Terminally Ill Adults (End of Life) Bill

Allison Gardner Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[John Glen]

I have been very clear that I have tabled my amendments in a constructive way to reflect the will that the hon. Lady has expressed, but to recognise the meaningful dilution in the authority of the process and what can reasonably be amended to invigorate it, based on the principles that I think were intended at the outset.

I will revert to the point I was making about the judiciary. They have a commitment to uphold the law, and that should be the standard we are looking for when it comes to matters of life and death. The Judicial Appointments Commission already conducts appointments for all tribunals, including lay members. The Government’s impact assessment compared the panel to the mental health tribunal. All appointments to the mental health tribunal, including the non-legal members, are made by the Judicial Appointments Commission, so this would not be a novel function for it.

Let me move on to amendment 85, which would ensure that all members of the panel have to take the judicial oath if they have not done so already. If other amendments pass, amendment 85 would be necessary only for the non-legal members, and it is crucial for public confidence that the judicial oath is taken.

Amendments 83 and 84 seek to preserve an important element of the Bill as originally presented to the House. They would ensure that the most senior decision-making figure, the chair of the panel, is a High Court judge with all the experience, responsibility and professionalism that that implies. Under these amendments, all High Court judges would be automatically eligible. They would need to be currently serving or at least be below retirement age, and would have to be a judge of the highest authority and not a deputy judge. Members of this House and the public were originally told that this would be a safe Bill precisely because it would have a High Court judge. That was a persuasive promise, and I think there is a way to honour it, even in the new version of the Bill.

I will briefly mention the retirement age, because it is important. It used to be 70, but judges can now continue until they are 75. However, there is no age limit for members of the panel. If we are saying that an 80-year-old retired judge is still with it and is able to decide on matters of life and death, why are they too old to help clear the backlog of criminal cases? That seems to be a meaningful anomaly.

I have been very clear about the purpose of my amendments. I have tabled them in the spirit of trying to strengthen the Bill and return it to what was intended, so that it can meet the expectations of so many Members who supported it at an earlier point.

[Dr Allison Gardner (Stoke-on-Trent South) (Lab)]

I rise to support a number of new clauses and amendments to the Bill. The common thread running through all of them is a need to address some of the gaps in the safeguards and oversight. Should the Bill pass, I at least want to ensure that we improve its protections and remove some of the risks that it contains.

New clause 4 requires the chief medical officer to monitor the operation of the legislation, rather than depending solely on the assisted dying commissioner. Alongside the requirement for a High Court judge, oversight by the CMO was removed during the Committee stage. This means that, essentially, the assisted dying commissioner would mark their own homework. New clause 4 returns the safeguard of independent oversight, which is sensible given the significant concerns expressed by many experts and organisations, which were often neutral on the principle, but concerned about the Bill. They include the Royal College of Psychiatrists, the Association for Palliative Medicine, the British Geriatrics Society, the Royal College of Physicians and many experts such as Professor James Monckton Smith, a leading criminologist, Baroness Finlay, Parliament’s leading expert on palliative care, Sir David Haslam, former head of the British Medical Association and of the National Institute for Health and Care Excellence—my previous employer—and many more. All have expressed concerns, even when neutral on the principle of the adequacy of the Bill.

Hence new clause 4 requires an annual report to include

“information about the application of the Act in relation to—

persons who have protected characteristics, and

any other description of persons specified in regulations made by the Secretary of State.”

I fervently hope that that includes domestic violence victims.

Amendment 13 very sensibly adds the requirement that the commissioner appointment is not the sole remit of the Prime Minister at the time, by requiring the consent of the Health and Social Care Committee. This provides a safeguard against ideological and politically motivated appointments, and I would be very critical of anyone who would want to prevent that.

Amendment 15 addresses the significant concerns about the involvement of private—for profit—providers of assisted dying. There are concerns that, when there is a commercial relationship between providers, there will be a gaming of the system. That risks compromising the relationship between the co-ordinating doctor and the independent doctor. Likewise, the existence of such providers does not allay concerns about doctor shopping, as was raised in the previous debate. Hence amendment 15 will require private providers to be transparent and provide reports on service members, service numbers, costs and revenue.

In previous debates and in the public discourse I have found it very disconcerting that, in response to legitimate concerns, all that we have been offered—as we have seen today—are some promised, unspecified future regulations that will fix the gap—[Hon. Members: “Hear, hear!”]

[Naz Shah]

My hon. Friend is making a powerful point. Does she share my concern that most of our discussions today were thrashed out in Committee, and now we are being told that we have to leave them to the Lords, because we cannot fix the issues here? That is a really flawed process.

[Dr Gardner]

I entirely agree with my hon. Friend.

To expect MPs to improve the Bill without clarity as to what the regulations are or what they will be, and how the service will be delivered without rigorous regulatory oversight is fundamentally wrong.

Furthermore, the fact that the implementation of the Bill will be automatic in 2029—a general election year, incidentally—is not realistic when reflecting on the many areas that still lack detail. Hence I support amendment 42, proposed by my hon. Friend the Member for Newcastle-under-Lyme (Adam Jogee), which allows the Secretary of State to determine the appropriate date for the Bill to be implemented. This would allow time to make the NHS fit for purpose, to strengthen palliative care, and for Parliament to draft and scrutinise adequate regulations without being rushed.

Similarly, but fundamental to the society in which we live, amendment 12 protects the status of our most dear institution, the NHS. The Bill before us provides Henry VIII powers to amend the National Health Service Act 2006 without limit, which could include a specification of charges. If, as Labour MPs, we are committed to the NHS remaining free at the point of use, then amendment 12 is vital, as it will require any changes to the 2006 Act to be made by an Act of Parliament. The future is uncertain. We must build safeguards in the Bill to protect us from measures that fundamentally alter the fabric of our society.

Briefly, amendment 27 requires the MHRA to license the drugs used for assisted dying. Research has shown that painful and protracted deaths via assisted dying drugs are not uncommon, with deaths ranging from three minutes to 137 hours—nearly a week— with up to eight hours to lose consciousness. Furthermore, serious side effects disproportionately affect younger people. Amendment 27 will help to ensure the safety and efficacy of these substances.

I will close by quoting Sir David Haslam on how we balance some of the individual stories used on both sides of the debate with the good of society. As we know, NICE has to make the difficult decision to approve or not approve medications and treatments based on a cost and clinical effectiveness model. It is experienced in weighing up societal good—[Interruption.] I will be quick, Madam Deputy Speaker—versus the needs and wishes of individuals.

Chronic Urinary Tract Infections

Allison Gardner Excerpts

Wednesday 21st May 2025 Westminster Hall

[Dr Allison Gardner (Stoke-on-Trent South) (Lab)]

It is an honour to serve under your chairship, Sir Desmond. I am not well today for the very reason that we are here. I may need to sit down during my speech if that is okay. I am deeply grateful to the hon. Member for Sutton and Cheam (Luke Taylor) for securing this incredibly important debate. [Interruption.]

[Jim Shannon (Strangford) (DUP)]

This is a difficult subject for those who suffer from this condition. I will give an example in my speech, as one of my staff members suffers from it. We are deeply indebted to the hon. Member for Sutton and Cheam (Luke Taylor) for bringing this forward. It is important to hear personal stories from sufferers, such as the hon. Member for Stoke-on-Trent South (Dr Gardner), and that they are given the opportunity to express themselves on the importance of this issue to them personally and to all our constituents.

[Dr Gardner]

As hon. Members may have guessed, this debate is not only important to thousands of women across the country—according to the Chronic Urinary Tract Infection Campaign, about 1.7 million women suffer from chronic UTIs—but incredibly personal to me. I have suffered from UTIs as a result of menopause for more than 10 years, and received a diagnosis of chronic UTI in 2023.

I do not think many people realise how debilitating and excruciating chronic UTI can be. At my worst, I wondered how I could go on. I even changed from a beloved lecturing job to one at NICE because I wanted to change things from within, and it is why I am an MP now. I have tried almost everything; I was even considering—as a final step before the final, final step—having my bladder removed.

Although my NHS consultant gave me Hiprex—methenamine hippurate—thank God, which is life-changing for me, he finally shrugged his shoulders and said that I would just have to live with this condition. In desperation, I tracked down a specialist who worked in private practice. How lucky I was to have the money. I can confidently claim that Dr Catriona Anderson saved my life, which I do not say lightly.

Chronic UTIs can lead to hospitalisation—I have been twice—and sepsis and death. I have a long list of all the drugs that I am on, but I will not read it out. I believe this is another case of how women’s medical conditions continue to be misunderstood, under-researched and underfunded. To illustrate that point, there is a belief that UTIs are more serious in men than in women. I acknowledge that men’s physiology—men have a longer urethra than women—means that they are less likely to develop a UTI, although the possible presence of an enlarged prostate means that they may experience restrictive urine flows and develop a UTI. That is certainly the case in older men. Consequently, all men are recommended seven-day courses of antibiotics compared with the three-day courses that women are recommended. By the way, there are three antibiotics to treat UTIs. Trimethoprim and nitrofurantoin are the top ones, but I am allergic to them, so I am on cephalexin when I need it.

There is a lack of acknowledgement that poorly treated UTIs can lead to bacteria becoming embedded in bladders. Incidentally, a much shorter journey in women means that the diligence afforded to men is not afforded to women. In addition, women’s immune response to pathogenic bacteria in the bladder is oestrogen-dependent, and so it is also age-related. Lack of official recognition of chronic UTIs means that women do not receive treatment equal to what men. I am a molecular biologist, but I will not bore Members by setting out the different types of receptors in the urethral lining of the bladder.

I will further illustrate this point in simpler terms. A campaigner told me how her doctor, who repeatedly prescribed her three-day antibiotic courses for her chronic UTI, prescribed her husband, when he presented with a UTI for the first time, a month-long course, which would entirely clear the infection, of course, and minimise risk of recurrence. That says it all. Incidentally, chronic prostatitis is recognised by NICE.

As has been mentioned, for many women—approximately 70%—three-day courses will be sufficient, but for rest of women, three-day courses clear only some bacteria. Those that remain are relatively resistant; they then increase in population and there is recurrence. Essentially, repeated short courses establish a system of natural selection for resistant bacteria. It also means that the remaining bacteria then have time to invade the bladder and become embedded, finally leading to chronic UTIs. So, patients are stuck in a loop.

The use of the useless urine dipstick test, which is no more accurate than the toss of a coin, and of the midstream urine test, which is even worse, means that infections go undetected. As a result, no antibiotics are prescribed until the infection gets worse and, finally, a short course of antibiotics is prescribed. However, the infection is still not fully cleared, so the loop starts again. The infection then becomes embedded in the bladder wall and chronic UTI develops.

Short-term antibiotic courses often do not treat chronic UTIs, because dormant populations of bacteria exist within the bladder wall. Your life revolves around desperately trying to convince doctors to prescribe a course that you know will work for you. I am due to move house soon and I am petrified of having to move GPs, which would mean again starting this battle of trying to convince a GP to take me seriously. I understand concerns around antibiotic resistance and the medical hesitancy in prescribing longer courses of antibiotics. However, the solution is not to minimise antibiotic use; it is to get the diagnosis right, treat thoroughly, recognise the existence of chronic UTIs and prevent their development.

I am concerned by the lack of research and guidelines for diagnosis and treatment of chronic UTIs. We could prevent them all together if we get things right. I am particularly excited by the UTI vaccine, which is not currently available in the UK. Prevention of UTIs would not only save the NHS countless hours and money, but save people from living miserable lives.

In April, the Minister for Care said in a response to a written question:

“there are no current plans to train GPs and urologists on recognising the symptoms of chronic UTIs”.

Also, current NICE guidelines do not contain guidance for chronic UTIs. This situation must change. Too many women are being left in unbearable pain without a proper diagnosis or appropriate medication.

I will be very quick now, Sir Desmond; you have been very patient with me. About 50% of all antibiotics are prescribed for UTIs. However, each year there are thousands of deaths from UTIs and approximately 200,000 A&E admissions are due to UTI-related illnesses. The cost of UTIs to the NHS, as well as to people’s lives, is huge.

This issue is personal for me. It is also personal for the millions living with the pain, frustration and isolation of chronic UTIs. Will the Minister meet me and others, including campaigners, to discuss how we can improve diagnostic tools, develop guidance and ensure that people suffering from this condition receive the care that they deserve?

Thank you for your indulgence, Sir Desmond.

NHS England Update

Allison Gardner Excerpts

Thursday 13th March 2025 Commons Chamber

[Wes Streeting]

The hon. Gentleman makes a fair challenge on the bureaucratic nature of decision-making. We are working with Treasury Ministers and colleagues across Government to take an axe to that unnecessary bureaucracy. He will be absolutely fuming when he finds out who was responsible for it.

[Dr Allison Gardner (Stoke-on-Trent South) (Lab)]

I am conscious that my former colleagues at NHS England will be concerned about today’s announcement, but I am very confident that the Secretary of State will do all he can to support them. It is an inescapable fact that the 2012 reorganisation led to inefficient layers of management in the NHS, delivering poorer care and greater costs to the taxpayer. How does he plan to cut excessive layers of bureaucracy, get resources to the frontline and, crucially, deliver better care for the people of this country?

[Wes Streeting]

That is a brilliant question. We have put in place a transformation team, led by Sir Jim Mackey, which we will work with to start fundamentally changing the way the NHS works, by shifting more power, resources and responsibility out of Whitehall and closer to the frontline and the communities where decisions are made, and by getting rid of the unnecessary bureaucracy that drives patients and staff to distraction.

Hospice and Palliative Care

Allison Gardner Excerpts

Monday 13th January 2025 Commons Chamber

[Dr Allison Gardner (Stoke-on-Trent South) (Lab)]

Twenty years ago this month, both my parents died aged 60, of cancer. They died just one week apart, but that is where the similarities ended. My father died a horrible death, receiving very poor—if any—palliative care. My mother won the postcode lottery, if you like, and passed away in the Royal Stoke, in Stoke-on-Trent, where she received superb care and died a dignified death. I live with the twin legacies of those deaths. I stress to the Minister the importance of ensuring that trained palliative care staff are spread equally throughout the country. It is vital. It makes a difference.

Stoke-on-Trent has also won the postcode lottery in a way, with our excellent hospice, the Dougie Mac. Having merged with the Donna Louise children’s hospice, it now provides care for all people of all ages across north Staffordshire. It provides many innovative services, including a dementia care service and a rapid response ambulance service, which responds for patients at the end of their lives. Instead of taking them to A&E, they travel to the hospice. That saves the local hospital 350 A&E visits a year, saving on ambulances and saving the trust money. Unfortunately, the hospice does not receive any funding to help deliver that service. I want to take the opportunity to put on the record my thanks to the chief executive, who I spoke to at great length recently, to all the staff across both sites, in Blurton and Trentham in my constituency, for all the work they do, and to all the amazing volunteers in the shops throughout Stoke-on-Trent.

I welcome the Government’s commitment to funding hospices and the £100 million injection, but like everyone else I support ending the postcode lottery. We must end inequality in the delivery of service and we must provide a more sustainable model in future.