Neil Shastri-Hurst MP: speeches

Speeches

• 30 Jan 2025 · Terminally Ill Adults (End of Life) Bill (Seventh sitting) · Hansard source

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  Q Clause 9(3)(b) would permit an assessing clinician to refer to a psychiatrist if they have concerns about the assessment of capacity. Some have suggested that in fact all patients who are seeking a voluntary assisted death should be assessed by a psychiatrist. Professor Owen, in terms of workforce capability and capacity, is it reasonably practicable to have a consultant psychiatrist assessing each and every one of these patients? Professor Owen: I think the answer to that is “Probably not,” given the current workforce. Another relevant point is that even if you were to insert into the Bill a very clear requirement for a consultant psychiatrist to be involved if there were concerns about mental health, what would happen in practice would be very different. You can see this in Oregon, whose law has a requirement for, essentially, a psychiatric referral in the case of mental health concern. Those referrals basically occur in less than 5% of cases; I think it is similar in California. Even if you put it in law, there is the question whether it will happen in practice. On the data, it does not. I think that that is a relevant consideration.

• 30 Jan 2025 · Terminally Ill Adults (End of Life) Bill (Sixth sitting) · Hansard source

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  Q I will direct this question initially to Mr Greenwich. The issue of coercion has been a significant concern to many in the debate. In line with the New South Wales legislation, the Bill as proposed does not provide a definition of coercion, either explicitly or by reference to other legislation. Have you found that to pose a difficulty in your jurisdiction? Alex Greenwich: In New South Wales, our legislation deals with and goes through coercion in quite some detail, with pathways to assess it. It deals specifically, for example, with a situation in which someone is under coercion from a person who is a beneficiary of their will; obviously, the person seeking voluntary assisted dying then becomes ineligible. In the space of coercion, that is a key part of the training for a doctor who will be a consulting or co-ordinating practitioner. We have made it a criminal offence in New South Wales, and indeed our board will report on it and on whether eligibility for access to voluntary assisted dying has been denied to someone. Our most recent report indicates that it has. The overwhelming experience is that having voluntary assisted dying in place is itself a safeguard from coercion for people with a terminal illness. If someone wants to end their life quickly, voluntary assisted dying through a regulated process is not the option that they are going to take. Someone engaging in voluntary assisted dying will be assessed against coercion and against decision-making capacity, and will have to make sure it is an enduring decision. When we talk about coercion, and the concern that people may currently have in the UK about people with a terminal illness feeling in any way coerced, the experience in New South Wales and elsewhere in Australia is that voluntary assisted dying has provided a safeguard in that regard. Our legislation, the training and the reporting is very clear on that.

• 29 Jan 2025 · Terminally Ill Adults (End of Life) Bill (Fourth sitting) · Hansard source

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  Q Dr Fellingham, to circle back to the issue of training, could you go into more detail about what the initial training consists of—the nature of it and the number of hours—and how that compares with the refresher training? What is the system for mentorship, supervision, appraisal and continuing professional development requirements? Dr Fellingham: It is important to reflect that only people who are at quite a significant point through their own specialty careers are eligible to become assisted dying practitioners in this country. For instance, I was a consultant anaesthetist and I had already been practising for more than a year. I had lived experience of caring for patients both living and dying, both anticipated and unexpectedly, over a career spanning more than 10 years, before I came to the point of assisted dying. To become eligible to offer assisted dying, I then had to undertake training developed in a special package by the Queensland University of Technology. That training package takes about two days to complete and there is an exam at the end before someone can become eligible. The exam has a 95% pass rate. Once someone has qualified with that training, they are offered the opportunity to give their details to the state-wide care navigator service. The vast majority of people opt to do that. Once they do that, they basically become engaged in this incredibly supportive, collaborative and nurturing multidisciplinary team within a professional organisation that, in our state, covers all the assisted dying practitioners—the doctors—but also the care navigators, the pharmacy service, the individual voluntary assisted dying programme managers and the end of life choices co-ordinators, who exist in all our hospital systems. Because we are all consultants in our own specialties, there is not the same level of supervisory oversight as we would give to junior doctors—there are not forms that we fill in; we do not accredit one another—but we do acknowledge that we are all learning and growing in this space. These are new laws: even the oldest in Australia has only been going for five years. Every single one of us is motivated from a place of wanting to support, collaborate, grow and learn from one another, and ensure that the care we are offering to people in this challenging space is of the absolute highest quality. We have a really robust community of practice. We meet monthly. Half those meetings are online to allow our regional practitioners to join, and half of them are face to face. They are extremely well-attended closed sessions where, especially over the time that we have developed relationships with one another, we find an incredibly supportive space to share our experiences and to learn, grow and develop from one another. In terms of CPD, we all have to maintain our professional registration. I have both general and specialist registration with our supervisory body, which is like the General Medical Council. I complete my mandatory CPD requirements each year, as per my specialist college. On top of that, I have just redone the refresher training, which is once every three years. That is just what was mandated in our state. If someone has not done VAD practice, they have to do the whole thing again. That is only for people who have been active in this space. That training is shorter—it is about half a day—but it is really a reflection of what we are doing on a weekly basis. We are living and breathing this work, and really strongly collaborating with everybody else who does it.

• 28 Jan 2025 · Terminally Ill Adults (End of Life) Bill (Second sitting) · Hansard source

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  Q Has the GMC undertaken a legal assessment of the openness to legal challenge around that Montgomery point—if those conversations were not initiated and patients say that they were not given all the options available to them? Mark Swindells: We have not done a forensic legal assessment of that nature, but obviously Montgomery is in case law, and Parliament has the power to set primary law. I listened to what the chief medical officer said and what Dr Green says about how restrictive or otherwise that might be in terms of the doctor’s role with the patient.

• 28 Jan 2025 · Terminally Ill Adults (End of Life) Bill (Second sitting) · Hansard source

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  Q Good morning, gentlemen. The initial discussion is dealt with in clause 4 of the Bill. There has been some significant concern about whether doctors should be initiating that conversation with patients who are terminally ill. The Bill states, in subsection (1): “No registered medical practitioner is under any duty to raise the subject of provision”. What are your views on the compatibility of that element of the Bill with the principles under Montgomery consent? Dr Green: Both of these items came about because of things that were in our policy, and we are pleased to see them in the Bill. You are right that assisted dying must not become just another tick-box thing that doctors mention to patients. That must not happen, and that is why we believe that it should not fall within those two Supreme Court judgements that you mentioned. But there is another side to that coin: we think that there are some circumstances in which doctors should be able to mention this to their patients. I will just explain why that might happen. The consultation shows that some patients find it very difficult to bring up sensitive subjects with their doctors, even when those are the most important thing on their mind. Doctors are aware of that, and I hope that we get very good at reading between the lines of what patients say to get at what is left unsaid. In those circumstances, we need to be able to open the door for the patient, so they can go into a safe space and have those difficult discussions. That is what we are talking about here. As a clinician, it is very difficult to know when to have those conversations. When we are battling with that internally, the last thing we would want is to feel the weight of legislation behind us, so please do not pass legislation that makes it harder for doctors to understand their patients. That is why it is important that in particular circumstances we should be able to gently raise the subject. Mark Swindells: The GMC sets guidance on decision making and consent, as you will know. That is based on the existing law, including the case law on Montgomery, so it puts a lot of weight on the patient’s autonomy, the patient’s role and the doctor’s role in supporting that in the provision of information on different options, including the option of no treatment. Our guidance follows the law, so were the law to change, we would look at it and accommodate. We do not have a formulated view on what the eligibility should be, but we know the BMA’s stance.

• 28 Jan 2025 · Terminally Ill Adults (End of Life) Bill (Third sitting) · Hansard source

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  Q I have a question for Dr Clarke and Dr Cox about the registration of deaths, which is dealt with in clause 29. Do you feel that the provisions set out in the clause are sufficient? If not, what further bolstering would provide the oversight needed to ensure that the processes and procedures are followed correctly? Dr Cox: My understanding of the plan is that in the Bill—forgive me, but I am sketchy on this—the aim is for the registration to be as a natural death. It would not be referred to the coroner, and “assisted dying” would appear on the death certificate. I am also a medical examiner. My concern is that, as a medical examiner, I am obliged by law to scrutinise all deaths to ensure that a referral to the coroner is not required and to identify any learnings. What concerns me in that role is whether enough recording is happening around decision making and the process to do my job properly. With my medical examiner hat on, do I know what happened? I do not see anything written down in the Bill about the records that are to be kept. What happened when the patient took the substance? What happened afterwards? Were any actions taken in the meantime? That is not so much something I have thought about a lot with my palliative care consultant hat on, but as a medical examiner it concerns me. Dr Clarke: For the sake of time, I do not have anything to add. I completely agree with that.

• 28 Jan 2025 · Terminally Ill Adults (End of Life) Bill (Third sitting) · Hansard source

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  Q Sir Nicholas, can I bring you in on that? You referred to it directly in your proposed amendment. Sir Nicholas Mostyn: I did. What particular aspect do you want me to address? The range is quite wide. In relation to the administration of the substance, it is interesting that in Spain, which is now in its second full year of doing this, take-up has been extremely low. There have been only 700 requests, with a quarter denied, and a quarter of the people died prematurely. Three hundred were granted, but of those 300, in 95% of cases the substance was administered by the doctor and auto-administered in only 5%. I am trying to work out why that is, culturally, in Spain. Maybe people go when they are extremely infirm, and that is the reason for it. I am not able to see the moral distinction between having the substance administered and auto-administration. On your question, there are devices that enable somebody who is locked in to end their lives by a blink of the eyelash, aren’t there? Sir Max Hill: Yes.

• 28 Jan 2025 · Terminally Ill Adults (End of Life) Bill (Third sitting) · Hansard source

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  Q I want to stick with clause 18, because as it stands there can be some assistance by the clinician but there cannot be total delivery or administration by the clinician. You could end up with a scenario where, for instance, you have somebody who is tetraplegic and then gets a terminal diagnosis, has capacity to make the decision and wants to end their life, but they do not have the physical means of doing so. Do you think that is open for challenge on grounds of discrimination? Sir Max Hill: I would not look at it on grounds of discrimination. What I would do is put that clause alongside what are generally referred to as the slippery slope arguments in other jurisdictions. In other jurisdictions—Canada might be one and some of the US states might be another—the provision of life-ending medication is expressed in a form of treatment by a doctor. This is not that. We are clear when reading clause 18 that it is not a permission to administer; in fact, it is a prohibition on administration. It is making available in certain tightly defined circumstances and then standing by—not necessarily in the same room, as stated in subsection (10)—while the self-administered medication takes effect. Having said that, I am absolutely clear that there is only so far a Bill or Act of Parliament can go as primary legislation. There is then further distance that must be covered by the provision of practical and professional rules, under the auspices of the national health service here, to indicate precisely the circumstances in which this will physically happen. I do not see that as discriminatory; we are dealing with a tight category of defined individuals to whom this applies and it does not apply to anybody outside that, as we have just discussed. But it is not prone to the slippery slope arguments of something that is generally to be made available in the course of treatment. In fact, the Bill has been couched in a very different way.

• 27 Jan 2025 · A&E Services: Solihull Borough · Hansard source

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  I am grateful to my hon. Friend for giving way and for bringing this debate to the Chamber. Being neighbouring MPs, he and I have worked very closely on this issue. He notes the size of Solihull borough; of course, with the Government’s housing plans, that is likely to increase significantly, almost touching a quarter of a million. Does he agree that in those circumstances, it is absolutely critical that we have an A&E provision within the borough to serve the community?

• 21 Jan 2025 · Terminally Ill Adults (End of Life) Bill (First sitting) · Hansard source

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  I, too, commend the hon. Member for Spen Valley for her efforts in pulling together this list; it is an unenviable task, given the number of contributions that were made. It is important that we do not let the perfect become the enemy of the good. There is a wide range of individuals and organisations that we would all benefit from hearing from, but given the time available to the Committee—which is much more extensive than most private Members’ Bills have, by some margin—we are not in a position to hear oral evidence from all of them. But there is an open invitation for everyone to contribute written evidence and for us, as my right hon. Friend the Member for North West Hampshire noted, to speak to engaged parties outside the Committee to feed into our thought processes and deliberations. On the amendments tabled, I understand the reasons for amendment (b) on the Royal College of Psychiatrists, but I have to say that I disagree. The hon. Member for Bradford West said it was about coercion. I could understand if she were making an argument that we need to hear from the Royal College of Surgeons about the issue of capacity, so I do not think that this is universally confined to psychiatrists; it is something, as a surgeon, I dealt with every day when I was getting consent for operations. We have to think about how we get a wide range of opinions on the subject: we have the Chief Medical Officer, who can comment on such issues from a policy perspective; we have the BMA, which I am sure will send representatives who will be most able to deal with the questions that are to be asked; and, of course, we have the General Medical Council, which is the ultimate regulator and arbitrator of this issue. The Committee is also about ensuring that this legislation is as fit and as robust as possible when it goes back to the House for consideration. That is where I think that having a legislator from a jurisdiction in which this has been implemented is crucial. Not having the member for Sydney in the New South Wales Parliament—where they have implemented this, and have dealt with some of the thorny issues that the Committee and subsequently the House will have to deal with—would be a mistake. Likewise, having more geriatricians and palliative care physicians is a better balance than having those with some other expertise—well-meaning as they may be, they are not necessarily dealing with this at the coalface. I do not support the amendments for those reasons.

• 16 Jan 2025 · Covid-19 Inquiry · Hansard source

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  Having served on the frontline during covid, I am acutely aware of the sacrifices made by clinicians, patients and staff. However, when it comes to preparing for any future pandemics, part of the solution is ensuring that we have robust epidemiological research. Could the Minister tell us, in rather more granular detail, what assessment he has made of the current projects commissioned by the Government?

• 9 Jan 2025 · Topical Questions · Hansard source

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  I am delighted to see that you are proudly wearing the newly formed Royal Army Medical Service tie, Mr Speaker. In Solihull West and Shirley, the new year has been welcomed by increases in bus fares and reductions in services. In places such as Cheswick Green, people are faced with choosing between either more expensive and difficult journeys or not being able to get to work, the shops or college. Given the Government’s stated ambitions, what assessment has the Minister made of the economic impact of the policy?

• 9 Jan 2025 · Public Finances: Borrowing Costs · Hansard source

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  At the back end of last year, borrowing figures were the second highest monthly figures on record. That was in no small part driven by the Chancellor’s decision to give inflation-busting pay rises to unions. Given that we have more union pay negotiations this year, should my constituents be braced for the Government giving into those union demands, at risk to taxpayers?

• 19 Dec 2024 · Knife Offences · Hansard source

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  I congratulate the Solicitor General on taking up her position. As a former trauma surgeon, I have seen at first hand the devastating effect of knife and other serious violent crime, so I welcome the Government’s specific commitment to halving knife crime within a decade. However, on the broader commitment on serious violent crime, no specifics have been provided to date. Will the Solicitor General tell the House which crimes are to be included, and the date by which that will be achieved?

• 19 Dec 2024 · Ukraine · Hansard source

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  I thank the Minister for his statement and welcome the announcement on our ongoing military support. It is critically important that those who wage Putin’s illegal war face the legal consequences for their actions. With that in mind, will the Minister set out the steps that the Government are taking to support the Ukrainian domestic legal system to ensure that these cases are prosecuted in their own courts?

• 18 Dec 2024 · Financial Assistance to Ukraine Bill · Hansard source

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  At a time of existential threat to Ukraine, I have been heartened by the tone from across the House towards the Ukrainian people. It is critical at this moment in history that this House and all European Governments step up and do not give up. While I welcome the details of this short Bill, we should be focusing on the untapped countermeasure and counter-offensive that is at our disposal. Like a number of colleagues, I gently say to the Minister that we should think about the use of frozen Russian assets to support Ukraine in its non-violent economic and political reconstruction. The UN General Assembly has already endorsed an international mechanism for compensating Ukraine, but we cannot wait for the war to be over before we enact that countermeasure. Back in 2022, Ukraine lost 29% of its GDP, so if it only receives its compensation at the end of the war, that will be far too late.

• 16 Dec 2024 · Budget 2024: Unemployment · Hansard source

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  1. What assessment she has made of the potential impact of the Autumn Budget 2024 on levels of unemployment.

• 16 Dec 2024 · Budget 2024: Unemployment · Hansard source

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  Will the Minister answer a simple question: since the Budget, have unemployment rates gone up or down?

• 12 Dec 2024 · Prison Capacity Strategy · Hansard source

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  This strategy does little more than commit to deliver the 14,000 places that the previous Government committed to delivering, except that it will cost more and take longer. To what extent have the Government factored in optimism bias when working out the delivery timeframe?

• 12 Dec 2024 · LGBT Veterans: Etherton Review · Hansard source

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  I welcome the tone and tenor of the Secretary of State’s speech. I wonder if he could assist the House in setting out the steps that the Government intend to take to ensure the reliability of gathering data about the size of the cohort who are affected and may be eligible for the compensation scheme.

• 12 Dec 2024 · Business Confidence · Hansard source

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  In the aftermath of the Budget, I spoke with many business leaders in my constituency of Solihull West and Shirley. Invariably, they told me that they are pausing recruitment and freezing their growth plans as a direct consequence of the decisions made around taxation and the Employment Rights Bill. What does the Secretary of State say to those businesses in my constituency that no longer have confidence in the Government and feel abandoned by their policies?

• 12 Dec 2024 · Business Confidence · Hansard source

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  3. What steps he is taking to help improve business confidence.

• 11 Dec 2024 · Finance Bill · Hansard source

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  A particular subset of pupils affected by this policy are those in receipt of the continuity of education allowance. The revised figures for the CEA, released recently, do not fully protect those pupils from the uplift on VAT on school fees. What assessment have the Government made of the impact of this policy on retention and recruitment into our armed forces and our diplomatic service?

• 10 Dec 2024 · Topical Questions · Hansard source

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  Since the beginning of this year, 17 inmates have died at HMP Parc. It has been under the control of G4S since opening in 1997. What consideration has the Lord Chancellor made of returning the prison to the Ministry of Justice?

• 9 Dec 2024 · Syria · Hansard source

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  No one should grieve the demise of Assad, who was propped up for far too long by Russia and Iran. However, the links of HTS to al-Qaeda mean that the future is far from certain or secure. With that in mind, what steps have the Government taken to promote the rule of law in Syria?