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.”
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“I agree that you are doing this for a noble purpose, and there are members of my family that want this Bill to go through, and yet I emphasise to all of you on the Committee that the question before you is: could this Bill have knock-on effects for some of your most vulnerable constituents? How many deaths are you okay with? If the safeguards fail once, that is a human being who maybe, in a despairing moment, was handed a lethal medication instead of the care, the treatment and the help they needed. That is what we are talking about. You really have to get this right, because those people are depending on you.”
“Actually, my question has already been asked. Chelsea Roff: May I respond briefly? I want to address the question. I know it is not your intention for eating disorders to be included in this Bill, and I am grateful for that. When I started our research, I thought, “We just need stronger safeguards.” That was where I began, and after looking at 33 jurisdictions around the world, I have real doubt about whether safeguards are enough; I know how difficult it is to put it on the page, and I am seeing it expand and be applied through interpretation. I disagree with Professor Shakespeare, respectfully, that diabetes is a reversible condition. You cannot go back in time and reverse that condition.”
“Notably, in the countries that have chosen to go down an assisted dying route—a variety of different ones have been chosen—a significant minority of people die before they actually get to the point where that occurs because there is uncertainty in both directions. I think that period is as good as any other, but I want people to be clear that this is not an exact science where you can say, for example, “On 20 August.” It is not as tight as saying that a baby is going be born on a certain date. It has a wider spread of uncertainty around it. In the overwhelming majority of cases, that does not mean that it will go on for months or years longer, but there will be some degree of uncertainty.”
“Q You have already said some words about prognosis, which is causing some anxiety. First, are you happy with a six-month prognostic period? Secondly, the Bill says that death should “reasonably be expected within 6 months.” Is that in line with your thoughts on the matter? Professor Whitty: I think that is a reasonable point in time provided that, in taking that period into account, Parliament assumes that we mean a central view that this is six months, although it might be before that and it might be after. Other times would be equally reasonable, but if you are going to choose one, then six months is reasonable. It is generally very predictable that someone is going to die in the foreseeable future, but predicting whether that will be in five months or seven months is a lot harder, and there would be some caution.”
“We have advice professionally around things such as abortions and working in embryo services and fertility, for example, so we need to make sure that the safeguards for our staff are really clear. As Chris has said, our staff will have a range of views and opinions on this, as will the wider public. So the work you do in creating this Bill is really important in terms of the advice that we give to people about signposting and having those conversations. Actually, our clinicians are having conversations every single day about the choices that people have at the end of their lives.”
“Personally, my view is that we should be able to have the range, provided that people are aware in general that, if one person cannot provide it and then does not wish to discuss it, there are alternative routes. But that really is a matter for Parliament and if Parliament says, “No, actually, that is unfair on the patient, because then the patient is having to go through an extra step,” that is an alternative and perfectly reasonable principle. Parliament is going to have to balance those two principles; that is not for me as a doctor. I just think that that range of opinion needs to be thought through when people are coming to that final parliamentary decision. Duncan Burton: If I could add to that, again, I think that bit about the wider workforce and how we would support them is really important. We have situations like this already.”
“Q I am interested in the opt-out whereby ethically, doctors can opt out of taking the decision for patients. Would they then need to steer someone towards another doctor, or can they just simply refuse to do it? Professor Whitty: Duncan may wish to comment for nurses. For doctors, we should be very mindful of the fact that for some doctors, as for some citizens, this is a point of very strong principle indeed, therefore there will be a gradation of people feeling that they can personally be involved in it. I suspect that if they themselves did not feel able to do it—because of conscience or choice, or because they did not feel that they had the necessary skills—the great majority would have no problem referring on, but it might be an issue for some people.”
“Doctors would not be able to be obstructive; they have the same duties under good medical practice as they do, for example, with termination of pregnancy requests.”
“Q I have a couple of points to make. First, clause 4(5) states that a “registered medical practitioner who is unwilling” to go forward with the assisted dying request “must, if requested…refer…to another registered medical practitioner”. Are you happy with that clause? Dr Green: No, we are not, because we know from our survey that some doctors feel very strongly about this. The word “referral”, to a doctor, means writing a letter or communicating with another doctor to see, but some doctors would find themselves not able to do that. For that reason, we believe that there should be an information service for the doctor to direct to. There is a particular problem with the word “referral”.”
“Q My other point follows on from the previous question and is about status. The GMC and the BMA have all specialties of doctors beneath them. Would it be appropriate to have, for example, both doctors as general practitioners, or should there be provision for different doctors as the second doctor? Dr Green: We have not taken a view on the qualifications of the doctors involved. We had discussions about what grade they should be, for example, but we took the view that their skillset and training was more important than their grade or position.”
“Q In some legal medical situations, you need to be five years post training before you can have a view. Is that something you would have in both of these practitioners, or is that not necessary? Dr Green: We did not take a view on that. We thought that training and experience was more important.”
“It is not because of an opposition to assisted dying in principle. It is because the real-world conditions of the NHS today are such that people’s suffering means that occasionally they will beg me to end their life, and I know that that begging comes not from the cancer, for example, per se, but because they have been at home not getting any adequate pain relief. Once you start to provide proper palliative care, very often that changes.”
“We all know about those real-world conditions—we are all familiar with the latest winter crisis, where patients have been dying on trolleys in corridors, etc—that are preventing the actual option of a death in which dignity, comfort and even moments of joy can be maintained right up until the end of life, when that patient is getting the high-quality palliative NHS and social care that they need. That is the crux of the issue. If you do not have that as a real option for patients, we can say that they are choosing autonomously assisted dying, but actually society is coercing them into that so-called choice because it is not funding the care that makes them feel as though life is worth living. That is why I think many of my colleagues are so concerned about legal change now.”
“Autonomy is the crux of the issue for me, because autonomy is predicated on having meaningful choices. Can you actually choose option a or option b? Let us say that option a is high-quality not just palliative care, but medical care in general—district nursing care or social care, for example. If that is not available to you, you are potentially being pushed towards “choosing” option b—the route of assisted dying—not freely and not autonomously, but because option a has been denied to you by real-world failures.”
“Q Thank you for all giving up your time, with your very high level of palliative care expertise and experience. I am a practising GP, and GPs and district nurses do a lot of palliative care with a lot of advice from you people. I have also noticed that, even with the absolute best quality palliative care, some people have still talked to me about an assisted death, or shortening their death. I would like to hear your comments. Is this more about autonomy than symptom control? Dr Clarke: I absolutely agree that in a small number of cases, palliative care at the highest level cannot eradicate all suffering, and cannot prevent a person from wishing to end their life and have assistance in ending their life. That is absolutely the case; I would say that it happens surprisingly uncommonly, in my experience, but it does happen.”
“Q Sir Nicholas, I have great sympathy with your position, but how would you frame this law so that it would cover yourself? Sir Nicholas Mostyn: I would frame the law to define terminal illness in the way that it is defined here in clause 2(1)(a), but where the “person’s death in consequence” is referred to, I would delete clause 2(1)(b) and substitute “suffering intolerably”.”
“We were the second state in the entire United States to pass this law and so the medical community was a bit hesitant. I will say that, in those last 15 years, we have seen a tremendous growth in the support of physicians and the medical community at large in wanting to make sure that this is an option for people and that they have access. Just in my own experience in Washington state—”
“In Oregon, of course, it has been legal since 1997, and it has been legal in Washington state since 2008. Both of those laws were actually started by voter referendum, so the general populace at large wanted this, and that is how these laws got started in both of those states. The general population has, by and large,, been supportive, and is growing more and more supportive of this as an option each year as it becomes normalised and clear that this is a practice which is careful, safe and has appropriate safeguards in place. The medical community has also come along with that. In Washington state, we have now 15 years of practice with assisted dying. When this law was first passed, there was hesitancy in the medical community: this was an unknown, in many regards.”
“I had seen lots of death before then; I saw how tragic and traumatic it often was and how this was a dramatically different experience, and I became a convert. Since then, I have seen many other physicians undergo the same journey with their patients. They have been very ambivalent to it until they have a patient who is asking for it. They go through it with that patient who they have known for a long time, and then they come out on the other end realising just how amazing this option is to the people who want it. Again, I am emphasising that this is a choice. For people who do not want this, they do not need to have it. For doctors who do not want to do it, they do not have to do it. But for the patients who want this, it is an incredibly powerful piece of agency. Dr Kaan: The jurisdictions I work in have quite a bit more experience.”
“Q What was the feeling before this came in among the general population and among doctors, and what has happened since the law has been in place? It has been in place since 2016, I understand. Could you give a brief description of whether there were anxieties before or whether most of the public were in support of it? Dr Spielvogel: I literally had not formed any kind of opinion on this. When I was in medical school, it was not talked about. We did not talk about it; we did not discuss it; it just literally was not a thing, and then when it became law in California, I still had not really thought of it until my medical institution asked me whether I wanted to participate. I said, “Sure, I will give it a try,” and then with my first patient, I saw how amazingly transformative it was for him and his family.”
“I have a very short question. Can the hon. Gentleman state the number of onshore wind installations that were put together under the last Tory Government?”
“As a co-sponsor, I have been so impressed by the way the Minister and the hon. Member for South Cotswolds (Dr Savage) have talked, negotiated and brought the Bill forward. She asks whether we are willing to act—yes, we are clearly willing to act. Will the Minister ensure that the dialogue continues?”
“We need to listen to them and learn from them, but having some of them against assisted dying is enough to give us due discipline and ensure we listen to exactly what the problems might be, so I disagree with the hon. Member for East Wiltshire.”
“The Bill as proposed is extremely similar to the Australian law, but it is not similar to Canadian law. Therefore, I do not see that bringing Canadian expertise into the Committee is of any use at all. I also back the right hon. Member for North West Hampshire when he said that in almost all situations we are just replacing one expert for another, so the only contentious bit is whether we have people from Australia in support of or against assisted dying. A split of 38 to 20, with the other witnesses being neutral, is appropriate and actually reflects the vote in the House. I do not see that as a disadvantage. Are the witnesses really going to change what we are saying?”
“The £29,000 minimum income threshold is already the highest in the world, and 75% of applicants would not be able to meet the even greater figure of £38,700 proposed by the previous Government. It is deeply unjust that many British citizens working in our NHS, our police forces and other key public services now earn too little to live with their spouse in the UK. This is a matter of basic fairness. Families belong together. I urge my hon. Friend the Minister, when the review is published, to commit to a policy that will keep families together.”
“Despite losing 250 extended family members in the February 2023 earthquake, Rebecca persevered, but because of the UK’s rigid financial rules, they remain separated, with no certainty about when they can reunite. The cost of applying for a spouse visa is now a staggering £14,256 and increasing regularly. Rebecca is essentially exiled from her own country because she does not meet an arbitrary financial threshold. Rebecca’s case highlights further issues with the present policy. Rebecca is having to go through the cash savings route, which means she must hold £88,500 in savings. The average 25 to 34-year-old in the UK holds about £3,500 in savings. That just goes to show that the £88,000 figure is absolutely ludicrous. The current policy means that family reunification is a luxury; as we have heard, it is only for the very richest.”
“This policy is not only inhumane, but economically flawed. This debate is not just about numbers on a spreadsheet and arbitrary thresholds; it is about real human lives and love, and the human cost is immeasurable. I will highlight the case of one of my constituents, Rebecca Gray, who played a pivotal role in securing the debate by rallying her social media followers to help to get this petition over the 100,000-signature line. In 2023, Rebecca and her husband married in Turkey and began the spouse visa application process, knowing they had to meet a savings requirement of £88,500. To achieve that, they both worked 18 hours a day, seven days a week, while living in a high-risk earthquake zone in Turkey.”
“In 2024, the UK issued 3.4 million visas; 87,000 were family visas, which accounted for 7%, and the spousal visas made up even less—less than 5%. Moreover, the narrative that foreign spouses are a burden to taxpayers is fundamentally misleading. The Home Office’s own guidelines explicitly state that foreign spouses have no recourse to public funds. In fact, they contribute through taxation, national insurance and an annual immigration health surcharge of £1,035. I also worry that the cost of enforcing this policy is greater than the financial benefits. As we have heard, families forced into single-parent situations often require more Government support. As a GP, I have been seeing a patient and their family; the children are suffering because they cannot live with both parents, which has caused a lot of mental health difficulties.”
“Friend the Home Secretary commissioning the Migration Advisory Committee to conduct a review of this area as soon as we entered government. In November, I, with 25 of my colleagues, wrote to the Migration Advisory Committee calling for the family visa income requirement to be lowered to the equivalent of the full-time national living wage. That adjustment would enable thousands of families to reunite, while still supporting financial stability; it would be a compassionate shift away from the previous Government’s harsh stance. I am hopeful that the committee will come to the same conclusion. Some people have sought to misrepresent the truth about this matter when discussing immigration. It is our duty to bring the facts to this debate.”
“I thank my hon. Friend the Member for North Ayrshire and Arran (Irene Campbell) for introducing this debate. I would also like to thank the more than 300 petitioners from Stroud who have made this debate possible, and the Petitions Committee for allocating parliamentary time to this crucial debate. As we have heard, the previous Conservative Government hiked the minimum income requirement to £29,000, and were seeking to raise it even further, to £38,000, all under the guise of controlling immigration. That does not seem to have worked, but let us be clear about this policy and what it has actually achieved: it has torn families apart and inflicted hardship on ordinary people. So I welcomed my right hon.”
“Will the hon. Lady say whether the policy of punitively attacking families was successful in reducing migration? Will she also say what effect immigration has on GDP?”
“On pregnancy, obesity actually begins in the womb—it does not even begin when we are born. In one fascinating experiment, one group of pregnant women were fed a lot of carrots and another group did not have any carrots. The children of the women who ate carrots loved carrots, so a memory is made in utero. It is therefore really important that pregnant women have a very healthy diet, as this is a risk factor for obesity in young people. Another is formula feed. Breastfeeding protects against obesity, but formula feeds do not. Follow-on feeds, hungry baby feeds, are just normal milk packed full of calories, so they tend to increase obesity. That is perhaps something we need to discuss, too.”
“One problem is that unhealthy and ultra-processed foods—UPFs—that are high in fats, salt and sugar are often the easiest, cheapest and most convenient. Crucially, they make the most profit for the food industry. The other problem with these types of food is that they are addictive—salty, fatty foods are addictive. Another problem, revealed by the Food Foundation, is that healthy foods, calorie for calorie, are twice as expensive as less healthy foods. So there are a lot of issues there to unpick. Inequalities and deprivation are very, very strong causes of obesity, with less well-off people being twice as likely to be overweight. Therefore, one strategy has to be to increase the living wage, reduce child poverty, improve health and social services, and invest in education —all of which the Government are doing.”
“What is the cause of obesity? From the evidence, it is clear that the main cause of obesity is diet—it is what we eat. The food system in this country is fundamentally broken. I welcomed the statement from the Secretary of State for Environment, Food and Rural Affairs, my right hon. Friend the Member for Streatham and Croydon North (Steve Reed) about sustainable food production: nutritious foods grown while restoring nature, and farms with good food production at its core, rewarded properly. There is a complicated relationship in food production, whereby farms mostly exist on Government subsidy with very small profit margins and then the supermarkets make profits out of what they sell. We need to look into that complicated relationship.”
“Ischaemic heart disease, the leading cause of death in the UK, is much more common in obesity, as is hypertension and osteoarthritis, which causes joint pain and reduced mobility. Something that a lot of people do not know is that 13 cancers are directly attributable to obesity—it is actually also the second commonest cause of cancer. As a GP, there are other things I see quite regularly, such as reflux, varicose veins, infertility and even thrombosis, all of which diminish quality of life. The commonest cause of liver disease is now obesity. I will not go into the cost too much but, as we can imagine, obesity costs the country an absolute fortune: on average, four extra sick days a year; and, taking into account the cost to the NHS and so on, an estimated £98 billion a year, or 4% of GDP. The cost to the NHS is £19 billion a year.”
“The figures are even more worrying in children: 10% of children aged four, when they enter school, are obese; that figure rises to 22%—nearly one in four—in year 6. One problem with obesity is that, as many of us know, once someone becomes overweight, it is difficult to shift. That is why the most important age group to concentrate on is young people. Obesity is now the single most important modifiable risk factor for the prevention of disease, and I will briefly go through its effects—as a doctor, I cannot resist. Around 4 million people in this country have type 2 diabetes, which is five times more likely in obesity. Type 2 diabetes almost doubles a person’s mortality rate, with 22,000 people with diabetes dying early every year.”
“I beg to move, That this House has considered the impact of food and diet on obesity. I thank the Backbench Business Committee for allocating parliamentary time to this crucial issue. We were actually going to have this debate before Christmas, but we decided that before Christmas was not a good time to discuss obesity; we were then going to have it last week, but it was postponed. I am really grateful to colleagues across the House for supporting the debate. Our country has an obesity crisis that is threatening the health and wellbeing of the whole nation. It is a cross-party issue: since 1990, rates of obesity have doubled. Two thirds of all adults in the UK are carrying excess weight, and a quarter of adults are classified as obese.”
“Nesta, the Obesity Health Alliance and the House of Lords Food, Diet and Obesity Committee have done multiple reports on obesity, and it is clear that we can halve it. All we need to do is reduce everyone’s calorie intake by 200 calories a day. That is the difference between McDonald’s large fries and standard fries—other fries are available—so it is not a massive thing, but we all have to do it. As always with public health, small drops in what we take can have a massive effect on the population.”
“I absolutely agree with that. We must treat people in a fair and compassionate way. We must point that out to them, as medical professionals, and help them to get better. I agree with the hon. Lady about stigma. On obesity strategies, since 1990, we have had 700 separate policies to tackle obesity, yet it has doubled. Clearly, we are doing something wrong. Having looked at the evidence, it is clear that voluntary targets do not work. Voluntary targets for the food industry and relying on individual agency—giving us choice in what we eat—cannot reduce obesity. The food industry, of course, has a vested interest in making money. While education and exercise are really good, there is not much evidence to suggest that they reduce obesity. It is all about food. There has been a lot of research.”
“Absolutely. One of the main pitfalls we must avoid is that there is no point in making cheap food more expensive. That will make people poorer. We need to be much more creative than that.”
“We certainly must not let takeaway outlets open near schools—that is a planning must. I would also caution against the treatment of the obesity crisis with injections of drugs such as Ozempic, which could well turn out to be dangerous.”
“In Stroud, I have been working closely with local primary schools to encourage them to eat fresh, locally grown, highly nutritious food. I think the Government’s target is to procure at least 50% of food in schools from local sources. Then there is the famous hospital food. I was recently in hospital with a relative, and I can tell the House that hospital food is not healthy. We had white-bread sandwiches and some crisps—that was our healthy snack. We must introduce healthy foods in hospitals. Takeaways are another big barrier to healthy eating—there was a massive explosion in their use during the covid pandemic—and we need to include them in any regulation. As I have said, in Scotland and Wales a ban on takeaway price promotions has been proposed. On average, those in deprived areas order more takeaways than those in non-deprived areas.”
“That is because the food is healthy and a healthy hot meal is really important, rather than high-calorie snacks, which are what a lot of packed lunches consist of. If we cannot have free school meals, because of financial problems, we should have auto-enrolment so that children who should be on free school meals actually get enrolled. That would benefit schools, too. We must have mandatory front-of-packet labelling. I have never met a parent who does not want to buy healthy food for their children. The trouble is that they pick up a packet of cereal and it says, “High in iron and filled with vitamins,” and think it must be healthy. Nothing could be further from the truth, so we must have accurate labelling. Healthy school foods should be sourced locally.”
“As is planned in Scotland and Wales, there should be a ban on price promotions, particularly for unhealthy foods, ultra-processed foods and takeaways. We also need to put a lot more resource into breastfeeding and diet in pregnancies—remember the carrots—and we must regulate formula feeds. One measure, which has worked with the drinks industry in reducing sugar, is a reformulation tax on foods that are high in sugar and salt. Supermarkets and food companies would reformulate their foods to avoid the tax, thereby making them healthier. My hon. Friend the Member for Slough (Mr Dhesi) mentioned breakfast clubs. There is a lot of evidence that free school meals and breakfast clubs reduce obesity. Where free school meals have been introduced in London, childhood obesity has been reduced by 11%.”
“Yes, I could not agree more. As I said in the debate on education, we should be careful about the food industry sponsoring school breakfasts. As I pointed out, there is no such thing as a free breakfast. Companies often make unhealthy and addictive food and get young people addicted to it, so we must be cautious. I wanted a recipe to solve this crisis and what I am suggesting comes from evidence from Nesta and the House of Lords Select Committee. It should be mandatory that all stores report on the food healthiness of their sales. We need a fully independent Food Standards Agency. We should have a ban on advertising junk food, as has already been proposed, and there should be a watershed for children—that is incredibly important.”
“The hon. Gentleman’s intervention reminds me of the GP I took over from—an old chap; very wise—who said, “Always be a few years out of date, Simon, because we never know what these new drugs are going to cause.” I think that is good advice—not that I am suggesting that doctors are out of date, of course. Are we proposing the creation of a nanny state? That is the great fear of many people when they are confronted by controls of this kind, but let us look at what happened with the ban on smoking inside pubs. People—particularly in Ireland, but also in England—were saying, “This is crazy; it is never going to work”, but it worked fantastically well. We need to be aware of the vested interests of food companies, and we need to take radical steps.”
“I entirely agree. I think that this Parliament could do to obesity what the Government who were in power between 1997 and 2010 did to smoking: we could drastically reduce it. For the sake of our children and our older adults, I urge everyone to accept that we need to act now, and we need to act radically.”
“I thank the Minister and all who have spoken because this has been a genuinely interesting debate about an essential topic. I would just like to say in summary that the hon. Member for Chester South and Eddisbury (Aphra Brandreth) needs to go into the supermarket when she is really busy and pick up a tasty healthy snack. If the Government can get people doing that, it will be fantastic. I say to the Minister that the House is behind him being radical; it is not the time for non-intervention. I thank all who have contributed. I missed supper and am starving, so I am going to go and have a healthy snack.”
“I too am interested in solar panels being mandated on public buildings. In my area, Rednock school has had solar panels retrofitted. Solar panels in educational facilities have two effects: they not only save money for the school, but teach young people about the issue. Also in my area, the NHS is looking to put solar panels on all south-facing roofs of hospitals. I wonder if we could extend the Bill to public buildings in general.”
“May I pick up some comments that were made a little earlier? Many of my constituents have written to me expressing their concerns about campaign finance laws following media reports that a certain foreign billionaire will be providing very large donations. Will the Government introduce legislation to cap individual donations, close existing loopholes and enhance the powers of the Electoral Commission?”