Resident Doctors: Industrial Action

Stuart Andrew Excerpts

Wednesday 10th December 2025 Commons Chamber

[Stuart Andrew (Daventry) (Con)]

I thank the Secretary of State for advance sight of his statement, and sincerely thank him for making me aware last night of his intention to come to the House today and make a statement. Given that the next set of planned industrial action is due just a few days before Christmas, and at a worrying time when winter pressures are increasing early, with more flu patients needing hospital beds, we all want to see an end to these strikes. We on the Opposition Benches offer our thanks and gratitude to all those in the workforce who have worked so hard to try to minimise the impact of the strikes so far.

In his statement, the Secretary of State talks about the competition for places. This is not new information. He said himself that the figures have soared in the last two years. Why is it only now that he is addressing it, so close to a damaging strike? He could have dealt with this issue back in the previous talks with the unions, but he did not. I have said, though, that I want us to be constructive in opposition, so I welcome the work that he has done to offer more places to UK doctors. Depending on the detail of the legislation, we will help to secure that aim. I make this offer to work with him to ensure that we get there.

On the 4,000 places that the Secretary of State has announced, and the 1,000 specifically announced for this year, can he tell the House in which specialisms those places will be? Can he break it down into GPs, surgery, obstetrics, anaesthetics and so on? Is he confident that there are enough trainers and that there is enough capacity in the training settings he has chosen? GPs are trained in general practice and in hospitals, and there is community training for some specialists, such as paediatrics. When will these places be available for applications? Will he also look at replicating the Australian model of placing any international doctors in areas of the country with the greatest need? We know we need to address those issues.

All of this is dependent on the BMA accepting the offer, but what if it does not? After all, its track record speaks for itself. We warned that giving pay awards with no conditions would encourage the BMA to come back for more, and it has. If its members rejects this offer, what are his plans to manage and deal with the situation? As the Secretary of State has said himself, the NHS is under pressure from combined flu and RSV, so what is he doing to ensure that those who are eligible for the vaccines actually have them? What additional resources has he made available to manage the strikes if they happen, and for winter pressures if they do not?

Does the Secretary of State recognise that if the BMA membership reject this offer and carry on with the strikes, his Government’s own Employment Rights Bill will make things much worse next year? Will he think again about the reductions in the minimum thresholds for strikes and reintroduce the minimum service levels? Does he expect that this new legislation and the announcements he has made today will have any implications for the Equality Act 2010? If so, what are they, and how will he address them? Will he have to disapply the Act?

These strikes must end. The BMA is behaving appallingly, but if the Secretary of State does not deal with those issues around thresholds and minimum service levels, it will only get much worse, with unions like the BMA causing more issues. It is patients—our constituents—and their families and loved ones who will suffer.

[Wes Streeting]

First, I thank the shadow Health Secretary for the constructive terms on which he has agreed to work with the Government. That should give resident doctors across the country who receive their survey the confidence of knowing that, should they vote for this deal, emergency legislation will be introduced in the new year. We will be able to work at pace, because with the majority that the Labour party has in this House, and with cross-party support in the other place, we can make sure that we expedite the legislation and achieve our goal of making the changes for international medical graduates that we have always intended to make, and that we committed to well in advance of today. By expediting those changes, there will be a direct impact on people applying for speciality places now and those who, even in recent weeks, have experienced the disappointment of not receiving the training place they had hoped for. We can keep that hope alive. We can improve the number of specialty places available if resident doctors vote for this deal, so I urge them to do so.

The shadow Health Secretary asked why we had not dealt with this before. I am tempted once again to revert to my usual analogy of the arsonist heckling the fire brigade, but given the constructive terms on which he has offered to work with us on this, I will pull my punches a little. I will say, however, that putting together the 1,000 extra places now, and bringing together the legislation urgently, requires significant operational detail. He is right: we have to ensure that we have enough trainers. Jim Mackey and his team have literally been working trust by trust to ensure that we can give the shadow Health Secretary, the House and resident doctors an assurance that we can facilitate those extra places.

When it comes to the legislation, the shadow Health Secretary will know, and people will appreciate, that this is fiendishly complicated. I have had to secure agreement from business managers, as we have a packed legislative programme. We have had to make sure that the Bill would be legally watertight and consistent with both domestic law and our international treaty obligations, and I have needed support from my counterparts in Wales, Scotland and Northern Ireland. I must thank them sincerely for the spirit in which, regardless of party, they have worked with this Government; we can give resident doctors that assurance.

As for what will happen if the strike goes ahead, let me say first that the shadow Health Secretary was right to say that frontline staff and NHS leaders did a superb job of managing previous rounds of strike action. In fact, during the last round we did indeed maintain 95% of planned care, and I believe—we will see when the waiting list figures are published in January—that the impact on waiting list progress will therefore not have been as severe as it might have been. However, I must be upfront with the shadow Health Secretary and the House and point out that there is a very different degree of risk this time. While we are aiming to maintain 95% of elective activity, I cannot guarantee that. I cannot give that assurance in all good conscience, given the level of pressure that we are under.

I offered to extend the mandate, so that the BMA could reschedule the same amount of strike action for January, if its members reject this offer, and I do not understand why the BMA would not do that. I find it inexplicable. As a Labour MP, I have spent a lot of time in rooms with trade unions and negotiating, and I honestly cannot think of a single other trade union in this country that would behave in this way. I am shocked by it. I am shocked because of the risk that it poses to patients and the pressure that it places on other NHS staff, and shocked because it threatens the recovery of the NHS that we all care about.

I would say this to resident doctors who are following these exchanges: listen to what the Conservative party has said about trade union laws, and about their rejection of the deal that we struck within weeks of coming into office. There is not a more pro-NHS, pro-doctor Government waiting in the wings. There is a Labour Government who are committed to the NHS, and committed to the NHS workforce, who have gone further than any other Government before on pay, on terms and conditions, and on the pace at which we are improving them. These were never grounds for strike action before, and they are certainly not grounds for strike action now. I appeal to resident doctors, over the BMA, to do the right thing, to vote for this deal, and to work with a Government who want to work with them.

Draft Health and Care Act 2022 (Consequential Amendments) Regulations 2025

Stuart Andrew Excerpts

Wednesday 19th November 2025 General Committees

[Stuart Andrew (Daventry) (Con)]

It is a pleasure to serve under your chairmanship, Mr Twigg. I am sure it will delight the Committee to know that I do not intend to detain us for too long. [Interruption.] I always get a cheer when I say that. I would like to begin by saying that I do not see anything particularly contentious in this. The Minister rightly points out that these are technical changes that bring the Down Syndrome Act into line with the reforms introduced by the Health and Care Act 2022, in particular the replacement of CCGs with ICBs and the renaming of the NHS Commissioning Board as NHS England.

However, it is worth questioning the Government on the longer-term stability of these changes. As hon. Members will know, the Government have stated their intention to abolish NHS England by April 2027. That process has already been delayed, reportedly due to uncertainty over who will meet the redundancy costs for staff within those organisations. If that abolishment proceeds, a new health Bill will be required. At present, we do not know when that Bill will be brought forward or what it will contain. It is therefore entirely possible that the statutory references being updated today will need to be amended again in the near future.

I also note that there is no statutory review clause in this instrument. While that may be understandable given the technical nature of the changes, it adds to concerns that further legislative changes may not be properly anticipated or subject to adequate scrutiny in good time.

While I support these draft regulations, I urge the Minister to clarify what transitional arrangements are being considered for the functions currently held by NHS England and the integrated care boards. That is especially important, as he rightly pointed out, for the consistency of support that we all want to see in the context of the Down Syndrome Act. We must ensure that people with Down’s syndrome are not adversely affected by any ongoing organisational changes within the health system. The Minister mentioned some of the updates to the Down Syndrome Act. Perhaps he could update us further on any other actions that are ongoing. How many still need to be done?

In addition, I note that the Act seems to require the Secretary of State to publish guidance, on which the Government have just launched a consultation. One of the criticisms of the Act at the time was that it is specific to Down’s syndrome. Although I obviously welcome that focus, others face similar disabilities and challenges. How might the Government support them?

Finally, it looks like people can respond to the guidance only online. Can the Minister assure the Committee that he is confident that those who are digitally excluded will not be prevented from taking part in this important consultation?

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.