Stuart Andrew MP: speeches

In a volatile world, I think we can all agree that energy security is important, but so too is food security. I was interested in the answer the Prime Minister gave to my hon. Friend the Member for North Dorset (Simon Hoare) a moment ago, because in the eastern side of my constituency there is an application for a huge solar farm on prime agricultural land, when on the western side there are huge distribution warehouses with not a single solar panel on their roofs. Will he commit to review this situation, so that we can have a policy that safeguards both our food and our energy?

Well, that was clearly no answer to my question, so let me give it: the Government’s own figures show that the number is higher. Additionally, in response to concerns that I have raised, the Office for Statistics Regulation confirmed that the published figures do not clearly distinguish between patients who are treated and those who are removed from waiting lists without treatment. With consultants now taking strike action and the situation potentially getting worse, how can the Secretary of State prove that patients are actually being seen faster, rather than that statistics are being massaged?

Is the number of patients waiting for admission for an operation or procedure today higher or lower than when this Government took office?

It is a pleasure to serve under your chairship, Dame Siobhain. I congratulate the hon. Member for South Ribble (Mr Foster) on securing this important debate and talking about his personal circumstances. It is always a very moving moment when colleagues talk about things that are so very personal to them. I also pay tribute to the wife of my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois) for the work that she and her team do. It was fascinating to listen to my right hon. Friend. There may have been a bit more detail than I would have wanted to hear, but it told us a lot about the importance of that treatment. I share an ambulance region with the hon. Member for North West Leicestershire (Amanda Hack), so I know exactly what she is talking about and how important it is. I thank her for her work with the APPG, and particularly for highlighting the issue for young people. It is important to remember that heart disease and stroke affect all age groups. I thank the hon. Member for Strangford (Jim Shannon) for his work on the APPG and for his kind words. I visited his constituency when I was a Minister. If only I could have as much love as he gets from his constituents—he is hugely respected. I feel like we will all have to club together to get a bat-phone for the hon. Member for Southport (Patrick Hurley). He made some incredible points, particularly about smoking. I confess that I gave up smoking in February. It was hard, but I know how important it is. I declare an interest. I, too, want to pay tribute to the British Heart Foundation, which was the first charity I worked for in my charity career. I saw at first hand the incredible work it does, particularly on research. I thank it and all the other charities and organisations that are active in this space. As we have heard so often today, heart disease and stroke continue to take people from their families far too soon. The hon. Member for Strangford spoke so powerfully about the 350 people in his area who are no longer around the table. Behind every statistic is a life cut short and a family left grieving, in too many cases in the knowledge that earlier action might have changed the outcome. A person’s chances of surviving heart disease or stroke should not depend on their postcode, income, sex, ethnicity or ability to navigate the health service. If we are serious about reducing premature deaths, the focus must be on prevention, earlier diagnosis, timely treatment, reducing inequality and proper support after the patient leaves hospital. We must begin with prevention, because high blood pressure and high cholesterol can exist without obvious symptoms. People may feel perfectly well while living with a condition that substantially increases their risk of heart attack or stroke. By the time somebody becomes seriously unwell, an opportunity to intervene may have already been lost. Prevention cannot simply mean advising people to live healthier lives. It means identifying those at risk, ensuring that NHS health checks reach the communities that need them most, and making full use of GPs, primary care teams and community pharmacies. Those services need the workforce, the time and the technology to identify risk and manage it properly. Detecting and treating high blood pressure and raised cholesterol must be regarded as core NHS work. The Government inform us that the NHS health check programme prevents about 500 heart attacks and strokes each year, which really is welcome, but the question is whether it reaches those at the greatest risk, including people in deprived areas. We must also recognise the close relationship between cardiovascular disease and kidney disease. Kidney disease affects an estimated 7 million people in the UK. About 60% of kidney patients are diagnosed only in the later stages, when their cardiovascular risk is highest. About 20,000 kidney patients die from cardiovascular disease each year. Early testing for people with diabetes, high blood pressure and cardiovascular disease can identify kidney damage before it progresses. Indeed, Kidney Research UK suggests that less than one in five patients with chronic kidney disease receive SGLT2 inhibitors, despite their potential to reduce major cardiovascular events. Will kidney disease therefore be explicitly included in the modern service framework? What action will the Government take to improve early diagnosis and equitable access to proven treatment? Early diagnosis is just as important for heart valve disease. In the UK, 1.5 million people live with that condition. Again, however, symptoms such as breathlessness, fatigue and dizziness are too often mistaken for the ordinary effects of ageing. That can mean that diagnosis comes only after the disease has become severe, and after irreversible heart damage has begun. Listening to the heart with a stethoscope remains a simple and low-cost first step. Where heart valve disease is suspected, patients need timely access and a clear route to specialist services. Will heart valve disease be explicitly included in the framework? And will the Government consider a single point of access for referrals to specialist valve services? We must also confront the inequalities experienced by women. Cardiovascular disease kills more than 80,000 women in the UK each year, yet women are less likely than men to have their risk factors assessed, slower to receive a diagnosis, less likely to be referred to a cardiologist and also less likely to receive cardiovascular medicines or interventions. Women’s symptoms may simply be dismissed or attributed to stress, hormones or ageing, and women have been consistently under-represented when it comes to cardiovascular research. The Government’s renewed women’s health strategy recognises some of those problems, and the commitment that publicly funded research should properly consider sex-based differences is really welcome. However, such recognition must translate into practice. Will the framework include measurable action to reduce sex-based inequalities in prevention, diagnosis, referrals, treatment and outcomes? And will women’s specific cardiovascular risk factors, including pregnancy history, gestational diabetes, menopause and autoimmune disease, be considered more consistently in NHS health checks and other assessments? As we have heard, every minute matters for stroke patients. The speed of recognition, ambulance response, brain scanning and access to thrombolysis and thrombectomy can profoundly affect a person’s chances of survival and recovery. However, 24-hour coverage has still not been achieved, as my right hon. Friend the Member for Rayleigh and Wickford mentioned. The Government say that progress is being made, but patients need to know when every part of England will have reliable access to this life-changing treatment. Will the Minister set a firm date for that full 24/7 coverage, and will she explain how progress will be maintained while NHS England’s responsibilities are being transferred?

My right hon. Friend is so right. When he was describing its importance, I was thinking about one of my very dear friends who suffered quite a debilitating stroke. I thought, “If only that had been available for him, how different his life might be now.” I thank my right hon. Friend for raising that. Care should not end when a patient leaves the acute ward. Someone who has survived a stroke might need to relearn how to walk, speak, eat and carry out other basic daily tasks. Rehabilitation and continuing community support are essential if people are to regain their independence and reduce the risk of another stroke. The same is true after a heart attack. Cardiac rehabilitation, medication reviews and support to manage risk factors can prevent further illness and save lives, yet access to rehabilitation remains uneven and too many patients experience a cliff edge between hospital and community care. The Government have committed to reducing premature deaths from heart disease and stroke by 25% within a decade. That is a serious ambition, and, where they are taking practical actions to achieve it, they will absolutely have our full support, but it is important that that ambition is matched by a credible plan. In a letter dated 28 May, the Minister said that the framework we are expecting would be published in the spring. That deadline has now passed, so, like others, I again ask when that will be published. Will it contain clear milestones against which that 25% commitment can be judged? Will the Minister commit to regular, transparent reporting to Parliament so that Members can see whether earlier diagnosis, access to treatment and premature mortality rates are genuinely improving? There is much on which Members across this House should agree. We all want fewer families to lose someone they love before their time; we all want patients to receive help before a manageable risk becomes a medical emergency; and we all want NHS staff to have the tools and capacity to provide the care their patients need. Reducing premature deaths from heart disease and stroke is achievable, but only through earlier identification of risk, faster diagnosis, timely treatment and rehabilitation that is available wherever a patient lives. Targets matter, but patients will judge success by whether they receive the right care in time, and that must be the measure of genuine success. They and their families deserve nothing less.

I thank the Secretary of State for advance sight of his statement, and I thank Baroness Amos and her team for their compassionate work. As I said last week, I pay tribute to the women and families who gave evidence and to the babies at the heart of the inquiry. Many revisited the most painful moments of their lives after years of fighting to be heard. Their courage places a responsibility on us all. Last week, the House confronted Donna Ockenden’s devastating findings in Nottingham. Today we face the wider national picture. Successive investigations expose the same failures: women dismissed, deterioration missed, staff silenced, inequalities unchallenged and leaders failing to learn. The problem is no longer a lack of evidence; it is a failure to act. Donna Ockenden said this morning that, sadly, so much in this report is stuff that we already knew. She also raised concerns about waiting until December, and I welcome the fact that the Secretary of State has just announced some of the work. She also said that no commissioner alone can fix a system needing action from every level from the Secretary of State right down to every ward. Donna Ockenden commands enormous respect and we should all listen to her, because she is right. When will the Leeds and Sussex reviews produce their reports, and how will Ministers act on concerns before they conclude, so that families in those areas can see the change that they need as soon as possible? Families should not have to keep proving the scale of harm. Their testimony must now lead to action. The Birth Trauma Association says that the report has overlooked serious injury to women and brain injury to babies, so will the action plan address those harms, and how will families shape and scrutinise it? We welcome the work beginning immediately on triage, discrimination, staffing and urgent estate risks. This is so important, and we must get on with that work, but families cannot wait until the end of the year for the wider plan. Those expecting babies now need reassurance about what will change and when. So many must be anxious, and we need to do all that we can to reassure them. The new triage standards will be published this week. By when must every trust meet them? Will the Secretary of State commit to update the House, by oral or written statement, on trust-by-trust progress? Will the estates funding include accommodation for parents close to neonatal units so that families are not separated from their critically ill babies? We do not oppose a statutory maternity and neonatal commissioner, but Ministers must be clear about the role’s purpose, powers and accountability, because just one person cannot bring the change that is needed; local leaders have a responsibility too. When will the commissioner be appointed, and what will they be able to compel trusts, regulators and national bodies to do? How will local leaders be held accountable when care remains unsafe? The additional midwifery posts are welcome, but temporary roles are not a sustainable workforce plan. Donna Ockenden has warned of rota gaps and of staff leaving obstetrics and midwifery. The 10-year workforce plan has been promised, delayed and pushed back repeatedly. When will it finally be published, and will it provide the permanent workforce that these recommendations require? With women having babies later and pregnancies becoming more complex, how will those at higher risk receive early specialist care? I agree with the Secretary of State that the culture has to change. Listening to women is a clinical duty, not a courtesy; as I said last week, it is at the core of our safety issues. When concerns are dismissed, warning signs are missed, and mothers and babies are put at risk. That duty must apply equally in respect of every woman. A woman’s safety must not depend on her ethnicity, first language, disability, income or ability to fight through the system. As I said last week, both to the House and to the Secretary of State privately, I want us to work together constructively. Where the Government act with the urgency that the report demands, they will have our full support. We all have a duty, and ours is to support these changes. Women and families will not judge today by new structures, promises or another report. They will judge it by what happens when a woman says that something is wrong. Is she heard? Are warning signs acted on? Is senior help available when needed? Are maternity units safely staffed? Can staff speak without fear? Do families receive honesty and compassion when harm occurs? Are fewer mothers and babies coming to harm? When decisions are taken, will they be fully explained? The evidence has been gathered. Families have told their stories. The system has been warned. Now it must change.

I thank the Secretary of State for advance sight of his statement and Donna Ockenden and her team for the care and compassion with which they conducted the review. We had a meeting with her yesterday, and I have to say that it was probably one of the most difficult meetings that I have ever had. I pay tribute to the hon. Member for Sherwood Forest (Michelle Welsh). I can see how deeply personal and painful this is, and I admire her and all her colleagues from the region at what must be a very difficult moment. Let me say from the outset that I want to be constructive in opposition when it comes to this issue. We need to work together; we have to see improvements. I begin with the women, babies, fathers, partners and families whose lives sit behind the review’s findings. To them, we owe a profound apology for failing them when a family should feel safest, most supported and most able to trust the care around them. For too many, that trust was broken; women were not listened to, families were not believed and warning signs were missed. Some suffered the deepest lost, others were left physically unsafe and others psychologically scarred. No statement can repair that pain, but it can mark the point at which testimony becomes responsibility, and responsibility becomes action. The painful truth is not only that the failings occurred but that the themes are familiar: women not heard, families dismissed, poor communication, missed deterioration, weak governance and people unable to speak up. Maternity and neonatal safety has challenged Governments of both parties, but it would be wrong to let that history soften the urgency. Women and families are tired of telling their story, hearing promises and seeing the same themes return. The question is whether the system will move because of this review, and so I put three tests to the Secretary of State. The first is the listening test. Women and families were not consistently listened to. Their concerns were too often dismissed or not acted upon. That is not a soft issue; it is a safety issue. How will the Government embed listening as a clinical discipline? How will trusts measure whether women feel heard? Will complaints and near misses be treated as information for improvement? The second is the culture test. The review describes bullying, hierarchy and poor psychological safety affecting staff’s decisions and willingness to escalate. I pay tribute to those who were brave enough to do so. In maternity and neonatal care, minutes matter. If staff cannot challenge, safety is weakened. Staff cannot provide the care they want to if they are exhausted or unsupported, or if hierarchy matters more than candour. So I ask: how will boards be held accountable for that ward culture? The third test is the delivery test. Harm rarely followed one error; it usually followed a chain of poor communication, weak risk assessment, delayed escalation, staff pressure, inadequate governance and missed learning. The response cannot be a single announcement. It must be accompanied by a delivery plan, so will the Secretary of State publish a national implementation plan with named accountability, delivery dates and regular updates to this House? That plan must address the workforce so that staff have the support and information they need to fulfil their roles to the ability they wish. That plan must design services for today and the future, not rely on assumptions from the past. Women are having children older, pregnancies are more complex and more women are entering pregnancy with pre-existing conditions, previous loss, fertility treatment, mental health needs or circumstances shaping care. That means a need for practical, personalised care, informed choice and each woman being treated as a whole. The review also requires us to confront inequalities. The safety of a patient must not depend on confidence, class, ethnicity, language or an ability to fight through the system. The issue with our mortuaries is also really shocking. The horror stories that we have heard must never happen again. Is the Secretary of State working with colleagues in the Department of Justice to see what more needs to be done to overhaul this area? Finally, we must recognise the psychological harm caused through silence, poor communication, lack of bereavement support and the battle for honesty. We know that our mortuaries need to have the highest standards. Compassion after harm is not a courtesy; it is a duty. Trust is rebuilt when women feel the difference in the room, when words change decisions, when staff speak without fear, when risk is escalated in time and when boards are judged by results. Where the Government act to improve safety, accountability, staffing and family voice, they will have our support so that we can see this through together. Where they do not, they will face our scrutiny. This review began with families who had to fight to be heard. The task now is to ensure that no family has to fight so hard again.

I am going to continue because I want to give the Minister the opportunity to respond. The Secretary of State says that this trial will help settle the evidence, but a trial that follows children for a limited period cannot by itself settle questions that may only become clear in adulthood. It cannot fully answer the questions of what a child will think at 25, 35 or 45 about decisions that were made at 11 or 12. When I was in my teens, struggling with my sexuality, it was complex enough. It was emotionally draining. It was scary. I cannot imagine how much harder that would have been if someone had added to the mix by telling me that maybe it was not my sexuality but my gender. This is why we must listen to people like Keira Bell. We must not confuse the creation of some evidence with the resolution of all uncertainty. The Opposition’s approach is careful, proportionate and child centred. We must pause this trial, complete the analysis of existing data, publish a full account of the known risks and unknowns and strengthen non-medical support. Then, and only then, should we consider what further research should be ethically justified. This is not abandonment; it is protection. The first responsibility of any health system is not to validate every proposed treatment, but to ask whether that treatment is safe, necessary and in the long-term interests of the patient. When the patient is a child, that responsibility is heavier still. We owe these young people more than good intentions. We owe them caution. We owe them honesty. We owe them services that see them in the round, and we owe them the humility to admit that when the evidence is uncertain, the answer is not to press ahead and hope; the answer is to pause, learn and protect. For those reasons, I urge the House to support this motion.

This has been an important debate. It has been a difficult debate, but a necessary one none the less. There are some subjects in public life where the easiest course is silence, where every word is weighed, where motives are questioned and where hon. Members may be tempted to step back rather than step forward, but when the subject is the safety of children, silence is not an option. Children and young people are at the centre of the debate. They are not slogans or political symbols to be used by either side of any argument; they are children, and often vulnerable children experiencing distress that can be profound, complex and deeply painful. They need kindness, patience and support from adults who listen and act responsibly. They need services that are timely, professional and compassionate. Compassion is measured not by how quickly we medicalise a child’s distress but by whether we protect the child’s future and respond to their present pain. That is the heart of the debate. Sadly, those of us who are concerned about this trial are often labelled as transphobic. Personally, I find that offensive. Child safety matters to me, and so does equality for trans people, but we have to think about children. The Government ask the House to accept that the Pathways trial is the responsible way to build evidence. Ministers say that it is a carefully controlled study, that safeguards have been strengthened and that only a small number of children will be involved. But the question before us is not whether research matters—of course it does—but whether this particular trial involving children as young as 11 and 12 is the right and ethical way to proceed. We on the Conservative Benches do not believe that it is. My position is rooted in a simple principle: when evidence is uncertain, risks may be lifelong. When the patient is a child, the burden of proof must be exceptionally high. That is not ideology; that is good medicine. The Cass review changed the debate because it brought clarity to a field that had been allowed to drift for too long. It found weak evidence, poor data, inadequate follow-up and a service model that too often failed to look at the whole child. It was the previous Government who treated those findings with the seriousness that they deserved. The routine prescription of puberty blockers on the NHS was ended because the evidence did not justify the practice. That was not a rejection of vulnerable young people; it was an act of safeguarding. The Government now say that this trial is different. They say that it is not routine prescribing and that there will be monitoring, consent, assessment and withdrawal criteria. Yet process cannot answer the central moral question: can a child, at the start of puberty, truly understand the impact of interrupting that stage? Can an 11-year-old meaningfully consider questions of fertility, bone development, cognitive effects, sexual function and future regret? Can a parent, faced with a distressed child and a desperate sense of need for relief, rationally navigate the uncertainty without enormous pressure? Those are not abstract questions; they go to the integrity of consent itself. In most areas of medicine, when the risks are serious and the benefits uncertain, we become more cautious, not less. We do not reassure ourselves merely because the cohort is small, or say that because only a limited number of children may be exposed, the ethical concern is reduced. For each child in the trial, the consequences are enormous and personal. For each family, the decision is life-altering. For each future adult, the question may one day be, “Did the people in authority protect me properly?” The Secretary of State has said he feels “discomfort and unease”. I welcome that honesty, and I believe it to be heartfelt. Yet discomfort in this area should not be something that Ministers try to manage away; it should make them stop and think again. Unease is sometimes the proper response of conscience. The Government point to safeguards, but safeguards are not the same as certainty. Monitoring every three months may identify some problems, but it cannot guarantee that long-term harm will not emerge years later. Objective withdrawal criteria may be better than vague discretion, but they do not remove the risk of treating a child unnecessarily in the first place. The Government have still not answered a fundamental question: why proceed now before the existing evidence has been fully examined? There are children and young people who were treated under previous services. There is data that may help us to understand outcomes. There is a Tavistock-related evidence base that should be completed and analysed before more children are exposed to puberty blockers in a new trial. Surely the first duty is to learn from what has already happened and therefore potentially identify wherever there may be gaps. That is not obstruction; it is responsibility. The Government must not ignore the wider context. Many children who experience gender distress also have other needs: mental health difficulties, autism, trauma, family pressures, anxiety, depression, eating disorders or safeguarding concerns. Dr Cass was clear that services must look at the whole child and not just one aspect of identity. We should not accept a system that is slow to provide holistic support but prepared to move ahead with powerful medical intervention under the banner of research. The House must be honest about the tone of this debate. There will be young people listening who will be feeling frightened by it. There will be parents listening who feel judged. There will be clinicians listening who are trying to do their best in a difficult and contested area. Let us be clear: our concern is not with the dignity of any child—their dignity is beyond question. Our concern is with the decisions made by adults in positions of power. Children deserve adults who can hold two truths at once: that their distress must be taken seriously, and that serious distress does not automatically justify experimental medical treatment.

I can assure the hon. Lady that I have given this an enormous amount of consideration. I understand what she is saying, but my argument is that we already have a set of data on children who have gone through some of these experiences, and that needs to be looked at. Having spoken to some of them, I do not want to see others experience it.

It is a pleasure to serve under your chairmanship, Mr Mundell. I thank the hon. Member for Sunderland Central (Lewis Atkinson) for opening this important debate on behalf of the Petitions Committee. The debate is an example of Parliament at its very best. I also acknowledge Jesy Nelson and her tireless efforts to raise awareness of spinal muscular atrophy following her twin daughters’ diagnosis with the condition. Little Mix have long used their platform to support a wide range of charitable causes, and I express my sincere thanks for their continuing to do so. However, to open up about something so deeply personal goes a step further. I also pay tribute to all the other families who have opened up to so many Members of Parliament. I have often spoken about my time working in children’s hospices, and it was always the families’ stories that made compelling cases for the extra support that was needed. I acknowledge the work of Spinal Muscular Atrophy UK, whose dedication to supporting individuals and families affected by SMA continues to make a meaningful difference in countless lives. In this country we are lucky to have so many wonderful charities that help families through difficult times. As we have heard, SMA is a progressive condition that causes muscle wasting and weakness. It is a most awful condition that is not reversible with treatment and, as we have heard, there are several types. SMA type 1, which my right hon. Friend the Member for Melton and Syston (Edward Argar) talked about Harvey having, is a severe form that develops between birth and six months of age. Without intervention, life expectancy is often less than two years. Type 2 develops between six and 18 months of age; children usually cannot walk unaided and may suffer respiratory complications into adolescence. Type 3 develops after 18 months of age; individuals can usually walk independently, although that may become progressively more difficult over time. Before 2019, there were no effective drugs available on the NHS to treat the condition. However, over the last seven years, three transformative treatments that can stop SMA in its tracks have become available on the NHS: one is administered by a lumbar puncture every few months; the second is gene editing infusion; and the third is a treatment that patients must take orally for the whole of their lives. There is encouraging evidence that those treatments really are helping. We have heard that SMA cannot be reversed, but NHS data from 2023 shows that children with SMA 1—the most severe form of the condition—are now surviving for longer. For families affected by an SMA diagnosis, time is everything, so that is an important start. When I worked in children’s hospices, I saw so many families go through incredibly difficult times. As the hon. Member for Portsmouth North (Amanda Martin) mentioned, it is not just about caring for a child; there is the impact on relationships, family finances and even sleep. I remember one father saying to me that if he got up eight times in the night, he considered that a good night’s sleep. We had a saying in the children’s hospices: while we cannot add days to their lives, we can add life to their days. However, in this case we can literally add days to their lives, and we really should do so. I agree with my right hon. Friend the Member for Melton and Syston that the Minister is very diligent and clearly cares, but will she tell us how many babies and children are currently receiving the drugs I mentioned from the NHS? Will data continue to be collected to give us fresh insights into the effectiveness of those drugs over time? While the damage inflicted by SMA is irreversible, if treatment is given before symptoms begin, that damage can be prevented. Screening can therefore be an absolute lifeline for babies and families if SMA is caught early. That is why we welcome the UK National Screening Committee’s recommendation to introduce in-service evaluation, which will see newborn screening for SMA trialled in the UK, and the role that the former Secretary of State, the right hon. Member for Ilford North (Wes Streeting), played in all that. It is a positive step forward. I want to add my voice to those of other Members today, and put some questions and points of clarification to the Minister. The ISE, recommended by the National Screening Committee, will evaluate newborn screening for SMA for some newborns in England, commencing in October 2026. However, as we have heard, reports suggest that about one third of newborns will initially not be included. Will the Minister explain the logic behind the choices that have been made? As I understand it, the seven NHS newborn screening laboratories in England that will undertake screening are in Birmingham, Great Ormond Street, Manchester, Newcastle, Sheffield, south-east Thames and south-west Thames. Government statistics do not suggest that babies born in those regions are more likely to have SMA, and there appears to be no correlation at all between instances of SMA and the location of the centres chosen to screen newborns for the condition. I could also find no correlation with the efficiency of delivery for the screening programme. That begs the question: what is the rationale for choosing just those centres, and why have others not been chosen? A baby born today who is screened and treated straight away is likely to walk at three years old. One born in a non-screened area, who is treated only when they become symptomatic, is very unlikely to walk and may not even be with us for very long. NHS England is responsible for organising the screening, but we know that the Government are going through with its abolition, along with the reorganisation of integrated care boards, so what assessment has the Minister made of the impact the restructuring may have on the capacity to deliver screening? That is an important point to bear in mind. There are other conditions that are excluded from newborn screening, such as metachromatic leukodystrophy. I met a mother who has been campaigning hard on that, along with other campaigners. Will that condition and others also be included in newborn screening in the UK? Surely we should help if we can, because, as I say, the impact is really difficult for those children and their families. I am a huge fan of early intervention, so if we can do something about it early on we should—I cannot remember which hon. Member said this, but even if we just look at it through the hard lens of finances and public money, we would save a huge amount of money over the years. It is desperately sad to see babies and their families affected by SMA. I hope that the Minister can provide some reassurance to those families that the forthcoming screening that they have long been fighting for will be fair, effective and accessible to all newborns in the UK. As I mentioned, the families I used to work with in children’s hospices would often say that, when their child was born or diagnosed with whatever condition it may be, their hopes and dreams for their child changed. When the baby was first born, they thought about the first day at nursery, primary school or secondary school, and then doing exams, going on to get married and have children and so on, and suddenly those dreams had to change because their life would be different. If we do this screening, some of those families, can keep their original dreams and we can add days to the lives of those children.

I am sorry, but that was simply waffle. This matter needs decisive action now; these drugs are absolutely critical to some children. This cancer drugs tax has already closed one scheme, and companies are making real-time decisions now about whether to continue programmes in the United Kingdom. The Secretary of State must urgently get the Treasury to exempt compassionate use medicines permanently, so that the patients in most need can get these vital drugs, which, in some cases, are simply their only hope.

I begin by welcoming the Secretary of State and the Under-Secretary of State for Health and Social Care, the hon. Member for Birmingham Edgbaston (Preet Kaur Gill), to their places. The Secretary of State was in the Treasury when it imposed VAT on compassionate access medicine programmes, which provide some patients—especially children with cancer—with a vital last chance to access treatment. The policy has already led to the closure of one scheme. Will he now commit to abolishing this tax before any more follow suit?

Do you know, I am going to cry in a minute! I thank the hon. Gentleman, although that is the second opportunity he has missed to mention Harlow—I am getting worried about him! [ Laughter . ] As I was saying, that experience has stayed with me; it reminds me why progress matters and can never be taken for granted. Prejudice may look different today, but it has not vanished. There are still people around the world, and some people in this country, who cannot come out or live the life they want to live. That is why Pride is not just a month in the calendar; it is a statement that those people are not forgotten. It is also why what happens in this House matters. The law can change lives. It can tell people whether they are recognised, protected and valued. That is why the passage of the equal marriage Act in 2013—the Marriage (Same Sex Couples) Act—remains one of the proudest moments of my time in Parliament. No party has a monopoly on progress. People from all parties and none have fought for the rights and dignity of LGBT people. I am proud that Conservatives played a part in delivering equal marriage and I am proud of the progress that Conservative Governments made on HIV prevention, testing and treatment, including HIV Testing Week and the legalisation of HIV self-testing kits. I also want to pay tribute to the Terrence Higgins Trust and its CEO Richard Angell, and all those who have been campaigning to end new HIV transmissions by 2030. As the shadow Secretary of State for Health and Social Care, I absolutely back the Government in their ambition to see that happen. When I was growing up, I never thought that we would see the end of it. It was so terrifying at the time and the fact that we now have that goal in sight is truly remarkable and wonderful. I also want to say clearly as the shadow Secretary of State for Health that LGBT health matters. That means keeping a strong focus on HIV prevention, testing and treatment, making sure that stigma continues to be broken down, recognising the particular mental health pressures some LGBT people face, and ensuring that everyone can use the NHS without fear, shame or discrimination. It also means remembering older LGBT people, including those who lived through the AIDS crisis, who should never feel forced back into the closet when they need social care or support later on in life, or if they end up in residential or nursing homes. I know that that has been happening and it is something we need to address. I hope the Minister, when winding up, might be able to update the House—she mentioned some of the continuing work on HIV prevention—on how that progress will be maintained, because the clock is ticking and I am conscious that there is still quite a bit to do, and update us on what work the Government are planning to do on older LGBT people as we think about their care needs in the future. I, too, want to address the Equality Act code of practice and the Supreme Court ruling, because they have been very prominent in recent days. The law is now clear that for the purposes of the Equality Act, sex means biological sex. Single-sex spaces must be protected where they are needed, particularly where privacy, dignity and safeguarding are at stake. That clarity matters for women, service providers, staff who need to know what the law requires of them, and the NHS. Decisions about female wards, intimate care, changing rooms and women-only services cannot be left to confusion or inconsistent local interpretation. We should also be able to and capable of saying two things at once. We can say that sex means biological sex and that single-sex spaces must be protected, and we can also say that trans people must be treated with dignity, respect, compassion and love. Those positions are not mutually exclusive. They are both part of a serious, humane and lawful approach. I hope the Minister can set out what the code of practice means in practice for the NHS, including for female wards and the other issues I have mentioned. NHS staff, patients and trusts need clarity on how the law should be applied. This House should be able to approach these issues without pretending they are simple, and also without pretending that clarity is unkind. That is why I think it is a mistake when Pride events suggest that political parties should have no place in them. The banning of political parties from some Pride events is disappointing, because Pride does not belong to one political tribe. The people elected to this House, and the LGBT organisations in all our parties, have helped to deliver real change. I pay tribute to them all and thank them for what they have done. LGBT people are Conservatives, Labour members, Liberal Democrats, Greens, nationalists, independents, and people of no political party at all. They should not be made to feel unwelcome. In fact, I want to see more gay and lesbian people in politics. Banning political parties from Pride flies in the face of its meaning, in my view. I want to mention lesbians specifically, because too often their voices are treated as an afterthought in debates about LGBT rights. Lesbian women have been central to the history of Pride, activism and community life. Their experiences matter in debates about healthcare, safety, dignity and sex-based rights. Pride Month should never allow the L in LGBT to become silent. No one should have to hide who they are in order to feel safe. That means taking anti-LGBT hate crime seriously. Too many incidents still go unreported because people think they are too minor or worry they will not be taken seriously. They should be taken very seriously indeed, and that is true in sport, schools, workplaces, healthcare, families and public life. Pride is a celebration of how far we have come, but it is also a promise that we will remember those who came before us, stand with those who still feel alone, and help the next generation live more freely, safely and honestly than the last. That is what Pride Month means to me, and that is why this debate matters.

May I begin by apologising to Members? I have sought permission from Mr Speaker to leave early today, because I have a long-standing event in my constituency that I have to attend. I apologise that I will not be here— [ Interruption. ] It is not to do with Pride, I am afraid. I am very happy to be leaving the rest of this very important debate in the capable hands of my hon. Friend the Member for East Grinstead and Uckfield (Mims Davies). What a pleasure it is to follow the Minister for Equalities, the hon. Member for Reading West and Mid Berkshire (Olivia Bailey). She made a really great and very personal speech. I am equally grateful, on behalf of His Majesty’s Opposition, to have the opportunity to open this important debate, because Pride Month is a celebration. It is a celebration of the progress that has been made, of the lives lived openly, of families formed, of communities built and of people who no longer have to hide who they are, but it is also a reminder of why that progress was necessary in the first place and why it can never be taken for granted. For me, this debate is deeply personal. I have seen changes in my lifetime that I could never have imagined when I was growing up as a young gay man on the isle of Anglesey. Back then, community was not always easy to find. I have joked before many times in this House that it often felt like I was literally the only gay in the village. But behind the humour is a serious point: for many people, particularly in small towns, in families, workplaces or faith communities, being LGBT can still feel a very lonely place indeed. That is one of the reasons why Pride still matters. I am very proud of my good friend and former Member of this House Eric Ollerenshaw, who was one of the first five people on the very first Pride march back in the early 1970s. He describes how, at the time, even the police were spitting at them—just unbelievable when we think about that today. Pride is not only about big parades, flags and public celebrations. It is about the teenager who feels completely alone; it is about the person who is quietly calculating every single word they say. I have spoken before about being attacked and hospitalised when I was younger just because of who I am. Walking down that road, being followed by three men, being called a queer and knowing what was coming next was terrifying. I am so glad that we now live in a country that has changed enormously since then.

The hon. Gentleman raises an important point, and it is exactly the sort of issue that will need further scrutiny in Committee. I note that local authorities will not have the same seat at the table and that it will be transferred for mayoral regions, but what about regions that do not have a mayor? That measure will create a real democracy deficit in the NHS. I hope that we can look at this in detail in Committee, because that serious oversight absolutely needs addressing.

Yes, and this is— [ Interruption. ] It is slightly patronising to say to someone, “Read the Bill”. Clearly my hon. Friend has, and we have been talking about this in great detail. There is a real concern here. We need much clearer answers to these questions, which many of our constituents will have. Those who give up their time to work in organisations to make the NHS better deserve decent answers to those questions and concerns. I certainly hope that reflection will be taken on those points. At its heart, the Bill is not simply a debate about technology or bureaucracy; it is about who holds, controls and safeguards the most personal data that any of us will ever possess. This is one of the most significant reorganisations of the NHS in modern political history, but it is wrapped carefully in the language of managerial simplification. Perhaps part of the Bill will help, and of course some reforms are necessary. Conservatives are not afraid of reform—definitely not. Indeed, if the NHS is to survive the demographic, technological and fiscal pressures ahead, modernisation is essential. That is because technology matters, innovation matters, integration matters, data matters, prevention matters, productivity matters and, yes, accountability matters too. That is why, where we see good work in the Bill, we will back it, and where we think there are questions that need to be drilled down into, we will do so. We want to ensure that the Bill works. There is a difference between modernisations rooted in political realism and announcements designed primarily for political theatre, and too much of the approach we have seen so far is Whitehall talking to itself; meanwhile, outside this Chamber, reality continues uninterrupted. Patients still wait, ambulances still queue outside A&E, the family still worries, the exhausted nurse still works a double shift and the GP still battles impossible demands. Here is the truth: the NHS does not primarily suffer from a shortage of announcements; it is marked by a persistent lack of grip and direction. The Government today increasingly resemble a man frantically changing labels on a filing cabinet while the building itself quietly catches fire. The Government say that abolishing NHS England will reduce bureaucracy—perhaps it will—but let us not forget that Whitehall sometimes possesses a remarkable historic talent for abolishing bureaucracies ceremonially before quietly recreating them under another name with slightly different headed paper. We need to ensure that that does not happen in this instance. We also have to think about the huge amounts of public money involved—yes, nearly £202 billion; an extraordinary sum of money. We understand that pressures rise—of course we do—we understand about ageing populations, we understand that medical advancement increases costs and we understand the aftershocks of the pandemic. But when a Government spend record sums while presiding over delays, workforce uncertainty, transformation paralysis, productivity collapse and public frustration, eventually the British public are entitled to ask a simple question: where has all my money gone? The Government are not judged by the size of the press release; they are judged by whether the thing actually works. We must now do everything to ensure that the Bill goes through with great scrutiny, as it needs to do, because healthcare is difficult, trade-offs are real and workforce shortages cannot simply be rebranded as opportunities. Indeed, the public increasingly suspect something very different here: they suspect that too much of modern politics has become performance without consequences, announcements without accountability and presentation without delivery. That is ultimately why the Bill matters. If this enormous centralisation of power succeeds, Ministers will claim vindication, but if it fails and bureaucracy persists, waiting lists remain stubborn, workforce pressures deepen and promised transformation dissolves into another cycle of reorganisation, the Government will no longer possess anyone else to blame—not NHS England, local structures, quangos or the system—because the Bill places responsibility squarely where the Government claim it belongs, on the shoulders of Ministers. Perhaps that honesty will prove the Bill’s greatest contribution. The British people are patient, but they are not naive. They can distinguish between serious transformation and political choreography, and they increasingly understand that there is no technological shortcut around the fundamental challenge facing healthcare. The Government cannot run a service this large, pressured and so deeply connected to people’s lives and wellbeing primarily through presentation. Eventually, every Government collides with reality, and reality—unlike leadership campaigns—cannot be managed through slogans. That is the inheritance facing the new Health Secretary, and that is why the House should approach the Bill not with breathless excitement but with very hard-headed scrutiny indeed so that we get the NHS we all want to see.

I am genuinely concerned about that. Members of Parliament from across the House have often brought to the House some very serious cases—things that have gone terribly wrong for their constituents, services that have been commissioned in their area, and awful things that have happened to patients. It is because of organisations like Healthwatch and the HSSIB that those issues have come to light, and work has gone into improving those services. That is what we all want to see, but I am really worried that that progress will be lost. If those functions are absorbed into the Secretary of State’s office, I really do not think it will be able to cope with the sheer volume. It needs to be done on a much more localised basis.

My hon. Friend raises a very important point; it is an area that the Committee will have to look at very carefully. I listened carefully to what the Secretary of State said, and I believe that he wants there to be a patient voice, but there is a serious flaw in the Bill. Abolishing Healthwatch and HSSIB is a terrible mistake, and I praise my hon. Friend the Member for Harwich and North Essex (Sir Bernard Jenkin) for the work that he has been doing on this. The reality is that HSSIB gives members of staff who work in the NHS the confidence to come forward and be a whistleblower. We need that. We need people to feel that they are in a safe environment. The CQC is a totally different beast in the minds of people who work in the NHS and social care, so to put those functions within that organisation is a terrible mistake and one that I hope the Committee will look at very carefully.

I begin by welcoming the Secretary of State to his new post, and thank him for sharing his very personal story about what the NHS means to him. I look forward to our future exchanges, however long he is in post. I also pay tribute to the former Health Secretary, the right hon. Member for Ilford North (Wes Streeting), with whom I have had a few moments across the Dispatch Box. I know that the NHS has also been very important to him personally. During my time in hospices, I saw the incredible work that the NHS does, and despite the politics that we may have—and I will be referring to the right hon. Gentleman a bit more later on—we all care deeply about the national health service and want the very best for it. There are moments in politics when one almost has to admire the confidence of Governments—not their competence, necessarily, or their judgment, and sometimes not their timing, but certainly their confidence—and nowhere has that confidence been more magnificently displayed than in the presentation of the Health Bill. If one had listened carefully to the former Secretary of State for Health and Social Care over the past two years, one could conclude only that this Bill was not merely legislation, but apparently the parliamentary equivalent of the second coming. In every speech, interview and carefully staged hospital visit with sleeves rolled up, they delivered the same message: at last—at long last—the NHS was to be modernised, integrated, digitised, streamlined, revolutionised and transformed into a gleaming technological marvel, where patients floated frictionlessly through a system powered entirely by innovation, efficiency and ministerial self-belief. I say gently to Ministers that whenever a politician begins using the phrase “once-in-a-generation change” on such a regular basis, it is usually wise to place one’s hands protectively over one’s wallet, given the sheer cost of what is to follow. What became increasingly striking was not simply the scale of the promises, but the sheer showmanship of them, with the former Health Secretary speaking less like a Cabinet Minister wrestling with one of the most complex public services in the world and more like a man auditioning to narrate the trailer for his own leadership campaign documentary. And now, Madam Deputy Speaker, we arrive at the great political twist: the man who spent two years announcing the future has departed before the delivery date arrived, like an architect unveiling magnificent blueprints before quietly moving abroad just before construction begins. Into this situation walks the new Health Secretary. Members can imagine the scene: the Prime Minister sits stubbornly in No. 10, grinning with all the reassuring confidence of a man standing knee-deep in a flooded rowing boat insisting that the situation merely requires a modest redistribution of water. Into this bunker is summoned the new Secretary of State—formerly the Chief Secretary to the Treasury, the very man who helped to allocate the famous £202 billion funding settlement now repeatedly cited as proof that every problem in British healthcare has theoretically already been solved.

Well, let me say directly to the right hon. Gentleman that there have been a lot of announcements from the Government. We know all about the fall in waiting list figures, and not just from comments from us in this Chamber challenging what is really happening—we are receiving email after email from people who have been taken off waiting lists despite still needing treatment. Patients are being taken off waiting lists, sometimes without their knowledge. This has not been about more appointments for patients—it is about massaging the figures, and he knows it. There is a lot in this Bill that we will support, and there are many areas where we would like the Government to perhaps go further, but there is also a rhetoric that needs to be addressed, because there are unresolved problems still. Social care is unresolved. Workforce pressures are unresolved. Mental health backlogs are unresolved. Productivity is unresolved. Pharmacy pressures are unresolved. GP satisfaction is unresolved. The Secretary of State is inheriting not just a Department but an expectations crisis, because the greatest danger in politics is not under-promising; it is convincing the public that complexity itself can be announced away. The Bill abolishes NHS England and centralises significant powers to be governed by the Secretary of State. It takes control out of patients’ hands.

“Yes—the pathway to No. 10.” And now I will give way to the right hon. Member! [ Laughter. ]

That is exactly one of the issues that needs to be ironed out. I am sure that the hon. Gentleman will ensure that the Committee considers the impact for devolved Administrations, particularly where they have responsibility for health in their areas. I hope that he will raise that with members of the Committee.

Give me time, give me time. “Well, indeed, Minister,” says Sir Humphrey. “I understand,” says the Secretary of State, “that abolishing NHS England will instantly reduce bureaucracy, improve accountability and unleash vast efficiencies.” “Well, Minister, it will certainly create a large number of meetings.” “And the single patient record will revolutionise healthcare, won’t it?” “Yes, Minister—assuming the NHS IT systems eventually stop communicating with each other via what appears to be medieval semaphore.” “But we have delivered 5 million more appointments.” “Certainly, Minister—only 1.5 million appointments behind the last Conservative Government.” “And integrated care boards now answer directly to Ministers.” “Yes, Minister.” “So accountability is now indisputable.” “Well, Minister, blame certainly is.” And so the conversation goes on. The Secretary of State asks, “And what about the workforce plan?” “Still developing, Minister.” “And social care?” “Still delayed, Minister.” “And mental health implementation?” “Still proceeding at approximately the speed of continental drift.” “And pharmacies?” “Still under pressure.” “And GP contracts?” “Still alarming GPs.” “And productivity?”, the Secretary of State asks desperately. “At present, Minister, the NHS measures productivity in the same way that astronomers in ancient Greece measured distant planets: with great optimism and very limited visibility.” At this point, the Health Secretary clearly begins searching the office for the exit map. “But Sir Humphrey,” he says, “surely my predecessor left me with a fully deliverable programme.” After a long pause, Sir Humphrey replies, “Well, your predecessor was primarily focused on a different pathway.” “A different pathway?”

I am talking about trying to get accountability down to the local area. That is where it matters, and that is where my constituents want to see it. They know their local services and the hospitals in their areas, and they are the ones who should have their voices.

I would point the hon. Lady to how the NHS was being run in Wales—it certainly was not the great success that she is trying to allude to. In politics there are difficult jobs and there are impossible jobs, and then there is inheriting a Department after one’s predecessor spent two years promising the electorate that this is the one Bill to rule all Bills and fix virtually everything short of death itself. This was not just a hospital pass, but a hospital pass delivered by catapult. One can almost hear the poor Secretary of State gulping. “Thank you, Prime Minister,” he replies faintly, in the tone of a man accepting command of the Titanic after it has already struck the iceberg. Off he trudges to the Department of Health and Social Care, where the automatic doors open and his nostrils are struck immediately by a strange, lingering aroma. It is not the scent of modernisation or the smell of efficiency, and it is certainly not the fragrance of falling waiting lists. No—it is the unmistakeable odour of political panic, mixed delicately with the perspiration of failed leadership manoeuvres and lightly seasoned with the ashes of abandoned promises. There waiting for him, naturally, is Sir Humphrey—because however much Governments modernise, digitise, integrate, recalibrate or synergise, Whitehall always produces a Sir Humphrey. I can imagine the conversation. The new Secretary of State says brightly, “Good news, Sir Humphrey. I understand that my predecessor has already solved everything through the Health Bill.” At this point, an eerie silence descends. Civil servants suddenly become more fascinated by ceiling tiles, and one junior official attempts to escape through a stationery cupboard. Sir Humphrey clears his throat in the way only permanent secretaries can; a sound rather like an early—

I gently remind the hon. Lady that it was the former Secretary of State who said that he did not want to go through another reorganisation, because it would be very costly. We still cannot get a clear answer from the Government about how much this is all going to cost the taxpayer, and there are estimates of £1 billion. There are still serious questions to be answered. The hon. Lady talks about democratic responsibility and accountability, and she is right to do that. She is fortunate—depending on one’s point of view—to have a mayor, but my constituency and county do not. Will my constituents get less of a voice in their NHS than her constituents in Shipley? That does not seem fair to me.

The latest industrial action by the British Medical Association has now ended, yet many will be appalled by reports of individuals boasting online that “the ability to have 10 days off will make turnout quite high.” Does the Secretary of State agree that this behaviour is indefensible and represents a slap in the face to patients whose treatments have been cancelled, as well as to the NHS staff who have been left to pick up the pieces?

This is a rare occasion, as I agree with the Secretary of State. The increasingly militant stance adopted by the BMA is plainly out of step with some resident doctors, who continue to report for duty. The Government’s handling of this dispute has been marked by inconsistency. First, they attempted to buy their way out of trouble, then they withdrew the training places that this House voted for. Instead of persisting with a failed strategy, is it not time for the Government to heed our calls and bring forward legislation to ban doctors from striking?

I am grateful to the Secretary of State for advance sight of his statement. Only yesterday he was boasting about progress in the NHS. Today we are back here again, facing more strikes, more disruption and more uncertainty for patients—quite the contrast. In opposition, he made resolving these strikes sound straightforward: “Just get around the table. Just negotiate. Just sort it out.” He repeatedly stated that the power to stop the strikes lay in the Government’s hands. Well, the power is now in his hands. He has had every opportunity to prove it, and yet here we are again. Not so easy after all, is it? The Government came into office promising to end these disputes. Instead, they have conceded heavily on pay, at enormous cost, and still failed to make it work. The Secretary of State says a comprehensive deal was on the table, developed with the BMA leadership. Despite that, we still face further strikes, so what exactly has this strategy achieved? After all the concessions, all the cost and all the disruption, there is still no resolution. If, as he says, the BMA leadership helped to shape the deal, why did it not secure the support of the wider committee? This morning, the chair of the BMA’s resident doctors committee said that all the Secretary of State needs to do to avoid these strikes is come back with a better offer. That was the Secretary of State’s argument in opposition, too. He has now had every opportunity to test that theory in government, and it has not worked, just as we warned. There is also an irony here that will not be lost on the public. The BMA says that a 3.5% pay rise for doctors is a “crushing blow”, yet it is offering its own staff just 2.75%. While it demands more from the taxpayer, it will not even meet its own standard for fairness. The inconsistency is obvious and hypocritical. The Government’s own position on affordability no longer seems to add up. In October, Ministers were clear that anything above 2.5% would have consequences for wider NHS commitments. They said that every additional 0.5% would cost around £750 million, yet we are now beyond what they previously said was affordable, so what has changed? Were those warnings overstated, or are other parts of the health budget now going to pay the price? The Secretary of State even pointed to global events as a reason for future constraints. That is a long way from “just negotiate and sort it out”. After repealing minimum service levels, the Government cannot now be surprised that patients are once again exposed to greater disruption. Labour promised to end the strikes. It paid a very high price, and it still did not get the result. Ultimately, it is patients who are caught in the middle of all this, but it is unfair on others in the NHS, too. Consultants are left picking up the pieces yet again. Other doctors and NHS staff are expected to carry the burden and keep services running—they do not get to walk away. That is not sustainable, and it is not fair. The Secretary of State says he may now have to call time on the extra jobs he announced. Were those jobs ever truly secured, or were they always conditional on the BMA accepting the deal in full? When he says that strike action will consume the money set aside for this deal, is he not really admitting that his own approach has ended up burning through the very resources he said would improve pay, jobs and conditions? What is the cost of this latest round of strikes expected to be, and where will that money now come from? What assessment has he made of the impact on patient safety, consultant morale and the training progression of junior doctors? What is his plan to end this dispute, rather than simply manage the next round of disruption? Patients need certainty. The NHS needs stability. That is why we have been clear that doctors should not be allowed to strike and that minimum service levels must be restored to protect patient safety.

I am grateful to the Secretary of State for advance sight of his statement and for the clarity that he has provided to the House this afternoon. Our thoughts are also with the families of the two young people who have so tragically lost their lives—I cannot imagine the pain that they must be going through at this difficult time. This will also be an extremely distressing time for parents, students, staff and the wider community across the south-east, especially as I understand that two more cases have just been announced. Yesterday, friends of mine were very anxious about their own son, who was in the vicinity over the weekend. I pay tribute to the NHS staff, public health teams, school and university leaders, and all those working at pace to respond. I welcome what the Secretary of State has set out on the daily publication of figures, the scale-up of antibiotic provision and the decision to introduce a targeted vaccination programme for students in halls of residence, alongside seeking further advice from the JCVI. However, a number of important questions remain. First, concerns have been raised out there on the timeline. The Secretary of State has set out the sequence of events in detail, but can he be clear about the threshold used for wider public communication? Is that threshold being reviewed in the light of this outbreak? He also set out that headteachers were contacted on Monday morning. Can he clarify when those schools were first identified, and whether there is a need to review how quickly educational settings are brought into the response, given that cases were identified several days beforehand? Secondly, turning to the nature of the outbreak, while many cases are linked to a single venue, can the Secretary of State confirm whether all cases are believed to be part of one cluster, or whether there remains a risk of multiple sources of infection? Thirdly, on escalation, given the involvement of both a university and schools, can he set out what criteria are being used to determine when more extensive interventions are required across educational settings? This situation will undoubtedly cause concern among families, particularly with the end of term approaching. Can the Secretary of State therefore set out what steps are being taken to manage the risk of onward spread as students return home, and what advice is being provided to families and local health services in other parts of the country? Can he also confirm that public health messaging is fully consistent across schools, GPs, local authorities and NHS services, so that families receive clear advice wherever they turn? What steps are being taken to counter misinformation online, where false claims may undermine confidence in public health advice? Can he also confirm that local laboratories, intensive care capacity and public health teams are fully resourced to manage any increase in cases, and that supply chains for antibiotics and vaccines are resilient, should further clusters emerge? Finally, although I welcome the targeted vaccination programme and the decision to seek further advice from the JCVI, the Secretary of State has acknowledged that most students will not have been routinely vaccinated against meningitis B, and protection among older teenagers is clearly not as strong as it is in infancy. Does he accept that this creates a particular vulnerability among older teenagers and young adults, and will he ensure that any further advice on eligibility or wider catch-up measures is brought forward as quickly as possible? This is a serious public health situation. It is right, though, that the response remains calm, evidence-led, and focused on protecting patients and supporting those families affected.

May I begin by congratulating the hon. Member for York Central (Rachael Maskell) on securing this important debate, and the independent commission on palliative and end-of-life care on the amazing work that it has undertaken? Its report certainly provides an important contribution to the discussion about how we ensure that people receive compassionate and high-quality care at the end of life. This debate is important. There is a saying that nothing is certain in life other than death and taxes, but it seems that we spend an awful lot of time in this place talking about taxes, and until recently we have not really talked about death. I agree with the hon. Member for Newcastle upon Tyne East and Wallsend (Mary Glindon), who said that we have gone into assisted dying but rather missed or leapfrogged the important debate around palliative care. I pay tribute to the hon. Member for Newcastle-under-Lyme (Adam Jogee) for his tribute to Dougie Mac, and to all colleagues who have made representations and congratulated hospices on the amazing work that they do around the country. We also heard moving contributions from the hon. Members for St Helens South and Whiston (Ms Rimmer), and for Worcester (Tom Collins). These debates are even more powerful when we talk about personal experiences that we have been through, and I thank them for sharing those. For me, palliative care is about dignity, compassion and choice at the most difficult moments in people’s lives. When it works well, it relieves suffering, supports families, and allows people to spend their final days in the place and manner that they choose. Before coming to the House I had the privilege of working for 16 years in the hospice movement in both children and adult hospices, and with organisations supporting families whose loved ones were edging towards the end of their life. Many of those were supporting the families of children who had life-limiting conditions. That experience has stayed with me and informed how seriously I take this debate, because I saw first-hand the extraordinary compassion and professionalism of the people who provide such care, and the profound difference that it makes to families facing unimaginable circumstances. When it comes to children, no parent expects to outlive their child. Often those parents would say to me that when they realised that their child was living with a life-limiting condition, it meant that their dreams and aspirations changed. Suddenly they were not thinking about their child’s first day at school or university, or their wedding day; they were changing their whole aspect and plan for that child’s life. That is why hospices and palliative care services are so important, and they support more than 300,000 people every year. Much has been said about the wonderful Dame Cicely Saunders, but we should also pay tribute to Sister Frances Dominica, who set up the first children’s hospice in the UK. There was a wonderful saying in children’s hospices that I always used to relay: they cannot add days to their lives, but they can add life to their days. That shows how important hospices are to so many families. Hospices are a vital part of our health system because they are relieving pressure on hospitals and providing specialist care in communities across the country. Hospices are not an optional extra in our health system—they are a core part of how our compassionate healthcare should work. Seeing adults and children get the care that they needed at the end of their lives, as I did at Hope House children’s hospice, East Lancashire adult hospice and Martin House children’s hospice, was phenomenal. It is no wonder that our hospice movement has been world-leading. However, the sector is under increasing strain. Hospice leaders report rising costs, workforce shortages and growing demand for services at the very moment that they are struggling. Across the country, we are seeing reductions in services, bed closures and significant financial pressures. As many hon. Members have said, Hospice UK has warned that two in five hospices are now cutting or reducing services. I know that concerns every Member of the House. The Government will point to recent announcements about capital funding for hospices and the continuation of the children’s hospice grant, and those investments are welcome. But capital investment and capital funding cannot pay for nurses, doctors or the day-to-day delivery of care. What the sector needs is sustainable revenue funding. As a former head of fundraising, I know that capital fundraising is often the easiest, because people want to buy a new building or a piece of equipment, and paying the wages is never as, dare I say, sexy. As many hon. Members have said, children’s palliative care also faces challenges. Children with life-limiting conditions and their families require specialist care that supports them from diagnosis through to the end of life and beyond. I remember one parent saying to me that if he got up eight times in the night to his daughter, he would consider that he had had a good night’s sleep— I cannot imagine what that must be like. I also saw siblings having a different life from those of their school friends because their brother or sister needed extra, additional care. Children’s hospices offer wonderful bereavement support to families, which is another issue that many hon. Members have mentioned. Access to that care remains inconsistent across the country. As my right hon. Friend the Member for New Forest East (Sir Julian Lewis) said, evidence suggests that fewer than one in five integrated care boards formally commission specialist children’s palliative care services that meet national standards. There are also serious workforce shortages. England has just over 1,000 community children’s nurses, when safe staffing estimates suggest that nearly 5,000 are required. Across the UK, there are only around 24 specialist paediatric palliative care consultants, when experts estimate between 40 and 60 are needed. For many families that means they cannot access the support they need at home, even when that is their preference. The Government have indicated that they will publish a modern service framework for palliative and end-of-life care later this year, which I absolutely welcome and I commend the Government for that. That framework presents a really important opportunity to address the challenges facing the sector. I would like to ask the Minister a couple of questions. I will not repeat the ones that my right hon. Friend the Member for New Forest East mentioned because we all had that briefing. What steps will be taken to address the workforce shortages facing palliative services, particularly community children’s nurses and specialist consultants? What plans do the Department have to ensure that hospices have the sustainable funding required to continue delivering these vital services and protect their independence? I get the call for us not to have so much reliance on fundraising, but there is a real danger that hospices lose that independence if they take that statutory funding. The thing I always noticed was how they were more able to respond very quickly to the needs of individual families than the NHS. It is really important that we safeguard that independence. How will the Government ensure that this opportunity with the new plan seizes the chance to stop that postcode lottery? Will it see where we should firm up some of the guidance to ICBs around the country? Will Ministers look at the innovation that charities are doing in this work around palliative care? I think particularly of Sue Ryder, which is investing in add-on wards at the Airedale general hospital in Yorkshire. It is also focusing more on home services, rather than services in the building, and on getting to more and more patients. It is important that we engage with and learn from it so that we can see it evolving into best practice. There is also a really important issue around transition, which is important for young adults. When I worked at Martin House, we had just opened the teenage unit, which enabled us to have a setting that was a bit more grown up but not old ladyish or old mannish, if I can put it that way; it was an environment suited to the needs of those young people. Thankfully, we now see that these young people are living longer. When I was working at Martin House, young boys with Duchenne muscular dystrophy would probably come to the end of their life at the age of 18. They are now living into their late 20s, 30s and sometimes even 40s. There needs to be an appropriate environment for those people to have support, because palliative care is one of the most compassionate parts of our health system. The professionals, volunteers and charities that deliver that care do extraordinary work every day, and they deserve a system that supports them and ensures that every patient and family can access the care that they need at the end of life. I hope the Minister can tell us how the Government intend to achieve that.

Another leadership ambition, I see. On 29 September, I wrote to the Secretary of State regarding the late Dr Susan Michaelis’s campaign for better research into lobular breast cancer, but sadly I still have not had a reply. She established the Lobular Moon Shot Project and the last Government committed to support its aims. However, despite meeting the Secretary of State, representatives from the project say that they still have no clarity on how the project and research will be expedited. Will the Secretary of State confirm now Government approval for the funding required for this research, which is critical for so many women in this country?

In the plan for change, the Government committed to meet the 18-week standard for routine operations, but the latest data suggests that the Government are not on track to meet that commitment by the end of the Parliament. In December, fewer people were treated within 18 weeks than in the previous month. Will the Secretary of State now accept the reality that patients are experiencing and, as the Institute for Fiscal Studies has warned, that the Government will not deliver their commitment on their key milestone to deliver the 18-week standard?

I thank the Minister for advance sight of her statement. May I say right at the outset that we share the ambition to improve cancer survival and outcomes? Almost every family in Britain has been touched by cancer, and patients deserve timely diagnosis, treatment and proper support. I also recognise the Minister’s personal experience and the commitment that she has clearly brought to this agenda. We on the Opposition Benches wish her every success for the future. I also join her in thanking all those who have taken part in the shaping of this plan. It makes a big difference when we hear the voices of patients and families who have been through these experiences. The national cancer plan sets out major commitments, including on early diagnosis, improving performance against cancer waiting time standards, the faster set-up of clinical trials, and the national roll-out of targeted lung screening. It also talks about modernising services through technology and innovation. Cancer Research UK has said there is “much to welcome” in the plan, but it is right for it to say that delivery, funding and accountability will determine whether patients see change. Too often, plans sound impressive on paper but fall short when it comes to clear published delivery milestones and accountability. In many respects, this plan mirrors the ambitions of the 10-year NHS plan: it is strong on aspiration, but light on the detail of how change will actually be delivered on the ground. My first question is simple: when will the Government publish clear, funded milestones showing how and when patients will see improvements in the next year or two? We welcome investment in diagnostics, technology and innovation. It is also right to recognise that this plan builds on the significant expansion of diagnostic capacity delivered by the last Conservative Government, including the roll-out of more than 160 community diagnostic centres. Earlier diagnosis on this scale is only possible because of that foundation, but technology is only meaningful if it translates into real capacity and quicker treatment for patients. That is why radiotherapy matters. Radiotherapy UK is right that it is a core part of modern cancer care, but it relies on up-to-date equipment and a skilled workforce. My second question is this: will Ministers set out how the plan will expand radiotherapy capacity in practice, including equipment replacement and the workforce, so that patients can benefit in reality, rather than the plan just being something written on paper? Are we learning the lessons from the Danish example? They invested in radiotherapy and saw significant improvements over a period of years. That point brings me on to the workforce. The success of this plan depends on cancer nurses, radiographers, pathologists and oncologists who are already under immense pressure. We have heard big promises before, but less clarity on delivery, so my third question is this: where is the fully funded long-term workforce plan to deliver the staffing needed to expand diagnostic and treatment capacity and to make sustained improvements, including in neighbourhood health centres? Will the Government explain clearly who will staff them and how they will be funded? Blood Cancer UK has highlighted the importance of ensuring that blood cancers are properly recognised in planning and that patients receive consistent support from the point of diagnosis, including access to a named healthcare professional. That underlines why delivery and accountability across the system matter so much to patients. I also welcome the commitments in this plan to children and young people. I pay tribute to my hon. Friend the Member for Gosport (Dame Caroline Dinenage), who I know did some incredible work in this area. Having worked in children and young people’s hospices, I will never forget the journey that those children and their families go on, and I am really grateful to the Government for having a big section on that in the plan. My fourth question is about life after—and at the end of—treatment. The plan rightly talks about improving quality of life and support after treatment, including personalised support and rehabilitation; we all want people to live longer, but for many patients and their families, hospice and palliative care are essential. Yet hospices across the country are under severe pressure, with many now in crisis, exacerbated by recent Government tax rises hitting staffing and running costs. Hospices are also notably absent from today’s statement. Will the Government urgently convene a crisis meeting with the hospice sector and set out what immediate steps they will take to stabilise services and expedite delivery of the palliative care plan? We will support any serious, deliverable reforms that improve earlier diagnosis, speed up treatment, strengthen the workforce and improve patient experience. But we will also hold Ministers to account on turning long term ambitions into real improvements now, because we want to see patients getting the care that they need.

Let me start by saying at the outset that—

No, I am most definitely not defecting. In the spirit of being constructive, I will start by saying that the Opposition support the principle behind the Bill. Doctors trained in Britain and funded by the taxpayer should have a fair, clear and consistent route to progress in our NHS. Britain trains some of the best doctors in the world, yet too many are leaving—not because they want to, but because they cannot access the training places they need. That wastes talent, damages morale, and ultimately affects patient care. However, support in principle is not a blank cheque; the Bill must work in practice, not just look good in a headline. We should also be honest about why we are here. Much of what is in the Bill has been promised by the Government since their election in plans, reviews and ministerial statements, and the fact that it is only being brought forward now suggests that this is catching up, not leading. The first test is delivery. We cannot solve a shortage by changing the queue. Unless the Government deliver the 4,000 new specialist training places that they have promised, including the 1,000 places that are needed early, the Bill will not fix the bottlenecks; it will simply shift frustration from one group of doctors to another. That is why we are proposing constructive amendments to the Bill that we believe are workable and fair. The next test is clarity. The real impact of this Bill will be determined by the rules that sit beneath it—who qualifies, how experience is assessed, and how decisions can be challenged. We welcome the focus on foundation training; prioritising UK and Irish graduates for foundation training is sensible, as it strengthens the pipeline and improves workforce planning. However, it will only work if there are enough placements and the system is transparent. That is why amendment 8 would clarify that a UK foundation programme must mean a programme in which the majority of training takes place in the United Kingdom. That is a necessary safeguard against loopholes. Amendment 9 would ensure that from 2027, British citizens on UK foundation programmes are prioritised in a meaningful way. Prioritisation must apply not only at the final offer stage, but at interview, which is where selection decisions are often made. The amendment addresses many of the points that Labour Members have been raising, so I encourage them to support amendment 9 when we divide on it. We are also concerned about doctors serving overseas with the armed forces. I was pleased to hear the Secretary of State talk about them, since they certainly should not be penalised because part of their training takes place abroad on service. As such, amendment 10 would expand the definition of a UK medical graduate to include those undertaking placements as part of an armed forces posting outside of the British Isles. I hope the Secretary of State will consider accepting that amendment to give reassurance to our armed forces, which I know is something he cares about. These are practical changes that would improve fairness and operability, and we hope the Government will adopt them. We also support new clause 2, tabled by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), which would make clear that once priority groups are established, training places should be allocated on merit. That allocation should be based on academic achievement and clinical performance, rather than a lottery or a computer-generated ranking divorced from real performance. Again, I hope the Government will seriously consider the new clause. When the Minister for Secondary Care sums up, will she put on record that merit will remain central to selection? Another issue that cannot be ignored is the impact on medical schools, especially those that rely on international students. New clause 3 would require an annual report to Parliament on the number of international students at UK medical schools and the financial consequences flowing from the Bill’s provisions. International students pay higher fees and help sustain our universities. If those numbers fall, what funding model would replace them? When she sums up, will the Minister for Secondary Care outline what assessment has been made of the impact on medical school finances? How many international places do the Government expect to fund in future, and on what basis? The Bill cannot stand in isolation. Workforce planning depends on more than allocating training posts; it requires enough trainers and clinical supervisors, viable rotas that support learning and facilities that make training possible. The revised NHS workforce plan must set out how those needs will be met, and how the extra training places will be staffed and supported. With NHS England set to be abolished in April 2027, we need to hear from the Government who will lead workforce planning and accountability thereafter. Our approach is straightforward. We will support measures that are fair and practical, that strengthen patient care and that respect staff. We will press the Government where we feel that proposals are rushed, underfunded or left vague. Backing doctors means giving them a route to progress and ensuring that the system is properly planned and properly resourced. I repeat that, in principle, we support the Bill. We want doctors trained in Britain to build their careers in the national health service. That brings me to enactment. As we have heard, the Government propose that the Bill should take effect when the Secretary of State decides, rather than on the date of Royal Assent. When he said that he wanted to introduce this Bill, and that it would be urgent, I said that we encourage that and support it. However, if this Bill is truly urgent, and if Ministers want it to affect this recruitment round, why would they not commence it immediately? The Secretary of State should not be playing politics with people’s jobs. It is not right for doctors, including those not involved in industrial action, to be treated as bargaining chips, and it is not right for Parliament to be treated in this way to give him the tools that he needs because he did the first set of negotiations so badly. Will the Government support amendment 1, so that the Bill takes effect on Royal Assent? Will they commit to enacting the Bill as quickly as possible? When does the Secretary of State intend to commence the Bill? If the Minister for Secondary Care cannot give the House a date today, what makes the Bill so urgent that it needs to be pushed through Parliament in a single day? Will the Government proceed with this legislation, even if no agreement is reached with the BMA? If industrial action is paused, will the Government still honour their commitment to prioritise UK medical graduates? Many doctors took industrial action because they felt that their career progression was blocked. This Bill could play a part in rebuilding that trust, but that will only happen if Ministers deliver, publish the detail and follow through. They must be straight with the House. If this Bill is urgent, it should commence on Royal Assent. If implementation takes time, the Government should publish a timetable and the steps required to deliver it. To do anything else, frankly, would be discourteous to Parliament.

I absolutely agree with my right hon. Friend. I said right at the outset that we would be constructive, but we have heard from many who are anxious about their future and do not know what will happen. The sooner that we can give them that certainty, the better. That was the premise on which we offered to support the Bill. I am grateful to him for making that point. I am conscious that others want to speak, so I will end by saying this. Prioritisation without capacity will not fix the workforce crisis. Promises without delivery and headlines without planning will not retain the doctors whom our NHS needs. The Government must fund the extra places, set out the operational detail, and begin this reform without delay, because that was the premise that the Secretary of State identified. When he came to Parliament just a few weeks ago, he said that we needed to get on with this urgently, and that he would encourage business managers to provide the time. Well, if that is the case, let us get on with the job.

Capital funding is welcome, but we cannot pay doctors and nurses with bricks and mortar. Hospice UK has said that without additional support, there will be “more unnecessary hospital admissions, more unneeded A&E attendances and more patients not getting the care” they need, so I push the Secretary of State again to accelerate the timescale. Their lordships are considering the assisted dying Bill and they need to see the palliative care MSF before making such an important decision. We must also make sure that we relieve hospices of this Government’s NIC hikes.

With one in five hospice beds no longer available because of increased costs such as national insurance contributions, it is hardly surprising that doctors are raising concerns about the increase in the number of end-of-life patients in our hospitals. It is therefore concerning to hear that the palliative care modern service framework will not now be available until the autumn. Given that the situation is increasingly urgent, will the Secretary of State commit to accelerating that timescale?

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on winter preparedness in the NHS.

This winter, a serious flu wave and rising respiratory syncytial virus infections are pushing the NHS to its limits. Flu admissions, as we have heard, are up 55% in a week, and RSV cases are rising, especially in older people. However, the Government have failed to prepare, as we pointed out earlier in the year. In July, the Health Secretary accepted Joint Committee on Vaccination and Immunisation advice to expand the RSV vaccine to over-80s, but that expansion seems to have been quietly dropped. Flu vaccine uptake remains dangerously low, with fewer than 30% of some key groups vaccinated. Most worryingly, that includes NHS staff, who are going off sick because of flu, adding to staffing pressures. Delayed discharges are worsening: 19,000 more bed days have been lost this year. Still there is no winter discharge plan, no new funding and no clarity—and today, yes, resident doctors confirmed further strike action this week, which will add pressure to a system already under significant strain. That is why we would ban strike action, but at the same time this Government are literally making it easier for unions through their Employment Rights Bill. When the NHS is under this level of pressure, families deserve the reassurance that care will be there when they need it, so I ask the Secretary of State: will he now publish the Government’s plan for managing winter pressures, including on delayed discharges and emergency care? Given that he is worried about a double whammy of rising flu cases and a strike, what extra resources is he providing, and if he is not, where is the money coming from? What action will he take to ensure RSV vaccine access for older people, and what will he do to raise flu vaccine uptake in vulnerable groups, particularly in NHS staff? Families are frightened, and some are already grieving. This crisis was not inevitable, but the Government’s failure to prepare has made it much worse.

I thank the Secretary of State for advance sight of his statement, and sincerely thank him for making me aware last night of his intention to come to the House today and make a statement. Given that the next set of planned industrial action is due just a few days before Christmas, and at a worrying time when winter pressures are increasing early, with more flu patients needing hospital beds, we all want to see an end to these strikes. We on the Opposition Benches offer our thanks and gratitude to all those in the workforce who have worked so hard to try to minimise the impact of the strikes so far. In his statement, the Secretary of State talks about the competition for places. This is not new information. He said himself that the figures have soared in the last two years. Why is it only now that he is addressing it, so close to a damaging strike? He could have dealt with this issue back in the previous talks with the unions, but he did not. I have said, though, that I want us to be constructive in opposition, so I welcome the work that he has done to offer more places to UK doctors. Depending on the detail of the legislation, we will help to secure that aim. I make this offer to work with him to ensure that we get there. On the 4,000 places that the Secretary of State has announced, and the 1,000 specifically announced for this year, can he tell the House in which specialisms those places will be? Can he break it down into GPs, surgery, obstetrics, anaesthetics and so on? Is he confident that there are enough trainers and that there is enough capacity in the training settings he has chosen? GPs are trained in general practice and in hospitals, and there is community training for some specialists, such as paediatrics. When will these places be available for applications? Will he also look at replicating the Australian model of placing any international doctors in areas of the country with the greatest need? We know we need to address those issues. All of this is dependent on the BMA accepting the offer, but what if it does not? After all, its track record speaks for itself. We warned that giving pay awards with no conditions would encourage the BMA to come back for more, and it has. If its members rejects this offer, what are his plans to manage and deal with the situation? As the Secretary of State has said himself, the NHS is under pressure from combined flu and RSV, so what is he doing to ensure that those who are eligible for the vaccines actually have them? What additional resources has he made available to manage the strikes if they happen, and for winter pressures if they do not? Does the Secretary of State recognise that if the BMA membership reject this offer and carry on with the strikes, his Government’s own Employment Rights Bill will make things much worse next year? Will he think again about the reductions in the minimum thresholds for strikes and reintroduce the minimum service levels? Does he expect that this new legislation and the announcements he has made today will have any implications for the Equality Act 2010? If so, what are they, and how will he address them? Will he have to disapply the Act? These strikes must end. The BMA is behaving appallingly, but if the Secretary of State does not deal with those issues around thresholds and minimum service levels, it will only get much worse, with unions like the BMA causing more issues. It is patients—our constituents—and their families and loved ones who will suffer.

I understood from the Secretary of State’s 10-year plan that he wants more involvement from the private sector. Perhaps the hon. Member needs to have a conversation with the Secretary of State and see how that goes. In fact, if he wants, he can invite me along, because I would be quite happy to observe that conversation. Finally, the Budget did not mention any of the issues that matter to many of our constituents, such as mental health, the hospice and palliative care sector—although I do welcome the announcement of the framework and look forward to seeing it—dentistry and general practice. What about the Government’s upcoming plans and strategies? The workforce plan is delayed. The cancer plan is delayed. The independent review of maternity and neonatal services is delayed. Nothing new was announced, suggesting that any resources to deliver those plans will have to come from existing budgets. What are this Government actually doing for the NHS—not just press releases and reviews, but actual action? It is more money without a plan for reform and no strategy to end the strikes or help patients and staff this winter. They cannot deliver the reforms to social care the country needs because the Prime Minister came into office without a plan and does not have the backbone to make the tough decisions. They are still too distracted with working out how to abolish NHS England to cut waiting lists. The Secretary of State claims Labour is investing in the NHS, but that suggests we get some kind of return on our money. It is clear that Labour does not have a plan to achieve its targets. This is a Budget where taxpayers are being asked to pay for benefits, not the NHS, and the Government need to own that. Of course, we wish them well. We want them to cut waiting lists, we want care to improve, and we want patients to get better quicker, but their actions do not match their rhetoric, and their plan is little more than an objective, with no method for getting there. For the sake of all our constituents, I hope the Health Secretary can put his leadership ambitions to one side and focus on the job he has, not the next one he wants, because if he fails to deliver, this will be his last.

We will see what happens. It would be interesting to know exactly where the money will come from. [ Interruption. ] The Secretary of State just said that if the prices go up, there will be no cuts to the NHS budget, but where will the money come from? Which other part of the national health service and social care will the money come from? We will have to wait and see. The Budget last week made no mention of social care. After all, Labour’s only plan is to delay coming up with a plan for a few more years, despite the urgency and the scale of the challenge. Many of us entered the cross-party talks in really good faith, and they were encouraging, but we have only met once. Surely we should be getting on with it. The message was loud and clear that we want to work together, but we want to get on with it. Please can we have another meeting, so that we can get on with tackling this really important issue? It is not quite true to say that social care is unaffected by what was announced. The increase in the national living wage will be welcomed by those on the lowest incomes, but the Nuffield Trust estimates that it will cost the social care sector £1.2 billion. The sector is already struggling with last year’s national insurance contributions hike, so who will pay for this? Will there be funding cuts to other parts of the health budget? Will self-funders have to fork out yet more again, or will it be passed on to local authorities, inevitably leading to council tax rises? What impact will this national living wage increase have on wider pay in the sector?

This Government are trying to tell the public that this Budget was all about taking tough decisions to deliver change, about raising taxes to support the NHS and about pursuing growth and backing business. Those are commendable aims, but it is simply not the reality of what was delivered in the autumn Budget. This was a Budget for benefits paid for by hard-working people. Last year, taxes were hiked by £40 billion, borrowing went up, inflation went up, unemployment went up and living standards fell, but at least we were promised by the Chancellor that this was a one-off. She categorically said that she would not be coming back for more. But like the promises made during the general election, that was just not true. Then, as Halloween approached, we had briefing after briefing, that infamous press conference, markets affected and consumer spending depressed, particularly in the hospitality sector, all leading to one Cabinet Minister reportedly saying that “The handling of this budget has been a disaster from start to finish.” I wonder who that could have been. Now we have another £26 billion in tax rises to fund more welfare, because the Prime Minister lacks the backbone to stand up to Labour MPs and make the real hard choices. At the previous Budget and spending review, big promises were made to the public about how the Labour Government would solve the challenges in the NHS through a financial settlement that they said would improve patient care, including by bringing waiting times back to the 18-week standard within five years. We warned at the time that that money would be swallowed up, in large part by decisions of the Government’s own making. The then chief financial officer of NHS England said that it would go almost entirely on pay awards, national insurance contributions and drug price increases. What does Labour actually have to show for that? Elective care waiting lists have fallen by less than 2% since October last year. Meanwhile, waiting lists for community health services and diagnostic scans are rising. Waits to start cancer treatment are increasing. Trauma and orthopaedic waits are up; ophthalmology—up; neurosurgery—up; gynaecology—up. Winter pressures are growing, and long waits in A&E have hit record highs. The truth is that the Labour Government do not have a plan for the NHS; they have fallen into the classic Labour trap of thinking that issuing a press release about cutting waiting lists will magically make it so, just because they are in charge. I am afraid that is not how government works. What has the Secretary of State been focused on? A top-down reorganisation of the NHS—which not only did he not tell anyone about before the election but he explicitly said he would not do. As Conservatives, we support the principle of cutting duplication, reducing bureaucracy and saving on administration costs. The House will remember that a recent Conservative Health Secretary, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), reduced in a single year the number of civil servants in the Department for Health and Social Care by around one in six. Let us be clear: this is yet another announcement made by the Government without any plan for delivery. For months, not one Minister has been able to answer any of our questions about how much NHS restructuring will cost or who will be expected to cover redundancy packages. For months, integrated care boards have been warning that frontline patient services were at risk because they simply do not have the money to do what is asked of them. For months, staff were left in limbo, not knowing whether their job would still exist or for how much longer. We welcome the fact that the Budget finally provided some clarity, but shifting money between years means significant risk. The NHS is already behind on its efficiency targets. If this reorganisation falls short of its goals—no small risk given the Government’s performance—there is an even more significant shortfall to make up in future years, which will hit patient care. There are other elements of the Budget that we welcome for the health service. Focusing on improving productivity is the right thing to do, but whether the extra investment will make any difference in the grand scheme of things remains to be seen. Neighbourhood health centres can be cautiously welcomed. They build on the great success of the Conservatives’ efforts to bring care closer to where people live through the community diagnostics centre programme. However, has Labour truly learned the lessons of all the private financial initiative deals that it botched back in the 2000s, which NHS trusts are still paying for decades later? Will the Government simply move resources around or will there be genuinely innovative new ways or working, joining up services and improving the patient care experience? I hope that it is the latter, because shuffling the deck chairs into new buildings will not deliver the benefits that patients deserve. Despite those few bright spots, it simply is not right for the Prime Minister, the Chancellor and others to justify this latest tax grab by saying that it is to protect the NHS. As the NHS Confederation noted, this year’s Budget did not have a health focus. That means that we are left with a lot of unanswered questions. The Office for Budget Responsibility specifically raised two risks to health spending. The first was the doctors’ strikes, which the Health Secretary has failed to resolve, despite making that sound very easy to do when he was in opposition. I will give him credit, because he did briefly end them, for a few short months, but only by caving in to the demands of the British Medical Association, in return for no productivity or modernisation reforms. We warned him that giving in to the trade unions would only see them come back for more—and indeed, here we are, with patients and taxpayers paying the price, and no end in sight. The OBR confirmed that strikes have already cost £500 million, and warned about further strikes. Now it has been confirmed, just before Christmas—the worst time of year for it—that the doctors are out again.

I am asking the question of who is going to pay for it. There is no detail in anything this Government do. They are full of plans and no delivery. The sectors I have been meeting are asking those questions—where is the money coming from?

My right hon. Friend is absolutely right. Let me tell the House, from 16 years of working in the hospice movement, primarily as the head of fundraising, that if you are suddenly asked to find nearly £100,000 overnight, it is almost impossible. It is therefore not surprising that hospices up and down this country are cutting the number of beds that are available. In some instances, up to 40% of beds are being cut, and those people will end up having to be in hospital beds, putting more pressure on our hospitals as we go into winter.

Well, we did not spend tens of billions of pounds in pay rises just for the same old problem to come back. There should have been proper reform, and conditions for those pay rises, but the Government did not make that happen, and here we are again. The NHS Confederation has also warned that local services cannot continue to absorb the costs of ongoing strikes by the BMA without consequences for patient care. I pay tribute to frontline staff, who have been trying to keep everything going. I remind the Secretary of State that we have the answer: ban doctors from striking, like the Army and the police, and introduce minimum service levels, using the legislation that our Government passed. That would protect patients and taxpayers, so why won’t he do it? Labour’s Employment Rights Bill will make things much worse, because it reduces the vote threshold for calling a strike, and there will be no minimal service levels. In addition, the Government have shown that they cannot stand up to the unions. By pushing up inflation, the Budget will make it harder to reach pay settlements across the rest of the NHS workforce. Even an additional rise in NHS pay of just 1% of what the Secretary of State included in his pay review body evidence would create another £1.5 billion hole in his budget. Is he confident that he can head off wider industrial action with a 2.5% offer, especially given that benefits are rising much faster under this Government? The OBR has also raised the unknown risk of increasing drug prices. My understanding is that the spending review assumed that spending on branded medicines would rise by 25%—or £3.3 billion—between 2025-26 and 2028-29. In winding up, will the Minister clarify what happens when the negotiated price costs more than what was assumed in the spending review? The rest of the money is surely intended to be used to deliver more care and to cut waiting lists, so are frontline services at risk?

On a point of order, Mr Speaker. I know that you have been incensed by the unprecedented briefings we have seen by the Government in the run-up to the Budget. It beggars belief that, despite your clear statements on this issue, they have done it again today by announcing that the Chancellor will announce £300 million for NHS tech in her Budget tomorrow—not through a briefing to journalists but with an article on the gov.uk website. This happened just today, after a Minister stood at the Dispatch Box yesterday and said: “I can assure the hon. Member, given the respect that the Government pay to this House and to their obligations in it, that if there is an important policy announcement to be made, it will be made to this House.” —[ Official Report , 24 November 2025; Vol. 776, c. 32.] Given that that was clearly not the case in this instance, despite your statements, can you advise us as to what we as Members of this House can do?

But, Mr Speaker: “The power to stop these strikes is in the Government’s hands.” —[ Official Report , 6 February 2023; Vol. 727, c. 660.] “They need to sit down and negotiate to end the strikes, but Ministers are too busy briefing against each other.” Those are not my words, but the Secretary of State’s words when he was standing here on the Opposition side. He said it was so simple. The Secretary of State is embroiled in a leadership battle that is taking over the need to focus on averting walkouts, and the Employment Rights Bill reduces voting thresholds on strikes and scrapping minimum service levels. Does the Secretary of State accept that things are only going to get worse as a result of the Bill? And in his words, does he agree that patients have suffered enough?

Thank you, Mr Speaker. Can I ask the Secretary of State why he has not sorted out the strikes and disputes?

This has been a really good debate so far, and I do not want to get into party politics, but the rise in national insurance contributions is having an impact on charities—it really is. The cost is about £1.4 billion. Charities have been a cornerstone of respite provision, and without them we would not have as many respite places as we need. The other point I want to make is about the social care review. I went to those cross-party talks, and I was encouraged by the first meeting—it felt like all of us, representing our political parties, wanted the talks to succeed—but it is disappointing that we have not had another meeting since. I am concerned. Baroness Casey is an exceptional person. She has a huge amount to contribute, and she certainly left me with the impression that she is absolutely determined to find solutions to some of the issues in social care, but I am anxious that she has responsibilities for other issues, all of great enormity. I hope the Minister can update us on when we might have another meeting. As the hon. Member for North Herefordshire (Dr Chowns) said, we do not have to be invited by Baroness Casey; we can be invited by the Secretary of State. I know that Baroness Casey is doing an enormous amount of work on this issue, but it is important that, politically, we try to find where we can agree. If we can introduce things earlier, that would be to the benefit of everybody in the country who needs care. I say that because I want to be constructive in opposition. I recognise that some of these things are not easy to deliver. They are difficult issues, but they demand more than our sympathy—they demand action. I do not claim that we got everything right in government, but I am clear that carers need to know that we are all listening and are keen to respond and deliver when we can. Unpaid carers do not seek praise; they just want systems that they can rely on, policies that reflect their worth and services that offer real support. Finally, this is not about just one Department—it is not just the Department of Health and Social Care. There are many other Departments. Having been a Minister, I know the structure of Government means that working cross-departmentally can sometimes be a challenge. Can the Minister update us on how that is going? I know it is a challenge, and I wish him well in any cross-departmental work that is happening. Unpaid carers deserve fairness, support and action. I finish by saying to every single one of them: thank you for the amazing contribution you make every day, looking after others and being the backbone I mentioned at the beginning.

It is a pleasure to serve under your chairmanship this afternoon, Ms Vaz. I am pleased to respond to this important debate on behalf of the Opposition, and I thank the hon. Member for Shipley (Anna Dixon) for securing it and for her long-standing leadership on carers’ rights. I acknowledge the contributions made by hon. Members across the House this afternoon. They have spoken very openly about their personal experiences, which helps to bring alive this debate and these issues. I am conscious that the hon. Member for Bexleyheath and Crayford (Daniel Francis) talked about how much work he has to do before he even gets to work, which reflects what so many people across the country feel. As has just been said, unpaid carers are the backbone of our care system. They provide vital support to loved ones, often around the clock and with little recognition, and at great personal cost. This debate is therefore not just timely, but probably overdue. Before entering Parliament, I spent over 15 years working mainly in palliative care, and much of that in children’s hospices—lastly at Martin House children’s hospice up in Yorkshire. I saw the extraordinary compassion, amazing resilience and sacrifice from unpaid carers every single day, whether from parents caring for their terminally ill children, many of whom had very complex needs, or relatives supporting someone at the end of their life—people managing both care and grief at the same time. I will always remember one parent saying they would consider it a good night’s sleep if they got up only eight times in the night to help their daughter, which gives an indication of how much work they do. As the hon. Member for Shipley said, so many carers end up giving up work because they have to provide that care. Sadly, so many relationships break down because of the pressures. I now find myself having to care for my elderly father. I had to move him into my home, and I am now seeing at first hand the things people have to do. When I am here, I always worry, “Is he okay? Is there enough food and milk in the fridge?” I also watch every single move he makes. I once turned my back, for literally a minute, and he fell flat on his face. I realise that it was not my fault, but I cannot help but have those feelings of guilt. I also pay tribute to the hon. Member for North East Fife (Wendy Chamberlain) for her amazing work on the Carer’s Leave Act. That really is important, and the cross-party support for it showed Parliament at its best. It is great that carer’s leave is now a day one right and that it can be taken flexibly, because that is what unpaid carers need. They need to be able to take that half-day, or full day, if they need it because, as we have heard, one in seven are juggling work and caring responsibilities. I thank the hon. Lady and my hon. Friend the Member for Gosport (Dame Caroline Dinenage), who I know would like to have been here today—she gave quite a bit of support during the Act’s passage—for encouraging the previous Government.

It just shows how, when Parliament works well, it works exceptionally well. I want to repeat some of the comments that have been made. The Government have launched a review of the potential benefits of paid carer’s leave, with the conclusions coming at the end of the year, I believe. As others have said, that is welcome, but I am sure that carers would hope that there will be clarity and no delays. I look forward to hearing the Minister’s response to some of the issues that have been raised in this debate, and to hearing whether the Government are genuinely open to acting on the review’s findings. A fair point has been made about the length of time that people have to contribute to that consultation, given the responsibilities that they have. We must ensure that the consultation is accessible. I was a critic of this when we were in government, but doing just online consultations means that those who are not digitally savvy can be excluded. It is important we make sure that is not happening. As other hon. Members have said, the financial pressures on carers remain severe, with one in four unpaid carers living in poverty. The employment rate among carers is just 50%, compared with 75% across the general population, but with the right support an estimated half a million carers could return to work. That would not only strengthen their security but contribute to the economy, which is what we all want to see. In fairness, it is not just the Government who have to act; there is a responsibility on employers, too. I saw in the hospices that some businesses took on our young adults despite their life-limiting conditions. The employers told us that what they got from those individuals was utterly amazing, and that they were really dedicated to their work. The recent increase to the carer’s allowance earnings limit is a step in the right direction, for which I thank the Government. However, the Carers Trust has rightly called for a full review of carer’s allowance and the wider support system. I am keen to hear whether that is something the Government are considering. I am also concerned that the level of respite support has been falling, and has dropped by 6% in local authorities in the last year alone. I am concerned about, and pay tribute to, the charities that offer so much respite support. I know, from my consultations with charities, that the rise in national insurance contributions has had an impact, and that they have had to reduce and scale back their staffing. That is a concern, and I hope we recognise the size of their contribution. At the hospices at which I worked, it was not just about end-of-life care. Some of the most important care they provided was respite stays. Either the child came on their own so that the family might go on holiday, or the whole family came together, which gave them the opportunity to be a family again. The child who needed care was being looked after by the care team, which meant the parents could be parents again to the siblings, who often miss out in such situations.

It is a pleasure to serve under your chairmanship, Mr Twigg. I am sure it will delight the Committee to know that I do not intend to detain us for too long. [ Interruption. ] I always get a cheer when I say that. I would like to begin by saying that I do not see anything particularly contentious in this. The Minister rightly points out that these are technical changes that bring the Down Syndrome Act into line with the reforms introduced by the Health and Care Act 2022, in particular the replacement of CCGs with ICBs and the renaming of the NHS Commissioning Board as NHS England. However, it is worth questioning the Government on the longer-term stability of these changes. As hon. Members will know, the Government have stated their intention to abolish NHS England by April 2027. That process has already been delayed, reportedly due to uncertainty over who will meet the redundancy costs for staff within those organisations. If that abolishment proceeds, a new health Bill will be required. At present, we do not know when that Bill will be brought forward or what it will contain. It is therefore entirely possible that the statutory references being updated today will need to be amended again in the near future. I also note that there is no statutory review clause in this instrument. While that may be understandable given the technical nature of the changes, it adds to concerns that further legislative changes may not be properly anticipated or subject to adequate scrutiny in good time. While I support these draft regulations, I urge the Minister to clarify what transitional arrangements are being considered for the functions currently held by NHS England and the integrated care boards. That is especially important, as he rightly pointed out, for the consistency of support that we all want to see in the context of the Down Syndrome Act. We must ensure that people with Down’s syndrome are not adversely affected by any ongoing organisational changes within the health system. The Minister mentioned some of the updates to the Down Syndrome Act. Perhaps he could update us further on any other actions that are ongoing. How many still need to be done? In addition, I note that the Act seems to require the Secretary of State to publish guidance, on which the Government have just launched a consultation. One of the criticisms of the Act at the time was that it is specific to Down’s syndrome. Although I obviously welcome that focus, others face similar disabilities and challenges. How might the Government support them? Finally, it looks like people can respond to the guidance only online. Can the Minister assure the Committee that he is confident that those who are digitally excluded will not be prevented from taking part in this important consultation?

Again, the Secretary of State cannot answer. His answers are too vague. He is very good at making promises, but the facts are that he is presiding over a reorganisation that has stalled, creating uncertainty for staff. Waiting lists are up 50,000 in the past three months, hospices are in crisis because of national insurance contribution rises, and we have had strikes again—despite big pay rises—with the threat of more. If the Secretary of State wants the leadership in the future, perhaps he should show leadership in the NHS now, and tell us not just the plans, but when he will give the details and how he will deliver on his promises to patients.

First, it is great to be in this new role. I genuinely want to be part of a constructive Opposition, but equally I want to do my role in holding this Government to account. I note the lack of detail in the Secretary of State’s answers on reorganisation, so can I ask the basics again? How many people will be made redundant, what will it cost and who is paying?

On a point of order, Mr Speaker. Before beginning my questions, I meant to pay tribute to our former colleague Oliver Colvile, who sadly passed away last night. He served as the Member for Plymouth Sutton and Devonport between 2010 and 2017 and was named by Conservative Home as one of a minority of Conservative MPs not to have voted against the Government, which, as a previous Whip, I thought was exceptional. He was a true gentleman whose eccentricities endeared him to many. I am sure the thoughts of the whole House are with his family.

I want first to recognise and thank everyone for the constructive debates we have heard here and in the other place throughout the Bill’s passage. In particular, I thank the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth (Dr Evans), for everything he has done on the Bill, especially in Committee. I pay tribute to my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) for his expertise, whose involvement with the Bill began before he was elected to this place. I also pay tribute to my right hon. Friend the Member for Salisbury (John Glen) and my hon. Friend the Member for Farnham and Bordon (Gregory Stafford) for their thoughtful contributions. This is clearly an important and emotive issue, and the respect and sensitivity that have been shown by all sides is a testament to this House. Since the election, we have said that we would not oppose for the sake of opposition. While we have rightly asked tough questions of the Government, we have done so with the best interests of patients at heart, because everybody here wants to help and support vulnerable people better—those patients with the most severe and complex mental health needs. This Bill, which started under the previous Government—I pay tribute to former Prime Minister Baroness May for that—and continued under this Government, will achieve that. We welcome efforts to improve the patient’s voice and involvement in their own care, to ensure that patients receive effective and appropriate treatments, to minimise restrictions on liberty so far as is consistent with patient and public safety, and to treat patients with dignity and respect. Although we are disappointed that opportunities to strengthen the Bill further have been missed, especially in public safety and the protection of vulnerable children, we listened closely to what the Minister said and to his assurances on action, for which we thank him. We will of course continue to push on these matters, not on party political grounds, but because doing so is the right thing for patients. We are very disappointed that the proportion of health spending on mental health has been reduced. We welcome the Government’s continuation of our work looking again at how we treat and protect people with the most severe mental health illnesses, so that we can improve the safety, treatment and dignity of patients and the wider public, and ensure that our laws remain relevant and proportionate in the modern world. The Government must now turn their words into action and deliver on the commitments that they have made. I thank everybody again for the constructive way in which they have dealt with the Bill. We are pleased to support its Third Reading. We hope that it will bring improvements for those we all care about: the patients.