Daniel Francis
MP for Bexleyheath and Crayford · Labour · United Kingdom
“As the Minister said, we were friends for many years in London local government prior to being elected to this place. I want to make two points. First, there is the issue of the Changing Places that have been provided in recent years and the amount of information out there about them.”
“As the Minister knows, I will hold her to account on this issue and continue to pursue it. I thank her very much for the commitments that she has given today that we can continue to pursue. I thank the hon. Members for Chester South and Eddisbury (Aphra Brandreth), for Bath (Wera Hobhouse) and for Strangford (Jim Shannon), my hon.”
“An expansion of capital funding for Changing Places toilets would lead to people with profound disabilities accessing more opportunities and more families and individuals contributing to our hospitality businesses, theme parks, leisure facilities and sports grounds—the list goes on. There was, of course, a previous fund.”
“I turn now to the importance of maintaining Changing Places toilets. I mentioned last year that, in Bexleyheath town centre, we had to close a Changing Places toilet because of the vandalism it was receiving, with people living in it and dealing drugs in it.”
“Although I acknowledge that changes to building regulations ensure that facilities continue to be installed in new buildings, I retain concerns that older buildings would greatly benefit from having a Changing Places toilet installed.”
“One said: “Without access to an appropriate facility, I am left with impossible choices: ending outings early, avoiding certain venues altogether, or changing my daughter on the floor of an accessible toilet, which is neither hygienic, safe nor dignified.” I have read through the responses to the survey, and there was a lot of appreciatio…”
The complete record
Every one of 600 lines we hold for Daniel Francis, in date order, each linked to its source. Free to read, in full, without an account. Page 8 of 12.
“As I have continually said to the Government, we clearly need to resolve that to protect some of our most vulnerable children in next year’s budget, but also residents and businesses across the London borough of Bexley.”
“I am pleased—in fact, I am proud—that, under a Labour Government, Bexley this year has had the sixth-highest public health increase of all the boroughs, but clearly that position remains, and our public health grant remains too low. As I have said, our finances remain in a very difficult position, with a £32 million budget gap next year, which needs to be addressed. Most worrying is our safety valve agreement. Our safety valve agreement was signed because of the significant overspends in special educational needs, but that will expire next year. We are not currently on course to achieve the requirements in the safety valve agreement and the statutory override. There is potentially £12.8 million at risk.”
“Demographic changes in outer London and inner London mean that the borough I was first elected to represent on the council 25 years ago is a very different borough today. Parts of my constituency, such as Slade Green and Northumberland Heath, are very different, demographically and in terms of poverty, from how they were then. My council’s position is that council tax should not be a primary driver of increased core spending power, and that we should simplify the assessments and reduce the number of relative needs formulae. Then there is the public health grant. I have sat there, through budget after budget, as either leader of the opposition or the opposition finance spokesperson, listening to the Conservative leader, Baroness O’Neill, saying that the public health grant for Bexley is the second lowest in London.”
“That includes the £5 million we needed to balance the budget in the 2018 council election year. Things became worse in 2021, when the council applied for its capitalisation order. It made 15% of staff redundant and had to sell a building for £9 million to fund the redundancy costs. In the period from 2010 to 2015, Bexley went from having the 10th most expensive council tax in London to the 8th most expensive. At my election speech last year, I pledged to work tirelessly with my Conservative-controlled local authority to deliver for local people and businesses, and I am here on their behalf to make some key pledges about the pressures they face and the pressures we have heard about today. First, as my hon. Friend the Member for Ilford South (Jas Athwal) said, we face the matter of the fair funding settlement.”
“It is a pleasure to serve under your chairship, Ms Lewell. I need to say at the outset that my wife is employed as a SEND co-ordinator in the London borough of Bexley. I was a councillor in Bexley for 20 years, including 10 years under the last Labour Government. I hear what the hon. Member for Bromley and Biggin Hill (Peter Fortune) says, but I assure him that we had a very different funding arrangement then—my local authority was not in the position it now is. The hon. Member for Old Bexley and Sidcup (Mr French) is no longer in his place, but he was the deputy leader on the council and I the leader of the opposition when we faced our funding crisis back in 2021. That funding crisis continues to this day. In our council, reserves have been used to balance the budget for years.”
“My hon. Friend the Member for Luton South and South Bedfordshire referred to IVF. My wife and I have been through IVF, and what exists is exactly what the hon. Member for Richmond Park described. There is an annual show at Olympia where it has been commercialised and it is put to people, “Why not go down this route? Why not go down that route?” Does the hon. Member agree that that is really not a route we want to go down?”
“I really did not intend to speak this morning, but I wonder whether, in the final part of the process that we are considering, there would be the sort of upsetting process that has taken root in the fertility industry in this country. We need more clarity on that by Report.”
“I visited it about 13 years ago. Frankly, it is complete marketisation. People who are already on their knees and really depressed are left feeling that companies are simply trying to make a profit out of them. People can already book their tickets for the event in May and navigate a path through it: there are expert-led seminars, real stories, whereby people connect with others who have been through the process, wellbeing workshops and more than 70 exhibitors. Of course, they are all paying a fee to be there, and they all aim to have made a profit by the end. Our first set of IVF treatment was free on the NHS. We paid £7,000 for our second, which was again through the NHS. We went through several visits to NHS and private providers to assess whether we were willing to pay a top-up for a slightly better service.”
“It is a pleasure to serve under your chairship, Ms McVey. I genuinely did not intend to speak today, but the debate, particularly the speech by the hon. Member for Richmond Park and the intervention from my hon. Friend the Member for Luton South and South Bedfordshire, has brought me to my feet. It was 13 or 14 years ago that my wife and I embarked on the IVF road. It never worked—our children came naturally in the end—but I know the pain and despair of that process. Although I do not call into question the efficacy of any doctor, some companies, looking to their profit margins, will always prey on people. We have had discussions today about the regulations to be made under new clause 36, but we need some clarity on Report. I referred to the annual fertility show at the Kensington Olympia; I have checked, and it is still held.”
“We would want to see strong representation from patient groups across that, as well as from people who have been involved in the process, such as family members, advocates and clinicians to make sure that if serious issues are being raised, they can be picked up early and addressed.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 280, Q367.]”
“It is a pleasure to serve under your chairship, Sir Roger. This has been a long process, and we are nearly at the end of it now. Members will recall that at the start of the process, I was very insistent that Mencap should give oral evidence. When it did so, Dan Scorer said: “Clause 35 is about the review of the Act. The lived experience of people is absolutely vital to that. The Bill says that it will be five years until we have that review. Our view is that that is far too long. If the Bill becomes law and if there are really serious issues and discrimination taking place against people, we will want to know that a lot earlier than in five years’ time, and we will want action to be taken. Our suggestion is that review should be earlier.”
“The annual reporting does give us some reassurance, but when we accepted some of Mencap’s recommendations last week, I said that I would welcome it if the entirety of its recommendations were accepted—and it wanted an overall review at an early stage in the process. Amendment 493 to 495, in my name, address those concerns. A consistent concern of mine is how we address issues that come to light from specific communities, particularly those with learning difficulties, and amend the legislation at a reasonable stage in the process.”
“I beg to move amendment 491, in clause 35, page 22, line 2, after “health” insert “and care”. This amendment, together with Amendment 492, would broaden the scope of the assessment criteria for the Review of this Act, by referring to “health and care services to persons with palliative and end of life care needs” to provide a more holistic consideration of palliative and end of life care needs, reflecting current clinical best practice.”
“It is in line with current clinical best practice and with the written evidence that Marie Curie has supplied to us. In addition, amendment 397 is in line with many other amendments I have tabled during this process and seeks “an assessment of the impact of this Act on persons with learning disabilities, including any concerns about the operation of this Act in relation to such persons”.”
“I will be brief. Amendments 491, 492 and new clause 28, which will be discussed when we come to the next group, have all been suggested by Marie Curie, the UK’s leading end-of-life charity. Amendments 491 and 492 are minor amendments that would broaden the scope of the required assessment of the availability, quality and distribution of palliative care services to be undertaken as part of the five-year review of the Act, by referring to “health and care services to persons with palliative and end of life care needs”. That provides a more holistic consideration of end-of-life care than the current drafting of “health services to persons with palliative care needs” and would reflect the current clinical best practice of palliative care multidisciplinary teams, incorporating both health and social care professionals.”
“Friend the Member for Spen Valley chose to highlight that she had “included in the Bill a requirement for the Secretary of State to report to the House on the availability, quality and distribution of palliative care.” —[ Official Report , 29 November 2024; Vol. 757, c. 1013.] At this point, the Bill requires such an assessment only after five years. I hope that she and other hon. Members will agree that it would be beneficial to support this new clause so that such an assessment may be undertaken within 12 months, in support of the ambition of seeing improvements in palliative and end-of-life care.”
“By requiring an immediate assessment of the state of health and care services available to persons with palliative and end-of-life care needs through new clause 28, we can create a framework for accountability within this legislation and a firmer basis on which future policy and spending decisions on palliative care can be made. It may be useful to recall that we have not had a national strategy for palliative and end-of-life care since 2008. While I appreciate that there are major policy milestones approaching, such as the 10-year health plan, that could help to address that gap, my hope is that an assessment of the quality and availability of palliative and end-of-life care services undertaken as part of the Bill can sit helpfully alongside other plans and strategies. When introducing the Bill on Second Reading, my hon.”
“The sad reality is that in too many cases today people are not able to make that choice. There will most likely be consensus among us that action is needed to fix end-of-life care to ensure that all dying people can have choice and dignity, even if we disagree on whether that is most appropriately achieved on the face of the Bill or through other mechanisms. There has also been a great deal of debate and discussion about what the impact of introducing assisted dying might be on palliative care services and reference to what might have happened in other jurisdictions. We should not leave this to chance and fool ourselves that improved access to palliative and end-of-life care would be an inevitability as a result of the debate or level of public interest in the Bill.”
“Above all, the intention behind this new clause is to ensure that, outside the proceedings of the Committee and the progress of the Bill, that relationship is properly and thoughtfully considered by Government. We have heard a range of expert evidence throughout the Committee that, despite the very high quality of palliative and end-of-life care in this country and the phenomenal efforts of the clinicians and organisations delivering it, access to that vital care is all too often inequitable and subject to a postcode lottery. As Marie Curie stated in its written evidence, if the fundamental aim of the Bill is to offer terminally ill people choice at the end of life, “genuine choice…cannot exist unless dying people are able to choose to receive high quality palliative and end of life care”.”
“Crucially, the assessment would incorporate an assessment of the current state of health and care services to persons with palliative and end-of-life care needs, and the implications of the Act for those services, including for the quality and distribution of palliative and end-of-life care services. The new clause seeks to mirror the requirement in clause 35 for an assessment after five years of the Bill passing, only within 12 months of the Bill receiving Royal Assent, in order to provide a benchmark against which the later assessment can be measured. There has been much discussion about the relationship between the Bill and palliative and end-of-life care services.”
“I wish to speak to my new clause 28, which was suggested by Marie Curie, the UK’s leading end-of-life charity. The new clause is more substantive than my two amendments in the previous group. It would require an additional assessment within 12 months of the Bill being passed, with the Secretary of State required to undertake an assessment of “the extent to which the Act is on course to meet its aim of allowing adults who are terminally ill, subject to safeguards and protections, to request and be provided with assistance to end their own lives”.”
“That new clause was tabled within the last week. Has my hon. Friend sought advice from the Clerks? The only way that we could amend this now is through a manuscript amendment, and I presume that now, at the eleventh hour, that would not be allowable. I just want to clarify the position.”
“I beg to move amendment 454, in clause 36, page 22, line 26, at end insert— “(e) any person who would not have capacity to request assistance to end their own life under this Act.””
“My amendment simply seeks to ensure that the person who is the proxy has mental capacity. I commend the amendment to the Committee.”
“Amendment 454 stands in my name, in relation to the clause on disqualification from being witness or proxy. Clause 36(2) outlines the reasons why an individual cannot be a witness or proxy: if they are a relative of the person; if it is believed they are a beneficiary of the will; if they may otherwise benefit financially; if they are a health professional who has provided treatment or care for the person; or if they have not yet attained the age of 18. Clearly—particularly on clause 3—we have had long debates about mental capacity, and it does not state in clause 36 as is currently stands that the person who is over 18 has to have mental capacity. Therefore, as the Bill stands, someone could bring their grandmother with Alzheimer’s or dementia along and get her to sign their paperwork.”
“As the parent of a wheelchair user with a severe sight impairment, I see many of the issues the report highlights on a daily basis. The report highlights the issues with aviation and the difficulties the Civil Aviation Authority has faced in enforcing regulations on behalf of wheelchair users and people with a severe sight impairment. Will my hon. Friend join me in asking the Government to fully consider the recommendations of the aviation accessibility task and finish group when it reports in the summer, along with the principles of my Aviation (Accessibility) Bill, to finally make changes for disabled people on airlines?”
“I have come to the position, however, that it is vital to try to capture the data on people with learning disabilities or for whom there is a judgment about their level of mental capacity, and that should be in the Bill. I therefore support the amendment.”
“Beyond new clause 8, tabled by my hon. Friend the Member for Spen Valley, which would require the Secretary of State to engage with the Equality and Human Rights Commission, there is a valuable reason for seeking to have that data and for ensuring that the assisted dying commissioner has that data. As I will talk about in debates on subsequent groupings, Dan Scorer from Mencap clearly asked about what happens if things go wrong for people with certain protected characteristics, and at what stage we will review that. Some of us have legitimate concerns about the characteristics in the amendment tabled by hon. Member for Richmond Park, and about coercion, particularly of women. People have listened long and hard about where I am coming from on this issue, and unlike some other Committee members, I am not opposed to assisted dying per se.”
“In the oral evidence, Dan Scorer from Mencap particularly talked about the experience in covid—for example, someone was five times more likely to have a do not resuscitate order placed on them if they have a learning disability. There is wide evidence of that, as Members, and me in particular, were well aware before we heard that oral evidence. As a councillor, I remember the experience of ethnic minority communities during that period. I used to represent a council ward with a high west African population. There were clear cultural issues around people’s experiences with the health service during that period, and whether they wanted to take up the vaccine. As the then leader of the opposition on my council, I had regular meetings about the different levels of uptake of health services among different communities.”
“It is a pleasure to serve under your chairship, Mrs Harris. I was also not intending to speak, but I think there are two slightly different issues here. Prior to Second Reading, the Equality and Human Rights Commission produced a briefing paper on some of the issues that have been covered in amendment 500. It also gave oral evidence where it was not happy about some aspects of the Bill and about not having the equality impact assessment. I hear what my hon. Friend the Member for Sunderland Central says, but the briefing that the EHRC produced—although I appreciate what the Equality Act says—did not talk about sexuality, for instance, but it did talk about many of the aspects that are in the amendment of the hon. Member for Richmond Park.”
“Members have heard my views on support for people with learning disabilities, and I am conscious that we will come to other amendments on this issue—but I will move my amendment when we get to the relevant stage, in a manner consistent with the approach that I have taken in Committee so far.”
“Dan Scorer from Mencap gave us oral evidence on advocacy support, the discussions and the role of families and said: “Individuals should be able to choose who supports them with those discussions, whether it is friends or family members or an independent advocate—that would probably be our preference—who is specifically trained to support people with a learning disability who are considering their end-of-life options.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 273, Q355.] I will not go on at great length—hon.”
“I will speak to amendment 394 in my name, which provides that codes of practice may be issued on “the provision of information and support to persons with learning disabilities who are eligible to request assistance to end their own life under this Act, including the role of advocates for such persons”. I am aware that my hon. Friend the Member for Spen Valley may speak to amendment 517 and new clause 25, which we will discuss shortly. I tabled a number of amendments, one of which was accepted, following conversations with Mencap.”
“She wrote: “My daughter has the mental capacity to make decisions about her daily routine, social, educational, and family matters, but she lacks the capacity to manage other aspects of her life such as her financial affairs and healthcare.” She went on: “My daughter is much more likely to defer to a clinician’s proposal as she might think that she ought to agree.” We heard that important point again in oral evidence. I would hope that the advocate would be in a position to provide support and advocacy to a person having to make that decision.”
“Advocates must not be seen as leading people into decision making, as they could be under the Mental Capacity Act 2005, which gives them that scope. We need to be clear in the training that they have to assist the person in making their decision. I will be supporting these proposals, because I am confident that we can overcome that in the training. In her written evidence, Patricia Cook talked about decision making for her daughter who has Down’s syndrome.”
“Friend said, the amendment and new clause join my amendment 394 in making that happen. The proposal includes people who have substantial difficulty in understanding the process or the information involved, or in communicating. I note that the specified conditions could include a wide range of people, and I thank my hon. Friend for including them. In due course, we will see what circumstances are dealt with in regulation. There are two issues that I have raised throughout this debate, and they remain a tension. One is that we must support people with learning disabilities and the other is capacity. We need to be very clear about that in the training, and I trust that that will be dealt with in due course.”
“We are in danger of having much consensus this evening. As hon. Members know, this issue is very close to my heart, and my hon. Friend the Member for Penistone and Stocksbridge knows more than anybody that inequality for disabled people in this country remains ingrained. As the parent of someone with a very complex set of disabilities, including a learning disability, I have seen that at first hand. I welcome new clause 25 and amendment 517, in the name of my hon. Friend. My concern with the Bill is that we must protect vulnerable people, particularly those with learning disabilities, and the amendment and new clause would address some of my concerns by providing an independent advocate, as Mencap asked for, in circumstances that the Secretary of State would specify. I welcome the fact that, as my hon.”
“Friend the Member for Penistone and Stocksbridge comes from a very good place. We will come to this next week but, like my hon. Friend, I have consistently listened to Mencap’s evidence, which also talked about reviewing the Bill at an earlier stage than is currently envisaged. That is why I have tabled amendments 493, 494 and 495 for next week. My view is that if the Bill becomes law, the system will work well if the regulations are implemented correctly. I will support the amendment tabled by my hon. Friend the Member for Penistone and Stocksbridge; I thank her for bringing it forward. I know that my hon. Friend the Member for Spen Valley has listened hard, and I am grateful. I think there will be a degree of unanimity this evening.”
“For many people such as my daughter, who is almost blind as well as being learning disabled, there are additional communication skills given that they have those extra sensory difficulties. It is vital for people such as Mrs Cook’s daughter, who might be vulnerable to influence, that the advocate must be able to explain all the options clearly without pressurising the person down one route. I believe the amendment will provide important support to those with less capacity or difficulty in understanding all the options in front of them. As I have said, the two things that I have banged on about consistently in this process have been about learning disability and mental capacity. There has been a conflict for me, even with this amendment, but I am confident that the amendment tabled by my hon.”
“My hon. Friend knows my concerns but she knows that I will be supporting the amendment this evening. Advocates must have an understanding of the available end-of-life options and be able to communicate clearly and explain to patients the medical treatments available: palliative care, social care and assisted death. That is quite complex. As I have said previously, my own experience of mental capacity relates to my daughter: she would never have the capacity to be able to make such a decision. But on a daily basis, including this morning, I have to explain a two or three-point decision-making process. It is vital that advocates are there and that they have the training.”
“I beg to move amendment 395, in clause 31, page 19, line 8, at end insert— “(2A) The persons consulted under subsection (2) must include persons with learning disabilities.”.”
“These amendments refer to the oral evidence we received from Mencap. They would add provisions to ensure those consulted in the preparation of the chief medical officer’s guidance include persons with learning disabilities. I commend the amendments to the Committee.”
“The amendment would simply mean that, if there were to be concerns or allegations at a later stage, the reason why the proxy was required would be written down.”
“If the first declaration is signed by a proxy, then the co-ordinating doctor—the independent doctor—would be able to examine that reason, so including the reason for someone being unable to sign their own declaration would improve transparency around the process. I hope that hon. Members will agree that we need to be able to monitor how those requests are made and the reasons that people are giving. In written evidence, several experts raised the importance of collecting good data to ensure that the assisted dying process is properly monitored, and amendment 321 would assist that; I believe that it would protect both vulnerable patients and proxies. I absolutely appreciate and understand that people may have a very good reason for requiring a proxy—if they are very ill during the process, for example.”
“Friend the Member for Spen Valley has also tabled amendments about the relationship and who the proxy could be, but I do not believe that amendment 321 would be a burden or cause any unnecessary complication. As the Bill currently stands, when a proxy signs the declaration they already have to include their full name and address, the capacity in which they qualify, and a statement that they have signed in the capacity of a proxy. As we have said before, it is vital to safeguard vulnerable people at every stage of the process; adding the reason why the proxy was required allows other people during the process, including if there were allegations later, to understand why that was required.”
“It is a pleasure to serve under your chairship, Ms McVey. Amendment 321 will mean that the proxy’s declaration must also include the reason why the person was unable to sign their name. That would add a vital safeguard for the person and for the proxy. In this Committee, we have consistently discussed the need to safeguard vulnerable people from being coerced into choosing assisted dying; for those who need a proxy, the risk of coercion might be higher. As the Bill currently stands, the person needs to tell only their proxy the reason why they are needed. I would like to make it clear why the amendment is important. The Bill does not currently specify that the patient’s declaration of the reason for needing a proxy has to be heard by anyone other than the proxy themselves. I am conscious that, since my amendment was tabled, my hon.”
“I welcome my hon. Friend’s acceptance of the amendment, and I think she sees the point behind it. It was meant not to be awkward—I do not think I have been at all awkward during this process—but simply to state that, if there were concerns later, the reason why the proxy was required should be there in a transparent way. I commend amendment 321 to the Committee.”
“It is important for us to think through, provide for and safeguard against all possible scenarios, however rare they might be. Of course, we would not want them to happen, but in some circumstances they might, and we would not want there to be a legal hole. Accepting the amendment would mean the Secretary of State has the opportunity to provide a code of practice for such circumstances. I hope hon. Members will be able to support the amendments in my name.”
“Again, we received oral evidence from a number of people that what a doctor is meant to do in the event of unexpected complications is a matter of concern from both a legal and a medical perspective. We know from the evidence received from other jurisdictions that—I accept in a small minority of cases—there can be complications or the death can take much longer than expected. We also received evidence that, on rare occasions, death can take days. Amendment 430 would show we have thought about those circumstances and provided for them by giving doctors a code of practice to refer to, rather than being left in the dark if a difficult situation arises at the time of death. We must not find ourselves in a circumstance in which doctors and patients are unprepared.”
“If the person were to suffer complications such as seizures or vomiting, or if they were exhibiting signs of distress, it appears that the doctor should be present. Members may think this could encroach on a patient’s privacy, but I think there is a discrepancy between the two subsections. On amendment 430, I am conscious that my hon. Friend the Member for Ipswich has tabled a similar amendment. The intention of my amendment is to ensure there are regulations in responding to any unexpected complications that arise in relation to the administration of the approved substance, including when the procedure fails. I am conscious that if a doctor intervenes, they could end up in breach of the Suicide Act 1961. I therefore left the wording in that vein, as I understand that we will receive more information in due course.”