Contribution
I understand where my noble friend is going with that. I intend to come back to some aspects of this when we get into informed consent because I was somewhat struck by what the noble Lord, Lord Winston, said, about declining to give treatment because he wanted people to, in effect, accept that they were dying—I think that is what he said, although I had better go back and check that because I do not want to misquote him. I have seen that myself; I saw it with my mother when doctors just had not treated her, and then when it came to it, when it was near the end, we had to fight to avoid even having a DNR on the ambulance so that she could die at home in a place of her choice. That is true patient autonomy—I am not trying to override that.
In terms of thinking through some of what the noble Lord has put forward in his propositions, others have already reflected on the concerns about working days and whether that is practical. I would be grateful to hear from both the sponsor and the Ministers about what assessment they have made of these amendments. I am also concerned about proposed new subsection (2)(g) in Amendment 771, about providing
“publicly available information on assisted dying”.
How does that vary from what is considered advertising, which is explicitly ruled out in other parts of the Bill?
The key point of my amendments links to this almost becoming its own service within the NHS. Various clauses start to remove powers from the voluntary assisted dying commissioner. This service would start to appoint the panels, and at the moment it is taking up all the training, licensing and all those different things. It is my understanding that this does not happen in the NHS today. What we actually get, and what I propose with my amendments, is that, for a start, we have a separate regulator through the Care Quality Commission, and that the General Medical Council undertakes the roles that it does for other parts of what happens in the NHS today. If the noble Lord, Lord Birt, brings this back on Report then I hope he will think more carefully about how to make this practicable, because I hope the Minister will say it is simply not operable, even if well-intentioned in what the noble Lord is seeking to achieve.
The noble Lord, Lord Mawson, has just started talking about the East End of London. It is important that noble Lords consider carefully not just the evidence that has been given to this House but evidence outside about the real concerns of people from BAME communities. It is evident that people in those communities seem particularly worried about this, and that has been communicated directly to this House through witnesses. Instead of not trusting the NHS as it is today to give treatment, imagine, as you go in and are unsure, your already overworked GP saying, “Here you go; here’s some information. Someone can hold your hand”. I worry that too many people would stay away from the NHS when they desperately needed treatment in other aspects of their lives, whether in addressing prostate cancer or the other rare cancers that we debated in the Chamber last week.
I remind noble Lords—I appreciate that this is probably the third time I have said this—that for me this comes back to the practical experience of when the NHS was left to deal with end-of-life care in certain ways. The Liverpool care pathway was so horrific that I cannot in any way see how it could be controlled if we were to adopt the proposals put forward by the noble Lord, Lord Birt. We saw it go badly wrong, and I am pleased that Ministers eventually intervened. It took time, but it did happen.
On these regulations and other aspects of running this service, if we are going to have it, I agree with my noble friend Lord Sandhurst that it should be more of an MoJ focus. Inevitably, it has become a big health focus. It is not clear, from what noble Lords have set out in their proposals, how this interacts with the whole Wales situation. The Bill’s sponsors have, I think, about 12 officials from the Department of Health and Social Care working on the Bill, which is three or four times the number at the MoJ, so there should be some understanding of how this will work. I genuinely hope that the Minister will start to share that, so that this House can make informed choices as we consider such a significant change in what could be the future of our NHS.