Terminally Ill Adults (End of Life) Bill (Fourth sitting)

Kit Malthouse Excerpts

Committee stage
Wednesday 29th January 2025 Public Bill Committees

[Dr Neil Shastri-Hurst (Solihull West and Shirley) (Con)]

Q Dr Fellingham, to circle back to the issue of training, could you go into more detail about what the initial training consists of—the nature of it and the number of hours—and how that compares with the refresher training? What is the system for mentorship, supervision, appraisal and continuing professional development requirements?

Dr Fellingham: It is important to reflect that only people who are at quite a significant point through their own specialty careers are eligible to become assisted dying practitioners in this country. For instance, I was a consultant anaesthetist and I had already been practising for more than a year. I had lived experience of caring for patients both living and dying, both anticipated and unexpectedly, over a career spanning more than 10 years, before I came to the point of assisted dying.

To become eligible to offer assisted dying, I then had to undertake training developed in a special package by the Queensland University of Technology. That training package takes about two days to complete and there is an exam at the end before someone can become eligible. The exam has a 95% pass rate.

Once someone has qualified with that training, they are offered the opportunity to give their details to the state-wide care navigator service. The vast majority of people opt to do that. Once they do that, they basically become engaged in this incredibly supportive, collaborative and nurturing multidisciplinary team within a professional organisation that, in our state, covers all the assisted dying practitioners—the doctors—but also the care navigators, the pharmacy service, the individual voluntary assisted dying programme managers and the end of life choices co-ordinators, who exist in all our hospital systems.

Because we are all consultants in our own specialties, there is not the same level of supervisory oversight as we would give to junior doctors—there are not forms that we fill in; we do not accredit one another—but we do acknowledge that we are all learning and growing in this space. These are new laws: even the oldest in Australia has only been going for five years. Every single one of us is motivated from a place of wanting to support, collaborate, grow and learn from one another, and ensure that the care we are offering to people in this challenging space is of the absolute highest quality.

We have a really robust community of practice. We meet monthly. Half those meetings are online to allow our regional practitioners to join, and half of them are face to face. They are extremely well-attended closed sessions where, especially over the time that we have developed relationships with one another, we find an incredibly supportive space to share our experiences and to learn, grow and develop from one another.

In terms of CPD, we all have to maintain our professional registration. I have both general and specialist registration with our supervisory body, which is like the General Medical Council. I complete my mandatory CPD requirements each year, as per my specialist college. On top of that, I have just redone the refresher training, which is once every three years. That is just what was mandated in our state. If someone has not done VAD practice, they have to do the whole thing again. That is only for people who have been active in this space. That training is shorter—it is about half a day—but it is really a reflection of what we are doing on a weekly basis. We are living and breathing this work, and really strongly collaborating with everybody else who does it.

[Kit Malthouse (North West Hampshire) (Con)]

Q Could you talk us through eligibility with regard to neurodegenerative diseases, and whether you have in place any variations and considerations for things such as Parkinson’s or motor neurone disease? Is the main delivery mechanism for VAD in Australia the mainstream health service, or is it delivered through a separate wing, arm or organisation?

[The Chair]

Who is best qualified to answer, please?

Dr McLaren: Greg, I might dob you in for the neuro-degenerative perspective, if that is all right? I have been involved in several of those cases but, as a medical oncologist, it is a little outside my field.

Dr Mewett: In most Australian states, the law was made so that a patient was eligible if they had a terminal prognosis of six months or less, except in the case of a neurodegenerative disorder—the most archetypal would be motor neurone disease, but there are a number of other neurodegenerative disorders for which prognosis can be made, including Parkinson’s—in which case it was 12 months or less. We have been trying to tease that out as part of our Victorian VAD review board work, and we could not find the logical or consistent reason why there would be two different prognoses for different disorders. We think it was because the advisory to the legislators thought that patients with neurodegenerative disorders might lose capacity to continue with the process earlier.

We and all our learned colleagues know, however, that patients with all sorts of diseases can lose their cognitive abilities during their disease, particularly with cancer and motor neurone disease. We do not see that as logical or reasonable. In fact, as Dr McLaren said, we are considering recommending that prognosis is set at 12 months, which is what Queensland legislated for and practices. A 12-month prognosis is reasonable for a whole range of reasons.

[The Chair]

Thank you very much. I have three questions remaining and five minutes, so we need brevity, please.

[Kit Malthouse]

Sir Roger, can I ask about mainstream delivery?

[The Chair]

I am sorry but we have to move on.

Terminally Ill Adults (End of Life) Bill (Money)

Kit Malthouse Excerpts

Money resolution
Wednesday 22nd January 2025 Commons Chamber

[Kit Malthouse (North West Hampshire) (Con)]

I rise to support the money resolution, broadly for two reasons. The first is the significant risk to the reputation of the House. One of the greatest criticisms of this place is that we play games and do not take these issues seriously. We all accept that, as my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) said, a money resolution is normally a technicality for private Members’ Bills. If the Bill fell at this moment, we would not only deny debate to those Members who expressed either soft opposition or soft support for it on Second Reading, but strike a hammer blow to millions of people in the United Kingdom who are looking to us for a sense of leadership and clarity on this issue.

I hope that there will not be a Division today, but if there is, I urge Members to vote in favour of the resolution. Those Members thinking of voting against should bear in mind that the message that would go out from this place would be that a matter of life and death—a matter fundamental to many people, and on which there are profound feelings on both sides of the debate, as we have seen—can be dismissed on the basis of a casual, technical vote on a quiet Wednesday afternoon. That would be a bit of a travesty. I hope that Members realise what is reputationally at risk.

Secondly, there is broad misunderstanding of what the Bill is designed to do. The hon. Member for Ribble Valley (Maya Ellis) said, in effect, that the money resolution offers a blank cheque. Well, the rest of the NHS is already a blank cheque. Over the years, things have evolved in such a way that Parliament gives Government Ministers permission, through estimates, to make judgments about how they prioritise spending on the services for which they are responsible; and the Chancellor makes judgments about spending for Departments. If this House starts micromanaging spending—saying what the Government should spend on particular drugs, treatments, crimes or interventions—we will end up in an unholy mess. I have yet to hear anyone in this House object, for example, to the creation of a new criminal offence on the grounds that it would be more costly for the police. I have yet to hear anyone in this House object to the NHS prescribing a new drug because it will be costly for the health service.

We must remember that the people we are talking about—the dying individuals who may want to make this choice at the end of their life—are already receiving treatment in the national health service. They are already reliant on expensive care services, drugs and so on, as well as social support mechanisms that cost the taxpayer. It is, of course, important that we see the overall impact assessment, but we should not pretend that the status quo is cost-free, because it is costly—not only in monetary terms, but in terms of humanity. We should not forget that we are attempting to put a price on quality of life, and on mercy at the end of life. I urge Members to reflect on that and support this motion.

Finally, let me address the misunderstanding by the hon. Member for Strangford (Jim Shannon). There was no attempt yesterday to create any air of secrecy about consideration of the Bill in Committee. There was a brief period in which we had hoped to have an informal discussion about witnesses, before the public sitting resumed, which is normal for Bill Committees in these circumstances. Unfortunately, that has been misconstrued, but I guarantee that the rest of proceedings will be open for the public to view.

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[Madam Deputy Speaker (Ms Nusrat Ghani)]

Thank you, Mr Shannon, for letting me know you would be making a point of order. The Chair is not responsible for the content of Member’s speeches, but I remind the House of the advice in Erskine May on the importance of good temper and moderation in parliamentary language.

[Kit Malthouse]

Further to that point of order, Madam Deputy Speaker. There was no intent in my remarks to undermine the integrity of the hon. Member for Strangford (Jim Shannon). I may have misunderstood his remarks, but he implied that the Committee was adopting some kind of veil of secrecy over our affairs and I was pointing out to him that, in my view, that was a misunderstanding of what we were attempting to do yesterday. I am sorry if the hon. Gentleman was offended, as he knows I hold him in great affection and I had no intention to do so.

[Madam Deputy Speaker]

Thank you, Mr Malthouse. I can see Mr Shannon nodding, so hopefully your apology has been accepted.

New Hospital Programme Review

Kit Malthouse Excerpts

Monday 20th January 2025 Commons Chamber

[Wes Streeting]

My hon. Friend is right about the sorry state that North Manchester general hospital has been left in by our Conservative predecessors, not least the critical infrastructure risk at that hospital. Most of the existing estate dates back to the 1870s, and NHS leaders, managers and staff are having to deal with multiple day-to-day operational issues, including poor fabric and fire safety, ventilation, asbestos and water management issues. That is why I am delighted to confirm to my hon. Friend that the work will continue and construction will start in 2027-28. I am looking forward to working with him, other Greater Manchester MPs, the leader of the city council and the Mayor of Greater Manchester to make sure that this project delivers for the health and the wider economic benefits and needs of the people of Greater Manchester.

[Kit Malthouse (North West Hampshire) (Con)]

Given how Government finance works, the Secretary of State knows that he has, in effect, cancelled the replacement of Basingstoke and North Hampshire hospital. That is despite, as my right hon. Friend the Member for East Hampshire (Damian Hinds) said, the now Prime Minister going there during the election campaign and making a specific, unequivocal and unconditional promise that the hospital would be replaced by 2030. Sadly, it looks like that will now not be the case. I am sure the hon. Member for Basingstoke (Luke Murphy), who is in the Chamber, will be considering his position, given the promises he made.

Are we able to rescue something from this wreckage by purchasing the site? As the Secretary of State will know, we are now likely to lose the land. It is a critical site, so can we please buy it before it slips from our grasp?

[Wes Streeting]

We are happy to receive sensible representations from Members about their projects, as we have from my hon. Friend the Member for Basingstoke (Luke Murphy). It is a bit rich for Conservative Members to talk about understanding how public finances work.

Government Policy on Health

Kit Malthouse Excerpts

Monday 9th September 2024 Commons Chamber

[Wes Streeting]

The right hon. Lady wants to compare experience. It took me three weeks to agree a deal with junior doctors—she had not even met them since March—and in the two and a half years that I was the shadow Secretary of State for Health and Social Care, she was the fifth and among the worst. Does it not just tell us everything we need to know about the Conservatives’ priorities? She does not ask me what we are doing to cut waiting lists. She does not ask about the action we took to end strikes. She does not ask about the action that has been taken to hire a thousand GPs, who she left to graduate into unemployment. She has not asked me about the news on the front page of The Daily Telegraph that, on their watch, 50 years of health progress is in decline. And funnily enough, there was nothing on the news from The Observer this weekend that the NHS was hit harder than any other health service by the pandemic because it was uniquely exposed by a decade of Conservative neglect. Having broken the NHS, all they are interested in now is trying to tie this Government’s hands behand our back to stop us cleaning up their mess.

What the right hon. Lady is implying in this question is that, as Health Secretary, she never sought the advice of people who did not work in her Department, which would explain quite a lot actually. I feel sorry for her, because when I need advice, I can call on any number of Labour Health Secretaries who helped deliver the shortest waiting times and the highest patient satisfaction in history. But she never had that luxury, because every single one of her Conservative predecessors left NHS waiting lists higher than where they found them—except, of course, for Thérèse Coffey, who was outlasted by a lettuce.

In fact, it says a lot about the modern Conservative party’s anti-reform instincts that the right hon. Lady is so opposed to Alan Milburn. They used to hug him close when they were cosplaying as new Labour. Andrew Lansley even asked whether Alan Milburn would chair the new clinical commissioning board that his top-down reorganisation created, although Alan sensibly turned him down and labelled the reorganisation “the biggest car crash” in the history of the NHS, which just goes to prove that Alan Milburn has sound judgment and is worth listening to.

But if the right hon. Lady wants to lead with her chin and talk cronyism, let us talk cronyism. Why do we not talk about Owen Paterson lobbying Health Ministers on behalf of Randox? The Conservatives care so much about cronyism that they welcomed Lord Cameron back with open arms following his paid lobbying for Greensill. For reasons of ongoing court cases, let us not even get into Baroness Mone and the £200 million contract for personal protective equipment. Where was the right hon. Lady during those sorry episodes? Cheering on that Government and presiding over a record of abysmal failure that has put them on the other side of the Chamber.

This Government are having to rebuild not only the public services that the Conservatives broke and the public finances they raided, but the trust in politics that they destroyed. We will put politics back into the service of working people and rebuild all three. Clearly, we will have to do it without the support of the Conservative party’s one- nation tradition, who are not even running and have abandoned their flag. It is clear that the Conservatives have not learned a thing from the defeat they were subjected to on 4 July, and we will get on with the business of clearing up their mess.

[Kit Malthouse (North West Hampshire) (Con)]

On a point of order, Madam Deputy Speaker. The Secretary of State has obviously decided that attack is the best form of defence, but the operation of the House will collapse if he declines to answer any questions about a very serious matter of public concern. Can we seek your guidance, Madam Deputy Speaker, on whether he is conducting himself appropriately in the House? We are seeking transparency on a matter of probity, and he has a duty to answer the House, not least under the ministerial code.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

The urgent question has just started, so there will be ample opportunity to continue to hold to account the Secretary of State, who no doubt believes that his answers are responding to the UQ. We have some time to go, so if Members bob, I will endeavour to ensure that they are called to do so.

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[Wes Streeting]

I am grateful to my hon. Friend and I am delighted to see him here, bringing his experience to the House, sharing it with the nation, standing up for his constituents and being part of the team that will do what the last Labour Government did, which was to ensure that our NHS is back on its feet and fit for the future.

[Kit Malthouse]

Notwithstanding the Secretary of State’s bluster, he must appreciate that, given Mr Milburn’s involvement in the private healthcare sector, his direct access to the Secretary of State may have conferred a competitive advantage. What does the Secretary of State say to those companies who compete with Mr Milburn’s companies about the access that he has had to the Secretary of State? How can we in the House be reassured about the kind of information that Mr Milburn has been able to access and what, if any, advantage that might have conferred upon him?

[Wes Streeting]

With the way that Conservative Members are carrying on, and with the smears and innuendo they are applying, I am surprised that Alan Milburn is not paying them a marketing commission. The right hon. Gentleman makes out that Alan Milburn has come into the Department and is making all the decisions. If he were up to what they are suggesting, I could not think of better word-of-mouth publicity.

There is a clear distinction between inviting people with a wide range of experience and perspectives into the Department to have policy debates and to generate ideas, and having meetings that are about transacting Government business. I can assure the right hon. Gentleman and the House that nothing commercially sensitive has been shared with Alan Milburn, and I am genuinely astonished that Conservative Members think it is inappropriate for a Secretary of State for Health and Social Care to seek views, input and advice from their predecessors. In fact, I wonder how one of my Conservative predecessors, who is coming in to see me soon, will feel about their objections.

Oral Answers to Questions

Kit Malthouse Excerpts

Tuesday 23rd July 2024 Commons Chamber

[Wes Streeting]

Of all the issues that keep me awake at night, maternity safety is top of the list. We have already heard about the staffing shortages and the actions we will take to address that, but I also want to reassure people that, as we build our 10-year plan for the NHS, patient voices, including those of recent and expectant mothers, will be part of that process.

[Kit Malthouse (North West Hampshire) (Con)]

During the election campaign the Prime Minister came to Basingstoke on a visit and specifically promised to replace Basingstoke hospital by 2030. Can we rely on that promise?

[Wes Streeting]

I would not rely on anything the former Prime Minister said—[Interruption.] Oh, our Prime Minister? I thought the right hon. Gentleman was talking about the former Prime Minister. In that case, I can reassure him that we are absolutely committed to the new hospitals programme. On the budgets and the timescales, as I have said, we will come forward with an honest appraisal of what we have inherited from the last Government and what we will be able to deliver within reasonable timescales.

Patient Choice

Kit Malthouse Excerpts

Thursday 25th May 2023 Commons Chamber

[Steve Barclay]

As so often, the hon. Gentleman raises an extremely important point about how we tackle the serious issue of eating disorders. As he knows, we are increasing our funding for mental health. It is a key priority in the long-term plan, which is providing an extra £2.3 billion a year. On different approaches, we are looking much more actively at our use of digital apps and platforms, which is an area that the Chancellor specifically funded in the last Budget. We are also looking at how we address mental health issues earlier, particularly for children. We are rolling out mental health support teams in schools because, obviously, early intervention has significant benefits and targeting schools is a great way to do that.

[Kit Malthouse (North West Hampshire) (Con)]

I, too, congratulate the Secretary of State on a profoundly Conservative step forward in dealing with the waiting list issue. Does he agree that the provision of greater patient choice holds out the possibility of stimulating more investment in private sector capacity, particularly for volume procedures such as hips and knees? However, the private sector, to make such heavy investments in facilities, requires long-range certainty. As waiting lists fall, will he review the threshold—the time limit—at which patients can seek private sector assistance in getting their operation done more swiftly, so that the efficiencies of the private sector can be realised for the system as a whole in the longer term?

[Steve Barclay]

My right hon. Friend raises a very good point. As he knows, there is interaction between what is and is not on the balance sheet. His point particularly relates to the roll-out of diagnostic centres. I have looked at the facility in Blackpool that is using artificial intelligence in endoscopy and picking up 20% more cases than would be seen with the human eye. We are thinking about how we use the private sector to add more capacity at scale and pace, and how it can use the latest technology. Obviously, we need to do that in a way that is compliant with Treasury rules. Ensuring there is greater capacity in the system—but doing so where it is free at the point of access to NHS patients—is an area where we have already done quite a lot. However, there is always scope to look at it afresh.

New Hospitals

Kit Malthouse Excerpts

Thursday 25th May 2023 Commons Chamber

[Steve Barclay]

My hon. Friend has campaigned assiduously over the past three years to make a compelling case for Airedale. I very much look forward to having the opportunity to visit in due course, and the commitment in today’s statement is to ensure that that hospital is built to the 2030 timescale.

[Kit Malthouse (North West Hampshire) (Con)]

Given the Secretary of State’s answers to my hon. Friend the Member for Winchester (Steve Brine) and my right hon. Friend the Member for Basingstoke (Dame Maria Miller), could I press him a little further for some clarity on the replacement for Basingstoke hospital? Could he confirm that it is agreed that a replacement is needed for the hospital; that the money is in the budget to do so; and that, notwithstanding the complexities regarding the site that he outlined in his previous answers, a site will be found and a new hospital will be open in the early 2030s to serve all of our constituents?

[Steve Barclay]

On the issues that my right hon. Friend raises, it is agreed that a replacement is needed and that North and Mid Hampshire will go into the rolling programme for the new hospital programme. As a result, a site will be found, and the intention is to work to a 2032-33 timescale—that is the plan. The original timescale was already stretched because of some of the complexity involved, and I have also signalled just how long previous designs for hospitals have taken, so we are speeding up the construction side but we also need to address some of the issues, particularly around junction 7 and the site design.

Mental Health Units (Use of Force) Bill

Kit Malthouse Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[Kit Malthouse (North West Hampshire) (Con)]

I think there has been an error, Mr Speaker. I am here for the second debate, not the first.

[Mr Speaker]

I thought the hon. Gentleman wanted to speak on this Bill, but if I am mistaken and he wishes to preserve his thunder then so be it. We will hear from him at a later stage.

Health Service Medical Supplies (Costs) Bill

Kit Malthouse Excerpts

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

[Mr Hunt]

Absolutely. The money comes back to the Department of Health and is invested in the NHS. Indeed, it would be wonderful if it was more than £1.24 billion, because there is an awful lot of need on the NHS frontline right now; the funds are much needed. Our concern is that companies have been exploiting the differences between the voluntary and statutory schemes, particularly the loophole, which the Bill seeks to close, that if companies have drugs in both schemes, we are unable to regulate at all the prices of the drugs that would ordinarily fall under the statutory scheme. That is why the Bill is so important.

[Kit Malthouse (North West Hampshire) (Con)]

Notwithstanding the Bill’s objectives, which I can see are admirable, does the Secretary of State accept that hundreds of millions of pounds could be saved in the drugs budget if there was better analysis of NHS prescription patterns? I have called before for the appointment of analytical pharmacists to look at the balance between prescription efficacy and cost and at trying to increase the use of biosimilars. Some of that £1.24 billion could be invested in that greater analysis.

[Mr Hunt]

Yes. My hon. Friend makes an important point. The third part of the Bill will provide for much better data collection to allow that analysis to take place. We are also seeking to break down the barriers between the pharmacy sector and general practice. During this Parliament, we will be financing 2,000 additional pharmacists to work in general practice so that we can learn exactly those sorts of lessons.

Community Pharmacies

Kit Malthouse Excerpts

Monday 17th October 2016 Commons Chamber

[David Mowat]

The hon. Lady made several points. On her last point, the access scheme on which we are currently consulting will protect pharmacies in rural and deprived areas. That is precisely the point of the scheme.

The hon. Lady’s first point was that Scotland has moved ahead on minor ailments, and we agree. I am on the record as saying that the pharmacy first scheme in Scotland is a good model. We want the profession to move away from just dispensing towards more value-added activities, such as services. That is precisely why we are putting into effect the minor ailments scheme that has been piloted. It will be implemented right across the UK—right across England, I should say—from April 2018.

[Kit Malthouse (North West Hampshire) (Con)]

In the lee of Watership down in my constituency, the village of Kingsclere was so alarmed by the Government’s plans that it raised a petition, possibly for the first time in its history, in support of its precious local pharmacy. Will the Minister confirm that, notwithstanding the consultation, the idea of protecting the dwindling number of rural pharmacies will come out at the end of the consultation as part of the access scheme?

[David Mowat]

Yes, I will confirm that. I am not in a position to announce today precisely how the access scheme will work, but I agree with my hon. Friend that a central part of it will be to make sure that everybody has a baseline distance to travel to get to a pharmacy and that everybody in the country will be able to access pharmacies within a reasonable time.