Dr Simon Opher
MP for Stroud · Labour · United Kingdom
“We must not say that things are getting worse, because I believe they are slowly getting better. As so many have said, we need to fix social care. We could have a system whereby the community is responsible for a patient as soon as they are ready for discharge.”
“I thank my hon. Friend the Member for Tooting (Dr Allin-Khan) for securing this debate and for her years of work in the A&E at St George’s. Emergency care is in crisis in the NHS, and corridor care is just an overspill because we cannot cope. That is because we are doing a few things wrong that we could remedy. I work as a GP.”
“That is absolutely true. We need to look at all the ways of reducing demand on GPs and, therefore, on A&E departments—that is what my speech is totally involved in—and pharmacies have a really good role to play. There is another thing here, which was noticed in the doctors’ strike.”
“We also need GPs to be assessing emergencies up until 10 o’clock at night to relieve the pressure on A&Es. There are a couple of other things. I have said about getting more experienced doctors involved earlier in the process, but we also need to invest in scanners—so many people in A&E are waiting for tests before they go home.”
“Dementia fluctuates, so just because someone has seen a slight increase in confusion, that does not mean that they need a whole batch of tests. We need to treat dementia more holistically. Polypharmacy—that is old people on loads of drugs—causes about 10% of admissions, so let us reduce that. We need good end-of-life care.”
“In Stroud alone, in four years, the number of over 90-year-olds went up 29% in just that short period of time. We have an enormous cohort of very elderly and frail people. Secondly, as we have heard, we have a lack of beds due to delayed discharge—I will not say any more on that.”
The complete record
Every one of 482 lines we hold for Dr Simon Opher, in date order, each linked to its source. Free to read, in full, without an account. Page 4 of 10.
“In Stroud, after 14 years of austerity, over 4,000 children are living in poverty. A recent Joseph Rowntree Foundation report stated that after removing the two-child limit, the next most effective way of reducing child poverty is to get rid of the benefit cap. Would the Minister be willing at least to review the benefit cap?”
“In the Stroud area, six schools are now teaching mental health first aid to 16-year-olds. Many students have received a form of qualification, which they can use for applications to jobs and university. At Rednock school, these students are wearing coloured lanyards so that other students can recognise them and ask them for help with their mental health. Would the Minister support and extend this innovative scheme?”
“If my hon. Friend looks at the statistics, he will see that it is usually the better-off in society who choose assisted dying, not the less well-off.”
“It is important to realise that if there are any suspicions around an assisted death, a coroner can still be involved. The new clause does not exclude that, but it stops the automatic referral to a coroner.”
“Q2. In Gloucestershire, after 14 years, waiting lists for both physical and mental health are finally falling. Last week I hosted a roundtable with young people and heard how music and arts programmes, such as Gloucester’s fantastic Music Works, are transforming mental health outcomes. I also chaired a Comedy-on-Prescription panel at South by Southwest with Lu Jackson and Jonathan Pie, utilising laughter to improve wellbeing and reduce waiting lists. Can I ask the Prime Minister to back our campaign for creative health, and urge him to go further in reducing waiting lists for all patients?”
“I agree with some of the things that the hon. Member is saying, but we all want to build faster. Under the local district plan in Stroud, we have been waiting four years for our housing plan, and this Bill will free us from the quagmire that is our current planning system. Last Friday, I met representatives of the Gloucestershire Wildlife Trust and the Severn Rivers Trust, who have serious concerns about part 3 of the Bill. Does the hon. Member agree that we should have a short pause on part 3 and keep some of it?”
“Peaceful protest is a cornerstone of a functioning and healthy democracy, but people in Stroud and across the country felt that the legislation passed by the Conservatives in 2022 limited the right to peacefully protest. One of my constituents, Adam Beard, with whom I have worked for over five years in my GP surgery, was convicted and sentenced to a year in prison for planning a peaceful protest. Given all the prison overcrowding, will the Minister consider whether peaceful protesters could at least avoid custodial sentences?”
“I have worked with the Stroud crisis team for many years as a GP, and I have always felt that, given a bit more strength and a bit more resource, they could keep a lot of people out of hospital and from being sectioned, but they need that resource. They also need close working with consultant psychiatrists.”
“The heroic nurses and consultants had to look after someone who was acutely psychotic. That simply is not is not tolerable in our system. We need to find a place quickly for people who are mentally ill, and we have to make sure that they get the best treatment, so that they can get better quickly, while protecting the rest of the NHS. This close relative of mine was moved to a bed 140 miles away from her family. We must ensure that we get more sufficient beds and more local provision. I know that will take time, and that mental health provision is not in a good state, but I hope that with this legislation and our new Labour Government, we can change that, so that people do not have to travel out of area for mental health provision. I am impressed by the idea of crisis hubs.”
“If they have an advance choice document, they can at least say what they would like while they are in a normal state of mind. That is important, and I look forward to that measure. I like the fact that police stations are being removed as a place of safety. I am concerned about how sections 135 and 136 of the Mental Health Act are being used. I notice that there are some schemes in which mental health workers go out with the police and work together with them, and that is crucial. A close relative of mine became extremely unwell, though it was not quite as awful as what happened to the hon. Member for St Neots and Mid Cambridgeshire (Ian Sollom). First, they were sectioned in an A&E department, and then no bed could be found for 48 hours for this poor relative of mine.”
“I am delighted to speak about this new Mental Health Bill. It follows up on the Mental Health Act 1983, which is as old as our Secretary of State, as we heard. What I have heard throughout the debate is that mental health affects us all in some way. It touches all of us, whether personally or through people we know really well. I welcome the greater protections under the Bill, especially for people with learning disabilities. I also welcome early intervention, the stress on out-of-hospital care and the idea of advance choice. People who have repeated psychoses know exactly what they want when they are well. When they become ill, they can become paranoid about their family and their friends, and they are not rational. That is one of the reasons why sometimes they need to be detained under the Mental Health Act.”
“When it comes to mental health, families are crucial, and I would like to adapt the Bill slightly to make them much more central and responsible. The concept of a family could be extended to certain other people whom a person, when well, could nominate, but families are the crux in a lot of psychiatric care. Their input must be valued, and they must be involved. This is a very good Bill, and it is about time we had it. I support all its greater protections, and I believe that it will reduce the number of compulsory detainments.”
“I had to nip out of the Chamber for half an hour earlier, to talk to the head of a neurodiversity taskforce which will report in July. What I think it needs to do is bring about a much more supportive service rather than going straight for medication, which is what seems to happen when people are referred to private psychiatric clinics. At present, the level of Ritalin-like substances with which people with ADHD are treated has increased by a factor of 500%—and, interestingly, that increase has occurred in social class 1 rather than social class 5. There is something here that we need to get a grip on: we need to provide proper services for people with ADHD. I was interested by the comment from the right hon. Member for Godalming and Ash (Sir Jeremy Hunt) about families.”
“They can also cause fairly long-term sexual dysfunction. I am asking the Medicines and Healthcare products Regulatory Agency to put proper warnings on its leaflets, and I am also asking for a special service to help people come off antidepressants, because doing so is extremely difficult and most GPs are not particularly well informed about the best ways of doing it. It has to be done extremely slowly. My hon. Friend the Member for Whitehaven and Workington (Josh MacAlister) talked about ADHD and autism, and what should be done about neurodiversity. I feel that we should be extremely careful in mental health services not to over-medicate people with so-called neurodiversity, and I look forward to speaking to my hon. Friend about that.”
“That is certainly true, but we need to be careful, because part of the issue is the resources for mental health, rather than the Mental Health Act. We must not blur the two. The current Government are putting 8,500 mental health workers into the system, and I am delighted about that. Hopefully, it will prevent the waits for mental health assessments that people are having to put up with. I want to say something about “appropriate medical treatment” and “therapeutic benefit”, to which the Bill refers. Some 8.7 million people in this country are on antidepressants, and about 25% of those people are trying to get off them. The harm that these drugs can do includes an increased risk of suicide when people are first going on to them and when they are coming off them, as we have seen in a couple of recent, tragic cases.”
“I realise that my hon. Friend’s new clause 1 comes from a good place, but can she not see that it is inconsistent with our ethical obligations as doctors? That is why the British Medical Association has suggested that although there should be no duty to raise the issue, neither should there be a ban on doing so. I ask her to consider that the Australian state of Victoria initially had such a measure—a so-called gagging clause—as part of its Bill, but it was removed because it caused confusion and was detrimental to patient care. Should we not learn from that?”
“Does my right hon. Friend not see that, in Committee, we were very aware of coercion? That is one of the reasons why we have a social worker on the panel of experts. Additionally, clause 1(2)(b) says it will be necessary to establish that a person “has made the decision that they wish to end their own life voluntarily and has not been coerced or pressured by any other person”. It is very clear in the Bill.”
“If we are absolutely forbidden to do that—new clause 1 would make it a crime, so we could be convicted for doing so—that totally wrecks the doctor-patient relationship. It is unprecedented and unworkable.”
“I will be very quick, Madam Deputy Speaker, because I am aware of the need to fit in as many people as possible. I will address a few issues on the assessment of capacity under new clause 9. One key point about assessing capacity as a doctor is that in most cases it is very clear cut: someone either has capacity or they do not. That is quite easy and quick to establish. With a very small number of patients, it is more difficult. By amendment to the Bill made in Committee, we must now refer such a person to a consultant psychiatrist for an assessment by a specialist. They are then in the best position to assess those very difficult points of capacity. That very much strengthens the Bill. I will speak very briefly to new clause 1. As doctors, we must, under our ethical obligations, give options to patients.”
“I am sorry, I cannot give way. I am just going to go through these points very quickly. That is why the BMA is against new clause 1. There is no duty for doctors to raise the issue, but there should not be any ban on them doing so. As I have pointed out, the so-called gagging clause was introduced in Victoria as part of the legislation. However, after five years that has now been removed by an independent review, because it caused confusion and it harmed patient care. I urge colleagues to vote against new clause 1. Let us respect the patient’s right to information, not restrict it. Let us ensure that no patient is left suffering simply because they did not know what to ask, and that no doctor is punished for trying to help.”
“I am interested in the community involvement aspect. I refer the House to my entry in the Register of Members’ Financial Interests. Mental health among men particularly is at a crisis point; in fact, suicide is a leading cause of death under 50. Will the hon. Member commend my club, Forest Green Rovers, which is trying to re-enter the English Football League, for developing a scheme of “football on prescription”, which refers men to football so that they can feel better and more socially included?”
“I must confess that I am slightly surprised that the Lib Dems have brought forward an Opposition day debate about hospitals and are stating their case in such a way, because the last thing we need in this country is a load of promises we cannot keep. I am proud that we Government Members have provided sustainable and affordable plans for the new hospital programme. I have been on the doorstep the last few weeks in the run-up to the county council elections, and the No. 1 priority that comes up is GP access. We have provided 1,500 new GP posts in this country, and waiting lists have been going down for the last five months. Emergency dentistry is also very commonly brought up on the doorstep, and we have provided 700,000 new dentist appointments. There are many other parts of the NHS that are crumbling.”
“We have to change all of this. Our NHS staff and patients deserve better; they deserve facilities that reflect the excellence of the care provided within them. The Labour Government are committed to rebuilding not just our hospitals, but trust, and the integrity of our public services.”
“I was glad to see the Government investing £100 million in GP surgeries. I was pleased to see £80 million put into GP advice and guidance; that will allow consultants to give GPs advice, so that they can care for patients in the community. I am also really delighted with the push for neighbourhood health centres; that must be the way. We must bring back the family doctor, as that continuity of care is what really makes patients better. That is so important. We must also integrate health and social care in the community, so that we can pull patients out of hospital. That also applies to emergency care, as far too many people are having to go to overwhelmed A&Es at big district general hospitals. At the moment, only 20% of acute admissions go through GPs, who are the best people to ensure that we avoid admissions.”
“The Vale hospital provides excellent minor injuries unit services, a specialist stroke service and in-patient beds for the community. We must invest in our community hospitals going forward. As we have heard, there were meant to be 40 new hospitals in the last few years, but none of them got built, and it turned out that they were not even funded. We need to get care out of hospitals and back into the community. The hon. Member for Oxford West and Abingdon (Layla Moran) talked about GP premises; 20% of GP premises were built before the inception of the NHS, and I inherited one of those premises in Dursley. Twenty years ago, we opened a purpose-built surgery at May Lane, and we are still enjoying the benefits; it provides patients with excellent services. We must therefore invest.”
“Of course it is essential that we maintain hospitals so that they are safe to treat patients in, so I agree with my hon. Friend about spending the money. In fact, the backlog bill for repairs in the NHS runs to £13.8 billion. I work as a GP in a GP practice, and I note that Lord Darzi estimates that £37 billion more should have been spent on the NHS since 2010, but was not. For those of us working in the NHS, it does feel like that. There is a massive building project ahead of us. I point out that the previous Labour Government built 100 new hospitals. One was the Vale hospital in Dursley, which we started in 2008, and which I had a hand in. As hon. Members have said, community hospitals such as Vale hospital are crucial to how the NHS works. We must invest in our community hospitals and use them properly.”
“In Stroud, Severn Trent has invested £25 million to stop overflow of sewage into the River Frome. Together with natural flood management from our district council, we have made rivers cleaner, and as a keen swimmer I am grateful for that. Would the hon. Member acknowledge that some water companies have been investing heavily?”
“I became a politician having been a medic all my life. If we ever had any influence from the pharmaceutical companies, we totally ignored that evidence, yet as politicians we allow lobbyists to come and talk to us. I was on a platform talking about obesity, and there was even someone from Sainsbury’s supermarket on the platform. Is it right that we allow people to influence our policy in that way?”
“I will not talk for very long because we have heard so many excellent speeches, but I would first ask if we should question whether the donations system is a good one on which to run our politics in the first place. Secondly, “know your donor” checks, which my hon. Friend the Member for Bolton West (Phil Brickell) mentioned, are incredibly important. We must vet donors and make sure that the money is coming from a fair place. We need to look at all overseas donors. In fact, I would say that we need to ban any overseas donors to our political parties. I also believe in a cap on any political donations, if we are going to have political donations in the first place; £100,000 seems rather generous to me—we should bring that down. Briefly, I want to talk about the influence of lobbying. This came as a slight shock to me.”
“In Stroud, we were supplied with a contract by a Tory councillor for personal protective equipment that was 85% faulty. People on the frontline were left with faulty equipment. We all wonder, but do not know, why that contract was issued. Something like £93 million has been donated to political parties, and two thirds of that was donated by 19 individuals in this country. Is it fair, in a democracy, that there is so much power in the hands of so few people? That is something of which we need to be aware. As many hon. Members have said, the external foreign donations are what brought this debate to a head, because we are all extremely alarmed by stories of hundreds of millions of pounds going to certain political parties.”
“I thank my hon. Friend the Member for North Ayrshire and Arran (Irene Campbell), for opening this debate, and Mr Stone, who started the petition. May I also say to the parliamentarians present that the speeches today have been excellent? I have really enjoyed listening and I thank hon. Members for that. I also thank the 235 people in Stroud who signed the petition and the many more who have emailed me about their worries regarding political donations. I have spent a lot of the last two years knocking on doors and the most common theme has been, “You’re all the same—you’re all corrupt.” The lack of trust in politics was very alarming, and it is something that parliamentarians of all parties need to be aware of. I would like to talk briefly about two issues: the financing of political parties and lobbying.”
“I thank the right hon. Gentleman for that point. The lack of transparency is a key issue. In 2023, oil and gas lobbyists spoke to Tory MPs on average 1.4 times per day, so is it really any wonder that they are now stepping back from their commitment to net zero? We must stop that sort of influence in Parliament. We must take the evidence and respond in the right way. We must restore trust in politics and reform how donations are made. We should look at the whole system of party funding and restore faith in politics.”
“Does the hon. Gentleman accept that end-of-life care is also part of the NHS? That has always been part of the NHS, and it is not promoting health but enabling a good death.”
“My hon. Friend is making a reasoned speech. The thing is that the way the NHS is delivered is already very complex: for example, GPs are private providers who are on a contract with the NHS. Amending the Bill to completely ban private providers will not in any way enhance it; it will create a situation in which almost no doctors can get involved. We need to keep the private aspect simply so that the NHS can control what is going on, albeit the providers can be from independent organisations.”
“I thank the hon. Lady for her impassioned speech, but we are rather getting off the point. The division between private and NHS provision is spurious in a process that will be delivered by doctors who are working under a code of practice. They will be rewarded in their pay which, as we have said, will be stipulated by the BMA in contracted arrangements with the Government and will be proportionate. The doctors will do the work and get the money for that. That is no different from IVF or anything else. If we accept that the NHS will be the commissioning body and will ensure standards in that way—sorry, I am going on a bit, Ms McVey; I shall now finish—the division between an NHS provider and a private one is spurious.”
“There may be an incentive to review a patient for assisted dying, but there is absolutely no incentive in the Bill to approve assisted dying. The idea that doctors would approve assisted dying for financial reasons is completely spurious.”
“I really want to point out that there is no incentive to agree to assisted dying, only to assess for it. There is no reason for people to be corrupted into agreeing, because it would not mean they would get any more money.”
“Briefly, the hon. Lady says that only 30% of palliative care is funded by the NHS, but that is quite spurious, because everyone who gives palliative care—all doctor time, palliative care consultants, palliative care departments, all GP services, all district nurses—gives it under the NHS. What she must be talking about is social care, which is obviously very different from medical NHS care.”
“I find the delay of four years that new clause 40 would introduce excessive in terms of the time taken and needed to deliver the requirements to implement the Bill in legal terms. I urge the Committee to reduce that at least to three years. That would mean four six-month checks, rather than six. The reason is that we have created a thorough Bill that is ready to implement. I understand that there are some pressures on the Department of Health and Social Care, so I accept a year’s delay. My worry is that a four-year delay might well take us past the next election and that the Bill will become an issue in the election.”
“I am afraid I do not understand how we could change this. I just wanted to put on record that I feel that a four-year delay is excessive. I have nothing further to add to that, but I would be interested in the legal opinion on whether we can change it.”
“Although I see the hon. Gentleman’s ideas and points, what will be paid for here is the assessment. I know no medical process where the outcome is paid for, rather than the assessment. Although I can see that his concerns are real, I do not believe—”
“I understand the hon. Gentleman’s concern, but that is just not the way that medicine works. The doctor is under a code of practice, so if he is seen to lie about assessment of capacity or coercion, for example, to enable him to approve the decision and then go on to assist the dying, he would be well outside that code. He would be referred to the General Medical Council and, in such a case, struck off the medical register. I understand the reason for the amendment moved by the hon. Gentleman, but I do not feel that it is necessary in this part of the primary legislation.”
“I will be very brief. This is the most difficult speech I have had to make in the Committee. I think all of us who support the Bill are disappointed; I am sure that my hon. Friend the Member for Spen Valley is incredibly disappointed. I believe that the Bill is deliverable within two years, but I have wanted this legislation for about 25 years, and my main aim is that the Bill passes. I understand, from certain dialogues I have had, that that is more likely if we accept amendment 548. In short, therefore, I will support the amendment. I will do so reluctantly, but it has my full support and I will vote for it.”
“The lack of an ability to assist in the final process would put medical professionals in a very difficult position. Would carrying the medicine to the room where the patient is count as assistance? I think we have to have assistance in the Bill, but I also feel that, as the Minister has outlined clearly, someone can help a person to self-administer but cannot administer. That is quite clear to me.”
“I agree with all the hon. Gentleman’s points. In terms of assistance, what we are talking about, potentially, if the technology arrives at that, is that the doctor may be able to put a Venflon into the patient’s vein, but they would not put the drug through the Venflon into the vein. That would enable the patient to have control. That is the type of assistance that could be quite useful in this scenario, but it would not involve the doctor actually delivering the drug.”
“Actually, if we did an autopsy on any person who has died, pulmonary oedema would almost certainly be found because that is what happens in death—the heart stops and the lungs fill with fluid. I would also like to correct the idea that there is neuromuscular paralysis with pentobarbital. There is no way that barbiturates act in that way. All they do is sedate and put the person to sleep, and death comes afterwards.”
“I understand that hon. Members are coming from a good place, but I do not understand how amendment 429 would stop the doctor having to stay with the patient until they die. I agree that it is an important issue, so could the hon. Lady elucidate on that?”
“I understand that what we are proposing is a new option that has not been there before, and we know that there are complications. But in a terminal situation, there would be no occurrence where we would call an emergency ambulance and take them to hospital, for example.”
“I am glad to serve under your chairmanship, Sir Roger. First, I will briefly address the whole area that we are talking about. GPs who are involved in terminal care will go and see a patient as they are slowly dying; we do not know at any point what will happen, and almost anything can happen. I have sat with people who may at any point have a massive pulmonary haemorrhage and drown, for example, or they may just quietly go to sleep—or they may start vomiting. What those of us in terminal care do is react to what is happening with the patient. For example, if they start to be sick, we would give them an anti-emetic; if they start to become very agitated we would then give them midazolam. What I am saying is that this is normal medical care. We have to be very careful not to stipulate in the Bill what is actually normal medical care.”
“I thank my hon. Friend for his sensitive and clear worry. But it is important to note that we would not in any circumstances try to do something that would finish someone’s life after they had been given their self-take medicine, because that is against the law. In the Bill we have made a clear distinction between the doctor—a euthanasian, if you like—taking the life, and the patient taking medicine that finishes life. What we need to do is simply support the patient. If, as my hon. Friend suggests, they are in pain we would give them a morphine drip, which is in common use in terminal care. I absolutely respect what he says, but the same treatment principles would be in place as in terminal care.”