Oral Answers to Questions

Stuart Andrew Excerpts

Tuesday 21st October 2025 Commons Chamber

[Mr Speaker]

I call the shadow Secretary of State.

[Stuart Andrew (Daventry) (Con)]

First, it is great to be in this new role. I genuinely want to be part of a constructive Opposition, but equally I want to do my role in holding this Government to account. I note the lack of detail in the Secretary of State’s answers on reorganisation, so can I ask the basics again? How many people will be made redundant, what will it cost and who is paying?

[Wes Streeting]

I welcome the shadow Secretary of State to his place. It is good to hear from the Conservative Front Benchers; I had almost forgotten they existed. The Conservatives created a complex web of bureaucracy. It is a bit rich to complain we are not abolishing their creation quickly enough. We have had a number of expressions of interest in voluntary redundancy across my Department, NHS England and the integrated care boards, and we are working through that as we speak.

[Stuart Andrew]

Again, the Secretary of State cannot answer. His answers are too vague. He is very good at making promises, but the facts are that he is presiding over a reorganisation that has stalled, creating uncertainty for staff. Waiting lists are up 50,000 in the past three months, hospices are in crisis because of national insurance contribution rises, and we have had strikes again—despite big pay rises—with the threat of more. If the Secretary of State wants the leadership in the future, perhaps he should show leadership in the NHS now, and tell us not just the plans, but when he will give the details and how he will deliver on his promises to patients.

[Wes Streeting]

Waiting lists are lower now than when Labour took office, and that is in stark contrast with the record of the Government in which the shadow Secretary of State served; waiting lists increased every single year they were in charge. This is the first year in 15 that waiting lists have fallen. That is the difference that a Labour Government make. We are only just getting started. As for leadership changes, we all know why they are calling the Leader of the Opposition “Kemi-Kaze”.

Points of Order

Stuart Andrew Excerpts

Tuesday 21st October 2025 Commons Chamber

[Mr Speaker]

First of all, you cannot continue the debate, but you have certainly put that on the record.

[Stuart Andrew (Daventry) (Con)]

On a point of order, Mr Speaker. Before beginning my questions, I meant to pay tribute to our former colleague Oliver Colvile, who sadly passed away last night. He served as the Member for Plymouth Sutton and Devonport between 2010 and 2017 and was named by Conservative Home as one of a minority of Conservative MPs not to have voted against the Government, which, as a previous Whip, I thought was exceptional. He was a true gentleman whose eccentricities endeared him to many. I am sure the thoughts of the whole House are with his family.

[Mr Speaker]

We all remember Oliver Colvile very fondly. He really was a good MP and a nice kind of guy to meet. I knew Oliver way before he came to this House. We are all saddened to hear the news.

Mental Health Bill [Lords]

Stuart Andrew Excerpts

Report stage
Tuesday 14th October 2025 Commons Chamber

[Stuart Andrew (Daventry) (Con)]

I want first to recognise and thank everyone for the constructive debates we have heard here and in the other place throughout the Bill’s passage. In particular, I thank the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth (Dr Evans), for everything he has done on the Bill, especially in Committee. I pay tribute to my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) for his expertise, whose involvement with the Bill began before he was elected to this place. I also pay tribute to my right hon. Friend the Member for Salisbury (John Glen) and my hon. Friend the Member for Farnham and Bordon (Gregory Stafford) for their thoughtful contributions.

This is clearly an important and emotive issue, and the respect and sensitivity that have been shown by all sides is a testament to this House. Since the election, we have said that we would not oppose for the sake of opposition. While we have rightly asked tough questions of the Government, we have done so with the best interests of patients at heart, because everybody here wants to help and support vulnerable people better—those patients with the most severe and complex mental health needs. This Bill, which started under the previous Government—I pay tribute to former Prime Minister Baroness May for that—and continued under this Government, will achieve that. We welcome efforts to improve the patient’s voice and involvement in their own care, to ensure that patients receive effective and appropriate treatments, to minimise restrictions on liberty so far as is consistent with patient and public safety, and to treat patients with dignity and respect.

Although we are disappointed that opportunities to strengthen the Bill further have been missed, especially in public safety and the protection of vulnerable children, we listened closely to what the Minister said and to his assurances on action, for which we thank him. We will of course continue to push on these matters, not on party political grounds, but because doing so is the right thing for patients.

We are very disappointed that the proportion of health spending on mental health has been reduced. We welcome the Government’s continuation of our work looking again at how we treat and protect people with the most severe mental health illnesses, so that we can improve the safety, treatment and dignity of patients and the wider public, and ensure that our laws remain relevant and proportionate in the modern world. The Government must now turn their words into action and deliver on the commitments that they have made.

I thank everybody again for the constructive way in which they have dealt with the Bill. We are pleased to support its Third Reading. We hope that it will bring improvements for those we all care about: the patients.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson.

Support for Life-shortening Conditions

Stuart Andrew Excerpts

Tuesday 7th June 2016 Westminster Hall

[Stuart Andrew (Pudsey) (Con)]

I beg to move,

That this House has considered support for children and young people with life-shortening conditions.

Mr Percy, may I say what a pleasure it is to serve under your chairmanship for the first time? [Hon. Members: “Hear, hear.”]

Prior to entering Parliament, I spent most of my working life in the hospice movement, with both adults and children. I worked in hospices, including Hope House in Oswestry; East Lancashire hospice, which cares for adults in the east Lancashire area; and Martin House children’s hospice, which cares for children in the Yorkshire area. During that time, I saw children and their families at their most vulnerable, looking for any kind of solace in what are probably the most challenging circumstances that any of us could possibly imagine.

In my 14 years working in the sector, I saw the hospice movement adapt and grow to meet the needs of children and young people as medical technology and provision developed. That growth was achieved by listening and putting the patients first at all times. However, unfortunately, there are still cases across the broader palliative care sector where that does not always happen, and that is why this debate is so important. There are currently 49,000 children and young people—and the number is rising—living in the UK with life-shortening conditions.

[Nick Thomas-Symonds (Torfaen) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Percy. I congratulate the hon. Member for Pudsey (Stuart Andrew) on securing such an important debate. He just quoted a statistic. Does he agree that data collection is one of the most important factors? Robust data collection is needed so that we do not underestimate the number of children who are suffering from life-shortening conditions.

[Stuart Andrew]

The hon. Gentleman makes an important point, which I will come to later.

Some 49,000 children and young people are living with conditions that are life shortening, by which we mean conditions for which there is no reasonable hope of a cure and from which most of those young people are expected to die. The conditions can include conditions for which curative treatment may be feasible but can fail, as is often the case with cancers or congenital heart diseases; conditions for which premature death is inevitable but where there may be prolonged periods during which the child is well, such as Duchenne muscular dystrophy; progressive conditions such as Batten disease, without any curative treatment; and irreversible, but non-progressive, conditions that cause severe disability, leading to susceptibility to health complications and premature death, such as severe brain injuries.

The number of young people affected by one of those four categories of condition is equivalent to one child in every single school, and 50% of the 5,000 children who die in the UK each year will have one of those conditions. Of course, the number of people affected in other ways is much higher. Parents, siblings and other family members and friends can bring the number close to 400,000 people, which equates to more people than the population of the city of Leicester.

The 49,000 children and young people need palliative care from the point at which their condition is diagnosed or recognised—often at birth—until the end of their lives. There is an entire package of outcomes that good palliative care should achieve, which is quite different from that which adults receive given that children often need care throughout their entire life. Good care should meet children’s physical, social and emotional needs, enhancing their quality of life to ensure that the child and their family can come to terms with such life-altering issues.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Gentleman on obtaining this important debate. I am sure that many people here will have come into contact with children with such difficulties. Does he agree—he touched on this point—that more psychological help is needed for the parents, especially when the children are approaching the time of death? It is a very difficult time. There need to be very quick results. Help is needed for the parents as well.

[Stuart Andrew]

I absolutely agree. During the time I spent in the hospice movement, I learnt that those final few weeks are incredibly distressing. None of us can possibly imagine what it is like unless we have been through it. The support for the parents and the wider family is what makes much of what happens in the children’s hospice movement such a success.

The care must be age appropriate—suitable for a child’s particular stage of development—and administered by people who have the exact skills needed to get the person through their care pathway. A comprehensive local children’s palliative care service spans health, social care and education. Joint commissioning is vital and should be accessible 24/7, 365 days a year, from diagnosis to bereavement. As a result of the complexity and severity of patients’ needs, the transition from children or youth services to adult services can be particularly daunting.

[Mr Robin Walker (Worcester) (Con)]

I am grateful to my hon. Friend for securing the debate and for the well-informed points he makes. Is it not the case that improvements in medical technology mean that more children with life-limiting conditions are transitioning into adulthood? Therefore, we have a real duty of care to ensure—as Acorns Children’s Hospice in my constituency is doing—that we find the best pathways to support those people into adulthood and to give them the best chance of living a quality life with the time that they have.

[Stuart Andrew]

My hon. Friend is right. I saw great advances throughout my time in the hospice movement. When I first joined Hope House, the life expectancy of the children who suffered from Duchenne muscular dystrophy was usually no longer than 18 or 19. By the time I had finished my career in the hospice movement, some were living into their late 20s and possible even their early 30s. Transition is incredibly important for them, because often the style of care provided is geared more towards the older generation than to young people.

Transition is incredibly important and centres such as Martin House, which I worked for, understand that. It built Whitby Lodge, a dedicated unit for teenagers and young people, which has state-of-the-art equipment designed to enable social interaction through things such as a mini nightclub—something that we all take for granted. As well as caring for children and young people in the hospices, members of the care team supported the family in their home. Even after a child has died, help is provided in the form of bereavement care for family members.

Transitioning to other services can sometimes present real difficulties. From dealing with new agencies and professionals, to transitioning to a completely different plan, the result can create quite severe gaps in service provision. The impact is, frankly, quite shocking, with 36% of families breaking down, 64% of mothers and 24% of fathers having to give up work entirely, and nearly 70% of siblings being bullied or feeling isolated at school.

All that can create a cocktail of problems that leads families into poverty. Therefore, at all times, it is vital that locally available, community-led children’s palliative care is at the heart of the service provision. These kinds of services are, thankfully, easier to find than they once were due to local offers and organisations such as Together for Short Lives, which provide directories of available services. That is just one example of how provision has changed since I began working in the hospice movement.

I will never forget seeing families, drained and exhausted, arriving straight from work or school on a Friday, the colour drained from their faces with no fight in them, dragging bulky equipment around in their car, when all they wanted to do was what we all like to do—go out for a simple meal on a Friday night. Great palliative care allows those families to have short respite breaks, the importance of which really cannot be overstated, because it provides support to everyone in the family. With the number of children and young people with life-shortening conditions increasing, it is becoming harder for the Government, the NHS and local councils to budget enough to meet those families’ needs, given that the number of people with such conditions is not being monitored, as the hon. Member for Torfaen (Nick Thomas-Symonds) mentioned. The complex care that such families need from multiple agencies and professionals is not joined up enough, and families have to fight with their last ounce of strength to get the services they need. I therefore ask my right hon. Friend the Minister what can be done to ensure that the number and needs of children and young people with life-shortening conditions are more accurately monitored.

Funding for voluntary sector providers of children’s palliative care is not being provided fairly or sustainably. It is limited to medical elements of care and does not include crucial non-clinical elements such as short breaks and bereavement support. Together for Short Lives expects to publish soon the results of a series of freedom of information requests it has made to clinical commissioning groups and local authorities. Those results will show the extent to which different elements of care are being commissioned, and I hope that colleagues from across the country will use those data to see how their own constituents’ care is performing.

Before that, I ask the Minister whether he can set long-term plans for funding children’s palliative care fairly, sustainably and in a way that reflects the growing demand for such services. Additionally, will he work with his colleagues to write to CCGs and local authorities to make it clear what their responsibilities are in commissioning palliative care? Local authorities have a duty to provide short breaks for disabled children. However, they are cutting funding for short breaks at a time when demand from seriously ill children is increasing. The Government and local authorities, of course, face a difficult situation in balancing budgets, and I fully understand the need for that to happen, but at the spending review the Government gave councils the ability to raise more money for adult social care through council tax. Children’s social care was left out and I struggle to understand why, so I would appreciate it if he expanded on that. Additionally, will he hold local authorities to greater account for the money they spend on short breaks for disabled children and ask them what action they are taking to secure access to such breaks?

As I have mentioned, without access to specialist adapted vehicles, which many families need and many of which I saw, families are unable to transport their seriously ill babies and young children to and from hospital. That often traps those babies and young children at home or in a hospital bed, preventing them from enjoying the things that we all take for granted. Children under three with life-shortening conditions are not currently eligible for the mobility component of disability living allowance, so will the Minister work with his colleagues in the Department for Work and Pensions to change the eligibility criteria so that nought to three-year-old children with life-shortening conditions, whose lives will end without heavy and bulky medical equipment, can have access to such important vehicles?

[Mr Gregory Campbell (East Londonderry) (DUP)]

Does the hon. Gentleman agree that that single gesture would do more to transform the lives of many families than all the recommendations and assurances that we all want to give those families?

[Stuart Andrew]

I certainly agree. As I mentioned earlier, it was staggering to see the smallest child come with so much equipment to keep them alive. Larger vehicles enable such families to do the things that every family likes to do, for example to go out for the day. The lack of such a vehicle often creates more isolation for the siblings I mentioned a moment ago.

[Mark Durkan (Foyle) (SDLP)]

Further to that point, does the hon. Gentleman agree that, given the sensitivity of the issue, as he has laid out so well, it is terrible that the basic message to those families who have a child with a life-shortening illness is that the reason they cannot get that support is that the child is not old enough? That is a perverse message for those families.

--- Later in debate ---

[Stuart Andrew]

I take that point entirely. In this debate I want the issue to be considered carefully, because it seems perverse for a child to be too young to get the support they really need.

Medical advances thankfully mean that more young people with life-shortening conditions are living into adulthood. That should of course be celebrated but, as I have said, the transition from children’s services to adult services can be daunting and is often not joined up. There is currently a distinct lack of age-appropriate and developmentally appropriate palliative care services to meet the growing demand, so again I ask the Minister whether he will look into providing seed funding to voluntary sector organisations so that they can set up age-appropriate services for young people transitioning from children’s services to adult services.

I end by paying tribute to all the organisations, including Together for Short Lives, and all the people who were involved with Children’s Hospice Week a couple of weeks ago. Those dedicated people are really quite superb. I could never have done my job at Martin House or at Hope House without their tremendous effort. Their reputation helped us to raise the money we needed, and we should all pay tribute to the tremendous work they do. I hope that today’s debate will mean that we can all work together so that things can change for those 49,000 children and young people who are battling with the most difficult issues that we could possibly imagine.

[Several hon. Members rose—]

--- Later in debate ---

[Antoinette Sandbach (Eddisbury) (Con)]

I am very grateful to my hon. Friend the Member for Pudsey (Stuart Andrew) for securing this debate, which, as Members know, is on an issue that I feel very strongly about. It was heartening to hear about the work of the Hope House hospice that serves my constituents, although it is based over the border in Shropshire, and about the work of Claire House, which is a very effective children’s hospice on the Wirral.

Other hon. Members have spoken powerfully about the transport issues and the transition issues, so I will concentrate on the families and the role that they play. It is particularly important to do so this week because it is Carers Week, and we know the vital role that parents play.

My hon. Friend made an important point about the 2% funding that was mentioned in the Chancellor’s Budget and the fact that that funding is limited to adult social care. There is no justifiable reason for that discrimination. It is clear that local councils have cut their funding for services, particularly for short breaks. The impact of that on families is devastating. Thirty-six per cent. of families with children who have life-limiting conditions experience family breakdown. Therefore, it is vital that the Minister recognises that cuts by local authorities to the funding for those short breaks lead to increased burdens on Government elsewhere and that it is short-sighted not to fund those short breaks, which give the families and the siblings the vital respite that is often needed to ensure that they stay together as a cohesive unit and get the break from some quite onerous caring responsibilities. I do not say that in a negative way. All the parents absolutely love their children and want to give them the best they can in the short lives they have, but they need that break and the time for themselves.

[Stuart Andrew]

I am grateful to my hon. Friend for making that important point and I would like to give an example. I always remember speaking to a father at the hospice who said that if he got up eight times in the night he considered that a good night’s sleep. Does that not highlight just how important it is that the families get the respite that they need?

[Antoinette Sandbach]

It is absolutely critical. I have experienced the situation in which, because of advances in medical science, the doctors cannot say whether someone will fall on one side or the other of the line of likely life expectancy—fewer or more than 25 years—and they do not qualify for support from the voluntary sector. Hospices play such an important role in supporting families and I give credit to the Government for funding children’s hospices, albeit not at the same level as adult hospice care.

There is, however, a cross-border issue, which Claire House neatly exemplifies. The hospice treats a number of Welsh patients—it will not turn children away—but it does not get funded for any of the treatment it gives to them. I urge the Minister to consider having National Institute for Health and Care Excellence clinical guidance that would apply nationally and help to iron out some of the wrinkles, perhaps taking some of the best practice in the devolved nations. We have heard powerful contributions about some of the efforts being made in Northern Ireland. There is some learning that can be gained from across the devolved nations, but guidelines would ensure that hospices were put on a sustainable footing.

On that point, I support the call for joint commissioning and ask the Minister to consider what happens after the death of a child. I am here partly in my capacity as the chair of the all-party group on baby loss, and the subject has been debated elsewhere. There is important counselling support that could be put in place before the loss of a child and, indeed, afterwards. Hope House, for example, has a dedicated counselling centre and I am delighted that recently—in fact, just this week— I got confirmation from the Treasury that the Alder Centre could apply for LIBOR funding. The centre provides vital bereavement support for families in the north-west and I very much hope that it puts in an application before August. That is a beacon of light perhaps in the north-west and in the debate.

Junior Doctors’ Contract Negotiations

Stuart Andrew Excerpts

Monday 8th February 2016 Commons Chamber

[Ben Gummer]

The hon. Lady is also an intelligent woman, so let me ask her this. If a trusted body, such as the BMA, tells its members that they will have a pay cut of 30% and an increase in hours, but that statement is incorrect, does it constitute a lie? That is the question I would put back to her.

[Stuart Andrew (Pudsey) (Con)]

A number of Members met representatives of the BMA in the House of Commons. We were disappointed that, despite continued questioning, they refused to go to the negotiating table, but thankfully they eventually did so, and made some progress. My constituents want a safe, seven-days-a week NHS. Is it not time to get back around the table, so that we can provide the service that NHS patients want?

[Ben Gummer]

It is, and that is why we need to move ahead in fairly short order. Ultimately, if staff contracts are not reformed across the service, those who will suffer most will be patients, and what will be most affected is the consistency of care that they receive at weekends.

Gay Conversion Therapies

Stuart Andrew Excerpts

Tuesday 3rd November 2015 Westminster Hall

[Mike Freer]

My hon. Friend makes a good point, given the evidence. I am about to quote the Royal College of Psychiatrists, which states that such therapies are damaging not only to the physical health, but to the mental health of individuals who have such therapies inflicted upon them.

[Stuart Andrew (Pudsey) (Con)]

I congratulate my hon. Friend on raising this important issue. Is he as disturbed as I am to see figures from the United States on people who have gone through conversion therapy showing that they are 8.9 times more likely to commit suicide, 5.9 times more likely to suffer depression and three times more likely to take illegal substances than their peers as a result of this frankly outdated and cruel method?

[Mike Freer]

My hon. Friend makes an extremely powerful point. I am not surprised to hear those figures.

Anyone who is conflicted and in need of support while coming to terms with their sexuality is experiencing some difficult feelings. If they are told that they can be cured—I am yet to find a case of the cure being proved successful—they then have to deal with those feelings as well.

Children’s Palliative Care

Stuart Andrew Excerpts

Tuesday 3rd March 2015 Westminster Hall

[Steve McCabe]

Yes, I agree. That is exactly the point. It is fantastic that so many children now survive for so much longer. That creates new demands and service needs that have to be considered. I should be grateful if the Minister said what work is being undertaken, both within Government and the NHS, to ensure that these transition issues are being considered in any new funding plans. I concur with the hon. Gentleman on that. The Care Quality Commission report, “From the pond into the sea: children’s transition to adult health services”—that is its title, I kid you not—also indicated that this focus is important.

We are moving towards the election, so it would help if the Minister clarified where we are with all these plans. As I have said, I acknowledge that the intention is to create a fair and sustainable framework, but we are now in March—the projected launch date for the introduction of the new non-mandatory currency is March—and as yet, unless I have missed something, we do not know the Government’s intention. What I would really like to know, and what I think the hospices would like to know, is what is going to happen with the hospice grant? Is the intention that it should continue during 2015-16 and beyond? I am sure that the Minister appreciates that not knowing is a real source of anxiety and a blow to any attempts at long-term planning.

Almost 96% of children’s hospice organisations are worried, according to the Together for Short Lives survey, that CCG funding will be less than their existing grant and harder to access. That grant covered about 13% of the care costs incurred by children’s hospices and existing clinical commissioning group funding represents about another 12%. Uncertainty over almost 25% of previously guaranteed funding is a difficult basis from which to operate.

I am sure the Minister knows that these bodies rely massively on public generosity and fund-raising efforts, but they also need some core guaranteed funding. If the grant ceases and is not matched by equal funding elsewhere, 89% of children’s hospice organisations could be forced to reduce their services. Areas at risk include short-break services for 60% of users.

[Stuart Andrew (Pudsey) (Con)]

As someone who has spent 14 years working for the children’s hospice movement as a fundraiser, I am completely aware of the point that the hon. Gentleman is making. Short breaks are incredibly important, because they are not only a break for the child, but for the whole family. Often people arrive on a Friday looking utterly exhausted. Just being able to have some normal family time until Monday is a great relief for them. Is that not the importance of these short breaks?

[Steve McCabe]

I do not think we can in any way overestimate the importance of short breaks to families and to children. Both need space at times, and the hon. Gentleman is absolutely right. The survey suggests that more than 60% of users could lose that service. There is also a risk of a 35% reduction in family support work, which is connected with short breaks and enables many families to keep going in stressful situations. There is also a risk of a 23% reduction in the amount of end-of-life care support provided.

Short breaks provide respite for carers and families and should be funded by local authorities and the NHS under their respective legal short-break duties. Despite being key providers of short breaks, a third of children’s hospices are not recognised by local authorities as being short-break providers. Some 42% of children’s hospice organisations receive no funding from local authorities. Page 56 of the palliative care funding review report states that

“pre-bereavement support is an absolutely essential part of palliative care and should be fully funded by the state.”

The review goes on to state, however, that far from being universal, only 65% to 70% of local authorities have open access services. Without the children’s hospice movement, there will be a gaping hole in end-of-life care.

I am not here to criticise the Government’s intentions, but the combination of the election and a new system with many unanswered questions risks significant funding problems. As organisations try to tighten their belts and take on new responsibilities, there is a danger that they will fall back on what they know or believe they know. It will not help the children or families of children with life-limiting conditions if clinical commissioning groups fall back on a narrow, clinical model that focuses on the child’s health needs as defined by doctors. The currency should not be used as a top-up for the acute sector providers, who can access other tariffs to fund care for children with life-limiting conditions.

Palliative care for children with a life-limiting or life-threatening condition is an active and total approach to care, from the point of recognition or diagnosis through the child’s life to death. It embraces emotional, social and spiritual elements and focuses on enhancing quality of life. It also supports the family and includes managing distressing symptoms, providing short breaks and care right through to the point of death and bereavement. That more holistic understanding of palliative care is reflected in national policy documents such as NHS England’s “Actions for End of Life Care: 2014-16” and the 2014 Care Quality Commission handbook. I welcome the interest that the Government have shown in an often neglected area, but we now need some clear messages, actions and signals to ensure that valuable work is not wasted and that an easily avoidable funding crisis is not allowed to develop. Local authorities under significant financial pressures are highly unlikely to fund what they might see as additional services unless required to do so. NHS England’s draft currency for children’s palliative care should be accompanied by clear guidance to local authorities on funding short breaks and bereavement care.

I would like the Minister to give an assurance that the structure is clear and that the intention is to have a three-source funding arrangement, with NHS England commissioning specialised children’s palliative care and utilising the experience of the children’s hospice movement, with CCGs commissioning general children’s palliative care using the new per-patient funding system and working closely with children’s hospices and with local authorities required to commission social elements of palliative care, such as short breaks, bereavement care and support for siblings and other family members, and seeing it as their duty to work with children’s hospices. It is vital that all three funding sources complement one another. If not, there is a risk that local authorities will regard those services included within per-patient funding as the entirety of palliative care and avoid playing their part. NHS England’s specialised care could fall prey to a narrow medical model and never leave the acute hospitals.

The Government need to provide some specific distinctions between specialised and general palliative care, so that one side is not tempted to avoid its responsibilities by relying on the funding of the other. We also need to know that NHS and local authorities are clear about their duties under the Children and Families Act 2014. It places a duty on them to jointly commission care for children and young people with special educational needs and disabilities up to the age of 25. I urge the Minister to provide what answers he can today to a valuable sector, which eagerly awaits his response.

Surrogacy

Stuart Andrew Excerpts

Tuesday 14th October 2014 Westminster Hall

[Jessica Lee (Erewash) (Con)]

It is a great pleasure to speak in front of you during this important debate, Sir Edward. I am grateful for the opportunity to raise the matter in Westminster Hall today.

Of the many functions of Parliament, one of the most important is to respond to changes in society and, when appropriate, to legislate accordingly. The law on surrogacy is outdated, limited and in places illogical. It is difficult to see how the current law, such as it is, can be said to help people who are starting families without the process involving significant stress and risk. Although there is no small or completely straightforward change to alleviate such problems, the time has come for Parliament to take a fresh look at the rules around surrogacy and to commit to helping people to start a family. I have some experience and interest in the matter from my time as a family law barrister.

Surrogacy is on the increase. Despite a lack of official figures, save for what is recorded on the parental order register, it is estimated that between 1,000 and 2,000 children are born through surrogacy each year, which is up from between 50 and 100 in 2008. The numbers are rising sharply, which is why the time is right for Parliament to explore the solutions to help the families and surrogates involved in the process. To start with, it is worth considering why families or individuals turn to surrogacy. There are of course several reasons, including unexplained infertility, cancer, couples being of the same sex or, occasionally, individuals wanting a child. Whatever the reason, however, the current system has uncertainties throughout. Some commentators have described surrogacy as a legal and political minefield, which may be right, but Parliament’s role is to face up to such problems and to try to find solutions.

Not only are there problems with the law in this country, but an international framework for surrogacy, unlike adoption, is lacking. The rules in the UK are so ambiguous that potential parents are increasingly turning to other countries to find surrogates, which has its own problems. The lack of an international structure leads to delays and complications when they return to the UK with their children. The problems were highlighted over the summer with the case of baby Gammy, one of a set of twins born to a surrogate in Thailand for Australian parents. Gammy happens to have Down’s syndrome, and there is a dispute between the surrogate and the intended parents as to the reasons why he is now separated from his twin, who has gone to Australia. It cannot be right for such children to be left without a clear set of international rules to resolve the dispute.

The Minister may not be surprised to hear that I am not short of possible solutions to the issues around surrogacy and ask her to reply directly to my proposals. I am sure that she will agree that the current system has problems and those problems must be the starting point. With that in mind, I am sure that she will be grateful for the opportunity to work with me and others and across Government Departments to help families by seeking solutions that can reform the system.

In summary, I am calling for the following changes. First, I want new legislation to be brought forward to update the law or to amend the current legislation to help prospective parents and surrogates. Secondly, there should be written agreements for those going into surrogacy to ensure that all potential future issues around the pregnancy have been discussed and agreed. Thirdly, I want an international framework for surrogacy. Fourthly, there should be a code of practice for prospective parents and surrogates. Fifthly, we should have pre-birth orders, because it is right that there should be an immediate transfer of parenthood upon birth. Sixthly, payments to surrogates need to be regulated and transparent and should be for the surrogate’s “inconvenience” rather than for the acquisition of a child. Finally, we should end the non-extendable deadline of six months for applying for a parental order. I will discuss a related development that came in a recent judgment later, but it cannot be right to have no flexibility in a family law application of this nature.

The Surrogacy Arrangements Act 1985 and the Human Fertilisation and Embryology Act 1990 provide for the current legislative arrangements. The 1985 Act made it a criminal offence to advertise for a surrogate mother, to advertise oneself as a prospective surrogate or for third parties to broker a surrogacy arrangement on a commercial basis. The Act made the UK surrogacy arrangement unenforceable and the legislation was perhaps aimed to discourage surrogacy. The reality, however, was that surrogacy cases were beginning to rise in the UK and the legislation left the whole structure without professional support, which was reflected on by High Court judges at the time. In 2007, Mr Justice McFarlane commented:

“Given the importance of the issues involved when the life of a child is created in this manner, it questionable whether the role of facilitating surrogacy arrangements should be left to groups of well-meaning amateurs.”

He makes a good point.

The 1990 Act created for the first time a bespoke legal process enabling married intended parents to reassign legal parenthood to themselves and obtain a parental order. It was updated in 2008 and extended those eligible to apply for a parental order to include unmarried and same-sex couples. That, however, is it. That is our entire legal framework. The various pitfalls in the current legislation are many and I will now speak of how Parliament can best legislate to help all involved.

Enforceable written agreements and a code of practice would deal once and for all with the uncertainty surrounding surrogacy. There are an infinite number of questions to ask before going into a surrogacy arrangement. A written agreement and a code of practice would provide clarity for intended parents and for surrogates. All those involved need proper advice and proper safeguards against all eventualities. What if the pregnancy results in more than one baby? What about communication between all involved during the pregnancy? What if the child has a disability? What about the arrangements for the actual birth? Those are just a few of the obvious, practical problems that need to be addressed and could be addressed by written agreements.

I have been discussing the matter with other MPs and some of my constituents. Following a conversation with a couple in my constituency, I will put it like this: I would not expect my constituents—the good people of Erewash—to have to purchase a house or lease a car without a contract, so why when trying to form a family, which is the most important thing that they will ever do, with a surrogacy would they do so with an inadequate framework? It cannot be right, but it is within Parliament’s power to change the rules.

The next change I would like relates to pre-birth orders. It is important to establish legally who the parents are from the moment of birth. At the moment, the surrogate, and their spouse if they have one, are the legal parents of the child. It has been said to me over the past few days that there is always the risk that surrogates will change their mind and that it must happen all the time. It is a common misconception. To my knowledge, only two cases of surrogates seeking to keep their baby have been reported in the past 30 years compared with some 1,000 successful arrangements. Typically, surrogates are mothers who have found pregnancy easy and then want to help other families. They have a commitment to help the intended parents and want to see them have their own family and see the child grow up in that unit. We need to support those women and to make the law work for them.

Furthermore, many children are being born abroad, if the surrogate is based there. That creates more problems, because the child can be born stateless, making arrangements to come home to the UK complex. If the parental order could be obtained during the pregnancy, arrangements to come home with the child would obviously be far more straightforward. A number of MPs have dealt with scenarios in which a child is born abroad and there are difficulties in returning to the UK.

The international context of surrogacy can add to the difficulties of applying existing UK legislation to the reality of modern surrogacy. Surrogacy law can be complex for foreign surrogacy arrangements. There is no international harmonisation of English and international law, and we do not automatically recognise a foreign birth certificate naming the donor parents as the legitimate parents of a surrogate-born child. In stark contrast with adoption, which requires the thorough vetting of parents, anyone can enter into a surrogacy arrangement abroad.

Automatic recognition of the surrogate as the legal mother, however, can cause its own problems in the context of international surrogacy agreements. In 2008, a British couple who had paid £23,000 to a surrogate mother who bore twins for them in Ukraine were at first unable to bring the children back to the UK, since the couple were not recognised as the legal parents. That situation took a year to resolve, during which time the children were left “marooned, stateless and parentless”, leading the judge dealing with the case to issue a stark warning about how dangerous such a scenario is.

There are many practical problems to getting home safely to the UK with the surrogate-born child after the birth, because of issues to do with the right travel papers, entry clearance and citizenship. Parents then have to look at the legal status of the child as soon as they return and any necessary interim legal measures. For instance, are the eligibility criteria for a parental order all in place? What about the legal position of the surrogate, and her partner if that is relevant, under English law? The complications are many.

Rules on surrogacy vary from country to country, so not only do we need to look at our domestic law, but all countries ultimately need to look at the international framework. In some countries, surrogacy is banned completely, such as in Germany, Italy, France and Sweden. In some countries, the law is complex, such as in the UK and Australia. Elsewhere, 19 states in America have laws clearly recognising surrogacy and another 10 states allow unpaid surrogacy. Also, anecdotally, I know of same-sex couples who have moved to the States with work, in part because they know that in due course it will be more straightforward there for them to have a child through surrogacy. Thus, all children born via surrogacy in the USA are eligible for a US passport, regardless of the citizenship of the parents, but that is inconsistent with other countries.

In July this year, the Government of Thailand announced changes to their regime for commercial surrogacy, stating that all surrogates will have to be blood relatives. As I made reference to earlier, a case in Thailand hit the headlines over the summer, and one can only feel sympathy for everyone involved in it. The case of baby Gammy, however, absolutely highlights the pitfalls and difficulties for all concerned. The outcome of such international situations—involving Thailand in this case, but it could be anywhere—might be that surrogate arrangements become more covert, and no one wants that. What we want is clear and transparent arrangements in this country and abroad.

[Stuart Andrew (Pudsey) (Con)]

I congratulate my hon. Friend on securing this important debate. Among a number of concerns, many people fear exploitation. Is not preventing that another reason for the importance of reaching international agreements?

[Jessica Lee]

My hon. Friend makes a good point. The way to avoid such exploitation is clearly to have a clear and transparent structure. That is what is missing in domestic law, where there are arrangements, although they are not working properly, and internationally. Far fewer UK couples would consider going abroad if the domestic arrangements for them in England and Wales were completely straightforward, preventing them from feeling the need to travel around the world to find a suitable surrogate.

Parental orders, as I said near the beginning of my speech, have a strict six-month deadline in which to be registered once a surrogate has had the child. The law provided for no flexibility on that until very recently—a judgment was published in the past few days. In that case, the president of the family division of the High Court made the following comment:

“Can Parliament really have intended that the gate should be barred forever if the application for a parental order is lodged even one day late…It is the very antithesis of sensible; it is almost nonsensical.”

The judge then went on to make the parental order and the wardship was set aside. There had been significant delays in returning the child to the UK.

It can be said, therefore, that case law has moved matters forward, but the rules remain the same and that is a matter for Parliament to resolve and to do so early. We are dealing with people’s families and with emotive issues. That is the most important thing. If there cannot be flexibility in obtaining a parental order, that is a most unsatisfactory position. That must be one of the first matters in which there has to be flexibility in an application under family law.

I want to address the issue of same-sex couples. Since the Marriage (Same Sex Couples) Act 2013 passed through Parliament, we probably have had an increase in the number of same-sex couples looking to have a baby through surrogacy. That has been on the rise for some time, but the Act supports it as well. On Second Reading, the Minister gave one of the most thoughtful and measured speeches on the legislation, which I recall clearly, so I am delighted that she is responding to the debate today. She has always taken a thoughtful approach to the issues surrounding same-sex couples.

In the UK, anecdotally, same-sex couples conceive with the help of a friend, relative, or a surrogate introduced to them by a UK-based non-profit surrogacy organisation. As we know, such surrogacy arrangements commissioned in the UK are unenforceable by UK courts, so the problem remains. Increasing numbers of same-sex couples are travelling abroad for surrogacy. As I mentioned earlier, a popular destination is the USA, because some states can guarantee that both fathers will be named on a child’s birth certificate from the outset. But, again, we come back to the problems that I have raised before. Parliament did well by passing the same-sex marriage Act and progressing matters in that way, but for issues that follow on from that, Parliament needs to do the same. We must have an even-handed approach in addressing every aspect of people’s social and family lives, and that is why we need to update the law.

I have set out for the Minister my key requests. I accept that they are not small ones, and some will take time to grant, in particular those concerning an international framework. However, I genuinely feel that there is a real change in emphasis. There is a momentum to address the issue. Judges, as I have quoted, are saying that statute law is not right, and we need to move matters forward. We have an opportunity here today to take the initiative. We very much need to start the process, which would be welcomed across the parties. I have been helped by the right hon. Member for Birkenhead (Mr Field), who apologises for the fact that he cannot be here today. There is strong cross-party support for moving things forward. I urge the Minister to take this one-off opportunity and take a stand today and offer some solutions to these complex and extremely important questions, which could transform people’s ability to have their families in this country.

Pancreatic Cancer

Stuart Andrew Excerpts

Monday 8th September 2014 Westminster Hall

[Stuart Andrew (Pudsey) (Con)]

It is a pleasure to serve under the chairmanship of my neighbour, Mr Davies. I begin by congratulating the hon. Member for Scunthorpe (Nic Dakin) on securing the debate. It has been my pleasure to work with him in the past on the campaign for the children’s heart unit in Leeds, and I know how dedicated he is to a cause once he gets the bit between his teeth.

I also pay tribute to my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw). I was interested to hear the hon. Member for Stalybridge and Hyde (Jonathan Reynolds) say that my hon. Friend’s mother lives in his constituency. Having heard a lot about my hon. Friend’s mother, I would love to see the canvass session when the hon. Member for Stalybridge and Hyde knocks on the door asking for support at the next election.

On the subject of the election, as someone in a marginal seat I have started to reflect a bit on my time here and wonder whether I will be re-elected. I have been remembering the things that have happened during those few years. I will take away many good memories, and I will be sincerely pleased also to take away my friendship with my hon. Friend the Member for Lancaster and Fleetwood. Thanks to his experience in politics over many years, he has given me good counselling and good advice.

On the subject of the debate in particular, my hon. Friend has often struggled with something that was very personal to him and very difficult, and he has often worried about his privacy and that of his partner. I want to put on the record how proud I am of him as a friend, and how proud I am of his campaign. I did not have the privilege of meeting his partner, but my hon. Friend has done that job exceedingly well.

I add my thanks and congratulations to the actress Julie Hesmondhalgh. She will not know this, but we met many years ago. Longer ago than I want to think about, I was at a Manchester Pride event dancing away on the set of Baker Street in Granada Studios, when bouncing along next to me came Hayley, as we all knew her then. She has clearly put her enthusiasm and her smile into the campaign. Having worked in the charity sector, I know that it is a great achievement to get someone with such magnetism behind a campaign. She has done a fantastic job in supporting the charities involved.

In 2012, I attended another debate on pancreatic cancer in Westminster Hall secured by my hon. Friend the Member for Lancaster and Fleetwood. I also attended his debate in March this year in the main Chamber, in which he rightly called for the drug Abraxane to be made available on the cancer drugs fund in England. I made the point that, given the short time that some patients face, if Abraxane gives someone only an extra couple of weeks, those are still an important couple of weeks for patients and their families to get their affairs in order. I was keen to take part in yet another debate on the subject, this time as a result of an e-petition. Many people have thanked Maggie Watts and her fellow campaigners. This is one of the occasions when Parliament actually works for people in this country.

I have been involved in a similar campaign for ovarian cancer. Through a debate like this one and by meeting Ministers, we managed to get an awareness campaign piloted in several areas in the country. I hope that that will be the start of improving diagnosis of that cancer.

During the debate in May 2012, my hon. Friend the Member for Lancaster and Fleetwood told us that 8,100 cases of pancreatic cancer were diagnosed each year. It is sad and terrible that that figure now stands at 8,800. It is even more tragic that 8,300 people died from pancreatic cancer last year—that is 23 people every single day. In simple terms, the mortality figures for pancreatic cancer are getting worse and the survival figures have remained largely unchanged. More people are being diagnosed with the disease and more people are dying of it. That is happening at the same time as mortality rates for most other cancers are falling and survival rates for most other cancers are rising. There is a huge inequality of outcomes compared with other cancers that needs to be addressed. There is still so much that needs to be done to improve the chances for pancreatic cancer patients, as well as for their families and loved ones, who are often overlooked in such situations.

I will now explore the inequality of outcomes in a little more detail and in a couple of different ways. The truth is that there is variation in pancreatic survival outcomes, both internationally and regionally within the United Kingdom. I will take the international outcomes first. The UK lags behind many G7 and G20 nations when it comes to pancreatic cancer survival rates. According to the Pancreatic Cancer Action charity’s website, the five-year survival rates in the US and Canada of 6% are nearly double the survival rates in the UK. Australia is also ahead of the UK on the same measure with 5.2%.

Our European neighbours also seem to perform better than us on pancreatic cancer. The EUROCARE-4 study of 2009 found that the UK’s relative one-year survival rate for pancreatic cancer, at 15.85%, was well behind the European average of 20.9% and behind countries such as Portugal, Spain, Poland and the Czech Republic. Belgium came out on top with 28.3%, nearly twice the UK’s figure.

I will now come closer to home. I know that the figures may come about because of the different ways in which data are recorded, but the trend seems to be clear. Will the Minister say whether any work is being undertaken to try to establish why other countries seem to be achieving much better patient outcomes? Is the Department of Health doing anything to try to learn from those other countries?

The truth is that there are large variations in survival rates across the UK, too. Five-year survival rates in England, based on the 2012 data, were 5%, whereas the survival rates for Scotland were just 3.2%, Wales 3.4% and Northern Ireland 4.7%. One-year survival rates saw the same fluctuation: England on 19.6% and Scotland again behind on 15.7%. There are even massive variations between the regions of England. Using a regional comparison of five-year survival data put together by the charity Pancreatic Cancer UK, based on the old English cancer network boundaries, the best-performing part of the UK was north-west London on 8%. That rate was four times greater than the rate in the Greater Midlands cancer network area. My own area of Yorkshire fared about average on 3.6%.

Again, those variations could be down to the way the data are collected, public health issues or any number of things, frankly. We need some research to get the answers because, on the face of it, if we can bring the worst performing parts of the UK up to the very best, we will go from being the laggard in world performance to being the world leader. What is the Department doing to try to work out why there are such variations in outcomes across the UK? What can we learn from north-west London and export to other parts of the UK? How can we start to end the existing postcode lottery? I am asking for research into why such differences exist.

In addition to more procedural and systems-oriented research, we need more scientific, medical and clinical research into pancreatic cancer. The National Cancer Research Institute report on spending across all cancer types between 2002 and 2011 concluded that spending on pancreatic cancer research is still relatively low. As we heave heard, £5.2 million a year is put into site-specific pancreatic cancer research, compared with well over £40 million for breast cancer. It seems fair to draw a link between those levels of research funding and the relative change in breast and pancreatic cancer survival rates over the same period. Breast cancer survival has soared, whereas pancreatic cancer survival has remained largely the same.

The Minister and her colleagues in the Department of Health have given a number of answers to written questions on this subject over the past year or so. All those answers point to large sums being spent at different institutes, including the Liverpool pancreas biomedical research unit, where £6.5 million is being spent on researching gastrointestinal disease. Although some of that money is likely to be spent on pancreatic cancer research, it will be only a small portion of the overall sum.

The fact remains that, although funding for general cancer research is welcome, and some of that work will undoubtedly benefit advances in pancreatic cancer care, there is still not enough site-specific research. Given that pancreatic cancer is such a difficult cancer to diagnose and treat, more support from major funders is needed if we are to see the advances that we need. Does the Minister have any plans to work with the NCRI, the Medical Research Council, the National Institute for Health Research and others to seek increased funding for pancreatic cancer research in coming years?

As we have heard, pancreatic cancer has some of the worst survival rates of any cancer tumour. Attention must rightly be focused on improving diagnosis and patient care, but support following a terminal diagnosis is also crucial. I have bored hon. Members many times about my background in the hospice movement, but in that movement I have seen the excellent work being done by so many organisations. I am pleased that we are seeing more palliative care in the community, but it is important that we get it right. There is a saying that nothing is certain in life other than death and taxes. In politics we seem to talk an awful lot about taxes, but we do not talk a lot about death.

I have seen so many people who were not able to die in the place they wanted. Recent studies show that 79% of people want the opportunity to die at home, and slightly fewer would prefer to die in a hospice, but just 23% of people get to die at home. The reason is that it takes planning, and the problem with pancreatic cancer is that time is often against the patient. There is not an opportunity for patients to go in and get the excellent care that hospices provide. Families I have spoken to have wanted to get their relative out of hospital but, as my hon. Friend the Member for Lancaster and Fleetwood said, they had entered the cancer world and suddenly all the decisions that had to be made became so difficult. Before the family knows it, the patient has sadly lost their life.

I pay tribute to the work of hospices, and I hope that we can do more work so that they are able to get to these patients quicker and provide a better environment as patients come to the end of their life. I hope we can expand palliative care in the community, and I pay tribute to nurses such as the Macmillan nurses, who offer excellent home support.

There are a couple of things that would help to get palliative care right. Access to emergency medicine packs is important. It is vital that they are stored in the homes of palliative patients who have chosen to spend their last days at home. The packs contain strong medication that can be administered by a registered nurse or doctor. Pancreatic Cancer UK’s support line, however, has received calls where that has simply not happened. In one case, the family had to wait for the Macmillan nurse to arrive and there was no emergency medicine pack. The nurse had to obtain a prescription from a GP and collect it from a pharmacist, which took four extra hours. That was incredibly upsetting for the patient and for the family, who had to watch their loved one suffer. I would like us to look more broadly at developing further packages of 24-hour, seven-day-a-week community care so that we can help more people die in the place of their choice.

We have heard some excellent, varied points today. There is a danger in such debates that we all make the same points, but it has been incredible that today’s speeches have all touched on different things. I also praise David Park for the work he has given us, and, finally, I pay a special tribute to my hon. Friend the Member for Lancaster and Fleetwood. I will break a parliamentary rule by saying that, Eric, you have done a fantastic job.

Oral Answers to Questions

Stuart Andrew Excerpts

Tuesday 15th July 2014 Commons Chamber

[Mr Hunt]

I make it absolutely clear that everyone should follow NICE guidance. As the right hon. Gentleman has talked about the reorganisation, will he please accept that we are now doing 850,000 more operations on the NHS every single year? That means that more people are getting help with their hearing, their hips and their knees, and with all the other things that they need. He bitterly opposed that reorganisation, but he must now realise that he was wrong to oppose it then and he is wrong to oppose it now.

[Stuart Andrew (Pudsey) (Con)]

T2. I recently had the pleasure of meeting my constituents Susan Childs and Doreen Smulders, who raised the issue of the inequalities that exist for men with prostate cancer. Will my right hon. Friend tell me what steps are being taken to address the shortfalls in care and support that such men are receiving across the country?

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

My hon. Friend is right to suggest that we want to drive consistency across the country, and NHS England is taking great notice of the cancer patient experience survey in a number of areas of cancer care. It has been a real driver of change where it has identified variation. I am sure he will welcome the fact that the overall range of variation for many indicators relating to prostate cancer has narrowed. None the less, we want to see NHS England working with NHS Improving Quality—NHS IQ—and others to ensure that struggling organisations are brought up to the standards of the best. The survey is a good way of driving that.