Rebecca Paul MP: speeches

Speeches

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I apologise, but I do want to get through my speech. It is important to make the point that someone suffering with anorexia, or indeed any mental condition, is not intended to be eligible for an assisted death. However, in the case of anorexia there are physical manifestations of the illness, such as malnutrition and diabetes, that might mean the patient meets the definition of being terminally ill, and that is the nub of the problem: the Bill does not adequately rule out physical manifestations caused by mental illness. That is why amendment 14, tabled by the hon. Member for Bradford West (Naz Shah), is so important, because it would ensure that anyone who voluntarily stops eating or drinking is ineligible for assisted dying. I support the amendment strongly as it addresses a big risk. Lastly, on eligibility specifically, I want to talk about capacity. There are such problems with the current approach to determining capacity that I barely know where to start. When it comes to ending one’s own life, a higher standard should be applied. The current definition of capacity was not created with such a monumental decision in mind, and if it were being drafted from scratch today, it would look very different. That is one of the reasons why the Royal College of Psychiatrists does not support the Bill. Under the Bill, a person is assumed to have capacity in the first instance. A clinician only needs to be over 50% sure that a person has capacity. If the person is making unwise decisions, that is not taken into account, and a person can be “helped” to make a decision—for example, when a patient has learning disabilities. I ask all Members today whether they are happy with that. Does that sound like a robust approach to assessing whether someone has capacity to make the decision to end their own life? Let us begin with the starting presumption of capacity. That, too, lacks the standard for assisted death decisions. I therefore support amendment 24, tabled by the hon. Member for Bexleyheath and Crayford (Daniel Francis), which would disapply section 1(2) of the Mental Capacity Act 2005 for the purposes of assisted dying. One of the biggest issues for me is the fact that the current approach requires an impairment or disturbance of the brain in order for someone to be considered not to have capacity, irrespective of whether they can make a decision. In the real world, that would mean a doctor could assess a patient who gives the impression of being confused, illogical, erratic, inconsistent—everything about them could scream that they are not in a good place to make this decision at that point in time—but they would still be considered to have capacity if there is no identifiable impairment or disturbance of their mind or brain. That could potentially put those with depression, anxiety, learning disabilities or eating disorders, or even those just experiencing physical pain that is driving them to distraction, in danger of being considered to have capacity when they do not. So far I have focused on eligibility. I will now talk about hospices.

• 7 May 2025 · Educational Opportunities in Semi-rural Areas · Hansard source

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  It is a pleasure to serve under your chairmanship, Sir Edward. I am sincerely grateful to the hon. Member for Hertford and Stortford (Josh Dean) for securing today’s important debate on tackling the barriers to educational opportunity faced by young people in semi-rural areas. This issue touches communities across the country, including parts of my constituency, so I am pleased that we are in Westminster Hall giving it the attention it deserves. I have certainly felt that, for too long, much of the discussion around educational disadvantage has focused to a large extent on inner cities. While there are undeniable challenges in urban settings, that somewhat narrow framing has obscured the realities faced by young people growing up in less densely populated areas. On the surface, rural and semi-rural pupils appear to perform well, often even outperforming their urban counterparts in headline attainment measures, but averages can be deceptive. Recent research from the University of Exeter has shown that when the data is disaggregated, a very different picture emerges. Pupils from disadvantaged backgrounds in rural and semi-rural communities actually do worse—sometimes significantly worse—than similarly disadvantaged pupils in urban areas. At GCSE level, the attainment gap can be as high as eight percentage points. We also need to be honest about the practical barriers that young people in semi-rural communities face—barriers that, while often not obvious to central Government, are plain to see for anyone who has spent time listening to families, school leaders or employers in these areas. The first and arguably the most pressing, which has been repeatedly raised today, is transport. The lack of affordable reliable public transport comes up again and again in conversations with headteachers, apprenticeship providers and young people themselves. The result is that some young people simply cannot take up the opportunities that exist, whether that is a college course in the next town, a part-time job or a work placement that would open doors. Employers, too, are feeling the strain, reporting that inadequate public transport limits their ability to recruit young staff. That is simply not good enough. No less important is solid digital infrastructure. In 2025, it should go without saying that high-speed broadband is a basic educational necessity, yet across pockets of semi-rural England, people still struggle to access reliable internet at home. During the pandemic, when learning moved online, that digital divide was laid bare, but it did not begin there and it has not gone away. Even now, slow speeds and patchy connections undermine students’ ability to complete homework, access the virtual tutoring used by their peers and easily apply for jobs and apprenticeships. The failure to deliver truly universal digital access is becoming a core driver of poorer outcomes in rural and semi-rural education. The third barrier relates to choice and proximity. In many semi-rural areas, the number of local education providers is limited, as we have heard today. That can mean fewer subject options at A-level, less availability of vocational and technical qualifications and more pressure on local schools to stretch resources across a wide catchment. Whereas a student in a city might have a dozen sixth-form or college options within easy reach, a student in a rural town might face a daily bus journey of more than an hour each way, if the bus runs at all. Schools and colleges everywhere are feeling the strain on their budgets, but for smaller settings in semi-rural communities the financial pressure is acute. The Government’s decision to increase employer national insurance contributions has added costs to education budgets. For a teacher earning £40,000, the combination of national insurance and teachers’ pension scheme changes means an additional cost of nearly £3,000 per year per staff member. The reality is that semi-rural schools and colleges are often the most vulnerable to cuts. Their smaller size limits economies of scale, their geographical isolation makes recruitment more difficult and their budgets are less buffered by reserves or alternative income streams. When costs go up and funding falls short, they feel it first and they feel it hardest, and it will have an impact on the most vulnerable students. In many semi-rural areas, students face a stark lack of choice as to further education and skills pathways post 16. The push for T-levels and other reforms has not been matched by the transport funding or delivery infrastructure needed to make them a realistic option outside urban centres. The promise of parity between academic and technical routes is laudable, but is hollow if it depends on travel that students cannot afford or on opportunities that do not exist locally. I ask the Minister: what is the strategy to ensure that young people in semi-rural areas can access the full range of educational opportunities, regardless of where they live? Where is the investment in transport links, digital infrastructure and sustainable funding settlements for small schools? When it comes to education, geography should never be destiny. We believe that every child, whether they have grown up in a city suburb, in a coastal town or in a rural village, should have access to a high-quality education that allows them to thrive. Despite our policy differences, I know that the Minister shares that aspiration. This has been an extremely valuable debate, and I repeat my thanks to the hon. Member for Hertford and Stortford for securing it. I will speak no longer, because we all want to hear from the Minister.

• 7 May 2025 · Automotive Manufacturing: Employment · Hansard source

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  I agree with the hon. Member on the importance of supporting businesses. We must make sure that we remove obstacles and barriers that hinder growth. I hope that conversation starts today and that we can get to a better place where we support our amazing automotive industry, which delivers so much for this country, including Northern Ireland. Energy costs must come down. The industry cannot manufacture at a competitive cost with energy costs being so high compared with what other countries pay. We must not shoot ourselves in the foot with a net zero obsession. We must make sensible decisions on the energy mix to ensure energy security and value for money so that our manufacturing industry can compete on the global stage. That means investing in nuclear and not making the mistake of thinking that solar and wind are a silver bullet. I urge the Minister to share her views on how she intends to reduce energy costs for manufacturing industries in the short to long term so that they are better able to compete. I recognise that some of this goes across many briefs, so I appreciate that this is not something over which she has full control. Another important challenge is ensuring that we have a skilled workforce. Research by the Institute of the Motor Industry suggests that around 107,000 additional technicians will be needed by 2030. That is an amazing opportunity for this country. The more the industry grows, the more jobs and opportunity there will be, but we must ensure that we have people here with the skills to take up the jobs to ensure the industry’s success. That is why it is so important to support apprenticeships, which are a great way for young people to gain the skills they need while working. A survey from the Society of Motor Manufacturers and Traders in February 2025 found that the UK automotive sector will increase apprenticeship numbers by 16% in 2025, with opportunities spanning manufacturing, supply chain logistics and vehicle maintenance. The most in-demand roles are design and development engineers, EV technicians and specialists in batteries and power electronics. That equates to over 700 new apprenticeships available among UK automakers. I want to take this opportunity to mention East Surrey college in my constituency, which offers full-time and part-time qualifications in vehicle technology, maintenance and electric/hybrid vehicles. I recently visited and was impressed by the expert teachers, the well-equipped workshops with industry standard equipment, and the very talented and engaged students. We must ensure that we provide the right courses so that people with the right skills will be available to fill job opportunities in the industry. East Surrey college is certainly playing its part. I ask the Minister to clarify what the impact of abolishing level 7 apprenticeships will be on the automotive industry and how she plans to mitigate any detriment. Additionally, I urge her to consider how the new Government’s Employment Rights Bill will impact on the automotive industry. In February 2025, a Motor Ombudsman survey found that 58% of businesses reported difficulty in recruiting qualified technicians to meet growing workload, and that those difficulties would be made worse by the Employment Rights Bill, which is causing businesses to re-evaluate their hiring strategies. It is vital that the UK remains competitive and that the industry is not further burdened when it already faces so many challenges. It is clear that the rise in employer national insurance contributions is putting additional pressure on the automotive industry, with a cost of £200 million. The increased cost of doing business in the UK will reduce inward investment, economic growth and ultimately jobs. The Institute of the Motor Industry stated: “These changes are likely to have a significant impact on costs for small businesses that operate in the automotive sector, which is already facing a skills gap of 20,000+ vacancies.” It went on to say that the additional costs will “dampen investment in training and continuous professional development”. If the Government are really committed to boosting job opportunities and growth in the automotive sector, they need to reflect on some of their recent policies. Just saying that growth is a priority does not make it so. They need policies that do not put obstacles in the way. Lastly, I want to raise the challenge of taxation. In the interests of time I will not speak in detail, but the automotive industry has raised concerns about recent announcements on proposals to ban employee car ownership schemes and changes to capital allowances and benefit-in-kind treatment for double-cab pick-up vehicles. The SMMT is concerned that those changes will “undermine the market, hit profitability and viability and have serious consequences for UK tax returns, automotive OEMs and their employees, and sole trader/small business operations.” Will the Minister confirm whether there are any plans to remove or adjust the vehicle excise duty expensive car supplement? That is enough from me for now. I will bring my comments to a close so that anyone else who wishes to contribute has the time to do so. I thank all hon. Members for attending the debate and showing their support for the automotive industry.

• 7 May 2025 · Automotive Manufacturing: Employment · Hansard source

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  I beg to move, That this House has considered Government support for employment in the automotive manufacturing sector. It is a pleasure to serve under your chairmanship, Sir John. The automotive industry is an important part of the UK economy, contributing £93 billion in turnover and £22 billion in value added. It invests around £4 billion each year in research and development and employs around 0.8 million people across the wider industry. Many of these are high-skilled, high-paid jobs, of which a considerable proportion are outside London and the south-east, but I am pleased to say that some of these high-value jobs are in the south-east, in places like my constituency of Reigate. In Burgh Heath, just down the road from Epsom, we find the UK headquarters of Toyota. It is not only one of the biggest employers in the local area; it is also an eco-HQ. In a project that started in 2014, Toyota partnered with Kew royal botanic gardens and the Surrey Wildlife Trust to create a landscaped oasis full of native species from the surrounding countryside, complete with an orchard and meadow. It is wonderful to see a business taking the time and energy to ensure its HQ fits into our special corner of Surrey. And it does not stop there. Outside the site, Toyota has supported many local initiatives, from providing rooms for community meetings to providing buses for local groups and charities. In 2024, more than £40,000 in grants were given to support the work of local groups, including, to name just a few: the Brigitte Trust; Home-Start Epsom, Ewell and Banstead; St Catherine’s hospice; and Warren Mead school parents and friends association. Before I talk more broadly about the automotive industry, I want to take the opportunity to thank Toyota GB for its significant contribution to the Banstead, Burgh Heath and Epsom area. The automotive industry is important to this country and our economy, and it is vital that it is not smothered by over-regulation, over-taxation and green initiatives. Only by creating an environment that is conducive to growth will we see the creation of more high-quality jobs. UK car and commercial vehicle production saw a significant decline of 11.6% in February 2025. Worryingly, that marks the 12th consecutive month of declining car production. This must be an important wake-up call. More must be done to protect the automotive industry we already have, to help it grow and to encourage inward investment in new plants and new technologies. It can only continue to create new jobs and innovative technologies with growth-supporting policies. The automotive industry accounts for over 12% of total UK goods exports, generating £115 billion of trade in total automotive imports and exports. Eight out of 10 cars produced in the UK are exported overseas to 140 different countries, but automotive manufacturers now face additional US tariff costs of around £1.9 billion, which will have a significant and detrimental impact on the industry. The USA is the UK’s second largest car export market after the EU, with exports of over 101,000 units in 2024. These tariffs have material implications for competitiveness, investment and export potential, and it is vital that the Government’s policymaking reflects this new protectionist and uncertain environment. With this massive setback to the industry, it is now even more important that we get things right domestically, to create an environment that stimulates growth for this important industry. I want to raise some of the biggest challenges here in the UK, and I ask the Minister to confirm her plans to address them. In simple terms, for an industry to thrive, it needs to be able to manufacture products at competitive cost, employ people with the skills it needs, have free access to a market for its products without barriers or restrictions, and not be taxed to high heaven, so that it can reinvest in innovation and growth. A good product will always do well. If it is something someone needs, if it provides value for money and if it makes their life easier, they will buy it—it really is that straightforward—so let us talk about the zero emission vehicle mandate challenge first. The ZEV mandate sets out the proportion of new zero emission cars and vans that manufacturers are required to produce each year up to 2030: 80% of new cars and 70% of new vans sold in Great Britain must be electric vehicles by 2030, increasing to 100% by 2035. Part of the reason for introducing this policy was to provide investment certainty for the charging sector to expand the network, given that lack of charging points is one of the things that puts consumers off buying an electric car. There can be no doubt that it is a well-intentioned policy, but as the old saying goes, the road to hell is paved with good intentions. Notably, the moving of goalposts by Governments of various colours in recent years has been deeply unhelpful. The previous Government made the decision to delay the ban on new diesel and petrol cars by five years, from 2030 to 2035, whereas the new Government have reversed that. Putting aside the question of which position is the correct one, such chopping and changing is not fair on the automotive industry, which needs certainty and consistency so that it can deliver what is expected of it while still growing its businesses. I do, however, recognise the Government’s recent announcement about increasing the flexibility of the ZEV mandate, which is welcomed by the industry and shows that the Government are listening. In particular, I welcome the reduction in fines for missing targets and the allowance for all forms of hybrid cars until 2035. However, I would suggest that the whole approach in this area needs to be reconsidered as a priority. Tinkering is not enough. The ZEV mandate targets are incredibly challenging for businesses to meet. It makes no sense to expect businesses to dictate what products their customers should buy, when we all know that consumer preference and need should drive the products that a business sells, and rightly so. In 2025, ZEV sales will need to increase by 43% for cars and 171% for vans for automotive businesses to achieve the mandate targets. That is not achievable, and a fine of £12,000 per vehicle is levied on those businesses for every missed EV sale. The automotive industry cannot win on this one. Consumers are not ready to buy EVs yet, because of the lack of charging infrastructure, the battery range issues and the cost, but the automotive businesses will be held responsible and expected to pay the price. If we continue in that way, we will see contraction of the industry, plant closures and job losses, all in the name of net zero. That has already started, with Vauxhall owner Stellantis announcing plans to close a van factory in Luton that employs around 1,100 people. The industry has already invested billions in bringing more than 130 ZEV models to market. Despite spending some £4.5 billion in market support for EVs in 2024, it still missed last year’s target by some way. Such a level of support from industry is unsustainable and is diverting resources away from investment in new technology, models, plants, and research and development. I urge the Government to take responsibility for their role in delivering charging infrastructure and lowering energy costs, rather than beating businesses over the head for their own failings. I also urge the Minister to review the mandate targets as soon as possible and to consider other, more effective ways of driving growth in EV take-up. It would make much more sense to incentivise consumers, rather than penalising businesses. The ZEV mandate targets cannot magically drive demand out of thin air. What we need is more carrot and less stick. Has the Minister considered such alternative options as reducing the VAT on EV sales and public charging, or offering plug-in grants for cars? Those could be straightforward and effective ways of boosting consumer demand. If the Government are wedded to the current draconian ZEV mandate approach, the fair thing would be for them to commit to delivering public charging infrastructure on equivalent targets. For example, in 2025 the target is for 28% of new car sales to be electric, so the Government must ensure there are sufficient public charging points across the UK to serve those new EVs by the end of 2025. If the Government fail to do that, the shortfall should be offset against the fines levied on the automotive industry, reducing what it has to pay. Surely that is fairer. The Government need to play their role and must also be held to account when they do not deliver. Before moving on, I want to touch on domestic energy prices, which apply to all manufacturing industries, not just automotive.

• 6 May 2025 · Dedicated Schools Grant · Hansard source

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  It is a pleasure to serve under your chairmanship, Ms Butler. I draw attention to my entry in the Register of Members’ Financial Interests. I am pleased to respond to this important and thoughtful debate on behalf of the Opposition. I thank the hon. Member for Tewkesbury (Cameron Thomas) for securing it, and I completely agree with his remarks about the importance of teaching children in the home as well as the school. It is clear from all the contributions we have heard that, across all political divides, we share a desire to see all children, regardless of their location, their background or the complexity of their needs, accessing high-quality education in a setting that supports their potential. That vision depends heavily on fair and sufficient funding for our schools. As we have heard, the dedicated schools grant is at the heart of that. It would be appropriate, before turning to the concerns raised today, for me to briefly review the last Government’s principal achievements in this space, all of which have a bearing on any debate on the dedicated schools grant. Hon. Members will recall that it was a Conservative Government that took the step of reforming school funding through the introduction of the national funding formula, thereby ending the postcode lottery that, for too long, left similar schools receiving vastly different allocations. The national funding formula delivered greater transparency and a demonstrably fairer methodology, and drew a clearer line between the needs of pupils and the funding schools received. However, as the hon. Member for Tewkesbury set out, there are clearly still some disparities. It is right that we look at those and consider what can be done to address them. I look forward to hearing the Minister’s view on that. It was also a Conservative Government that increased core schools funding to record levels. Between 2010 and 2023, funding per pupil rose in real terms, with particular investment in the high needs block of the dedicated schools grant. In fact, by the final year of the previous Government, we had delivered a £10 billion increase in overall schools funding compared with 2019-20, including a £4 billion increase to the high needs budget, bringing total high needs funding to £10.5 billion in 2023-24. We backed that up with targeted support for pupils with SEND through capital investment focused on expanding special school places and improving facilities across the country. It was the Conservative party that took decisive action to address poor-quality provision, cracking down on unregistered settings and increasing the powers of local authorities and Ofsted to take action where provision fell short. Our approach was unambiguously vindicated, as England soared up the Programme for International Student Assessment league tables between 2009 and 2022 in maths, English and science. In that period, England went from 21st to seventh for maths, from 19th to ninth for reading, and from 11th to ninth for science. Moreover, in December 2023, children in England were named best in the west for reading, and in December 2024 they were ranked the best at maths in the western world in the 2023 TIMSS—trends in international mathematics and science study. Regrettably, where England has surged in international education rankings, Labour-led Wales has slumped. While England went from 21st to seventh in maths, Wales went from 29th to 27th. While England went from 19th to ninth for reading, Wales stayed 28th. While England went from 11th to ninth for science, Wales slumped from 21st to 29th. Ultimately, whether in England or Wales, there will always be more to do, as the hon. Member for Tewkesbury highlighted, but I can say without hesitation that the legacy left by the last Government on school funding and educational outcomes is overwhelmingly positive, based on a relentless focus on sustained investment and principled reform, and a clear commitment to inclusion. It is not just our record; it is the yardstick by which the current Government must be judged. Our position today is consistent with that record: we support fair funding, we support the principles behind the dedicated schools grant and we believe in the importance of local flexibility and accountability. We support the overarching aims of the SEND and alternative provision improvement plan, and the continuation of investment to support the transition to new national standards, but we also recognise the real pressures that local authorities and schools are facing. While funding has increased, so too has demand, and the current system is struggling to keep up. The number of pupils with an education, health and care plan has more than doubled in the last decade. Local authorities up and down the country—Conservative, Labour and Liberal Democrat alike—are grappling with high needs deficits, a growing wave of legal challenges and spiralling parental frustration. In my constituency, SEND makes up an ever-growing proportion of casework, and I hear every week from parents struggling to secure the provision that their child so desperately needs. It is little wonder that the Public Accounts Committee recently found that the current system risks creating a “lost generation” of children without intervention from central Government. The National Audit Office was equally blunt in its 2024 report on SEND provision, which made it clear that, without systemic reform, there will be systemic collapse. The crux of the matter is that, as of January 2024, approximately 1.9 million children and young people in England were identified has having special educational needs, with 1.7 million attending school. Despite the 58% real-terms increase over the last decade in high needs funding, which reached £10.7 billion in 2024-25, the system is not delivering improved outcomes for those children and young people. The financial strain that is placing local authorities under is deeply alarming. The NAO estimates that, by March 2026, 43% of local authorities will have deficits exceeding or close to their reserves, leading to a cumulative deficit between £4.3 billion and £4.9 billion. The situation is exacerbated by the impending end of accounting arrangements that currently prevent those deficits from impacting local authority reserves. Without a clear plan to manage the deficits, many councils risk issuing section 114 notices, effectively declaring bankruptcy. Demand for education, health and care plans has surged by 140% since 2015: the number of children with one reached 576,000 in 2024. That increase, coupled with long waiting times—only 50% of EHCPs were issued within the statutory 20-week target in 2023—has eroded confidence among families and children in the system’s ability to meet statutory and quality expectations. Sadly, at the very moment that clarity and support were most needed, the Education Secretary introduced the Children’s Wellbeing and Schools Bill, which would do nothing less than destroy standards in English schools. No less serious are the broken promises on compensation for national insurance contributions, which have left schools in an impossible funding situation. It is reported that some schools face funding gaps of up to 35% for those additional NIC costs. That shortfall will only exacerbate existing financial pressures, forcing schools to divert funds from essential services, potentially leading to the loss of valued staff, reduced capacity to accommodate pupils with special needs and a generally lower standard of education provision. In summary, we are at a point where the Government are asking councils to maintain high-quality provision even as they manage large accumulated deficits, some exceeding £100 million, without knowing how or when those will be resolved. Schools have been asked to go further and faster on inclusion without the confidence that adequate support services will be in place to back them up. At the same time, parents are being asked to trust a system that all too often feels both overwhelming and overwhelmed. I want to put a number of questions to the Minister that reflect the concerns raised by Members, local authorities and professionals across the education sector. First, the Government have confirmed that they will continue funding local authorities through the dedicated schools grant for the foreseeable future, but what is the long-term plan for managing the high needs deficits that many councils have accrued? The safety valve programme and the delivering better value programme provide some support, but they are not available to every authority and they do not provide a long-term solution. Will the Minister confirm whether the dedicated schools grant will remain ringfenced beyond 2025? Will she guarantee that local authorities will not be forced to divert core council budgets to prop up SEND provision at the expense of other vital services? Secondly, on transparency and accountability, colleagues have spoken of the challenges that their local schools face in not just securing adequate funding but navigating a system that is complex, fragmented and adversarial. Parents are turning to tribunals in record numbers, while local authorities are caught between an ever-growing web of statutory duties and finite budgets with which to deliver them. What steps are the Government taking to reduce the number of SEND tribunals, and what support will be offered to schools to manage rising demand? Finally, I want to address the issue of place planning and capacity. One of the most frequent complaints we hear from local authorities is about the mismatch between need and availability, particularly in relation to specialist settings. This is not just about funding; it is about the ability to plan, build and adapt provision to changing demographics and trends. Will the Minister set out what work is being done to support local authorities in expanding specialist provision where it is most needed? How will the Department ensure that capital investment keeps pace with rising demand? What role does she see for the dedicated schools grant in ensuring that sufficient places are available for all? I will end my long list of questions by thanking the hon. Member for Tewkesbury for securing today’s debate. The dedicated schools grant is a critical part of how we deliver education in this country, but if it is to work as intended, particularly in relation to SEND, it must be fair, transparent and sustainable. I look forward to hearing from the Minister how the Government will make it so.

• 30 Apr 2025 · Gender Incongruence: Puberty Suppressing Hormones · Hansard source

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  I beg to move, That this House has considered the potential impact of puberty suppressing hormones on children and young people with gender incongruence. It is a pleasure to serve under your chairmanship, Ms Lewell. I am pleased to have the opportunity to shine a light on this important topic, one that impacts the health and wellbeing of some of the most vulnerable children in our country. This debate must be led by science, data and evidence, not by ideology, bias or belief. I will do my best to do that today. The number of children and young people presenting to the UK NHS with gender distress has increased year on year since 2009, with an exponential rise in 2014. What is behind the increase among Generation Z is unclear and the reasons are likely to be multifaceted. It is speculated that the factors may include 24/7 internet access, increased acceptance of trans identities, or even peer, social and cultural influences. Over the last 20 years we have seen groups such as Stonewall and Mermaids call for better access to treatment and increased rights for trans people. Large corporates have gone big on diversity and inclusion to boost their brands, impactful TV dramas centring trans stories, such as “Butterfly”, have been widely viewed, and the public sector, from the NHS to the police, has been flying the progress flag at every opportunity. So it can be no surprise that gender identity is at the front of young people’s minds in a way that it simply was not when I was growing up. In 2009, only 51 patients were referred to GIDS—the NHS gender identity development service for children—of whom two thirds were male. In 2016, there were 1,766 referrals and two thirds of them were female. That is quite the change. There has been an overall surge in the number of children suffering gender distress, but the increase is especially notable among girls; we also see over-representation of neurodiversity, mental health issues and trauma in this group. To put it another way, these children are much more likely to have been in care, to suffer with anxiety and depression, to be autistic and to have been abused. It is a group of incredibly vulnerable children. GIDS was established in 1989. Its main approach to treatment at that time was therapeutic—referred to as watchful waiting. Early studies from the 1980s showed that in around 85% of cases, the gender incongruence or distress ceased in the child after going through puberty. Later studies reached a similar conclusion, with between 67% and 90% desisting after puberty. Only a small cohort of children continued to experience gender dysphoria or incongruence after puberty, and it was that small group who would likely adopt a permanent trans identity in adulthood. Everything changed with the emergence of the Dutch protocol, which involved the use of puberty blockers from early puberty. Puberty blockers are gonadotropin-releasing hormone analogues, which supress oestrogen production in girls and testosterone in boys. They are licensed for use in children with precocious puberty—when puberty starts much too early and it is beneficial to suppress it until a more normal developmental time and age—but in the case of gender dysphoria they are used to delay or even indefinitely stop natural pubertal development and maturation, and it is important to note that puberty blockers are not licensed for that purpose. The original rationale for using puberty blockers to treat gender dysphoria was to press pause on puberty and give children time to think, but for some the aim was also to increase the chances of a child passing as a member of the opposite sex in adulthood. GIDS started trialling puberty blockers in the UK after 2011. The preliminary results in 2015-16 did not demonstrate psychological benefits, with some of the females suffering a worsening of symptoms, including higher incidence of wanting to hurt or kill themselves. The results of the study, which were not formally published until 2020, demonstrated no statistically significant improvement in gender dysphoria or mental health outcomes. It is also important to remember the early studies that told us that in the majority of cases, going through puberty could relieve gender distress. It follows, therefore, that stopping or delaying puberty using medication could derail that natural desistence, essentially locking in or prolonging the gender distress, rather than allowing it to naturally resolve. One would think that, in the absence of any evidence of benefit from puberty blockers, the NHS would have stepped back from using them after the trial. Furthermore, the high numbers of autistic, traumatised, mentally unwell and same-sex attracted youth in the group of children referred should have rung alarm bells loudly, but no; instead, puberty blockers and cross-sex hormones were routinely made available to an even broader group of children, including those with neurodiversity and complex mental health presentations. An independent systematic review of published studies on puberty blockers, of which there were 50, was undertaken by the University of York as part of the Cass review. It was found that puberty blockers do indeed suppress puberty effectively. It was also found that, given that most children progress on to cross-sex hormones after starting puberty blockers, the main objective of pausing development is not achieved. No reduction in gender dysphoria or improvement in body satisfaction was demonstrated, and there was limited evidence of positive mental health outcomes. Worryingly, bone density in those taking puberty blockers was compromised, and height gain may lag behind normal. In the case of biological males, it can make vaginoplasty more difficult in future, due to insufficient penile growth, forcing the use of gut tissue instead. The Cass review reports: “There seems to be a very narrow indication for the use of puberty blockers in birth-registered males…in order to stop irreversible pubertal changes. Other indications remain unproven at this time.” I take that to mean that those drugs have been given to young girls, not because they benefit them specifically, but because they might benefit a very small group of males. Professor David Bell, a retired consultant psychiatrist at the Tavistock, and Dr Sinead Helyar, a clinical trial nurse, also warned of the potential harms in a recent article. “Current known and potential harms of puberty blockers are multi-fold and include a reduced bone density and early-onset osteoporosis, brain swelling and concerns around impairment of future sexual functioning and ability to form emotional relationships. A recent review of the impact of suppressing puberty on neurological function highlighted that adolescence is a critical window of neurodevelopment and puberty plays a critical role in this process. The author concluded that suppression of puberty impacts brain structure and the development of social and cognitive functions, in which the effects are complex and often sex specific.” The over-representation of same-sex attracted girls and boys in the group of children being treated with puberty blockers is particularly worrying. In a study in the Netherlands of 70 patients given puberty blockers between 2000 and 2008, 89% were same-sex attracted, and most of the rest were bisexual. The same pattern was seen in most of the other trials, with the majority of the children growing up to be same-sex attracted adults. A paper from GIDS in 2016 reported 89% of the biological girls being either same-sex attracted or bisexual. Why would same-sex attraction be over-represented in that way? Could gender distress be symptomatic in some cases of struggling with sexuality? Is sufficient emphasis put on reassuring those young adolescents about their sexuality, to establish if the gender distress is linked or separate; or is our society’s hyperfocus on gender identity and gender conformity putting them on an unnecessary medical pathway to change their body? Keira Bell, who has now detransitioned, says, “I became attracted to girls. I had never had a positive association with the term ‘lesbian’ or the idea that two girls could be in a relationship. This made me wonder if there was something inherently wrong with me. Around this time, out of the blue, my mother asked if I wanted to be a boy, something that had not even crossed my mind.” The Cass review received several reports from parents of biological females that their child had been through a period of trans identification before recognising that they were, in fact, a lesbian. That begs the question: why are so many young lesbians being medically transitioned? Before I move on to my questions to the Minister, it is important to note that almost all the children and young people who take puberty blockers go on to take cross-sex hormones. I raise that because it links the two treatments. The impact of puberty blockers cannot be looked at in isolation, because cross-sex hormones may lead to further surgeries, lifelong medication, and loss of fertility and sexual function. These are catastrophic impacts. How can a prepubescent child really understand what never experiencing an orgasm means and the impact that could have on their future relationships, or indeed what losing the opportunity to have children could mean? It is very apparent that the lack of solid long-term data on outcomes for patients who are treated with puberty blockers is problematic. No doctor should prescribe something in the absence of strong evidence of its effectiveness and a clear understanding of the side effects. In May 2024, the previous Government temporarily banned the use of puberty blockers for the treatment of gender incongruence and gender dysphoria in under-18s, following the Cass review’s findings of insufficient evidence to show they were safe and effective, and this ban was made permanent by the current Secretary of State for Health and Social Care in December 2024. In the light of everything that I have set out today, I fully support that decision: it is sensible, has full regard to the data, and puts the safety and wellbeing of children first. It is also important to note campaigners’ claim that suicides among young patients with gender dysphoria increased due to puberty blocking drugs previously being restricted, following the High Court decision in the Bell v. Tavistock case, has been disproved by Professor Louis Appleby’s investigation and report, published on 19 July 2024, in which he confirmed that the data did not support such assertions. He concludes that: “The way that this issue has been discussed on social media has been insensitive, distressing and dangerous, and goes against guidance on safe reporting of suicide. One risk is that young people and their families will be terrified by predictions of suicide as inevitable without puberty blockers.” At the same time that the Secretary of State announced the permanent ban on puberty blockers, he announced that a clinical trial would be set up in 2025 to examine the use of puberty blockers, in order to establish a clear evidence base for the use of this medicine in gender incongruence. The £10.7 million trial, called Pathways, will be carried out by a team at King’s College and is due to run until 2031. Over two years, it will track: “the physical, social and emotional wellbeing” of young people who want to delay puberty, and whose parents and the gender service agree with this treatment option. I will be grateful to the Minister for an update on the trial and how she intends to ensure that children are not physically or psychologically harmed. A trial of this nature of a drug that is unlicensed for gender incongruence raises many ethical concerns. In the words of Professor David Bell and Dr Sinead Helyar: “The first duty of any clinician inside or outside of a clinical trial is to ‘do no harm.’” Can there ever be a situation where it is ethical to run such a trial when the harms could be significant? It is important to remember that the children who would participate in this trial are physically healthy children who stand to have worse health by the end of it. This trial is in no way similar to a clinical trial for a cancer drug, where the patient is seriously unwell at the beginning of the trial. Secondly, approximately 9,000 children and young people were treated by GIDS over the years, which provides a plentiful supply of data about the long-term outcomes for those who took puberty blockers and those who did not. Would the Minister please clarify matters and explain why a new trial is needed, given this abundance of data? Will she please provide an update on the exercise that is currently under way to obtain more data? Thirdly, the current trial only proposes to look at outcomes over a two-year period. To put that into context, a child who starts puberty blockers at the age of 13 will only have their outcomes followed and assessed until the age of 15. That is not long enough to understand medium and long-term outcomes. A positive result for a 15-year-old might look very different for a 25-year-old, when physical health, sexual function and fertility are likely to be more important and relevant to them than when they were 15. Does the Minister agree that two years is not a sufficient timeframe to properly evaluate the impact of puberty blockers on physical and mental health? If this trial goes ahead, will she commit to funding and ensuring that there is long-term follow-up of these children into adulthood? Fourthly, how many children will the trial be limited to, and what criteria will be used to determine which children are eligible and which are not? Is it possible that all eligible children will be included and prescribed puberty blockers as part of the trial? How many children in total does the Minister expect to take part in the trial over its duration? How will the trial establish an appropriate control group? Fifthly, given that gender nonconformity sometimes correlates with same-sex attraction in adulthood, how will the trial safeguard those children who may simply be uncomfortable with their sexuality rather than experiencing true gender distress? Sixthly, given the high rates of progression to cross-sex hormones following puberty blockers, will only children who agree not to progress to cross-sex hormones be accepted on to the trial, so that the impact of the puberty blockers on outcomes can be seen in isolation? If the answer is no, given the corresponding likelihood of impaired sexual function and loss of fertility, which are monumental ramifications, how will the children taking part in the trial be able to give consent? Finally, will the Minister please provide details of other trials that have been approved for paediatric medical interventions with equivalent or similar diagnostic uncertainty, to reassure the public that moving forward with a trial in this situation has precedent? I look forward to hearing the Minister’s answers and thank everyone for attending this debate.

• 23 Apr 2025 · Hospitals · Hansard source

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  I am grateful for the chance to speak in today’s debate and to be able to give voice to so many of my constituents’ frustrations about how their right to access quality healthcare has been deprioritised by this Labour Government. Many of my constituents, especially those in the north of my constituency, are served by the Epsom and St Helier university hospitals NHS trust. To be blunt, the situation at the trust today is simply not sustainable—clinically, financially or structurally. The trust currently operates two acute hospitals, in Epsom and St Helier, with duplicate services spread across both sites. The arrangement, while a product of historical necessity, today places considerable pressure on clinical teams. Allocation of staff members between sites is challenging and service delivery is stretched. No matter how committed the staff—their dedication is beyond question—they are constantly being asked to do more with less, in buildings that are often quite literally falling apart around them. To give just one brief example, earlier this year St Helier was forced to cancel scheduled blood tests because of widespread flooding in the phlebotomy section. We simply cannot go on like this. Indeed, time is not a luxury we have, with the estate now deteriorating faster than it can be fixed. The trust is spending millions every year simply to keep the most urgent problems at bay: patching leaks, coping with flooding, and addressing the worst outbreaks of damp and mould. I think we all agree that these are not the conditions in which 21st-century healthcare should be delivered. That is why it was so disappointing to learn earlier this year that the planned specialist emergency care hospital in Sutton—a long-standing scheme under the new hospital programme that was carefully conceived to address the very issues I have mentioned—has been delayed to the point that work will now not even begin until 2030 to 2035, with opening coming in 2037 at the earliest. The new hospital will consolidate emergency care into one state-of-the-art facility, delivering world-class treatment, faster access to care, and safer outcomes. At the same time, it will allow for major investment at Epsom and St Helier hospitals, helping to modernise crumbling buildings, improve planned care pathways and ensure that most services remain close to home. Under the trust’s plans, 85% of services would remain on the Epsom and St Helier sites, including out-patient care and diagnostic appointments. Local people would continue to receive the vast majority of their care where they always have done, but would benefit from shorter waiting times and access to better facilities, particularly for surgery. I passionately believe that the new hospital at Sutton is a once- in-a-generation chance to overhaul healthcare provision and ensure that my constituents receive the high-quality care they deserve in a timely fashion.

• 3 Apr 2025 · Access to Sport: PE in Schools · Hansard source

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  I am grateful for the opportunity to respond to today’s important debate on access to sport and physical education in schools. I thank the hon. Member for Stafford (Leigh Ingham) for securing this debate, and all hon. Members here for speaking about this vital issue, which cuts across our approach to education, health, mental wellbeing and social mobility. At its heart, physical education is about giving every child, regardless of background, the chance to lead a healthy, active life, while learning important life skills such as teamwork, resilience, perseverance and respect for others. Sport is about so much more than just being healthy. It creates opportunity and can transform lives. Indeed, many of our country’s most famous sporting heroes began their athletic journey while still at school. Olympic champion Dame Jessica Ennis-Hill wrote about the positive impact that sport had on her: “Playing sport as a child helped me enormously. I met lots of different people, both teammates and competitors and faced new challenges. The camaraderie and support that you get from sport massively helped build my confidence and my ability to overcome setbacks and defeats both on and off the track.” It is precisely because sport has the power to do so much good that Conservative Members worked so hard to make real, measurable progress on improving access to sport and PE in our schools when we were in government. Let me start with what we did. The last Conservative Government took a clear stand in favour of equal access to sport for all children, girls and boys alike. In March 2024, the Department for Education published new guidance for schools, making it clear that boys and girls must be offered the same sports, both during curriculum PE and in extra-curricular activities. For too long, some pupils have missed out because of outdated or inflexible provision, and that is no longer acceptable. Our new standards ensure that opportunity in school sport is not determined by sex; it is driven by fairness, aspiration, and choice. That guidance followed the success of the Football Association’s #LetGirlsPlay campaign, which aimed to change perceptions and ensure that girls got the chance to play football as part of the school curriculum, as well as at break time, after school, and at local clubs. It has proved very successful; much larger numbers of girls are playing football, inspired by our amazing Lionesses, following their success at the Euro 2022 tournament. But that is not all we did. Our 2023 school sport and activity action plan set out the clear expectation that schools would provide a minimum of two hours of PE per week. We took that step because we know that exercise is not a luxury or an optional extra. It is fundamental to children’s physical health, mental wellbeing, and ability to focus and succeed in the classroom. In addition to considering what happens during school hours, we took decisive action to boost participation across the country. In August 2023, we launched our Get Active strategy, which provided for a new national taskforce, including Government officials, education experts and former sports professionals. The taskforce was given the bold mission of getting 2.5 million more adults and 1 million more children physically active by 2030. Those serious ambitions were backed by serious actions, and they reflected a long-term strategic commitment from the last Conservative Government to increasing participation, promoting inclusion, and tackling the root causes of inactivity. I do not pretend for one moment that the job is done. There is more to do, but I am proud of our record in this field. However, I regret to say that there has been fallout from this Government’s Budget. We are seeing evidence that the decision to end business rates relief for independent schools is having damaging consequences. Some such schools now question whether they can continue to operate community sports facilities, including school playing fields. Lest we forget, those facilities are used not just by the schools, but by local primary schools, community groups, youth sports teams and families. I see the benefits of that on my doorstep. Many children in my constituency attending local primary schools are learning to swim and getting the benefit of other sports facilities at their local independent school. If this policy ends up forcing the sale or closure of those facilities, it will only have succeeded in reducing access to sports for the very communities who most need it. I am disappointed that the Government have chosen to scrap the opening school facilities fund, a programme designed to keep school sports halls and playing fields open over the holidays and outside school hours. That fund enabled schools to support healthy, active lifestyles all year round, not just during term time. In addition, will the Minister end the uncertainty and finally confirm the Government’s plans for the School Games network, which is set to end this year? The network supports 2.2 million participation opportunities for children and is hugely valuable. Will she confirm that that has not been scrapped as well? I want to take a moment to recognise the importance of access to sport for disabled young people, as powerfully set out by the hon. Members for Beckenham and Penge (Liam Conlon) and for Thornbury and Yate (Claire Young). It is vital that barriers to inclusion are removed, so that disabled young people can benefit in the same way as all other children in school. I cannot speak about the importance of sport without touching on the subject of sex. The concerning trend of gender ideology threatens to undermine efforts to promote sport among young women and girls. Let me be clear: it is bodies that play sport, not feelings. In women and girls’ sports, participants must be separated by sex, not only for safety reasons but for fundamental fairness. Former Olympic swimmer Sharron Davies MBE has been warning about the negative impact of this issue on women’s sport for many years, and it is important that she and other advocates for women are listened to. I urge the Minister to ensure that, as soon as possible, we finalise and issue the draft guidance for schools and colleges on gender-questioning children, which was prepared under the last Conservative Government, and which makes it clear that sports participants should be split by sex. Until we act to address the rise in environments where young female athletes feel unsafe or simply cannot ever win, how can we feign surprise when girls are less inclined to participate in sports? The Conservatives believe that access to sport and PE is a fundamental part of good education for boys and girls. We believe that children should be given the tools to live healthy, active lives, and that sport builds confidence, resilience and teamworking skills, not just health and fitness. Those are beliefs that we put into practice in Government, through new equality standards, mandated PE entitlement and a joined-up national strategy, and by allocating funds to widen access to facilities. That is how we build a healthier, fairer and more active future for every child in this country. I look forward to hearing from the Minister about how the Government will seek to ensure access to sport, and to her responses to all the excellent questions asked by Members, including mine.

• 2 Apr 2025 · Universities: Funding and Employment · Hansard source

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  I will in a moment. Such a reform could begin by addressing the unacceptable lack of transparency around the student loan system. The public have a right to know how the system is operating, who is borrowing, who is repaying, and where there may be a risk of fraud or misuse. I understand that a paper on this very subject, compiled by the IFS and commissioned by the last Government, remains unpublished, despite efforts to obtain it via freedom of information requests. I hope the Minister will explain why that is the case, and will understand that transparency builds trust, while withholding data only fuels suspicion. On a related theme, questions have rightly been asked about the eligibility criteria for student loans, particularly for non-UK nationals and EU citizens with settled status. It is surprising to many that, even several years after Brexit, more than 180,000 individuals were granted settled status in the first six months under this Government. That figure deserves scrutiny, and it is legitimate to query the implications for access to taxpayer-funded support for accessing higher education. It has been widely reported that the Student Loans Company is now accepting a mere certificate of application for settled status in order to approve loans. If that is the case, I urge Ministers to review that policy as a matter of urgency. We must ensure that eligibility checks are robust and that the system is not open to exploitation.

• 2 Apr 2025 · Universities: Funding and Employment · Hansard source

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  It is a pleasure to serve under your chairmanship, Mr Vickers. I thank the hon. Member for Bedford (Mohammad Yasin) for securing this important debate, which could not be more timely, and I am grateful to all colleagues who have contributed. Our universities are among the most important institutions in our national life. They are centres of research, innovation and learning, and for many thousands of young people every year, they are the route to opportunity, economic independence and personal growth. Despite its great importance, the higher education sector has come under increasing pressure in recent years. The latest modelling from the Office for Students suggests that nearly three quarters of English higher education providers could be in deficit by 2025-26, and 40% would have fewer than 30 days’ liquidity. Indeed, as we have heard from many Members today, redundancy programmes are already under way in some institutions and, across the country, university staff are understandably anxious about the future. I will say at the outset that I am deeply sympathetic to those who work in institutions that have found themselves in financial difficulty. Nevertheless, I believe it is past time for us to have a grown-up conversation about university finances, in which we look seriously at what is driving the pressures and what it might be possible to do to alleviate them. I will begin by stating the obvious: decisions taken in recent years have increased the financial pressure on students and graduates, without necessarily addressing the deeper questions of value and sustainability. We have seen steady rises in student loan interest rates and tuition fees, which both fall heavily on students, and now, the spike in employer national insurance contributions is putting further cost pressures on universities. Meanwhile, the Government’s proposals to cut funding for level 7 apprenticeships, which are essential qualifications in a number of fields, including education, health and engineering, risk further undermining key parts of the post-18 education ecosystem. Many university departments rely on that funding not just to sustain course provision, but to attract and retain highly qualified staff. The impact of the cuts will not be evenly spread, and it is right that we consider how they will affect institutions already under financial pressure.

• 2 Apr 2025 · Universities: Funding and Employment · Hansard source

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  I am going to continue because of the time. On the concerns about the quality of some higher education provision, the Government have said they are considering changes to the regulation of franchise providers, some of which have been implicated in cases of poor-quality provision and potential fraud. Although I welcome the consultation launched by the Department for Education, I caution that many of the largest franchise providers are already regulated by the Office for Students, so the key question is not simply whether they are regulated, but how well the regulatory framework is working and whether it is actually driving up standards. Finally, we have heard Ministers speak in recent months about “tweaking” the role of the Office for Students to strengthen its focus on value for money. In September, the Department said that it was “developing options for legislative change,” and the Secretary of State has since re-announced that commitment, but as far as I can tell no tangible progress has been made. When will we actually see legislation brought forward? We have also heard mention of the Public Sector Fraud Authority being brought in, but that sounds remarkably similar to the Internal Audit Agency investigation mentioned in last year’s National Audit Office report. What is changing, exactly? Are we simply hearing the same announcement robed in new language? I conclude by emphasising that the largest losses to the taxpayer do not always come from outright criminal fraud, and can come from legally operating institutions that provide poor value. These providers operate within the letter of the law, but not within its spirit. They enrol students on low-value courses with high drop-out rates and weak earnings potential, while drawing down large sums from the student loan system—sums that in many cases will never be repaid. We cannot continue like this. Our goal should be a higher education system that is sustainable, high quality and genuinely life-changing. I look forward to continuing this discussion in the months ahead.

• 2 Apr 2025 · Universities: Funding and Employment · Hansard source

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  I suggest to the hon. Member that we need to deal with the situation that we have now, and that her questions should be targeted towards the Minister. We should make the right decisions to do the right thing for our country, and for our students and university staff. We must confront an uncomfortable truth: there is mounting evidence, including from the Institute for Fiscal Studies, that a sizeable share of higher education courses simply do not provide good value for money either for the taxpayer or for the individual student. The IFS has concluded that around 30% of graduates, both men and women, would have been better off financially had they not gone to university at all. That raises important questions about how we can ensure that our higher education system delivers for those who fund it—namely, the students who invest years of their lives and take on significant debt, and the public whose taxes support the student loan system. The current funding model is failing under the enormous weight of rapid expansion, marketisation and insufficient quality controls. The ability of an institution to prop itself up on the backs of overseas students who pay vast fees is coming to an end. Although fee income from international students has grown by an average of 15% a year between 2017 and 2023, the recent international recruitment environment has been challenging. Recent Home Office data indicates that 393,125 visas were issued to main applicants in 2024. That is down 13.9% year on year and down 18.8% compared with two years ago. While some institutions have embraced innovation, strong outcomes and world-class research, others have pursued growth at all costs, adding courses with limited market value, often to attract overseas students or to maximise short-term income. We cannot and should not return to a time when university was accessible only to a wealthy minority, but we do need to have a serious conversation about the purpose of higher education, who it is for, and how it can be sustainably funded in a way that delivers for students, taxpayers and the wider economy. That means looking at systemic reform, rather than simply demanding that young people pay more without addressing the underlying issues. We need to examine course quality, graduate outcomes, student choice, and the role of further education and apprenticeships alongside traditional degrees.

• 1 Apr 2025 · Relationship Education in Schools · Hansard source

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  It is a pleasure to serve under your chairmanship, Sir Jeremy. I thank the hon. Member for Epsom and Ewell (Helen Maguire) for securing this important debate on relationship education in schools, as well as for touching on the harrowing stories of violence against women and girls in her constituency. Before I proceed further, I offer my heartfelt condolences to the families, friends, colleagues and pupils of those impacted. In the decade between 2008 to 2018, around three women a week were killed by men in the UK. Shockingly, around one in four women have been raped or sexually assaulted. This shows the gravity of the misogyny in our society faced by women and girls. Although relationship education can only go so far in addressing male violence against women and girls, it plays an important role in educating our young people on what positive and healthy relationships look like and the importance of putting in place clear boundaries. Those skills are vital in navigating relationships, recognising potential abuse, including that of coercive control, and knowing how and when to seek help. Relationship education was made compulsory in all primary and secondary schools in 2020. Although schools are able to determine their own curriculum, they must have regard to the statutory guidance released in 2019. From my experience of looking at some of the school materials used, it seems that focus in relationship education has a tendency to gravitate towards other topics rather than spending the necessary amount of time on propagating positive and respectful relationships between boys and girls and addressing many of the issues raised today. That is something that schools and the Government need to reflect on. An important part of relationship education is teaching young people about the risks and harms of the internet and social media. With damaging online porn available at the touch of a button on smartphones, young men are fed a constant stream of misogynistic content that will change how they view women and girls. While they are able to access hours of degrading and violent content directed at women whenever they like, the relatively small amount of time spent learning the opposite in a classroom cannot hope to offset the harmful influence. That is why the Conservatives have called for a ban on smartphones in schools for under-16s, which would at least go part of the way in promoting children’s wellbeing and protecting them from harmful content on social media during the school day. It is also important to note that, for many young people, the distinction between the online and media world can be blurred, so they need the skills to navigate that safely. We all know that people feel more anonymous online, say things that they would never say face to face and may even present themselves as someone different to who they actually are. On top of this, they are fed a stream of factually incorrect information and unobtainable body images. In accordance with Department for Education guidance, schools should be alive to issues such as everyday sexism, misogyny, homophobia and gender stereotypes, and take positive action to build a culture where those are not tolerated. In spite of this, sexual violence and harassment does, I am afraid to say, take place in schools. It is vital that such behaviours are not tolerated and are never acceptable. Any reports of sexual violence or harassment should be taken seriously, and it must be recognised that girls are much more likely to be victims, with boys the most likely perpetrator. With that being said, it is vital that our boys are not made to feel that this behaviour is inevitable as a result of them being male. Indeed, it is only a minority who behave in this way. When it comes to our boys, we should value their unique attributes and not demonise them or make them feel bad for having masculine traits. These traits are not, in the great majority of cases, toxic. The requirement to deliver RHSE has led to a surge in outside providers making available their resources to schools. Some are good, and some are not so good. The guidance is clear that schools should not, under any circumstances, work with or use materials produced by external agencies that take or promote extreme political positions. Accordingly, schools are required to assess each resource to ensure it is age-appropriate and sensitive to their needs, and should provide examples to parents on request. Parents should be given every opportunity to understand the purpose and content of materials, and it is certainly not appropriate for such materials to be withheld under the guise of copyright restrictions. All parents have a right to know what a school is teaching their child. It was confirmed by the previous Education Secretary in the Conservative Government that materials used in the classroom can be shared, irrespective of copyright restrictions. It should never be forgotten that parents and carers are ultimately responsible for the education of their children, so in most cases teaching in schools should be done with parents, not contrary to them, and in a way that is sympathetic to their values and beliefs. That starts with being transparent about what is being taught. It is also important to note that schools have a legal obligation to be politically impartial when teaching, which means that children must be offered a balanced presentation of opposing views. It seems that many schools have struggled with the impartiality requirement on this specific topic, which drove additional guidance to be released in 2022. I note the reference to a backlash—

• 1 Apr 2025 · Relationship Education in Schools · Hansard source

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  Thank you, Sir Jeremy. I note the reference to a backlash against RHSE lessons due to anti-LGBTQ+ rhetoric, and I want to push back on that. It is not unreasonable for parents to raise their concerns about schools teaching factually incorrect, ideological and damaging content about gender identity. They are right to do so, and it is the responsible thing to do. I agree that the teaching of such harmful concepts as fact has done damage to the important subject of RHSE as a whole. In closing—

• 28 Mar 2025 · Looked After Children (Distance Placements) Bill · Hansard source

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  I am pleased to contribute to this important debate, and I congratulate the hon. Member for Rother Valley (Jake Richards) on bringing the Bill before the House. I commend him for shining a spotlight on an issue that affects some of the most vulnerable children in the country. These children are not simply statistics or case numbers; they are young people who have experienced trauma, instability and, in many cases, loss. It is essential that they get the loving home and the support that they deserve, so that they can flourish. He has brought this issue to the House with compassion and care, and I commend him for doing so. As a serving Surrey county councillor and a former member of the corporate parenting board, this is an issue close to my heart, too. I have seen at first hand many of the challenges and systemic failings that have been talked about. As was set out, local authorities have a duty, so far as reasonably practicable, to ensure that looked-after children are placed in accommodation that meets their needs in the local area, but many local authorities fail to achieve that, and often shockingly high numbers of children are placed out of area. I am sure that the inclusion of the words, “so far as reasonably practicable” was intended to give some leeway to local authorities where needed, and to recognise that sometimes distance placements are in the best interests of the child. However, I am afraid that in far too many cases those words have become a licence for abject failure. Yes, I accept that there are many challenges for local authorities in meeting their duties, including the higher cost of living, which makes it difficult to recruit and retain foster carers; the increased national demand for placements; and even the recent ban on using unregulated accommodation for 16 and 17-year-olds. Those pressures are real, but it is unacceptable that high numbers of looked-after children are being placed in accommodation far away from the communities that they know—far from their schools, their extended family and their support networks. Such placements are often made not because they are seen as the best option for the child, but because there is simply nowhere else to put them. The problem is that it becomes almost normal to send high numbers of children out of area, so it becomes more acceptable. I am here to say that, except in specific cases, it is not acceptable. Local authorities and national Government need to do more to ensure that the sufficiency duty is met. The wellbeing and safety of these vulnerable children depend upon it. The damaging consequences of these long-distance placements are obvious. Children placed miles away are more likely to experience educational disruption, go missing and lose contact with friends, siblings and trusted adults. In some cases, the sense of being cut adrift from everything familiar only deepens an already present feeling of abandonment. It should be noted that these placements are often beyond the local authority boundary, giving rise to myriad further risks. It is self-evident that the system needs further intervention, and I am pleased that any policy decisions taken in the future will build on the major reforms introduced by the previous Conservative Government. Perhaps the most impactful reform in this space was the introduction of the staying put policy in 2014, which allowed young people in foster care to remain with their foster family until the age of 21. That was a transformational step. For the first time, young people in care were offered the stability and ongoing familial support that many of their peers take for granted. It was also the previous Conservative Government who rolled out regional adoption agencies, which are designed to reduce delays in the adoption process and increase the number of children finding permanent, loving homes. Since their introduction, adoption timeliness has improved, and agencies have been better able to match children with prospective parents across wider geographical areas. We also published our strategy and consultation, “Children’s Social Care: Stable Homes, Built on Love”. Our strategy was backed initially by £200 million of additional investment over two years to transform children’s social care, including by delivering a decisive multi-agency child protection system and ensuring that every child has a valued, supported and highly-skilled social worker when needed. Finally, the publication of the independent review of children’s social care in 2022, commissioned by the last Government, was a landmark moment. It provided a comprehensive and honest assessment of the system’s challenges, and offered a road map for reform focused on early intervention, family help and a more relational, less transactional model of care. Those milestones, taken together, demonstrate that we have always taken the needs of looked-after children seriously, and we will continue to work constructively alongside Government Members to improve the support available to these children; I know Government Members have the same overarching objective of transforming life outcomes for these children. I return to the Bill. The ambition of improving the transparency of data about placements of looked-after children is much welcomed. The Bill would place a duty on local authorities to publish such information, making it easier to identify where there are issues, and where local authorities are not performing. We will start to see tangible improvement only when the extent of the issue nationally is clearly laid out. As is often the way, measurement prompts improvement. Undoubtedly, one of the most consequential aspects of the Bill is the requirement for the Secretary of State to produce a national sufficiency strategy for looked-after children. Local authorities can and should do more to collaborate at regional level to ensure that children are put in placements close to their homes, but the structural challenges faced likely cannot be solved by local government alone. National leadership is essential, and I urge Ministers to look seriously at how best to increase placement capacity where there are shortages, and at how to ensure that the right children end up in the right locations, not just the cheapest locations. That is not to say that local authorities are not at the heart of this challenge—they are—but I know that they find it increasingly difficult. The residential care market is now heavily dominated by private providers, and the cost of placements continues to rise, placing a huge strain on local authority budgets. A shift to a more strategic approach is needed, and I recognise that the hon. Member for Rother Valley has sought to kick-start that shift with the requirement in his Bill for local sufficiency strategies to be published by local authorities in England. At this point, I should acknowledge that for all the justifiable talk today against distance placements, there is a very limited set of circumstances in which they are appropriate and necessary. Some children need specialist provision that simply does not exist locally. Others may need to be placed at a distance to ensure their safety if they have become involved with gangs or are threatened by an abuser. The question is not whether distance placements should be banned—they should not—but how we can get to a point where they are used only when it is truly and demonstrably in the best interests of the child. A key focus is how we recruit, retain and support foster carers, and how we encourage local authorities to invest in local residential provision at a time of such pressure on their budgets. Many of the answers lie in not only legislation but funding, training and leadership, both local and national. I look forward to the Minister’s comments on these important issues. When a child is taken into care, the state becomes their parent. That is not a responsibility to ever be exercised lightly. We must hold ourselves and the systems we put in place to the highest standard—the standard we would expect and demand for our own children. The hon. Member for Rother Valley has brought this Bill forward in precisely that spirit, and I congratulate him once again on doing so. It was truly a pleasure to speak on it.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-eighth sitting) · Hansard source

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  I will come on to some of that, and it goes back to my belief that there should be a degree of separation. I think it should be separate from normal healthcare services and there are multiple ways that we could do that. I regret that we are not specifically debating the various different options, with a proposal in front of us detailing exactly how it would work. I am assuming, from the new clause put forward, that the proposal is for this to go through the NHS as healthcare; that is the only assumption I can make based on what is in front of me in this Bill, because there is no other detail to give me any other impression. Sarah Davies, a consultant respiratory physician in north Wales, argues for a separate service so that ordinary NHS care is not associated with assisted dying. She said: “It is already my experience that patients and their families are anxious about limiting treatment when they are dying. Many people believe that symptom control medication, such as those delivered in a syringe-driver to aid symptom control amount to hastening or bringing on death. This perception can hinder the patient’s acceptance of medications which can afford significant alleviation of distressing symptoms.” I have raised my concerns about providing an assisted dying service alongside and in conjunction with day-to-day healthcare many times over the last few weeks. I think it is a massive mistake both for patients and healthcare staff. It blurs the lines of what a treatment is, increases the risk of bad decisions and, as we heard so powerfully from Dr Jamilla Hussain, it will discourage some of the most vulnerable groups from seeking essential healthcare. We have received so much evidence and it is really important that we take it on board, so I will be quoting some in my speech. Dr Green of the BMA said: “It should be set up through a separate service with a degree of separation. We believe that is important for patients, because it would reassure patients who may be anxious about the service that it would not just be part of their normal care… It would reassure doctors, because doctors who did not want to have any part would not feel that it was part of their normal job, whereas the doctors who wanted to go ahead would be assured of having support, emotional support and proper training.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 45, Q32.] In oral evidence, Professor Preston argued for a separate system and pointed to the Swiss example. She said: “In covid, we did research in care homes, and there was real concern about ‘do not resuscitate’ orders and emergency care plans that were blanketed across the care homes. Care home staff were traumatised by that, so there are real issues. We know that there are real issues day to day in how people are treated within the NHS. I think it is unconscious—I do not think people are intending it—but we know that people are treated differently and that different things are done. That is partly why we think a system outside that would protect them, because then you are not within the healthcare team that is treating you and giving you advice about such things”. She went on to talk about the Swiss system, also being adopted in Germany and Austria, which seeks to “protect these people by keeping it one step removed” from normal healthcare. She said: “Most hospitals in Switzerland will not allow assisted dying to occur, because they do not want a lack of trust in their patient group.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 246, Q317.] I therefore support amendment 525, tabled by my hon. Friend the Member for East Wiltshire, which would amend clause 32 in order not to allow the provision of the assisted dying service to be done through the health service. That would ensure that much-needed degree of separation. In light of what the Bill’s promoter has said, I recognise that there are different ways to do that; I am very open to those different ways, but I need to see that degree of separation from normal healthcare. I also support new amendment (a) to new clause 36, also tabled by my hon. Friend, which does the same thing. Let me come to the other amendments in this group. Amendments 537 and 528, tabled by the hon. Members for Shipley and for Richmond Park respectively, are important to debate—we have had some good debate on them this morning—as they raise the different ways of delivering an assisted dying service. I have been listening closely to the points made. Amendment 537 would limit the provision of an assisted death to charities rather than to the NHS, and conversely, amendment 528 would limit provision to public authorities only. I do not have the answer on the best way to do this, and that is why I regret that a royal commission has not been set up to properly investigate and evaluate all the options and recommend the best way forward. Instead, we are here without all the relevant information and expertise available to us, trying to land on the best way to do it. That is not the way to make such an important decision. I can tell the Committee, however, that—like many others, including my hon. Friend the Member for East Wiltshire—I have huge reservations about delivering such a service through the NHS alongside normal healthcare. I agree with much of the evidence that has already been cited: there should be a degree of separation. The BMA said that assisted dying could be part of the NHS, but should be outside existing care pathways and separate in some way: “Our view is that assisted dying should not be part of the standard role of doctors or integrated into existing care pathways—it is not something that a doctor can just add to their usual role… The separate service could take the form of a professional network of specially trained doctors from across the country who have chosen to participate, who come together to receive specialised training, guidance, and both practical and emotional support. They would then provide the service within their own locality—for example, in the patient’s usual hospital, or their home. Or it could be a combination of some specialist centres and an outreach facility.” In its written evidence, the Royal College of General Practitioners also proposed a separate service: “The establishment of a separate service which covered every stage of the process would ensure healthcare professionals of multiple disciplines (including GPs) who wanted to do so could still opt in to provide assisted dying, but this would be arranged through a different pathway.” I agree with both bodies that the service should be separated out in some way. It is now apparent that my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), whose amendments would have created an assisted dying agency, was on the right track. I regret that the Committee did not explore his ideas in any real detail during our proceedings. We received important written evidence from Robert Twycross, a pioneer of palliative care who sadly died in October, but had given his friend Ariel Dempsey permission to submit it. Dr Dempsey writes: “Twycross recommends a de-medicalized model in which AD is a separate service, delivered outside of healthcare practice. He argues for a standalone Department for Assisted Dying, separate from the NHS. He writes, ‘Data indicate that the primary reason for a persistent desire for AD is to relieve distress over a perceived loss of autonomy and to experience a sense of personal control over the circumstances of their dying. These are not medical reasons. Thus, for patients fulfilling the legal criteria, a separate AD service should be established. Indeed, this would be the best way to prevent a corrosive effect on medical practice generally.’ ‘Given the widespread disquiet felt by doctors, a law with minimal medical involvement would be the most equitable.’ He suggests, ‘One way to achieve this would be for [AD] to be delegated to a stand-alone Department for Assisted Dying, completely separate from the NHS and with its own budget. Victoria almost achieves this with its combination of Care Navigators, mandatory training for participating doctors, and a separate Voluntary Assisted Dying Statewide Pharmacy Service.’ Twycross emphasizes that hospice and palliative care must be a ‘sanctuary’ for patients – ‘an assisted dying free zone. Even in the absence of AD, some people decline referral to palliative care despite unrelieved pain and/or other distressing symptoms because they fear they will be “drugged to death”…This unfounded fear will most likely be enhanced if AD is legalized, particularly if palliative care is involved’ and result in an overall increase in suffering.”

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  It is a pleasure to serve under your chairmanship, Sir Roger. I rise to speak about amendments 518 and 520. As we have said, it is important that we understand what coercion means in a legal sense, and I am really grateful to the hon. Member for Penistone and Stocksbridge for trying to set that out, because it is not an easy task. Like her, I am concerned that defining it in this way may make it harder to prove coercion and may undermine the safeguards in the Bill. Under the amendments, the assessing doctors and the panel are meant to look not just for evidence of coercion but for evidence of intent to induce assisted suicide, and they will have to show that the applicant is requesting assisted suicide against their will. That could make the law powerless against many kinds of behaviour that we want to prohibit. To start with the point about intent, coercion and pressure take many forms, and they do not always involve a clear intent. Amendment (b) to amendment 518 and amendment (b) to amendment 520, in the name of the hon. Member for Lowestoft, very reasonably draw attention to family relationships. On Second Reading, the right hon. Member for Hackney North and Stoke Newington (Ms Abbott) said: “people do not generally write letters to sick relatives urging them to consider assisted suicide and then put those letters on file. Coercion in the family context can be about not what you say but what you do not say—the long, meaningful pause.” —[ Official Report , 29 November 2024; Vol. 757, c. 1030.] But even in more blatant cases, we cannot necessarily prove intent directed towards assisted suicide. Sue Smith, a clinical psychologist, said in written evidence that coercive control often ramps up when the abused partner receives a cancer diagnosis: “The seriousness of the cancer diagnosis may be systematically and actively denied or minimised, claims can be made by the male partner that she is attention seeking, or she is accused of making up the effects of treatment, and can be left isolated and alone when in physical need…a woman learns to doubt her reality and experience, and is extremely isolated. This can lead to heightened anxiety, hopelessness and helplessness, and abject despair, which can lead to a person wishing they were dead.” That could be seen as coercion towards assisted suicide, but in that scenario does the abusive partner demonstrate clear intent? I am not sure the doctor or panel could demonstrate that in that instance, especially as they need to be satisfied only on the balance of probabilities that there is no coercion. If the panel think that there is a 45% chance that there is intent, but no more than that, they have to grant the application. The harrowing story of Ryan Wellings and Kiena Dawes shows that even when coercion can be proved, proving that an abuser intends someone else’s suicide is a completely different matter. After Kiena Dawes took her own life, Wellings was convicted of coercive control and assault. The judge told him: “from May 2020 until her death you abused, assaulted, exploited, controlled and demeaned her. When she died it is clear that she had begun to believe your lies to the effect that she was deranged, physically disgusting, friendless, worthless and an unfit mother. You had persuaded her that she had no one to turn to.” Before her death, Dawes wrote a note saying, “Ryan Wellings killed me.” Although he was convicted on other counts, Wellings was acquitted of manslaughter. That demonstrates that coercive control, even if it is followed by suicide, does not always mean that intent can be demonstrated. It is really tricky. Similarly, people may pressurise a relative without intending to override their will. The barrister Ruth Hughes KC, who has been quoted before, said: “It is surprisingly easy for a relative, whilst completing a variation on ‘the classic asset strip’, to persuade themselves that they are actually acting in their aunt Dorothy’s best interests or in accordance with her wishes”. In other words, someone can pressurise a relative into assisted suicide without intending to. Again, including intent here could actually muddy the waters. I have a similar concern about the phrase “against that other person’s will”. That sounds very straightforward, but in practice it can be much less clear. Part of the effect of coercion is that people lose confidence in their own will and adopt that of others. In written evidence, many frontline workers pointed out that coercion does not always clearly appear as someone acting against their will. Janet Reiss, a specialist doctor in palliative care in Wolverhampton, says patients will not “even necessarily be aware of being coerced”. Dr Jennifer Hardes Dvorak, a senior lecturer at Canterbury Christ Church University specialising in medical law, states that the Bill “does not consider how people internalise feelings of coercion and…act on this.” If someone has internalised a feeling that they would be better off dead, that may be their will, even if we hope we could change it. Anni Donaldson, a domestic abuse expert at the University of Strathclyde, said: “Decades of work examining the impact of coercive and controlling behaviour has shown that ‘coercive control’ is not merely persuasion, but a complete change in the perspective of the victim so that she truly believes that she is worthless, a burden to her partner or wider family, and would not be missed should she die…Women are regularly humiliated, demeaned, and told they would be ‘better off dead’, or, that they are a ‘useless mother’, or that the children would be better off without them. This abuse erodes women’s confidence, autonomy, and self-esteem. Cut off from support, women often come to believe these lies, fearing reprisals from their partner if they report the abuse, many choose to tell no one. This long term, relentless, dehumanising process can result in a woman believing that she is ‘disposable’.” Similarly, the writer and campaigner Sarah Ditum warns that the Bill may not protect “the patient who, through lengthy cruelty and coercion from a partner or carer, becomes genuinely convinced that she (or sometimes he) is a burden who would be better off dead. Such a person may even refuse treatment, causing a curable disease to become terminal and placing them within the purview of the bill.” So we might not believe that assisted suicide is in someone’s best interests, but there is no best interest test in the Bill or the amendments—just a reference to the person’s will. If a victim of coercive control truly believes they ought to die, it is not clear how the doctor or the panel can refuse their application, unless coercion can actually be proved, and proving it is not always easy, as we have just discussed. My hon. Friend the Member for East Wiltshire has tabled amendments to remove the phrase “against that other person’s will”. Obviously, that is all academic now, as we are not pressing the amendment to a vote, but I would support doing that, because that phrase does more to narrow the definition than anything else. On another point, amendments 518 and 520 refer to pressure and coercion from organisations. I do not know exactly what the hon. Member for Penistone and Stocksbridge has in mind with that. I guess an example might be the cases we have heard about in other jurisdictions where a health insurer or provider tells someone that they cannot fund a treatment but can fund assisted dying options. It could be that the hon. Lady had other things in mind there. That would possibly count as pressure under some circumstances, but it would be very hard to show that there was intent on the part of the organisation. It is not clear that the amendments help us to identify and avoid coercion and pressure in that sense. Before I finish, I would like to point out something else that might be missing from the amendments: it is my favourite topic, the question of undue influence—my apologies to the Justice Minister, because I know we have gone over it a few times.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  Before I get into my speech, I thank the hon. Lady for her useful questions, as it is important to explore these issues. I will talk in more detail about new clause 23, but I would happily expand its provision, if that would make her happy. I wish to speak to amendment 481 and new clause 23 in my name. I welcome clause 23, which makes it clear that no registered practitioner or other health professional is under any duty to participate in the provision of an assisted death. I believe, however, that it can be further bolstered by the amendments that my hon. Friend the Member for East Wiltshire has spoken to, including my amendment 481 and new clause 23. The amendments concern a practical issue that would face hospices and care homes from day one of the legislation coming into force—namely, how they can continue to operate effectively with a huge diversity of views among staff members. We will all remember Sarah Cox’s oral evidence to the Committee. She cited a 2023 Royal College of Physicians survey in which 43% of Association for Palliative Medicine members said that “if assisted dying were implemented within their organisation, they would have to leave.” Dr Cox said that if this Bill became law, it would have “a massive impact on palliative care, in terms of its potential to develop both our funding and our workforce, who are really concerned about this.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 70, Q83.] In written evidence, the Association for Palliative Medicine said: “The APM recognises the importance of organisations also being able to conscientiously object to involvement in assisted dying. This is essential for the organisation and also for healthcare professionals choosing where to work with their conscience. By not having robust conscientious objection at all levels, the Bill risks imposing harm on health or social care practitioners, violating their autonomy and risking an exodus of skilled and valuable health and social care practitioners.” There will be many people in the sector who support and want to participate in assisted dying, but it is likely that some institutions and organisations will want to have a clear policy of not providing assisted dying. Some nurses, doctors and other professionals will want to work only in that kind of organisation. Either we carve out a space for them, or we risk losing some very dedicated people from end-of-life care. I am trying, through amendment 481, to carve out that space. It allows an employer—a hospice, for instance—that has a blanket policy of not offering or supporting assisted dying to require their employees to adhere to their policy. My amendment clarifies that clause 23(2) does not make blanket policies impossible to enforce: a care home or hospice can prohibit its employees from participating in the provision of assisted dying. They can still believe whatever they want to believe, but it sets out clearly what is expected if they are employed in those premises.

• 12 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-second sitting) · Hansard source

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  I welcome the hon. Lady’s intervention, but the point I am making is not about coercion; it is about the subtleties in families’ relationships. I was trying to bring to life a situation—sometimes it is families who understand the relationships, the dynamics and the pressure points. It is very hard for professionals to get underneath that. In a sense, families are the greatest experts, but the process as drafted excludes that expertise. Under my amendment, if a family member had knowledge that could make the difference between life and death, they would be able to apply to the panel. If there had been a clear error in applying the eligibility criteria, the application would be reconsidered. It is true that the panel will be informed by at least one of the doctors and that it has the option of hearing from others. Perhaps the panel will always be incredibly thorough and explore every avenue, but we have to legislate for every situation, including situations that are not ideal. We can learn a lot from other jurisdictions. In written evidence, the academic Christopher Lyon from the University of York describes his experience in Canada. Dr Lyon writes that his father, who was “openly suicidal” and had a “history of mental illness”, qualified for medical assistance in dying in 2021. In Dr Lyon’s words: “He was classed as having a ‘foreseeable natural death’ (i.e., terminal illness), my family was told, because he had momentarily skipped some meals at his residence and had an elevated but unremarkable white blood cell (WBC) count that the AD doctor suggested might be an infection that, if untreated, might become lethal, despite being a common side effect of his arthritis medication.” Dr Lyon says that when he was informed two days before the event, he pushed for an urgent psychiatric assessment to be carried out. Dr Lyon has obtained a copy and says that it is “full of errors. It claims he wasn’t suicidal, when he had a whole history of suicidality. It states he didn’t think he was depressed, and yet on the list of medications there was listed antidepressants.” Dr Lyon’s concerns about his father’s prognosis, the assessment and other aspects of the events were widely shared, he says: “After he died, the provincial regulatory college, police, and even other AD clinicians suggested his death was questionable or even wholly unlawful. However, privacy law and the continuing resistance from the local health authority have so far succeeded in blocking access to his medical records necessary for a full investigation”. In Ontario, meanwhile, the chief coroner has published a report detailing the assisted death of an anonymous patient, Mr A, who had inflammatory bowel disease. He was unemployed, dependent on his family for housing and financial support, and struggled with alcohol and opioid misuse. He received an assisted death on the basis that his illness was advanced, irreversible and causing intolerable suffering. According to the coroner, the family were not consulted by those involved with processing the application, even though it was recorded that the family expressed concerns. Most members of the death review committee thought that shutting the family out was a mistake. The committee concluded: “Engagement with family and/or close relations in the MAiD process should aim to be a key component of MAiD practice.” We can hope that these were exceptional events, but they are the kinds of situation in which a panel might have benefited from a family perspective, which is the reason why I cite them.

• 7 Mar 2025 · Protection of Children (Digital Safety and Data Protection) Bill · Hansard source

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  I concur with everything my right hon. Friend says. It is completely accessible to all our children, so it is very hard for one child to be kept separate from it. That is why it is important that we address it. However, increasing the digital age of consent is just the first step—we have so much more to do. We also need to ban smartphones in schools for children under the age of 16. On a typical workday, 42% of older teenagers say their smartphone is distracting them from schoolwork, and half say that social media has distracted them enough to impact their grades. Notably, only 11% of schools are genuinely smartphone free, and children at these schools get GCSE results one to two grades higher, so there is clearly a big upside to banning smartphones in schools. I urge the Government to seriously consider implementing this much needed restriction, which would be a game changer, protecting children and improving educational outcomes in one fell swoop. Our schools need this ban in statute, not just in guidance, in order to be able to effectively police and enforce it. I pay tribute to Smartphone Free Childhood for all its work to raise awareness on this important issue. In closing, I hope that Members will support the Bill today, which would move us forward in our mission to protect our children from an increasingly insidious online realm that they are simply not equipped to navigate. I also hope that this is just the beginning, and that in moving forward we will see the digital age of consent raised to 16 and a ban on smartphones in school. The value of those two changes alone would be huge for our society, and would safeguard the wellbeing of this and future generations of children. I cannot think of anything more important.

• 7 Mar 2025 · Protection of Children (Digital Safety and Data Protection) Bill · Hansard source

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  I am pleased to speak in support of the Bill. I must start by declaring an interest: I am a mother of three children who enjoy nothing more than staring at their screens day in, day out—if they could, they would be on them 24/7. No longer are our children clamouring to go out and play or to see their friends; instead, they want to do everything through a screen. They want to watch endless YouTube videos. I never realised that the unpacking of a toy or slime making could hold such interest. It seems that they take their joy in watching others do things online—even, rather bizarrely, playing computer games—instead of actually doing them in the real world. I would be a hypocrite if I did not call out my own behaviour on this front. I, too, am addicted to my phone. Yes, I need it for this job, so I can justify some of my use, but I often find myself endlessly doomscrolling, and I am too embarrassed to tell the House how many hours I spend staring at it every week. At least my addiction started when I was a fully developed adult, after a childhood of play and socialisation when I learned much-needed life skills. This generation of children is not so lucky. The huge amount of time spent online is incredibly damaging in so many ways. It is no coincidence that we see a mental health crisis in our young people at the same time as mass adoption of smartphones and access to social media. Some may underplay the importance of social media and screens in the challenges we face as a society, and indeed it can be difficult to conclusively prove the role of one particular factor in the effects we are seeing, but I suggest that when it comes to our children, we should always err on the side of caution and protect them from potentially harmful influences. In a recent survey, social media and excessive screen time was ranked as the top issue affecting children’s mental wellbeing. To put that in context, it was ranked higher than alcohol and bullying. Another significant risk to mental health is exposure to harmful online content. I am incredibly concerned about that, especially given the proliferation of extreme pornography, harmful content and unrealistic body images. If children spend all their time in this fantasy world that is completely disjointed from reality, of course it will change how they view people, relationships and the world in general. That is supported by Ofcom’s 2024 research, which showed that older teens are finding it harder to distinguish the real from the fake online. The more mundane things in life that do not trigger a dopamine hit seem an even less appealing way to spend time to a child jacked up on likes and shares. Children’s attention spans are getting shorter, and they have an ever-increasing need for higher levels of stimulation. Is it any wonder that our children seem less interested in reading a book or baking a cake nowadays? The evidence from Health Professionals for Safer Screens shows that children who routinely spend extended periods on their smartphones have poorer eyesight, inhibited speech and language development, interrupted sleep, and rising rates of anxiety. We are allowing our children to become addicts. Social media is designed with exactly that in mind. It is meant to be addictive and compelling. It wants users to stay online for prolonged periods and to keep engaging with content. Those of us who use it ourselves know this all to be true, so how on earth do we expect our children to manage and moderate appropriately? Ofcom’s 2024 research showed that the overall use of social media sites or apps among five to seven-year-olds had increased year on year. Online gaming among that group had also increased significantly, as had the watching of livestreamed content. Under current data protection law, the age at which children can access information society services—ISS—is 13. ISS includes most social media platforms and content streaming services. It is important to acknowledge that the Online Safety Act 2023 introduced protections for children by ensuring that online platforms will have to remove illegal content such as child sexual abuse material, prevent children from accessing harmful content—for example, that encouraging suicide, self-harm or bullying—and introduce age-checking measures to restrict access to pornographic material. Those are all very welcome improvements, but they need to be put in place at pace and be effectively enforced. I commend the hon. Member for Whitehaven and Workington (Josh MacAlister) for all his work on this important topic. I will do all I can to support him in making the online world safer for our children. The Bill is an important precursor to the myriad changes needed in this area, and I know that many parents will support him in calling for the digital age of consent to be looked at again. While the Bill does not call for the age limit to be raised to 16, it does call for the UK’s chief medical officer to look at this important issue in detail and, ultimately, issue a statement on whether it should be raised. Some 75% of Brits now back raising the minimum age from 13 to 16, as per a recent survey by More in Common, for all the reasons that have been raised today, and 129,000 people signed an e-petition calling for social media companies to be banned from letting children under 16 create social media accounts. It is past time for tech companies—and Members of this House—to take responsibility for keeping our children and young people safe. I am not normally in favour of blanket bans, and I often talk about the importance of parents and carers taking responsibility for their children. However, in this instance, I deviate a little. As a parent who is wrangling with this exact issue myself, I know how difficult it is to tell a child that they cannot do something that every single other child in their class is doing. If their group of friends interacts only online, what are the consequences for my child if I prohibit them from joining in? Isolation? Loneliness? Loss of self-esteem? There are very real costs that should not be underestimated, which is why the state needs to step in. Members will not often hear me say this, but the state needs to step in and remove the option for all, helping parents across the country who want the best for their children without the downsides.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I think most points have been covered, so I will be brief. The point of the amendment 296 is to recognise the challenges faced by medical practitioners in the NHS. It is really well intended. I suspect that there are different ways to do this, which we could discuss, but the amendment would recognise that medical practitioners will come under a lot of pressure. The very nature of the assisted dying process means there is pressure to move quickly—for obvious reasons. If someone is in pain and an assisted death is what they have chosen to do, they are going to want to move forward at pace. It cannot be as usual, with however long it can take in the NHS—often for a normal procedure. The point of the amendment is simply to be cognisant of the fact that other patients, too, require healthcare. This comes back to the debate we have had many times about what is healthcare and what is not. It is one of the issues that comes up when we have assisted dying amalgamated with general healthcare in the NHS. We are hearing concerns from doctors on the frontline. In written evidence, eight doctors, six of them GPs, say that the NHS lacks both the time and the capacity to create the new role of co-ordinating doctor with its grave responsibilities. The statistics bear out their concerns. In a 2024 survey by the Royal College of General Practitioners, over 40% of UK GPs who responded said that they were “unlikely” to be practising still in five years’ time; 40% feel stressed to the point of “not coping” at least once a week; and 79% are concerned about having fewer GPs at their practice and its impact on the quality of care that their practice can deliver. The reality of the matter is that we have to recognise that the introduction of assisted dying places another pressure on our health system, and to try to address that head on.

• 4 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Seventeenth sitting) · Hansard source

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  I rise to speak briefly to amendments 413 and 414, which are very thoughtful and well-considered amendments. I thank the right hon. Member for Dwyfor Meirionnydd for setting out powerfully and persuasively the importance of the subject. I support the amendments, but in reality we probably need to go further by specifying exactly who would be interpreting and making sure that it is regulated reliably. We do not want just anyone coming in off the street and doing that. That would not be appropriate, so we need to think about whether we need to go further. However, the amendments are a great starting point and would move us closer to where we need to be. There is much subtlety in this debate. We talked a little in the first week of this Committee about the importance of language and the words that are used. We always need to be cognisant that when we are imparting information to people, particularly in a healthcare context, it is vital that we use language that people understand so that the ramifications of what is being discussed are clear. That is where these amendments become really important, because for those for whom English is not their first language, some of the subtlety and nuance around what a term means could be lost. Interpreters could be an important part of adding the clarity required to ensure that everyone going through the process understands exactly what it involves. A 2024 Nuffield Council on Bioethics survey found that 39% of people think that assisted dying means withdrawing life support, 19% think that it means providing people who are dying with drugs that relieve symptoms of pain or suffering, and 13% think that it means providing hospice care. That echoes our debate a couple of weeks ago about how assisted dying can be interpreted in quite a few different ways. It is really important that we are clear in the language we use and what we mean by it. We also find that among ethnic minorities there is sometimes a greater misunderstanding about palliative care. A 2024 King’s College London survey found that 6% of people believe that it is accurate that palliative care involves giving people medicines in order to shorten their life, but 18% of ethnic minority groups think that. We need to be cognisant of that. While 18% of people trust healthcare providers “not very much” or “not at all” to provide high-quality care towards the end of life, that figure increases to 30% for ethnic minority groups. While 6% of people say they have not heard of palliative care, that increases to 22% of people in ethnic minority groups. It is important to recognise that the text of the amendment is much less stringent than that of section 7 of South Australia’s Voluntary Assisted Dying Act 2021, which strictly regulates interpreters. That goes back to my initial point. Under the South Australian law, they must be “accredited by a prescribed body”. They cannot be a family member, cannot stand to benefit from the will and cannot be involved in the patient’s healthcare. It is really important to ensure that a recognised professional is involved in this most important of processes and information sharing. I support the amendments, although I think they need to go a little further. I look forward to hearing what other hon. Members have to say.

• 26 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Fourteenth sitting) · Hansard source

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  I rise to speak to my amendment 398. I recognise that much debate about capacity has already taken place, so I will do my best not to be too repetitive, but it is an important topic and I want to cover a few things. Fundamentally, I consider the bar for the capacity to make a decision to seek an assisted death to be far too low if, as we have already discussed, the approach currently proposed in the Bill is adopted. The Committee has received powerful written evidence that the Mental Capacity Act, as it stands, is not suitable for assisted dying. The Royal College of Psychiatrists says in its written evidence: “It is the RCPsych’s view that the MCA is not sufficient for the purposes of this Bill.” The former president of the Royal College of Psychiatrists, Baroness Hollins, says: “The Mental Capacity Act has proved very difficult to implement and doctors have not been found to be good judges of capacity.” The eating disorders expert Chelsea Roff says: “The MCA is not fit for purpose for determinations of capacity in life-ending decisions.” I do not think it is contentious to say that there should be a higher standard for ending one’s own life than for other courses of action. Baroness Hale has called the Mental Capacity Act threshold “not a demanding one.” The Royal College of Psychiatrists says in its written evidence: “While we are of the view that a person’s capacity to decide treatment can be reliably assessed, an assessment of a person’s mental capacity to decide to end their own life is an entirely different and more complex determination requiring a higher level of understanding.” Even if the Mental Capacity Act is working well in some other contexts, it does not necessarily translate well to assisted dying. Professor Gareth Owen told the Committee in oral evidence that although the Mental Capacity Act is quite reliable in current practice, “in areas of decision making where the decision itself is unsettled or conceptually much more profound or novel—I would suggest that the decision to end one’s own life has those characteristics—you cannot expect there to be such levels of reliability.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 239, Q303.] The Mental Capacity Act definition of capacity was not created with such a monumental decision with respect to assisted dying in mind. Although I note Chris Whitty’s recommendation that it is the starting point, I do not think it can be the end point. Further provisions are needed to ensure that it is fit for purpose, given the significance of the decision being made. Professor Owen said: “I have looked at mental capacity a lot in research, and there is no experience of the decision to end one’s own life. It is outside the experience of the Mental Capacity Act, the Court of Protection, the associated research and practitioners on the ground. The reference to the Mental Capacity Act in clause 3 puts you into an area where there is no experience of the central capacity question under consideration. It is very important that Parliament be clear-eyed about that.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 226, Q287.] Dr Sarah Hooper, a retired oncologist, says that “the patient in question may undoubtedly have ‘capacity’ for most important decisions. However, in the early days after a cancer diagnosis their ability to make clear judgements is nevertheless likely to be impacted. This kind of decision (for assisted suicide), once acted upon, is plainly irreversible. It is a very bad time to make that kind of decision.” It is true that the Mental Capacity Act is used for decisions to stop life-sustaining treatment, but, as Professor Owen said, we should not simply equate that with assisted dying. As he pointed out: “One is a refusal; one is a request. One is traditionally considered to be about bodily integrity—it is the so-called shield of the person, or the patient, against the intervention on the body that is being made by the medical profession. You are giving the patient an important right, which is a shield-like right. That contrasts with a request for assisted dying, which is a request. You are involving other people in an act that is an act of ending one’s life. That is not something that the medical profession has been comfortable with, going back thousands of years.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 236, Q288.] I also draw attention to a great deal of written evidence making the point that the current Mental Capacity Act is not as well understood by medical practitioners as we hope or expect. Alexander Elphinston, a retired solicitor, says, “from my experience doctors and other medical practitioners often applied the test of mental (in)capacity incorrectly.” Victoria Wheatley, a palliative medicine consultant, says, “I have observed a tendency to overestimate a person’s mental capacity in the absence of obvious features to the contrary.” Alan Thomas, a professor of old age psychiatry at Newcastle University, says: “The preferences of the assessor bias the capacity decision towards the assessor’s preference.” I will move on to the specific issues with the current definition of people who lack capacity under the Mental Capacity Act when applied to assisted dying, all of which my amendment 398 attempts to address. Part of my amendment does exactly the same as amendment 322, tabled and already eloquently spoken to by the hon. Member for Bexleyheath and Crayford, so I will be brief on those overlapping bits. Under the Mental Capacity Act, there is a starting presumption of capacity. That is too lax a standard, as the Royal College of Psychiatrists says in written evidence. I quote: “The presumption of capacity may be problematic in the context” of assisted dying, given that the consequence would be the person’s death. This is literally a matter of life and death, and the presumption of capacity must not apply; the work must be done to assess capacity properly and thoroughly. Professor Preston said during the evidence session: “I think the aim is to have that bit of extra concern, so that we do not presume capacity, but instead almost presume that there is not capacity.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 241, Q307.] I think those are wise words, and my amendment and amendment 322 seek to give that protection. Both amendments also disapply section 1(3) of the Mental Capacity Act on helping a person to make a decision. The hon. Member for Bexleyheath and Crayford has already made his point powerfully about that, so I will not add anything further. There are some differences where my amendment 398 goes further than amendment 322. First, given the uniqueness and irreversibility of the decision, there should also be a higher threshold of probability. As it stands, a person should be treated as having capacity if that is more likely than not, which is sometimes referred to as the “51% sure” approach. It would be much safer if doctors and judges had to establish beyond reasonable doubt that an applicant has capacity, given the significance of the decision. In my view, 51% sure is just not good enough for such a monumental decision, and amending this part of the Bill would ensure a more rigorous and comprehensive assessment. Secondly—for me, this is one of the biggest issues with the current approach—the Mental Capacity Act requires an impairment of, or a disturbance to, the mind or brain for someone to be considered not to have capacity, irrespective of whether they can make a decision. Under the Bill currently, even if someone cannot understand, retain or use the information to make a decision—they cannot communicate that decision—they will still be deemed capacitous in the absence of an impairment, or a disturbance, of the mind or brain. In the real world, a doctor could assess a patient who gives the impression of being confused, illogical, erratic or inconsistent—everything about them could scream that they are not in a good place to make the decision—but they will still be considered to have capacity if there is no identifiable impairment of, or disturbance in, the function of the mind or brain at that point in time. That potentially puts those with depression, anxiety, learning disabilities or eating disorders, or even those in physical pain, in danger of being considered capacitous. In oral evidence, Professor Alex Ruck Keene said, “If I doubt that you have capacity to make the decision to take your own life, or end your life, but I cannot prove it, is it logical or are we required to proceed on the basis that you do?...In other words, I think you cannot understand the information, but I cannot prove the reason that you cannot understand it is that you have an impairment or disturbance.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 90, Q120.] According to his written evidence to the Committee, this means that someone could be approved for assisted dying even if they did not understand the relevant information, as long as they do not have an identifiable impairment of, or disturbance in, the mind or brain. He wrote, “the Committee may well feel that it would be problematic that such a person should be considered to be eligible for the receipt of assistance in dying.” In a letter to the hon. Member for Richmond Park, Professor Alex Ruck Keene KC said, “no matter how intensive the scrutiny of the person’s capacity, this would not address the issue of the situation where the person appears not to be able to understand, retain, use and weigh the relevant information but that is not caused by an impairment of, or disturbance in, the functioning of their mind or brain.” That is why my amendment seeks to remove this diagnostic element, so that section 2(1) of the Mental Capacity Act for the purposes of this Bill only would read as, “a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter.” That would provide better protections for this life and death decision, and I hope it addresses the issue raised so powerfully by Professor Alex Ruck Keene KC. As I close, I would like to make reference to amendment 49, tabled by my hon. Friend the Member for Runnymede and Weybridge, which sets out starkly the deficiencies of the current capacity test if it remains unamended for the purposes of this Bill. If autonomy is what counts, and we are using the Mental Capacity Act as gatekeeper for assisted death, then the Bill in its current form means that: a person is assumed to have a capacity as a starting point; a clinician only needs to be just over 50% sure that a person has capacity; unwise decision making is not taken into account in determining capacity; and supported decision making is acceptable—for example, for those with learning disabilities. I ask the Committee members whether they are comfortable with that. If not, then as a minimum, amendment 322 should be accepted, but ideally my amendment 398 should also be, as it goes even further to increase the threshold for capacity and it addresses the significant issue with the diagnostic leg of the test. I am pleased to say that Baroness Finlay, who established and chaired the National Mental Capacity Forum, supports my amendment. Unlike the current drafting of the Bill, my amendment requires that a person is not assumed to have capacity in the first instance. It requires capacity to be proven beyond reasonable doubt, that unwise decision making is considered in assessing, and that a person is not helped to make a decision. I hope the Committee will support it.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Twelfth sitting) · Hansard source

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  I rise to speak to amendment 11, which stands in the name of my hon. Friend the Member for South Northamptonshire. This is one of the areas of the Bill where we all agree on what we are trying to achieve, so it comes down to making sure that the drafting does exactly what we all intend in order to protect people. The definition of “terminal illness” in the Bill has two components. The first is that the person has an inevitably progressive and irreversible condition; the second is that their prognosis is less than six months. An issue raised in our evidence sessions is that there is a risk that a person with a mental disorder or disability will meet that definition if they are suffering physical symptoms that mean that they satisfy both parts of the test; a possible example could be a young woman suffering with severe malnutrition as a consequence of anorexia. With respect to the point that the hon. Member for Stroud made, I agree that anorexia on its own would not qualify, but the issue arises when there is a physical manifestation from that disorder such as severe malnutrition or even diabetes, which can co-occur, as we heard in the evidence sessions. It is clear that that is not the intention of the hon. Member for Spen Valley or anyone on the Committee, as evidenced by the inclusion of subsection (3). I thank the hon. Member for making that point; it is much welcomed. However, in oral evidence, Chelsea Roff said that “we have case law in the UK where people with anorexia are being found to be terminal. We have to take that reality into account.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 153, Q194.] Before I get into amendment 11, which aims to address the issue, it is important to understand what clause 2(3) is trying to do. It reads as follows: “For the avoidance of doubt, a person is not to be considered to be terminally ill by reason only of the person having one or both” of a mental disorder or a disability; it refers to the relevant bits of law. As my hon. Friend the Member for East Wiltshire has set out, the words “for the avoidance of doubt” make it clear that this is a clarifying subsection that does not make any change to the rest of clause 2. It appears to be clarifying that mental disorders and disabilities alone will never qualify someone for assisted dying—I think we all concur with that—unless they also have a physical condition that meets the terminal illness test, namely that it is inevitably progressive and irreversible and that the person has a prognosis of less than six months. This is where the problem lies. If someone has a physical condition arising from their mental illness, such as severe malnutrition resulting from anorexia, and if the physical condition meets the definition of a terminal illness, they will qualify. As the Royal College of Psychiatrists said in its position statement: “The wording of the Bill could also be interpreted to include those whose sole underlying medical condition is a mental disorder. While anorexia nervosa, for example, does not itself meet the criteria for terminal illness as it is not an ‘inevitably progressive illness, disease or medical condition which cannot be reversed by treatment,’ its physical effects (for example, malnutrition) in severe cases could be deemed by some as a terminal physical illness, even though eating disorders are treatable conditions and recovery is possible even after decades of illness.” To remedy the issue, amendment 11 would remove the words “For the avoidance of doubt”, to make this a legally effective clause, rather than just a clarifying one. That means that it is providing an additional safeguard to those with mental disorders and/or disabilities. It would also remove the word “only”, to ensure that a physical condition resulting from a mental disorder or a disability will not make a person eligible for assisted dying. The amendment is further bolstered by amendment 283, tabled by the hon. Member for York Central, which would make it clear that comorbidities arising from a mental disorder do not qualify a patient for an assisted death. I thank the hon. Member for Spen Valley for tabling amendment 181 to try to address the issue, but I do not believe that would quite solve the problem, which is quite a tricky one. “For the avoidance of doubt” would still be there, as would “only”. The sentence beginning with “Nothing in this subsection” makes it crystal clear that if a condition meets the six-month condition and the rest of the definition, it will be considered a terminal illness. There is therefore no exclusion for physical symptoms manifesting from mental illness or disability, which I think is what we are all trying to get to. In my view, the only amendment that would address the issue is amendment 11, tabled by my hon. Friend the Member for South Northamptonshire. It would remove both “For the avoidance of doubt” and “only”, and would therefore better ensure that a physical condition resulting from mental illness or a disability does not make a person eligible for assisted dying.