Hughes Report: Second Anniversary

Sarah Green Excerpts

Wednesday 11th February 2026 Westminster Hall

[Sarah Green (Chesham and Amersham) (LD)]

I beg to move,

That this House has considered the second anniversary of the Hughes Report.

Although it is a pleasure to open this debate under your chairship, Dr Allin-Khan, I do so with a sense of déjà vu, because we have been here before, on the anniversary last year and in debates on the Cumberlege review before that. The issue of redress for the victims is a well-trodden road.

I start by paying tribute to the many individuals who have campaigned tirelessly for justice and change, and to prevent their experience from happening to others. I thank the Patient Safety Commissioner, Professor Henrietta Hughes, for the work she put into her report. She is with us in the Gallery today, along with many campaigners. I put on the record my thanks to Baroness Cumberlege for her exceptional work, before the Hughes report, to give voice to victims during the two years she led the Cumberlege review. I pay tribute to her for her continuing commitment to the victims.

We are here today because, two years on from its publication, the Government have still not published an official response to the Hughes report. No redress scheme has been implemented and no timeline has been announced. We have repeatedly been told that the recommendations are being carefully considered, yet there is no date, no framework and no mechanism for justice in place. To be clear, the Patient Safety Commissioner did not decide one day to write the report; she was asked to pull it together and to look at the options for redress for those harmed by valproate and pelvic mesh. The report was commissioned by the Department of Health and Social Care in late 2022.

In her foreword to the report, Professor Hughes was clear that, in accepting the commission,

“the case for redress had already been made by the First Do No Harm review so my report would primarily focus on ‘how’ to provide redress rather than ‘why’…Secondly, patients must not be subjected to an emotional rollercoaster, meaning that commissioning this work would inevitably raise expectations and that it would be profoundly unfair to do so if the government had no intention of providing redress.”

[Chris Vince (Harlow) (Lab/Co-op)]

I thank the hon. Member for bringing this important debate to Westminster Hall. I secured a debate on the Cumberlege report 18 months ago; I said at the time that I hoped it would be the last time we debated this issue, yet here we are again. Does the hon. Member agree that the emotional impact on the women involved is hugely important? I was approached by a number of constituents in my constituency, including Debbie, who joined me for my debate. It is so important that the review’s recommendations are acted on.

--- Later in debate ---

[Sarah Green]

The emotional toll is significant. It is a daily struggle for some of those affected, and they are battling a system.

Right at the start of her report, the Patient Safety Commissioner was clear that she should not be asked to look into the options for redress for those harmed by valproate and mesh if there was no real intention or desire in the Department to make a redress scheme a reality. Why commission the report and raise the expectations of thousands of families if there was never any intention to follow through on the recommendations?

As colleagues know, 30,000 women and children have been harmed, through no fault of their own, by valproate and pelvic mesh. They are paying the price of the failure to keep them and their children safe with immense pain, agony, fear and guilt. Five years on from the Cumberlege report and two years after the Hughes report, the Government have still not confirmed plans to provide financial redress. Financial redress is unfinished business, and it is past time that the Government responded.

Let us not forget that of those affected by valproate and mesh, 85% report not being able to work, 73% report that their finance has suffered as a result, 91% report that their mental health and wellbeing are adversely affected—as the hon. Member for Harlow (Chris Vince) just said—and 88% report that their relationships have been negatively impacted.

Let me unpack that for a second. Those statistics represent my constituent Carol, a doctor by training who was forced to take long-term sick leave and see her health and her career deteriorate. They represent the valproate families who, on top of the physical effects, face the nightmare of child and adolescent mental health services and personal independence payment reassessments every few years, having to explain what foetal valproate spectrum disorder is to every clinician they encounter because it is not widely understood. They represent the heartbreaking situation of one victim who shared with me, in tears, the devastating impact that mesh has had on her ability to be intimate with the love of her life. The lack of a clear timeline for action by the same slow, dismissive system that harmed patients is further compounding their physical and mental pain.

[Calum Miller (Bicester and Woodstock) (LD)]

My hon. Friend is making a powerful speech. Although financial redress is an incredibly important part of the Hughes report, it also lays out other important elements, such as healthcare and special educational needs and disability provision. My constituent Debra has two sons. It was only when her second son went to school that the school realised there might be something affecting both boys due to her taking sodium valproate. She had to battle against the system and is now having to drive her eldest son to university because, suffering from autism, he is unable to make that journey using public transport. Does my hon. Friend agree that those recommendations are also an incredibly important part of the Hughes report?

[Sarah Green]

I do agree with my hon. Friend and thank him for his intervention.

[Laura Kyrke-Smith (Aylesbury) (Lab)]

This is about so many different aspects of support. One of the recommendations in the Hughes report that has been drawn to my attention is the one on housing, which is so crucial. My constituent was prescribed sodium valproate during pregnancy. Her son, who is now 25, lives with foetal valproate syndrome, requires 24/7 support, and will do for the rest of his life. My constituent said that even relatively modest adjustments to their home and some specialist equipment could make a real difference, but she has not found any way of getting funding for that. Does the hon. Member agree that housing is also a really important area for us to look at?

[Sarah Green]

I do agree, and I thank the hon. Member for raising it.

I know that many colleagues present have been championing this cause for years. There is a string of parliamentary questions going back to the launch of the report two years ago, asking for progress updates. The Patient Safety Commissioner herself used her statutory powers for the first time, in October last year, to ask for more detailed answers from the Department of Health and Social Care. The responses were published in November and just a few weeks ago in January. We now know that there have been meetings, roundtables and briefings, but no progress on redress. If I am reading between the lines of these responses correctly, it is the dead hand of the Treasury that is the issue.

Before I conclude, I wish to mention Carol. I have shared Carol’s story before, and I return to it today because it lays bare the cost of years of Government inaction. When I first met her online—I hope she will not mind my saying this—she was a physical wreck. She needed assistance to get a visa to the US during the pandemic for urgent medical treatment following a hysteropexy and rectopexy using surgical mesh. A procedure that was intended to resolve her pelvic organ prolapse instead caused devastating harm.

Carol was left with a serious autoimmune disease, struggling to walk and unable to live her daily life. Her prognosis was bleak, and she needed to have the mesh urgently removed. That treatment was not available to her on the NHS. While suffering from chronic pain, and with limited mobility, Carol accessed private treatment in the United States. A combination of determination, medical knowledge and personal resources allowed her to do so, and Carol is now mesh-free following a successful surgery.

Carol attempted to pursue a clinical negligence claim against the surgeons who harmed her, but multiple law firms declined to act because the same surgeons were advising them on other cases. Those conflicts of interest blocked Carol’s access to justice. In one case, the surgeon who caused her life-changing harm acted as an expert witness in an unrelated mesh case. The judge in that case found that the surgeon selectively chose evidence supportive of the defence, failed to provide balanced evidence, and failed in his duty to the court. That finding is on the record.

Such conflicts are not isolated. Conflicts of interest and the closing of ranks among professionals remain a structural barrier to justice for victims. That is just one of the reasons why an independent redress scheme is long overdue. The current system is failing these women, children and families.

I have two questions for the Minister. What conversations are she, her Department and her officials having with the Treasury and Downing Street to make redress a reality for the victims? Will she meet some of the affected families to hear directly from them why redress is so important to them?

[Several hon. Members rose—]

--- Later in debate ---

[Sarah Green]

In his November letter to the Patient Safety Commissioner to which the Minister referred, the Under-Secretary of State for Health and Social Care, the hon. Member for Glasgow South West (Dr Ahmed), states in reference to redress:

“Additional information is still required on the practicalities of further action on this area. This includes approaches to cost and affordability, legislation and scope of any potential redress. No final timetable has been agreed at present.”

The thoughtful and insightful contributions we have heard today show that Members are not going to stop asking the question. In tribute to the many families and campaigners, who are so inspiring and yet exhausted, I hope very much that we are not here in 12 months’ time dusting down the same speeches and chasing for progress.

Question put and agreed to.

Resolved,

That this House has considered the second anniversary of the Hughes Report.

Terminally Ill Adults (End of Life) Bill (Twenty First sitting)

Sarah Green Excerpts

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Danny Kruger]

I want to speak briefly in support of the hon. Lady’s amendment and also in support of amendment 310, tabled by the hon. Member for York Central. The hon. Member for Richmond Park is absolutely right. I will not rehearse her argument, which is very straightforward. The question is: what other reason could there be to justify a co-ordinating doctor transferring the case? The Committee might reject that amendment, in which case I hope they will accept the amendment tabled by the hon. Member for York Central, which specifies that whatever the reason, particularly if it is other than death or illness, it is important for the High Court or the panel to be notified of the substitution and the reason why.

[Sarah Green (Chesham and Amersham) (LD)]

Maternity leave is one reason and retirement might be another.

[Danny Kruger]

Those might be appropriate reasons; I hope that can be specified. The crucial thing is that if there is an unwillingness—not an incapacity but an unwillingness—to proceed, that is of some concern. It is not that they are no longer able to do it—possibly for the reasons that the hon. Lady suggested—but if there is an actual unwillingness to proceed, what is the reason?

On amendment 309, if the first doctor is replaced for whatever reason, surely it is imperative that the new doctor conduct their own assessment, rather than taking the previous doctor’s word for it. A doctor is legally responsible, obliged under all medical regulation and law for their actions, and they cannot rely on a previous assessment. If the first doctor gave up the case because of some kind of incapacity—an illness, or, indeed, their demise—it might be that their own judgment was impaired at the time. I would have thought it was obvious that the new doctor should take responsibility for conducting an assessment and proceeding with full responsibility for the case.

--- Later in debate ---

[Sean Woodcock]

May I say what a privilege it is to have you in the Chair, Mrs Harris? [Laughter.] Clearly, I know how to win and lose an audience.

I rise to speak to amendment (d) to new clause 21, which has been tabled by my hon. Friend the Member for Derby North. I will start by saying how glad I am that the promoter of the Bill, my hon. Friend the Member for Spen Valley, has recognised some of the concerns regarding the multidisciplinary panel, and I welcome the improvements that she has made in the new clause.

I am pleased that the panel “must” now hear from the person to whom the referral relates, whereas previously it was the case that the panel “may” hear from them. That is a partial concession, but an important one. It will allow the commissioner to have greater scrutiny over the application and better assess the person’s eligibility for assisted dying.

Amendment (d) is a technical amendment. We have discussed a number of such amendments before in this Committee, many of which have fallen for reasons that I understand, even if I do not agree with them, including on the basis that doctors are already having these conversations and we do not want to police them. The panel stage is brand new; given that and given the level of public scrutiny of the Bill, I make no apology for supporting putting something into primary legislation to say what is expected of this process. It is very important that we make sure from the off that we get things right.

I am deeply concerned about some of the potential oversights in the panel model. The purpose of the panel is to provide meaningful scrutiny of a person’s application. The panel draws on a wider range of experts to assess the complex aspects of the application, such as assessing for coercion and capacity. However, the panel’s ability to fulfil this scrutinising role is in many ways quite limited.

Amendment (d), which was tabled by my hon. Friend the Member for Derby North, would address the significant oversights in new clause 21. It would introduce a far more comprehensive set of requirements for the panel in its review. Those changes are not barriers to access; rather, the amendment would ensure that the panel has a far wider range of information—a theme to which I referred earlier—on which to review the application for an assisted death. Fundamentally, the amendment would give the panel more tools to conduct meaningful scrutiny.

However, let me list what the panel is not required to do under new clause 21. It does not have to hear from one of the two registered medical practitioners. It will hear from the other registered medical practitioner, perhaps via audio link, but it does not have to question them. Likewise, it will hear from the person, perhaps via audio link, but it does not have to question them. The person may have a proxy to sign their declarations, but the panel does not have to hear from or question the proxy. The panel does not have to hear from or question any other person. Let us be clear who that includes: the panel could assess the person’s application without any information from the person’s relatives, family members, friends, social workers or care workers.

New clause 21 states only that the panel

“may ask any person appearing to it to have relevant knowledge or experience to report to it on such matters relating to the person to whom the referral relates as it considers appropriate.”

Subsection (4) makes it clear that, whereas paragraphs (a) to (c) require the panel to hear by live audio from the person seeking assisted dying, the evidence that the panel chooses to take from anybody else could be in written form.

Let me draw out with an example what that might mean in practice. A person is diagnosed with a terminal illness—in this case, heart failure arising from coronary heart disease. Both doctors approve the person’s application for assisted dying, on the balance of probability. The person has a physical disability and asks a proxy—a neighbour, say—to sign off the application. The first doctor speaks to the panel via video link restating the schedule forms and providing no new information. The panel then hears from the person, also via video link. It cannot see the person, but after hearing their statement it decides that it is satisfied that the conditions are met and approves the person’s assisted death.

The panel has not spoken to the second doctor and has not put any questions to the second doctor or to the person applying for an assisted death. Incredibly, the panel has not spoken to the proxy, who may just be someone of good standing in the community. Nor has it spoken to the person’s relatives, to anyone standing to benefit from the person’s death or to anyone in the person’s care. Any one of those people could have concerns that the person is being coerced into an assisted death. They may even have evidence of coercive behaviour. However, at no point is the panel required to consider speaking to any of those people.

Time and again, the Committee has heard from experts that coercion and controlling behaviour can be extremely difficult to detect. Often, the person will not reveal that they are suffering from that form of coercion, yet it is often those who are closest to the sufferer—a close relative, a member of the family or a social worker—who pick up the signals. Any of them could be looking out for the person’s welfare and noticing them becoming more isolated and emotionally manipulated by another. At no point, however, does the panel have to consider hearing from that person. If this Bill is going to do everything to safeguard against the risk of coercion, as everybody on this Committee believes it should, that should change.

The panel must consider listening to the people closest to the person. Amendment (d) to new clause 21, in the name of my hon. Friend the Member for Derby North, would address those flaws by giving the panel a higher standard of scrutiny. The panel would have to hear from and question both doctors. It would have to question the person, not simply hear from them. If the person has a proxy, as under clause 15, the panel would have to hear from and question that proxy. Crucially, the panel would have to consider hearing from and questioning persons properly interested, and any other person who has provided treatment or care for the person being assessed in relation to that person’s terminal illness. It would also be able to hear from and question any other person whom new clause 21 states can be asked to report to the panel.

The changes in the amendment would significantly improve the scrutiny provided by the multidisciplinary panel. It would provider a broader range and greater detail of evidence for the panel to base its review on. Ultimately, it would make the multidisciplinary review far more meaningful. Why is this greater scrutiny necessary? This is about protecting the vulnerable people who are easily forgotten. The amendment seeks to provide the strongest possible protection for them. This robust and comprehensive scrutiny is necessary to have a better chance of preventing the worst abuses.

I foresee one possible criticism from some hon. Members, which is that the amendment would slow down the decision-making process for people who are at no risk of coercion. That may well be true, but if the amendment is accepted, the panel would have to question both doctors, not just hear from one, and it would have to determine whether to hear from and question other people. In straightforward cases, in which the panel discovers no initial evidence that disquiets it, a small amount of time might be added to the hearing; in cases in which the panel finds evidence that means it may need to dig deeper, there could be a greater delay to the decision.

Personally, I do not see how we can avoid that. If we are serious about having safeguards to protect the most vulnerable, we should and must accept it. The process of vetting applications will take more time on average, and a lot more time in some cases, but the alternative is a simpler and faster system in which it will be much harder for the panel to detect coercion and other disqualifying factors. In that case, the chances will be higher that some coercive or abusive people will find it possible to push people towards an assisted death. Such a system is what we see in new clause 21, as drafted. We face an inescapable trade-off. We cannot lift protection for those who are most vulnerable to coercion because it would make the process easier for people who do not face that risk. I urge hon. Members seriously to consider supporting the amendment.

[Sarah Green]

I rise to speak to two aspects of this group of amendments. The first is the inclusion of social workers. When we first started receiving written evidence, I found the submissions from social workers the most compelling. I agreed with them that their profession has a key role to play in the process. I am pleased that they will feature on the panel: I believe that that will strengthen the safeguards in the Bill.

My second point relates to amendment (a) to new schedule 2, in the name of the right hon. Member for Dwyfor Meirionnydd. I was fortunate to grow up in a Welsh-speaking part of rural north Wales. I am a Welsh speaker, and Welsh is the first language of some of my friends, my neighbours and my family members. It is the language that they dream in, the language they count in and the language that they are most comfortable using, so when it comes to end-of-life conversations it is important that they can use the language in which they are most proficient and fluent.

Should an individual choose to access an assisted death through the medium of Welsh, they should be able to do so without the use of an interpreter. Crucially for the panel, that means that where an individual has chosen that route, the panel will need Welsh proficiency. Welsh speakers have had the right to ask for services in Welsh for years now, so assisted dying should be no different. That is why services in Welsh need to be on the face of the Bill. I wholeheartedly support the amendment and will vote for it if the right hon. Member chooses to press it.

[Sojan Joseph]

I will not talk for long, because most of my points have already been raised. I welcome the provisions in new schedule 2 on membership of the panel. I was concerned about all patients having access to a psychiatrist and a social worker, so the measures proposed are welcome and reassuring. My reservation, which other hon. Members have raised, is that it would be even better for people to have earlier access to the panel. I am also concerned about whether the panel would have the power to overturn the decisions taken by the two doctors and whether it might be influenced by them.

In addition, will the Health Minister clarify his response to amendment 1? He said that specifying one category of doctor, a registered psychiatrist, would create capacity issues. I hope that that will not be an issue when we have a psychiatrist on the panel. Otherwise, I welcome the proposals.

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

Sarah Green Excerpts

Committee stage
Tuesday 4th March 2025 Public Bill Committees

[Kim Leadbeater]

I am done.

[Sarah Green (Chesham and Amersham) (LD)]

We have had a good debate on the amendments in this group. I do not intend to push amendment 278 to a vote, and I have nothing further to add to my previous remarks. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendment proposed: 8, in clause 4, page 2, line 16, leave out from “practitioner” to end of line 20 and insert

“shall raise the subject of the provision of assistance in accordance with this Act with a person who has not indicated to that or another registered medical practitioner that they wish to seek assistance to end their own life”.—(Daniel Francis.)

Question put, That the amendment be made.

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

Sarah Green Excerpts

Committee stage
Tuesday 4th March 2025 Public Bill Committees

[Liz Saville Roberts]

While I agree with the hon. Member in principle, I am operating within the law in terms of Welsh and English, because there are legal considerations with those two languages in particular.

In the matter we are discussing, the ability for the person to communicate as directly as possible is of the greatest importance. I wonder whether the Minister will respond by saying that the codes of practice in clause 30 will be sufficient, but I emphasise that I took advice from the Welsh Language Commissioner’s office, and it was the Welsh Language Commissioner’s officer who advised that I table the amendments. We are operating in unique circumstances with this being a private Member’s Bill, and we need to have clarity on what is required in relation to how the legislation operates between England and Wales.

[Sarah Green (Chesham and Amersham) (LD)]

The hon. Lady will know that the Welsh Language Act 1993 put the Welsh language on an equal footing with the English language in Wales. Does she agree that it would be helpful to have clarity on whether the provisions in that Act apply to the Bill?

[Liz Saville Roberts]

That is exactly what I am seeking to do, and I am seeking to do it as co-operatively and collegiately as possible. But we need to have clarity on this, and our discussions need to be thorough and exact in order to be accurate.

When it comes to the individual’s right to use Welsh in their daily lives, two pieces of legislation are relevant to the Bill: the Welsh Language Act 1993, which predates devolution, and the Senedd’s Welsh Language (Wales) Measure 2011. The Welsh Language Act remains applicable for reserved matters, such as justice, and the Ministry of Justice operates a Welsh language scheme that enables people to use Welsh in courts, tribunals and other areas of justice. The Welsh Language Measure established the office of the Welsh Language Commissioner, who has the power to investigate complaints from Welsh speakers who assert that their freedom to use Welsh has been interfered with; created a Welsh language tribunal to hear appeals against the commissioner’s decisions; and enabled the development standards, which are particularly significant here.

The Welsh Language Measure states that individuals in Wales should be able to conduct their lives through the medium of Welsh if that is what they choose to do. Under the Measure, the NHS in Wales has a statutory duty to deliver services to the public in both Welsh and English. The Welsh language standards are a set of statutory requirements that set out responsibilities to provide services, and they apply to health boards in Wales, as well as to NHS primary care services that are contracted by the health boards. The standards do not apply to independent providers, which since 2019 must follow six Welsh language duties, one of which is to establish and record the language preference of patients. That is where I have got the terminology used in amendment 413.

That is a summary of the relevant considerations but, before I close, it is important to say why this matters to Welsh speakers. I spoke recently to medical practitioners in Wales who wanted me to emphasise their concerns at the lack of specific mention of language rights. I also spoke to the Welsh Language Commissioner’s officers, who advised me on the necessity of the amendments. There is a critique against providing Welsh language services that shrugs its shoulders and says, “Why bother? They all speak English anyway.” That is to ignore how integral language use is to the individual.

We are drafting a Bill to do two things in a very delicate balance: to respect the autonomy of the individual and to safeguard people against abuse in any form. For many Welsh speakers, Welsh is the language of their emotions. It is the language in which they express themselves most fluently, and the first language of their feelings. It matters to this Bill. English is the language of authority, and many Welsh speakers are anxious not to challenge the authority of high-status people such as doctors. They do that out of ingrained politeness, and out of fear of not being able to access services if they put any barriers in the way. That is the way that language gets used. Welsh speakers do not use Welsh in the way that monolingual English speakers use English; monolingual English speakers use English because it is the only language they have. For anyone who is bilingual or multilingual, the use of language is very complicated and sophisticated, and we need to be alert to it in all its respects.

I return to the nature of the relationship between doctors and their patients. Doctors have high status, and a patient approaches a doctor seeking services, advice and context. That is not a power dynamic that we should allow to go unchecked, so I urge the Committee to consider the amendment. I do not intend to press it to a vote, but I want a response from the Ministers. Before Report, I want absolute clarity on its legal necessity or otherwise. I feel instinctively—especially because the Welsh Language Commissioner’s office has told me this—that it should be in the Bill. I would also like a response from Ministers on amendment 414, tabled by the hon. Member for Ipswich.

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

Sarah Green Excerpts

Committee stage
Wednesday 26th February 2025 Public Bill Committees

Initial discussions with registered medical practitioners

[Sarah Green (Chesham and Amersham) (LD)]

I beg to move amendment 278, in clause 4, page 2, line 16, leave out from beginning to “nothing” in line 16 and insert—

“(1A) No registered medical practitioner may raise the subject of the provision of assistance in accordance with this Act with a person if that person has made an advanced decision which has been recorded in their medical records that they will not in future wish to seek assistance under this Act.

(1B) The provisions in subsection (1A) do not prevent a person indicating to a registered medical practitioner that they wish to change their previous decision and seek assistance under the Act if they have the capacity to do so.

(2) Other than the condition in subsection (1A),”.

This amendment would prevent a doctor from raising assisted dying with a patient if that patient had previously recorded an advanced decision that they would not in future wish to seek assistance under the Act.

--- Later in debate ---

[Sarah Green]

I will be brief. Amendment 278, tabled by my hon. Friend the Member for Wells and Mendip Hills (Tessa Munt) has some merit. It seeks to offer a more formal protection to those who are certain that they do not, and will not, want to avail themselves of the choice to end their life if they are terminally ill at any point in the future. It attempts to do so through an advance decision recorded on their medical records.

A person’s ability to record their wishes now, as opposed to at some future crisis point, might allay a number of concerns, in particular for those who are fearful of coercion. Being able to say, “This is not for me”, and knowing that it will not be raised with them, might offer some people a degree of reassurance, so I think that the amendment has some merit. It also allows for such an advance decision to be reversed—it allows for people to change their mind.

What is not clear to me is how enforceable this provision would be, or what legal status such an advance decision would have. I have great sympathy with the aim of the amendment, so I am keen to hear from the Minister on the point. It may be that an alternative amendment that achieves a similar aim can be tabled to a later clause, if amendment 278, as drafted, is not workable.

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

Sarah Green Excerpts

Wednesday 29th January 2025 Public Bill Committees

[The Chair]

Colleagues will have noticed that there is a slight delay on the line. Take account of it when asking questions and ask them briefly, please.

[Sarah Green (Chesham and Amersham) (LD)]

Q 157 I am keen to hear about the training, education and clinical supervision you have in place for assisted dying. Perhaps I will address that to Dr Fellingham, but I am sure you could all answer.

Dr Fellingham: Certainly. The training is very stringently developed, and very rigorously tested. Our management training practice, which is required of all doctors who want to practice assisted dying, was developed by our colleagues in the Australian Centre for Health Law Research at the Queensland University of Technology. It drew on extensive research that the group had conducted around the world to create an online training package that takes at least a day to complete and covers a huge amount of things that are of great concern. Not unsurpris-ingly, it includes things like how to assess capacity, how to detect coercion, how to assess for voluntariness, and how to determine the various different eligibility criteria that apply in our Western Australian law.

To be able to access that training and become a voluntary assisted dying practitioner, a person already has to be a doctor of quite some standing in their own specialty. They have to be a consultant in a specialty with at least one year of full-time practice under their belt, or a general practitioner with at least 10 years of broad experience. We are not talking about junior doctors being able to offer this; we are talking about doctors of significant clinical standing with a very broad range of patient experiences. They put themselves forwards and do that training, and then that training has to be refreshed and updated every three years.

I have five hospitals in my health network, and together with my colleagues I developed a very comprehensive package of training, education and awareness that is tailored for people who may have a role in this at various different levels, from a nurse on the ward all the way through to someone who actively taking part in the process. A very wide range of documents and training packages have also been developed by our Department of Health. In addition, all practitioners who work in this space are invited to become members of our community of practice, where we share peer education and experiences. We also have guest speakers from national and international viewpoints to continue to educate us as a group, and to ensure that our practice is consistent and in line with local and international standards.

[The Chair]

Do either of the other witnesses want to come in on that?

Dr McLaren: When we started this in Victoria, we saw a bit of a gap with the implementation. A lot of the education was surrounding the legalities of providing an assessment service in a way that conformed with the legislation, rather than that focused on the clinical skills and applications. I am quite proud of the role that we have had in rolling that out, in providing that peer experience, and in focusing more on some of the clinical skills that apply within a VAD context.

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

Sarah Green Excerpts

Committee stage
Wednesday 29th January 2025 Public Bill Committees

[The Chair]

Colleagues will have noticed that there is a slight delay on the line. Take account of it when asking questions and ask them briefly, please.

[Sarah Green (Chesham and Amersham) (LD)]

Q 157 I am keen to hear about the training, education and clinical supervision you have in place for assisted dying. Perhaps I will address that to Dr Fellingham, but I am sure you could all answer.

Dr Fellingham: Certainly. The training is very stringently developed, and very rigorously tested. Our management training practice, which is required of all doctors who want to practice assisted dying, was developed by our colleagues in the Australian Centre for Health Law Research at the Queensland University of Technology. It drew on extensive research that the group had conducted around the world to create an online training package that takes at least a day to complete and covers a huge amount of things that are of great concern. Not unsurpris-ingly, it includes things like how to assess capacity, how to detect coercion, how to assess for voluntariness, and how to determine the various different eligibility criteria that apply in our Western Australian law.

To be able to access that training and become a voluntary assisted dying practitioner, a person already has to be a doctor of quite some standing in their own specialty. They have to be a consultant in a specialty with at least one year of full-time practice under their belt, or a general practitioner with at least 10 years of broad experience. We are not talking about junior doctors being able to offer this; we are talking about doctors of significant clinical standing with a very broad range of patient experiences. They put themselves forwards and do that training, and then that training has to be refreshed and updated every three years.

I have five hospitals in my health network, and together with my colleagues I developed a very comprehensive package of training, education and awareness that is tailored for people who may have a role in this at various different levels, from a nurse on the ward all the way through to someone who actively taking part in the process. A very wide range of documents and training packages have also been developed by our Department of Health. In addition, all practitioners who work in this space are invited to become members of our community of practice, where we share peer education and experiences. We also have guest speakers from national and international viewpoints to continue to educate us as a group, and to ensure that our practice is consistent and in line with local and international standards.

[The Chair]

Do either of the other witnesses want to come in on that?

Dr McLaren: When we started this in Victoria, we saw a bit of a gap with the implementation. A lot of the education was surrounding the legalities of providing an assessment service in a way that conformed with the legislation, rather than that focused on the clinical skills and applications. I am quite proud of the role that we have had in rolling that out, in providing that peer experience, and in focusing more on some of the clinical skills that apply within a VAD context.

Cumberlege Review: Pelvic Mesh

Sarah Green Excerpts

Thursday 5th December 2024 Westminster Hall

[Sarah Green (Chesham and Amersham) (LD)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I thank the hon. Member for Harlow (Chris Vince) for securing today’s debate. We are here because four years after being published, the Cumberlege review has not been implemented and there is still no redress scheme. I will turn in more detail to the progress made on those recommendations, but first I pay tribute to the many individuals who have campaigned so hard for so long to be heard, for their experiences to be taken seriously, to receive some sort of justice, and to know that the same harm will not be done to others. Some of them are in the Public Gallery today and I thank them for their tireless campaigning.

I also pay tribute to the right hon. Member for Godalming and Ash (Jeremy Hunt), when he was Health and Social Care Secretary, and to the former Member for Maidenhead, when she was Prime Minister, for commissioning the review in the first place in February 2018. Baroness Cumberlege has never stopped giving voice to those she encountered during the two years she led that review. She has gone to great lengths to keep this issue on the agenda. She is due to retire shortly and we will miss her. I would like to say how grateful I am, as I know others will be, not just for her advocacy on this issue but for her encouragement and support of hon. Members in this place to do the same. If I may be so bold, Baroness Cumberlege has played her part. It is now up to us in this place to hold this new Government to account and to ensure that her recommendations are implemented in full.

Let us not forget that the Cumberlege review was called “First Do No Harm”, because at its centre are people who suffered avoidable harm—harm done to them by our health system. I was first introduced to this issue by my constituent Carol. I have shared her story before and remain in awe of her dignity and desire to help others despite having experienced the most devastating medical trauma. She needed her MP to help her get a visa for the United States for urgent medical treatment during the pandemic because of the travel restrictions that hon. Members will remember. She had undergone a hysteropexy and a rectopexy using surgical mesh.

Instead of resolving Carol’s pelvic organ prolapse, the procedures left her with a serious autoimmune disease, struggling to walk and unable to continue her normal daily life. She had to take long-term sick leave from her job as a doctor and could not remember a day without pain. When she contacted me for help with her visa, she was seriously unwell and had been told that she urgently needed her mesh removed or her prognosis was not good. We managed to get her the visa she needed. She is now mesh-free following a successful removal, and she is the first person in England to have undergone successful rectal mesh removal. She is still suffering, but is no longer in the same danger that she was. She is clear that she was able to look outside the NHS and the UK only because her medical training and personal resources enabled her to find Dr Veronikis, who treated her successfully. I should say at this point that there needs to be more awareness of rectopexy mesh, which affects men, women and children.

Carol and others like her were given hope when the Cumberlege review was initiated, and again when it was published in July 2020 with its nine recommendations. I am sorry that to say that not enough progress has been made on those recommendations since. The reality is that only two of the nine recommendations have been implemented in full. The first was an apology, which was given as soon as the report was published. The second was to establish the office of the Patient Safety Commissioner.

Beyond that, things have stalled. Recommendations 3 and 4 called for an independent redress agency, and for redress schemes to be established for all three interventions. After originally rejecting those two recommendations, the Health Minister at the time asked the Patient Safety Commissioner in late 2022 to look at the options for providing redress for those who had been harmed by mesh and valproate. The commissioner’s report—the Hughes report—was published in February. I was present at its launch, and it really felt like a milestone; it felt as though progress had been made. Surely the Department would not commission that work if it had no intention of following through on a redress scheme.

That was in February this year. By the summer, when the election was called, the previous Government were still saying that they would respond to the report, so they never gave a formal response. To date, there has been no official response from the new Government to the Hughes report. In the words of the Patient Safety Commissioner:

“it is now urgent for the government to give those families some clarity. Many of them live with pressing financial hardship, as well as physical pain and disability…we must not compound the physical and mental harms experienced by these families by setting and raising false expectations if there is no intention to deliver on redress.”

[Mrs Hodgson]

I am grateful to the hon. Lady for covering the recommendations, which I was not able to do. That has relieved me somewhat. We have at last seen some compensation for the victims of Windrush, the infected blood scandal and the Horizon scandal. Does she agree that it is incumbent on the Government to treat this scandal with the same seriousness, fully accept recommendation 4 and put the redress scheme in place?

[Sarah Green]

I could not agree more. This is where I must pick up Carol’s story again. She tried to pursue her claim against her original surgeons through the courts, and she hit on an unexpected problem. She approached multiple legal firms who would not take her case because one or both of the surgeons were advising them on other cases and, as such, it would have been a conflict of interest. Indeed, the same surgeon who caused Carol life-changing injuries acted as an expert witness in an unrelated surgical mesh negligence case. The judge in that case said:

“he had cherry-picked those parts of the evidence which were supportive of the Defendant’s case and did not comment on those parts which were consistent to the Claimant’s. That is not the correct approach to be taken by an independent expert, whose duty is to the court. His evidence lacked balance and was unpersuasive.”

On this occasion, the judge called it out, but that is not the only instance of the medical profession closing ranks—it is not a unique occurrence. Such clear bias and conflicts of interest are a huge barrier to justice for mesh victims around the country.

The point of recommendation 3 in the Cumberlege review was to establish a non-adversarial avenue for redress after someone has been harmed in a healthcare setting. Both the Hughes report and, more recently, the Darzi report found that the current clinical negligence system is difficult for patients to navigate and prevents the healthcare system from learning from its mistakes. It is also eye-wateringly expensive for the taxpayer. If it is the dead hand of the Treasury blocking a redress scheme, Ministers would do well to reflect on that. As the Patient Safety Commissioner points out, the clinical negligence system is behind only nuclear disarmament and pensions on the list of liabilities on the Government’s balance sheet. I must ask the Minister when the Department will respond to the options outlined in the Hughes report, and when families can expect to see redress schemes up and running.

Recommendation 5 relates to the establishment of mesh centres around the country, and while such centres have been established, they get mixed reports from patients. My question on the mesh centres is about their outcomes. How is the Department ensuring a consistent service across them all, and how are outcomes being measured? With so many people reporting dissatisfaction with the centres, it is not enough that they exist; they need to be working well for the patients they are there to serve. Recommendation 6 relates to the MHRA, and it is clear that we still need the yellow card reporting system to improve. I would also welcome the Minister’s thoughts on progress against recommendation 7, which is about creating a central patient-identifiable database. To my understanding, it is still a work in progress.

The previous Government’s decision not to take forward the eighth recommendation, which is for a mandatory register, is disappointing. The recommendation called for

“Transparency of payments made to clinicians”

and

“mandatory reporting for pharmaceutical and medical device industries of payments made to teaching hospitals, research institutions and individual clinicians.”

I fail to understand why more progress has not been made on that. I know that campaigners have written to the Department asking it to consider a sunset Act that speaks to that recommendation, and I urge the Minister to chase a response to them.

[Graham Stringer (in the Chair)]

Order. The 10-minute time allocation is up. I now move to the official Opposition.

Oral Answers to Questions

Sarah Green Excerpts

Tuesday 5th March 2024 Commons Chamber

[Maria Caulfield]

I am very sorry to hear about the experience of my hon. Friend’s constituent. That level of care is absolutely unacceptable. I know he has raised this particular issue with the Patient Safety Commissioner, Henrietta Hughes, but I am very happy to meet with my hon. Friend and his constituent to discuss those complaints, because that care is not acceptable.

[Sarah Green (Chesham and Amersham) (LD)]

6. What steps she is taking to reduce waiting times for gynaecology treatment.

[The Minister for Health and Secondary Care (Andrew Stephenson)]

At Buckinghamshire Healthcare NHS Trust, the number of gynaecology patients waiting more than 52 weeks reduced by over 30% between August and December, but I sympathise with the many women who are still waiting too long. NHS England has been doing targeted work to help trusts with the most long waiters to support gynaecology patients in the community where appropriate, and to find specialist services that can treat them as quickly as possible.

[Sarah Green]

My local NHS trust recently stated that the average wait for a gynaecology appointment is 18 weeks, with patients starting treatment within 24 weeks, but that does not include those on cancer pathways. One of my constituents who had been identified as having abnormal cells in her cervix waited more than 60 weeks for a diagnostic assessment. She is one of many contacting me with tales of long delays for gynaecology appointments and paying to go private out of desperation. What steps is the Department taking to reduce waiting times for gynaecology assessments and treatment for those on cancer pathways?

[Andrew Stephenson]

Significant investment is going in to reduce both general wait times and cancer wait times. More patients on the cancer pathway have been seen than ever before; nearly 220,000 patients were seen last December following an urgent GP referral for suspected cancer, representing 117% of December 2019 levels. We continue to keep this under review and continue to strive to make the system go faster and reduce the elective backlog.

Oral Answers to Questions

Sarah Green Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Victoria Atkins]

I thank the hon. Gentleman for bringing some insight into how we can best reach families. Of course, it is not just mums, but fathers or carers who can have a huge impact on our children. That is why the Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), is investing so much energy and commitment in our family hubs. We believe that they can be the centre for families to make the very best start to a child’s life.

[Sarah Green (Chesham and Amersham) (LD)]

2. What recent progress her Department has made on supporting the timely discharge of patients from hospital into social care.

[The Minister for Social Care (Helen Whately)]

Discharging people on time is better for them and frees up hospital beds. We are changing how our health system works to do that: joining up health and social care and care transfer hubs; helping people to recover at home, with more than 10,000 new virtual ward beds; and investing in social care. And it is working. Last month, delayed discharges were down 9% compared with the end of December 2022 despite almost 1,000 extra urgent admissions to hospitals every day in December.

[Sarah Green]

Nearly one in six beds in my local healthcare trust in Buckinghamshire continues to be occupied by patients fit for discharge. A recent King’s Fund report found that the Government’s current practice of providing one-off funding to reduce delay, while welcome, comes with insufficient advance notice to allow for effective planning. What steps is the Minister’s Department taking to ensure the best use of this funding?

[Helen Whately]

One reason we distributed discharge funding back in April last year was to give more advance notice to organisations, so that they could put in place what is needed to speed up discharges. I say to the hon. Lady that our plan is working. That is why, in her own trust, discharges at the end of December were down by a third compared with the previous year.