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

Simon Opher Excerpts

Committee stage
Wednesday 29th January 2025 Public Bill Committees

[The Chair]

Colleagues, if we are to try to get everybody in, I will have to confine Members to one question each from now on. Panel, if you could, be kind and, without denying us the information we need, keep your answers as brief as possible.

[Dr Simon Opher (Stroud) (Lab)]

Q Could you briefly run through the patient pathway? Where does the patient first arrive in the healthcare setting? Who are the two doctors? Indeed, who provides assistance at the end of life?

Dr McLaren: Again, each of our states, as well as the Australian Capital Territory, has different legislation and therefore different processes. In broad speaking terms, say in Victoria, for example, a patient will express their wish to engage in voluntary assisted dying independently, and often they are connected to the state-wide patient navigator service, which will connect them with a doctor to receive that patient’s first request and become their co-ordinating medical practitioner. That doctor will then conduct the patient’s co-ordinating assessment and determine whether they believe the patient is eligible or ineligible. If the patient is eligible, the doctor will refer them on to a consulting doctor, or a doctor who acts as the consulting doctor, for a consulting assessment.

If that process is also approved and the patient is found eligible, they meet again with the co-ordinating medical practitioner to make a written application to engage in voluntary assisted dying. That process then goes to our review board, to ensure that it is compliant with the legislation, before we can apply for a permit to prescribe the medication. The permits are specific to our state; many other states, such as Dr Fellingham’s, do not require a specific permit for individual prescription. The permit will come back within three days, and then we write a prescription, which goes to our centralised pharmacy service. The pharmacy will wait for the patient or the contact person to contact the pharmacy and organise the delivery or dispensing of the medication.

In Victoria, self-administered oral medication will be dispensed to the patient, and that is then their property; they may use it immediately or never use it—that is completely up to them. They do not require medical attendance at that time, although I have provided that on many occasions, sitting with a patient and their family as the patient has taken their medication and died. If the medication is not used, the contact person nominated by the patient is legally required to return the medication to the pharmacy.

If the patient is unable to ingest or digest oral medication, we can apply for practitioner administration, which I believe your Bill does not currently provide for. This authorises a co-ordinating medical practitioner to administer the medication, either via a percutaneous endoscopic gastrostomy feeding tube or by other means, including intravenously, to the patient to bring about their death. I have certainly done that—I do not keep count, but I have engaged in that many a time.

[Dr Opher]

Can I just confirm—

[The Chair]

Order. I did say one question per person; we have to stick to the timings.

--- Later in debate ---

[The Chair]

I call Simon Opher.

[Dr Opher]

Actually, my question has already been asked.

Chelsea Roff: May I respond briefly? I want to address the question. I know it is not your intention for eating disorders to be included in this Bill, and I am grateful for that. When I started our research, I thought, “We just need stronger safeguards.” That was where I began, and after looking at 33 jurisdictions around the world, I have real doubt about whether safeguards are enough; I know how difficult it is to put it on the page, and I am seeing it expand and be applied through interpretation. I disagree with Professor Shakespeare, respectfully, that diabetes is a reversible condition. You cannot go back in time and reverse that condition.

I agree that you are doing this for a noble purpose, and there are members of my family that want this Bill to go through, and yet I emphasise to all of you on the Committee that the question before you is: could this Bill have knock-on effects for some of your most vulnerable constituents? How many deaths are you okay with? If the safeguards fail once, that is a human being who maybe, in a despairing moment, was handed a lethal medication instead of the care, the treatment and the help they needed. That is what we are talking about. You really have to get this right, because those people are depending on you.

[Lewis Atkinson]

Q Mr Amin, given your expertise in representing these cases in the court, can I ask you for your view around the Mental Capacity Act issue regarding eating disorders and other disorders? Obviously, we have heard one version of that. Given your experience of working with UK law to the highest level, what is your assessment of this?

Yogi Amin: I have worked in a range of medical treatment cases over many years, covering different illnesses and conditions, and clause 2 reads fine to me. It works. It is clear. I do not consider that it needs any additional words. I can understand, when we go to court, that cases will come through and they will fall within those definitions, and it will be clear. I do not consider anorexia to come under a terminal illness unless it is right at the end of life, and that does not really fit within the parameters of the Bill, because we are not talking about right at the end of life. We have section 63 of the Mental Health Act, which deals with anorexia, and there is force-feeding that clinicians consider. That is my view on the anorexia side of things.

Doctors will provide the evidence on terminal illness. You heard from the chief medical officer yesterday, and they will provide guidance around all of that. Subsequent to the Bill, there will be secondary legislation and then the guidance. They will provide clear guidance that will then feed into this and the evidence that will be before a judge that says, “Yes, it is a terminal illness, and this is the prognosis” and so on. It is nothing different from what we produce in medical treatment cases before the court at the moment, where the doctors produce expert reports and give evidence. They explain the condition, the prognosis and their decision on capacity, and they explain what is in the best interests of an individual if they lack capacity. As I understand it, the Bill is crafted to produce the evidence as you go along the path here, and then eventually to the judge.

Chelsea Roff: May I add one sentence, because it is related to eating disorders? I would refer to a 2012 Court of Protection case, where a 29-year-old with anorexia was described as being in the terminal stage of her illness and multiple physicians described her death as inevitable. I would also refer to a 2023 case seen at the Court of Protection, which said, “I recognise with deep regret that it will probably mean that she will die.” She was also described as being at the “pre-death stage”. Again, that young woman is still alive and still fighting for services. Although I respect what Mr Amin is saying, and I agree with his interpretation, we have case law in the UK where people with anorexia are being found to be terminal. We have to take that reality into account.

Yogi Amin: I do not think they were found to be terminal. They were described by a doctor in a case as being terminal, and that doctor may not have described it properly.

Chelsea Roff: Indeed, but a judge will be relying on doctors.

Terminally Ill Adults (End of Life) Bill (Money)

Simon Opher Excerpts

Money resolution
Wednesday 22nd January 2025 Commons Chamber

[Sir John Hayes (South Holland and The Deepings) (Con)]

The hon. Member for Spen Valley (Kim Leadbeater) is right that this is not unprecedented; in fact, it is the normal procedure for a money resolution relating to a private Member’s Bill to be debated ahead of Report. That is not true of Government Bills, as you know, Madam Deputy Speaker. However, it is really important that we examine the detail of what we are presented with today, which is an open-ended commitment. The wording makes it absolutely clear that

“any expenditure incurred under or by virtue of the Act by the Secretary of State, and…any increase attributable to the Act in the sums payable under or by virtue of any other Act”,

money is so provided. The hon. Lady says that this is not a blank cheque, but it cannot get much more blank than that. Essentially, any moneys associated with the Bill—if it becomes an Act—will be provided.

Pertinent to this vote, we have to ask the question: where will that money come from? Presumably it can come only from existing resource, and one assumes palliative care; it will not come from A&E, surgical treatments or GPs, so it will presumably come from that source. One does not know, of course, but it is perfectly reasonable to ask that question.

[Dr Simon Opher (Stroud) (Lab)]

Will the right hon. Member give way?

[Sir John Hayes]

I will in a second.

On the judicial point, I simply say to the hon. Lady that the establishment of a judicial competence to deal with this system will be resource-hungry. To offer her a parallel example, when I took the Investigatory Powers Act 2016 through the House, we established what was then described as a double lock—it became a triple lock—which required a whole new judicial function to make it happen. It may well be that the same applies in this case, with immense cost and immense pressure on an already overstretched judiciary.

Therefore, in considering those precise matters—not the ethics of the Bill, which are an entirely different consideration, and highly questionable—it is absolutely right and pertinent to ask what this will cost, when, and how it will be delivered. Those questions have not been answered. I scanned the hon. Lady’s speech on Second Reading, and it contained no mention of scale or cost. That is why I am immensely sceptical about what we have before us. While I accept that the money resolution is not unprecedented, it is certainly not desirable.

--- Later in debate ---

[Dr Simon Opher (Stroud) (Lab)]

Will my hon. Friend give way?

[Maya Ellis]

I will not, if that is all right. Sorry.

At the other end of the spectrum, we need to be acutely aware that we are not today expanding overall budgets in the NHS, so what we agree to in this money resolution will put further strain on our already stretched NHS. That means that, for example, St Catherine’s hospice in my constituency, which already requires private fundraising for almost 80% of its income, will have further NHS funding pulled away to accommodate publicly funded assisted dying. It is prudent for us to make clear what we put at risk if we vote through the Bill, having agreed this money resolution. The resolution means that money for palliative care will likely be diminished. The House should consider that in the next stages of the Bill, given what it is supposedly designed to alleviate.

Finally, let us make it clear what we are agreeing to today. I have asked a few times, and never really got a clear answer, why making assisted dying legal has to go hand in hand with a commitment to funding assisted dying on the NHS. Most of us, including me, fiercely protect the idea of an NHS that is free at the point of use, but we risk maternity services encouraging women to pursue induced births rather than planned caesareans, partly because of resource limitations in the NHS. I caution against an agreement to spend money on guaranteeing dignity in dying when we lag so far behind on guaranteeing dignity in birth, and in many other areas.

--- Later in debate ---

[David Smith (North Northumberland) (Lab)]

I would like to raise a couple of practical and principled concerns about the finances around assisted dying. First, on the practical, I welcome the comment from my hon. Friend the Minister that there will be an impact assessment in due course. However, until we see it, we have no idea what the measure will cost. We are being asked to approve a blank cheque for assisted dying. We have heard that the NHS is a blank cheque, but the NHS has a clearly defined budget. At this point, we do not have any sense of what the Bill will cost. If that were the case for any other legislation, we would be shouting about it.

The Bill represents a profound change to the very nature of our healthcare system, and we are simply guessing at the cost. That is not good for the Bill Committee’s ability to scrutinise, and not good for this place, or for the democratic and legislative process. In order to legislate well, we need a firm commitment. I am glad to have heard that the impact assessment will be published before Report. We have heard from my hon. Friend the Member for Spen Valley (Kim Leadbeater) that the motion is routine, and I accept that. However, the consequences are extraordinary, and that is why this is an important moment.

On the principle, whatever the cost, once it is assessed, and despite the Government’s recent financial boost for the hospice sector, palliative care is massively underfunded. The postcode lottery in the provision of end of life care has led to some of the horror stories that we heard on Second Reading. The hospice sector has only 30% of its funding provided by central Government, so this technical stage represents a commitment to taking potentially scarce funding from end of life care and allocating it to ending lives.

[Dr Opher]

Will my hon. Friend give way?

[David Smith]

I do not have time. That opens up the dark possibility of a race to the bottom—to looking for savings in the health and social care budget. Any Government would be tempted, where cost saving is a possibility, to push assisted dying as a cost-saving measure; we have seen that in jurisdictions such as Canada.

Finally, let me say this with humility and respect to my hon. Friends on my left. I fear that the Bill will lead to the marketisation of death and dying. We have learned from other jurisdictions that many medical services and clinicians do not want to be part of the delivery of assisted dying, for reasons of principle or because they fear that they will be sued. Independent private health organisations will have to take over to fill the space. Those businesses will have shareholders and annual reports. They will be driven by the desire to maximise profit, with death for the bottom line. They will advertise and seek to expand their market share.

[Dr Opher]

Will my hon. Friend give way?

[David Smith]

I am sorry; I am almost finished. This could seem like a tangential point to make on a money resolution, but, to summarise this and my other points, I fear the consequences of the relationship between money—this resolution in particular—and assisted dying. Although I will not be voting against this resolution, because I believe in the democratic process, I think we seriously need to consider the relationship between money and this Bill.

--- Later in debate ---

[Antonia Bance (Tipton and Wednesbury) (Lab)]

Last summer’s Labour manifesto included the words

“Fully costed, fully funded—built on a rock of fiscal responsibility”,

and they were words on which I was proud to be elected. Money resolutions are normally a formality, but not this one—not today. This resolution asks us to give a blank cheque to this Bill, which makes me nervous, because that sounds like something that we in this changed Labour party just do not do. When we put forward a proposal for public spending, we know how we will fund it.

[Dr Opher]

Will my hon. Friend give way?

[Antonia Bance]

No, I will not.

In the case of this Bill, we not only do not know how much it will cost or how it will be paid for, but we do not even know what the money will be spent on. Let us think of the questions that we do not know the answers to. What will be the cost of NHS doctors attending the final appointment and waiting while their patient dies? What will be the cost of a second doctor to sign off? What drugs will be used, and how much will they cost? Will assisted dying happen in hospitals, in hospices or in new, purpose-built facilities? How many will there be, and where?

Obesity: Food and Diet

Simon Opher Excerpts

Monday 20th January 2025 Commons Chamber

[Dr Simon Opher (Stroud) (Lab)]

I beg to move,

That this House has considered the impact of food and diet on obesity.

I thank the Backbench Business Committee for allocating parliamentary time to this crucial issue. We were actually going to have this debate before Christmas, but we decided that before Christmas was not a good time to discuss obesity; we were then going to have it last week, but it was postponed. I am really grateful to colleagues across the House for supporting the debate.

Our country has an obesity crisis that is threatening the health and wellbeing of the whole nation. It is a cross-party issue: since 1990, rates of obesity have doubled. Two thirds of all adults in the UK are carrying excess weight, and a quarter of adults are classified as obese. The figures are even more worrying in children: 10% of children aged four, when they enter school, are obese; that figure rises to 22%—nearly one in four—in year 6. One problem with obesity is that, as many of us know, once someone becomes overweight, it is difficult to shift. That is why the most important age group to concentrate on is young people.

Obesity is now the single most important modifiable risk factor for the prevention of disease, and I will briefly go through its effects—as a doctor, I cannot resist. Around 4 million people in this country have type 2 diabetes, which is five times more likely in obesity. Type 2 diabetes almost doubles a person’s mortality rate, with 22,000 people with diabetes dying early every year. Ischaemic heart disease, the leading cause of death in the UK, is much more common in obesity, as is hypertension and osteoarthritis, which causes joint pain and reduced mobility. Something that a lot of people do not know is that 13 cancers are directly attributable to obesity—it is actually also the second commonest cause of cancer.

As a GP, there are other things I see quite regularly, such as reflux, varicose veins, infertility and even thrombosis, all of which diminish quality of life. The commonest cause of liver disease is now obesity. I will not go into the cost too much but, as we can imagine, obesity costs the country an absolute fortune: on average, four extra sick days a year; and, taking into account the cost to the NHS and so on, an estimated £98 billion a year, or 4% of GDP. The cost to the NHS is £19 billion a year.

What is the cause of obesity? From the evidence, it is clear that the main cause of obesity is diet—it is what we eat. The food system in this country is fundamentally broken. I welcomed the statement from the Secretary of State for Environment, Food and Rural Affairs, my right hon. Friend the Member for Streatham and Croydon North (Steve Reed) about sustainable food production: nutritious foods grown while restoring nature, and farms with good food production at its core, rewarded properly. There is a complicated relationship in food production, whereby farms mostly exist on Government subsidy with very small profit margins and then the supermarkets make profits out of what they sell. We need to look into that complicated relationship.

One problem is that unhealthy and ultra-processed foods—UPFs—that are high in fats, salt and sugar are often the easiest, cheapest and most convenient. Crucially, they make the most profit for the food industry. The other problem with these types of food is that they are addictive—salty, fatty foods are addictive. Another problem, revealed by the Food Foundation, is that healthy foods, calorie for calorie, are twice as expensive as less healthy foods. So there are a lot of issues there to unpick.

Inequalities and deprivation are very, very strong causes of obesity, with less well-off people being twice as likely to be overweight. Therefore, one strategy has to be to increase the living wage, reduce child poverty, improve health and social services, and invest in education —all of which the Government are doing.

On pregnancy, obesity actually begins in the womb—it does not even begin when we are born. In one fascinating experiment, one group of pregnant women were fed a lot of carrots and another group did not have any carrots. The children of the women who ate carrots loved carrots, so a memory is made in utero. It is therefore really important that pregnant women have a very healthy diet, as this is a risk factor for obesity in young people. Another is formula feed. Breastfeeding protects against obesity, but formula feeds do not. Follow-on feeds, hungry baby feeds, are just normal milk packed full of calories, so they tend to increase obesity. That is perhaps something we need to discuss, too.

[Wera Hobhouse (Bath) (LD)]

I am the chair of the eating disorders all-party parliamentary group. To make any progress, we have to understand that eating disorders are highly stigmatised. Many people with obesity also have an eating disorder. To make real progress, is not the first thing to take the stigma away from obesity and get to the people who really want to improve their lives?

[Dr Opher]

I absolutely agree with that. We must treat people in a fair and compassionate way. We must point that out to them, as medical professionals, and help them to get better. I agree with the hon. Lady about stigma.

On obesity strategies, since 1990, we have had 700 separate policies to tackle obesity, yet it has doubled. Clearly, we are doing something wrong. Having looked at the evidence, it is clear that voluntary targets do not work. Voluntary targets for the food industry and relying on individual agency—giving us choice in what we eat—cannot reduce obesity. The food industry, of course, has a vested interest in making money. While education and exercise are really good, there is not much evidence to suggest that they reduce obesity. It is all about food.

There has been a lot of research. Nesta, the Obesity Health Alliance and the House of Lords Food, Diet and Obesity Committee have done multiple reports on obesity, and it is clear that we can halve it. All we need to do is reduce everyone’s calorie intake by 200 calories a day. That is the difference between McDonald’s large fries and standard fries—other fries are available—so it is not a massive thing, but we all have to do it. As always with public health, small drops in what we take can have a massive effect on the population.

[Peter Swallow (Bracknell) (Lab)]

Does my hon. Friend agree that it is important, when there is such a strong correlation between child poverty and child obesity, that we tackle not only the food systems leading to poor health outcomes, but the price of food? We must see those two challenges in lockstep and work to address both the quality of food and the cost.

[Dr Opher]

Absolutely. One of the main pitfalls we must avoid is that there is no point in making cheap food more expensive. That will make people poorer. We need to be much more creative than that.

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

I thank my hon. Friend for securing the debate and for allowing me to intervene. I commend the Government’s new policy of free breakfast clubs for all primary school children, but does he agree that we should not miss the opportunity to ensure that that meal is wholesome and nutritious so that all our kids can get off to the best possible start?

[Dr Opher]

Yes, I could not agree more. As I said in the debate on education, we should be careful about the food industry sponsoring school breakfasts. As I pointed out, there is no such thing as a free breakfast. Companies often make unhealthy and addictive food and get young people addicted to it, so we must be cautious.

I wanted a recipe to solve this crisis and what I am suggesting comes from evidence from Nesta and the House of Lords Select Committee. It should be mandatory that all stores report on the food healthiness of their sales. We need a fully independent Food Standards Agency. We should have a ban on advertising junk food, as has already been proposed, and there should be a watershed for children—that is incredibly important. As is planned in Scotland and Wales, there should be a ban on price promotions, particularly for unhealthy foods, ultra-processed foods and takeaways. We also need to put a lot more resource into breastfeeding and diet in pregnancies—remember the carrots—and we must regulate formula feeds.

One measure, which has worked with the drinks industry in reducing sugar, is a reformulation tax on foods that are high in sugar and salt. Supermarkets and food companies would reformulate their foods to avoid the tax, thereby making them healthier. My hon. Friend the Member for Slough (Mr Dhesi) mentioned breakfast clubs. There is a lot of evidence that free school meals and breakfast clubs reduce obesity. Where free school meals have been introduced in London, childhood obesity has been reduced by 11%. That is because the food is healthy and a healthy hot meal is really important, rather than high-calorie snacks, which are what a lot of packed lunches consist of. If we cannot have free school meals, because of financial problems, we should have auto-enrolment so that children who should be on free school meals actually get enrolled. That would benefit schools, too.

We must have mandatory front-of-packet labelling. I have never met a parent who does not want to buy healthy food for their children. The trouble is that they pick up a packet of cereal and it says, “High in iron and filled with vitamins,” and think it must be healthy. Nothing could be further from the truth, so we must have accurate labelling. Healthy school foods should be sourced locally. In Stroud, I have been working closely with local primary schools to encourage them to eat fresh, locally grown, highly nutritious food. I think the Government’s target is to procure at least 50% of food in schools from local sources.

Then there is the famous hospital food. I was recently in hospital with a relative, and I can tell the House that hospital food is not healthy. We had white-bread sandwiches and some crisps—that was our healthy snack. We must introduce healthy foods in hospitals.

Takeaways are another big barrier to healthy eating—there was a massive explosion in their use during the covid pandemic—and we need to include them in any regulation. As I have said, in Scotland and Wales a ban on takeaway price promotions has been proposed. On average, those in deprived areas order more takeaways than those in non-deprived areas. We certainly must not let takeaway outlets open near schools—that is a planning must.

I would also caution against the treatment of the obesity crisis with injections of drugs such as Ozempic, which could well turn out to be dangerous.

[Jim Shannon (Strangford) (DUP)]

According to today’s press, there is clear evidence of that. Apparently, 400 people across the United Kingdom who took Ozempic experienced poor health as a result. It is not for everyone, and the sooner that people know that, the better.

[Dr Opher]

The hon. Gentleman’s intervention reminds me of the GP I took over from—an old chap; very wise—who said, “Always be a few years out of date, Simon, because we never know what these new drugs are going to cause.” I think that is good advice—not that I am suggesting that doctors are out of date, of course.

Are we proposing the creation of a nanny state? That is the great fear of many people when they are confronted by controls of this kind, but let us look at what happened with the ban on smoking inside pubs. People—particularly in Ireland, but also in England—were saying, “This is crazy; it is never going to work”, but it worked fantastically well. We need to be aware of the vested interests of food companies, and we need to take radical steps.

[Max Wilkinson (Cheltenham) (LD)]

I thank my Gloucestershire neighbour for giving way. He mentioned the nanny state. As a Liberal, I believe in freedom, but there are two sides to it: freedom from and freedom to. Should not freedom from some of those representing the big, powerful vested interests in the food companies, who are not interested in our health, be at the centre of this debate?

[Dr Opher]

I entirely agree. I think that this Parliament could do to obesity what the Government who were in power between 1997 and 2010 did to smoking: we could drastically reduce it. For the sake of our children and our older adults, I urge everyone to accept that we need to act now, and we need to act radically.

--- Later in debate ---

[Dr Opher]

I thank the Minister and all who have spoken because this has been a genuinely interesting debate about an essential topic. I would just like to say in summary that the hon. Member for Chester South and Eddisbury (Aphra Brandreth) needs to go into the supermarket when she is really busy and pick up a tasty healthy snack. If the Government can get people doing that, it will be fantastic. I say to the Minister that the House is behind him being radical; it is not the time for non-intervention.

I thank all who have contributed. I missed supper and am starving, so I am going to go and have a healthy snack.

[Hon. Members]

Hear, hear!

Question put and agreed to.

Resolved,

That this House has considered the impact of food and diet on obesity.

Medicines and Healthcare Products Regulatory Agency

Simon Opher Excerpts

Thursday 16th January 2025 Commons Chamber

[Dr Simon Opher (Stroud) (Lab)]

Thank you, Madam Deputy Speaker. I have quite a lot to say here, but I shall squeeze it into four minutes.

First of all, having a regulator funded by a drug company is genuinely a case of marking one’s own homework, and we need to change that straightaway. I think we need a reform there.

From clinical experience, I would also say that the yellow card system does work, but that we never get any feedback from it. That is one of the problems. The other problem is that clinically one is often not sure whether or not something is an adverse effect. We need a very easy system that can just be fired off. The right hon. Member for Tatton (Esther McVey) mentioned low white blood cells, for example, and whether that was a reaction. Then, when a number of different doctors get it, we can accumulate that information.

If I may, I want to say a few things about vaccinations. Vaccinations save far, far more lives than they cause damage. Every medicine that has ever been invented has side effects and I do not deny vaccine side effects. However, the vaccine saved hundreds of thousands of lives. I ran the covid vaccination service in our area in Dursley. At the height of the pandemic, if we injected 180 people over 80, we saved a life—that is incredible. Compared to that, the side effect rate was incredibly small. It does exist and we need to look at it, but let us not get on the backs of vaccines. Vaccines have saved more lives than anything else.

I really want to talk about antidepressants, on which the hon. Member for East Wiltshire (Danny Kruger) has already said a few words. We have a problem with over-prescribing in this country. Some 8.7 million people are on antidepressants. My hon. Friend the Member for Blackley and Middleton South (Graham Stringer) spoke about Paroxetine causing increased risks of suicide. We need to wean ourselves off medications. National Institute for Health and Care Excellence guidelines say that for mild to moderate depression we should not start tablets, yet they are started. That is because people have become a bit over-medicalised, we have 10-minute appointments and no psychological therapies. We must also make use of social prescriptions, available to the NHS, where we can prescribe to patients something that is not medical. We need to de-medicalise what is going on. That can include lots of different things, such as exercise and being very creative. In fact, yesterday I went with the Lord Mayor of Westminster and Lu Jackson to St John’s Wood library for a Comedy-on-Prescription event. Making people laugh can avoid the need for medication. We need to look at those things much more seriously and get people off tablets.

The right hon. Member for Tatton (Esther McVey) said that one of her constituents took their own life when they were trying to get off antidepressant medication. The MHRA needs to put warnings on the packet, but it has failed to do so. We also need a support mechanism for people coming off tablets. Of the 8 million people on antidepressants, about 2 million are trying to get off them, so it is a major problem. GPs, actually, are not that well informed about this. There are some very strong Maudsley guidelines based around micro-tapering, so that people can come off slowly and safely. Some kind of support service might have helped her constituent and stopped them taking their own life.

In conclusion, we have a pandemic of over-prescription and we need to start looking at that. As chair of the beyond pills all-party parliamentary group, with the hon. Member for East Wiltshire we are trying to reduce prescriptions and make it safe for people to come off antidepressants.

NHS Dentistry: South-west

Simon Opher Excerpts

Tuesday 12th November 2024 Westminster Hall

[Dr Simon Opher (Stroud) (Lab)]

Thank you, Mr Vickers, for chairing this essential debate about dentistry in the south-west. My mailbox is full of people complaining about the lack of NHS dentistry, and we have heard all the horror stories. As a GP, I see people staggering into my surgery holding their face. I know no more about teeth than anyone else here, but we GPs have to try to treat them with painkillers and antibiotics, because there is nothing else available. We must change that.

Let me quickly talk through the dental contract; I then have a couple of positive stories, which will perhaps stimulate the Minister in respect of what could lie ahead. As has been said, the current dental contract nationally has an £86 million underspend, which is absolute madness, but it is because the contract is incredibly restricted and restrictive. The funding for units of dental activity is very poor.

[Richard Foord]

The £86 million underspend relates to the south-west in particular.

[Dr Opher]

Yes, but that is even more shocking, is it not?

There are also disincentives in the contract for dentists to take on new NHS patients. When we look into it, there are all sorts of other things. For example, a dentist cannot provide urgent NHS dentistry unless they have used up their quota of UDAs, which are issued to dentists at the start of the year. The whole system is crazy, which is why there has been such a massive saving. As we have heard, dentists are leaving the profession, and it is clear that we are not training enough. I accept what the hon. Member for South West Devon (Rebecca Smith) said about how dentists are trained and where they are likely to end up working, because that is incredibly important.

As to solutions, we must have prevention. Dentistry is exceptional because dental treatment is preventive in its own right, so as soon as NHS dentistry is stripped away, there are immediately problems. We also have to make sure that young people’s diet is better. Dentist Cerri Mellish and I have developed a project in our area. Cerri sees young pre-school children who are under five. She has a quick look in their gobs and if there are signs of decay, they are whipped out and the children are given treatment. If there are any other signs of problems, she can give them fluoride enamel. These types of innovative solutions are really important.

One thing that happened with the pandemic was that NHS dentists stopped registering new patients. The pandemic started in 2020, so almost all pre-school children are likely not to be registered with a dentist, which is a real disaster. We should remember that two thirds of general anaesthetics used for children are used for dental reasons, and a general anaesthetic is not without risk.

[Chris Bloore (Redditch) (Lab)]

I congratulate the hon. Member for Honiton and Sidmouth (Richard Foord) on securing this important debate. I apologise for being an interloper from the west midlands, but it such an important debate that I want to add some thoughts.

My hon. Friend has hit on an important point. As the father of a toddler, I struggle every day to ensure that he brushes his teeth. The gap in the number of registrations since covid is creating a generation of children who are not used to going to the dentist. We have to reverse that trend; otherwise, we will have huge problems as a society, having to treat teenagers and adults with severe dental problems who have never been to the dentist.

[Dr Opher]

That is absolutely true. Simple things such as dental brushing schemes, which we introduced in the Stroud area before the election, are essential. Those sorts of things are often laughed at, but they are probably the most important thing we do as a Government.

One other quick win relates to urgent care. The Gloucestershire ICB, particularly in the Stroud area, was able to pay more for the units of dental activity and allowed all NHS dentists to do urgent care. In that way, some of the £86 million that the hon. Member for Honiton and Sidmouth (Richard Foord) talked about was spent. We were able to quadruple the number of urgent appointments.

We can do that kind of work on a smaller scale, but I suggest that we need to do things step-wise. We must get the prevention in place and start doing urgent dental care, and when we have enough money we can do more. It is all very well talking about fantastic NHS dentistry, but we need the funding for it and we need the taxes to pay for it. As a Government, we are responsible for that. In the long term, we need to look to universal NHS dentistry in this country.

Mental Health Support

Simon Opher Excerpts

Thursday 10th October 2024 Westminster Hall

[Dr Simon Opher (Stroud) (Lab)]

On World Mental Health Day, I am wearing this slightly ghastly yellow tie. May I also do a little promotion? In room M in Portcullis House at 3 o’clock, at the end of the debate, we have some young people, through YoungMinds, telling us what they think of the service. It is really important, particularly with young people, to make sure that we develop services that they want and that we do not dictate.

I am still a practising GP in Stroud. More than 90% of mental health consultations take place in primary care and more than 40% of GP consultations concern mental health. I am sure the hon. Member for Hinckley and Bosworth (Dr Evans) will concur with me on that front. I would like to divide mental health into two sections. There is serious mental illness, which is serious and enduring, affecting about 130,000 people in this country. I will make a little plug: they tend to die 10 to 20 years earlier than other people and we must promote their physical health.

The other area is anxiety and depression. We have 8 million people in this country on antidepressants—selective serotonin reuptake inhibitors—and at least 2 million of them are trying to get off. We need to ensure we do not over-medicalise mental health. I was pleased to hear what my hon. Friend the Member for Ashford said about mental wellbeing and mental health. We all get a bit pissed off sometimes—that is normal for humans—and it is extremely important that we do not conflate that with mental ill health.

[John Glen]

May I just say how much I agree with that remark? We may disagree about resourcing and what has happened over the past 14 years, but we need the confidence to talk about building resilience and prevention so that people do not get to the point where they need medical intervention. We have the responsibility to talk about that in this place and in our communities so that we get to the root causes, which are not always to do with socioeconomic matters.

[Dr Opher]

Absolutely; I fully agree with that.

I want to make a couple of comments about the state of mental health services, for which there are extraordinary waits: a patient of mine had to wait six months following a suicide attempt. That is simply not good enough. In Stroud, we have to wait four years for neurodiversity assessments because we do not have enough resource. In my opinion, we need to move the resource into the community.

I also support what my hon. Friend the Member for Ashford said about health and education. We need mental health support teams in our schools, and we must spread SEND provision evenly.

The Under-Secretary of State for Public Health and Prevention is with us, so I want to talk about the prevention of mental health issues. There is quite a lot of evidence about promoting maternal and infant mental health, and also about parenting and bullying at school. Using arts and culture is an incredibly strong way of improving mental health.

I was impressed with what my hon. Friend the Member for York Central (Rachael Maskell) said about the community basis of mental health treatment. For many lower-level conditions, there is no need for consultant-led care. Support that takes place in the community costs much less and can be really effective.

The CAMHS waiting list is appalling, and we have a crisis with SEND and delays with education, health and care plans. We do not have enough educational psychologists either. I want to stress what my hon. Friend the Member for Ashford said about care co-ordinators. Young people’s social prescribers are very effective and tend to de-medicalise things that can be supported in the community.

I am really impressed that we are going to get 8,500 more mental health workers. I am also impressed by what they will be doing in schools. We need to improve the physical health of people with serious mental illness, reduce the number of SSRI antidepressant medications, and promote social prescribing, the arts and community care in our mental health services.

[Peter Dowd (in the Chair)]

Can I just remind Members about modes of expression? I will be diplomatic about it.

Maternity Services: Gloucestershire

Simon Opher Excerpts

Wednesday 9th October 2024 Westminster Hall

[Dr Simon Opher (Stroud) (Lab)]

I thank the hon. Member for Cheltenham (Max Wilkinson) for calling this debate. Maternity care in the Stroud area has been a big issue for the past couple of years in particular. I have been a GP for 30 years, and I have helped with antenatal and post-natal care and, indeed, intrapartum care for six months, which was the hardest work I have ever done in my life. I also delivered my second daughter in a Worcester hospital.

I know and have worked with fabulous midwives, who are the absolute key to maternity services, as we have been discussing. Doctors are occasionally called in for other reasons, but midwives run maternity services; they have to be central, and they have to make their decisions around women. That is one of the reasons I promote Stroud maternity unit: as my hon. Friend the Member for Gloucester (Alex McIntyre) said, midwife-based units have lower levels of intervention and better outcomes for babies.

As many hon. Members have said, the key problem here is the lack of midwives. We should not shy away from that, but I also want to talk about a number of other issues. Something that seems to have been missing from the discussion is women’s choice over where they give birth—we seem to have reduced that choice to just Gloucestershire Royal hospital. Although Stroud maternity unit is open for intrapartum care, it does not have post-natal beds, so women are generally choosing it less often. That is a pity, because it is a fantastic place to give birth and has a low intervention rate. Equity and equality also seem to have been lost from the discussion recently, and we need to get them back into the decision-making process.

Maternity care is actually a longer process than just where someone gives birth. I will outline where those interventions take place. Pre-conception and antenatal care tends to be done in GP surgeries by community midwives with the help of GPs. Intrapartum care can be done at home—a small proportion of people do give birth at home—or in midwife-led units, such as Stroud maternity, or in either midwife-led or consultant-led units, such as in Gloucester Royal and Cheltenham. They are the possibilities. When it comes to post-natal beds, the only choice at the moment is Gloucestershire Royal; there is no other option in Gloucestershire. Either mothers go there for their post-natal care or they have to go home and have a community midwife.

The last part, I always think, of the whole maternity service is the eight-week check of the baby by their GP. I have done thousands of those checks in my life, and it is one of the best things I ever do. The GP can check babies for problems and talk to mums about not sleeping and all the other issues.

That is the whole, rounded nature of maternity care. I now want to talk about Stroud maternity, because that is what I know about most and what we are missing most. First, it is a very much loved and valued service in Stroud and we are missing the six closed post-natal beds. As I have said, it is a stand-alone, midwife-led unit. That is unusual in this country, and it is a shame it is unusual, because it is a really good place to have intrapartum care, so it is something that I am really trying to promote. We have 1,000 live births in Stroud a year, and at the moment only about 300 take place at Stroud maternity unit, but as I have said, there are lower levels of intervention and there is increased maternal satisfaction. For that reason, we must get these beds open again; they have been closed since 2022.

I want to make a few points about post-natal care, because often people say, “Oh, it’s a luxury; we can’t really afford it.” It is not a luxury. There is very good evidence that for certain families, certain mothers, good post-natal care saves a huge amount of money later on. It is about making sure that the baby and the mother bond properly and that breastfeeding starts properly. It is about making sure that they have a couple of days away from, perhaps, a number of other children and properly bond and that mothers learn how to look after babies. A lot of my colleagues say, “Well, post-natal care, we don’t really need that,” but we do need it. If we lose it, it will cost the country more, but it is also part of the whole maternity service. That is the first thing I would say.

Secondly, the people at the CQC have stipulated various things. The CQC is about safety, which none of us can argue about. However, some of its decisions, I feel, do not make sense and all they do is give safety to the organisation and not to the mother. For example, postnatal beds are being closed because it insists on having two midwives on the unit at all times; that makes it safe. However, closing the post-natal beds means that all these mothers have to go home. Are they safer at home or are they safer at hospital, with maternity care assistants and other nursing staff? I would say that the safety of the mother is better served with those post-natal beds open, even if there is just an on-call midwife as a second midwife. I want to slightly question the logic of the CQC—we must go back to it—so one of the things that I will do after this debate is write to the inspectors and arrange a meeting with them, because we must consider the safety of the mother and the child first. This is not about covering the organisation and making that safe; it is about making the mother safe, so I would iterate that as well.

There is something else that we have been doing. The League of Friends at Stroud hospital in general and at the maternity hospital is fabulous and has been providing extra services for post-natal and antenatal mums for some time. We now have an interim plan whereby we are going to open a sort of day hospital in the maternity unit so that at least mothers can come and have a bath while someone else looks after their baby, for example, and they can receive advice from health visitors and midwives. That is an interim plan. I do not want to say that it is a good replacement. We must get those post-natal beds open, so I am also due to meet the maternity and neonatal voices partnership, which is a crucial agent that we must talk to.

In summary, we need to train and, crucially, retain more midwives, because we have trained quite a lot of midwives who have almost immediately left the profession, as the hon. Member for Cheltenham was saying, because of stress. We need to secure a better working arrangement for them, and I look forward to my hon. Friend the Minister outlining plans to train thousands more midwives. We need to review CQC safety and make sure that the stand-alone nature of midwife units is fully understood by the CQC. We also have to make midwife working much more flexible. There could be on-call systems for these stand-alone units, so a second midwife does not need to be present if they are available to be called in. I have talked to midwives about that, and they seem happy to run that type of service. We also need a commitment from the ICB and the Gloucestershire Hospitals NHS foundation trust to reopen all six post-natal beds at Stroud maternity hospital.