Children’s Health
Simon Opher Excerpts(2 days, 17 hours ago)
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Dr Simon Opher (Stroud) (Lab)
I beg to move,
That this House has considered children’s health.
I thank the Backbench Business Committee for granting this incredibly important debate. This Government’s ambition is to raise the healthiest generation of children ever. There is so much about improving child health in the 10-year plan, “Fit for the Future”. I am genuinely quite excited about the 10-year plan—maybe I am sad, but that is the sort of thing that excites me. I have been a GP for 30 years, and I have a special interest in child health and child mental health. I will talk briefly about prevention, mental health and then paediatric services.
First, obesity is a massive problem in young people. At the age of five, 10% of children are obese. By the age of 11, 22% are obese—and that does not count the children who are overweight. This starts in pregnancy. We must ensure that pregnant women have really healthy diets, because that reduces obesity. When a baby is born, parents need to be aware that follow-on milks and “hungry baby” milks are basically just milk packed full of sugar. That will not do the child any good. If they are hungry, they need to change their diet and possibly go on to solids. Baby snacks often look healthy—they might have a nice, healthy carrot on them—but when we look at what is in them, they are packed full of sugar as well. Parents need to have a clear idea of what is healthy, so that they can choose the healthiest foods for their children.
The Government are going to bring in a watershed for junk food advertising—it was going to be in October, but it is now promised for January 2026. That is incredibly important, because young people are very sensitive to advertising. A recent report in The BMJ found more than 90 different sponsorship deals in football and six other sports with foods that are high in fat, salt and sugar. We need to look at that issue, because young people look up to sports stars and are very influenceable. They have to advertise healthy foods, because otherwise we will continue to have an obesity epidemic.
In the 10-year plan I was delighted to see measures in the national planning policy framework about fast-food outlets near schools. We must stop those. They are cynically placed close to schools, and they are particularly prevalent in more deprived areas. A couple of other things that I am delighted about include free school meals for children from households in receipt of universal credit. Free school meals have an obvious relationship to obesity and tend to bring it down. I am also delighted that in the autumn we will look at school food standards, and hopefully reduce the amount of processed meat that seems to be in a lot of school foods. The other part of the 10-year plan that excites me is the mandatory health food sales with supermarkets. That has been evidenced to reduce obesity, so I am delighted about that. Let me move on quickly to physical exercise—I am keen for other Members to get the opportunity to talk—because 50% of children are not sufficiently active, and two-thirds cannot swim 25 metres.
Rachel Taylor (North Warwickshire and Bedworth) (Lab)
Does my hon. Friend agree that the previous Government’s lack of investment in vital leisure facilities, such as the swimming pool in Atherstone in my constituency, which is overdue for renovation, is causing many of these problems? The lack of PE in schools and the lack of safe places for children to play, be active and get involved in sport is causing some of the obesity problems.
Dr Opher
I totally agree—indeed, my hon. Friend pre-empts some of my remarks.
Another proposal in the 10-year plan involves the investment, through Sports England, of £250 million into such opportunities for children. The Starlight Children’s Foundation promotes play and exercise, and I am a particular fan of adventure playgrounds in urban areas, which allow children to cut loose, particularly after school, expend energy, and have fun in a safe setting.
I am also working with colleagues on access to nature. It is incredibly important that every child has access to nature, so that they can explore nature and have that type of exercise. I also stress that 50% of children have active travel—bike or walking—to get themselves to school. Let us increase that; let us try to get more children cycling and walking to school, as that will increase their fitness.
Dental care is also in the 10-year plan. I am delighted to see that supervised brushing is already there, and also that fluoride varnish will be applied by people to prevent dental caries from occurring. I will give a quick shout-out on asthma prevention, which is key and all about air quality. I know some young people who, since the ultra low emission zone scheme was introduced, have stopped using their inhalers because pollution has gone down. That is something we must emphasise.
Adam Jogee (Newcastle-under-Lyme) (Lab)
On air quality, will my hon. Friend join me in paying tribute to the Stop the Stink campaigners in Newcastle-under-Lyme, who fought so hard to clean the air around schools such as St Mary’s primary school on Silverdale Road? Their work helped to make the lungs of our young people that bit healthier.
Adam Jogee
Will my hon. Friend join me in calling on the Government to adopt World Health Organisation levels for particulate matter 2.5?
Dr Opher
I am afraid that is not my special area, but it sounds like a good idea and I thank my hon. Friend. Because we cannot see clean air, we do not realise what it is doing, but people genuinely need their inhalers less, and particularly for young people with asthma that is incredibly important.
I want to talk quickly about early years support. In Gloucestershire, an organisation called Home-Start involves volunteers going into the homes of women who have just given birth to support them. Interestingly, women who have had that support often go on to be volunteers. It is a fantastic organisation. This week I was delighted that the successor to Sure Start, Best Start family hubs, is coming back. Sure Start was one of the most glorious things that the Blair Government did, and it affected the health of young people enormously. I am pleased that childcare is getting much more funding. Furthermore, as set out in the 10-year plan, Healthy Start will be restarted in 2026-27, providing money to pregnant women and children aged one to four whose families are in financial difficulty, helping those who are less well off.
Mental healthcare is in a bit of a crisis. Some 25% of young people have mental health issues. We spend only 10% of NHS funds on mental health, but it contributes to over 20% of morbidity. About a million people are on the child and adolescent mental health service waiting list at the moment, and I know that Ministers are doing all that they can to bring that down. To prevent poor mental health, we need to look at exercise, as I have mentioned, and at music in schools, which is proven to reduce rates of mental ill health. I am backing the National Education Union campaign to get rid of SATs, which cause enormous tension and stress in young people.
On treatment, I am delighted that we will have mental health support teams in every school—I understand that 60% will be in place by next April, and 100% by the end of this Parliament. We will have 8,500 more mental health workers and a whole-school approach. I particularly endorse the mental health first aid training that has happened in some Stroud schools, and I have also been looking at the Young Futures hubs.
With the massive CAMHS waiting list—in my area, people sometimes have to wait for two years—and the sudden increase in neurodiversity, we need to look at schemes that use creative and social prescriptions to deal with those children while they are on the waiting list. Given the right support, I reckon a lot of them will not need specialist psychiatric assessment. I am chair of the beyond pills all-party parliamentary group. Are hon. Members aware that one in eight 12 to 17-year-olds have been put on a selective serotonin reuptake inhibitor antidepressant? That is scandalous.
This year, I hosted a roundtable at the Royal College of Paediatrics and Child Health. Children are generally waiting longer than adults for care, which we must turn around. As I said, there are often long waiting lists for mental healthcare. Sadly, Harry, the son of my constituent, Louise Turner, had a sarcoma and died at the end of last year. She reports that the nursing staff and doctors were fantastic, but there was a lack of facilities, such that sometimes they would turn up for chemotherapy but there was no bed for Harry, so they had to go away and come back the next day. Going forward, we must ensure that that does not happen.
What is the solution? We need to get paediatric care out of the hospital and into the community. We need to get hot paediatrics—feverish kids—seen in the community, potentially by paediatricians or well-trained GPs. Furthermore, during GP training, which I have carried out for about 25 years, it is essential that every single doctor who becomes a GP has time in a paediatric assessment unit. The main feedback from the roundtable at the Royal College of Paediatrics and Child Health was that we must involve children in designing paediatric services, otherwise they will not work.
Several hon. Members rose—
Dr Opher
I will not keep hon. Members long; I know it is late on a Thursday and people want to get back to their constituencies. I thank all hon. Members, including the Minister and Opposition Members, for staying and giving excellent speeches.
If we get children’s health right, it will bring a whole lifetime of benefits. That is why child health is so important. It is about getting them to do regular exercise, which will continue for life, and to have a decent diet, which will also continue for life, making them the healthiest generation we have ever known, so I thank Members and the Minister very much.
Question put and agreed to.
Resolved,
That this House has considered children’s health.
GP Funding: South-west England
Simon Opher Excerpts(2 weeks, 3 days ago)
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Dr Evans
The hon. Lady is spot on. I posed my question to the Government because we know that primary care is one of the most efficient parts of the NHS. Why? Because the people running those businesses—they are businesses, and we have to be open and honest about that—pay attention to where the money comes in and goes out. They take full pride in it, first, because they care, and secondly, because their salaries are paid from the profit that comes out of that. Again, “profit” is a dirty word that people do not like to use, but it is the reality of what we are dealing with when it comes to how we break down the funding.
The Government have proposed to get rid of NHS England, and it is still unclear not only how much that will cost, but how much it will save and where the administrative burden will fall. On top of that, we do not know what will replace the partnership model if we lose it, and this is the question to be asked. Given that it was only six months before the election that the Secretary of State stated his intent, I too am keen to find out the answer.
I have a second question to pose to the Government. There are concerning reports this month in the Health Service Journal, which has had sight of a leaked version of the Government’s 10-year plan to improve the NHS. It says that the plan will push back the Government’s ambition to increase the share of NHS spending on primary and community care to 2035, rather than 2029 as originally promised. Can the Minister confirm or deny those reports?
When it comes to funding, the Government raised taxes directly on GPs as part of the national insurance increase. Has the Department made any assessment of how much of the £886 million uplift that has been allocated to GP practices will be needed to meet the increase in employer’s national insurance contributions?
I turn to the figures for the ARR scheme. The Government announced in April that they thought they had reached 1,500 new GPs, but as the RCGP pointed out at the time, although having
“more GPs employed in the workforce is encouraging, when considering full time equivalent GPs—which gives the most accurate picture of the GP workforce and the care and services GPs are able to deliver for patients—the numbers published today are lower, at 851 GPs”.
The increase is encouraging, but when we dig into the data, it appears that we are simply seeing more locum doctors coming back into the scheme. I would be grateful to understand exactly how the numbers are made up, and where the inference of 1,500 GPs comes from.
More importantly, where is the scheme going in the future? Is it time-limited? Will it continue? Will it be expanded and, if so, what does that look like? Although it is an important part of addressing provision, we also need to understand exactly what is going on. Initial reviews of the data suggest that appointments have not kept up with the pace of the introduction of GPs, so I am interested to understand from the Minister why, despite the supposedly new GPs coming in, the number of appointments has not increased proportionately. I would be grateful for any comment on that.
Finally, I turn to recruitment. Training new GPs has understandably been seen as the priority when it comes to solving the long-term workforce problems in England. As Pulse magazine puts it:
“This is probably one of the areas of workforce planning that could be considered a success. Health Education England, which has been incorporated into NHS England, has been able to meet its target of over 4,000 new GP trainees a year.”
The NHS workforce report, launched under the previous Government in 2023, made commitments to increase that. It set goals to increase the number of GP specialist training places to 6,000 by 2031, ensure that all foundation-year doctors do a rotation in general practice, and require GP registrars to spend the full three years in general practice.
There has been progress, but along with progress come new problems. The British Medical Association has warned that up to 1,000 GP registrars could face difficulty when qualifying in summer 2025 without funding for GP practices to recruit newly qualified, unemployed or underemployed GPs. What active steps are the Government taking to avoid that, and what support will they be offering newly qualified GPs?
Dr Simon Opher (Stroud) (Lab)
The ARR scheme in my practice at May Lane surgery in Dursley is employing newly qualified GPs who provide a lot of extra appointments for the surgery, so the scheme is working quite well for newly qualified GPs.
Dr Evans
I am pleased to hear that the scheme is working well, but the question is—as the hon. Member would know if he had been here for the start of the debate and all the way through it—what does it look like going forward?
In other places, are locums simply being stepped into the ARR scheme because there has been a shift in the way that GPs commission their work and PCNs are looking to deal with that? That is the question at the heart of it. We seem to be training more GPs than ever, yet at the same time, we have a disproportionate number of people at the top end who are not able to find work.
It is important to build up multidisciplinary teams that take account of the pharmacists, nurses and mental health workers around GPs, and I welcome the fact that the ARR scheme allows that. It has been widened to get more funding but, as the hon. Member will know, there is a discrepancy in how much doctors are funded for and there are limitations on how long they can work in the scheme. If I were to return to practice, I would not qualify under the scheme. The Government need to pose these questions; although the scheme is welcome, does it solve the whole problem? I do not think so, and my final set of questions relates to that.
We have seen a trend in international medical graduates coming to work in the UK, with the number of international medical graduates overtaking domestically trained medics for the first time in 2023. Have the Government considered something similar to the Australian scheme? Australia classifies locations using the modified Monash model or the Australian statistical geography standard to rank areas from major cities to remote regions, and then prioritises overseas doctors into the areas of most need. That could help to deal with the disparities across different parts of the UK. Will the Government consider that model in attempting to address those disparities? Whether it is right for the UK is for the Government to decide.
Hospitals might save your life, but your GP has been quietly guarding it for decades. That fact is often lost in our debates, so it has been a privilege to remind the Government, the House and the public of that fact today. I look forward to the Government’s response.
Terminally Ill Adults (End of Life) Bill
Simon Opher ExcerptsFriday 13th June 2025
(4 weeks, 1 day ago)
Commons ChamberRead Full debate Terminally Ill Adults (End of Life) Bill 2024-26 View all Terminally Ill Adults (End of Life) Bill 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Consideration of Bill Amendments as at 13 June 2025 - large print - (13 Jun 2025)
Rebecca Smith
I thank the hon. Member and I will come to that point very soon. I will now make some progress; I will not take any further interventions.
I struggle to see how removing automatic oversight of assisted deaths squares with a commitment to enact legislation with the “strongest safeguards in the world”. By doing so, the Bill sets a lower bar for scrutiny and review, and creates an information deficit. Put another way, we simply do not know what we do not know. Implementing a novel piece of legislation such as this without ensuring the most robust possible scrutiny of deaths taking place under the Act is astonishing. Under the Bill, assisted deaths would be the outlier, as any other intentionally procured death would automatically be reviewed by a coroner. Why should deaths under this legislation be any different?
Requiring automatic scrutiny from a coroner for assisted deaths should not be viewed as an add-on at the end of the process or perhaps just a safety net, although it is that.
Rebecca Smith
No, I have already said that I am not going take any further interventions. I have been very generous with my time.
It is imperative to consider the whole picture, particularly regarding malpractice or coercion—whether that be on the part of medical professionals, families or third parties. In written evidence to the Committee, Dr Rees Johnson, a legal expert from Essex Law School, highlights that, in some cultures,
“decision-making is a collective process involving family and community members.”
Rebecca Smith
No.
Beyond coercion, automatic inquests provide vital opportunities to identify other critical issues that may not otherwise be picked up. Without a coroner’s inquest, there would be no post-mortem examination. This is not merely an academic point; studies have shown that autopsy reveals that one in four cases have been misdiagnosed. Without this oversight, as His Honour Judge Thomas Teague KC, the former chief coroner, notes, there is
“no certain means of knowing whether the approved substance has led to a quick and painless death, or a lingering and distressing one, or even whether it had failed to cause death altogether and the deceased had been dispatched by manual asphyxiation or some other unlawful means.”
I am not sure whether that could be more clear. The view of experts in this area—both the Royal College of Pathologists and the former chief coroner of England and Wales—is that this Bill’s proposals, as drafted, are not fit for purpose. I strongly urge hon. Members to support my amendment (a) to new clause 15.
Alison Hume
New clause 15 particularly addresses the role of coroners. Coroners investigate deaths in which there is a reasonable suspicion that the deceased has died a violent or unnatural death, where the cause of death is unknown, or if the deceased died while in custody or state detention. This is not the case with an assisted death, and there would already be strong safeguards in place, including multiple layers of oversight and assessment. The process is cautious, thorough, and heavily safeguarded. There is no need to investigate an assisted death, as it is not unnatural. In this country, it is still a crime to help someone die peacefully and with dignity, even when they are suffering unbearably from a terminal illness.
Alison Hume
I will make some progress, thank you.
It is still a crime, even when the person is of sound mind and even when it is their deeply considered wish. Anthony wanted a good death—he wanted to die peacefully and with grace, without pain and without profound suffering. He got that in a foreign country, far from home and far from family, because our laws force people like him to make that desperate journey abroad. That is why I support this Bill and, in particular, new clause 15, as there is no need for coroners to investigate an assisted death.
Alison Hume
My hon. Friend makes a powerful case on behalf of her constituent. New clause 15 is a compassionate and practical clause, ensuring that the Bill works not only for the individual making the choice, but for the families they leave behind. Let us not turn our backs on people like Anthony and Louise; let us not make criminals out of the compassionate. The death of a loved one is always difficult. When someone has gone through the legal and safeguarded process of assisted dying, it is not right that their family should face an unnecessary, potentially lengthy and distressing coroner’s investigation.
Alison Hume
I am coming to my conclusion. New clause 15 will protect bereaved families such as that of my constituent Anthony, and therefore I urge hon. Members to support it.
Ellie Chowns
I am very short of time, so I think I had better continue.
Turning to new clause 15, which relates to the role of coroners, if the Bill is passed, assisted dying would be a very strictly regulated process—the choice of an individual; not a death caused by others, but by the individual themselves. As Aneez Esmail has pointed out, this would be the most scrutinised type of death in the country, and it therefore makes no sense to require another legal process at the end when there have already been multiple layers of scrutiny before the death.
Ellie Chowns
I am so sorry, but we are very short of time.
New clause 15 is a compassionate and practical clause. There are strong safeguards already in place, and requiring a coroner’s inquest would go against the spirit of compassion that should be driving us all.
I will briefly turn to amendment 42, tabled by the hon. Member for Newcastle-under-Lyme (Adam Jogee), which would remove the backstop commencement. Essentially, the amendment would leave it in the hands of the Secretary of State to decide when, or if, the Bill comes into effect. That would go against the will of the House. If the House passes this Bill, it is perfectly reasonable and workable for the detail of it to be worked out within the next four years. We have already doubled the length of time allowed for that to happen. Amendment 42 is effectively a wrecking amendment that seeks to kick the Bill into the long grass. [Interruption.] That would be its effect.
To conclude, I will briefly address the misconception that seems to have informed some of the comments I have heard in today’s debate, which is the assumption that families would want to pressure family members to die quicker. My mum is a specialist palliative care social worker, and she has told me that in all her years of practice she has never experienced that happening. It is the other way around.
Blair McDougall
The hon. Member makes an important point that we have to consider. We must recognise that, as he says, people’s choices are limited by the unfair distribution of wealth, the injustices that disabled people face throughout their life, or the attitudes of the powerful in society towards those who are less fortunate.
Blair McDougall
I will come to that point shortly.
We have a duty to ask whether the poorest and most vulnerable will be coerced into choosing assisted dying over palliative care because of economic disadvantage. Will they be exploited by those with a financial interest in their choosing to end their life? Will their death become a commodity? If we are really going to pass legislation that allows someone’s death to become a matter of business, we must have full transparency on those financial motivations, and my amendment 15 would require that. If we are really going to pass legislation that allows someone’s death to become a matter of business, we must have full transparency on those financial motivations, and my amendment 15 would require that.
Carers in the private sector are not bad people any more than people working directly in the NHS, but private healthcare operates in a context. The evidence that profit influences the moral choices made in the care and treatment that is already provided in this country is overwhelming; this is not a hypothetical concern. For example, a systematic review published by The BMJ found that private equity ownership of healthcare is associated with lower standards of care. Around the wonderful miracle of IVF there is an industry profiting from people’s desperation as they start life rather than end it. Already, at the end of life—this relates to the point made by my hon. Friend the Member for Stroud (Dr Opher)—choice in palliative care is limited by economic status, with the wealthy more likely to die a good death than the poor. My amendment seeks to address the fundamental question of whether free choice really is free by bringing into daylight the financial motivations of those involved in individuals’ decisions.
Blair McDougall
My hon. Friend makes an important point. Amendment 15 seeks to recognise that there is a difference in where private providers’ income stream comes from and that that raises moral issues.
Blair McDougall
I do not wish to exacerbate your bronchitis, Madam Deputy Speaker, so I will continue.
Amendment 15 touches on a fundamental point at the heart of the debate. Disabled people and the sick, in every aspect of their lives, have to fight every day for resources from a state, a market and a society that view them as a drain on finances. Do we honestly believe that at the moment when the most vulnerable are least able to argue for themselves, under the most intense societal and cultural pressure, and at their most expensive, those same public and private sector institutions will succeed in making choice real for them when they have failed to do so throughout the rest of their lives? Even if we stretch credulity and convince ourselves that that will be true in the state sector, can we say that it will be true in the market? I do not believe that the Bill should be passed, but if it is, let us not make it worse by allowing unscrutinised profit from the loss of human beings.
Lloyd Hatton (South Dorset) (Lab)
I rise to speak in support of new clause 15 and amendment 54, and against new clause 5. As right hon. and hon. Members will be aware, new clause 15 would not classify a death under the Bill as suspicious or unexpected, so a full coroner’s inquest would not be needed.
If the Bill becomes law, assisted dying would be a legal, strictly regulated and well monitored choice made freely by the individual concerned. To be absolutely clear to hon. Members, it is not assisted suicide. The Bill concerns people who want to live but who, faced with an inevitable, irreversible and terminal diagnosis, want choice over the manner of their death. That is an important choice that removes some of the trauma and anxiety for not only the patients but their family and loved ones. New clause 15 and its consequential amendment 54 will ensure that families who are naturally grieving the loss of their loved one are not needlessly subjected to an invasive coroner’s investigation.
Lloyd Hatton
I share my hon. Friend’s sentiment. I firmly believe that we should protect bereaved families against such a distressing ordeal happening automatically, particularly when the process, as set out in the Bill, will already be legal and transparent.
With that in mind, it makes practical sense to support new clause 15. If we pass legislation to permit assisted dying with the full weight of the law behind it, we must also respect that choice in the way that we classify and record such deaths. Those deaths would not be in any way unexpected or suspicious, so to classify them as such would simply be inaccurate.
As has already been touched on in great detail today, if the Bill is passed, it would implement the most robust assisted dying framework anywhere in the world. It already includes multiple layers of oversight. In my view, the process is cautious, thorough and robustly safeguarded. A retrospective investigation would be to duplicate the process, and risks suggesting wrongdoing when none has occurred.
Mental Health Bill [Lords]
Simon Opher ExcerptsMonday 19th May 2025
(1 month, 3 weeks ago)
Commons ChamberRead Full debate Mental Health Bill [HL] 2024-26 View all Mental Health Bill [HL] 2024-26 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts Amendment Paper: HL Bill 93 Running list of amendments – 14 April 2025 - (14 Apr 2025)
Dr Simon Opher (Stroud) (Lab)
I am delighted to speak about this new Mental Health Bill. It follows up on the Mental Health Act 1983, which is as old as our Secretary of State, as we heard. What I have heard throughout the debate is that mental health affects us all in some way. It touches all of us, whether personally or through people we know really well.
I welcome the greater protections under the Bill, especially for people with learning disabilities. I also welcome early intervention, the stress on out-of-hospital care and the idea of advance choice. People who have repeated psychoses know exactly what they want when they are well. When they become ill, they can become paranoid about their family and their friends, and they are not rational. That is one of the reasons why sometimes they need to be detained under the Mental Health Act. If they have an advance choice document, they can at least say what they would like while they are in a normal state of mind. That is important, and I look forward to that measure.
I like the fact that police stations are being removed as a place of safety. I am concerned about how sections 135 and 136 of the Mental Health Act are being used. I notice that there are some schemes in which mental health workers go out with the police and work together with them, and that is crucial. A close relative of mine became extremely unwell, though it was not quite as awful as what happened to the hon. Member for St Neots and Mid Cambridgeshire (Ian Sollom). First, they were sectioned in an A&E department, and then no bed could be found for 48 hours for this poor relative of mine. The heroic nurses and consultants had to look after someone who was acutely psychotic. That simply is not is not tolerable in our system. We need to find a place quickly for people who are mentally ill, and we have to make sure that they get the best treatment, so that they can get better quickly, while protecting the rest of the NHS.
This close relative of mine was moved to a bed 140 miles away from her family. We must ensure that we get more sufficient beds and more local provision. I know that will take time, and that mental health provision is not in a good state, but I hope that with this legislation and our new Labour Government, we can change that, so that people do not have to travel out of area for mental health provision.
I am impressed by the idea of crisis hubs. I have worked with the Stroud crisis team for many years as a GP, and I have always felt that, given a bit more strength and a bit more resource, they could keep a lot of people out of hospital and from being sectioned, but they need that resource. They also need close working with consultant psychiatrists.
Claire Young (Thornbury and Yate) (LD)
One of my constituents waited more than eight hours in a mental health crisis for 111 to get back to them, in which time their mental health deteriorated. Previously, they accessed a dedicated local support line, which gave them prompt access to professional support. Does the hon. Member agree that prompt access to support in a crisis is vital to reducing the need for the greater degrees of intervention covered by this Bill?
Dr Opher
That is certainly true, but we need to be careful, because part of the issue is the resources for mental health, rather than the Mental Health Act. We must not blur the two. The current Government are putting 8,500 mental health workers into the system, and I am delighted about that. Hopefully, it will prevent the waits for mental health assessments that people are having to put up with.
I want to say something about “appropriate medical treatment” and “therapeutic benefit”, to which the Bill refers. Some 8.7 million people in this country are on antidepressants, and about 25% of those people are trying to get off them. The harm that these drugs can do includes an increased risk of suicide when people are first going on to them and when they are coming off them, as we have seen in a couple of recent, tragic cases. They can also cause fairly long-term sexual dysfunction. I am asking the Medicines and Healthcare products Regulatory Agency to put proper warnings on its leaflets, and I am also asking for a special service to help people come off antidepressants, because doing so is extremely difficult and most GPs are not particularly well informed about the best ways of doing it. It has to be done extremely slowly.
My hon. Friend the Member for Whitehaven and Workington (Josh MacAlister) talked about ADHD and autism, and what should be done about neurodiversity. I feel that we should be extremely careful in mental health services not to over-medicate people with so-called neurodiversity, and I look forward to speaking to my hon. Friend about that. I had to nip out of the Chamber for half an hour earlier, to talk to the head of a neurodiversity taskforce which will report in July. What I think it needs to do is bring about a much more supportive service rather than going straight for medication, which is what seems to happen when people are referred to private psychiatric clinics. At present, the level of Ritalin-like substances with which people with ADHD are treated has increased by a factor of 500%—and, interestingly, that increase has occurred in social class 1 rather than social class 5. There is something here that we need to get a grip on: we need to provide proper services for people with ADHD.
I was interested by the comment from the right hon. Member for Godalming and Ash (Sir Jeremy Hunt) about families. When it comes to mental health, families are crucial, and I would like to adapt the Bill slightly to make them much more central and responsible. The concept of a family could be extended to certain other people whom a person, when well, could nominate, but families are the crux in a lot of psychiatric care. Their input must be valued, and they must be involved.
This is a very good Bill, and it is about time we had it. I support all its greater protections, and I believe that it will reduce the number of compulsory detainments.
Hospitals
Simon Opher Excerpts(2 months, 2 weeks ago)
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Dr Simon Opher (Stroud) (Lab)
I must confess that I am slightly surprised that the Lib Dems have brought forward an Opposition day debate about hospitals and are stating their case in such a way, because the last thing we need in this country is a load of promises we cannot keep. I am proud that we Government Members have provided sustainable and affordable plans for the new hospital programme. I have been on the doorstep the last few weeks in the run-up to the county council elections, and the No. 1 priority that comes up is GP access. We have provided 1,500 new GP posts in this country, and waiting lists have been going down for the last five months. Emergency dentistry is also very commonly brought up on the doorstep, and we have provided 700,000 new dentist appointments.
There are many other parts of the NHS that are crumbling. I see the crumbling of the hospital buildings as a metaphor for what has happened to the NHS over the last 14 years.
Melanie Ward (Cowdenbeath and Kirkcaldy) (Lab)
My hon. Friend is talking about the important work done by Lord Darzi, and the findings on crumbling hospitals in England. He may be interested to hear that recent figures show that the bill for the high-risk repairs needed to Scottish hospitals stands at £64 million. Those repairs have not been carried out under the SNP. They include two high-risk repairs that are badly needed, and have been outstanding since 2016, at Cameron hospital in Fife, which is used by some of my constituents. Does my hon. Friend agree that the Scottish Government should use some of the record funding provided to them by this Labour Government to fix our hospitals in Scotland?
Dr Opher
Of course it is essential that we maintain hospitals so that they are safe to treat patients in, so I agree with my hon. Friend about spending the money. In fact, the backlog bill for repairs in the NHS runs to £13.8 billion. I work as a GP in a GP practice, and I note that Lord Darzi estimates that £37 billion more should have been spent on the NHS since 2010, but was not. For those of us working in the NHS, it does feel like that. There is a massive building project ahead of us.
I point out that the previous Labour Government built 100 new hospitals. One was the Vale hospital in Dursley, which we started in 2008, and which I had a hand in. As hon. Members have said, community hospitals such as Vale hospital are crucial to how the NHS works. We must invest in our community hospitals and use them properly. The Vale hospital provides excellent minor injuries unit services, a specialist stroke service and in-patient beds for the community. We must invest in our community hospitals going forward. As we have heard, there were meant to be 40 new hospitals in the last few years, but none of them got built, and it turned out that they were not even funded.
We need to get care out of hospitals and back into the community. The hon. Member for Oxford West and Abingdon (Layla Moran) talked about GP premises; 20% of GP premises were built before the inception of the NHS, and I inherited one of those premises in Dursley. Twenty years ago, we opened a purpose-built surgery at May Lane, and we are still enjoying the benefits; it provides patients with excellent services. We must therefore invest. I was glad to see the Government investing £100 million in GP surgeries. I was pleased to see £80 million put into GP advice and guidance; that will allow consultants to give GPs advice, so that they can care for patients in the community. I am also really delighted with the push for neighbourhood health centres; that must be the way. We must bring back the family doctor, as that continuity of care is what really makes patients better. That is so important.
We must also integrate health and social care in the community, so that we can pull patients out of hospital. That also applies to emergency care, as far too many people are having to go to overwhelmed A&Es at big district general hospitals. At the moment, only 20% of acute admissions go through GPs, who are the best people to ensure that we avoid admissions. We have to change all of this. Our NHS staff and patients deserve better; they deserve facilities that reflect the excellence of the care provided within them. The Labour Government are committed to rebuilding not just our hospitals, but trust, and the integrity of our public services.
Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting)
Simon Opher ExcerptsTuesday 18th March 2025
(3 months, 3 weeks ago)
Public Bill CommitteesRead Full debate Terminally Ill Adults (End of Life) Bill 2024-26 View all Terminally Ill Adults (End of Life) Bill 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 18 March 2025 - (18 Mar 2025)
Stephen Kinnock
The right hon. Member sets out clearly the difference between self-administration—the concept at the heart of the Bill—and the performance of the act either jointly or by the doctor. The latter is not permitted under the terms of the Bill; the former is. That is where we are.
Dr Simon Opher (Stroud) (Lab)
The lack of an ability to assist in the final process would put medical professionals in a very difficult position. Would carrying the medicine to the room where the patient is count as assistance? I think we have to have assistance in the Bill, but I also feel that, as the Minister has outlined clearly, someone can help a person to self-administer but cannot administer. That is quite clear to me.
Stephen Kinnock
I thank my hon. Friend, who speaks with considerable clinical expertise. It is about exactly that difference between self-administration and administration. If we cleave to those two principles, that is the basis on which we will achieve the stated aim of my hon. Friend the Member for Spen Valley.
Dr Shastri-Hurst
My hon. Friend hits the nail on the head, because it is the patient who is driving the decision. They are making that act by activating the electronic device—the computer or whatever it may be in terms of assistive technology—but they have the power and control over that decision-making process, which is completely distinct from a clinician doing that act. It is distinct because it is activated by the patient—by the person making that decision—and that is why I draw the distinction. My hon. Friend may not agree, but that is my rationale for drawing a distinction between the two.
Dr Opher
I agree with all the hon. Gentleman’s points. In terms of assistance, what we are talking about, potentially, if the technology arrives at that, is that the doctor may be able to put a Venflon into the patient’s vein, but they would not put the drug through the Venflon into the vein. That would enable the patient to have control. That is the type of assistance that could be quite useful in this scenario, but it would not involve the doctor actually delivering the drug.
Dr Shastri-Hurst
I am grateful for that helpful and thoughtful intervention.
For the reasons I have set out, I consider that the amendments create unnecessary and highly undesirable legal confusion, so I shall not support them.
Dr Opher
Actually, if we did an autopsy on any person who has died, pulmonary oedema would almost certainly be found because that is what happens in death—the heart stops and the lungs fill with fluid. I would also like to correct the idea that there is neuromuscular paralysis with pentobarbital. There is no way that barbiturates act in that way. All they do is sedate and put the person to sleep, and death comes afterwards.
Danny Kruger
I was not suggesting that pentobarbital has a paralytic effect. Often in assisted dying, a paralytic is administered first as part of the cocktail of drugs. Subsequently, we discover that while the patient may have appeared entirely calm, sleeping peacefully, significant trauma may have been occurring beneath the surface.
I defer to the hon. Member’s knowledge, but my understanding from the scientific evidence I have read, and that medics have given to me, is that the extent to which people executed by lethal injection, by pentobarbital, have their lungs fill with fluid is peculiar—it is remarkable. They effectively drown beneath their peaceful exterior.
I intend to press amendment 464 to a vote, and I intend to support other amendments in this group. Although I support the aspiration of amendment 532 to make provision for what to do in the event of a procedure’s failure, I think it gives too much leeway to the Secretary of State, so I will oppose that amendment. I think the amendments that the hon. Member for York Central and I have tabled are preferable.
To make the obvious case for those amendments, and as I said in a previous debate, there are three choices in the event of failure. The first is to ignore the plain signs of distress, of things going wrong and of the patient suffering, which is clearly a failure of the doctor’s duty of care. The second is to expedite the death, which we have decided would be illegal under the Bill. Therefore, the only option is to revive the patient and escalate treatment, rather than actively or passively facilitate their death.
I hope Members will agree that, on the rare occasions when assisted suicide goes wrong, it is right that the patient is immediately revived and taken to hospital, or for the doctor to take whatever action is necessary. I am interested to understand why those amendments should not be supported.
Sarah Olney
I am grateful for the hon. Gentleman’s professional experience, which is extremely helpful. He is absolutely right. Following the point made by the hon. Member for Banbury, we cannot define the circumstances in which a patient will find themselves when this is taking place. That is why it is incumbent on us to make sure we provide very clear guidance on precisely what Parliament intends.
As Dr Rebecca Jones told us in written evidence:
“As the death may take many hours, I’m uncertain of the practicalities of”
doctors remaining with the patient
“for many doctors…have competing demands on their time.”
In written evidence, Dr Chris Ainsworth asked how this will work in cases where death takes several days, as has happened in Oregon, while Dr Trevor Stammers wrote:
“If the doctor is required to be present until the patient’s death, this may require hours of practitioners’ time to fulfil and is unlikely to be adhered to in many cases if the dying process is protracted.”
Dr Rachel Fisher said in her written evidence that for Australian doctors, who are not required to be present at the final act, each assisted death requires around 60 hours of professional time. For British doctors, we will need to add the time it takes for the self-administration to result in death. Dr Fisher also raised the real impact on doctors, writing,
“imagine the practicalities of those who must deliver it. The GP, motivated by a deep desire to preserve life and relieve suffering arrives at the home of the patient with a cocktail of powerful drugs. What if the patient has symptoms? Who will collect their child from nursery or school if the patient takes a long time to die? How will they know when to decide the death was unsuccessful? Will there be counselling for GPs observing and feeling complicit in a potentially drawn out and symptomatic death?”
Finally, Dr Paul Shaw asked in his written evidence:
“How will this service be funded? What support will be required from the NHS when things go wrong or death takes longer than expected? Will this be a 0900-1700hrs service? What will be the out of hours arrangements?”
A lot of the written evidence touches on the practicalities of a doctor being required to remain with the patient until they die. Amendment 429, in the name of the hon. Member for Bexleyheath and Crayford, seeks to clarify whether “being with the patient” requires the doctor to be physically present in the room.
Sarah Olney
The hon. Gentleman gives me an opportunity to conclude my remarks. I support amendment 429 because it is important to provide clarity that when we say “with the patient,” we mean in the room. However, I invite the Minister to expand further on the resource requirement of assisted dying. I want the doctor to remain with the patient, which I think is critical. That is why I support amendment 429, but the implication of the Bill is a considerable resource requirement, particularly for GPs, and I would like the Minister to respond to that.
Dr Opher
I am glad to serve under your chairmanship, Sir Roger. First, I will briefly address the whole area that we are talking about. GPs who are involved in terminal care will go and see a patient as they are slowly dying; we do not know at any point what will happen, and almost anything can happen. I have sat with people who may at any point have a massive pulmonary haemorrhage and drown, for example, or they may just quietly go to sleep—or they may start vomiting.
What those of us in terminal care do is react to what is happening with the patient. For example, if they start to be sick, we would give them an anti-emetic; if they start to become very agitated we would then give them midazolam. What I am saying is that this is normal medical care. We have to be very careful not to stipulate in the Bill what is actually normal medical care.
I understand that what we are proposing is a new option that has not been there before, and we know that there are complications. But in a terminal situation, there would be no occurrence where we would call an emergency ambulance and take them to hospital, for example.
Sean Woodcock
My hon. Friend speaks with a lot of knowledge, and every time he contributes I learn something about the medical profession. My challenge to him is that while he is right that at the end of someone’s life GPs and doctors are used to looking after somebody, and there are lots of different complications from medical treatment, in the situation we are talking about the treatment—if we can call it that—is to end their life. That is a distinct difference. Something has gone wrong if their life has not ended suddenly or peacefully, as they were hoping. That means that they might die hours or days later, potentially in agony, or they will linger on, potentially also in agony. The amendment is to try and clarify what then happens, because I would suggest that this is very different from a normal medical procedure.
Dr Opher
I thank my hon. Friend for his sensitive and clear worry. But it is important to note that we would not in any circumstances try to do something that would finish someone’s life after they had been given their self-take medicine, because that is against the law. In the Bill we have made a clear distinction between the doctor—a euthanasian, if you like—taking the life, and the patient taking medicine that finishes life. What we need to do is simply support the patient. If, as my hon. Friend suggests, they are in pain we would give them a morphine drip, which is in common use in terminal care. I absolutely respect what he says, but the same treatment principles would be in place as in terminal care.
Danny Kruger
Even in terminal care, when it is understood that a patient is close to death, doctors would surely not overlook a patient for whom an assisted death is clearly failing. The hon. Gentleman suggests that it would be inappropriate to—and that he would never—call an ambulance, or send a patient to A&E; I wonder whether he also means that he would never seek to revive a patient or bring them back to life, as it were, if they were experiencing complications. To his often-repeated suggestion that there is no difference between this and normal medical treatment, there is an enormous difference. Doctors administer lethal drugs to a patient, and are then also supposed to be somehow caring for the patient in the traditional way that doctors should. These things are inherently incompatible, and there is a choice between the two : is the doctor helping the patient to die, or is he helping them to live? That questions remains, and does he not acknowledge that there will be circumstances where it would be appropriate to revive the patient, and seek to support them as if they were living?
Dr Opher
I almost agreed with the hon. Gentleman earlier, when he asked at one point, should we not just leave this to doctors?
One of the key things the hon. Gentleman said is that the doctor administers the drug. This is self-administered, first of all, so that is a very clear line. However, also, in a case of terminal care—this is what I am trying to get across to the Committee—we know the patient is dying, and therefore if they are becoming worse we simply do things to make them comfortable, and we do not try to revive them, because they are dying. It is important that we realise that this is a very different medical situation from normal care, and that it actually needs very different skills as a doctor. Here, a doctor is not trying to prolong life, but trying to make a death as comfortable as possible.
That is why I support the Bill—because I think it will enhance a comfortable death. I wanted to make it clear that that is normal practice now in terminal care: we do not revive a patient with a terminal diagnosis who is in terminal care, but we make them comfortable.
Sojan Joseph
This is a very good discussion, and with a clinician as well—maybe my hon. Friend can help here. Are we leaving the Bill to professionals to administer, who might be confused and not clear about what they should be doing? In normal current practice, when somebody has a poor prognosis and is very fragile; we use “do not resuscitate” or “do not attempt CPR” decisions. Why do we not build that into the Bill—that everyone who is going through this process should have a DNR or DNACPR in place?
Dr Opher
I thank my hon. Friend for his experience in a clinical setting. I would remind everybody that in the Bill we are trying to help people die in a comfortable way, and I do not feel it is the Bill’s job to define exactly how we treat nausea or abdominal obstruction and so on. What we would like to do here is ensure that a patient has a pain-free death, and a death that they are in control of.
Dr Opher
I will make a little progress and will then take my hon. Friend’s intervention.
On amendment 436, all medical practitioners are required under their code of practice to record any event they come across. I feel there should be better data and I agree with the hon. Member for East Wiltshire that we need to collect data. We are actually very good at doing that in the NHS. Under clauses 21 and 22 there are provisions for the Secretary of State to collect data on complications. I am therefore not sure that particular amendment tabled by my hon. Friend the Member for York Central is necessary. I think I have covered amendment 464, from the hon. Member for East Wiltshire.
On amendment 429, about the doctor being in the same room, I totally understand the anxieties presented by my hon. Friend the Member for Bexleyheath and Crayford, but I feel that whether the doctor is there should be the choice of the family and the patient. There may be some confusion about this, but to me, what the Bill implies—I am interested to hear the Government’s opinion—is that the doctor should deliver the medicine to the patient, check that the patient is willing to take the medicine as per amendment 462 from the hon. Member for East Wiltshire, give the medicine to the patient, and then ask the family whether they want them to be there or in the next room. They need to be available, but do they need to be in the same room? I think that should be the choice of the family.
Daniel Francis
I hear what my hon. Friend says, but the wording of clause 18(9) and (10) is ambiguous. Subsection (9) says that the co-ordinating doctor must remain with the person until “the person has died”, but subsection (10) says that the doctor
“need not be in the same room”.
I do not want to get into measuring metres, but where exactly is that place? Is it in the same room or is it in the same building? If it is in the same building, you cannot possibly be with the person until they die. Does my hon. Friend have comments on that?
Dr Opher
I am interested to hear what the Government say about the wording around that amendment and whether it is safe. I would defer to the Minister on that.
Amendment 430 from my hon. Friend the Member for Bexleyheath and Crayford, about a code of practice that must address complications and failures, is quite a strong amendment and I am willing to support it. If as doctors we have a code of practice about how we handle this type of thing, the amendment would potentially help, and perhaps answer some of the questions from my hon. Friend the Member for Banbury.
I do not believe that amendment 255 from my hon. Friend the Member for Filton and Bradley Stoke is necessary. I believe it should be dealt with under clause 21.
I believe that the very well put amendments 532 and 533 from my hon. Friend the Member for Ipswich could be covered by amendment 430.
Dr Opher
I am in two minds about the doctor being present until the patient dies. In the circumstances, we need to encourage this to happen at home predominantly, because I think that is where most people would prefer to do this action. We perhaps need to look further at whether the doctor needs to stay, in the rare situation where the patient goes on.
Let me conclude by saying that I know that the amendments all come from a good place, and that this is an anxious time, but terminal care is an anxious time for doctors, for patients, for everyone, because we do not know exactly what is going to happen. The Bill allows someone a way of dying, when they have a terminal illness, that has a bit more exactitude than normal practice.
Jack Abbott
I fully understand and am very sympathetic to my hon. Friend’s point about the family having privacy and space in the last moments. However—this is a genuine question—what happens if things start to go wrong? Although it is uncommon, we know it is possible. Do we expect the family members who are going through the last traumatic moments to have to go out of the room to find the doctor, albeit they might just be behind the door? I do not know that that would necessarily make it less traumatic, and for some people it could make it worse if the doctor is not there and present next to their bed.
Dr Opher
I think there is some truth in that, to be fair, but I believe we should leave it open to the family’s discretion, with the proviso that the doctor should be close at hand, whether that means outside the door or whatever. We need Government advice on whether amendment 429 is safe. I have nothing further to say.
Lewis Atkinson (Sunderland Central) (Lab)
It is a pleasure to serve under your chairship, Sir Roger. I will cover a few of the amendments, and follow on from my hon. Friend the Member for Stroud, whose points I broadly agree with.
When it comes to the location and, actually, a lot of the elements, I fear we are trying to over-specify practical matters. As in so many cases, this is not about capacity, coercion, assessment and so on; it is about the practicalities of death, and it is right that we allow the healthcare team for dying people and their families to operate with the professional skill with which they currently operate.
On amendment 429, on the doctor being in the same room, I can think of many instances in healthcare in which a healthcare professional is in an adjoining room, potentially even with a door open so there is a line of sight, and that is entirely appropriate. I think of observations, for example, in various settings. That provision is absolutely necessary and allows an appropriateness of proximity without intrusion. I am sure the doctor will be in the room at the point at which the substance is taken, but if someone then goes into unconsciousness fairly quickly, as would happen in the vast majority of cases, and then takes half an hour or so to die, it is entirely unnecessary for a doctor to be standing there in the same room, towering over the family, when they could be near at hand. I just do not think we need to specify that in the Bill.
I have some sympathy with amendments 532 and 533, tabled by my hon. Friend the Member for Ipswich, on the Secretary of State setting out regulations, but I fear the hon. Member for East Wiltshire did an excellent job of persuading me that they should not be accepted, because when a “must” is included in that way, we get into saying, “The Secretary of State must tell a doctor exactly what they must do in every situation.” The legal parameters are clearly set out in the Bill as drafted. There is no administration by a doctor on a person’s behalf; it must all be self-done. Additionally, we have not yet mentioned the existing provisions in clause 9(2)(c), which requires, at the point of assessment, a conversation between the assessing doctor and the patient about their wishes in the event of complications or any sort of delay.
Naz Shah
I absolutely agree and share those concerns. This is important. I appreciate that we have had this debate for many days now. Is this a healthcare intervention? Is it a treatment? What words should we apply? In this instance, when it comes to drugs, there are potential side effects. We have seen that they do not work everywhere and that they create complications. We have just debated whether a doctor should be in the room, outside the room or round the corner, as well as whether they should be visible or able to see what is going on. Ultimately, this is about the drugs. Having looked at the issue, I genuinely cannot imagine anything but the MHRA in this role. Are we really going to set up something completely new, outside our health service, that regulates drugs, their side effects and the potential implications?
Dr Opher
The matter of unlicensed drugs sounds very alarming, but we cannot regulate a drug through the MHRA if it unlicensed, and we would be looking for therapeutic effect, which would not apply in this case. More importantly, many other regulatory bodies, like the pharmacy framework and the General Pharmaceutical Council—
The Chair
Order. Remember that an intervention should be a sketch, not an oil painting. It should be a question or should seek clarification; it should not be a mini-speech.
Naz Shah
My hon. Friend clearly speaks with expertise. There are other regulators, but the reason why I support amendment 465 is that the MHRA is an institution that we trust and that has the expertise. My understanding—my hon. Friend might be able to tell me differently—is that, of the regulators, the MHRA is the body that does the ultimate rubber-stamping and gives our country confidence in the national health service.
NHS England Update
Simon Opher Excerpts(3 months, 4 weeks ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Wes Streeting
I am grateful to the Liberal Democrats for those questions. Much of the change needed can be delivered without the need for primary legislation, which is a relief because, as right hon. and hon. Members will have noticed, this Government have come into office with the most ambitious legislative programme of any incoming Government. Time is at a premium, given the business of this House and the other place. We will work immediately to move forward without changes to primary legislation, but we will need to make them. I am working with the Leader of the House and business managers to ensure an appropriate timetable that enables us to do the things that we need to do in a timely way, but that also safeguards the ambitious legislative programme that has already been set out.
The hon. Lady is right to talk about the importance of social care. She asked where the urgency is. It was to be found in the immediate steps that the Chancellor took on coming into office to stabilise the finances of my Department, with an immediate release of funding. It came with the Budget, which delivered an extra £26 billion for the Department for Health and Social Care, protected funding specifically for social care and boosted spending power for local authorities. It came with the biggest expansion of carer’s allowance since the 1970s, and an £86 million increase in the disabled facilities grant not just from next year but released in January for the remainder of this financial year. The urgency is reflected in the Employment Rights Bill, which makes provision for fair pay agreements to deal with the work- force crisis—work with employers and trade unions to prepare for that legislation and the introduction of fair pay agreements is already under way.
I regret that we have not convened cross-party talks. That is genuinely due to practicalities on the part of a number of parties involved. We will be in touch over the next week to make arrangements for Baroness Casey to engage with parties across the House.
Dr Simon Opher (Stroud) (Lab)
I thank my right hon. Friend for his excellent statement. As he knows, I am a working GP in Stroud. We clinicians are simply fed up with the micromanagement of our caring clinical role, and many hospital colleagues feel the same. We want to be free to deliver excellent clinical care. Does he think that the abolition of NHSE will reduce the admin task for doctors?
Wes Streeting
I do think that is the case. I also think that this is not just about form and function but about the opportunities for productivity gains through modern technology and practices. One of my frustrations is that whenever we talk about the exciting frontiers of life sciences and medical technology—this country’s competitive advantage, and how we need to build on that position— I am greeted with a weary sigh from poor frontline NHS staff, and managers for that matter, who say, “That’s lovely, and we agree with you, but we’d just like a machine that turns on reliably, and it would be nice to use systems that do not require seven passwords to deal with a single patient.” I feel their pain. We will prioritise that investment in technology.
Finally, we do want to liberate the frontline, and I am grateful for the leadership that GPs have shown in agreeing a contract with the Government for the first time since the pandemic, which contains substantial reform to benefit them and, even more importantly, their patients. We also have to liberate management in the NHS. As Lord Darzi said, it is not the case that there are too many managers, but there are layers and layers of bureaucracy between me as the Secretary of State and frontline staff. We have to liberate frontline staff and managers to help them be more effective, to manage their resources more efficiently and, most importantly, to deliver better and safer care.
Terminally Ill Adults (End of Life) Bill (Twentieth sitting)
Simon Opher ExcerptsTuesday 11th March 2025
(4 months ago)
Public Bill CommitteesRead Full debate Terminally Ill Adults (End of Life) Bill 2024-26 View all Terminally Ill Adults (End of Life) Bill 2024-26 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Public Bill Committee Amendments as at 11 March 2025 - (11 Mar 2025)
Sarah Olney
The hon. Member is exactly right. An assessment of whether somebody should qualify for assisted dying needs to be based on objective criteria. If those are not met, the only way that a second independent doctor should have a role is if either the circumstances have changed or, for whatever reason, the first doctor is unable to reach a conclusion. There must not be a situation in which the first doctor has made one decision and a second doctor arrives at a different decision, because that would imply a variability in the way the objective assessments are made. Not tightening this loophole would imply that we are prepared to allow such a variability across the medical profession, and I do not think we should allow that.
My final amendment in this group is amendment 460. I am concerned that the word “particular” in clause 10(3) negates the subsection’s purpose of ensuring that only one second opinion from the co-ordinating doctor can be sought, because a person could withdraw their first declaration, make a new one and start the process afresh; that declaration would then not be the “particular” first declaration. By removing “particular”, the loophole would be closed, and the safeguard would be made more effective. This concern was brought out well in Disability Labour’s written evidence:
“We are concerned that whilst 10(3) only allows for one second opinion to be sought, there appears to be nothing in the bill that stipulates a waiting period before a new application can be made. This risks applications being repeated until a supporting opinion can be obtained, thus negating the purpose of 10(3).”
I hope the Committee will accept my amendments.
Dr Simon Opher (Stroud) (Lab)
I thank the hon. Member for Richmond Park for her considered amendments. I would like to go through all the amendments in the group.
Amendment 348 is about the doctor communicating the outcome of the assessment, but I understand that that is already covered in clause 8(5)(b), which states that, having carried out the second assessment, the independent doctor will
“provide each of the coordinating doctor and the person who was assessed with a copy of the statement.”
I therefore do not think the amendment is necessary—it would be doubling up.
Rebecca Paul (Reigate) (Con)
I just point out that the amendment states that the independent doctor would
“inform the person’s usual or treating doctor”,
and that is not covered by the paragraph the hon. Gentleman just mentioned. I hope that is helpful.
Dr Opher
I do not see what that would add to the Bill. The co-ordinating doctor would have a result and the patient would have had the report back. I do not feel the amendment is necessary—it would over-complicate the Bill—but we can see what the Government’s legal position is on that.
Amendment 303, tabled by my hon. Friend the Member for York Central, suggests that the independent doctor should have to check that there has not already been a second opinion. We need to step back a bit and remember how the Bill will work. Basically, a doctor will refer to a co-ordinating doctor, who will make a full assessment of the patient. If, having carried out the first assessment, the co-ordinating doctor is satisfied that the requirements in the Bill are met, they will refer the person for the independent assessment. That doctor will therefore need to see a report, because he is the co-ordinating doctor. He cannot then get a second opinion from a different doctor; that would not be part of the process under the Bill. I do not feel the amendment would make the Bill any safer.
Dr Opher
Actually no, I will not. I will go on, if that is okay.
Amendment 459 states that the second-opinion doctor “must produce a report” outlining their reasons for reaching a different opinion, but the whole nature of this is that the doctor is independent. As we have heard, if it is suggested that someone either is or is not allowed to get an assisted death, that might affect the assessment of the independent doctor. It would not be good medical practice to have that assessment in front of the independent doctor—that would lead to poor assessments. We need a right to a second opinion and we should have a truly independent doctor.
Amendment 460, which is the last in the group, would allow a patient only one declaration in any part of their lives, even if circumstances change. Although there will be vanishingly few instances where that would be relevant, I do not feel that such a provision would make the Bill any fairer or safer.
Amendment 143, tabled by my hon. Friend the Member for Broxtowe, would allow a second and a third opinion. It is my opinion, and the opinion of many of us, that we do not want doctor shopping. We want to allow one second opinion from an independent doctor, but not more than that.
Lewis Atkinson (Sunderland Central) (Lab)
It is a pleasure to serve under your chairship, Sir Roger.
I rise to speak to a couple of the amendments. Amendment 348 is likely unnecessary. I would have been minded to support it had it referred to a registered GP, but the language of “usual or treating doctor” is unconvincing. I am not sure what those terms refer to. The registered GP absolutely should be informed, and both normal practice and the provisions in the Bill about entering information into medical records would mean that that is the case. For me, “usual doctor” is not the right terminology; it does not achieve what I think some of its proponents want. With reluctance, I will vote against that amendment because it does not refer to a registered general practitioner.
On amendments 303 and 458, I believe there must be provision for a second opinion. However, I am persuaded by the points made by the hon. Member for Richmond Park about amendment 459. I slightly disagree with my hon. Friend the Member for Stroud: although the independence of the second opinion is important on matters such as the terminal prognosis, when it comes to the detection of coercion, the more information, the better. It is one thing to be independent in a medical assessment, but the amendment speaks to a psychosocial assessment. We are trying to detect coercion, so it is important that every decision maker gets further information as the process progresses.
The provision for five different touchpoints of assessment is one of the strengths of the Bill. Each assessment should be done in a way that can be progressed with more information. It is not just five different independent points of information; because of the Bill’s record-keeping provisions, the assessment should become increasingly informed throughout the process. I certainly think that the panel, or whatever we get to, should have sight of any negative assessment from an independent doctor, as well as any positive one. The panel will then be able to do its job of scrutinising the two decisions, potentially weighing them up, and calling the different doctors who have given different decisions. I am, then, persuaded by amendment 459.
Danny Kruger
What the amendment clarifies is that the doctor does not have to look at any records at all unless he or she considers them relevant. It gives total discretion to the doctor to disregard huge swathes of the patient’s history. Yes, I do expect the doctor to review the entirety of a patient’s record—obviously, the record of a childhood broken leg can be skipped over quickly. What I do not want to do, as the Bill currently does, is allow the doctor to say, “Oh, I missed this evidence of a mental health condition” or “this indication of coercion from five or 10 years ago, because I didn’t consider that aspect of their records to be relevant.” It places a significant obligation on the doctor, but that is, I am afraid, what we are doing in the Bill. We are placing huge obligations on doctors and we should do it properly.
Dr Opher
As the amendment states, it is about examining medical records for things that are relevant. If we are talking about coercion or capacity, these sorts of items will be relevant. I do not know if Members have ever seen medical records. Some people have extremely large medical records, and we have summaries for that, but if a part of that summary indicated something that we were suspicious of, we would look into it. As my hon. Friend the Member for Sunderland Central has just said, the complexities of childhood tonsillitis do not really need to be examined in this case. We have to, and we always do, specify what we look into doctors.
Danny Kruger
As I have said in my many exchanges with the hon. Gentleman, I want to see the good practice that he claims—absolutely accurately, I am sure—to perform is applied across the system. He says that if doctors see in the summary some indication of concerns, they will look more closely into it. Well, I jolly well hope they would. The problem is that the summary might not be complete. I suppose the distillation of my point is that we should say, “Don’t rely on the summary. Proceed with a proper analysis. Take responsibility for making sure that you have reviewed the entirety of the patient’s record.”
We have to address throughout our consideration of the Bill the workload that we are placing on busy professionals. Nevertheless, if we consider that this matters—and it is a question about knock-on effects on the NHS, which we could discuss in due course—it is appropriate to expect proper time to be taken. A specialist with two hours and a full record in front of them might spot the misdiagnoses, question the prognosis, flag the depression and catch the abuse. If given half the time and a licence to skim the record, as the amendment would give them, they could very easily miss something, so I think the word “relevant” is a great gamble.
Naz Shah
I will try to keep my remarks brief. I first speak to amendment 468, tabled by the hon. Member for Reigate, on the asking of the question why someone wants to have an assisted death. When I originally came to this debate, Dermot, a humanist who was also my election agent—a lovely guy—came to me and said, “Now that this Bill is going through Parliament, will you support it”? I said, “Explain it to me.” He never once mentioned the word “autonomy”. If I remember correctly, what he talked about was suffering, pain and horrible deaths, which many hon. Members have referred to. We have heard lots of examples during this Bill Committee.
My hon. Friend the Member for Luton South and South Bedfordshire said that the decision was none of a doctor’s business and that the issue was about autonomy. However, if a woman was being coerced into an assisted death, the idea that it was none of the doctor’s business would not quite wash with me. We talk about autonomy, but if someone does not have autonomy in their lives—if they are in an abusive relationship, are a victim of coercion or have a vulnerability—they might not have the choice.
When we ask a question, it is often about something else. I have experienced this myself. I am very passionate; when I am talking about things, somebody might just stop me and say, “Naz—what’s this actually about?” That is all it takes to make me stop, take a step back and a breather, and think for a deeper minute about whether the issue could actually be about something else. We do not always stop to think.
Dr Opher
The amendment is good practice; I do not in any way deny that. The hon. Member for Reigate is obviously coming from a really good place. However, the amendment is almost like specifying that when someone goes to see a doctor, the doctor has to say, “How can I help? What is wrong?” It is just unnecessary; that is my only feeling about it. If someone came in and said, “I would like to request an assisted death”, the doctor would not just say, “Okay”—they would ask how the patient was feeling. It is normal medical practice to ask what is going on in someone’s mind, so that does not need to be specified in the Bill.
Naz Shah
I thank my hon. Friend for his intervention. There is a medical model and a social model of intervention. If I walk into a GP surgery with a really bad headache, I am prescribed paracetamol. If the headache gets worse, I am prescribed something stronger—maybe co-codamol or codeine. Doctors are really busy. We have had to add another 40,000 appointments just for people to get through systems, so we know how hard it is to get a GP appointment.
If the person who turns up at the GP’s with a headache is usually quite healthy, the doctor might not take a minute to ask about what has actually happened. If I say, “I have a headache because I am banging my head against the wall—I have that much stress”, that is a whole different conversation. Having that conversation with the patient—probing a little more—is, for me, very important from a holistic point of view.
Terminally Ill Adults (End of Life) Bill (Eighteenth sitting)
Simon Opher ExcerptsWednesday 5th March 2025
(4 months, 1 week ago)
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Danny Kruger
It certainly is. Okay, so it could be either. This will be an NHS service, with all the implications for general practice, doctor-patient relations and secondary care and social care, but there will also be an opportunity to deliver it privately, without any clarity or transparency on who is being paid and how.
In answer to my right hon. Friend the Member for North West Hampshire, this is different from cosmetic surgery, as even cosmetic surgery is regulated. In many ways, there is more regulation of the administering of Botox than there is in this Bill. The administering of assisted dying is of a significantly different category and gravity. It is appropriate and important that financial interests are clearly revealed and made public, particularly with the new intervention we are creating. If other hon. Members do not support the amendment, what provisions do they propose that would reveal where there may be potential conflicts of interest and how we may regulate this?
Dr Simon Opher (Stroud) (Lab)
I thank the hon. Member for East Wiltshire for the amendment. The set-up of this scheme is similar to other NHS services. Essentially, a medical professional will opt in to provide the service. That will involve extensive training followed by a short exam, as it does in Australia and California, after which they will be accredited under the scheme—that is how I understand it will happen in the UK. No one is forced to provide the service, but training is offered and many doctors take that up. Therefore, it is a medically based service.
The British Medical Association will then negotiate the fee for doing the assessment with the Department of Health and Social Care. That is not about agreeing to provide the service; it is about doing the assessment. That is mirrored in many aspects of general practice, which itself is a private service contracted to the NHS. It is very complicated. It would be inaccurate to portray this as a private service, where people may profiteer, as it is based on medical professionals performing a duty for which they are trained and for which the price is clear to the general public, because it is negotiated and published.
On publishing the number of patients seen by a single doctor and the fees that doctor has accrued from the scheme, that is not something that happens for things like minor operations, which we perform outside general medical services, although we are rewarded by the Government at a set fee. There are other such services—inserting a coil, for example—where we are given a certain amount of money.
How this is arranged is very complicated. Doing appraisals, being a trainer and all these things have a price attached, and we need training before we can perform the service. I see this scheme as no different. The problem with publishing how many patients have been seen by a single doctor regarding assisted dying is that it puts a target on that doctor. As we have seen with abortion clinics and even this Committee—certain Committee members have been targeted by the press for what they have said—this is a very sensitive issue, and it would not be fair to publish the figures so that doctors could be targeted in the press and made to feel unworthy in all those ways. It is extremely difficult.
Dr Neil Shastri-Hurst (Solihull West and Shirley) (Con)
The hon. Gentleman makes a powerful argument about doctors being vilified in the press, but does he believe there is a risk that it may go further and present a genuine safety risk to those doctors?
Dr Opher
Exactly. That is what worries me. I acknowledge what the hon. Member for East Wiltshire said about pharmaceutical sponsorship, but I do not think that has anything to do with what we are talking about here. What we are talking about is specifying what doctors are doing as part of their daily job, for which they are trained. It would not be fair to publish those figures and put those doctors at risk.
Naz Shah
I appreciate what my hon. Friend is saying, because I have mixed views on this. I would like to understand what would be appropriate. My concern is that there will be a difference, because doctors normally have these set-ups for treatment options but, in this instance, the service is not a treatment, so to speak. I genuinely want to understand: in his eyes, what would a good service that provided scrutiny and accountability look like?
Dr Opher
There are examples. Appraising other doctors, for instance, is specified as a job that doctors are trained for, and it is paid at a set rate agreed with the Department of Health and Social Care. There are many instances where this occurs. I totally agree that the fee a doctor attracts for the service should be clearly specified and in the public domain, but I do not agree that a single doctor should be identified as having seen, say, 10 patients who have requested assisted death. I think that is unnecessary, will not lead to increased patient safety and will make it less safe for the medical practitioners too.
Terminally Ill Adults (End of Life) Bill (Nineteeth sitting)
Simon Opher ExcerptsWednesday 5th March 2025
(4 months, 1 week ago)
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Rebecca Paul
This is a complex issue, and that is why I welcome the debate on this group. There are lots of things that need to be thought through to make sure that, if assisted dying is legalised, we manage it in the most effective way for patients.
Dr Simon Opher (Stroud) (Lab)
I thank the hon. Lady for making this point, which is important, although probably not specifically relevant to what we are talking about in general with regard to making the Bill safe. Has the hon. Member for East Wiltshire not just completely contradicted the whole point of the amendment, however, by saying that we really do not know whether this process will cost more or less time for the NHS?
Rebecca Paul
Different situations will give a different result. It is a complex situation. We could have a patient who, if they did not have an assisted death, would be on a palliative care pathway, which might not involve as much time from their GP—the assessing doctor, in that instance. If they moved on to the assisted dying pathway, however, the assessment process would need to start, and it has to happen quickly for all the reasons that I have set out.
The Bill relies on doctors being highly conscientious and hard-working, but it also risks taking them for granted if it makes no allowance for the present realities that they face in our healthcare system. This amendment tries to reflect and recognise that.
In November, the hon. Member for Stroud said,
“I have watched with horror as our NHS has gone from being the best health service in the world…to being a service on its knees.”—[Official Report, 6 November 2024; Vol. 756, c. 358.]
If the NHS is to get off its knees, surely we cannot afford for assisted suicide to jeopardise the care of patients who already struggle to get an appointment. We must recognise that there are people out there who cannot get an appointment to see their GP, and reflect that in the Bill.
Daniel Francis
Absolutely. This amendment, of course, is widely supported by Committee members for that very reason. As I was saying, we already use that assessment for organ donation, and Members supporting this amendment believe that should be the case for those that are seeking an assisted death.
I now move on to amendment 284, in the name of my hon. Friend the Member for York Central. This amendment would change clause 9(3). Currently, that subsection lays out, and I will quote the language of the Bill, that the assessing doctor,
“(b) may, if they have doubt as to the capacity of the person being assessed, refer the person for assessment by a registered medical practitioner who is registered in the specialism of psychiatry in the Specialist Register kept by the General Medical Council or who otherwise holds qualifications in or has experience of the assessment of capability;”
This amendment would change the word “may” to “must”. In other words, the assessing doctor would have a duty to refer the person being assessed to a consultant psychiatrist if they had any doubt about that person’s capacity. I argue that this is a change that we both should make, and can easily make. If a doctor has doubts about the capacity of an applicant, it is good practice for them to refer that person to a doctor or a specialist in that field.
Dr Opher
Could I ask which amendment the hon. Member is talking about? Is it 284 or 6? Amendment 284 says that psychiatric assessment is mandatory in all cases, whereas amendment 6 says it is mandatory if capacity is in doubt. I just wondered which one he was talking about, because I support one and I do not support the other.
The Chair
Dr Opher, maybe you want to catch up on the papers and then intervene when you have a question to ask.
Jake Richards
I will be brief. I will talk about my amendment 280, which I will not press to a vote. There remains an area that needs more exploring in this legislation—it has come up in debates already, but needs to be looked at further—namely, that a person may have capacity but have other mental health conditions that may impair their judgment. In those circumstances, a more thorough assessment than the two-doctor stage there is at the moment would be right. In reality, that is very likely to happen under the current structure of the Bill. My amendment simply attempts to make sure that it is mandatory. Having had discussions with my hon. Friend the Member for Spen Valley, I know that she is sympathetic to that.
There are amendments in the next group that aim to do the same thing. They, along with my amendment, may not be quite right. I urge the Government to look at this issue and see how we can work together to come to a conclusion, because I think that all members of the Committee would want that. I also support amendment 6, as I think everyone does.
Dr Opher
I apologise, Mrs Harris—I have got slightly confused with all the amendments. I do not have a speech that has been prepared for me, or anything like that, but I would like to make some comments. I think this is about the role of psychiatry and capacity, and how we deal that in the Bill. All these amendments reflect that. I would like to concentrate on whether we should actually mandate referral for all patients to a consultant psychiatrist, or adopt amendment 6, which suggests that if one of the two assessing doctors has concerns about either capacity or mental health, they should refer the patient to a psychiatrist. Those are the two choices I think we have here.
Danny Kruger
I appreciate the hon. Member’s point, and it is very logical that it should only be in the case of doubt, but does he not recognise that in the case of organ donation, it is mandatory? If people have this proper assessment when they are giving an organ, why should they not be asked to have one if they propose to give their life?
Dr Opher
That is an interesting point, but we are not discussing organ donation, and we are dealing in a different environment here; the patients we are talking about are about to die, and all we are giving them is the right to control the moment and manner of that death. I acknowledge that using a psychiatrist in organ donation has its benefits, but in this service, getting every patient—who, for example, are frail and ill by definition, because they are about to die—to see a psychiatrist is frankly neither applicable nor appropriate.
Kim Leadbeater
My hon. Friend makes a powerful point. If we think about some of the people we have met—the families who have lost loved ones to terminal illness and the patients who are terminally ill—they are very clear in their decision. For me, it would be another barrier to those patients, who are dying people, to make them see a psychiatrist for every single case.
Danny Kruger
It is a very important point. Yes, we are talking about those people, but we are also talking about a different category of people who have a terminal diagnosis of six months or more, and may only be reasonably expected to die within six months. I am not just talking about people at the very end of their life, who are at death’s door; we are talking about people who qualify for the Bill, which is a much larger category of people, so it is appropriate to require them to do this.
Dr Opher
I agree with all of this. I think psychological assessment is incredibly important in all patients, and I personally specialise in it from a primary care basis. But we are suggesting here that the two other doctors have no ability to do any sort of psychological assessment, and that is simply not true.
Dr Opher
I apologise to my hon. Friend; I will continue for a little bit. We use secondary care and psychiatrists when we have a doubt about our decisions. If we have a doubt, then it is entirely appropriate to use psychiatrists in that instance, and we must do so. That is why I approve of amendment 6.
Kit Malthouse
As I understand it, I do not think if someone is donating an organ that they do actually have to see a psychiatrist; they have to see somebody who is an appropriately trained assessor from the Human Tissue Authority. To me, that sounds equivalent to the second doctor in our process—someone who is appropriately trained to assess patients and what they need to do. This talk of it having to be a qualified registered psychiatrist, compared with an organ donation, is incorrect.
Dr Opher
I completely agree with the right hon. Gentleman. By amending clause 12 to include social workers, who specialise in spotting coercion, there would be a psychological component in that panel. I emphasise that the first two doctors are trained in psychological assessment—they have to be to become a doctor, and we must respect their knowledge and decision making. Psychiatrists will be incredibly useful in difficult cases of capacity, but using them in every case would not be using them in the best capacity.
Naz Shah
My hon. Friend is being generous with his time. I do not question the capability of those doctors, but how does that square with the concerns of the Royal College of Psychiatrists that if a doctor has never met the person before, they cannot make an assessment on coercion? That might impact on capacity.
The Chair
Dr Opher, I remind you yet again that “you” is me, and I have not asked you any questions. It is “my hon. Friend”.
Dr Opher
I am grateful that you have not intervened as well, Mrs Harris. You did say that I am allowed to call you “you”.
I will finish on this serious point. Amendment 6 has much power, and we would all agree that if the first or second doctor has doubts, they must—not may—refer to a psychiatrist. Expecting every patient who requests assisted death to have a psychological or psychiatric assessment is simply not necessary, and it would not improve the safety of this Bill.