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

Neil Shastri-Hurst Excerpts

Committee stage
Wednesday 29th January 2025 Public Bill Committees

[Kim Leadbeater]

Q Was it a multidisciplinary board that Dr McLaren set up to look at the safety and quality of voluntary assisted dying?

Dr McLaren: This was born out of when we started as a Victorian group. We were very individual and we interpreted the law in our own ways. We complied with it as best we could, but we did not have a centralised discussion board or peer group set up at the time. We have propagated advice through the other states to ensure that there are what we call community practices, where clinicians can discuss their cases and learn from each other.

Several months after, from I think June to November, we had no interconnection with other VAD-practising doctors. In November, we had a forum set up where we are able to connect and talk about difficult cases and how we would each interpret them. As the subsequent states came online, we were approached by some of the practitioners from other states saying, “We don’t really want to reinvent that wheel, so can we join your community of practice?” Because it was set up by our state government, they were unable to join, so I saw a gap in terms of creating an organisation where we could propagate that knowledge and not all start from scratch.

It initially started as a group of voluntary assisted dying medical practitioners, and we would discuss cases across the board and ask things like, “What would you do under your legislation?” and we all learned from that. Then we were approached by pharmacists, nurses and others involved in voluntary assisted dying provision, including legislators who wanted to contribute to the custodians of the voluntary assisted dying law, who are the people who actually run the projects. That then led to the creation of Voluntary Assisted Dying Australia and New Zealand, which is a multidisciplinary group of predominantly doctors, but we do have nurses, pharmacists and legislators involved. We have had two annual conferences where we discuss issues faced by many of our practitioners. That has been a great resource for people.

We are developing standards. We feel that in our legislation there was perhaps too much about instilling what the standards are. We feel as though the appropriate-ness of such things as telehealth should be regulated via standards rather than via legislation, which it currently is in Australia. These are the types of topics we have weighed in on and created position statements for in order to protect the laws that we believe in, uphold and like to think of ourselves as responsible practitioners of.

[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?

A&E Services: Solihull Borough

Neil Shastri-Hurst Excerpts

Monday 27th January 2025 Commons Chamber

[Saqib Bhatti]

Of course, investment will make a big difference. That is why I think integrated care boards play an important role, because there is accountability all the way up to the Minister. It is also about how resources are distributed locally for the needs of the community.

I spoke about the journey to Heartlands hospital. At any given time, it can take 40 minutes, and it quite regularly takes more than an hour. In a situation where every minute matters, I am afraid that is just not good enough for my constituents. It could quite literally be a matter of life or death.

Solihull borough has a population of approximately 216,000 people, and that is set only to grow.

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

I am grateful to my hon. Friend for giving way and for bringing this debate to the Chamber. Being neighbouring MPs, he and I have worked very closely on this issue. He notes the size of Solihull borough; of course, with the Government’s housing plans, that is likely to increase significantly, almost touching a quarter of a million. Does he agree that in those circumstances, it is absolutely critical that we have an A&E provision within the borough to serve the community?

[Saqib Bhatti]

I thank my hon. Friend for that contribution and for all the work he has done on the matter, including the petition he launched, which I will come on to later. He is absolutely right, and he leads me to my next point.

The Minister’s own Government have set out their planning reforms, which mean that valuable and precious green belt will now be built on as housing numbers are massively increased, putting our local infrastructure under strain. As we can see, that is a concern across the country, on a cross-party basis. My hon. Friend the Member for Solihull West and Shirley (Dr Shastri-Hurst) has made significant progress talking to his constituents on this issue. I know they feel exactly the same way, and I look forward to working with him.

Significantly, more than 40% of our residents are reportedly over the age of 50. As we go through this especially cold winter, as the hon. Member for Birmingham Northfield (Laurence Turner) said, we must all remember that the winter is a challenging time not only for the NHS, but for our constituents. Cold and flu cases are at their peak and place additional pressures on the NHS. Every Christmas, we face a timely reminder that we are in desperate need of an A&E in Solihull, so I am grateful to have secured this debate early in the new year.

Although I will not focus on social care today, I can assure the Minister that I will return to this topic at some point. I simply make the point that kicking the can down the road on issues such as social care will cause further anxiety to my constituents and exacerbate the strain on our hospitals. All Governments, of all ilks, need to deal with social care.

The Government’s response does not deal with social care, nor does it deal with the problem of the country’s ageing population, especially in areas such as Meriden and Solihull East. The long-term social care issues faced by our NHS are made far worse by the fact that there is a national average of 14% more attendees at A&E than there were 10 years ago, which means that more people now face longer waiting times. As of August 2024, 65.4% of patients in Birmingham and Solihull ICB spent less than four hours in A&E departments, and that is markedly below the NHS target of 95%. I hope that the Minister might be able to comment on that and share any thinking on increasing that figure.

I believe I have already set this out adequately, but it is worth repeating that residents in my borough have to travel to different areas to access A&E services. Given the size of the local population and the likelihood that demand for emergency services will only increase further, it is obvious that Solihull residents need to be supported by dedicated A&E services. That is because a dedicated A&E in Solihull borough will take pressure off other A&E departments, lowering waiting times across the whole area to the benefit of thousands of people in the west midlands. Can the Minister give any indication as to whether she considered those arguments in the previous correspondence that my hon. Friend the Member for Solihull West and Shirley and I have had with her?

Moreover, my constituents and I are very concerned that this issue will become increasingly pressing because of the Government’s planning changes and their potential changes to the national policy planning framework. If the Government were to achieve the objective of removing consent from local people, the demand for local infrastructure—from schools to roads and health services—would go up and inevitably become unsustainable.

I launched my petition in May last year to restore A&E services to Solihull hospital. I can confirm to the Minister that I did not know a general election would be called a week later. Within a week, we had about 1,000 signatures. I have had about 1,600 and I think my hon. Friend has had a similar amount, so we are reaching more than 3,000 residents who support our campaign. The petition remains open on our websites for further support. I assure my constituents that I will not falter or waver in my resolve to see the campaign through.

Let me help the Minister. I understand that such projects do not happen overnight, but surely she will agree that a case such as this must be looked at. There has to be a long-term vision and plan to start to deal with issues, such as an increased population, which are clearly coming down the road. When my hon. Friend and I wrote to the Minister in November, we outlined the arguments for enhanced healthcare provision for Solihull borough. We were disappointed with the Minister’s response, which failed to cover some of the assertions we made, and that is why I put in for an Adjournment debate. I want to give the Minister another chance, because it cannot be possible that she does not have a view on long-term health provision for my constituents.

For clarity, the Minister argued that the NHS Birmingham and Solihull ICB was responsible for funding and implementation in the area. I am sure that is a matter of fact, but she must have a view, even though it will play a decisive role in decision making on these matters. It would be really helpful to my constituents and those of my hon. Friend if she agreed, at least in principle, to look at our plans, even if she does not quite support them. Will she agree to look at the long-term need of my constituents, especially in the light of the extra housing the Government are demanding be delivered on our greenbelt? It is a point worth making that as a result of the extra building, my constituents will be making huge sacrifices. The least the Government could do is to recognise that and provide the infrastructure to match.

The Minister confirmed that the Government were committed to delivering the new hospital plan. She said the Chancellor had confirmed that in the Budget there would be a £3.1 billion increase in the overall departmental capital budget over this year and the next. The Secretary of State committed, in his piece in the London Standard in June, to delivering the new hospitals programme, so I was disappointed that there was no mention of Solihull borough in his statement last week. I want to ask the Minister a very simple question. The Government set out plans that take hospital building to 2039. Does that mean that our constituents in Solihull borough will not get a look-in from the Labour Government until then? Will it be 15 years before we can even start to think about new plans to support Solihull borough? It would be really helpful to get clarity on that.

In our correspondence, my hon. Friend and I made the case for part of the £3.1 billion uplift in the NHS capital budget to be spent in our area. The Minister should be assured that we will take every opportunity in this House to make the case for an A&E in Solihull. Will she now instruct her officials to take a long, hard look at that and take a constructive view on the long-term plan? Indeed, just a few days ago—this is the point I wanted to come to when I was intervened on—it was reported in the Birmingham Mail that the University Hospitals Birmingham NHS Foundation Trust is looking for a £200 million investment to create a new urgent and emergency care facility at Heartlands hospital, because the facilities are “disconnected and inefficient”, and that

“patient numbers continue to increase, being cared for in buildings which are dark, cramped and not fit for the current purpose”.

That could not be clearer. The report prompts the question: why should my constituents be subject to those conditions? They deserve better. They deserve the very best health facilities. I will not let up, and nor will my hon. Friend. We will keep coming back. With more than 3,000 people having signed our petitions, will the Minister do the right thing and back our campaign for a new A&E in Solihull?

When I raised this issue on the Floor of the House, the Health Secretary wanted to know where I would spend the money differently. Perhaps the Minister has a similar line in her speech. This is not a party political point, but we would have chosen not to spend billions on trade union sweetheart deals in return for nothing. We would probably not have spent billions on GB Energy, which will not deliver outcomes or reduce bills. That money could pay for an A&E in Solihull many times over. Politics is all about choices, so I ask the Minister: will she do the right thing and choose to engage constructively, so we can deliver the best outcomes for our constituents?

NHS Performance: Darzi Investigation

Neil Shastri-Hurst Excerpts

Monday 7th October 2024 Commons Chamber

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

May I start by congratulating the hon. Member for Esher and Walton (Monica Harding) on her deeply affectionate speech? Her constituency is a place that is close to my heart, my grandparents having resided in Claygate for a number of years. I also congratulate the hon. Member for South West Norfolk (Terry Jermy), and I am sure his father would be hugely proud of how he spoke with great affection for his home constituency.

On 5 July this year, 76 years to the day since the NHS came into being, my mother was involved in a serious road traffic accident. But for the skill and care of the health service, she may well not have survived. Many of those who cared for her were my former colleagues in the major trauma service at University Hospitals Birmingham. I know that the care they provided was not an exception; it was not a case of going a little further for a former colleague. No, this was yet another example of the brilliant and dedicated care that our healthcare professionals provide every day.

While we rightly acknowledge and praise the endeavours of all our healthcare workers, we must not put the NHS on such a pedestal that it becomes a sacred cow. While we can all appreciate the hard work and dedication of our NHS staff, it would be unwise and a mistake to construe those same workers and the institution as one and the same thing. There is a real risk that such a religious fervour develops around the institution of the NHS that its growth and development are stifled. We have reached a point where any constructive criticism of the organisation is deemed to be levelling the same criticism at the staff who keep the wheels grinding through every shift.

The NHS was built to provide episodic acute care. Now it is heavily dominated by the management and treatment of chronic conditions. The hospital-centric model that presently exists is arguably outdated, and a paradigm shift to a more preventive, community-based model should be pursued. For far too long it has been the workforce who have risen to the challenge, rather than the organisational structure itself. The principle that our health service should care for everyone regardless of their personal wealth is profoundly important. To undermine that would be to disrupt the foundations upon which it is built. However, we would be doing the NHS a disservice if we failed to have an honest debate about how we improve it.

In the short time that I have remaining, I wish to raise the issue of the over-centralisation of decision making. We have ended up in a position where clinicians and managers on the frontline are less empowered and trusted to make decisions and deliver for their patients. Too many decisions are made at the centre, which leads to overly complicated and often conflicting layers of approval and process. Ultimately, by enabling risk to be held by other parts of the system, local decision makers will be more empowered, decisions will be made in a more timely manner and a greater sense of trust will be established.

Oral Answers to Questions

Neil Shastri-Hurst Excerpts

Tuesday 23rd July 2024 Commons Chamber

[Andrew Gwynne]

Public health and prevention are priorities for me and this Labour Government. Obviously, the Environment Agency takes the lead in this specific instance, but I am more than happy to jump off the train at Stoke—if my hon. Friend will pick me up—and visit his constituents to listen to their concerns, and to ensure that the public health considerations are amplified to Environment Agency colleagues.

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

5. Whether he is taking steps to ensure the provision of fracture liaison services in all hospitals.

[The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)]

I thank the learned and gallant hon. Member for his question. More than 500,000 fragility fractures occur every year, and up to 40% of fracture patients will suffer another fracture. I praise the campaigns by the Sunday Express, The Mail on Sunday and the Royal Osteoporosis Society for their campaigns on this. I am pleased to reiterate the Government’s commitment to expanding access to fracture liaison services. The Department is working closely with NHS England to develop plans to ensure better quality and access to these important preventive services.

[Dr Shastri-Hurst]

First, I congratulate the Minister and the rest of the Front-Bench team on their appointments. As a former orthopaedic surgeon, I am mindful of the impact of osteoporosis on many of our constituents, including my own in Solihull West and Shirley. In England, more than 67,000 people suffer a fracture every year, and a disproportionate number of those are women. What we do know, however, is that fracture liaison services, where they are delivered well, can prevent many of those fractures. Currently, half of the country has access to such services. The last Conservative Government made a commitment to roll them out to the whole country by 2030. Will the Minister honour that commitment?

[Andrew Gwynne]

The hon. Gentleman makes a really important point, and we are absolutely committed to ensuring that these services across England are better than those we have inherited. Of course, I completely agree with him about the need to improve these services in specific parts of the country, which is something we will be looking at in detail. However, I have to say to the hon. Gentleman that the one thing those of us on this side of the House will not be doing is what he has written about in “ConservativeHome”, which is health rationing and cutting back on treatment.