Stephen Kinnock
MP for Aberafan Maesteg · Labour · United Kingdom
“I thank the shadow Secretary of State for her kind words and look forward to our exchanges across the Dispatch Box. I am ready to engage with her on getting the maximum benefits for the people of Wales.”
“I thank the right hon. Lady and look forward to working with her. My understanding is that there were challenges around the helicopter capability. Decisions were taken by Natural Resources Wales some time ago to change the way that the tendering for helicopter capability works. We certainly need to look at that.”
“I thank my right hon. Friend for his question. Like him, I pay tribute to all those involved in the collective and heroic response to the wildfires.”
“I thank the right hon. Lady for her question. Many of the ideas coming forward for devolving power right across our United Kingdom, beyond Cardiff Bay and Holyrood, are very exciting, and I look forward to exploring them with her.”
“Just to be clear, this is not about staying out of the issue; it is about respecting the devolution settlement, but being prepared to work constructively where we can in partnership with the Welsh Government. The hon.”
“I know about and welcome the right hon. Gentleman’s strong connections to Wales. I recognise the connectivity benefits that WSMR’s proposal could deliver, particularly for passengers in Wales and the west midlands.”
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“Without knowing the exact implications for the number of people who the hon. Member mentioned, it is difficult to answer her question, but fundamentally the Government’s position on every aspect of the Bill is to be clear that we want the Bill Committee to make informed decisions. Those informed decisions should be based on whether the Government think that amendments to the Bill would have a positive or negative impact on its workability and the legal framework. We also have to ensure that we protect the integrity of the statute book.”
“Section 3 states that a person is unable to make a decision if they are unable to “understand the information relevant to the decision…retain that information…use or weigh that information” as part of the decision-making process, or communicate their decision. As the Committee will be aware, the Mental Capacity Act has for some time provided a robust framework for important and difficult decisions, and it is familiar to clinicians. I hope that my remarks have been helpful to the Committee in considering the Bill and the amendments.”
“The Bill has a two-year commencement date. Within that two-year period, the Secretary of State will make regulations to determine precisely the kind of training and capacity building that are required, and that training will be delivered within that two-year period. Those sorts of issues will be dealt with if the Bill gains Royal Assent. Clause 3 sets out that any assessment as to whether a person has the capacity to make a decision to end their own life is to be determined in accordance with the Mental Capacity Act 2005, sections 1 to 3 of which establish the principles and criteria for assessing a person’s capacity to make decisions. Section 2 of that Act establishes that a person lacks capacity if they are unable to make the decision in question, owing to an impairment or disturbance in the functioning of the mind or brain.”
“That would mean that a co-ordinating doctor would not be able to make a statement following a first assessment, and therefore refer a person to the independent doctor for a second assessment, unless the person had had a consultation about palliative care options with a palliative care specialist. As with previous amendments, the amendment would increase demand for palliative care specialists, and we would need to work with the NHS and other provider organisations to assess how to operationalise it, should hon. Members decide to pass amendments in that area.”
“Our assessment suggests that the present drafting, adding a subsection to clause 1(2), would not achieve that effect without further amendments to other clauses in the Bill. The amendment would increase demand on palliative care specialists and, should Members decide to amend the Bill in this way, we would need to work with the NHS and other provider organisations to assess how to operationalise it. Amendments 298 and 299 would require the co-ordinating doctor to have received confirmation that the person seeking an assisted death has had a consultation with a specialist in palliative medicine about palliative care options before they are able to make a first statement under clause 7(3)(a).”
“It is a pleasure to serve under your chairmanship, Mr Efford. As previously stated, my role, and that of the Minister of State, Ministry of Justice, my hon. and learned Friend the Member for Finchley and Golders Green, is not to give a Government view, given that the Government remain neutral on the Bill, but to outline the legal and practical impacts of amendments tabled. The amendments are intended to add a new step in the process set out in the Bill, requiring consultation with a palliative care specialist. The purpose of amendment 281 is to require a person to have met a palliative care specialist before completing the required steps and assessments to end their life. The purpose of the amendment is to ensure that the person has understood the full range of end of life options available to them.”
“As I have said, the Government remain neutral on the substantive policy questions relevant to how the law in this area would be changed. The clause is a matter for the Committee and Parliament to consider, but the Government’s assessment is that the clause, as amended, is workable, effective and enforceable. Question put and agreed to. Clause 1, as amended, ordered to stand part of the Bill. Clause 2 Terminal illness”
“This clause provides that, in particular, clauses 5 to 22 of the Bill require steps to be taken to establish that the person has a clear, settled and informed wish to end their own life and has made the decision that they wish to end their own life voluntarily and has not been coerced or pressured by any other person in making that decision. The clause, as amended by the insertion of new subsection (3), will ensure that the service can be accessed only by an individual ordinarily resident in England and Wales. That amendment, amendment 180, has been drafted to give effect to the policy intent of my hon. Friend the Member for Spen Valley for this legislation: that it is to apply only to those in England or Wales and is not to be accessed via medical tourism.”
“I will make some brief remarks on the legal and practical effect of clause 1, as amended, to assist hon. Members in making their own assessment. Clause 1 sets out the eligibility criteria that a person must meet in order to request to be provided with lawful assistance to end their own life under the provisions of this Bill. A person must be terminally ill; this term is defined in more detail in clause 2. Clause 1(1) sets out a further four requirements, which require that a person must also have the necessary capacity to make the decision, which is to be read in accordance with the Mental Capacity Act 2005; be aged 18 or over; be ordinarily resident in England and Wales and have been resident for at least 12 months; and be registered as a patient with a GP practice in England or Wales.”
“Amendments 399 to 401 would remove the term “medical condition” from the Bill’s definition of a terminal illness, so that only those with an inevitably progressive illness or disease would be able to request to end their life, rather than, as under the current drafting, those with a “disease or medical condition”. The amendments could narrow the scope of those who may access assisted dying services. However, clinical advice suggests that the use of the terms has changed over time, may not be used consistently and remains debated in both medical and lay circumstances. Removing the term “medical condition” may lead to disputes or protracted debates about whether a particular condition is or is not a defined disease or illness, despite there being medical consensus around whether it will lead to death within six months.”
“It is a pleasure to serve under your chairship, Mr Dowd. Although it is for Parliament to progress any Bill, the Government have a responsibility to make sure that legislation on the statute book is effective and enforceable. For that reason, the Government have worked with my hon. Friend the Member for Spen Valley; where changes have been agreed mutually between her and the Government, I will offer a technical, factual explanation of the rationale for those amendments. That applies to amendment 181 in this group. This group of amendments is linked to how the Bill’s definition of a terminal illness applies to those with a mental disorder or disability.”
“It is possible that this is a case in which there has been an overabundance of caution on the part of the Government. I am delivering the Government’s position, but I want the hon. Member to know that that will not necessarily determine how I vote if this amendment does go to a vote.”
“What the hon. Member will have picked up throughout this debate, on every day that we have met, is that the Government are concerned about adding or taking away terminology that delivers clarity, stability and familiarity. I have to say that I am quite torn on the hon. Member’s amendment 399, because I absolutely see where he is coming from. It is one of those situations in which my position as a Government Minister is made somewhat more complex by my personal view that his amendment is perfectly reasonable. My instinct—speaking personally as a Member of Parliament, rather than as a Government Minister—is that the remaining terms in the Bill, if we removed “medical condition”, would continue to cover the waterfront or spectrum of conditions.”
“As I have said, the Government have taken a neutral position on the substantive policy questions relevant to how the law in this area could be changed. However, to ensure that the legislation works as intended, we have advised the sponsor in relation to amendment 181, to further clarify the Bill such that only having a disability and/or mental disorder does not make a person terminally ill and eligible for assistance in accordance with the Bill.”
“In the context of the Bill, the essential test is whether any morbidity, comorbidity or otherwise, meets the requirements in the Bill. Although it is unlikely that a terminal morbidity would be thought of as a comorbidity, it is not inconceivable that it might be, for the reasons that I have set out. The phrasing of the amendment, notably the term “alongside”, potentially increases that possibility. The effect might be that a condition that would otherwise be considered terminal would instead be considered a comorbidity alongside a mental disorder. The amendment would prevent a person with a mental disorder who would, but for the amendment, have been considered terminally ill from accessing assisted dying services under the Bill.”
“Amendment 283 sets out that a person who has one or more comorbidities, alongside a mental disorder within the meaning of the Mental Health Act 1983, would not be considered terminally ill by virtue of those comorbidities alone. The reality of modern healthcare is that many patients, not least those towards the end of life, will be dealing with several conditions or comorbidities. The term “comorbidity” in a clinical context can sometimes be used to distinguish the main problem that someone has experienced experiencing from additional but less serious problems, but it can also be used by those specialising in one or more other aspects of a patient’s care to distinguish their area of focus from other issues.”
“Members who tabled the amendment. I turn to amendment 181. In executing our duty to ensure that the legislation, if passed, is legally robust and workable, the Government have advised my hon. Friend the Member for Spen Valley in relation to the amendment. It clarifies that a person who seeks assistance to end their own life based only on a mental disorder or a disability, or both, would not be considered terminally ill for the purposes of the Bill. Such a person would therefore not be eligible to be provided with assistance to end their own life under the Bill. Someone who has a disability or a mental disorder, or both, and who also already meets all the criteria for terminal illness set out in the Bill would not be excluded by the amendment, as drafted. The amendment therefore brings important legal clarity to the Bill.”
“It is a well-made case; I am still reflecting on it, because of the somewhat complex nature of my role on this Committee, but I am inclined to support the hon. Member’s amendment. Amendment 11 also seeks to amend clause 2(3). Our assessment of the effect of this amendment is that a person who has a mental disorder and/or a disability may not qualify under the Bill as terminally ill, even if they have an inevitably progressive illness and can be reasonably expected to die within six months. There might be concerns from the point of view of the European convention on human rights and the Equality Act if the amendment were passed as currently drafted, because its effect would be to exclude people from the provisions of the Bill if they had a disability or a mental disorder. That may not be the intention of the hon.”
“My answer to that question is yes. My understanding is that so long as the terminally ill, six-month criteria are met, that person would qualify for assistance under the Bill.”
“My understanding is that amendment 181 is clear that the qualification for accessing assisted dying has to be based on the definitions in the main body of the Bill. If passed by the Committee, the amendment will make it clear that an eating disorder does not qualify for access to that service. There has to be another, clear definition that does qualify under the terms set out in the main body of the Bill.”
“The right hon. Member makes an excellent point. I think it goes back to our basic view that there are some amazing health professionals in our healthcare system who do fantastic work. Eating disorders are a truly tragic condition and, of course, there is all sorts of support in place. It is not always perfect or exactly how we would want it to be, but I think it would be a false move for the Committee to think that this is an either/or situation. This is a both/and situation. Of course it is not always perfect, but I think we should pay tribute to our amazing health professionals, who look after all sorts of people with all sorts of conditions, including eating disorders.”
“My hon. Friend makes an excellent point. She brings us back to the fundamental point made in the Bill, which is that it has to be “an inevitably progressive illness”. Eating disorders do not fall under that definition: that is very clear. I hope that that explanation and the observation that I have made on the other amendments are helpful to members of the Committee in their consideration.”
“The amendment may make assessment of a person’s prognosis and eligibility under the Bill more extensive, as it would be likely to require an assessment of a broader range of treatment options.”
“That would widen the pool of those able to access assisted dying services by reducing the level of certainty that a doctor must have that the illness, disease or medical condition in question is progressive—from one that is “inevitably” progressive to one that is “typically” progressive. Amendment 9 seeks to amend the definition of “terminally ill” such that it would not include a person who has an inevitably progressive illness, disease or medical condition that can be reversed, controlled or substantially slowed by treatment. The effect of the amendment is that such a person would not be eligible for lawful assistance to voluntarily end their own life. Should the amendment be accepted, the effect would be to restrict the eligibility for assisted dying services to a narrower category of patients than is currently set out in the Bill.”
“As usual, I will make brief remarks on the legal and practical impact of amendments, while emphasising that the Government continue to remain neutral on the Bill and on assisted dying more broadly. This series of amendments, which I will take in turn, seeks to change the definition of “terminally ill”, either widening or narrowing the cohort of people able to access assisted dying services. Amendment 123 would change what it is to be “terminally ill” for the purposes of the Bill from having an “inevitably” to a “typically” progressive illness, disease or medical condition that cannot be reversed by treatment.”
“The Government have taken a neutral position on the substantive policy questions relevant to how the law in this area could be changed. Questions around the definition of terminal illness and who should be eligible to access voluntary assisted dying under the legislation are matters for the Committee and for Parliament as a whole. However, I hope that these observations are helpful to the Committee in considering the Bill and the amendments tabled by various Members.”
“The Government’s analysis suggests that this may also exclude people who are terminally ill under the definitions of the Bill and who are, for various reasons, unwilling or unable to eat or drink. For example, it may include those with conditions such as oesophageal cancers, which could result in their being unable to eat or drink. Furthermore, it is unclear whether someone who is on intravenous fluids or being fed through a feeding tube would be considered to have stopped eating or drinking under the amendment. I think that addresses the concern expressed by my hon. Friend the Member for Bradford West, but she is welcome to intervene again if she would like to. The amendment could therefore lead to uncertainty over the person’s eligibility for assistance under the Bill.”
“Amendment 10 would provide that, if treatment exists for a person’s progressive illness, disease or medical condition that alters the overall prognosis of that person’s condition, they are not terminally ill and would not be eligible for assisted dying services. Amendment 402 would exclude a person who would not otherwise meet the definition of “terminally ill”—namely, being diagnosed with an inevitably progressive illness with six months or less to live—if that person meets that definition as a result of stopping eating or drinking. The effect of the amendment would be to prevent a person from being defined as “terminally ill” as a result of their own actions of stopping eating or drinking, or both.”
“If agreed to, it would expand the pool of people eligible for lawful assistance to voluntarily end their own life beyond those with a life expectancy of six months or less. In other words, it would remove the timeframe requirement of when death can be reasonably be expected. Amendment 234 would widen eligibility to include cases of neurodegenerative diseases, illnesses or medical conditions where a person is reasonably expected to die within 12 months. Matters such as this are for the Committee, and ultimately for Parliament, to decide, but it is clear that the effect of the amendment would be to broaden the number of people eligible for lawful assistance to voluntarily end their own life under this legislation.”
“I thank my hon. Friend for her intervention. I am just talking about the amendment to reduce the time from six months to one month. I will come on to the issue of eating and drinking in a second. As amendment 282 would reduce the time within which the person is expected to die from six months to one month, it would also limit the number of people with a terminal illness who would be eligible for assisted dying under this legislation. Furthermore, there may be very challenging workability issues in delivering a service within one month, given the other time-dependent safeguards elsewhere in the Bill. Amendment 51 would remove the requirement for the patient to have a six-month prognosis to be defined as “terminally ill”.”
“It is not clear what types of illnesses, diseases or medical conditions are intended to be captured in such regulations. I hope that those observations on the purpose and effect of amendments 12 and 13 are helpful to the Committee in its considerations.”
“The CMO said that multiple diseases may interact, making it “quite difficult to specify that certain diseases are going to cause death and others are not”. –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 32, Q5.] It is also the case that many illnesses, diseases or conditions that may be terminal in one case may not be so in another. Committee members may therefore wish to consider where a focus on specific illnesses or diseases, rather than on the facts of an individual case, could aid clinicians in their decision making. The amendments also include a discretionary power for the Secretary of State to make regulations that expire after 12 months in order to make temporary additions to the list of illnesses that meet the definition of terminal.”
“I have some brief comments to make. Amendments 12 and 13 seek to further define a terminal illness for the purpose of the Bill; I will set out some details about their effect. The amendments would add a requirement that a list of a terminal illnesses for which people are eligible to seek assistance under the Bill be specified in regulations made by the Secretary of State. The effect would be that only a person who has an illness, disease or medical condition listed in regulations, and who meets the other eligibility criteria, would be eligible to be provided with lawful assistance to voluntarily end their own life. I draw the Committee’s attention to the chief medical officer’s oral evidence given on 28 January, which was well articulated by my hon. Friend the Member for Sunderland Central.”
“As I understand it, lipoprotein(a) measurement is not currently recommended by NICE guidance, and there are no treatments available that specifically target Lp(a). Instead, our focus is to improve the uptake of lipid-lowering therapies for prevention of CVD and to treat people with established CVD to NICE treatment targets. We will look closely at new tech and innovation and the essential role they will play in reducing health inequalities.”
“We know that around 70% of the CVD burden is preventable and due to risk factors such as living with obesity, high blood pressure, high cholesterol and smoking—all of which can be reduced by behaviour changes, early identification and treatment. In England, the NHS health check is a free check-up for people between 40 and 74. The NHS health check is a wide-reaching programme delivered by local authorities in England. This CVD prevention programme aims to prevent heart disease, stroke, diabetes, and kidney disease—and also dementia for older patients. In the very short period of time that I have left, I just wanted to say that the hon. Member for Strangford called for the introduction of Lp(a) tests.”
“Gentleman referred to premature deaths, and we know from the most recent figures that I have, from 2023, that in England alone over 130,000 people died from CVD and over 30,000 people died before they turned 75. The best estimates show that the annual cost of CVD to the NHS is a staggering £8.3 billion, with knock-on effects of £21 billion to the wider economy. This is a huge challenge, which is why we are meeting it with great ambition: to reduce premature deaths from heart disease and stroke in people under 75 by one quarter within a decade. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire (Ashley Dalton), will be spearheading our work in this area, and will also be picking up on many of the issues that the hon. Gentleman raised in his speech.”
“As part of our 10-year health plan, we are committed to helping everyone to live a healthy life for longer, and as the hon. Gentleman also outlined in his remarks, too many lives are cut short by heart disease and strokes. In 2022, one quarter of all CVD deaths in the UK occurred among people under the age of 75. Tackling CVD is not just the right thing to do for patients; CVD is also having an impact on growth. People with CVD are more likely to leave the labour market than people with poor mental health, and we must dispel the fiction that people with CVD are always old and infirm. Around one in three people who have a heart attack, one in four people who have a stroke, and two in five people with coronary heart disease are of working age. The hon.”
“The last Labour Government made significant progress on reducing premature deaths from CVD through the introduction of big-hitting interventions such as the ban on smoking in public places and increases in statin prescribing. However, as the hon. Member for Strangford said, among the many appalling findings of Lord Darzi’s report, there is clear evidence that progress on CVD stalled, and even went into reverse in some areas, between 2010 and 2024. That is why it is this Government’s mission to invest in the health service, alongside fundamental reform to the way that healthcare is delivered. We will build a health and care system fit for the future by moving from sickness to prevention, hospital to home, and analogue to digital. Tackling preventable ill health is a key part of these shifts.”
“Friend the Member for Ilford South (Jas Athwal), who spoke so movingly about his family and personal experiences, and the hon. Member for Mid Sussex (Alison Bennett), who spoke passionately about the shocking health disparities that blight our country, caused by 14 years of Tory neglect and incompetence. Before I begin my remarks, I want to pay tribute to people working in local government, our NHS staff and GPs up and down the country for their efforts to find, treat, and manage people at risk of cardiovascular disease—also known as CVD. As hon. Members will know, health is a devolved issue, so my remarks will be limited to matters in England; however, I am happy to pick up on many of the broader points that the hon. Gentleman for Strangford has made.”
“It is a great pleasure to serve under your chairship, Mr Mundell. I am indeed starting with an apology. I am very embarrassed by the fact that the debate was put by my officials in my diary as starting at 3.30 pm, and it is completely unacceptable that I arrived late. I apologise to you, Mr Mundell, and to the hon. Member for Strangford (Jim Shannon). It is a very embarrassing situation, and I am not happy about it at all. I thank the hon. Member for Strangford for securing this debate on such an important issue and for the vital work he does as the chair of the APPG on vascular and venous disease. For their excellent contributions, I also thank my hon. Friend the Member for Dudley (Sonia Kumar), who spoke powerfully on the basis of her extensive real-world experience and expertise, my hon.”
“I absolutely will. I would be happy to complete my remarks, but I do not know that would work, given that Mr Shannon has made his second contribution.”
“I will ask the Minister for Public Health and Prevention to write to him on all his points, many of which I think would be best dealt with in correspondence.”
“The cost of smoking to our economy is even greater, with around £18 billion lost in productivity every year. Smokers are a third more likely to be off work sick, which is why we introduced the Tobacco and Vapes Bill: the biggest public health intervention in a generation. It will break the cycle of addiction and disadvantage, and put us on track towards a smoke-free UK. That will make a real difference in constituencies where smoking contributes to the cycle of poverty and ill health. We are also supporting local stop smoking services with an additional £70 million this financial year. Today’s debate has shown what a challenging and complex area this is. The shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), raised a range of issues.”
“If we improve treatment rates for people with CVD to 95%, more than 18,000 CVD events, such as heart attacks and strokes, may be prevented over three years. We will look closely at how we can get that done. The hon. Member for Strangford called for the introduction of Lp(a) tests. As I mentioned, that is not currently recommended by NICE guidelines. I have taken account of his other remarks, including his request for a meeting and engagement with system partners. The Minister for Public Health and Prevention will take all those requests on board. She is the right person for him to meet, given that she leads in this policy area. Smoking costs health and care services £3 billion a year—resources that could be freed up to deliver millions more appointments, scans and operations.”
“We could prevent around 17,000 heart attacks and save more than £20 million in healthcare costs alone over three years just by treating 80% of patients on target. The hon. Member for Strangford also mentioned high levels of cholesterol as a key risk factor in CVD. For every three NHS health checks delivered, one person is found to have high cholesterol, and there are well-known health inequalities in CVD affecting underserved communities in England. Addressing undetected and poorly managed high blood pressure and raised cholesterol is key to preventing CVD and reducing health inequalities. There are effective drug treatments. Statins are readily available and very cheap. They can reduce an individual’s risk of CVD in four to six weeks.”
“This joint initiative between NHS England and Diabetes UK aims to support eligible people with type 2 diabetes to achieve clinically significant weight loss, improve blood glucose levels and reduce the need for diabetes-related medication. A recent study found that almost a third of patients with type 2 diabetes who completed the programme went into remission. Around half of heart attacks and strokes are a result of high blood pressure. A third of adults have high blood pressure and, worryingly, almost a third of these conditions are currently untreated, meaning that over 4 million people do not know that they have high blood pressure. It is often referred to as the silent killer, as high blood pressure is largely symptomless. The tragedy is that the treatment is so cheap and effective.”
“Each year, the NHS health check identifies 22,000 people with high blood sugar who are referred on to primary care for further assessment and management. GPs can refer people at risk of developing type 2 diabetes into the Healthier You NHS diabetes prevention programme. The programme has been highly effective: some 35,000 people have been referred to it by their GP, and over 20,000 have started the programme since September 2020. For people who complete that programme, it can cut the risk of developing type 2 diabetes by 37%. For those who already have diabetes and are overweight or obese, the NHS type 2 path to remission programme is available.”
“Member for Strangford that the National Audit Office report shows that there is still so much more to be done. That is why we have asked officials to be more ambitious, developing policy proposals for how that programme can go even further. In the meantime, we are focused on delivering a new digital NHS health check, available through the NHS app, so that people can assess, understand and act on their CVD risk at home. We want to make it easier for people to access that programme, especially our constituents who have caring or childcare responsibilities, or cannot easily get to their GP surgery during opening hours. The creation of a state-of-the-art national digital NHS check service will improve access to this lifesaving check. The hon. Member was right to mention diabetes as a key risk for CVD.”
“This has been an interesting debate on so many levels. I thank you for that clarification, Mr Mundell. I was just talking about the fact that around 70% of the CVD burden is preventable, and that the causes include obesity, high blood pressure, high cholesterol and smoking. All those factors can be reduced by behaviour changes, early identification and treatment. In England, the NHS health check is a free check-up for people between 40 and 74. It is a wide-reaching programme delivered by local authorities in England. This CVD prevention programme aims to prevent heart disease, stroke, diabetes and kidney disease, as well as dementia for older patients. It engages over 1.4 million people a year and, through behavioural and clinical interventions, prevents around 500 heart attacks or strokes annually. I agree with the hon.”
“In my contribution, I have sought to demonstrate our commitment to getting on with the shift from sickness to prevention with our cast-iron commitment to expanding NHS health checks, the shift from hospital and community by making it easier for people to get checks at their convenience and at home, and the shift from analogue to digital through an innovative and expanded digital service. I once again thank the hon. Member for Strangford for securing this important debate, and thank all hon. Members across all parties for their excellent contributions. Watch this space: we will continue to work on this issue with focus and at pace.”