Shivani Raja MP: speeches

Speeches

• 11 Sept 2026 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  As Members of this House, our fundamental obligation, above all political considerations, is to protect those who are most exposed, most vulnerable and least able to advocate for themselves. I acknowledge that colleagues from all parties view this Bill as a measure of compassion, but if compassion is to truly serve the public interest, then it must be paired with rigorous scrutiny and an examination of all consequences of the intended legislation. I voted against this Bill on Second Reading in 2024 and on Third Reading in 2025, and I intend to do so again today. I believe that Government should assist people to live, not to die. Our focus should be on providing hope and support to all those who feel that death is the only way out of a dark situation. That is the purpose of humanity—to preserve life. We should prioritise the improvement of palliative care and end-of-life care, as opposed to directing taxpayer money away from those services and into assisted suicide. Around 60% of the public agree that we should first fix our NHS before even considering whether to introduce assisted suicide into law. I note that during his tenure as Health Secretary, the right hon. Member for Ilford North (Wes Streeting) concurred with that majority in June 2025, describing how such a measure would take time and money that is already in short supply. In addition, our new Prime Minister has outlined his commitment to a new national care service and to implementing reforms to strengthen our existing services. I welcome the fact that this Prime Minister is acting to protect the function of our health and care networks to support our constituents in life, because ultimately the NHS should be saving lives, not taking lives. Our palliative and end-of-life care services are an essential part of our NHS and wider healthcare system. I pay tribute to LOROS hospice, which provides free and high-quality care to terminally ill and adult patients across Leicester, Leicestershire and Rutland. It cares for around 2,500 people and plays an important role in our community in Leicester East, not only in its direct support for patients, but through its provisions to wider families and friends affected by such situations. In its evidence to the Public Bill Committee, it highlighted that there should be one specialist palliative care bed for every 12,000 people, but, with just 22 beds, it has one bed for every 55,000 people. How can I turn around to my constituents and say that they will have a choice other than assisted death against that backdrop?

• 9 Sept 2026 · Pharmacies: Government Funding · Hansard source

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  I beg to move, That this House has considered Government funding for local pharmacies. It is an honour to serve under your chairmanship, Mr Betts. I am pleased to have secured this debate, and I thank colleagues from both sides of the House for joining me to discuss this vital pillar of our primary care network. Community pharmacies are the frontline of healthcare in our constituencies. In Leicester East, they are not just commercial premises but places that serve the very heart of our community. It is estimated that 1.6 million people access pharmacy services in neighbourhoods every day, ranging from elderly residents accessing swift advice to busy families picking up emergency prescriptions and vulnerable constituents using the opportunity to receive healthcare close to home without needing a GP appointment. Despite that, in Leicester East and across the country this crucial sector is reaching a tipping point. Independent economic analysis of community pharmacy finances for the NHS revealed that community pharmacy is facing a funding gap of around £2.5 billion. As a consequence, England lost roughly 1,000 pharmacies between 2016 and 2026, which is an 8% decline. In Leicester East, we have seen our local provision drop from 32 pharmacies down to 29, which is a net loss of 9% of our local community network. Behind the numbers is a harsh reality for a vast number of people. We have to consider not only the impact of small business closures on our local high streets, but the everyday consequences for residents who rely on pharmacies for their care. A loss of three pharmacies may sound like a minor shift, but the real implication is deeply concerning. Fewer pharmacies means longer journeys for frail patients, longer queues at the counters that remain open and increased pressure on nearby GP surgeries that are forced to pick up the slack. We have seen a 19.5% increase in online pharmacies since 2021, and although it is positive that medication and assessments can be accessed in that way, it must be a priority for the Government to protect in-person high street chemists. The closures are obviously not due to a lack of demand. People across my constituency recognise the importance of local pharmacies and use their services constantly. The reason for the closures lies in the structural financial strains that make running an independent pharmacy untenable. My team and I have had several conversations with the owners and staff of pharmacies across Leicester East, and I recognise and thank them for all their hard work on the frontline of our healthcare provision. They have raised several alarming issues; I hope that, by outlining them today, we can collectively commit to positive and constructive changes to support these independent businesses. The current reimbursement model for medicines is the first aspect of the system that fails independent providers. As it stands, pharmacies are expected to buy medicines up front. They can then wait anywhere from two to three months for the NHS to reimburse those costs. To make matters more severe, the NHS reimbursement calculation works on the assumption that pharmacies receive massive bulk-buy discounts from suppliers. Large national chains may possess the purchasing power to make that assumption work, but such bulk discounts simply do not exist for a small, independent community pharmacy in Leicester East. Small pharmacies routinely pay more to acquire necessary drugs than the NHS repays them. Although concessionary pricing mechanisms exist to adjust for market spikes, the delay in the adjustments means that independent contractors are constantly left bridging the shortfall. That disparity forces wholesalers to look overseas for cheaper stock, creating supply chain bottlenecks and leaving local pharmacists to face the frustration of patients when vital medicines are backordered for weeks. The Independent Pharmacies Association recently conducted research that shows that an average pharmacy dispensing 10,000 items a month still faces a shortfall of circa £56,000 compared with what is needed to keep in pace with inflation. Pharmacies cannot be expected to continue to foot this bill. The Government must do more to ensure that pharmacies are properly reimbursed, to prevent further pressure and demand on other areas of our NHS. On top of the margin pressures, pharmacy owners in my constituency are caught in a constant struggle between rising operating costs and completely fixed incomes. Over recent years, overheads have increased right across the board. The recent decisions to raise employer national insurance contributions and the minimum wage and to escalate business rate liabilities have significantly increased the financial burden on pharmacies up and down the country. Furthermore, unlike other small high street businesses, community pharmacies receive no business rates reliefs on their premises—a major oversight for essential healthcare providers operating right at the heart of our local economies. When running costs go up for a normal high street business, such as a local shop, café or dry cleaners, it can adjust its prices to cover higher wage bills and energy costs. Independent communities pharmacies cannot do that. Their primary income is fixed directly by the Government tariff. When employment taxes increase or utility bills rise, independent business owners cannot pass those costs on. They must absorb the loss directly until their reserves run dry. I welcome that our new Prime Minister has introduced business rates relief for the leisure and hospitality sector, but does the Minister agree that we must also introduce further assistance for the pharmacy sector? GP and dental premises benefit from the NHS reimbursement of business rates, while community pharmacies, which also provide vital frontline services, do not. Introducing a form of relief to end the disparity for local pharmacies would make a substantial difference. In addition to the fixed margins, the current funding framework expects community pharmacies to deliver essential services at a financial loss. For example, home delivery services for housebound or vulnerable residents became vital during the pandemic, and remain a crucial lifeline for many elderly constituents across Leicester East, but local pharmacies receive no core NHS funding to run delivery vehicles or pay driver wages. They fund the operations entirely by themselves, committing their own profit to ensure that vulnerable patients receive their medication on time. In addition, pharmacy owners have described how, although the Government support preventive clinical services, the rules and restrictions imposed are unnecessarily constraining. It is positive that vaccinations and immunisation are being moved into pharmacies, but the Independent Pharmacies Association suggests that shifting more flu vaccinations into pharmacies could free up around 4.5 million GP appointments each year. As we approach winter and flu season, the Government should seriously consider the benefits of reallocating services, and ensure that proper funding is in place to back up the increased expectations. Blood pressure screening is another service that is being redirected to pharmacies. It is a simple, cost-effective way to catch cardiovascular issues early and prevent avoidable hospital admissions, yet under the current NHS caps reimbursement is limited to just one check per patient every five years. No small business can survive indefinitely when its costs are rising, its prices are frozen by the Government and it is expected to deliver services for free. This financial pressure feeds directly into an acute workforce crisis. The pharmacy pressures survey published by Community Pharmacy England revealed stark results: 60% of pharmacy teams reported active staffing shortages, and 54% of owners said they were struggling to recruit permanent staff. Crucially, more than 80% reported longer patient wait times and more than half acknowledged that shortages were reducing their ability to offer direct advice. We are also seeing a troubling rise in temporary closures, when a pharmacy must shut its doors for hours or days at a time simply because it cannot secure a qualified pharmacist. The freedom of information data collected by Healthwatch across various integrated care boards revealed that, in a single year, there were nearly 14,000 temporary closures across England, resulting in over 46,000 lost hours of care. Without strategic planning for staffing, the long-term future of our community pharmacies remains deeply uncertain. The Company Chemists’ Association estimates that England could face a shortfall of 16,000 community pharmacists by 2036. While it is positive that thousands of pharmacists have been recruited into the GP practices via the additional roles reimbursement scheme, we must be careful not to strip our high street pharmacies of the very talent they need to remain open. As the long-awaited NHS long-term workforce plan continues to undergo revisions, it is vital that the Government give sufficient priority to the baseline staffing needs of community pharmacy. We know that expanded training targets and the roll-out of independent prescribing qualification upon registration present a real opportunity to expand clinical care on our high streets. Similarly, recent regulatory challenges to allow pharmacy technicians to supply specified medicines and deliver services under the Pharmacy First scheme have the potential to free up valuable pharmacist time. But none of these reforms will succeed if the underlying pharmacy network is allowed to shrink due to unfunded operational mandates. I want to be entirely fair to the Government and to Ministers and acknowledge that we have seen some positive movement in this policy area. Progress is being made, but we must ensure that the pace of our action matches the urgency of the situation before us. The community pharmacy contractual framework—CPCF—settlement for 2026-27 secured almost £3.7 billion for the sector, which is a £340 million increase on the previous year. That builds on the two-year agreement that saw funding rise in previous settlements. Pharmacy trade bodies have expressed concern, however, that the funding uplift will not be sufficient to support the introduction of independent prescribing. We must ensure that the new expectations placed on pharmacies to share services are matched by funding commitments. We have also seen practical relief in the write-off of historic pandemic-era medicine margin debt, and in adjustments to the single activity fee. Furthermore, the roll-out of the Pharmacy First scheme has demonstrated the real appetite for community-level care. Across England, more than 10,900 pharmacies are participating, delivering millions of consultations for common conditions like earache, shingles and minor infections. That is a demonstration of real and effective triage that takes pressure off A&E departments and GP surgeries. However, we must listen to what sector stakeholders are telling us. Community Pharmacy England welcomed the recent funding adjustments as a step away from real-term cuts, but was explicit that this was a “first step” towards stability and not the final destination. The National Pharmacy Association made the same point: structural underfunding means that current settlements will struggle to match the “true cost” of service delivery. The Health and Social Care Committee was blunt in its analysis, describing the current CPCF funding model as “not fit for purpose” and “overly complex”. A major flaw in the scheme is that pharmacies only get paid for many clinical services if local GPs or hospitals actively refer patients to them. In practice, that leaves independent business owners completely dependent on someone else’s admin system, meaning many pharmacies are fully staffed and ready to treat people but receive zero referrals simply because a local surgery is not using the system properly. The current policy framework is simply not delivering for our high streets, and we need an operational model fit for the next decade. If we want pharmacies to continue delivering on the frontline, expanding Pharmacy First, delivering preventive health checks and taking pressure off our local GP surgeries, we must fix the underlying economic model that keeps their doors open. As a Conservative, I believe in supporting small business owners, encouraging enterprise and removing unnecessary administrative barriers. High street pharmacies are independent businesses delivering frontline public care efficiently, but when Government policy sets fixed tariffs while escalating business rates liabilities and employment taxes, it creates a system that actively undermines independent providers. I ask the Minister to address four specific, practical areas today. The first is reimbursement reform. We must review the drug reimbursement formula and concessionary pricing mechanisms, so that payment calculations reflect the actual market acquisition prices paid by the independent pharmacies, rather than relying on assumed bulk discount rates that small independent businesses simply cannot access. The second area is contractual and operational certainty. We need to update the CPCF to ensure that core funding is predictable, transparent and fair, rather than heavily dependent on variable, patchy referral targets managed by NHS bodies over which pharmacy owners have no control. The third area is business overhead and rates relief. I urge the Minister to work with colleagues in the Treasury to address the cumulative tax and cost burden facing small health providers. That includes reviewing business rates liabilities and the impact of the employer national insurance contribution increases on independent high street providers. The final area is workforce and capacity support. NHS workforce planning must balance the expansion of primary care roles with the baseline staffing requirements of high street community pharmacies. As policies such as independent prescribing expand, Ministers must ensure that independent pharmacies are provided with the direct resource and funding needed to put clinical roles into practice safely. Community pharmacies are one of the most cost-effective, high-impact assets that our healthcare system possesses. They keep people well, they prevent avoidable emergency admissions, and they give local high streets across Leicester East and the country vital commercial and civic life. The current approach needs real correction to ensure that independent business owners and patients are properly supported. I look forward to hearing the Minister’s response, and I urge the Government to give our local pharmacies the financial certainty and stability that they desperately need and deserve.

• 9 Sept 2026 · Pharmacies: Government Funding · Hansard source

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  Thank you for your chairmanship of the debate, Mr Betts. I express my sincere thanks to colleagues from across the House who have contributed today. It is a reflection of how valued our local pharmacies are in communities throughout the country, and it highlights the importance of our commitment to improving Government support for these invaluable frontline small businesses. I thank my right hon. Friend the Member for Richmond and Northallerton (Rishi Sunak) for his contribution. He is a long-standing advocate for pharmacies and has witnessed at first hand the value that high street pharmacies bring to our communities and their potential to improve primary care provision. I thank him for his commitment to serving the community, which started at a very young age, as we heard. I am also grateful to the hon. Member for North Somerset (Sadik Al-Hassan) for bringing his experience to the debate and raising the important issue of integration across primary care. I thank him and the hon. Member for Newbury (Mr Dillon) for all their hard work on the APPG. I also thank my hon. Friend the Member for South West Hertfordshire (Mr Mohindra) for his continued efforts and campaigning for community pharmacies. The breadth and range of the contributions reflect how deeply this issue resonates in every constituency in the country. I am grateful to the Minister for her detailed response and for taking the time to address the concerns raised. These initial measures, welcome as they are, must be the starting point for further structural reform. Our local high street pharmacies are independent businesses delivering essential public care right on the frontline, but, as we have heard throughout the debate, they cannot continue to absorb squeezed margins, rising wage bills and uncompensated business rates liabilities while their income remains tightly capped by fixed Government tariffs. To ensure that our primary care network remains resilient, I urge the Minister and her team to take away the four core priorities raised today: reforming the medicine reimbursement model and concessionary pricing mechanisms; updating the community pharmacy contractual framework; collaborating with Treasury colleagues to address the rising overheads; and ensuring that the NHS long-term workforce plan safeguards high street community pharmacy capacity. Community pharmacies keep our constituents well, relieve acute pressures on our GP surgeries and A&E departments, and bring vital commercial life to our local high streets across Leicester East and the entire nation. They are one of the most cost-effective assets in our primary care system, but they require a stable economic foundation to survive. I urge the Government to give our independent local pharmacies the financial certainty, fair treatment and long-term backing they so urgently need and deserve. Question put and agreed to. Resolved, That this House has considered Government funding for local pharmacies.

• 4 Sept 2026 · Infants, Parents and Carers Bill · Hansard source

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  I thank my right hon. Friend for that wisdom, and I could not agree more. As a first-time parent and a young mum, I can confirm that I have felt the pressures faced by many mums across the country. Again, that is why I am grateful to Leicester Mammas for providing guidance in my post-partum journey, including breastfeeding support. They give encouragement to my family and many other families across Leicester, and they have truly grown to be an integral part of our community. The Royal College of Psychiatrists reported in 2024 that up to 85,000 mothers across England had experienced post-natal depression. That is staggering, and it is all happening well within the first 1,001 days of a baby’s life. The last national maternity review, in 2024, described the harsh and devastating reality that three in 10 women reported symptoms of depression, anxiety or post-traumatic stress just six months after giving birth. We have to do more, and that begins with being better listeners. The Bill would enable the Government to continue to monitor the situation for parents and carers, prospective parents and carers, and newborns, but ultimately we have to make sure that our listening is followed up by action. The second component of the Bill would improve the level of accountability in that area. The third element of the Bill focuses on information and support, specifically in ensuring that we introduce a stronger legal foundation beneath the resources and services that families rely on during pregnancy and the first 1,001 days. There sadly remain inequalities throughout our system. The reality in many of my constituency’s communities is that pregnancy and childbirth are far from straightforward. Evidence shows that women living in the most deprived areas die during childbirth at nearly twice the rate of those living in the least deprived areas. Having a firm legal basis for the care that is provided to new mothers across demographic groups will ensure that some of the anxiety is taken out of pregnancy. For many mothers and prospective mothers in Leicester East, that would be life-changing. As a mother with a son who is growing up at an unbelievable pace, I know the reality of both the challenges and joys of the first 1,001 days. However, no country in the world has fully recognised in law the huge opportunity that strengthening the support to families in this early period carries. It would be transformative, and I support the Bill because I know from personal experience as a new mum that, as many mums in this House will also know, parents and carers need more support, and I believe the Government can offer that. We have the evidence to back up the need for the Bill, and we are now presented with the perfect opportunity to lead the world in our approach to championing young families and their children. I urge Members across the House to join me in supporting the Bill.

• 4 Sept 2026 · Infants, Parents and Carers Bill · Hansard source

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  I begin by paying tribute to my right hon. Friend the Member for New Forest West (Sir Desmond Swayne), and I thank him for his continued work and his commitment to this Bill. As colleagues may know, this Bill carries a particular significance for me, as I recently celebrated the first birthday of my son. In fact, today we celebrate him being 395 days old, so I am pleased that Members on the Opposition Benches are taking action to highlight the undeniable importance of those critical first 1,001 days in a child’s life. I hope that Members from all parts of the House will join me in supporting this Bill. In Leicester East, we are fortunate to benefit from an excellent quality of service throughout the Leicestershire, Leicester and Rutland NHS trust. I put on record my thanks to the wonderful nurses, doctors and midwives who supported me through my pregnancy and birth and have supported my son on several occasions since. To be clear, this Bill is not about critiquing the quality of healthcare we receive through our NHS, or placing further demands on the hard-working healthcare professionals who serve on the frontline every day. It is focused on establishing an enduring legal foundation for the best start in life and the healthy babies programme. As my right hon. Friend mentioned, the first 1,001 days of a child’s life are a time of rapid and vital development. During this period, babies strengthen their physical, neurological and emotional capacity, with the brain reaching about 80% of its adult size by the age of two and forming more than a million new neural connections every single second. To support that profound chapter of change in a newborn’s life, babies must be safe and secure. That not only improves the first 1,001 days of their life, but has a lasting impact into adolescence and adulthood. Statistics show that children whose mothers were stressed during pregnancy are twice as likely to experience mental health difficulties during those teenage years. By investing in the measures promoted by this Bill, we change our approach from crisis management to prevention. We will target early support for families to ensure that they are prepared to manage those early days of parenthood, saving billions of pounds of annual spending on public services later down the line. In an ever-changing world, with swift advances in healthcare and technology, we must continue to check in with the parents and carers who are taking on responsibility for these new lives. We must also continue to be available to prospective parents and carers—those who anticipate the arrival of new life with great excitement, but also with great trepidation. Listening is a fundamental part of what we do here, and we have to make sure it stays at the forefront of all decision making in this House. I have been privileged on a number of occasions to spend time with the incredible Sally and her team at Leicester Mammas. They do some amazing work within my constituency supporting mothers through the early stages of parenthood.