Dr Neil Shastri-Hurst
MP for Solihull West and Shirley · Conservative · United Kingdom
“I am normally a temperate man, but this is a farcical situation. I have huge respect for the Leader of the House, but I suspect that he has come here with gritted teeth, because the reality is that our constituents want to hear from the new Prime Minister.”
“We have seen it in genomics and targeted therapies and we see it in the increasing recognition that treatment must be shaped by the biology of the disease and the needs of the patient. There is no reason that lobular breast cancer should be left behind in that progress. There has been movement—it is right to acknowledge that.”
“One duty of a good health system is to reduce the burden on the patient and prove that they are worth listening to. Susan Michaelis understood that deeply.”
“Compassion reminds us why we keep working. Responsibility requires us to bring those two factors together. The last Government invested in cancer research, including support for the Institute of Cancer Research and the Royal Marsden biomedical research centre, along with wider work relevant to lobular breast cancer.”
“We have heard about how she challenged assumptions, gathered evidence and pursued truth in an area where the consequences mattered for passengers, crews and the wider public. In 2013, she received her devastating diagnosis of invasive lobular breast cancer.”
“We cannot dispute that that is a significant sum, but we have to look at it in the context of national health spending and what cancer costs: the cost to families and patients and the cost to the NHS when it is detected late or treated inadequately. We have to bear those factors in mind.”
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Every one of 599 lines we hold for Dr Neil Shastri-Hurst, in date order, each linked to its source. Free to read, in full, without an account. Page 8 of 12.
“All the amendments in this group have been tabled in the name of my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer). Amendments 52 and 53 deal with grounds for detention and treatment—specifically, with how those grounds differ depending on whether a patient has the capacity or competence to consent. At the heart of both amendments is the simple but vital proposition that capacity matters, not only ethically, but legally. The ability of an individual to make decisions about their own care must shape the basis on which the state may act against their will. The revised wording introduces an important distinction between the two scenarios, where a patient lacks capacity and where they retain it.”
“It would provide firm legal clarity; remove any ambiguity about when detention procedures can begin; allow timely intervention, enabling quicker responses for an individual in crisis who is already at hospital but has not been admitted; reduce the risk of harm by allowing earlier application of safeguards; and align the legal framework with the reality of hospital procedures. The distinction between those who are in attendance at a hospital and those who have been admitted in a state of crisis is a false one.”
“While the Act currently allows for the detention of an individual who is already an in-patient, there is ambiguity about whether that applies to individuals who are on hospital grounds—who have attended A&E, for example—but have not yet been formally admitted as a patient. In those cases, the Act fails to capture people who arrive voluntarily or are brought to such an institution during a crisis. New clause 24 seeks to close that gap by explicitly allowing an application for detention to be made in such circumstances, ensuring that a timely intervention can occur when necessary for safety or treatment. A number of significant benefits would arise from the new clause.”
“It seems a lifetime ago since I was last on my feet. I am sure the Minister was waiting in anticipation for the crescendo of my speech. He heard my observations on amendments 52 and 53, and I know he will be mindful of ensuring that the balance between intervention and detention is held in equilibrium. I would be grateful if he addressed the points I raised before the interlude in his response. New clause 24 would amend section 5(1) of the Mental Health Act 1983 to clarify that a formal application for detention can be made not only for a patient already admitted to hospital, but for individuals who have attended or been brought to a hospital seeking help or admission. It would therefore expand the legal basis for initiating detention procedures under the Act. The new clause makes an important distinction.”
“My hon. Friend is right. An individual can attend an emergency department to be assessed and be seen by a doctor before a decision is made on whether that patient should be admitted to that hospital, transferred to a tertiary centre or discharged back into the community. New clause 24 seeks to provide clarity and certainty for practitioners on that grey area and, crucially, it seeks to provide a safeguard for patients who have yet to be formally admitted to an institution—a hospital, community placement or wherever—but need a crucial intervention.”
“I have listened carefully to the Minister, who has addressed the issue with his usual thoughtfulness. I ask that he looks into sharing that data, particularly around new clause 24, but on the basis of the reassurances that he has provided, I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn. Ordered, That further consideration be now adjourned. —(Taiwo Owatemi.)”
“Crucially, it is subject to the full rigour of parliamentary approval under the affirmative resolution procedure. It is not a case of Executive overreach; it is a recognition that the pace of medical and neuroscientific research is such that legislation risks obsolescence unless we allow for responsible adaptation. One need only look at the evolution of our understanding of conditions such as autism spectrum disorder and complex post-traumatic stress disorder to appreciate how quickly definitions can move on. Clearly, any change must reflect best practice and take place under broad consultation. However, I argue that we are not opening the back door to arbitrary change; we are safeguarding the front door against stagnation. For that reason, I support the amendment.”
“The amendment provides for a narrowly drawn but important power, namely, to update, via regulations and subject to affirmative procedure, the statutory definitions in clause 3, in response to developments in scientific and clinical understanding. I recognise that any clause that confers powers on the Executive to amend the statutory definitions must be treated with due caution. There could be concerns that changes could be made without broad clinical consensus. However, on this occasion, I believe that my hon. Friend, who brings to the debate the weight of his clinical expertise, has struck the right balance. The proposed power is tightly scoped. It is triggered only by new scientific knowledge. It cannot be exercised on ministerial whim.”
“I beg to move amendment 56, in clause 3, page 3, line 19, at end insert— “(4) The Secretary of State may by regulations update the definitions in subsection (2) in response to scientific advancements. (5) A statutory instrument containing regulations under this section may not be made unless a draft of the instrument has been laid before and approved by a resolution of each House of Parliament.” This amendment would allow the definitions for mental disorder, autism, learning disability and psychiatric disorder to be updated by secondary legislation as science evolves. It is a pleasure to serve under your chairmanship, Mr Vickers. I rise to speak to amendment 56, which is in the name of my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), who has extensive clinical experience.”
“Building on the Minister’s last point, can he reassure the Committee that any consultation will have a strong focus on ensuring that practitioners have the training and, most importantly, the resources that they need to achieve a seamless transition from one set of regulations to another?”
“I have a certain degree of sympathy for the amendments, but I am sure the hon. Lady will recognise that patients and their families often find the review process overwhelming in and of itself. Bringing it forward to six months, when such reviews would often not be required, can cause a huge amount of stress and place pressure on those family units and patients. Of course, reviews can be brought forward when clinical need requires it. To stipulate that within the legislation puts an enormous burden upon those families and, most importantly, the patients.”
“Does my hon. Friend share my concerns that not resolving housing and accommodation at the point of discharge could lead to a delay in transition? Patients would remain in hospital for longer than might be beneficial to them.”
“Does my hon. Friend agree that there is a risk that the amendment would not only increase the workload of practitioners, but divert attention from patient care?”
“There appears to be universal support for this damascene conversion by the Government. Last year, they told pensioners that the right course of action was to scrap the winter fuel payment for millions, but they are now telling them that a means-tested system is right, so how can pensioners possibly believe anything that the Government say?”
“Public confidence in the criminal justice system—and, importantly, the confidence of victims—is paramount. Since 2010, the use of community-based orders has decreased by 61%. That is in no small part because of concerns about offender engagement in the process. If the Government are going to pursue this route, what steps has the Lord Chancellor taken to model how many will reoffend and, more importantly, that they will be rigorously reinforced?”
“The petition to protect Northern Ireland veterans from prosecution has, in a matter of days, amassed over 98,500 signatures. Will the Leader of the House commit that the petition, once it reaches the 100,000-signature threshold, will be granted debating time at the earliest opportunity?”
“The Government’s position appears to be predicated on a hypothetical judgment to a hypothetical claim. In this hypothetical scenario, why would the Government not simply appeal?”
“While that may be appealing superficially as a safeguard, it represents a fundamental misunderstanding of the doctor-patient relationship. We trust our clinicians every day to raise subjects of great complexity and moral weight.”
“This House is now faced with a responsibility as profound as it is complex: to ensure that this Bill remains clear in its purpose, cautious in its application and compassionate in its impact. That purpose is simple, yet solemn: to grant adults of sound mind with a terminal diagnosis the legal right to seek assistance to end their lives in carefully regulated circumstances through a legal framework in which compassion and control co-exist. With that in mind, I rise to speak against new clauses 1, 2 and 9, which, while no doubt well intentioned, threaten to confuse, dilute or duplicate what is already a well-constructed piece of legislation. I begin with new clauses 1 and 2. New clause 1 would prohibit healthcare professionals from raising the topic of assisted dying unless it is first broached by the patient.”
“I am grateful to the hon. Member for that intervention. I fear there is some rhetoric that engenders a fear around the medical profession, which is misplaced.”
“I will give way in a moment, if I may. Those are not my experiences in clinical practice, nor are they those of family members who have worked in it. We must trust our medical professionals, who are highly trained and capable individuals, to have these difficult and complex conversations, which they do every day on issues such as aggressive chemotherapy or the withdrawal of ventilation.”
“I am grateful to the hon. Gentleman for his intervention. These are complex conversations that take place up and down the country every day; we know that they are taking place in St Thomas’ hospital at this moment. We are treating our medical professionals as though they do not take their professional obligations seriously. We must recognise the expertise that they bring and the sensitivities in which they have these conversations.”
“I am grateful to the hon. Lady for her intervention. I commend those family members who are really powerful advocates for their children, parents and relatives in their engagement with the medical profession. We are at real danger of treating our clinicians as though they have no care for their patients—”
“I am grateful to the hon. Gentleman for his intervention. That is why it is so important that we have the rigorous training and safeguards that are a fundamental part of this Bill.”
“I will make some progress, if I may. The point is that people cannot have a fully informed discussion and weigh up the balance of the decision if they do not know the full options available to them. That is a part of informed consent.”
“I will make a little progress, if I may. In respect of new clause 2, those who have had the privilege of meeting a young person living with a terminal illness will know that they often display a maturity and a depth of understanding far beyond their years. To deny them the opportunity of a considered conversation about their future upon reaching adulthood is not an act of compassion, in my view; it is to abandon them. It is to leave them isolated, navigating a complex and deeply personal journey through the filter of online forums, rather than in dialogue with trusted, qualified professionals. We owe them better than that.”
“The boundaries of any legal test or hurdle must be clear. A failure to do so creates a great deal of uncertainty. Furthermore, the proposal to shift the standard of proof from the civil to the criminal, requiring panels to operate on the standard of beyond reasonable doubt, is deeply inappropriate. The balance of probabilities is the cornerstone of medical and civil decision making. To adopt a criminal threshold risks freezing the entire process, creating a very risk-averse system.”
“I am grateful to the hon. Lady for her intervention. That is a very powerful personal story from Noah, who I think reflects the maturity of many young people when dealing with these challenging issues. By imposing, in effect, a statutory gag in this one area, new clauses 1 and 2 risk infantilising terminally ill patients, creating a chilling effect on communication at the very moment when clarity and compassion are most needed. If anything, new clauses 1 and 2 may result in harm to patients, forcing them to suffer in silence, unaware of lawful options simply because they do not know how to ask. Finally, I turn to new clause 9, which presents a number of issues. In the first instance, subsection (1) would permit there to be, in effect, two different standards of proof. That must be legal nonsense.”
“I am grateful to the hon. and learned Gentleman for his intervention. These are individuals who are making this ultimate choice for themselves. My fear is that this well-intentioned new clause would make the Bill so unusable as to become ineffective. We are not prosecuting a crime here; we are enabling a choice under tightly prescribed circumstances. While I accept that each of these new clauses in their own way seeks to improve the Bill, we must be cautious about layering protections to the point of paralysis. The Bill as drafted is not a blank cheque—it contains safeguards, panel oversight and rigorous eligibility criteria. Let us not bury its moral clarity under legal clutter. In defending this legislation, we are not abandoning care; we are affirming dignity. Let us do so with confidence and reject these amendments.”
“Has the Ministry of Justice conducted an impact assessment for this policy? If so, will it release that to the House as soon as possible? If not, can the Lord Chancellor confirm how she knows what impact the policy will have on victims and the wider public?”
“10. What estimate she has made of the potential impact of increases in employer’s national insurance contributions on the number of teachers employed in schools.”
“Can the Minister solve this equation? VAT is pushing more students into the state sector and increases in national insurance are squeezing staff budgets, yet the Government say their ambition is to improve school standards and staff retention. How does that add up?”
“Can the Minister update the House on whether yesterday’s meeting involved discussion of any potential future co-operation between the US and Russia on energy? If it did, did he impart to his US counterparts that such an arrangement would be a folly?”
“Q10. The danger posed by China to our national security is self-evident. Can the Prime Minister explain why he and his Government have chosen to treat Beijing as a business partner and not as the hostile state that it truly is?”
“I am grateful to the Secretary of State for his statement. Will he set out what recent steps have been taken by the Government to support the Ukrainian prosecutor general in investigating and prosecuting domestic war crimes?”
“It is estimated that 25,000 jobs directly linked to the automotive sector are at risk due to reduced exports to the United States. That is a deep concern to many of my constituents who work at either JLR in Solihull or Aston Martin in Gaydon. Can the Secretary of State set out what specific steps he is taking to protect those jobs, and whether it will involve reforming the regulatory environment in which they operate?”
“The Minister will have heard the feelings of the House, so can he provide us with the specific guarantees that the Foreign Secretary has secured in relation to preventing hostile states such as China from increasing their influence in the Chagos islands while we as a nation are still paying for them?”
“T4. What further information did the Foreign Secretary have that led him to make a decision that differed from the detailed objections of the police, the security services and our allies, and to support the new Chinese super-embassy? Will he share that information with the House?”
“My hon. Friend is making an passionate argument. I think most of us would agree that billboards and television adverts would be egregious. I note that subsection (3) talks about “electronic form”. That could involve email correspondence between parties. How would that not be an advertisement under the amendment?”
“I concur with my hon. Friend the Member for South Suffolk (James Cartlidge) that it is deeply disappointing that France has blocked European Union countries from allowing SAFE—Security Action for Europe—funds to be used for the procurement of British weapons. With that in mind, what has the Minister done to ensure that actions are being taken to guarantee a multilateral, NATO-wide procurement strategy, with the UK at its centre?”
“For example, they would not be allowed to hold a glass or steady a straw as a patient moved towards it to imbibe a substance. Those are circumstances that are entirely foreseeable, when through the ravages of an illness, somebody is limited in what they are physically able to do. Of course, assistance could be provided in alternative ways—for instance, through assistive technology, which we have seen being used in other jurisdictions. The Swiss, for example, use a significant amount of assistive technology in administering and assisting the process of self-administration at the end of life.”
“In my view, the amendment would make the operation of the Bill, were it to become an Act, unnecessarily restrictive. Clause 18(7) already stipulates that “the decision to self-administer the approved substance and the final act of doing so must”— I stress the word “must”— “be taken by the person to whom the substance has been provided”. On any interpretation of the construct of that, it is clear that the person seeking an assisted death must be the active participant in the process; it is mandatory. There is no discretion in that, by virtue of the word “must”. Were we to remove clause 18(6)(c) and the Bill passed into law, it would have the effect, in what is an entirely legal process, that a doctor would be unable to aid a patient in any circumstance.”
“Friend’s amendment 462. It strikes me that, after doing so, the Bill would provide a further check and balance that creates no greater onus on either the individual seeking an assisted death nor the co-ordinating doctor who is assisting them. In those circumstances, it appears eminently sensible to improve the Bill in that way. From the indications we have already heard, it appears that there is significant support for that amendment. I struggle with amendment 463, which would remove paragraph (c) from clause 18(6). The effect would be to prohibit the co-ordinating doctor from providing assistance to the person seeking an assisted death, either through ingestion or other self-administration of that substance, in any circumstance.”
“It is a pleasure to serve under your chairmanship, Ms McVey. I will speak briefly to this group of amendments, setting out why I support amendments 462, 497 and 498, but oppose amendment 463. My hon. Friend the Member for East Wiltshire set out very eloquently the reasons behind amendment 462. On the one hand, there is a cogent argument that it is not strictly necessary in the light of the provisions set out in subsection (4)(b) and (c), which set out that the individual wishing to have an assisted death must have “a clear, settled and informed wish to end their own life” and is “requesting provision of that assistance voluntarily”. However, it appears to me a logical and entirely appropriate extension of the intentions behind clause 18(4) to express that in slightly more explicit terms in the Bill by adopting my hon.”
“That is why clause 18(7) is so important: the final act must be undertaken by the person seeking an assisted death. The example my hon. Friend gives of tipping tablets into a mouth is a final act. Pushing a syringe is a final act. There is a significant distinction between an individual or practitioner holding a cup with a straw and the person seeking an assisted death moving their mouth towards the straw, sucking from it and imbibing the substance and the passive act of a substance being raised to that individual’s lips and poured in without any movement by the individual seeking an assisted death themselves.”
“It is very clear from subsection (7) that this must be an active step taken by the individual. There is a risk that we go down a rabbit hole in terms of— [ Interruption. ] I am sure my hon. Friend would like me to finish my point. We risk going down a rabbit hole in drawing examples. I raised the example of a cup, but of course there are much wider assistive technologies that can be used and are used in different jurisdictions. I gave the example to illustrate the point that this is an active act, not a passive act.”
“I agree entirely with the right hon. Member’s interpretation of the Bill. There is a further unintended consequence of the amendment tabled by my hon. Friend the Member for East Wiltshire, which I am sure is not his intention but would sadly be the effect: were an individual to qualify under the Bill, should it pass and were the amendment to be adopted, they would inevitably be forced to take the final decision at an earlier stage. If there is a restriction that they can have no assistance whatsoever in performing the act, they will end up making the decision when they know that they have the entire physical strength available for them to do it, and that actually brings forward the point at which they choose to die to an earlier stage.”
“My right hon. Friend makes an important and powerful point. I think there is a consensus among the Committee that there is no desire for people to take this ultimate step at an earlier stage than is absolutely necessary for them. My very real fear is that, were we to adopt this amendment, we would bring forward that point of decision.”
“It is a pleasure to serve under your chairmanship, Sir Roger. My hon. Friend the Member for East Wiltshire was mid-intervention when the Committee adjourned this morning, and I would not want to pull the rug from underneath him. Does he wish to intervene again?”
“I can deal with amendments 497 and 498 in short order. They would tighten up the Bill by providing greater clarity around the circumstances in which the substance would be removed from the presence of the individual who had previously indicated a wish to have an assisted death. Amendment 497 specifies that the individual would need to set out to the co-ordinating doctor that they no longer desired to go through with the process. In my view, that is eminently sensible. Amendment 498 elaborates on the Bill to provide greater clarity to those who will be operating it. It will make it a much more workable piece of legislation. I support both amendments.”