Baroness Hollins (CB)

My Lords, I will speak to Amendment 75, which I have added my name to. It addresses probably the most decisive yet hardest to confirm clinical issue, and is central to the Bill. Prognosis is not determined by diagnosis alone. Throughout my career as a doctor, I have seen many patients whose disease sounded on paper as though death was imminent, yet their course was significantly altered by evidence-based treatment and high-quality palliative care. In evidence to the Select Committee, the Royal College of General Practitioners stated: “It is possible to give reasonably accurate prognoses of death within minutes, hours or a few days. When this stretches to months then the scope for error can extend into years”. I agree with my noble friend that a 50% likelihood of a six-month prognosis is not reasonable. Amendment 75 would ensure that, when we speak of an expected prognosis of six months, we do so in the context of treatment offered to them, in line with national NICE guidelines and tied to clinical reality. Without this safeguard, there is a risk that people who choose to participate in assisted suicide could start the process even where treatment is delayed, unavailable or not even offered, and where symptoms or fear of the future are instead driving a perception of hopelessness. A three-month prognosis, as proposed in Amendment 444A, from my noble friend Lady Finlay, would be much more accurate, as there is an evidence-based assessment tool available through the continuing healthcare fast-track process. Noble Lords may be unaware that fast-track funding is available for those who have a rapidly deteriorating condition where they are approaching the terminal stage and the end of their life. This funding is used to provide much-needed nursing care, hospice involvement and support for families, and can be put in place usually within 48 hours. NHS guidance notes that the fast-track funding tool is used when urgent care is required at the end of life. The most robust data currently available comes from a 2023 observational study published in the British Medical Journal Open Quality. It examined 439 patients referred for NHS continuing healthcare fast-track funding. The median survival for patients whose fast-track funding was approved was only 18 days, and a minority of patients were still alive at 90 days after referral, showing a much more accurate prognosis. The short survival time found in the study suggests that many referrals occur very late, sometimes limiting the ability to arrange preferred care settings. I think ignorance within primary care of this funding pathway and its usefulness in supporting people to stay at home during their last days and weeks contributes to its low take-up, and perhaps the rather unnecessarily large number of people who spend their last days in hospital. Approval for fast-track funding helps clinicians by grounding prognosis—an already incredibly difficult task to predict—in nationally agreed standards rather than variable local practice. There must be absolute clarity that no one becomes eligible for assisted suicide because the system has failed them, especially regarding geographical variability in treatment options or lack of awareness of these treatment options.