Oral Answers to Questions

Neil Shastri-Hurst Excerpts

Tuesday 20th October 2026 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

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

Thank you, Mr Speaker. May I start by associating myself with your remarks on the tragic events involving Helen Haines over the last 24 hours?

According to a recent report from Future Minds, more than 2.7 million referrals have been made since the last election to children’s and young people’s mental health services in England, with more than a third of those referred still awaiting treatment. How can the Government seriously claim to be tackling the rising number of young people not in education, employment or training while simultaneously overseeing the waiting list run out of control?

[Alison McGovern]

I refer the shadow Minister to the Fonagy review. It details the causes, which started before covid, of the rise in mental distress for young people. As I mentioned a moment ago, we are already asking ICBs to reduce the longest wait, and we have seen some successes with that, but we have way more to do to address this challenge. We will have more to say in the mental health strategy that will be published soon.

Unpaid Carers

Neil Shastri-Hurst Excerpts

Thursday 15th October 2026 Westminster Hall

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

It is always a pleasure to serve under your chairmanship, Mrs Barker. I congratulate the hon. Member for Mid Sussex (Alison Bennett) on securing the debate and all hon. and right hon. Members on their very thoughtful and, at times, moving contributions.

As we heard during the debate, across the United Kingdom 5.8 million people provide unpaid care. Those carers collect prescriptions, organise appointments and help with all aspects of personal care, and many do so either before or after they have done a full working day. For millions of families up and down the country, this has become part and parcel of ordinary life, but we should never underestimate the toll it takes over time. Of those 5.8 million carers, 1.7 million provide at least 50 hours of care each week—more than a full-time working week—and they often do it alongside employment or while raising a family or managing their own personal health needs.

Of course, caring responsibilities rarely fit neatly within the timetable that defines our normal week. Likewise, the way that care, and the need for it, presents itself is often varied and complex. For some, it can come with little forewarning; they may need it after a sudden accident, such as a catastrophic spinal injury. For others, it comes much more incrementally, over a period of time: needing help with shopping becomes needing help with medication, or an occasional visit becomes a daily necessity. Eventually, it can feel as though it is becoming all consuming.

Clearly, individuals must adapt because someone they love needs that help. However, our services must adapt, too. Too often we assume rather than asking whether the person who is undertaking the care is able to manage, and whether they have been shown what to do or how to use the necessary equipment and so forth. It is worth remembering that a relative’s presence is not in itself a care plan, and nor should their willingness to help be taken as proof that they do not need any support themselves.

We have heard a plethora of examples of what happens when those questions are ignored. One can only imagine the frustration encountered by so many carers who are forced to describe their circumstances, often repeatedly, only for nothing to happen. That risks leaving the carer carrying entirely the same burden and responsibility as they had beforehand, but with less confidence that if they ask in the future it will make an iota of difference, and consequently, potentially, with declining physical and mental wellbeing. Others are forced to cut back on essentials just to make ends meet.

These individuals deserve a clear plan from the Government. Carers frequently find themselves putting the needs of those they care for above their own. As we have heard, employment can become more challenging, which often leads people to reduce their hours in order to make caring manageable, which of course has a knock-on impact on their income. Some are ultimately forced to leave work, which brings further financial pressures and often makes returning to the workplace much harder. As a society, we should be helping people preserve their working life wherever possible. Work provides not only financial freedom, but an environment where carers are recognised for achievements beyond their incredibly commendable responsibilities as carers.

We must remember, too, that many older carers are managing their own fragility, and that younger carers are often in education and their own childhoods can be affected. Support must reflect people’s different circumstances rather than assuming that every family can manage in entirely the same way. Alan Milburn’s interim review identified around 300,000 informal carers aged between 16 and 24. It described young carers as

“one of the least visible groups in the NEET conversation and one of the most systematically miscounted.”

A young person who misses college, declines an apprenticeship interview or struggles to attend a job or university may be managing responsibilities that somebody has simply not asked about. In those circumstances, it cannot be right that their commitment to a loved one should cost them opportunities.

The previous Conservative Government took action through the 2018 carers action plan, the carers innovation fund and support for statutory carer’s leave. I welcome this Government’s publication of the unpaid carers action plan in July. The task now is to ensure that those commitments actually reach the people the plan is intended to help. With that in mind, I have three specific questions for the Minister.

First, with NHS England to be abolished by April 2027, who will have ownership of the actions in the unpaid carers plan thereafter? Secondly, NHS England currently has powers to support service integration between local authorities and the NHS and for the functions of the better care fund, a major source of funding and resourcing for unpaid carers. The BCF in its current form requires the NHS and local authorities to pool budgets for the purpose of service integration, as there is a requirement to use section 75 agreements. That means that to pool budgets, the BCF must involve local authorities.

The impact assessment for the Health Bill sets out that, following the abolition of NHS England, that function will be conferred on the Secretary of State. In addition, what is currently a mandatory requirement on the use of section 75 will change to a discretionary power. In short, the Secretary of State will retain the power to require pooled budgets should they wish, but that will not be the default position, as is currently the case. Does the Minister share the concerns of carers’ charities that this change may lead to significant cuts for schemes that support unpaid carers?

Thirdly, the Prime Minister set out in his conference speech the bare bones of a plan for a national care service. The Government have of course proposed to fund that through reforms to the triple lock. However, those reforms will, self-evidently, not be sufficient to fund and deliver such a service. Notwithstanding the statement in the main Chamber earlier today, the details of the funding still appear to be somewhat lacking. Much more detail of what the Government are proposing is needed. Do the Government intend to set out further details of how the national care service will be funded, and will the Minister rule out increased borrowing or tax rises to fund it?

The Conservatives look forward to working constructively on this issue. It is an important issue that we all face in our inbox every day, but for too long, across the political spectrum, we have kicked it down the track and not got a grip of it. In that spirit, we look forward to the ongoing cross-party talks on the issue. Ultimately, the marker of success must be whether carers can obtain the help that they need, are able to access respite breaks when they need them, and can look after their own health and wellbeing at the same time. That of course requires proper policy consideration, not just headline announcements, and I hope the Minister is able to provide greater clarity on that front today.

Vascular Sector Reform

Neil Shastri-Hurst Excerpts

Thursday 10th September 2026 Westminster Hall

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

It is a pleasure to serve under your chairmanship this afternoon, Dr Huq. As the hon. Member for Glasgow South West (Dr Ahmed)—I call him my hon. Friend—pointed out, I have a particular interest in this subject. It is a number of years since I held a licence to practise, but the debate has taken me back to clinical days. Even worse, it took me back to vivas for Royal College examinations—I am still a member and am proud to support that community.

I start by thanking the hon. Member for Strangford (Jim Shannon) for securing this debate. I congratulate him and the APPG on vascular and venous disease on their work. As has been noted, vascular disease perhaps does not attract quite the same attention as cancer or heart disease. However, that does not make it any less serious. The consequences for patients can be extreme. We have heard about pain, loss of mobility, prolonged hospital stays and, in the worst cases, amputation.

What makes this particularly frustrating is that a great deal of this harm is avoidable. The problems identified by the APPG are not especially complicated. There are delayed diagnosis and treatment, inconsistent referral pathways, variable access to specialist care and fragmented services. The result is that patients who might have retained their limb and their independence do not always do so.

The APPG’s report therefore makes five fairly practical recommendations: the national foot attack pathway, with same-day or next-day triage; community-based foot protection services in every integrated care system; maximum waiting times for vascular assessment and revascularisation, with national reporting; commissioning that rewards outcomes rather than simply activity; and faster adoption of proven innovation. None of those propositions strikes me as particularly revolutionary. Indeed, much of the thinking behind them is not new.

The “Getting it right first time” programme established under the previous Conservative Government produced a vascular surgery report in 2018, which recommended a hub-and-spoke model to improve early diagnosis, specialist decision making and timely intervention. The NHS long-term plan subsequently committed to universal access to multidisciplinary foot care teams. In 2022, NHS England introduced a two-year commissioning for quality and innovation scheme intended to encourage timely revascularisation for patients with chronic limb-threatening ischaemia.

The Government have said that they welcome the APPG’s report. They have said that the Department of Health and Social Care and NHS England have engaged with stakeholders, and that recommendations will be considered as part of the cardiovascular disease modern service framework. That sounds encouraging, but there is a rather obvious difficulty: although it is welcome that the modern service framework, which was published in July, contains considerable material on cardiovascular disease, it contains no specific reference to vascular or venous disease.

If the Government accept that vascular disease is an important part of the cardiovascular picture, why does their new modern service framework not specifically address it? If the answer is that the framework is intended to cover vascular disease through its wider approach to cardiovascular risk, that poses a second question: where precisely are the specific standards against which vascular services are to be judged? The APPG has given the Government some specific proposals, and it would be helpful if the Minister could tell us which of the five recommendations the Government accept and, perhaps more importantly, which they reject.

The question then is who will deliver the services? The Government have embarked on a major reorganisation of the NHS, including the abolition of NHS England, and a substantial reduction in the size and cost of integrated care boards, with the Government saying that ICB budgets are to be reduced by 50%. How does the Minister expect ICBs to deliver these additional responsibilities at precisely the point when their budgets and staffing levels are being substantially reduced? Has his Department assessed the effect of those reductions on the commissioning of vascular care and foot protection services? I am far from opposed to reducing bureaucracy in the health service, but the test of any NHS reform has to come down to patient outcomes.

I hope the Minister will also address the question of clinical leadership in this area. Currently, although there are clinicians with huge experience and expertise in the field, including vascular clinical leads for GIRFT, there is no national clinical director specifically responsible for vascular and venous disease. The Government have previously said that national clinical directors play an important role in policy development and implementation, which is right, but we know that the future role and responsibilities of national clinical directors are being reconsidered as part of NHS reorganisation. Could the Minister set out the Government’s position on future clinical leadership for vascular and venous disease after NHS England has been abolished? Will a clearly identified senior clinical voice continue to be responsible for that important area, and if not, who will have responsibility for ensuring that the specific recommendations on vascular care are implemented?

It is helpful that the national vascular registry already collects data on major vascular procedures, including bypass surgery and major lower-limb amputations, and there has been some improvement in the proportion of vascular providers meeting the relevant CQUIN framework, but we need to be careful not to confuse the mere collection of data with improvements in care. Will the Government therefore introduce national maximum waiting times for vascular assessment and revascularisation? If they do not propose to do so, why not, and if they do, when will it take place?

Returning to the national foot attack pathway proposal, the principle behind it seems difficult to argue with. Where a patient presents with a potentially serious foot problem, particularly in the context of diabetes or vascular disease, as we have heard, they should have a clear route to an appropriate specialist assessment. Will the Government commit to establishing such a pathway nationally? Will the Minister ensure that data on performance against that is published?

The same principle applies to innovation. The NHS has no shortage of good ideas, but it has traditionally lacked a reliable mechanism for taking an idea that works in one hospital and making it available elsewhere. Therefore, the APPG’s recommendation to make greater use of mechanisms such as the NHS innovator passport is sensible. However, what happens at the other end? If a technology is demonstrated to be clinically effective and cost-effective, does an NHS organisation have an obligation to consider adopting it? How will the Government prevent another postcode lottery, where an effective treatment is available to patients in one part of the country but not in another?

In this debate, there is not much disagreement on the broad objectives: we all want to see earlier diagnosis, faster treatment and fewer amputations, as well as better use of NHS resources. Any disagreement is about whether the Government have set out a sufficiently specific plan for achieving those objectives. It is easy to welcome a report or publish a framework; it is much harder to deliver it. The Government have a genuine opportunity to take the practical recommendations of the APPG and turn them into measurable outcomes. That is the test: will they do that, or will they just allow vascular services and vascular disease to remain a subsidiary issue within the much broader context of cardiovascular disease and hope that local services are simply able to deal with it?

Surrogacy Law and Legal Parenthood

Neil Shastri-Hurst Excerpts

Monday 7th September 2026 Westminster Hall

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

It is a pleasure to serve under your chairmanship this afternoon, Mr Pritchard. I start by declaring an interest in this debate as a former member of the appeals panel of the Human Fertilisation and Embryology Authority.

I pay tribute to the hon. Member for Lichfield (Dave Robertson) for the tone in which he opened the debate, and I recognise the more than 113,000 people who have signed this petition. Behind many of their signatures will be personal experience of infertility and loss, and a long-held wish to start a family. For intended parents, surrogacy is not simply a legal process; it is about getting a family they never thought they could have, and in many cases, it comes at the end of a long and difficult journey.

Nobody doubts the love that such parents have for their children. Families formed through surrogacy deserve dignity, certainty and respect. However, our job in this House is to consider more than the wishes of the adults involved. We must speak for the child who cannot speak for themselves. We must also protect the woman who carries and gives birth to that child.

The issue for us to consider is whether legal parenthood should pass automatically at birth, before the state has considered the child’s welfare, the surrogate mother’s consent and the circumstances in which the arrangement was made. As a starting-point, any reform to the legislation must do three things: first, and most importantly, it must protect the child; secondly, it must preserve the free and continuing consent of the woman who gives birth; and thirdly, it must address the safeguarding concerns arising from the increase in international commercial surrogacy.

First, on protecting the child, the petition describes the upset and strain of months of court proceedings and visits from social services workers before the intended parents are legally recognised. I understand why that process might feel intrusive and unsettling. Intended parents have planned for the child and cared for them from birth, and already see themselves as a family. However, a parental order is not merely words on a piece of paper; it is the legal means by which parenthood is transferred from one person to another. That is a serious act, with lifelong consequences for the child.

The process, as it currently stands, allows a court to consider the child’s welfare, establish that the surrogate mother has freely consented, examine any payments that have been made either through expenses or cash, and consider the circumstances in which the child will be raised. CAFCASS provides an independent assessment, so that the decision is not based only on what the adults expected or agreed before the child was born.

It is argued by some people that those checks are unnecessary because the overwhelming majority of applications are approved. I simply do not accept that. The fact that a system usually finds that everything is in order does not mean that the checks serve no purpose at all. Their existence helps to ensure that proper standards are followed. If the process is too cumbersome, it should be made more intuitive; if families receive inconsistent advice, that advice should be made clearer; and if the courts or CAFCASS lack the resources to deal with applications promptly, the Government should address that. Delays should be reduced, but that does not warrant the underlying protections’ being diminished. I ask the Minister whether the Government remain committed to the parental order process, and what they will do to reduce unnecessary delays while retaining independent welfare assessments.

My second point concerns the woman who gives birth. Under the present law, the woman who carries and gives birth to a child is the child’s legal mother. Legal parenthood is transferred only after she has given valid consent following the birth. It would be ill-judged to dismiss that as an outdated legal technicality, as it recognises the physical, medical and emotional consequences of pregnancy and childbirth. The law normally prevents consent from being given until six weeks after the child is born. That period of time is necessary: a decision made before childbirth cannot fully account for the experience of giving birth, the mother’s health afterwards or how she may feel when the child is born.

If intended parents became legal parents automatically, that protection would be reversed. The woman who carried and delivered the child would instead have to take legal action if she wished to withdraw her consent or assert her own rights. That should concern us all, particularly where there is a financial or social imbalance between the surrogate mother and the intended parents. A system that depends on someone’s having the knowledge, confidence and money to begin legal proceedings may offer very little protection in practice.

Compassion for intended parents cannot require Parliament to treat the woman who gives birth as a temporary party to somebody else’s story, nor should this be presented as a contest between traditional and modern families. Recognising different kinds of family does not require us to reduce the rights of the woman who carries the child. If the Government are considering recognising intended parents from birth, I ask the Minister to set out what protection would remain for a surrogate mother who changed her mind after giving birth.

The third issue is of growing concern: the increase in international commercial surrogacy. The majority of parental order applications now concern children born overseas. Applications relating to children born internationally reportedly rose from 215 in 2021 to 509 in 2025; in that same year, there were 150 applications relating to children born in the United Kingdom. That marks a significant change in surrogacy in this country. International arrangements may involve large differences in wealth and power, commercial contracts that would not be enforceable here, complicated payment arrangements made through intermediaries and serious doubts about whether consent was properly informed and freely given.

[Jim Shannon]

I should have said this in my earlier contribution, but I refer the hon. Gentleman to page 31 of the Library’s “Surrogacy in the UK” briefing, where it refers to some physical circumstances and risks that came up in a Canadian population-based surrogacy study that I think are incredibly important. It says:

“Some research suggests that using an egg from a relative may reduce these risks”.

Does the hon. Gentleman agree that we need to consider the Canadian perspective and the surrogacy study that they did?

[Dr Shastri-Hurst]

The hon. Member always comes to these debates well prepared and well briefed. I think the point he is making, which we can all agree on, is that this is an incredibly complex area that we cannot rush to legislate on, nor should we seek to water down the clear protections that currently exist.

[Steve Yemm]

We now prohibit commercial arrangements in the UK, yet we allow intended parents to travel overseas to exploit that type of arrangement. I am interested to know whether the shadow Minister thinks that that is a morally coherent position, and whether we should be looking at the rights of UK citizens to exploit commercial surrogacy overseas.

--- Later in debate ---

[Dr Shastri-Hurst]

It is almost as if the hon. Gentleman can read my mind, because I was going to say that there is a clear inconsistency in prohibiting the practice here, while allowing such arrangements to be made abroad.

Of course, intended parents may also encounter immigration and nationality problems that they are aware of before entering the arrangement, if those arrangements take place overseas. In some cases, a British court may have difficulty locating the surrogate mother when deciding whether valid consent has been provided. In that case, a parental order process and a CAFCASS assessment would be the only independent scrutiny carried out in this country. The Government’s overseas surrogacy guidance was last updated by the Foreign, Commonwealth and Development Office in 2022. Given the rise in international cases, it needs to be updated. It should deal clearly with safeguarding, consent, payments, independent legal advice, immigration and nationality. With that in mind, will the Minister commit to reviewing the international surrogacy arrangements and to publishing updated guidance?

Some will say that the law is outdated. I understand the frustrations behind that argument. There is a case for a quicker process, clearer guidance and greater consistency, but making a process easier for one party does not necessarily make the law better. Reforming the law must also protect those with less power and ensure that the child’s interests are the main consideration.

Of course, families formed through surrogacy deserve our support. However, the child whose future is being decided also deserves independent protection. The woman who gives birth should not lose her rights before she knows how the experience of childbirth has affected her. We can shorten needless delays and give families greater certainty without discarding the principles on which the current system rests. Legal parenthood should be transferred only after the child’s welfare has been properly considered, the surrogate mother’s consent has been confirmed and the arrangement has received the necessary independent scrutiny. In surrogacy as in every other part of family law, the wishes of the adults are important but the welfare of children must always come first.

Lobular Breast Cancer: Moon Shot Project

Neil Shastri-Hurst Excerpts

Thursday 9th July 2026 Westminster Hall

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

It is a pleasure to serve under your chairmanship today, Mrs Hobhouse. I am grateful to the hon. Member for Horsham (John Milne) for securing today’s debate, and to the Members from across the House who have given their voice to this campaign over a number of years. It is entirely right that Parliament should pause today to consider not just the science, the policy and the funding, but the human reality that sits behind all three of those things.

Behind the words “lobular breast cancer” are people who knew something was wrong, but the system could not prove it. That is the point at the heart of today’s debate. This is not a call for special treatment or a demand that we place one cancer above another; it is a recognition that different cancers behave differently, present differently and may require different approaches if we are serious about improving outcomes.

Today, we are also remembering Dr Susan Michaelis. Many people in public life are described as courageous, but in Susan’s case that word feels insufficient. She was, as we have heard, a commercial pilot, a researcher, a campaigner, a wife and a woman whose instinct, when faced with injustice or uncertainty, was not to turn away from it but to investigate it. She had already devoted much of her professional life to public safety, particularly in the aviation sector. We have heard about how she challenged assumptions, gathered evidence and pursued truth in an area where the consequences mattered for passengers, crews and the wider public. In 2013, she received her devastating diagnosis of invasive lobular breast cancer. As we have heard today, her symptoms were not dramatic; they presented as just a tiny mark on her breast.

Two mammograms and two ultrasounds failed to identify the disease, and it was ultimately identified by an MRI scan. We have heard how that revealed what appeared to be a relatively small lesion of about inch that was later confirmed to be over 7 cm. That single account tells us why this debate continues to matter and shows the particular challenge of a cancer that can be harder to detect through standard imaging.

Remarkably, Susan did not live her final years in retreat from the world; she continued with her work and her research, and continued campaigning. As we have heard, nine days before her death, she travelled to Manchester to help launch the scientific programme for the lobular breast cancer Moon Shot Project, knowing full well that any breakthrough would come too late for her. That is an extraordinary act of generosity and a challenge to all of us in this place. If someone is living with advanced cancer and can spend her final days and the last of her strength ask for progress for others, surely it is our responsibility and Government to find the clarity and urgency to respond.

As we have heard, lobular breast cancer is not rare. It is the second most common type of breast cancer, accounting for around 15% of cases, but despite that it too often remains hidden in plain sight.

[Seamus Logan]

This is not a party-political issue; it is something the shadow Minister and the whole House can agree on. In 2022, the Scottish Government began the process of improving their imaging kits with the introduction of 3D mammography, which is a major step forward. Two months ago, the Scottish Parliament lodged a motion supporting the lobular breast cancer Moon Shot Project and called for the £20 million to be allocated. Does he agree that the breadth of support for this campaign—440 MPs now support it, including myself—is now irresistible, and that the Minister should award the funding?

[Dr Shastri-Hurst]

The hon. Gentleman is right; there is collective support for doing more on this issue. That starts with getting the research right. Without the research, we do not know how to plan for the treatments of the future. I will move on to the other points, but he is also entirely right that this is not a party-political issue, but one that affects all of us and all of our constituents. We have to work with a sense of urgency around it.

As we have heard, the lobular breast cancer Moon Shot Project is looking for £20 million over five years to advance the understanding of invasive lobular breast cancer and to support better detection, treatment and surveillance. We cannot dispute that that is a significant sum, but we have to look at it in the context of national health spending and what cancer costs: the cost to families and patients and the cost to the NHS when it is detected late or treated inadequately. We have to bear those factors in mind.

We should also be clear about what research funding means in practice. It does not mean a guarantee of easy answers. Science does not work like that, but it does mean giving our best minds the chance to ask the right questions. It means building the evidence base and moving beyond a generic understanding of breast cancer and towards a more precise understanding of this specific disease. That is the direction of travel that we have seen over a number of years in modern healthcare. We have seen it in genomics and targeted therapies and we see it in the increasing recognition that treatment must be shaped by the biology of the disease and the needs of the patient. There is no reason that lobular breast cancer should be left behind in that progress.

There has been movement—it is right to acknowledge that. The National Institute for Health and Care Research has issued a highlight notice encouraging applications for research into lobular breast cancer; the Government have published their own national cancer plan; and the Health Bill speaks of research duties and innovation. Those are by no means meaningless, but they are not yet enough. That is why today’s debate must focus on delivery, so I ask the Minister whether the Government will set out a timeline to fund the lobular breast cancer Moon Shot Project. If the answer is yes, campaigners deserve to know how and through what mechanism that will happen. If the answer is no, they deserve an honest explanation. Is it a financial barrier? Is it a scientific one? Is it procedural? Are the Government waiting for further proposals, reviews or assessments? The people who have campaigned with such dignity on this issue should not be left trying to decode in silence.

I also ask the Minister to address the issue of guidance. Lobular breast cancer is referred to only in limited form in existing national breast cancer guidance, and campaigners have called for the National Institute for Health and Care Excellence to review whether the guidance properly reflects the disease. That guidance, of course, shapes clinical practice and influences what clinicians look for, what tests are considered and how treatment is approached. If the evidence is not yet strong enough to support separate recommendations, that should strengthen the case for targeted research, not weaken it. We cannot use the absence of evidence as a reason not to gather it. That would be a circular argument. The patients affected by this disease deserve much better.

There is also a wider lesson here about women’s health. Too often women’s symptoms have been dismissed as vague, complex or difficult to categorise. Too often women have had to become their own advocates at the very moment when they are frightened, unwell and least able to fight. One duty of a good health system is to reduce the burden on the patient and prove that they are worth listening to. Susan Michaelis understood that deeply. As we heard earlier, on 24 June last year, while on oxygen and clearly in pain, she stood outside Downing Street as part of a silent vigil representing the 22 people diagnosed every day with lobular breast cancer in the United Kingdom. She delivered a letter asking for help. Two weeks later she died wearing her Lobular Moon Shot Project T-shirt. That is an image that should stay with all of us today, not because policies should be made on emotion alone—clearly they should not. Policy has to be evidence-based, financially responsible and clinically sound. But should policy not be stripped of a moral seriousness, either. Evidence tells us what may work. Compassion reminds us why we keep working. Responsibility requires us to bring those two factors together.

The last Government invested in cancer research, including support for the Institute of Cancer Research and the Royal Marsden biomedical research centre, along with wider work relevant to lobular breast cancer. In opposition we have continued to press the Government on the Moon Shot Project, including through the shadow health team and other colleagues. But this should not, as we have discussed, become a party political contest. Cancer does not observe party lines, and neither should our determination to improve the outcomes for patients.

The test for the Government is relatively simple. Can they turn sympathy into a plan? Can they gave campaigners a clear route forward? Can they match the scale of the problem with a response that is specific, funded and time-bound? What those affected by lobular breast cancer need is not another expression of admiration for their bravery and courage. They need progress: a system that sees their cancer sooner, treatments shaped by its biology, surveillance that reflects the risk of recurrence and spread, guidance that recognises the particular character of the disease and research funded at a level that gives discovery a fair chance.

Susan Michaelis gave the final chapter of her life to this cause. She did so not for herself, but for women she would never meet and families she would never know. That legacy is worthy of more than a mere tribute; it is worthy of action. I hope the Minister will leave this debate having listened carefully, but also prepared to act decisively. The Government should not only meet the campaigners, but set out the remaining barriers, publish a route to a decision and make clear whether they will fund the Moon Shot project. Dr Susan Michaelis spent her life making hidden risks visible; the task before us now is to ensure that lobular breast cancer is hidden no longer.

Neuropsychiatric Conditions: PANS and PANDAS

Neil Shastri-Hurst Excerpts

Thursday 25th June 2026 Commons Chamber

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

It is a privilege to respond to the debate on behalf of His Majesty’s loyal Opposition. I pay tribute to the hon. Member for North East Fife (Wendy Chamberlain) for securing the debate and for setting out the landscape facing those with PANS/PANDAS in the UK, as well as recognising the lack of knowledge about the conditions and the challenge that presents. I thank her for her sustained work through the APPG on the issue.

Many right hon. and hon. Members have contributed to the debate. The hon. Member for Carlisle (Ms Minns) spoke movingly about Joanne and Jake, who have been living with PANS/PANDAS for the past six years, and the challenges of not getting the treatment or the funding that they need. The hon. Member for Henley and Thame (Freddie van Mierlo) made a good point about how those affected do not want sympathy but action. He talked about the excellent campaigning by Albie, who is in the Gallery today, following his brother’s diagnosis—I suspect Albie’s handwriting is somewhat better than my doctor’s scrawl and I commend him on his campaigning. The hon. Member for Harlow (Chris Vince), who is always keen to speak up and champion issues on behalf of his constituents, spoke about the importance of guidance. My right hon. Friend the Member for New Forest East (Sir Julian Lewis) talked about the importance of the early use of antibiotics.

Above all, I want to speak directly to the families and children who are following the debate and who live with PANS/PANDAS every day, some of whom are with us in the Gallery today. For them, this is not an abstract discussion about guidance, systems or clinical pathways; it is about the child they love, the moment something changed and the exhaustion of trying to explain that change to people who may never have heard of the condition before. It is about parents who overnight become advocates, researchers, case managers and campaigners, while simultaneously trying to hold their families together, and about the children and young people whose lives can be altered suddenly and terrifyingly.

As we have heard, PANS/PANDAS sit at the intersection of neurology, psychiatry, immunology and infectious diseases. That matters because they do not fit neatly into one service, specialty, clinic or budget line. For the children affected, symptoms can be sudden and severe. They include obsessive-compulsive behaviours, restricted eating, tics, anxiety, behavioural change, sleep disturbance, regression, movement difficulties, school refusal and distress that can overwhelm the entire family.

For some families, the story is stark. A child who was settled and sociable becomes frightened, withdrawn and unable to eat. A child who was thriving at school begins to struggle. Families find themselves moving from GPs to child and adolescent mental health services, from paediatrics to emergency departments, and from school meetings to safeguarding conversations, often without a clear pathway or a clinician who is able to say, “Do you know what? I recognise this, and this is what we need to do next.”

The first task before us is to diagnose the problem honestly. The problem is not that every scientific question has been answered, because clearly it has not. There is uncertainty and professional disagreement, and there is a need for stronger evidence, better data and more research into diagnosis, treatment and long-term outcomes. However, uncertainty has too often translated into inconsistency. It has meant too many families left without a clear answer, too many clinicians left without guidance, too many schools unsure of how to respond and too many children caught between services. Each see part of the picture, but they do not see the child as a whole.

At present, there is no official NHS clinical guidance for the diagnosis and treatment of PANS/PANDAS. NICE has previously concluded that the evidence was insufficient to provide useful guidance. The Government have said that data on the number of children affected is not currently collected, because internationally the criteria cannot be agreed. Local integrated care systems are expected to plan services, but they are asked to do so without consistent national direction, which risks variation.

As we have heard, in reality variation leads to a postcode lottery. It means that one family may find an informed GP, paediatrician or neurologist, while another family is left scrambling for help. It means that one school may understand the sudden onset and fluctuating need, while another school sees only challenging behaviour. It means that one parent may feel believed, while another parent feels blamed. That is the difficulty at the heart of this debate.

PANS/PANDAS cut across the way our systems are organised. The NHS is still too often structured around separate silos, whether it is mental health, neurology, infectious disease, immunology or paediatrics, but children living with these conditions do not arrive in neat administrative categories; their needs are complex, sudden and overlapping. That makes it hard for families to know where to turn, as well as for clinicians who want to help but may not have had the training to do so, and for schools that see a child’s behaviour change dramatically without understanding what is driving it.

We must also be candid about the emotional difficulty. Parents can feel dismissed. They can feel treated as difficult or seen as overanxious when they are simply trying to explain what has happened to their child. No child should be left waiting for help because the system is unsure about where they fit. The previous Government did not solve this issue, but foundations were laid through the UK rare diseases framework, annual action plans and engagement with research, including with the APPG and the working group.

The current Government have welcomed clinical guidance being developed by PANS PANDAS UK and have said that NICE will consider national guidance as evidence improves. They have also pointed to NIHR research and extended the rare diseases framework into 2027. Where the Government do the right thing, we should welcome it, but the question is whether those actions are sufficient. Do they need to go faster? Are they reaching the families on the ground?

Families do not experience this as a framework, action plan or written answer; they experience it as the moment when a child refuses food, compulsions appear, school attendance collapses or a parent is told that a professional has never heard of the condition. If the problem is complexity, inconsistency and a lack of recognition, the solution must be equal in its seriousness. The foundations have been set, and now we must all go further.

We need action on guidance. The clinical guidance being developed by PANS PANDAS UK and the PANS guideline development group brings together expertise from general practice, paediatrics, neurology, immunology, infectious diseases, psychiatry, psychology and nursing. I would be grateful if the Minister could set out how the Government will engage with that guidance once it is published. Will she commit to a clear process for assessing emerging evidence?

We also need to take action on professional awareness. I recall reading about these conditions in Kumar & Clark when I was a medical student, but I do not recall receiving any formal training on them. It is not enough to ask our clinicians to be responsible for keeping their knowledge up to date; atypical, complex and contested conditions require practical support. As such, I ask the Minister to consider an awareness package for frontline professionals, developed in conjunction with clinicians, families and experts. We also need action on data and research—we need better data, diagnostic clarity, and research into treatment and long-term outcomes. With that in mind, I would appreciate the Minister setting out how the Government intend to support that work and encourage greater patient involvement.

There is also a need for greater consistency across local systems. If support is left entirely to local discretion, care will depend on where a family lives or how hard they are able to fight for it. Clearer information on how suspected cases can be supported across specialties should be available to ICBs, and schools also have to be part of the answer. For many families, school is where the change is first noticed; better awareness of sudden onset and fluctuating symptoms could help ensure sensible attendance policies and flexible, rapid and responsive classroom adjustments.

This debate should not be one that divides the House, but one that unites it. There will be different views on the evidence, on treatment and on guidance, but there should be no difference between us on the need for children to be seen, for families to be heard, for clinicians to be supported, and for care to be based on evidence, rather than the accident of geography. For families living with PANS/PANDAS, progress will be measured by whether the next family gets an earlier answer, whether the next child is believed sooner, whether the next GP has somewhere to turn, and whether the next school understands. That is a fair and compassionate standard, and it is the one that the Government should now meet.

NHS Federated Data Platform

Neil Shastri-Hurst Excerpts

Thursday 16th April 2026 Westminster Hall

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

I was expecting a promotion there, Dame Siobhain. It is a pleasure to serve under your chairmanship. I congratulate the hon. Member for Newton Abbot (Martin Wrigley) on securing the debate. He has brought forward an issue that sits right at the centre of how we shape the future of our national health service: how we use data, who we trust with it and how we ensure that technology supports care rather than complicates it.

The debate has been a thoughtful one, and in many respects it has been revealing. It has shown both the promise of the NHS federated data platform and the unease that still surrounds it. That tension really matters. I am grateful for the significant contributions we have heard from right hon. and hon. Members, with 13 coming from the Back Benches by my count. Let me start by setting out where I think there is common ground across the House.

The NHS is under enormous pressure as demand is rising, complexity is increasing and waiting lists remain too high. Too often, clinicians are working without the full picture in front of them. Anyone who has spent time in the health service knows that this is not a system that lacks dedication. It is, however, a system that too often lacks coherence. Data is part of that problem as it is scattered, fragmented and difficult to use in a joined-up way. Records do not always reliably follow the patient, and information is duplicated, delayed or simply not available when it is needed most. The consequence of that is not just theoretical; it is time lost, inefficiencies and, at times, patients not getting the care they should when they should.

The case for doing things better is a strong one; in fact, it is unavoidable. The FDP is one attempt to respond to that challenge. It seeks to bring together information in a way that allows the NHS to work more effectively, helping clinicians and supporting managers with the ultimate aim of improving care for patients. There are some early signs that this is beginning to deliver; waiting lists have been cleaned up, and some hospitals have reported better flow through theatres and wards. Those are practical improvements. As is so often the case in government, the easier question is whether something can work; the much harder question is whether it will be accepted. There are clearly concerns here.

We have heard about reluctance in part of the workforce. I am not suggesting there is uniform opposition, but there is certainly hesitation and, in some cases, disengagement. We should be careful, however, not to exaggerate that. Big reforms in the NHS have always faced resistance, often at the start. This is not necessarily something new, and on its own it is not necessarily decisive. At the same time, however, it is not irrelevant; if the people expected to use this system do not have confidence in it, its impact will always be limited. Will the Minister say what is the assessment of staff engagement with the FDP and how the Government are ensuring that this is something done with the NHS, rather than done to it? In the end, that will make the real difference.

The same issue arises with public trust. People are right to care about their medical data—it is sensitive, personal and deeply private. Once confidence is lost in this area, it is very difficult to rebuild it. There are important safeguards in place: the data remains under NHS control, the access is tightly regulated, and the provider does not own or use the data for its own purposes. The legal framework underpinning those safeguards is strong. Those are not minor points—they really matter.

However, we also have to recognise something else. People are not just asking whether the system is safe today, but what it enables tomorrow. Could the data be combined in ways that reveal more than people expect? Could systems evolve in ways not originally intended? Could future Governments choose to use the capability in different ways? Those are not unreasonable questions; they are the natural questions people ask when large new systems are created. Again, I ask the Minister what more will be done to reassure the public about the limits of how NHS data can be used and whether he can set out clearly where parliamentary oversight comes in if the use of data is expanded in the future. Trust is not built by reassurance alone; it is built by clarity and restraint.

A significant part of this debate has understandably focused on Palantir, and it is right that it has. Palantir is now a major supplier within the NHS data infrastructure as well as elsewhere across Government, and that raises legitimate questions about not just capability but dependence. For some the concern is political, while for others it is about principle. For many, though, it is something much more practical: what happens if we become too reliant on a single provider for something as critical as health data infrastructure? I think that is a fair question.

However, we should also separate those questions from the broader argument about the company’s international work. In a global economy, companies will inevitably work with different Governments, and that alone is not a sufficient reason to exclude them from public contracts in the UK. The question of procurement design, competition and resilience, however, is a different matter.

[Andrew George]

Will the hon. Gentleman give way?

[Dr Shastri-Hurst]

If the hon. Gentleman will forgive me, I will not. I want the Minister to have sufficient time to respond to the multiple contributions there have been today.

I ask the Minister the following questions. How are the Government ensuring that the NHS is not locked into a single supplier over the long term? What is the plan for maintaining genuine competition in this space? How easy would it be in practical terms to move to an alternative system if that was ever required?

There is then the issue of resilience. Some have argued that the FDP creates a single point of failure, while others have argued that the current fragmented system is itself a weakness and that greater coherence improves security and oversight. Both arguments deserve to be taken seriously. But practical questions remain: how resilient is this system to cyber-attacks or technical failure? What safeguards are in place? What happens if something goes wrong at scale?

The last matter I wish to address is that of governance. With the abolition of NHS England, there is now a question about where the responsibilities for the FDP properly sit. That matters because accountability cannot be diffuse. I take this opportunity to ask the Minister: who is responsible for the programme now, where does that accountability lie, and how will Parliament be able to scrutinise its performance going forward?

Better use of data has a real role to play in NHS reform, and the FDP may well prove to be part of that answer. Success will depend on more than just delivery; it will depend on confidence within the system: confidence from clinicians that the system helps rather than hinders them, confidence from patients that their data is properly protected and confidence from the public that our decisions are transparent, proportionate and properly accountable. If those conditions are met, this reform can succeed. If they are not, even the best designed system will struggle. We, as His Majesty’s loyal Opposition, will support what improves care and welcome what works, but will continue to ask questions that ensure reform is done properly in a way that sustains public trust. I look forward to the Minister’s response.

Meningitis Outbreak

Neil Shastri-Hurst Excerpts

Tuesday 17th March 2026 Commons Chamber

[Wes Streeting]

I am very grateful to my hon. Friend for his question, and I am mindful of the concerns of neighbouring communities across his part of London and the wider south-east. I can provide reassurance on two points. The general risk is low because of the nature of the transmission of this disease and because of the active contact tracing that is under way, on which UKHSA has done a particularly impressive job, given the unusual nature of this outbreak. We can be reasonably confident that we are tracing people and managing risk in that way. Even as students return home from university, we are managing the risk, proactively contacting people and making antibiotics available. We are preparing for a targeted vaccination campaign in the coming days, but we are also considering the wider cohorts that UKHSA may deem necessary to vaccinate.

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

I know from my time in medicine that all those involved in combating this outbreak will be working at pace, and they have our utmost respect. However, there will be concern about the report in The Independent in the last hour or so that certain pharmacies in the region are running out of or running low on the menB vaccine. Will the Secretary of State commit to looking into that personally and ensure that we get a robust supply chain?

[Wes Streeting]

I can understand that some people may choose to buy the vaccine, but I will reassure the hon. Gentleman on two points. First, we have a significant stockpile of vaccines. Secondly, we are taking an evidence-based approach to vaccination, starting with the targeted vaccination programme that UKHSA is preparing. We are thinking about additional cohorts, and we always keep an eye on our medicine supply more generally.

Defibrillators

Neil Shastri-Hurst Excerpts

Tuesday 2nd September 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Stringer. I also congratulate the hon. Member for Bishop Auckland (Sam Rushworth) on securing this important debate, and I start by sending my condolences to George Smith’s family at this very difficult time.

Many Members may know that, before coming to this place, I was both a doctor and a barrister. As a doctor, I worked predominantly in acute care, so I have seen the brutal speed with which cardiac arrest can lead to death. But as a barrister, I specialised in inquests and clinical negligence, and I also saw what happened when people did not get timely interventions, and the devastating consequences that arose.

As many Members have set out, the stark reality is that every minute counts. Every minute reduces life expectancy by 10%. If someone gets prompt intervention, their survival rate can be as high as 70% if their defib is within 200 metres of their location. That is a three-to-five-minute brisk walk there and back. But the stark reality is that out-of-hospital arrests have a survival rate of less than one in 12. Compared with in-hospital arrests, the survival rate to discharge is in the region of 25%. That is why this was an important focus for me when I was elected to Parliament for Solihull West and Shirley.

Despite the fact that my constituency has a mix of urban and semi-rural places, only 40.32% of our defibs are within the recommended distance and there are only seven public defibs per 10,000 people, which is well below the national recommendation. Across the United Kingdom, the per-population count for defibs is approximately five to 10 times lower than it is in a country such as Japan. That cannot be right in this day and age, which is why, for one of my office fundraisers this year, we all went and did the Solihull way. We walked 20-odd miles in the day, and raised money for two defibs and some bleed kits on behalf of a brilliant charity called the Daniel Baird Foundation. It was particularly moving to be able to donate one of those defibs to the Wave café in my constituency, where a valued member of the community had sadly died some months earlier because they did not have access to a defib.

I am going to reiterate a couple of calls that have already been made to the Minister, who I know has been listening carefully. First, we should exempt defibs from VAT—it is ridiculous. For every five defibs that are currently bought, we could afford another if we got rid of VAT.

[Douglas McAllister (West Dunbartonshire) (Lab)]

I agree with the hon. Member that this is a UK-wide issue. However, my concern is the potential for inequality and the need to ensure that poorer communities such as my constituency, where 63% of postcodes are out of direct reach of these lifesaving machines, are not left behind. The hon. Member referred to the fact that he is a barrister; believe it or not, because public and community access is essential, defibs are often stolen or vandalised, so does he agree not only that a VAT exemption would help to tackle the issue of inequality in poorer constituencies, but that we should consider creating a specific criminal offence to help to protect these vital machines?

--- Later in debate ---

[Dr Shastri-Hurst]

The hon. Member makes a really important point. The consequences of vandalism or damage to this equipment can be life-changing—it can end a life. The ramifications have to be clearly pointed out and reflected in the law of the land.

Secondly, my hon. Friend the Member for Dumfries and Galloway (John Cooper) and I recently wrote to the Secretary of State for Transport about expanding education on lifesaving skills as part of driving tests, and we should also incorporate it more into the national curriculum. Will the Minister speak to her colleagues in the Department of Health and Social Care and the Department for Transport about ensuring that everybody in this country knows not only where a defib is but how to operate one, to enable lifesaving interventions as quickly as possible?

Mental Health Bill [ Lords ] (Ninth sitting)

Neil Shastri-Hurst Excerpts

Committee stage
Tuesday 24th June 2025 Public Bill Committees

[Dr Evans]

I beg to move, That the clause be read a Second time.

I rise to speak in support of the new clause, which was tabled by the Conservative party. It would place a duty on the Secretary of State to review the effectiveness of the regulatory authority’s role under the Mental Health Act 1983 within one year of the Act’s passage.

Allow me to provide the current legal and regulatory context. Under the framework in the Mental Health Act 1983, the Care Quality Commission, which is the regulatory authority in England, is tasked with monitoring and regulating providers of mental health services. We have debated some of this, and there are issues still to be addressed.

The CQC inspects hospitals, community mental health teams, and other relevant services to ensure compliance with statutory safeguards and standards. It publishes reports on providers and issues recommendations where it identifies failings. Additionally, there is an existing reporting framework under the Act whereby the Secretary of State is expected to oversee and ensure the Act’s proper implementation, with periodic ministerial reports to Parliament and CQC inspection outcomes made publicly available. However, there is currently no statutory requirement to review the CQC’s own role and effectiveness in carrying out these specific mental health functions. The gap means that although providers are scrutinised, the regulator itself escapes similar structured accountability and review.

This question was debated in the other place and I welcome the comments from the Minister in the Lords, Baroness Merron, who, in a letter, rightly highlights existing transparency measures. She states that,

“findings from CQC’s monitoring activity are reported annually in their Monitoring the Mental Health Act report, which is laid before Parliament and published publicly.”

That is true. She also notes the annual quality account reports produced by NHS healthcare providers under the Health Act 2009, which cover patient safety, treatment effectiveness, and patient feedback. True. Those are indeed important components of the current oversight framework, and we support the continuation and strengthening of those transparency mechanisms.

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

My hon. Friend makes a powerful point about transparency, but it is not just about that. Does he agree that it is also about having an evidence base that allows reform and improvement of the regulator?

[Dr Evans]

I do, and to expand the point, this is about understanding the performance of CQC as well. We know from the Dash report and from Mike Richards that there are, and have been, concerns about CQC performance. That is at the heart of this new clause—to try to make sure we actually look at the performance and regulation of the regulator. Those reports focus on the performance of mental health services and providers, but they do not amount to a dedicated statutory review of the regulator itself—specifically, the CQC’s role, effectiveness, and capacity under the Mental Health Act.

Annual reports primarily reflect the CQC’s monitoring outcomes rather than a comprehensive, independent evaluation of whether its regulatory functions are being discharged optimally, or whether it is adequately equipped to meet the new challenges posed by the legislation. In other words, reporting on what the regulator monitors is not the same as reviewing how well the regulator performs its duties.

The new clause would address that distinct gap by mandating a focused review with a parliamentary report and a Government response, thereby strengthening accountability at the regulatory level. The new clause aims to establish an additional layer of scrutiny, not duplicative reporting. It would require the Government, within 12 months of the Bill becoming law, to conduct a formal review of the CQC’s effectiveness, specifically in regulating mental health services under the 1983 Act. It mandates an assessment of whether the CQC is adequately fulfilling its duties, including monitoring, inspection, and enforcement responsibilities, as well as whether it will be capable of carrying out its duties under the new legislation. Given the well-documented problems in mental health, it seems entirely appropriate to address the key point: is the regulator regulating effectively?

[Dr Shastri-Hurst]

My hon. Friend makes a strong point about having a review to ensure that the regulator is operating effectively. Does he share some of my concerns that a one-off review may not demonstrate ongoing oversight and scrutiny of the performance of the regulator?

[Dr Evans]

We do not want to introduce too much bureaucracy, but ensuring an accountable statutory mechanism to ensure adequate oversight is incredibly important. Much of the debate about the Bill has been about whether we put things in primary legislation or in policy, or whether we allow policy and legislation to be done at a secondary level—or even leave them for the organisation to deal with. My concern with the CQC is that we have not seen the organisation step up in the way that it should do. That does not mean that it is not making progress, but we need to see further progress.

--- Later in debate ---

[Dr Chambers]

I beg to move, That the clause be read a Second time.

The new clause would require the number of patients transferred to hospitals outside their area to be reduced to zero within five years, and the Secretary of State would have to produce a report on how this would be achieved. We should not underestimate the harm and distress caused to patients and their families when they are allocated an out-of-area mental health placement. At the end of March 2024, there were 900 active out-of-area placements in England, of which 89% were deemed inappropriate.

Patients must be treated in a centre close to their home and family, and that can be achieved by increasing capacity and co-ordination between services. The new clause calls on the Secretary of State to publish guidance within six months of the Bill’s passage, setting out what processes and funding will be available for that purpose. Vulnerable people deserve to be treated near to their families and home, and the new clause would ensure that happens.

[Dr Shastri-Hurst]

The new clause is underpinned by noble intentions, but does the hon. Gentleman believe that patients would be better served if such a process were in guidelines rather than in the Bill? That would ensure that it is deliverable.

[Dr Chambers]

I welcome the hon. Gentleman’s comments. That is a sensible and insightful point, and I will take on board the Minister’s response too.