your machines reliably boot up and the number of passwords you have to enter across a range of applications, we don’t even share patients’ records across primary and secondary care.

    I know there are issues we need to work through together around information governance, risk and liabilities. There’s also, let’s be honest, some producer interest in play.

    But here’s the consequence of inaction.

    Keir and I met a family at Alder Hey earlier this year. Their baby had heart surgery to save his life. When they’d taken the baby home and visited their GP, they weren’t just surprised to find their GP didn’t have sight of the hospital records, they were frightened. Imagine how those parents felt: a tiny life in their hands in front of a medical professional who had only a partial sight on their experience. Imagine how the GP felt, having to ask basic questions about fundamental aspects of that baby’s medical history.

    So we need to work together to create a single patient record, owned by the patient, shared across the system so that every part of the NHS has a full picture of the patient.

    This applies as much to research as to care. The two go hand in hand.

    World-leading studies like the UK Biobank, Genomics England and Our Future Health are building up incredibly detailed profiles of our nation’s health.

    Patients have given their consent for their data to be shared with these studies.

    But we still see, far too often, that this data is not shared according to patients’ wishes.

    That’s why I am directing NHS England to take away this burden from you. Just like they did during the pandemic, if a patient explicitly consents to sharing their data with a study, NHS England will take responsibly for making this happen. In return, we will demand the highest standards of data security.

    My concern is that this isn’t just an information governance issue, it’s a culture issue that, unless addressed, will not only exacerbate the shortcomings of the system today, but also squander the potential of tomorrow.

    A world in which genomics, AI and machine learning will combine to change our entire model of care – not simply to drive earlier diagnosis and treatment, but to predict and prevent illness in the first place – is a world that we’ve got to embrace.

    The UK could lead the world in medical research.

    The NHS, created in 1948, a single payer system, is ideally placed to harness the benefits of the revolution in science and technology in a way that Attlee and Bevan could never have imagined 76 years ago.

    This isn’t just about the system, the model, but also the ethos. Why do we pay our taxes into an NHS that is free at the point of use? Of course it is because we all derive a personal benefit, but it is also because we are paying in for the common good. In this century, our data will be as valuable as our taxes: we contribute our data in the knowledge that it will lead to more personalised medicine, but also because it will contribute to better care for everyone.

    It is that collectivist ethos that created the NHS in 1948 to see us through the 20th century, that will underpin an NHS fit for the 21st century.

    Nothing I have seen or experienced in the last 3 months as our country’s Health and Social Care Secretary has weakened my conviction that, while the NHS may be broken, it is not beaten.

    But the future isn’t just in my hands, it’s in yours too.

    The 3 shifts that underpin this government’s reform agenda:

    From hospital to community.

    Analogue to digital.

    Sickness to prevention.

    Those shifts aren’t new ideas and they aren’t radical.

    But delivering them really would be.

    I can’t do it on my own.

    I need every part of the NHS to pull together as one team with one purpose:

    To be the generation that took the NHS from the worst crisis in its history, got it back on its feet and made it fit for the future.

    That’s the mission of this government and I’m confident that together we will rise to it.

    Thank you.

  • Wes Streeting – 2024 Speech at Labour Party Conference

    Wes Streeting – 2024 Speech at Labour Party Conference

    The speech made by Wes Streeting, the Secretary of State for Health and Social Care, on 25 September 2024.

    Dave has worked in the ambulance service for nearly thirty years.

    But nothing could have prepared him for what he faced on Monday the 29th of July.

    He arrived on the scene in Southport to find children who had gone to dance to Taylor Swift, and the adults whose sole purpose was to bring joy to their young lives, lying bleeding, some tragically dying.

    The result of an unimaginable, senseless, mindless attack.

    I listened to Dave describe the split-second decisions he had to make, of who to treat, in what order, to give them the best chance of survival.

    And I heard how the whole NHS team came together: security rushing children through busy hospital corridors; technicians mobilising blood supplies; reception fielding calls from panic-stricken parents; and surgical teams fighting to save those young lives.

    Those heroes represent the very best of the NHS, and we owe them a debt of gratitude we can never repay.

    Conference, I can’t tell you the weight of responsibility I feel to make sure that the National Health Service that has been there for us since 1948, is there for the next century and beyond.

    And I tell you, I will not let you down.

    But the truth is, Conference, right now the NHS is letting people down.

    Let me tell you about Claire, who messaged me on Instagram.

    She is a stage four cancer patient.

    When she felt pain two years ago, she struggled to get diagnosed.

    Her employer provides private health insurance, and for the first time in her life, Claire used it.

    Had she stayed with the NHS, Claire is certain she’d be dead.

    Instead, she’s been able to live her life to the full, including getting married in Ibiza.

    Every cancer patient deserves world-class care.

    But for every person like Claire, who was able to go private, there are thousands more who can’t.

    That cruel lottery is the legacy of 14 years of Conservative neglect.

    That is the two-tier system of healthcare that Labour will end.

    And that is why we must reform our NHS.

    It starts with honesty.

    So I asked Lord Darzi – a cancer surgeon with 30 years’ experience – to lead an independent investigation into our National Health Service.

    The results are grim.

    100,000 toddlers and babies left waiting for six hours in A&E last year.

    Cancer – more likely to be a death sentence here than in other countries.

    Nearly three million people off work sick.

    Waiting lists at record highs.

    Patient satisfaction at a record low.

    And the fundamental promise of the NHS, that it will be there for us when we need it, has been broken.

    Broken by a decade of underinvestment; by a disastrous Tory top-down reorganisation; and by ditching the reforms made by the last Labour Government.

    All of this meant that when the pandemic hit – our NHS was on its knees, and hit harder than any other comparable healthcare system.

    It’s not that the Tories didn’t fix the roof while the sun was shining, they doused the house in petrol, left the gas on, and Covid just lit the match.

    That’s why millions are stuck on waiting lists.

    That’s why ambulances don’t arrive on time.

    That’s why you can’t see your GP.

    Never forgive, never forget, never let the Tories do it again.

    I know the doctor’s diagnosis can sometimes be hard to hear. But if you don’t have an accurate diagnosis, you won’t provide the correct prescription.

    And when you put protecting the reputation of the NHS above protecting patients, you’re not helping the NHS – you’re killing it with kindness.

    So I say respectfully, but unequivocally, I won’t back down.

    The NHS is broken but not beaten, and together we will turn it around.

    Make no mistake, the Tories had a plan for the NHS: mismanaged decline; a status quo so poor, people are forced to raid their savings to go private; a crisis so bad that seven in ten people now expect charges for NHS care to be introduced.

    I’ve said it before, I’ll say it again.

    Over my dead body.

    We will always defend our NHS as a public service, free at the point of use, so whenever you fall ill, you never have to worry about the bill.

    We can only deliver recovery through reform.

    Without action on prevention, the NHS will be overwhelmed.

    Without reform to services, we’ll end up putting in more cash for poorer results.

    That’s the choice.

    Reform or die. We choose reform.

    Since the general election we’ve hit the ground running.

    We inherited the farce of newly qualified GPs facing unemployment.

    Patients can’t get a GP appointment, while GPs couldn’t get a job.

    We cut red tape, found the funding, and we’ll have 1,000 more GPs treating patients.

    That’s the difference a Labour government makes.

    We are banning junk food ads targeted at children.

    The first step towards making our country’s children the healthiest generation that has ever lived.

    That’s the difference a Labour government makes.

    Strikes have crippled the NHS, cost taxpayers billions and saw 1.5 million appointments cancelled.

    My predecessor, the previous Conservative Health Secretary hadn’t even bothered to meet the junior doctors since March.

    I called them on day one, met them in week on, and in just three weeks we negotiated a deal to end the strikes.

    That’s the difference a Labour Government makes.

    Ending the junior doctor strikes was central to our commitment to deliver 40,000 more appointments a week.

    But as well as getting staff back to work, we need to get them working at the top of their game.

    We’re sending crack teams of top clinicians to hospitals across the country to roll out reforms – developed by surgeons – to treat more patients and cut waiting lists.

    And I can announce today that the first twenty hospitals targeted by these teams will be in areas with the highest numbers of people off work sick.

    Because our reforms are focused not only on delivering our health mission but also moving the dial on our growth mission too.

    We will take the best of the NHS to the rest of the NHS, get sick Brits back to health and back to work.

    That’s the difference a Labour government makes.

    But Conference we can’t fix the NHS without fixing the crisis in social care.

    And we can’t fix social care without the people who work in it.

    I loved what Keir said yesterday about his sister, a care worker.

    About his determination to make sure that when she walks into a room and tells people what she does for a living, that she receives the same respect as the Prime Minister.

    As the Secretary of State for Social Care, I won’t let Keir down or fail more than a million care professionals like his sister.

    Angela and I will deliver a New Deal for Care Professionals: a Fair Pay Agreement, to improve pay and conditions and give staff the status and respect they deserve – our first step towards building a National Care Service.

    Every day in this job I see the scale of the challenge. But I also see something else: the potential of our NHS.

    The Tories’ biggest betrayal wasn’t that they left the NHS unable to care for us today.

    It’s that they left it totally unprepared for tomorrow.

    Advances in genomics and data mean the healthcare of the future will be more predictive, more preventative and more personalised than ever before.

    Detecting from birth a child’s risk of disease so we can act to keep them well; spotting cancer earlier, saving countless lives; treating patients with targeted medicines.

    To make these advances a reality for the many not the few, we need a universal health service, free at the point of need – able to share data, partner with innovators, and adopt new technologies at scale.

    Such a service would be unique in the world.

    Conference, the good news is, that service already exists – it’s called the National Health Service.

    And our job is not just to get the NHS back on its feet, we must make it fit for the future.  And that is what our ten-year plan will achieve.

    Conference, if we get this this right, we will end two-tier healthcare in our country for good.

    So that preventative care, precision medicine, personalised treatment are no longer just for the few, but for the many.

    That fairer future is possible. But only if we act today.

    An NHS running on fax machines can’t seize these opportunities.

    But a reformed NHS can.

    From analogue to digital, from hospital to community, from sickness to prevention

    Reform is not just possible, it is happening.

    From AI detecting skin cancer and cutting waiting times to weight loss jabs slashing the risk of heart attacks for diabetes patients.

    But Conference, to seize that potential we have to reform the NHS to make it fairer.

    When the wealthy receive a diagnosis, they already know the best surgeons and can push to get the best care. But working people can’t.

    If the wealthy are told to wait months for treatment, they can shop around. But working people can’t.

    And if they pay top dollar, the wealthy can be treated with cutting-edge equipment and technology. But working people can’t.

    Our ten-year plan will give all patients – rich and poor alike – the same information, the same choice, the same control.

    Now I know there are some on the left who cringe at this. Who view choice as somehow akin to marketisation.

    But our party has always believed that power should be in the hands of the many, not the few.

    That public services exist to serve the interests of the pupil, the passenger, the patient above all else.

    That world class services shouldn’t just be the preserve of the wealthy.

    So starting in the most disadvantaged areas, we will ensure patients’ right to choose where they are treated, and we will build up local health services so it’s a genuine choice.

    And where there’s capacity in the private sector, patients should be able to choose to go there too, free at the point of use, paid for by the NHS.

    Because working people deserve to be treated on time, just as much as the wealthy.

    Conference, when we look around our country today, it’s easy to be pessimistic. But the public have turned to us to give them hope. So here it is: we are in the foothills of a decade of national renewal.

    10 years in which our country and our health and care services will change enormously.

    The NHS transformed into a Neighbourhood Health Service.

    A digital health service powered by cutting-edge technology.

    A preventative health service that helps us stay healthy and out of hospital.

    And a new National Care Service, ensuring people can live dignified and fulfilling lives

    That’s the change that lies before us.

    It will take time and it won’t be easy.

    We will have to fight loud opposition, cynicism, and vested interests.

    But Conference, bring it on.

    It is up to us to prove that politics can be a force for good again.

    So let me to say to every one of you in this hall and to the millions of dedicated staff in health and social care across our country.

    We are the generation that will take the NHS from the worst crisis in its history to build an NHS fit for the future.

    We are the generation that will build a National Care Service worthy of the name.

    The NHS there for us when we need it.

    With world class care for the many, not just the few.

    That’s the change Britain voted for.

    That’s the change we’ll deliver together.

    And Conference, that change has already begun.

    Thank you.

  • Keir Starmer – 2024 Keynote Speech on the NHS

    Keir Starmer – 2024 Keynote Speech on the NHS

    The speech made by Keir Starmer, the Prime Minister, at the King’s Fund on 12 September 2024.

    [NB, this is the redacted speech issued by 10 Downing Street with political comment removed]

    As you have heard today, Lord Darzi has published his independent report on the state of our NHS.

    It is an incredibly comprehensive analysis. Some of you will have seen it, there are copies available, please read it.

    A raw and honest assessment. That is what we asked for.

    And that is why I wanted to come here to the King’s Fund.

    Home to many of our country’s leading healthcare experts.

    Because your contributions are going to be vital.

    As we get this precious institution back on its feet,

    And build an NHS that is truly fit for the future.

    And look, our starting point couldn’t be further from that goal.

    Public satisfaction in the NHS has fallen…

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    To an all-time low today.

    Think of the impact that has on staff who are putting in so much day in day out, knowing that confidence is at an all-time low.

    And that is because, as everybody in the country knows, the last government broke the NHS.

    But until this morning, we didn’t know the full scale of the damage, which is laid bare in the report.

    Even Lord Darzi, with all his years of experience.

    Is shocked by what he discovered.

    It is unforgiveable.

    And people have every right to be angry.

    It’s not just because the NHS is so personal to all of us.

    Or because when people can’t get the care they need…

    They’re off work sick, with huge costs for our economy.

    It’s because some of these failings are literally life and death.

    Take the waiting times in A&E…

    More than 100,000 infants waited more than 6 hours last year…

    And nearly a tenth of all patients are now waiting for 12 hours or more…

    That’s not just a source of fear and anxiety…

    It’s leading to thousands of avoidable deaths….

    And that phrase avoidable deaths should always be chilling.

    That’s people’s loved ones who could have been saved.

    Doctors and nurses whose whole vocation is to save them…

    Hampered from doing so.

    It’s devastating. Heartbreaking. Infuriating…

    And that’s just scratching the surface.

    High-risk heart attack patients waiting too long for urgent treatment.

    Cancer diagnosis patients waiting too long….

    With cancer death rates higher than other countries

    And when it comes to getting help for mental health …

    …. 345,000 are waiting over a year.

    That’s roughly the entire population of Leicester.

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    Covid hit our NHS harder than healthcare systems in other countries.

    The NHS delayed, cancelled, or postponed far more routine care during the pandemic than any comparable health system.

    And why?

    Because our NHS went into the pandemic in a much more fragile state.

    Fewer doctor, fewer nurses and fewer beds than most other high income health systems

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    What Lord Darzi describes as a “calamity without international precedent”.

    A “scorched earth” approach to health reform, the effects of which are still felt to this day.

    And at the same time, they inflicted what the report describes as:

    “the most austere decade since the NHS was founded”

    Crumbling buildings.

    Decrepit portacabins.

    Mental health patients in Victorian-era cells infested with vermin.

    When we say they broke the NHS…

    That’s not performative politics.

    Just look at it.

    The 2010s were a lost decade for our NHS.

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    And it’s not just the state of our National Health Service in crisis.

    It’s also the state of our national health.

    We’re becoming a sicker society.

    Spending more of our lives in ill-health than ten years ago.

    There are 2.8 million people economically inactive because of long-term sickness.

    As today’s report makes clear –

    “The NHS is not contributing to national prosperity as it could.”

    But perhaps Lord Darzi’s most damning finding is about the declining physical and mental health of our children.

    Fewer children getting vaccinated…

    While those from the most deprived backgrounds…

    Are twice as likely to be obese by reception age.

    And much of this is a direct result of wider social injustices..

    Poor quality housing

    Lower incomes,

    Insecure employment.

    All of it, not just damaging the health of our nation…

    It’s piling up the pressures on our NHS.

    That’s the report.

    But look, I haven’t come here just to set out this appalling inheritance. Though it is really important that we know it and properly understand it in detail.

    Getting people back to health and work would not only reduce the costs on the NHS.

    It would help drive economic growth – and fund public services.

    My government was elected on a mandate for change so I’m also here to talk about how together we fix it.

    I feel very deeply the profound responsibility for this.

    And indeed, the opportunity of this moment.

    The NHS may be broken, but it’s not beaten.

    As the report says, the NHS may be in a “critical condition”.

    But “its vital signs are strong”.

    And we need is the courage to deliver long-term reform.

    Major surgery not sticking plasters.

    We’ve got to face up to the challenges….

    Look at our ageing society.

    And the higher burden of disease.

    Look, the NHS is at a fork in the road.

    And we have a choice about how it should meet these rising demands.

    Don’t act and leave it to die.

    Raise taxes on working people.

    Or reform to secure its future.

    Working people can’t afford to pay more.

    So it’s reform or die.

    So let me be clear from the outset, what reform does not mean.

    First, it does not mean abandoning those founding ideals.

    Of a public service, publicly funded, free at the point of use.

    That basic principle of dignity.

    Inspired of course by Bevan,

    That when you fall ill,

    You should never have to worry about the bill.

    That is as true today as when the NHS was founded 76 years ago.

    And I believe that so deeply.

    As some of you will know, my mum and my sister both worked for the NHS.

    My wife works for the NHS.

    The NHS cared for my Mum throughout what was a very

    But “its vital signs are strong”.

    long illness…

    The NHS runs through my family like a stick of rock.

    And you know, this isn’t just about emotion.

    It’s about hard facts too.

    The NHS is uniquely placed for the opportunities of big data and predictive and preventative medicine.

    So the problem isn’t that the NHS is the wrong model.

    It’s the right model.

    It’s just not taking advantage of the opportunities in front of it.

    And that’s what needs to change.

    Second, reform does not mean just putting more money in.

    Of course, even in difficult financial circumstances.

    My government will always make the investments in our NHS that are needed.  Always.

    But we have to fix the plumbing before turning on the taps.

    So hear me when I say this.

    No more money without reform.

    I am not prepared to see even more of your money spent

    On agency staff who cost £5,000 a shift

    On appointment letters, which arrive after the appointment,

    Or on paying for people to be stuck in hospital

    Just because they can’t get the care they need in the community.

    Tonight, there will be 12,000 patients in that very position.

    That’s enough to fill 28 hospitals.

    So we can’t go on like this.

    As Lord Darzi has said –

    NHS staff are “working harder than ever”

    But “productivity has fallen.”

    Because patients can’t be discharged,

    And clinicians are spending their time trying to find more beds.

    Rather than treating more patients.

    That isn’t just solved by more money – it’s solved by reform.

    And third, reform does not mean trying to fix everything from Whitehall. It really doesn’t.

    When Lord Darzi says the vital signs of the NHS are strong.

    He’s talking about the talents and passion of our NHS workforce.  That’s what he’s talking about.

    The breadth and depth of clinical talent.

    The extraordinary compassion and care of our NHS staff.

    If we are going to build an NHS that is fit for the future…

    Then I tell you, we are going to do it with our NHS staff.

    And indeed, with our patients too.

    We are going to change it together.

    Now, that starts with the first steps,

    40,000 extra appointments every week.

    But we’ve got to do the hard yards of long-term reform.

    So this government is working at pace

    To build a Ten-Year Plan.

    Something so different from anything that has gone before.

    This plan will be framed around three big shifts,

    Three fundamental reforms,

    Which are rooted in what Lord Darzi has set out today.

    First, moving from an analogue to a digital NHS.

    Already we can see glimpses of the extraordinary potential of technology,

    Like the world’s first ever non-invasive, knifeless surgery for Kidney cancer… Just imagine that.

    Pioneered by Leeds Teaching Hospitals.

    Or the precision cancer scanners…

    I saw just yesterday.

    Or simply for transforming how we manage a condition.

    We went to Kingsmill Hospital earlier this year and met a 12-year old called Molly.

    She used a smartphone to monitor her glucose levels…

    Instead of being forced to repeatedly prick her fingers.

    It made such a difference to her daily life and gave great reassurance to her mum who could remotely check on the settings and the findings.

    We’ve got to make these opportunities available to everyone.

    We’ve got to use technology to empower patients and give them much greater control over their healthcare.

    Take an innovation like the NHS app.

    This could be a whole digital front door to the NHS.

    Appointments, self-referral, reminders for check-ups and screenings.

    Patients in control of their own data,

    Healthcare so much more transparent,

    So you always know your options,

    And the standards that you should expect.

    And you know, earlier this year I went to Alder Hey Hospital. Many of you will know it, it’s a fantastic hospital, where they carry out heart surgery on infants, which is really humbling to see.

    I met the parents of a two-year old who had extremely complicated heart surgery. A tiny infant, an incredible surgery.

    I asked them about their child’s history and condition, how did he come to be here, what’s the story behind it,

    And as they told me, I could see them welling up as they went through the history, conditions, all the background through all of that over and over again.

    They really struggled to tell the story and they have to do this every single time.

    Because the records weren’t held electronically.

    We’ve got to have fully digital patient records.

    So that crucial information is there for you.

    Wherever you go in our NHS.

    And while I’m on technology

    We’re also going to throw the full weight of the British Government behind our world leading life sciences.

    Second, we’ve got to shift more care from hospitals to communities.

    Now The King’s Fund has long called for this.

    Successive governments have repeatedly promised it.

    But what’s happened?

    The opposite.

    The share of the NHS budget spent on hospitals has actuallyincreased.

    Now this Ten-Year plan has to be the moment we change this.

    The moment we begin to turn our National Health Service

    into a Neighbourhood Health Service.

    That means more tests, scans, healthcare offered on high streets and town centres.

    Improved GP access.

    Bringing back the family doctor.

    Offering digital consultations for those who want them,

    Then they told me that every time they went to a different hospital, they had to go virtual wards.

    And more patients can be safely looked after in their own homes.

    Where we can deal with problems early,

    Before people are off work sick and before they need to go to hospital.

    And we’ve got to make good on the integration of health and social care.

    So we can discharge those 28 hospitals worth of patients.

    Saving money.

    Reducing the strain on our NHS,

    And giving people better treatment.

    And third in terms of the shifts, we’ve got to be much bolder in moving from sickness to prevention.

    Now we’ve already announced NHS health checks in workplaces.

    Blood pressure checks at dentists and opticians.

    And that is just the beginning.

    Planning for ten years means we can make long-term investments in new technologies

    That will help catch and prevent problems earlier.

    And there are some areas in particular

    Where we’ve just got to be more ambitious.

    Like children’s mental health.

    Or children’s dentistry.

    You know, one of the most shocking things that I saw, I’ve ever seen…

    This was actually when I was at was at Alder Hey Children’s Hospital again.

    As I mentioned earlier, I went to the ward where they do heart operations.

    The single biggest cause of children going into that hospital…

    Between the ages of 6 and 10…

    Was to have their rotting teeth taken out. I couldn’t believe it. I was genuinely shocked.

    All politicians say they are shocked too often, but I was honestly shocked, the single biggest cause of going into hospital of children between 6 and 10 is having their teeth taken out.

    Can you think of anything more soul-destroying?

    For those children what a price to pay.

    And for that brilliant NHS team who want to use their talents to save lives.

    Instead spending their time taking out rotting teeth.

    Something that could be so easily prevented.

    And look, I know some prevention measures will be controversial.

    I’m prepared to be bold even in the face of loud opposition.

    So no, some of our changes won’t be universally popular.  We know that.

    But I will do the right thing – for our NHS, our economy, and our children.

    Now, the task before us is the work of our generation.

    We’ve already hit the ground running.

    Negotiating an offer to end the strikes

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    Strikes that were costing us all a fortune.

    And we inherited 1,000 trainee GPs who were set to graduate into unemployment…

    Instead we hired them.

    But only fundamental reform and a plan for the long-term can turn around the NHS and build a healthy society.

    It won’t be easy, it won’t be or quick.

    It will take a ten-year plan.

    Not the work of just one Parliament.

    But I know we can do it.

    Because we’ve done reform before.

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    To deliver better outcomes for patients and better value for taxpayers.

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    My Government has a huge mandate for change.

    We are mission-driven.

    And I think the themes of this conference today are fitting for this moment.

    Challenge. Change. And hope.

    Because the challenge is clear before us.

    The change could amount to the biggest reimagining of our NHS since its birth.

    And the hope, well that’s what’s really exciting and galvanising about this moment.

    Because if we get this right,

    People can look back and say –

    This was the generation that took the NHS from the worst crisis in its history.

    Got it back on its feet and made it fit for the future.

  • Andrew Gwynne – 2024 Statement on Respiratory Syncytial Virus Immunisation Programmes

    Andrew Gwynne – 2024 Statement on Respiratory Syncytial Virus Immunisation Programmes

    The statement made by Andrew Gwynne, the Parliamentary Under-Secretary of State for Health and Social Care, in the House of Commons on 18 July 2024.

    I am today confirming that the new immunisation programme to protect infants, with a vaccine during pregnancy, and older adults against respiratory syncytial virus will start this September.

    RSV is a common respiratory virus that usually causes mild cold-like symptoms but can cause severe illness, especially for young infants and older adults. There is a significant burden of RSV illness in the UK population which greatly impacts NHS services during the winter months. RSV accounts for over 30,000 hospital admissions for children under five and is estimated to cause around 9,000 admissions among adults over the age of 75 each year. The programme could free up thousands of hospital bed days and help to prevent hundreds of deaths each year.

    In June 2023, the Joint Committee on Vaccination and Immunisation advised that an RSV immunisation programme that is cost-effective should be developed to protect both infants and older adults. From September, a routine programme will begin in England for those turning 75 and for pregnant women, who will be offered vaccination from 28 weeks of pregnancy until full term to protect their baby during the first months of life when they are most vulnerable to RSV. A one-off campaign will also run from September 2024 until 31 August 2025 for all older adults aged 75 to 79 years old on 1 September 2024.

    The UK Health Security Agency is now working rapidly with the NHS to ensure we are ready, in September, to deliver the UK’s first RSV vaccination programme. The programme will save lives and protect people most at risk. We are delighted that the RSV vaccination programme will begin soon across all four UK nations.

    His Majesty’s Government are encouraging eligible members of the population to come forward for their vaccination when they have been invited to do so by the NHS, to protect those most vulnerable to RSV illness and to reduce NHS winter pressures.

    Older adults will be invited to come forward when they turn 75 and will be able to book their vaccination appointment with their GP.

    Older adults aged 75 to 79 years old on 1 September 2024 will be invited to receive their RSV vaccination with their GP in a timely manner to ensure as many people as possible are protected this winter.

    Those that are at least 28 weeks pregnant should speak to their maternity service or GP surgery to get the vaccine to protect their baby.

  • NHS England – 2024 Statement on IT Outages

    NHS England – 2024 Statement on IT Outages

    The statement made by NHS England on 19 July 2024.

    The NHS is aware of a global IT outage and an issue with EMIS, an appointment and patient record system, which is causing disruption in the majority of GP practices.

    The NHS has long-standing measures in place to manage the disruption, including using paper patient records and handwritten prescriptions, and the usual phone systems to contact your GP.

    There is currently no known impact on 999 or emergency services, so people should use these services as they usually would.

    Patients should attend appointments unless told otherwise. Only contact your GP if it’s urgent, and otherwise please use 111 online or call 111.