Terminally Ill Adults (End of Life) Bill (Twenty-fourth sitting)

Neil Shastri-Hurst Excerpts

Committee stage
Tuesday 18th March 2025 Public Bill Committees

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

It is a pleasure to serve under your chairmanship, Ms McVey. I will speak briefly to this group of amendments, setting out why I support amendments 462, 497 and 498, but oppose amendment 463. My hon. Friend the Member for East Wiltshire set out very eloquently the reasons behind amendment 462. On the one hand, there is a cogent argument that it is not strictly necessary in the light of the provisions set out in subsection (4)(b) and (c), which set out that the individual wishing to have an assisted death must have

“a clear, settled and informed wish to end their own life”

and is

“requesting provision of that assistance voluntarily”.

However, it appears to me a logical and entirely appropriate extension of the intentions behind clause 18(4) to express that in slightly more explicit terms in the Bill by adopting my hon. Friend’s amendment 462. It strikes me that, after doing so, the Bill would provide a further check and balance that creates no greater onus on either the individual seeking an assisted death nor the co-ordinating doctor who is assisting them. In those circumstances, it appears eminently sensible to improve the Bill in that way. From the indications we have already heard, it appears that there is significant support for that amendment.

I struggle with amendment 463, which would remove paragraph (c) from clause 18(6). The effect would be to prohibit the co-ordinating doctor from providing assistance to the person seeking an assisted death, either through ingestion or other self-administration of that substance, in any circumstance. In my view, the amendment would make the operation of the Bill, were it to become an Act, unnecessarily restrictive. Clause 18(7) already stipulates that

“the decision to self-administer the approved substance and the final act of doing so must”—

I stress the word “must”—

“be taken by the person to whom the substance has been provided”.

On any interpretation of the construct of that, it is clear that the person seeking an assisted death must be the active participant in the process; it is mandatory. There is no discretion in that, by virtue of the word “must”.

Were we to remove clause 18(6)(c) and the Bill passed into law, it would have the effect, in what is an entirely legal process, that a doctor would be unable to aid a patient in any circumstance. For example, they would not be allowed to hold a glass or steady a straw as a patient moved towards it to imbibe a substance. Those are circumstances that are entirely foreseeable, when through the ravages of an illness, somebody is limited in what they are physically able to do. Of course, assistance could be provided in alternative ways—for instance, through assistive technology, which we have seen being used in other jurisdictions. The Swiss, for example, use a significant amount of assistive technology in administering and assisting the process of self-administration at the end of life.

[Danny Kruger]

My point is that it is very difficult to draw a line here. I recognise the scenario that my hon. Friend raises: why should a nurse not be able to hold a straw for a person to drink from? I might say that should be acceptable; however, I do not think it should be acceptable for the nurse to tip the pills into the patient’s mouth. Does he think that scenario would be acceptable? Or to give another one, would it be acceptable to actively provide force on top of a patient’s finger to press a syringe? Would he regard that as acceptable assistance?

[Dr Shastri-Hurst]

That is why clause 18(7) is so important: the final act must be undertaken by the person seeking an assisted death. The example my hon. Friend gives of tipping tablets into a mouth is a final act. Pushing a syringe is a final act. There is a significant distinction between an individual or practitioner holding a cup with a straw and the person seeking an assisted death moving their mouth towards the straw, sucking from it and imbibing the substance and the passive act of a substance being raised to that individual’s lips and poured in without any movement by the individual seeking an assisted death themselves.

[Danny Kruger]

When we talk about this in future debates, it might be appropriate for this conversation to be referenced. I think my hon. Friend is suggesting that it should be acceptable, and that assisted death would be legal, as long as the patient moved their head towards the straw and cup, and that it would be illegal, according to my hon. Friend’s definition, were a doctor applying a cup to a patient’s lips and the drugs fell in by gravity. Is that right? Is that how judges in future should determine whether assistance has crossed the line?

[Dr Shastri-Hurst]

It is very clear from subsection (7) that this must be an active step taken by the individual. There is a risk that we go down a rabbit hole in terms of—[Interruption.] I am sure my hon. Friend would like me to finish my point. We risk going down a rabbit hole in drawing examples. I raised the example of a cup, but of course there are much wider assistive technologies that can be used and are used in different jurisdictions. I gave the example to illustrate the point that this is an active act, not a passive act.

[Liz Saville Roberts (Dwyfor Meirionnydd) (PC)]

The hon. Gentleman mentions subsection (7). Subsection (8) states quite clearly that it

“does not authorise the coordinating doctor to administer an approved substance to another person with the intention of causing that person’s death.”

I think the passive and active roles are quite clear between the two subsections.

[Dr Shastri-Hurst]

I agree entirely with the right hon. Member’s interpretation of the Bill.

There is a further unintended consequence of the amendment tabled by my hon. Friend the Member for East Wiltshire, which I am sure is not his intention but would sadly be the effect: were an individual to qualify under the Bill, should it pass and were the amendment to be adopted, they would inevitably be forced to take the final decision at an earlier stage. If there is a restriction that they can have no assistance whatsoever in performing the act, they will end up making the decision when they know that they have the entire physical strength available for them to do it, and that actually brings forward the point at which they choose to die to an earlier stage.

[Kit Malthouse]

After 10 years of campaigning on this issue and spending so much time with people whose family have gone to Switzerland, one of the things they consistently say is that people went to Switzerland much earlier than they wanted to because they had to go while they were still physically able. I think this is a critical point that people have to realise. We should not compel people to do this earlier than they would otherwise wish to simply because of these restrictions.

[Dr Shastri-Hurst]

My right hon. Friend makes an important and powerful point. I think there is a consensus among the Committee that there is no desire for people to take this ultimate step at an earlier stage than is absolutely necessary for them. My very real fear is that, were we to adopt this amendment, we would bring forward that point of decision.

[Danny Kruger]

The logic of that argument is to allow physician-administered suicide, because there will be a point at which people are physically unable to perform the act but have capacity, and their autonomy should be respected—

Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting)

Neil Shastri-Hurst Excerpts

Committee stage
Tuesday 18th March 2025 Public Bill Committees

[The Chair]

I remind the Committee that with this we are discussing the following:

Amendment 463, in clause 18, page 12, line 34, leave out paragraph (c).

Amendment 497, in clause 18, page 13, line 9, leave out “decides” and insert

“informs the coordinating doctor that they have decided”.

This amendment provides that the duty to remove the approved substance arises on the coordinating doctor being informed that the person has decided not to self-administer the substance.

Amendment 498, in clause 18, page 13, line 10, leave out

“that the substance is not”

and insert

“to believe that the substance will not be”.

This amendment clarifies the circumstances in which the coordinating doctor is under a duty to remove the approved substance from the person.

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

It is a pleasure to serve under your chairmanship, Sir Roger. My hon. Friend the Member for East Wiltshire was mid-intervention when the Committee adjourned this morning, and I would not want to pull the rug from underneath him. Does he wish to intervene again?

[Danny Kruger (East Wiltshire) (Con)]

I am grateful to my hon. Friend. I was simply asking what causes him to object to physician-administered assistance to die. If he supports the principle of assisted suicide and believes in doctor autonomy, why does he not think that doctors should be able to administer the fatal dose?

[Dr Shastri-Hurst]

This gets to the root of how the law has operated in another jurisdiction, Switzerland, where Dignitas has managed this scenario over the past 40 years or so. The key—these are the words that its own guidance uses—is ensuring that the power of control remains with the person seeking the assisted death. That provides the individual who is making the choice with the ultimate autonomy at the end in controlling the circumstances and the manner in which they pass.

I have set out why I feel that although amendment 463 arises from good intentions, it would not achieve what is intended. There is a real risk that the constraints that adopting the amendment would create would lead to the regrettable unintended consequence of individuals being forced to have an assisted death at an earlier stage than they would otherwise have wished.

I can deal with amendments 497 and 498 in short order. They would tighten up the Bill by providing greater clarity around the circumstances in which the substance would be removed from the presence of the individual who had previously indicated a wish to have an assisted death. Amendment 497 specifies that the individual would need to set out to the co-ordinating doctor that they no longer desired to go through with the process. In my view, that is eminently sensible. Amendment 498 elaborates on the Bill to provide greater clarity to those who will be operating it. It will make it a much more workable piece of legislation. I support both amendments.

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Sir Roger. Before I speak to amendments 497 and 498, on which the Government have worked with my hon. Friend the Member for Spen Valley, let me address amendments 462 and 463.

Amendment 462 would amend clause 18 to require the co-ordinating doctor to explain to the person that they do not have to proceed and self-administer the approved substance, and that they may still cancel their declaration. Although it is not specified, it is presumed that the amendment refers to the second declaration that the person will have made. The Committee may wish to note that there is already a requirement in clause 18(4)(b) that,

“at the time the approved substance is provided”,

the co-ordinating doctor must be satisfied that the person

“has a clear, settled and informed wish to end their own life”.

The purpose of amendment 463 is to limit what the co-ordinating doctor is permitted to do in relation to providing the person with an approved substance under clause 18. As the clause stands, subsection (6) sets out the activities that the co-ordinating doctor is permitted to carry out in respect of an approved substance provided to the person under subsection (2). It states that the co-ordinating doctor may

“(a) prepare that substance for self-administration by that person,

(b) prepare a medical device which will enable that person to self-administer the substance, and

(c) assist that person to ingest or otherwise self-administer the substance.”

Additionally, subsection (7) provides that

“the decision to self-administer the approved substance and the final act of doing so must be taken by the person to whom the substance has been provided.”

Amendment 463 would remove subsection (6)(c), which would result in the co-ordinating doctor being unable to assist the person

“to ingest or otherwise self-administer”

the approved substance. The co-ordinating doctor would still be permitted to prepare that substance for self-administration and to prepare a medical device to enable the person to self-administer the substance. This could mean that a co-ordinating doctor may not be able to provide assistance such as helping the person to sit up to help with swallowing, or explaining how the medical device for self-administering the substance works. This could result in practical difficulties in self-administration of the substance and/or place the co-ordinating doctor in a difficult position.

--- Later in debate ---

[Danny Kruger]

I am absolutely certain that if the amendment had been in the original Bill, the Bill would not have passed Second Reading, because it would have validated the argument that many of us made that the implication of assisted suicide is euthanasia. The distinction between them, while valid in the abstract, does not apply in practice, and that distinction will be quickly overridden in time. I agree with the hon. Gentleman.

[Dr Shastri-Hurst]

Although I have certain sympathies with these amendments, I do not feel that they are necessary or desirable. They are not necessary because of the provisions that are already stipulated in clause 18(6)(b), which provides the co-ordinating doctor with the ability to prepare

“a medical device which will enable that person to self-administer the substance”.

That subsection, in effect, negates the scenario that is put forward in amendment 350 around dysphagia or the loss of a limb. It would permit, for example, the use of a nasogastric tube or a percutaneous endoscopic gastrostomy feeding tube to be used for the administration of the substance in the case of dysphagia. In the case of the functional loss of limbs, as was discussed in the debate on the previous group, a range of assisted technologies are available that would remove the barriers that that would present.

Beyond the necessity, or lack of necessity, of these amendments, I fear that they create legal uncertainty, which is clearly undesirable and, in this instance, could have a serious and significant unintended consequence through the amendments’ interaction with clause 24. Subsection (3) of that clause inserts proposed new section 2AA of the Suicide Act 1961, which is an exemption to that Act in respect of the assistance provided under this Bill. In effect, proposed new section 2AA disapplies sections 2(1) and 2A(1) of the Suicide Act where the provision of assistance is done in accordance with the Bill. Those sections specifically relate to an act

“capable of encouraging or assisting the suicide or attempted suicide of another person”.

Introducing the concept of additional assistance, as these amendments would, creates a legal uncertainty. The word “additional” creates a further concept that is beyond assistance but is, thus far, ill defined. Would it go as far as, for example, the clinician taking full control of administering the substance? It is entirely unclear. It would therefore place the clinician in an invidious position as to what it would mean for them to provide additional assistance in such circumstances. As I read the interplay between the Suicide Act and the proposed legislation, the clinician would not then be exempt by virtue of clause 24(3), leaving them open to prosecution under the Act.

[Danny Kruger]

I am grateful for that; I particularly respect my hon. Friend’s concern to protect the doctors from any confusion in the law they might be operating under. Just to take him back to the question of technology resolving what I regard as an insuperable problem—the difference between assistance and administration—is it my understanding that my hon. Friend would oppose a patient’s being able to ask a doctor to administer a lethal drug to him or her, but that he would support a patient’s being able to ask a computer to administer a lethal drug to him or her? Would he accept the computer performing the act at the patient’s request?

[Dr Shastri-Hurst]

My hon. Friend hits the nail on the head, because it is the patient who is driving the decision. They are making that act by activating the electronic device—the computer or whatever it may be in terms of assistive technology—but they have the power and control over that decision-making process, which is completely distinct from a clinician doing that act. It is distinct because it is activated by the patient—by the person making that decision—and that is why I draw the distinction. My hon. Friend may not agree, but that is my rationale for drawing a distinction between the two.

[Dr Opher]

rose—

[Dr Shastri-Hurst]

I am being ambushed by the left.

[Dr Opher]

I agree with all the hon. Gentleman’s points. In terms of assistance, what we are talking about, potentially, if the technology arrives at that, is that the doctor may be able to put a Venflon into the patient’s vein, but they would not put the drug through the Venflon into the vein. That would enable the patient to have control. That is the type of assistance that could be quite useful in this scenario, but it would not involve the doctor actually delivering the drug.

[Dr Shastri-Hurst]

I am grateful for that helpful and thoughtful intervention.

For the reasons I have set out, I consider that the amendments create unnecessary and highly undesirable legal confusion, so I shall not support them.

[Stephen Kinnock]

Currently, clause 18(6) permits the co-ordinating doctor, in respect of an approved substance provided to the person under subsection (2), to undertake the following activities: prepare the approved substance for self-administration; prepare a medical device to enable self-administration of the approved substance; and assist the person to ingest or otherwise self-administer the substance. Furthermore, subsection (8) expressly provides that subsection (6)

“does not authorise the coordinating doctor to administer an approved substance to another person with the intention of causing that person’s death.”

Amendment 350 seeks to enable the co-ordinating doctor, in the presence of an independent witness, to provide “additional assistance” to the person to administer the approved substance. Such assistance can be provided only where the person has authorised it, and where the person is

“permanently and irreversibly unable to self-administer the substance”

due to a significant risk of choking due to difficulty swallowing—dysphagia—or loss of the use of their limbs. The term “additional assistance” is not defined in these amendments.

Amendment 351 is consequential to amendment 350 and would require any decision to authorise additional assistance for the self-administration of the substance to be made by the person to whom the substance has been provided. Amendment 352 would create an exception to the condition in clause 18(8), and would have the effect of permitting the co-ordinating doctor to administer an approved substance to another person with the intention of causing that person’s death where the criteria introduced in amendment 350 are met—that is, where the co-ordinating doctor is satisfied that the person is permanently and irreversibly unable to self-administer the substance, and that the person has authorised that the additional assistance be provided.

Our assessment is that the amendments would enable the co-ordinating doctor to administer the approved substance to the person, rather than merely assisting the person, in the limited circumstances provided for in clause 18(6), to self-administer. That would be a significant change to one of the fundamental principles of the promoter’s Bill—that the final act of administering the approved substance must be taken by the person themselves, and not by a co-ordinating doctor. That is a policy matter and a decision for the Committee.

However, should the amendments be accepted, further amendments may be needed to ensure that this provision is fully legally coherent and workable in several areas. First, amendment 350 does not define who qualifies as an independent witness—for example, whether this would have to be a health professional or whether it could be a family member. Secondly, it does not address whether anyone would be disqualified from being an independent witness, as provided for through clause 36, which is entitled “Disqualification from being witness or proxy”.

Finally, as drafted, amendment 350 does not detail how authorisation of the additional assistance must be obtained and/or recorded in order to be valid. It also does not require that any details about the independent witness be recorded. This could lead to difficulties in complying with and/or evidencing that the requirements to provide the additional assistance have been met. By extension, there will be a lack of clarity over when and how the criminal provisions are to apply. I hope that those observations were helpful.

--- Later in debate ---

[Rebecca Paul]

I rise to speak in support of amendment 408, in the name of the hon. Member for Broxtowe. I also support amendments 499 and 210, in the name of the hon. Member for Spen Valley, and amendment 22, in the name of the hon. Member for Lowestoft (Jess Asato).

Clause 19 states that

“the coordinating doctor may authorise, in writing, a named registered medical practitioner to carry out the coordinating doctor’s functions under section 18…A registered medical practitioner may be authorised under subsection (1) only if…the person to whom the assistance is being provided has consented, in writing, to the authorisation of that practitioner”.

I support amendment 408, which adds that the person must also have been consulted.

I am sure the Committee recognises that, even where someone has basic training and the experience specified, delegating care at the end of life is something that must be done with great care, given the vulnerability of patients. If a co-ordinating doctor has guided someone through this profound and significant process, there are some intrinsic risks that come with delegating the administration of the final approved substance to someone else. I concede that there will be situations where a substitute may be required, but it will not be the doctor that the patient has trusted, confided in and relied on.

A new doctor will of course do the final checks for capacity and consent, but they do not necessarily have any specific detailed knowledge of the patient and may be unable to pick up less obvious cues that someone who knows the patient may be better able to. That gap matters, and history shows that it can lead to problems. The risks of delegation are well documented. If we take the Mid Staffordshire NHS foundation trust scandal in 2005 to 2009, detailed in the Francis report, consultants often delegated tasks to junior staff or nurses without adequate supervision, which contributed to poor care and an estimated 400 to 1,200 excess deaths. Patients suffered from neglect, untreated infections, dehydration and medication errors. That was partly because delegated staff lacked the training or authority to act decisively, and consultants failed to monitor effectively.

In surgical contexts, delegation can also falter. A 2006 Daily Mail report highlighted NHS payouts exceeding £1 million for wrong-site surgeries, where consultants delegated preparatory or operative tasks to trainees or assistants, who then misidentified sites—for example, operating on the wrong leg or tooth. Those errors often stemmed from inadequate briefing or supervision, pointing to a systemic delegation risk. We have to be really aware of this.

Those examples suggest that when consultants delegate, whether to junior doctors or other practitioners, including their peers, things can go wrong if communication breaks down, or if the replacement lacks equivalent expertise or is simply not aware of some of the detailed information. In order to manage some of the risks better, patients must be consulted about who takes over their care, and not just asked to consent after the co-ordinating doctor has decided what will happen.

[Dr Shastri-Hurst]

Given that valid consent requires a voluntary and informed decision, can my hon. Friend set out why that would not involve being consulted on the matter in any event?

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

Neil Shastri-Hurst Excerpts

Committee stage
Wednesday 5th March 2025 Public Bill Committees

[Dr Simon Opher (Stroud) (Lab)]

I thank the hon. Member for East Wiltshire for the amendment. The set-up of this scheme is similar to other NHS services. Essentially, a medical professional will opt in to provide the service. That will involve extensive training followed by a short exam, as it does in Australia and California, after which they will be accredited under the scheme—that is how I understand it will happen in the UK. No one is forced to provide the service, but training is offered and many doctors take that up. Therefore, it is a medically based service.

The British Medical Association will then negotiate the fee for doing the assessment with the Department of Health and Social Care. That is not about agreeing to provide the service; it is about doing the assessment. That is mirrored in many aspects of general practice, which itself is a private service contracted to the NHS. It is very complicated. It would be inaccurate to portray this as a private service, where people may profiteer, as it is based on medical professionals performing a duty for which they are trained and for which the price is clear to the general public, because it is negotiated and published.

On publishing the number of patients seen by a single doctor and the fees that doctor has accrued from the scheme, that is not something that happens for things like minor operations, which we perform outside general medical services, although we are rewarded by the Government at a set fee. There are other such services—inserting a coil, for example—where we are given a certain amount of money.

How this is arranged is very complicated. Doing appraisals, being a trainer and all these things have a price attached, and we need training before we can perform the service. I see this scheme as no different. The problem with publishing how many patients have been seen by a single doctor regarding assisted dying is that it puts a target on that doctor. As we have seen with abortion clinics and even this Committee—certain Committee members have been targeted by the press for what they have said—this is a very sensitive issue, and it would not be fair to publish the figures so that doctors could be targeted in the press and made to feel unworthy in all those ways. It is extremely difficult.

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

The hon. Gentleman makes a powerful argument about doctors being vilified in the press, but does he believe there is a risk that it may go further and present a genuine safety risk to those doctors?

[Dr Opher]

Exactly. That is what worries me. I acknowledge what the hon. Member for East Wiltshire said about pharmaceutical sponsorship, but I do not think that has anything to do with what we are talking about here. What we are talking about is specifying what doctors are doing as part of their daily job, for which they are trained. It would not be fair to publish those figures and put those doctors at risk.

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

Neil Shastri-Hurst Excerpts

Committee stage
Tuesday 4th March 2025 Public Bill Committees

I ask hon. Members to support amendment 277. It will give patients time to think. It will give them that time near the beginning of the assisted dying process, whereas the Bill as currently drafted gives them time almost at the end of the process. Most importantly, it will give patients what senior psychiatrists have asked for: simply put, the chance for people who have received a shocking diagnosis and prognosis to work with their doctors and social carers to put new treatment plans in place.

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

I rise to set out why—reluctantly—I cannot support amendments 403 and 404, which have been tabled by my hon. Friend the Member for East Wiltshire. It is not because of the principle involved, because my hon. Friend was very clear in setting out the amendments. They would not provide for a prescriptive situation where an individual must tell their family. A range of options are set out, which I anticipate that any sensible and responsible doctor or clinician would take a patient through, encouraging them to involve their family in their decision making.

The issue that I have is around the legal clarity of the wording of the amendments, because under the English and Welsh legal system there is no statutory definition of “family”. There is a concept of family, but the concept of family to me may be very different from that of my neighbour, or from that of someone who lives in another city. For example, for some people stepbrothers, stepsisters and step-parents are very much part of their family; for others, they are not. For some people, unmarried couples with children are a family; for others, they are not. For some people, unmarried couples without children are a family; for others, they are not.

[Danny Kruger]

I take that point; families are difficult to define. Nevertheless, the Bill currently refers to the opportunity for a doctor, or the suggestion that a doctor,

“in so far as the assessing doctor considers it appropriate, advise the person to consider discussing the request with their next of kin and other persons they are close to.”

That is more precise. Would my hon. Friend accept an amendment along the lines that I have proposed, prior to the first declaration, but using the language that is currently in the Bill about

“their next of kin and other persons they are close to”?

[Dr Shastri-Hurst]

That would satisfy me. The reason I say that is because at the moment the wording is too broad and ill-defined. The question is: is this about the closeness and proximity of a relationship? The suggested wording that my hon. Friend just put forward would be much closer to that and much clearer, and more akin with the language of medical registration. When someone turns up in A&E, they are asked to give the name of their next of kin. That defines the closeness, the proximity and the permanency of that relationship.

If my hon. Friend was perhaps to consider withdrawing this amendment and tabling it again in an alternative form, or rewording it, that would certainly be something that I would be open to supporting. I have outlined why, as the amendments currently stand, I cannot support them.

[Stephen Kinnock]

Although it is for Parliament to decide whether to progress the Bill, this Government remain committed to ensuring the legal robustness and workability of all legislation. For that reason, the Government have worked closely with my hon. Friend the Member for Spen Valley, and some amendments have been mutually agreed upon by her and the Government: in this group, those are amendments 184, 418, 420, 195, 209, 220, 421, 203, 204, 207, 208 and 214.

This group of amendments replaces the forms set out in the schedules to the Bill, with the requirement for the forms to be set out in regulations by the Secretary of State. The amendments also make provision about the content and form of the first and second declarations, statements and reports.

Amendment 184 provides that the form of the first declaration must be set out in regulations made by the Secretary of State, as opposed to in schedule 1 as currently drafted. Operationally, using regulations will allow for consultation in relation to the form and content of the declaration. It will also provide flexibility to tailor or update the content of the declaration.

The effect of amendment 289 would be to limit those able to act as a second witness to a first declaration to registered clinicians, though that term is not defined in the amendment. In normal usage, “registered clinician” is broader than “registered medical practitioner”, so practically the amendment may lead to a wide range of registered healthcare professionals being able to act as a witness to a first declaration under the Bill.

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

Neil Shastri-Hurst Excerpts

Committee stage
Tuesday 25th February 2025 Public Bill Committees

By making the change in the amendment, we would make sure that individuals considering assisted dying understand that the doctor is unable to provide a prognosis with complete certainty. Prognosis is often not an exact science, and it can vary depending on numerous variables, including the course of the disease, the patient’s response to treatment and other unforeseeable factors. If we are giving doctors the essentially impossible task of proving “inevitably” that death will occur in six months—

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

Will the hon. Lady give way?

[Juliet Campbell]

I have almost finished, so I will carry on.

If we give doctors the essentially impossible task of proving that death will inevitability occur in six months, there is a risk of an individual being advised to stop treatment, to accelerate them artificially into a serious or terminal state or speed it up to ensure their eligibility. As medical intervention is so key in the prognosis of a seriously ill patient, it makes no sense to me to use language that is not consistent with real-life medical experiences or reasonably within the scope of medical diagnosis.

--- Later in debate ---

[Rebecca Paul]

I know the hon. Member has a huge amount of experience on this matter given his career, so I thank him for that contribution.

It must not be forgotten that it is the nature of such illnesses for there to be periods of unwellness, when people are at their lowest ebb, and it is our job to protect them from something that could sound appealing at that moment in time. The crux of this issue is that—subject to the point that the hon. Member for Spen Valley made about the improvements that we may now see following the amendments that we have just discussed—the Bill makes no distinction between a condition that is inevitably fatal and one that could be substantially slowed with treatment.

[Dr Shastri-Hurst]

My hon. Friend is making a valid argument, but I want to pick up the point made by the hon. Member for Stroud. He talked about illnesses that are inevitably progressive and cannot be reversed by treatment. For type 1 diabetes—I think that is what my hon. Friend the Member for South Northamptonshire (Sarah Bool) is addressing, as opposed to other forms of diabetes—a person either has insulin or does not.

[The Chair]

Order. Interventions should be pretty short, and Members really should be asking a question of the Member who has the floor, not making a mini-statement. Will they stick to that, please?

[Dr Shastri-Hurst]

Forgive me, Chair. I will come to the point. If the person does not have insulin, the diabetes could be treated by administering it. Does my hon. Friend accept that, in those circumstances, it would fall within this clause?

[Rebecca Paul]

I thank my hon. Friend—another doctor. I would suggest that diabetes cannot be reversed, but can be managed with treatment. All I am trying to do is make sure that that piece is picked up. I think we all agree that we would not expect diabetes to fall within the terminal illness diagnosis.

No fewer than 15 clinicians and medical researchers mentioned diabetes in written evidence. Other conditions are mentioned too. Two consultant physicians—Rosemarie Anthony-Pillai and DP Whitehouse—say that those on medication for heart failure could qualify if they stopped taking their medication. Dr David Randall, a consultant nephrologist at the Royal London Hospital, sets out in written evidence the example of a young man who has benefited from a kidney transplant but stopped his immunosuppression medication. That would lead to transplant rejection and, likely, death within a few months. Would he qualify as terminally ill if we were not to agree to these amendments?

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.