Lord Blencathra (Con)

My Lords, I will speak to my Amendment 110A, which seeks to insert into Clause 3 a requirement that, where a person is ordinarily resident in a registered care home or nursing home, a registered medical practitioner must not certify capacity for the purposes of the future Act unless a specialist clinical review and an independent psychiatric capacity assessment have been completed, with their findings considered and any delay recorded. I will begin with what I hope is a simple, uncontroversial proposition: care home residents are a medically vulnerable group and deserve the highest standards of protection when the law contemplates irreversible outcomes. Many residents experience delirium, acute infection, dehydration, polypharmacy and other reversible conditions that cause fluctuating capacity. An assessment at a single point in time, however carefully performed, can miss those transient but decisive impairments. My amendment recognises that clinical reality and responds with proportionate, targeted safeguards. My amendment is narrowly drafted and practical. It requires three things before capacity can be certified for a care home resident under the Bill. First, there must be a specialist clinical review by a physician with expertise in geriatric medicine or complex care. Secondly, there must be an independent psychiatric capacity assessment by a consultant psychiatrist with expertise in fluctuating or complex capacity, to be completed within five working days of the specialist review, subject to the limited recording provision where delay occurs. Thirdly, the registered medical practitioner must consider the findings of both reviews before certifying capacity. The specialist review must explicitly record whether any reversible causes of impaired or fluctuating capacity have been identified and treated, including delirium, infection, dehydration or medication effects. If the psychiatric assessment cannot be completed within the five-day window, the practitioner must record the reasons for the delay. Those are modest, sensible requirements. They would not prevent assessments; they would ensure that they are done properly. They would create a short statutory timeframe, so that the process is not indefinitely protracted, and an audit trail where delays occur. They would also require explicit documentation that reversible causes have been sought and treated. That is clinical best practice, and it should be statutory practice where life-ending decisions are at stake. We must also place this amendment in the practical context in which the Bill would operate. We all know that care homes are already operating under chronic strain—falling bed capacity, severe workforce shortages and the legacy of Covid pressures—and those realities must shape our debate about assisted dying. Care home capacity in England has fallen relative to the ageing population: places per 100 people aged 75 and over have declined over the past decade and the sector has not kept pace with demographic demand. At the same time, the social care workforce is under sustained pressure: vacancy and turnover rates remain high; recruitment and retention are major challenges; and many areas rely heavily on international recruitment. These shortages reduce clinical time, limit specialist input and make consistent, high-quality capacity assessments harder to deliver at scale. We all remember Covid-19, which exposed and amplified these pressures. The discharge to assess policy and rapid hospital discharges into care homes in 2020 were possibly a necessary emergency response, but reviews have concluded that some discharges contributed to outbreaks and that operational and clinical oversight was variable. That episode shows how system pressure can degrade safeguards and lead to mistakes, not because clinicians lacked compassion or were uncaring but because the system was overwhelmed. If we accept that as a reality—it was—we must ask whether a new assisted dying pathway could create similar perverse pressures.