Contribution
I will speak to Amendment 146, tabled in my name and the name of the noble Baroness, Lady Eaton, but before I do so, in the interests of brevity, I say that I support all that has been said in the context of the appointment of the commissioner. This cannot be a personal prime ministerial appointment; it cannot be a matter of patronage. The role must be insulated from day-to-day politics, especially given the risk of damage to trust in nurses, doctors, the judiciary and in this new process by which the state enables the taking of life. I agree, too, with the amendments which seek to introduce some process to the actual appointment of the commissioner, and I agree with the amendments in relation to conflicts of interest and registers of interests.
Through Amendment 132, the noble Baroness, Lady Cass, seeks to establish conclusively that the commissioner’s principal functions are monitoring and reporting on the assisted dying process. Her Amendment 122 would introduce a new role, that of director, who will put the assisted dying regime into action, selecting and overseeing panels, receiving applications, and deciding on appeals and the other duties in Clause 44. Both the British Association of Social Workers and the Law Society gave evidence that an independent regulator for VAD was essential. In Amendment 128, the noble Baroness, Lady Foster, who is not able to be with us today, identifies necessary duties which would provide additional safeguards, ensuring compliance, identifying risk and identifying the circumstances in which things may go wrong with possible tragic consequences.
I want to speak to Amendment 146—the noble Baroness, Lady Eaton, is unable to be with us today—which is about the very specific risk to people in care and nursing homes, the majority of whom are vulnerable for one reason or another. The situation of care homes is a matter which the noble Baroness and I have raised repeatedly during the course of the Bill. This amendment develops an obligation which would be imposed by the noble Baroness’s Amendment 128, requiring identification and mitigation of risk. It imposes a duty on the commissioner to monitor and identify emerging risk in the operation of assisted dying in registered care or nursing homes, and to take reasonable and proportionate steps to prevent or mitigate that risk. Where such risk appears systemic, the commissioner must notify the Secretary of State for Health and Social Care, so that appropriate remedial action can be taken.
The issues of vulnerability and capacity, the risk of coercion and the risk of abuse are all particularly relevant to care and nursing homes. Can the noble and learned Lord, Lord Falconer, assure the Committee that these matters really have been properly considered and provided for? I have some difficulty, because the scope of the issue is massive. In 2023, the year for which there are the latest official figures, nearly 400,000 people lived in some 15,000 care and nursing homes in England and Wales. Some 85.7% of the total number of beds in care homes were occupied at the time of the survey. Some 70% of all care home residents have dementia or severe memory problems. The average period of residence in a care home is about two and a half years, and most of them die in the homes. Those figures will have increased in the three years since they became available. Some 120,000 people a year over 75 are diagnosed with cancer. There will therefore be a significant number, possibly the largest cohort in England and Wales, with a terminal illness—however you define it—who will have a prognosis of six months or less to live, and who live in our care homes. On the basis of these figures, it is possible to extrapolate that tens of thousands of people living in care homes will be eligible for assisted dying.