Terminally Ill Adults Bill – Current Status and Key Provisions of the Bill

The Terminally Ill Adults (End of Life) Bill was introduced into Parliament on 11 November 2024 as a Private Members Bill, by Kim Leadbeater MP (Labour). This Bill would enable adults who are terminally ill to request and receive lawful assistance to end their lives, subject to meeting clear eligibility criteria and passing through a regulated process. The intention is to allow individuals a dignified and peaceful death, under strict safeguards to prevent abuse. If passed, care services may become the place where someone chooses to end their life. Care England takes no position on the principle of the Bill itself. This briefing is produced to inform members about the current status of the Terminally Ill Adults (End of Life) Bill, to share results and analysis of Care England’s snap survey and key provisions of the Bill affecting the sector.

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Timeline and Current Status of the Terminally Ill Adults Bill

The Bill has passed through the House of Commons and has completed the first and second reading in the House of Lords. The Bill is currently in the committee stage in the House of Lords, with the latest debate taking place on Friday, 16th January 2026, which followed a decision to allow the Lords extra time to debate the Bill. The Bill has a record number of amendments, creating tension between the need for scrutiny to ensure it is workable and safe, and concerns that it may not pass before the end of the parliamentary session. 

At the start of this stage, a new committee was established to scrutinise the implementation of the Bill more closely, focusing specifically on:  

• Funding 

• Potential impact on health and justice systems  

• The role of coroners and medical professions in the process.  

Care England’s survey, which assessed the preparedness of the adult social care sector, was presented as evidence in this committee. If members would like to have a further say, please inform us via this link: Terminally Ill Adults Bill Survey  

The latest debate focused on whether palliative care assessments should be part of the assisted dying process. Supporters argued this allows for a real, informed choice, pointing to Oregon, where individuals who have received comprehensive palliative care support have retracted their requests for assisted deaths. Opponents argued this could increase the risk that palliative care will be used when it does not align with the wishes of the patient. A decision was not reached, and the issue will return in future debates.

The Lords’ amendments to the Bill will need to be voted through the House of Commons, ensuring both Houses agree on a finalised version. This process is often referred to as ‘ping pong’. Once the final text of the Bill is agreed on by both Houses, received royal assent, and the implementation is phased over four years, the earliest the law could come into force is 2029.

With the Bill in its current form, the following criteria must be met by an individual if they wish to request an assisted death:

• They must have capacity to ‘make a decision to end their own life’ (with capacity to be read in accordance with the Mental Capacity Act 2005).
• Be aged 18+
• Be a resident in England & Wales for at least 12 months.
• Be registered as a patient with a GP practice in England or Wales.

Terminally ill definition: when an individual has an inevitably progressive illness or disease that cannot be reversed by treatment and is reasonably expected to die within 6 months.

The process of seeking assisted dying is designed around four main stages:

• Preliminary discussion.
• The person makes a “first declaration” (and two medical statements are provided).
• The approval of an Assisted Dying Review Panel.
• The person makes a “second declaration” (and a medical statement is provided).

Key Safeguards:

• No medical professional is required to participate if they object.
• The Voluntary Assisted Dying Commissioner will monitor cases and compliance.
• Coercion or assisting someone outside the legal process is a serious criminal offence.
• Review panels serve as an extra legal safeguard to ensure the person meets all criteria.

Adult social care providers may be involved in signposting individuals, coordinating support, or contributing to multi-disciplinary teams (MDTs). The process would be underpinned by legal and clinical oversight.

Timeline of Bill

This table outlines the parliamentary process of a Bill and where the Terminally Ill Adults Bill currently is at in this process.

	House of Commons	House of Lords
First Reading – this is the first formal stage, where the bill is introduced to the respective House. There is no debate	16th Oct 2024 – Introduced by Kim Leadbeater (Labour MP).	23rd June 2025
Second Reading – the main principles of the bill are debated. No amendments can be made, only suggested. The bill is then voted on to see if it proceeds further in the legislative process	15th November 2024 – the bill was supported in principle (passed with 330 to 275 votes). This was a historical moment in England and Wales as the principle had previously been rejected at this stage.	12th and 17th September 2025 – Over 200 Lords spoke over two sessions, with the focus of detailed scrutiny and refinement of the Bill. When the adult social care sector was mentioned, the debate mainly focused around the sector needing further funding to ensure choosing an assisted death is a free choice, not a financial need. Lord Green of Deddingham raised concerns: due to amendment NC10(a), care homes cannot opt out, thus some might feel obliged to close, which was reflected in our survey results. The Bill was voted through to the committee stage.
Committee Stage – this is when in depth consideration of the bill occurs, with a smaller group of MPs, which represent the political composition of the House ·       Written and oral evidence is considered from a range of interested parties. ·       Amendments considered can be: o   Changes to existing material o   New material entirely, but it has to relate close enough to the bill	28th-30th Jan 2025 – Unusually for a private member bill, it got scrutinised by a Public Bill Committee. More than 50 experts gave evidence. 11th Feb 2025 – clause-by-clause scrutiny began, with a clear focus on improving the bill, not debating the principle of assisted dying. There were 90 hours of scrutiny over 29 sittings in total. A major amendment, clause 12 which originally stated the need for high court oversight was replaced by a new Voluntary Assisted Dying Commission role and Assisted Dying Review Panels comprising of a retired judge or lawyer, psychiatrist and social worker. Additional safeguards included specialised training for doctors, independent advocates for vulnerable individuals, and enhanced oversight/prosecution standards.	Baroness Berger and Lord Falconer compromised on creating a new committee to provide extra scrutiny of the details of the Bill, focusing on: funding, potential impact on health and justice systems and the role of coroners and medical professions in the process. This committee will begin on the week commencing 20th October, hold 6 meetings over three weeks, allowing conclusion by 7th November. Baroness Berger acknowledged Care England’s survey will be used as evidence to understand the impact of the Bill on care homes.  5th Dec 2025 – many amendments were debated, including the proposal the Bill should only apply to individuals aged 25 and over. Baroness Finlay proposed individuals aged 18-25 would undergo a more enhanced assessment. This compromise recognises the importance of choice and the ongoing prefrontal cortex development in that age group.
Report Stage – in the chamber, only amendments are discussed. These will have been tabled in during the committee stage.	16th May and 20th June 2025 – there were some key amendments NC10 – Conscientious objection clause was extended to anyone involved in the provision of assisted dying, not just registered medical practitioners NC10(a) – employers cannot opt out, only employees on an individual basis – this has implications on the social care sector. Amendment 14: Added a new subsection stating that a person cannot be considered terminally ill solely because they voluntarily stopped eating or drinking. This ensures that self-induced cessation of sustenance doesn’t qualify someone under the definition of terminal illness. NC14 – Ban on advertising dying services that may result in indirect coercion – ‘“(1) The Secretary of State must by regulations make provision prohibiting— (a) the publication, printing, distribution or designing (anywhere) of advertisements whose purpose or effect is to promote a voluntary assisted dying service;…’”
Third reading – another general discussion of the (often) revised bill. No amendments possible. Then a vote	20th June 2025 – the Bill passed (314 to 291 votes). The same process is now repeated in the House of Lords.

Assessing Preparedness of the Adult Social Care Sector in respect of the Terminally Ill Adults (End of Life) Bill

Care England’s Snap Survey

This snap survey sought to understand the sector’s awareness, preparedness and views on the proposed Terminally Ill Adults (End of Life) Bill. The findings highlight a sector that feels largely excluded from consultation, uncertain about its role, and deeply conflicted about the ethical and practical implications of such legislation.

The 122 care providers that responded to the snap survey represented small, medium, and large care home groups, and independent care homes and are clear that whilst the Bill may create new rights in principle, its implementation in care home settings raises unresolved questions about workforce readiness, clinical capacity, and alignment with the core mission of social care.

Key statistics from providers who responded to the survey:

• 84% have not been consulted on the Bill or its implications.
• 24% said staffing would become very difficult due to conscientious objections, with a further 16% expressing similar concerns.
• Only 14% reported staff being willing to participate in the whole procedure; compared to 34% reported their staff not being willing to participate at all.
• Only 13% said they could manage assisted dying in their Homes.
• Only 27% reported 24/7 access to specialist palliative care support on site

This disparity in end-of-life provision raises questions about whether all care providers could meet the clinical and safeguarding standards required to support assisted dying in practice, particularly in more complex care settings.

• 16% were unsure whether the purpose of care homes would be undermined, with many requesting more information about implementation before commenting further.

This final statistic reflects how personal care is as a profession, and therefore how it could be challenging for those working in the sector to remove personal beliefs from the care and support they provide on such a strong issue.

Analysis of Survey Results

The survey results indicate that awareness and engagement with the Terminally Ill Adults Bill within the adult social care sector remains limited, with consultation being largely absent. There is a concerning lack of information and dialogue, suggesting that many providers are not yet equipped to understand or respond to the practical and ethical implications of the proposed legislation. Written feedback reveals that many providers are still in the early stages of internal discussion, with a number expressing the need for more practical guidance before making formal decisions.

Workforce readiness emerged as a key concern, with widespread conscientious objection anticipated potentially due to the diversity of the workforce and limited training or clinical capacity. Most homes lack access to rapid palliative care support, meaning the infrastructure required to deliver assisted dying safely and consistently is not in place. Furthermore, many providers disclosed formal conversations with staff had not begun, and several emphasised the need for time, structured conversations, and clear policies before committing to a stance. This further highlights the current uncertainty and the likelihood that a significant proportion of the sector may remain undecided or opt out altogether without adequate support and guidance.

Finally, the survey explored whether the Bill would impact the central mission and values of care providers. Some providers, including those supporting faith-based care, expressed strong ethical opposition to assisted dying, while others acknowledged the need to reassess their philosophical stance in light of the proposed legislation. There is clear variation across the sector, with implications for regulatory compliance, and funding arrangements.

Taken together, the survey reveals a key concern with the Bill in its current form: assisted dying could become a legal right without a practical route, leaving care home residents facing inconsistent access, fractured continuity of care, and cultural divisions across the sector. If the Bill becomes law, successful implementation will depend on clear legal frameworks, practical guidance and national consultation.

The Impact of Care England’s Survey

Care England’s snap survey to assess the preparedness of the adult social care sector for the Terminally Ill Adults Bill was mentioned in a letter by Members of the House of Lords which asked for the creation of a select committee. This new committee has been voted through, sitting Monday 20th October to Friday 7th November, to look into the implementation of the Bill in more detail, particularly how the current 42 delegate powers handed to ministers will be applied in practice. This recognition shows Care England’s work is shaping Parliamentary scrutiny.

If one would like to read the full letter, please click here.

Care England has thanked members of the House of Lords for our acknowledgement, and will continue to work with them through the progress of the Bill in parliament. We have urged the following topics to be discussed on behalf of the adult social care sector to ensure smooth implementation, if the Bill is to become law. These have been informed by our feedback from care providers.

1. The introduction of a provision that allows organisations to have the choice to opt out of the assisted dying process, as nobody who has a moral or philosophical objection to the Bill should be required to engage with the process.
2. The need for a fully funded training and development program for the adult social care sector. This training will help staff develop the necessary knowledge, skills and support to fulfil their roles and responsibilities under the provisions of the Bill, including their involvement in the assisted dying process.
3. The improvement of rapid response out of hours palliative care support 8am-8pm, with advice available over the phone 24/7. The patchy access to palliative care support was highlighted as an implementation issue for care providers in our survey results, and this would be a key step to overcoming that barrier.
4. The potential impact of the Bill, not only on end-of-life care, but also Working Age Adults and older persons care, who have been largely absent from the political debate to date.

Key Provisions Of the Terminally Ill Adults Bill Affecting Adult Social Care

Care England’s role is not to debate the principle of the Terminally Ill Adults Bill, but to ensure the care sector is ready should the legislation proceed. In its current form, and without clear guidance from Government, the Bill could present significant challenges for care providers and staff working with people in care settings. We believe it is our duty to ask the following, enlightened by a recent survey on behalf of the sector and Care England members. The points focus not on the principle, but purely on what measures and procedures will be put in place by the Bill for implementation. There is a need for a clear legal framework for providers to operate within.

Assisted Dying at a Place Individuals Choose to Call Home – How will the Bill:

• Set out how it will manage, support, and engage with individuals who choose to opt out of the assisted dying process, ensuring they are released from responsibility and accountability if they decide not to be involved?
• Ensure clear protections are established for staff who refuse to be involved, including whether safeguards such as anonymity will apply?
• Define “participation” for care homes, nurses, and non-clinical staff?
• Ensure support is available to families and staff to address potential trauma arising from involvement in an assisted death?
• Provide guidance to care providers on handling privacy when a resident chooses to die at home?

Mental Capacity – How will the Bill:

• Define the role of a care provider in the assessment of mental capacity and the prevention of coercion?
• Put in place protections for providers if families or loved ones take action against them in disputes over capacity assessments?
• Support providers in circumstances where there are disagreements about an individual’s mental capacity?

Procedures – How will the Bill:

• Establish safeguarding measures to support care providers involved in assisted dying?
• Address circumstances where a resident changes their mind during the assisted dying process?
• Set out the evidence and paperwork required to support assisted dying in a residential care facility?
• Determine the most appropriate medication to be administered to assist death?
• Support different care providers in implementing assisted dying, particularly where access to palliative and nursing care varies across service types?

Regulatory – How will the Bill:

• Ensure the regulator engages effectively with providers on documentation and evidence related to assisted death?
• Support regulators in their role when care providers engage in assisted dying?
• Require assisted deaths to be reported, recorded, or registered, and what processes will govern this?

Commissioning – How will the Bill:

• Support commissioning bodies, in line with the Care Act 2014, to respond to requests for assisted dying?

Faith-Based Care – How will the Bill:

• Address situations where faith-based providers do not support assisted dying?
• Deal with regulators where providers refuse to engage with assisted dying on grounds of faith?
• Consider individuals who, for faith or religious reasons, do not support the process?
• Ensure that individuals receiving state-funded care, placed in faith-based care homes where all staff object on religious grounds, are not excluded from access to assisted dying?
• Ensure faith-based providers who do not support assisted dying are not discriminated against in commissioning decisions?

Workforce – How will the Bill:

• Provide training and education for the workforce on assisted dying?
• Require evidence from staff who refuse to participate in assisted dying?
• Guide employers on engaging staff about their willingness to be involved in assisted dying during recruitment or role allocation?
• Support the workforce where divisions arise between staff who do and do not support assisted dying, particularly in a sector already facing high vacancy and low retention rates?

Relationships – How will the Bill:

• Support the workforce in engaging with family members who do not support a resident’s choice?
• Protect a provider’s duty to respect a resident’s choice if family members attempt to block or delay an assisted death unlawfully?

To conclude, Care England urges these points be considered by the Lords as part of the Bill and its impact on the adult social care sector workforce. Care England have a duty to raise these considerations on behalf of our members, informed by the survey, not to challenge the Bill’s intent, but to understand how it will address these challenges in practice.

We are gathering thoughts and feedback on the Terminally Ill Adults Bill, if you wish to participate, please click the form below.