Rural GPs: Funding

Karin Smyth Excerpts

Wednesday 11th February 2026 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship, Ms Lewell. I thank the right hon. Member for Tatton (Esther McVey) for securing the debate and raising a critical issue that I know is important to many hon. Members. I am pleased to be here on behalf of the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), who is working hard on the issue.

This Government have made primary care a pillar of NHS reform, to make the left shift and put more healthcare into the community. In our 10-year plan, we specifically highlighted our commitment to people in rural and coastal areas, because they have been left behind. As the hon. Member for Chester South and Eddisbury (Aphra Brandreth) highlighted, the infrastructure is appalling in many places, and some of those areas have the worst deprivation in the country. Last week, I was pleased to visit Redruth in Cornwall and talk to a GP practice about the deprivation it faces and the work it is doing. We do understand that, which is why we highlighted it in our 10-year plan.

Over the last 18 months, we have taken a number of measures to increase funding, support our workforce and improve patient access, so that we can rebuild the front door to the NHS and create a neighbourhood health service. It is important to remember that when we came into office 18 months ago, we found GP services in an appalling state: underfunded, understaffed and in crisis. First, we inherited an absurd state of affairs where patients could not book appointments, while GPs could not find work. We took immediate action to put GPs to work so that patients could get the care they need. We promised to recruit 1,000 more GPs through the additional roles reimbursement scheme, and we recruited not 1,000 or 2,000, but 3,000. In the right hon. Lady’s ICB area of Cheshire and Merseyside, there were 102 more GPs on the frontline at the end of last year compared with when we took office.

Secondly, for the first time in more than a decade, we have agreed a GP contract, which means more than £1 billion extra for general practices, bringing total spend on the contract to £13.4 billion this financial year. That is the biggest cash increase in more than a decade. Thirdly, the previous Government left GP surgeries across the country with leaky pipes, falling roofs and buckets catching rainwater. We are investing £102 million to fix GP surgeries this year, and over the next four years, we are committed to investing another £426 million on GP estates and refurbishing neighbourhood health centres. On top of that, ICBs will have £195 million every year to support strategic primary care investments, with a focus on replacing crumbling infrastructure —an issue that many Members have raised today.

I am proud to say we can now see some green shoots of recovery in primary care. According to the Office for National Statistics, patient satisfaction has gone from 60% to 73% since this Government took office. A lot has been done, but we absolutely recognise that there is a lot more to do, especially as GPs become the cornerstone of our neighbourhood health services. Over the course of this Parliament, we will train thousands more GPs. We have already made an additional 250 training places available this year, taking the total to 4,250 places, with plans to expand that further.

Let me turn to the specific points raised by the right hon. Member for Tatton, starting with Knutsford—as she said, we met about that last year. On the medical centre, East Cheshire trust is working on the outline business case, which it needs to submit to the ICB. The ICB needs to be satisfied with the submission, which would progress to a full business case, which would take some time to secure the necessary planning permissions. It also needs to look at how the clinical services work for both the general practice and the trust, and how they will be delivered, while ensuring that it is value for taxpayers’ money and lines up with the overall development that we want to see towards neighbourhood health services.

As I have said to the right hon. Lady and many hon. Members, we expect ICBs to be collaborative and to keep their local MPs up to date and in the loop regarding plans for their constituencies. That is the situation at the moment: the trust is working on the outline business case with the medical centre, which is where that conversation needs to progress.

On the main subject of the debate and the Carr-Hill formula, I must confess that I have seen this over many years in my time working as a manager in the NHS. It is a difficult issue, and one we are taking seriously, particularly when it comes to wider access in rural areas. Rural and remote areas face specific pressures, whether that is recruitment challenges, longer travel times or population fluctuations for various reasons, including tourism in some places. That is why the previous Labour Government introduced the formula in 2004, but we believe the formula is no longer fit for purpose today.

A lot has happened in those 20 years and the research underpinning the formula was done in the 2000s, which means that so-called workload coefficients were estimated on the basis of data that may reflect clinical practice, such as patterns of home visits, from as far back as the early 1990s. Clinical practice and population health have changed markedly since that time. GP practices serving more deprived areas receive 9.8% less funding on average per needs-adjusted patient than those in less deprived communities. That is despite having greater health needs and significantly higher patient-to-GP ratios.

We are asking experts to help us to design a formula that reflects patient need more accurately, working on the principle that funding for core services should be distributed equitably between patients across the country. Deprivation is a factor, but not the only one. Let me be clear, this is not about taking GPs away from urban areas or robbing Peter to pay Paul. It is about ensuring that funding is fairly distributed.

The right hon. Lady rightly said that the review is being conducted by the National Institute for Health and Care Research. The review team has already engaged with partners at the Royal College of GPs, the general practice committee of the British Medical Association and the NHS Confederation, among others. Although I cannot pre-empt the review, the point is to ensure that funding is targeted towards areas that need it most. That means considering a broad range of factors relevant to the delivery of primary care services, including difficulties delivering services in rural areas, as she and others have outlined. We expect the first phase of that to conclude in March.

We will then see whether there is a need for further work to technically develop and model any proposed changes to the formula. In response to the right hon. Lady’s question, we will of course look to understand the impact of any changes to the current formula on practices across the country ahead of implementation. The Minister for Care, my hon. Friend the Member for Aberafan Maesteg, will update the House on the progress and outcomes of the review in the normal way.

Lastly, although many hon. Members will know this, it is worth highlighting that some 40% to 50% of GP practice funding is currently not determined by this formula. The income into GP practices is based on a number of other areas as well. We will obviously develop our neighbourhood health services in future, so we need to take notice of all those factors.

I want to comment on the point that the right hon. Lady raised about analogue and digital. That is a key part of our 10-year plan. As the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire (Ashley Dalton), said last week, wherever people live in our country, they deserve the same access to healthcare as everyone else. Wealth should not determine health, nor should a postcode.

I understand the point that the right hon. Lady and others have made—it has been made to me very often—about infrastructure and access, particularly digital. However, using digital based on geography offers huge potential to fight inequalities. For example, because of the online services for GPs that we launched in October, patients can now contact GPs through online services to request an appointment or raise a non-urgent query, which is in addition to telephone and in-person requests. That is tackling the 8 am scramble that we committed to addressing when we came into power, so that patients no longer have to wait by their phone to call GPs at a time of day when many go to work or get their kids ready for school.

The right hon. Lady correctly says that rural communities largely have older populations. We want to be digital by default—and many older people are very digital—but human where it matters. That means that people in rural areas and elsewhere will still be able to use the phone if they want to, and they will not be waiting nearly as long because the other phone lines are being freed up. We are seeing real progress in that area.

When we came into government, the front door of the NHS was hanging off its hinges. In these 18 short months, we are seeing the green shoots of recovery in general practice and recovery and reform in primary care. Our plan for change is creating a neighbourhood health service that puts GPs at its heart, so that the NHS is there for everyone, wherever they need it. We know that is not going to be easy and we want to work with it to develop that. I hope that today we have set out how we are trying to get there. Yes, there is more investment, but there is also fundamental reform, and my hon. Friend the Member for Aberafan Maesteg will be happy to keep in contact with Members as we progress this issue.

Question put and agreed to.

Hughes Report: Second Anniversary

Karin Smyth Excerpts

Wednesday 11th February 2026 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under you chairship, Dr Allin-Khan. I am grateful for the opportunity to address the House following the second anniversary of the report by the Patient Safety Commissioner, Dr Henrietta Hughes. I pay tribute to her work and, as others have, to Baroness Cumberlege for her work in the lead-up to that report. I also thank the hon. Member for Chesham and Amersham (Sarah Green) for securing this important debate. It has been a thoughtful and constructive debate on an issue that is highly sensitive for Members across the House, for campaigners and people who are here today, and for people watching online.

To answer the question from the hon. Member for Sleaford and North Hykeham (Dr Johnson), I am responding to this debate on behalf of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Glasgow South West (Dr Ahmed). He is the lead Minister for this area, but unfortunately cannot be here today—as Members will understand, that is often an issue, but I am happy to stand in. This is a matter of great interest to him personally. As colleagues know, he is a clinician, so has valuable insight into patient safety and how it works from a clinical perspective.

My hon. Friend wanted me to be clear that he is very happy to meet campaigners, as the hon. Member for Chesham and Amersham asked, to discuss our work in more detail. He met the Patient Safety Commissioner in December to discuss the Department’s ongoing work in relation to her report. Since then, he has continued his engagement with the commissioner on how we can do more to address the immediate needs of those affected by sodium valproate and pelvic mesh. As we have heard, and as many of us know from constituents—I know that many other Members have affected constituents but were not able to attend the debate—some of these women’s lives, as well as those of their families, have been changed forever because they were misled about the effects of sodium valproate and surgical mesh.

Many examples have been given in the debate, and constituents of mine have shared the most intimate details of the impact of sodium valproate and pelvic mesh. It has been truly harrowing for me and many other Members to listen to those details, as I am sure it was for those women who bravely shared them with a stranger, their Member of Parliament. That point was made well by many Members, including my hon. Friend the Member for Rushcliffe (James Naish), the hon. Member for Frome and East Somerset (Anna Sabine), and the Liberal Democrat spokesperson, the hon. Member for South Devon (Caroline Voaden), who spoke on behalf of her constituents.

We owe honesty, transparency and contrition to all the women affected, and we are determined to make sure that the lessons are learned and to keep patient safety at the heart of the reform. My hon. Friend the Member for Wolverhampton West (Warinder Juss) rightly highlighted the issue of trust in the system, which is so important as we go forwards. Our focus remains on building a system that listens and that acts with speed, compassion and proportionality. Everybody who has suffered complications from sodium valproate and pelvic mesh implants has my deepest sympathies. I express my gratitude to Dr Hughes and her team for the report that was published two years ago, and I am grateful, too, for her continued engagement with the Department as Patient Safety Commissioner.

[Caroline Voaden]

Will the Minister give way?

[Karin Smyth]

I will, but I do want to respond to Members’ comments.

[Caroline Voaden]

The Minister said that she supports a system that acts with speed. Could she give us an idea of when there might be a response to the report?

[Karin Smyth]

I want to address the main concerns and, as I said, the Under-Secretary of State is very keen to talk with Members and campaigners.

We remain committed to working alongside Dr Hughes and her team to better support patients and ensure that steps are taken to prevent similar harm in the future, both in this area and across the wider patient safety landscape. That is obviously crucial. Many Members mentioned the importance of women’s voices being heard in this area, and many of us were involved in the campaign in the previous Parliament. We must make sure that women’s voices are better heard in the health system. As my hon. Friend the Member for Morecambe and Lunesdale (Lizzi Collinge) said, the campaigners are doing that, and I pay tribute, as she did, to In-FACT, as well as Sling the Mesh and the very many other patient groups that have raised this on behalf of women. They should not have to, but I commend their work.

I assure Members and people listening to the debate that we remain committed to advancing this work across Government and to looking at lessons from any cases in which patient safety has been affected. I fully understand why colleagues are asking for an official response to the Hughes report here and now. It is important that we get it right, and we need to carefully consider all options and the associated costs before coming to a decision on the report’s specific recommendations. I am sure that many Members have seen the letter that my hon. Friend the Under-Secretary of State wrote to the Patient Safety Commissioner in November, and I reconfirm, as he wrote, that that work includes looking at the costs.

We must take forward the lessons learned from this work—including, as the right hon. Member for New Forest East (Sir Julian Lewis) and my hon. Friend the Member for Ellesmere Port and Bromborough (Justin Madders) highlighted, work on similar areas—and the Government are doing that. We must ensure that our approach provides meaningful, often ongoing support to those who have been so profoundly affected.

The Government have to consider options for financial redress collectively, with input from a number of Departments, and we started that work immediately. As was mentioned, the previous Government did not respond to the report when it was published, but we have picked up that work. Initially, Baroness Merron was the lead Minister, and it is now the Under-Secretary of State, my hon. Friend the Member for Glasgow South West.

I assure the hon. Members for Strangford (Jim Shannon) and for Aberdeenshire North and Moray East (Seamus Logan) that my hon. Friend recently met the devolved Government Health Ministers to discuss their respective positions further. He will continue to do so across all devolved Government areas; as Members have said, patients there are affected too. We have to proceed with care to ensure the correct approach. We are committed to providing updates at the earliest opportunity, once all relevant advice and implications are considered.

[Sir Julian Lewis]

Will the Minister give way?

[Karin Smyth]

I will continue, if I may.

On non-financial redress, the Department is committed to meeting the needs of current patients with clinical requirements via three principal avenues. The first is improving clinical services and treatment to patients, and the second is commissioning further research and development programmes on sodium valproate and pelvic mesh to address the remaining knowledge gaps. I commend my hon. Friend the Member for Bexleyheath and Crayford (Daniel Francis) for sharing again his personal experiences and for laying bare the deep complexity and the need for more research and development, to which my hon. Friend the Under-Secretary of State is committed. The hon. Member for Leicester South (Shockat Adam), with his clinical knowledge, also added useful experience to the debate. That is absolutely what my hon. Friend will be taking forward. The third avenue is initiating longer-term preventive measures that will help ensure that the system can pick up on adverse trends in patient care and act more quickly in the future.

I will take each avenue in turn. On improvement of clinical services, although the number of women up to the age of 54 who have been prescribed sodium valproate has nearly halved since 2018, there is a significant group of patients already affected who have complex and varied needs, and the health system has to ensure that that cohort receives high-quality and tailored care. NHS England has committed to a pilot project on foetal exposure to medicine in the north of England, involving multiple clinical specialties and a wide range of clinical experts, that will undertake a comprehensive review of the service. Eighty patients have been seen as part of the pilot, representing 560 appointments and 650 clinical hours. We have received feedback from patients on the value for their quality of life of being seen by clinical experts and wider multidisciplinary teams. We are considering options to commission this service further nationwide.

NHS England has also completed an internal review of mesh centres across England. Mesh centres undoubtedly offer a valuable and impactful service, with nearly 3,000 patients now seen since their introduction. However, as a relatively new service, distinct areas for improvement remain, and we will look closely at the results of the internal review and promptly deliver the necessary improvements.

With regard to further research and development, the National Institute for Health and Care Research has been commissioned for a £1.56 million study to develop patient-reported outcome measures for prolapse, incontinence and mesh-complication surgery. In the longer term, those measures will be integrated into the pelvic floor registry, which monitors and improves the safety of mesh patients. Further research is also taking place in this area, and we will ensure that future work takes into account the recommendations of the pilot project and of the mesh centre audit.

On longer-term prevention work, recent discussions with NHS England and the Medicines and Healthcare products Regulatory Agency indicate that longer-term improvements in digitisation will help position the UK as a world leader in reducing valproate-exposed births and applying the insights to other teratogenic medicines. The Department will explore increasing centralisation and visibility of the annual risk acknowledgment form across care settings, as highlighted in the Hughes report, and may consider expanding the medicines and pregnancy registry to better link data with research outcomes.

[Several hon. Members rose—]

[Karin Smyth]

I will give way first to the hon. Member for Aberdeenshire North and Moray East.

[Seamus Logan]

I appreciate the complexities of the steps that the Minister is outlining. Nevertheless, in repeated contributions, Members have asked for a timescale, so will the Minister respond by the end of the Session? Will she respond by the autumn? Will she respond by the end of the calendar year? Can she give us some clarification, please?

[Karin Smyth]

I am happy to answer that at the end of my comments, but first I will take the intervention from the right hon. Member for New Forest East.

[Sir Julian Lewis]

I appreciate that the Minister does not have primary responsibility for this area, but it worries me that we are hearing an awful lot about process. What I fear is really going on is that Ministers have been told at the highest possible level, by the Chancellor or a Treasury Minister, that the money for redress will not be made available and they have to take that as their starting point. She may not be able to confirm this now, but I would like an answer as to whether a conversation of that sort has taken place.

[Karin Smyth]

I thank both Members for their comments. Experienced parliamentarians will know what I will be able to say. As my hon. Friend the Under-Secretary of State, the hon. Member for Glasgow South West, outlined in his letter, costs—I think that is what the hon. Member for Aberdeenshire North and Moray East was alluding to—are part of the overall consideration, along with the complexity, in the work that he is leading on behalf of the Department across all Government Departments.

[Marie Goldman]

Will the Minster give way?

[Karin Smyth]

I am going to close by emphasising again that we are profoundly sorry, of course, for the enduring harm experienced by women affected by sodium valproate and pelvic mesh. Their pain, which we keep in our minds at all times, and the life-altering consequences they have suffered are truly heartbreaking. We recognise the immense toll, much of which we have heard about again today, that this has taken on them and their families. We have listened closely to calls for clarity, speed and decisive action on the report’s recommendations. To be very clear, we are committed to setting out our response at the earliest credible opportunity while ensuring that it is both robust and deliverable. I think that, as we have heard again today, Members here and people listening recognise the complexity of that. I assure those listening that my hon. Friend the Under-Secretary of State is determined to progress this matter, and he is willing to meet campaigners and discuss that in more detail, as Members have asked us to do today.

Medical Training (Prioritisation) Bill

Karin Smyth Excerpts

Committee of the whole House
Tuesday 27th January 2026 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

In the interests of time, I will address the amendments at the end of proceedings, when I have heard from them—I think we have the gist of most of those issues. I restate our firm commitment to the Bill and all clauses.

Let me turn to clause 4 and clarify how we are defining “UK medical graduate” and “the priority group” for the purposes of the Bill. “UK medical graduate” in this context excludes those who have spent all or the majority of their time training for their medical qualification outside the British isles. This means that if a person has obtained a primary UK qualification but has studied mainly overseas, they will not be eligible for prioritisation as a UK medical graduate unless they fall into another group that is to be prioritised under the Bill. While internationally educated graduates from overseas remain an important part of the workforce and can continue to be recruited under the Bill, we are committed to growing home-grown talent, who are more likely to work in the NHS for longer, and to be better equipped to deliver healthcare tailored to the UK’s population.

Clause 8 sets out the territorial extent of the Bill and deals with commencement. The Bill extends to England, Wales, Scotland and Northern Ireland, and we have worked closely with the devolved Governments to ensure that it meets all needs and provides consistency. We are grateful to them for their support in bringing these measures forward so quickly. The Bill will engage the legislative consent motion process, and the devolved Governments have committed to commence this process in their Parliaments.

To ensure that the systems, planning and operational capacity required for successful implementation are in place, the Bill will be commenced

“on such day or days as the Secretary of State may by regulations appoint.”

As the Secretary of State outlined on Second Reading, this is an important fail-safe to ensure that we are not in a position in which a law is enacted that we cannot implement effectively at the time. I am happy to expand on that after we have discussed the amendments, but the key issue is the ability of the NHS and training providers to deliver the measure. That is why we have a fail-safe; we first need to be very clear that the NHS is in a position to deliver. Members have talked about the strikes. Those would be one consideration, and there are many others. We are asking the NHS and training providers to do something very difficult very quickly, and in order to ensure that they have the capacity and capability to do it safely, we are reserving the right to commence the Bill at a later date, rather than at the end of this Session. I will come back to the amendments when I close the debate.

[The First Deputy Chairman of Ways and Means (Judith Cummins)]

I call the shadow Minister.

--- Later in debate ---

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

As always, Mrs Cummins, it is a pleasure to serve under your chairmanship. I rise to speak to new clause 2, which stands in my name and is supported by many other Conservative Members. I declare again that I am now a non-practising doctor and my wife is a doctor.

I believe that ambition should be encouraged, and success should be dependent on the talent and hard work of the individual. However, in a vocation where we really want to encourage and support the brightest and the best, the signal being beamed out by the NHS and its various arms and quangos is unfortunately quite different. We have already seen this over the years in how the NHS treats competence and excellence among doctors—someone could be the best doctor in the world and be treated exactly the same as someone who is just about competent. No other operation would approach employment, and celebrating and supporting success, in that way.

I do not think, though, that I have ever seen as egregious and extreme an example of completely ignoring talent and merit as the preference informed allocation system. The shadow Minister, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), has laid out some of the details behind that system, but I encourage Members across the Committee to read about how preference informed allocation works—about the soulless, computerised, algorithmic method by which it allocates human beings a random number. That random number is then the sum total of those people’s dreams, hopes and ambitions when it comes to placements as they take their first steps into their medical career. To me, PIA looks better suited to the dystopian sci-fi programmes that I enjoy watching—better suited to “Logan’s Run” or “The Prisoner”, in which people are allocated numbers. It is not the way that we should be treating people in this country, and it is outrageous that such a system has been brought into force. We in this House should stand up for merit, and I really hope the Minister will affirm from the Dispatch Box today that the Government will dismantle this awful scheme.

[Karin Smyth]

I am grateful to Members for their contributions to the wider debate at this hour and for their considered amendments. I will respond briefly to their points and the amendments that have been tabled.

Amendment 6 and 7 would widen the scope of who is prioritised for specialty training starting in 2026 by prioritising applicants who worked as a doctor in the health service on 13 January. Although we welcome the intention to recognise the importance of internationally trained doctors, we cannot accept the amendments at this time. They would mean that the Bill was ineffective in delivering on its intention to tackle bottlenecks and ensure that we have a sustainable medical workforce that can meet the needs of the population.

I remind the Committee again that the Bill does not exclude anyone. In particular, there are likely to be opportunities in specialties such as general practice, core psychiatry and internal medicine, which historically attract fewer applicants from the groups we are prioritising for 2026. International medical graduates also continue to have opportunities in locally employed doctor roles. That could lead to NHS experience that might count towards future prioritisation as we look to make regulations to set criteria for what is considered “significant” NHS experience from 2027.

Amendment 10 would ensure that members of the armed forces are not excluded from prioritisation due to having undertaken medical training while on posting outside the British islands. We cannot accept that amendment as we believe it is not necessary. That is because medical cadets do not spend time outside the British islands as part of their UK medical degree. While cadets undertake their elective with the military, which may be overseas, that is no different from other civilian medical students, many of whom undertake electives overseas. As such, we do not believe that medical cadets are disadvantaged by the Bill.

Amendment 9 would include all British citizens within the priority groups so that British citizens will be prioritised for the purposes of the foundation programme and specialty training from 2027 onwards. It has no effect for 2026 specialty training, as British citizens are already prioritised by virtue of their immigration status. We therefore cannot accept the amendment. To do so would risk a significant increase in the pool of prioritised doctors who would compete with UK-trained doctors. The amendment would incentivise the expansion of the market for overseas medical schools, including medical schools working with foreign Governments to grow the overseas campus sector. That could offset any increase in postgraduate training places and undermine workforce planning. While British citizens will be prioritised for specialty training places in 2026, this is a proxy that is necessary for practical reasons. From 2027 we want to prioritise applications with experience and training based in the NHS.

Again, prioritisation does not mean exclusion. International medical graduates who are not prioritised will still be able to apply and will be offered places if vacancies remain after prioritised applicants have received offers. However, it is important that we do not incentivise actions that will undermine the Bill. This Bill will reduce competition for places for UK-trained doctors so that home-grown talent can become the next generation of NHS doctors.

Amendment 8 would limit the definition of a UK foundation programme in clause 5 to include programmes only where the majority of training has occurred within the UK. Although I understand the desire to do that, the number of doctors on a foundation programme within the meaning of the Medical Act 1983, but where the majority of training occurs outside the UK, is very small. Indeed, we understand that there is only one such active training programme. There are fewer than 25 doctors on that programme this year, of which fewer than five applied to continue their training in the UK. As such, there is no material impact on the Bill, so we do not think amendment 8 is necessary. However, we will keep the situation under review.

Amendments 2, 3, 4 and 5 would change the procedure for making regulations to set additional priority groups for specialty training from 2027. The regulations would prioritise additional groups based on criteria indicating that a person is likely to have significant experience of working as a doctor in the health service or by reference to their immigration status. To be clear on our intention, the Bill sets out the groups of people who are to be prioritised for specialty training from 2027 onwards. The delegated power is limited to adding to that list by reference to their having

“significant experience of working as a doctor in the National Health Service”,

or immigration status. Although I am sympathetic to the desire for more parliamentary scrutiny, as outlined by the hon. Member for North Shropshire (Helen Morgan), we believe that, due to the limited scope of the power, the negative procedure is justifiable. I therefore encourage her not to press those amendments to a Division.

Amendment 1 would change the commencement of the Bill—from being commenced by regulations to being commenced automatically on Royal Assent. As my right hon. Friend the Secretary of State outlined, the commencement clause is important, and I have addressed that point. It is a failsafe that, given the tight timeline for introducing the Bill, will ensure that we are not in a position where a law is enacted that we cannot implement effectively for whatever unforeseen reason.

As I have said, there is also the question of whether it is even possible to implement prioritisation if, for example, the strikes are ongoing, given the strain that they put on resources and the impact that could have on delivery of the Bill. Because our objective is not just to move quickly but to get this right, these considerations are key to the commencement of the Bill, which is why the Government believe that we need to be able to commence the Bill when it makes sense to do so. For those reasons, we cannot accept the amendment.

We do not think that new clauses 1 and 3 are necessary, because the data is already published, or, as we have said, we would be seeking to monitor the impact. New clause 2 would require the allocation of individual candidates to foundation and specialty training places on merit, once the requirements to prioritise certain applicants had been met. We consider the new clause to be unnecessary at this time because existing systems for recruitment to foundation and specialty training already assess the applicants on many of the merits outlined by in it. The Bill does not alter that; it simply ensures that UK medical graduates and other eligible applicants are prioritised.

[Dr Spencer]

Will the Minister give way?

[Karin Smyth]

I am coming to the hon. Gentleman’s point. We will keep the current system under review—I think the Secretary of State was clear about that—but we think that any change is best made through established guidance rather than through legislation.

Many Members raised the issue of our relationship with Malta and Queen Mary, and the work that is done there. That relationship is clearly important. We have a great deal of work ongoing with Queen Mary, in the medical field as well as others. We are not excluding anyone. We are making sure that the prioritisation works in the best way possible, and we will of course keep all that under review. I thank hon. Members for their constructive debate on this important legislation.

Question put and agreed to.

Clause 1 accordingly ordered to stand part of the Bill.

Clauses 2 and 3 ordered to stand part of the Bill.

Clause 4

“UK medical graduate” and “the priority group”

Amendment proposed: 9, page 3, line 3, after “are” insert

“a British citizen or are”.—(Stuart Andrew.)

This amendment would require British citizens to be prioritised for places on UK Foundation programmes and for interviews and places on speciality training programmes from 2027 onwards.

Question put, That the amendment be made.

--- Later in debate ---

[Karin Smyth]

I beg to move, That the Bill be now read a Third time.

I will not use this time to rehearse any of the arguments made today. We have had some good discussions. I want to thank the Leader of the House, the Chief Whip, parliamentary counsel and business managers, the public servants in my Department and NHS England, who have worked so hard to bring this together, and the devolved Governments for their support. They really have worked well together to bring this important measure to this place.

I am also grateful to all colleagues for scrutinising the Bill so thoughtfully and thoroughly during today’s proceedings and, as I said previously, for meeting me last week to go through some of the provisions. It shows that Parliament can put its shoulder to the wheel and get stuff done in the public interest. We act in the public interest because we were elected on a mandate to fix our broken NHS and make it fit for the future, and we will not succeed in that goal without our workforce, who are and will always be our greatest asset.

When I worked in the NHS during the Lansley reforms, I had a front-row seat to see their devastating impact on staff morale. I saw that patients bore the brunt of some of that collapsing morale. When our workforce does well, our NHS does well. That is why we are working to restore confidence and renew belief among frontline staff. The Bill is another step on that journey, and I urge colleagues to come with us and see it through.

Question put and agreed to.

Bill accordingly read the Third time and passed.

Medical Training (Prioritisation) Bill

Karin Smyth Excerpts

2nd reading
Tuesday 27th January 2026 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to close on behalf of the Government. I welcome the support of the Opposition spokespeople and the Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran). I put on record my thanks to them for meeting me in advance of the Bill and for airing their concerns.

From the many contributions this afternoon, there is clearly a broad base of sympathy and support right across the House for the measures in the Bill to support our NHS staff, who have been at the sharp end of every ill-conceived policy of the past 14 years—not least since the previous Government lifted the visa restrictions in 2020, as outlined by my hon. Friend the Member for Bournemouth West (Jessica Toale). The last Government’s failure to do any proper workforce planning has also led to patients struggling to find a GP appointment while GPs struggle to get a job, bottlenecks for resident doctors and an over-reliance on overseas workers and a refusal to foster our own home-grown talent.

Although I welcome the support, I find it slightly ironic that some of the Opposition speeches were around the need for clear and consistent routes and for clarity. That is exactly what we intend to provide to fix the mess. We will bring forward wider issues in the workforce plan, which, as the boss said earlier, will be in the spring. That is as a result of the concerns around training from the Royal Colleges and other stakeholders and making sure that we do that properly. We will bring that forward in due course.

[Helen Maguire (Epsom and Ewell) (LD)]

rose—

[Karin Smyth]

I am going to make some progress. Time is of the essence, I am afraid, but we can pick up more in Committee.

When I was a manager in the NHS, I worked alongside many overseas doctors, and I want to make it clear from this Dispatch Box this afternoon that they are, of course, welcome here. The NHS is and always will be one of the most diverse employers in the world. This Bill is about bringing future generations into the health service and giving them the secure future that we all know they need. It is about sustainable workforce planning so that patients are no longer at the mercy of the market. Crucially, it is also about fairness. How is it fair that every year the taxpayer picks up a £4 billion bill to train medics who cannot then get jobs? Those taxpayers deserve a return on their investment. How is it fair that medics in this country put themselves forward to train, make sacrifices, get into debt and work long hours only to find themselves trapped in bottlenecks?

I am going to try to address a number of colleagues’ points. I commend my hon. Friend the Member for Sunderland Central (Lewis Atkinson), for his experience and for outlining the capacity and demand issues that people like him have to face as managers, and also for his important point about our workforce needing to reflect our society. He talked about the great work being done in Sunderland, and I was pleased to meet the leaders there, including Dr Wilkes, to see the work they are doing so that we can take that elsewhere. That is exactly what we want to do.

I also commend my hon. Friend the Member for Carlisle (Ms Minns)—the mum of a nurse, as she told us—for putting on the record the work of the Pears Cumbria School of Medicine and the intention of growing doctors who are steeped in Cumbria. She also mentioned health inequalities, and I would be pleased to meet my hon. Friend to discuss those issues further. My hon. Friend the Member for Thurrock (Jen Craft) was right to highlight the soaring numbers of people we are losing and to recognise that it was all going back to front.

Why do we need emergency legislation? We need Royal Assent by 5 March at the latest to ensure that the change happens this year. We do not want medics to face another year of bottlenecks. Specialty training offers will be made from March, and any delay will risk vacancies in August. This emergency legislation gives the NHS the certainty and stability it needs to carry on bringing down waiting lists and to keep us on the road to recovery. The people applying for those posts need enough time to make decisions about their lives, including deciding where they will move, finding accommodation and sorting childcare, and they deserve enough time to get on with that.

A number of colleagues have raised the definition of prioritisation for training posts. Let us be clear that, for specialty training posts starting this year, we will prioritise UK medical graduates and others, using their immigration status as a proxy for having significant experience of working in the health service. Colleagues might wonder whether there has been some pulling of strings to include Irish doctors in that prioritisation, but I can assure them that that is not the case. Ireland is included because of our special and long-standing relationship with Ireland and very similar epidemiology. I thank the hon. Member for South Antrim (Robin Swann) for the important points he raised about Magee College and working with the devolved institutions. I can assure him that officials have worked closely with officials in Northern Ireland on this. If there are any other issues, he should please raise them, but we have worked closely on that point.

From next year, 2027, immigration status will no longer automatically determine priority. I accept some of the points from my hon. Friend the Member for Poole (Neil Duncan-Jordan) . He perhaps suggested that the proposal was crude, but it is a proxy for this year. Next year we will bring forward regulations to prioritise whether someone has significant experience as a doctor in the health service or by reference to their immigration status. This point was raised by the Chair of the Select Committee, the hon. Member for Oxford West and Abingdon, and many others. We will continue to work with all partners and the devolved Governments to agree those criteria in time for the autumn application round.

On international staff, my hon. Friends the Members for Birmingham Edgbaston (Preet Kaur Gill) and for Uxbridge and South Ruislip (Danny Beales), the Chair of the Select Committee and others raised the issue of foreign doctors. Let us be clear that international staff play an important role in our NHS and they always will. The NHS might be the most diverse public body in the world, and we would not have it any other way, but we are recruiting doctors from abroad—sometimes even from countries that are short of medical staff—when there is already a pool of applicants at home.

As my hon. Friend the Member for Morecambe and Lunesdale (Lizzi Collinge) said, we are not about nicking other people’s workforces. Home-grown doctors are more likely to work in the NHS for longer, and be better equipped to deliver healthcare tailored to the UK’s population, because having been trained in the UK’s epidemiology, they better understand it. It is not fair for British taxpayers to spend over £4 billion training medics every year, as my hon. Friends the Members for Worthing West (Dr Cooper) and for Cannock Chase (Josh Newbury) said. Nor is it fair for doctors who struggled to get into specialty training places. As my hon. Friend the Member for Birmingham Edgbaston said, a responsible Government get a grip on this.

I will refer to the amendments when we move into Committee of the whole House. We are seeing the green shoots of recovery as we repair the NHS following the damage done over the past 14 years. We are turning another page on that decline. However, the decision in 2020 to lift visa restrictions has done untold damage to the system and to staff morale, and contributed to a national mood of cynicism and pessimism, especially among the young, so we need to act. Those points were articulated well by the hon. Member for Weald of Kent (Katie Lam), and expertly, as always, by my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley).

Let me end my remarks by talking about the many young people who will be affected by the changes that we are setting out. As my hon. Friend the Member for Ipswich (Jack Abbott) said, these are not abstract statistics but personal costs. When I speak to those in my family, my constituency and even my parliamentary office who have breached the first barrier of getting to a medical school from a state school, I am disheartened to hear how many of them feel that their careers would be better served by moving abroad. In the 1970s, James Callaghan said that if he were a young man, he would emigrate. I do not want young people to take that path; I would rather say to them, “By all means, travel, see the world and enjoy that time, but there are great opportunities for you all in this country, and we want you to rebuild the NHS with us.” My niece is currently in Australia, and we sometimes call this the “bring Talia home Bill”.

The NHS must play its part in training our young people and keeping top talent in the UK. If colleagues agree that that is worth doing, and if they want to keep our people here, they should join us in voting for the Bill.

Question put and agreed to.

Bill accordingly read a Second time; to stand committed to a Committee of the whole House (Order, this day).

NHS Urgent Care: Staffordshire

Karin Smyth Excerpts

Monday 26th January 2026 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to respond to this debate, and I am grateful to my hon. Friend the Member for Cannock Chase (Josh Newbury) for securing it and raising in a constructive way the important matter of urgent care in Staffordshire. It is always good to have more proud NHS non-clinical bureaucrats in this place to pursue these issues.

This Government are clear that the patient should expect, as my hon. Friend says, high standards of care. We recognise that that has not always been the case in recent years, with too many people waiting too long to access the help they need, but we are determined to change that. We are taking serious, sustained action to restore timely access to high-quality urgent care across the country. Our urgent and emergency care plan for 2025-26 sets out that clear path to strengthening urgent care outside hospitals, so that patients can access timely, appropriate support without needing to attend A&E unless clinically necessary. We are increasing the number of patients treated closer to home by scaling up our urgent community response teams providing rapid two-hour care, expanding virtual wards to provide hospital-level treatment at home and growing multidisciplinary neighbourhood teams that intervene early and prevent avoidable deterioration.

We will support patients to book into the most appropriate urgent care service for them, whether via 111 or the NHS app, and we are using data from shared patient care records and digital tools to support better triage, to join up services and to anticipate pressures before they arise. That is backed by £2 billion of investment in NHS digital infrastructure. We are also investing £250 million to strengthen same-day emergency care and urgent treatment centre provision, helping systems across the country to avoid unnecessary admissions and supporting the same-day diagnosis, treatment and discharge of patients.

Turning specifically to my hon. Friend’s constituency, I know the work that he has done with his local NHS to ensure that his constituents’ voices are heard. In preparing for this debate, I also met the local NHS to understand better the situation that he describes. It is taking steps to strengthen urgent care capacity and to improve patient pathways, in line with the policy outlines that we have made. I am also aware of the concerns about the closure of the minor injuries unit.

As my hon. Friend said, following the closure during covid the ICB undertook a review of whether the service should be reopened. The review concluded that demand previously met by the Cannock Chase minor injuries unit was being met elsewhere. In that time, the NHS has strengthened the wider urgent care offer for local people. It includes enhanced primary care—my hon. Friend talked about wound care, which is very important to local people—as well as GP out-of-hours services accessed via NHS 111, urgent community response services, and access to urgent treatment centres in other locations. Those arrangements ensure that patients can receive timely and appropriate care.

As my hon. Friend mentioned, neighbourhood integrated teams will be scaled up, delivering more proactive and preventive care in order to intervene earlier and reduce avoidable deterioration. Those teams, as he outlined, are central to shifting care out of hospital and towards community care support. Urgent treatment centres do play a vital role in the wider urgent care system, providing timely assessment and treatment for patients whose needs are urgent but not life-threatening. The system is therefore ensuring that those centres meet national standards, improving consistency and simplifying access for the public, to help divert activity away from type 1 emergency departments and ensure that more patients receive the right level of care closer to home. Let me say in response to my hon. Friend and also his neighbour, my hon. Friend the Member for Stoke-on-Trent Central (Gareth Snell), that it is important for Members in the area to understand that that wider movement of capacity will ensure that they have the necessary information.

I am pleased to report that the system in Staffordshire has become the first in the midlands to establish a 24/7 integrated care co-ordination centre, which provides a single access point for clinicians, co-ordinates urgent community services, and prevents unnecessary A&E attendances. Nearly half the calls to the service are now successfully redirected away from hospital, which helps patients to access help more quickly and eases the pressure on A&E departments. Moreover, capacity has been increased in urgent community response services, virtual wards, same day-emergency care and intermediate care. Urgent community response performance is particularly strong, with more than 78% of referrals seen within two hours—well above the national ambition of 70%. Additional clinical resource has been put in place to meet rising demand and support resilience through the winter.

This work sits alongside strengthened pathways for people whom my hon. Friend described—especially those who may be elderly and experience falls, those who may be frail, those who need end-of-life care, and those in care homes. We need to ensure that those patients in particular receive timely and appropriate support and are confident that the service is there for them in that time of need. Together, these integrated services are helping to manage demand in A&E departments, improve patient flow, and make best use of urgent care capacity across Staffordshire, including in Cannock Chase. As my hon. Friend rightly said, those improvements must be felt by the people of Cannock Chase, and as my hon. Friend the Member for Stoke-on-Trent Central also pointed out, we need to ensure that demand is well managed and to support people across Staffordshire.

We are planning for the future as well. Our 10-year health plan sets out the long-term vision for urgent and emergency care reform. As I have said, a central priority is to shift care from hospitals into the community, and that will be driven by continuing to expand urgent care through urgent community response, virtual wards, rapid access clinics and better co-ordination through neighbourhood-based care.

Our plan is working: in the past 18 months the Government have invested a record £26 billion in the NHS, delivered more than 5 million additional appointments, cut waiting lists by 312,000, and launched the 10-year health plan to deliver more care in the community. We know that there is more to do, but our investment and modernisation are making a difference, and the NHS is showing clear signs of recovery. Thanks to these steps, this winter ambulances are arriving faster, A&E waits are shorter, and more patients are being treated closer to home.

I pay tribute to NHS staff across Staffordshire and across the country. Doctors, nurses, paramedics, healthcare assistants and support staff continue to show exceptional commitment, often in the most challenging circumstances, and they deserve our thanks and support. We know that the NHS is under pressure, but this Government are taking decisive action through our urgent and emergency care plan, our winter preparations, and our long-term reforms. We are putting the service back on its feet, and ensuring that patients receive timely, high-quality care.

As we make the NHS fit for the future by making the changes we need to move care out of hospital and into communities, and by making the switch from analogue to digital and from sickness to prevention, we have to communicate better with patients and the public, as my hon. Friend the Member for Cannock Chase has clearly outlined this evening. That includes keeping MPs well informed of the proposals.

[Gareth Snell]

I want briefly to highlight the fact that one of the perverse things in Staffordshire is that my constituency is serviced by the Royal Stoke hospital, as is Stafford. Its headquarters are within the ICB that funds it. Some of the places that the Minister has mentioned this evening include Cannock, Burton and Tamworth. Their hospitals are smaller and are linked to a much larger acute hospital in a trust that is headquartered outside the ICB. That is a perversity for cross-border invoicing, and it sometimes make us wonder what the incentive is for some of the trusts. Could a group of us MPs meet the Minister to discuss that?

[Karin Smyth]

When I became a Minister, my hon. Friend was one of the first through the door to share some of the issues in Stoke. In my meeting today, in which I had my map in front of me to point out some of the journey times, his comments were in my mind.

As I said, it is really important that we take local people with us as we move the system on the basis of the best clinical evidence. For me, that includes making sure that MPs are well informed of the proposals and the rationale behind them. As we have heard today, MPs are willing to be very constructive advocates for local systems on behalf of their constituents. I welcome the engagement with Members on this issue, and I am very happy to continue working with my hon. Friend the Member for Cannock Chase, other colleagues in Staffordshire and NHS leaders on how we can further strengthen emergency care services for people in Cannock Chase and, indeed, across Staffordshire.

Question put and agreed to.

Domestic Abuse-related Deaths: NHS Prevention

Karin Smyth Excerpts

Tuesday 20th January 2026 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship this morning, Sir John. I thank my hon. Friend the Member for Stroud (Dr Opher) for securing the debate and, as others have said, for sharing his direct experience as a practitioner—he is still a jobbing GP, among his other roles. His expertise was apparent throughout his speech.

As a Member of Parliament I have long talked about this issue, which is massive for me personally and as a constituency MP. All colleagues will be aware, through our casework, of how widespread domestic abuse is. It is one of the biggest issues for me in Bristol South. The number of women who fear injury or worse at the hands of their partners should keep us all up at night.

The Office for National Statistics estimates that well over 2 million women have experienced domestic abuse in England and Wales in the last year alone. Year on year, domestic homicides are present in all our constituencies. There were 108 domestic homicides in the year ending March 2024. Getting the right support early could help to prevent these needless and tragic deaths.

My hon. Friend the Member for Stroud asked the Government to publish a comprehensive plan for health. We now have a clear agenda for officials, as set out in the commitments in the violence against women and girls strategy. I will personally ensure that we make progress on that throughout 2026.

My hon. Friend asked for the Department’s contribution to the VAWG strategy to be increased in future budgets. I am happy to confirm that we are doing that over this spending review period. As well as the £5 million annual investment for victim and survivor support services, we are committing up to £50 million over the next three years to the roll-out of the child house model. In addition, the Department will provide dedicated funding for the Steps to Safety referral service for those affected by domestic abuse. I will address both those points later in my speech. My hon. Friend was also right to emphasise the importance of specialised NHS training on domestic abuse, which I will also pick up later.

Tackling domestic abuse has to become everyone’s business, as we have heard today, so the whole of Government are behind the agenda to prevent abuse and save lives. We saw before Christmas—if people had not recognised it before—the Prime Minister’s personal commitment to this agenda.

I spoke plainly from the Opposition Benches about how the cost of living crisis was impacting women, and I will not now sugarcoat that fact from my Government position. Many women face the impossible choice of staying in an abusive situation or destitution. My right hon. Friend the Work and Pensions Secretary is doing everything he can to support people back to work more generally, and particularly to help women to gain financial independence and keep them free of coercion.

While this work is all necessary, it is not sufficient. NHS staff will play a vital role in helping victims and survivors to access health, housing and justice. As we have heard, healthcare workers are often the first point of contact, offering support, treatment and rehabilitation. They have their eyes on those at risk. My hon. Friend the Member for Stroud made an excellent point about fragmented services, and I take the point made by the Opposition spokesperson, the hon. Member for Farnham and Bordon (Gregory Stafford), that with recognition comes responsibility for delivery. We absolutely recognise that.

The support we offer must be consistent, responsive and easier to reach. As the Liberal Democrat spokesperson, the hon. Member for Epsom and Ewell (Helen Maguire), said, the incidents we have heard about from colleagues this morning are not isolated; this is a systemic issue. As my hon. Friend the Member for Bolton North East (Kirith Entwistle) said in her excellent speech, we need to join the dots.

Like all our public servants—teachers, social workers and the police—NHS workers already play an essential role in safeguarding. As my hon. Friend the Member for Leeds Central and Headingley (Alex Sobel) said, that includes dealing with so-called honour-based killings. For instance, partners are often asked to leave the room before a midwife asks a mother whether she feels confident that no one will try to hurt her or her baby. We take our duty of care towards survivors of abuse extremely seriously, because violence against women and girls is, as we have heard, a public health emergency.

GP surgery staff are at the frontline of our commitment to safeguard lives. Since we came into office, we have supported primary carers and GPs as the front door to the NHS, and we have recruited over 2,500 more GPs. We have since seen patient satisfaction improving, with the recognition that access is improving, and online consultations are ending the morning scramble for appointments, thereby supporting that frontline.

This year, we will work with all ICBs to help staff in GP surgeries to identify and support victims and survivors of domestic abuse and refer them into wider support services. As we have heard, the Steps to Safety strategy will, first, introduce training for all staff in GP surgeries, to help them to spot the telltale signs of abuse and give them the skills and confidence to offer support to affected people. Secondly, a specialist worker will advise GP practices on supporting victims and survivors to take their first steps to safety by linking them with local support services. Thirdly, we will learn from the excellent practice that is already happening locally—for example, in places like Devon, Cornwall, Birmingham and Solihull.

Support services could help women to escape their abusers and get back on their feet, whether by helping them to find housing, to get back into work or to put the perpetrators behind bars. We are rolling out this initiative from April, starting with 10 ICBs in the first year, and by 2029 any victim or survivor in England will be able to get the help they need by talking to staff at their general practice.

We are determined to ensure that services do not become a postcode lottery. It is a shameful truth that some of the most alarming health inequalities are those faced by victims and survivors of domestic abuse and sexual violence. That is why my right hon. Friend the Secretary of State has asked my hon. Friend the Member for Lowestoft (Jess Asato), who made an excellent contribution to the debate, to advise the Government. She will look at how we reduce the impact of alcohol on violence against women and girls, how we commission services to ensure that the right support is in the right place, and how we embed support into neighbourhood health services so that women and girls can be connected to the specialist support they need.

A lot of colleagues talked about training, including the hon. Member for Richmond Park (Sarah Olney) and my hon. Friend the Member for Stourbridge (Cat Eccles). We need to remember that health professionals are trained to identify and respond to all types of violence and abuse, using blended learning methods including e-learning, in-person training and supervision. National mandatory safeguarding training is being strengthened for launch in late 2026. We recognise that that needs to be done.

The training will reinforce to staff their safeguarding responsibilities and support them in identifying and responding to victims of abuse. It will include training on the importance of recognising the impact of trauma and the cultural barriers to discussing abuse. It is the responsibility of employers to ensure that staff complete the mandatory safeguarding training. The Care Quality Commission assesses compliance with that requirement. The NHS England safeguarding team oversees this work, and has audited integrated care boards on completion rates. We will strengthen that work.

It takes immense bravery for survivors, not least the survivors of child sexual abuse, to come forward and tell their story, and we are doing everything possible to end the trauma of children and young people having to relive their ordeal over and over, by bringing a range of specialist support services under one roof in every NHS region in England. This is called the child house model. We have started to recruit the extra mental health workers we want by the end of this Parliament, to help survivors who still carry the scars of their abuse, and we are more than halfway towards our target. Whenever and wherever a victim or survivor contacts the NHS, it must be there for them with compassion, care and dignity.

The changes we are making to NHS England are to resolve many of the problems outlined by the Opposition spokesperson. We have huge problems with pathways as a result of layer upon layer of provision and bureaucracy have been introduced to the system over the last decade. There are confusing pathways, confusing levels of accountability, and massively increased costs with no improvement to the services received at the frontline. We need to support local delivery, where people present, and that is our intent with the changes. I was not aware that the Opposition were against the abolition of NHS England, but we will obviously make sure that we focus on service delivery as we go through the changes.

Our starting point is that women and girls who are victims of abuse are never responsible for the abuse. The perpetrators are responsible for it, but tackling it is everyone’s problem. That is why my right hon. Friend the Home Secretary has started to deploy domestic abuse experts in 999 control rooms, building on best practice across the country, including in my own Avon and Somerset police area. It is why my right hon. Friend the Justice Secretary has introduced new measures to protect victims of stalking, and why my right hon. Friend the Education Secretary is taking steps to challenge misogyny in the classroom.

The hon. Member for Strangford (Jim Shannon) highlighted the really shocking levels of killings, as well as abuse, in Northern Ireland. It is good to have that voice in this place. As he knows, I take a great interest in Northern Ireland, but we do not often hear about that particular situation there. I assure him that the Home Office, as the lead Department, has been working with all devolved partners to produce the strategy, and the Department of Health and Social Care is sharing learning, but we absolutely need to keep an eye on that to ensure that we support colleagues in Northern Ireland on this agenda.

We are working across Government, which is why I am determined that the NHS will do its part in halving violence against women and girls by the end of the decade. However, our strategy is not just a Government plan; it is a national endeavour. Everyone in this room or watching on screen has their part to play.

I want to end by speaking directly to survivors and anyone who may be trapped in an abusive relationship. This Government are on your side—and we have heard this morning a willingness across all parties to make this work. We have not forgotten you. You can get in touch with the Refuge national domestic abuse helpline, Women’s Aid or Respect—an organisation that works with male victims and perpetrators of abuse. Please get in touch with those or other specialist charities, or contact your local sexual assault referral centre. The Government are determined to make the strategy work and I am really grateful to have had the opportunity to respond to the debate.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 13th January 2026 Commons Chamber

[Rosie Duffield (Canterbury) (Ind)]

3. What discussions he has had with King’s College London on the compliance of the PATHWAYS puberty blocker trial with the Medicines for Human Use (Clinical Trials) Regulations 2004.

[The Minister for Secondary Care (Karin Smyth)]

The PATHWAYS trial has undergone a thorough independent review and has received all the regulatory and ethical approvals. The sponsors of the study, King’s College London and South London and Maudsley NHS foundation trust, are working to ensure that it is conducted in compliance with the relevant regulations.

[Rosie Duffield]

The United States Department of Health and Human Services’ peer-reviewed report found that harms from paediatric medical transition are significant, long term and too often ignored and inadequately tracked, as testified by Keira Bell, who is here in Parliament today. What is the Government’s rationale behind medicalising yet more vulnerable children, given that we have no evidence of any benefit to this approach and, in fact, plenty of evidence of harm?

[Karin Smyth]

As the hon. Lady knows, the Government are acting on the recommendations of the excellent report from Hilary Cass, which I think she would agree is world-leading evidence, and moving the model away from medical intervention towards a more holistic approach to care. The Government will continue to be guided by that evidence, as the whole House will appreciate. The hon. Lady referenced Keira Bell, and I know that my hon. Friend the Member for Birmingham Edgbaston (Preet Kaur Gill) has asked the Secretary of State to meet clinicians and others who disagree with the trial. That meeting is being arranged, and we will continue to work under the guidelines for clinical evidence.

[Nadia Whittome (Nottingham East) (Lab)]

I remind the House that puberty blockers are still prescribed to young people who are not trans; I do not see some of my colleagues who are so exercised when puberty blockers are given to young trans people expressing the same concerns for their cisgender peers. Even Dr Cass herself acknowledged that puberty blockers are effective for some young trans people and recommended against a blanket ban. While the trial is ongoing, can the Minister outline what steps the Department is taking to increase funding and capacity for children and young people’s gender services to address the unacceptably long waiting times, which continue to cause enormous harm?

[Karin Smyth]

We need to be very careful about our language, in line with Dr Cass’s report. We are talking about children who are presenting with gender dysphoria and in gender distress. The Government support moving away from the medical intervention model towards a holistic approach to care based on the evidence, and that has cross-party support more generally, although I am not entirely sure of the position of the Liberal Democrats on supporting it. That is the model with which we are progressing. On the wider issues with regard to support for children and young people, particularly as they present across the board, this Government are investing much more than anyone else has indicated that they would in support for all services.

[Gregory Stafford (Farnham and Bordon) (Con)]

Part of the trial is to ask the child participants the Avon longitudinal study of parents and carers romantic relationships questionnaire. Is the Minister as concerned as I am that children under the age of 13 will be asked sexually explicit questions?

[Karin Smyth]

I think all Members across the House are concerned about the distress with which young people are coming forward for all of these services, and the need to support them and their families. Again, it is important that all parts of this trial follow clear ethical and clinical guidelines.

[Jonathan Hinder (Pendle and Clitheroe) (Lab)]

The Government were right to bring in the indefinite ban on puberty blockers due to concerns over the past 15 years about the gender services treatment that was being given. Over that time, 2,000 children who were questioning their gender identity have been given puberty blockers, so could the Minister explain why we are not following up on their long-term outcomes before we administer these powerful drugs to 200 more children?

[Karin Smyth]

I thank my hon. Friend for his question and his constructive work in this area on behalf of young people. I think there is a further question on this topic on the Order Paper. The Government are looking at how we can best use the data linkage study from that previous work. As I think hon. Members understand, that data was collected for different purposes—it is not of the quality that might be needed for this review—but we will continue to use all the evidence that is available, both in this country and in others, in line with the best clinical practice and under the guidance that Dr Hilary Cass prescribed in her review.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

The Secretary of State has previously said that he accepts all the recommendations in the Cass review. One such recommendation is that the Secretary of State mandate the release of data for the data linkage study. Can the Minister tell us what specific steps have been taken to mandate the release of that data?

[Karin Smyth]

We absolutely stand by that work, and we are working with NHS England to make sure it is mandated to do exactly that.

[Edward Morello (West Dorset) (LD)]

4. What steps his Department is taking to ensure the accessibility of regular NHS dental check-up appointments in West Dorset constituency.

--- Later in debate ---

[Aphra Brandreth (Chester South and Eddisbury) (Con)]

8. When he plans to publish the NHS 10-year workforce plan.

[The Minister for Secondary Care (Karin Smyth)]

The Government will publish the 10-year workforce plan in the spring. This plan will ensure that the NHS has the right people in the right places with the right skills for patients when they need them, and we are engaging extensively with partners to ensure that this plan delivers for staff and patients.

[Aphra Brandreth]

I have been contacted by concerned doctors in Chester South and Eddisbury who, after five or six years at medical school and a further two years of foundation training, are now struggling to secure specialty posts and are being forced to consider leaving the NHS altogether. While I will reserve judgment on the medical training Bill to be presented later today until I have seen it in full, I welcome the fact that the Government are finally treating this issue with the urgency it deserves. Can the Minister set out how this legislation will be accompanied by a credible plan to expand training numbers, so that the number of places is sufficient to meet the NHS’s short, medium and long-term workforce needs?

[Karin Smyth]

I thank the hon. Member for her almost support for the Bill that we will present later to address much of this problem. Again, we are clearing up the mess we were left by her party, which, by changing the rules in delivering a workforce plan in 2023, essentially ramped up the supply of staff by extrapolating existing trends without any reference to the constraints or needs of the service. Our workforce plan will be different. We do hope for support for the Bill to remove some of the problem with foundation and specialty training places, and we look forward to rigorous debate on that subject.

[Jen Craft (Thurrock) (Lab)]

Unfortunately, my constituency is not unique in seeing long waits for diagnosis of neurodiversity. From 18 to 24 months is the expected waiting time in Thurrock, and some have to wait much longer. Given that, for a child, a wait of 18 to 24 months can sometimes be their whole lifespan or half their lifespan, will the upcoming workforce plan make sure that there is a plan for paediatric care, particularly for allied health professionals such as occupational therapists, speech and language therapists, and clinical physicians?

[Karin Smyth]

The services my hon. Friend outlines cover a number of different areas in different locations, and I think it is very important that the workforce plan we are bringing forward reflects a different model of care. We have seen more services going into secondary care and particularly hospitals, at the expense of community care and particularly primary care. That needs to change across the age spectrum, and the new workforce plan will be designed in lockstep with a new service design, more staff in neighbourhoods and more digital support, as well as to address the issues she outlines.

[Joe Robertson (Isle of Wight East) (Con)]

A study by the Health Foundation has found that the cost to the NHS of staff sickness and staff turnover is of the order of £12 billion a year. Will the Government’s new workforce plan cover the issue of excessive cost through the entirely avoidable turnover of staff?

[Karin Smyth]

Yes, because those issues are a result of the shocking staff morale as a result of the policies of the hon. Gentleman’s Government. As highlighted by Lord Darzi, staff morale, and issues around staff sickness and the huge increase in agency spending on their watch, are all signs of a system that is not functioning for patients or staff. We absolutely will bring forward measures to address those issues.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

When the Secretary of State was in front of the Health and Social Care Committee, he recognised that we will not solve the workforce problems in the NHS without solving the workforce problems in social care as well. There are 150,000 unfilled posts in social care—three times greater than in the wider economy. What are we going to do to help solve this problem?

[Karin Smyth]

My hon. Friend and the Secretary of State are right to address the fact that we need to look across the whole span, and at people moving between those workforces. As he will know, the fair pay agreement, with the £500 million increase to support it, is part of our work to ensure those issues are addressed across the piece.

[Jo Platt (Leigh and Atherton) (Lab/Co-op)]

10. What steps his Department is taking to improve ADHD services.

--- Later in debate ---

[John Whitby (Derbyshire Dales) (Lab)]

T9. Until covid, Hulland Ward had a local NHS clinic serving the community. However, it was closed, first temporarily and then permanently, leaving many vulnerable and elderly residents without healthcare and putting immense pressure on services in Brailsford. Will the Minister consider reopening that health centre? What steps is the Department taking to ensure that more people in Hulland Ward can access healthcare close to where they live?

[The Minister for Secondary Care (Karin Smyth)]

I know that this is of great concern to my hon. Friend and his constituents. It is a matter for the commissioning officer at his local ICB. I recommend that he keeps talking with them about the best provision for his constituents.

[Dame Caroline Dinenage (Gosport) (Con)]

I was fascinated by the Minister’s earlier answer about the closure of pharmacies, because there has been fantastic news in Lee-on-the-Solent in my constituency: a new pharmacy wants to open there. Local people are desperate for a second pharmacy in Lee-on-the-Solent and the local GP practice supports it. The problem is that the Hampshire ICB has rejected it. Does the Minister share my disappointment that local people are not going to be served in the correct way by pharmacy provision, and will he meet me to discuss this?

--- Later in debate ---

[Tracy Gilbert (Edinburgh North and Leith) (Lab)]

I and a number of colleagues have concerns about the upcoming PATHWAYS trial. The Secretary of State has powers to use existing medical records for research purposes. Will he therefore consider using those powers to increase the evidence base and prevent the PATHWAYS trial from proceeding?

[Karin Smyth]

I thank my hon. Friend for her constructive approach to this difficult issue. She is right to challenge; we must have open and transparent debate. To be very clear—and to refer to my previous answer—the Secretary of State will use that power. We will have a retrospective data linkage study to identify the associations informing patient experience and outcomes, through the analysis of available digital information in health records and other nationally held databases. It will not establish causation but will be an important contribution to the evidence base.

[Ben Obese-Jecty (Huntingdon) (Con)]

Mr Speaker, I am not ashamed to say that I have had a finger up my bum—not like that! In all seriousness, as a black man in the target age range, and with a family history, I am a keen advocate for prostate cancer screening. One of my constituents has been told by his GP surgery that, as there is no national screening programme for opportunistic testing, they follow national guidance and patients cannot request a screening without GP authorisation. What advice does the Secretary of State have for those of my constituents who are struggling to get screening for prostate cancer? I say a big thank you to the team at Kingston hospital for their swift action in moving my dad from active surveillance to treatment—he raves about them.

Transgender People: Provision of Healthcare

Karin Smyth Excerpts

Tuesday 16th December 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mr Turner. I thank and congratulate my hon. Friend the Member for North Warwickshire and Bedworth (Rachel Taylor) on securing this important debate. Without giving away any state secrets, we are roughly the same age; I am not gay, but I also marched and campaigned against section 28—I remember those days from very early on.

I want to say from the outset that this Government stand for the important principle in our healthcare system—which has been echoed this afternoon by many Members—that everyone in our country deserves access to first-class healthcare. I will not rehearse here the mess that we inherited from the last Government; we do not have time. However, we are determined to ensure that what I have set out happens. If we are to make good on that principle, we must take account of the diverse needs of our society. That of course includes trans people and the wider lesbian, gay and bisexual community.

Colleagues are right to say that transgender people experience significant and specific health inequalities throughout their lives. As we have been reminded again this afternoon and should always bear in mind when we have debates in this place, these are real people’s lives. Many people are with us today in the Public Gallery, and I am sure that many others are watching online. That is why this Government have commissioned NHS England to undertake a health evidence review, led by Dr Michael Brady, the national adviser on LGBT health, whom I met in advance of this debate. He has held the position of adviser since 2019 and works as a sexual health and HIV consultant at King’s College hospital. I am pleased that he is doing that review. The work is considering how we can better understand lesbian, gay, bisexual and transgender healthcare needs and will provide a clearer picture of what the problems are—the data, the evidence—and how we need to address them.

That is particularly important in relation to preventive healthcare and the inequalities space. The Government have been very clear about our commitment to reversing the shocking health inequalities in this country. My hon. Friend the Member for Walthamstow (Ms Creasy) highlighted where there is good practice across the country. In addition, it is important to highlight the fact that despite the umbrella term of LGBT, needs are different in this group, and equality terms are covered by different aspects of the Equality Act 2010. All of this needs to be clearly evidenced and brought forward in the work to which I am referring. Lots of people asked this question: we anticipate that the findings of the evidence review will be finalised in the new year. We will then be considering those very carefully.

We have talked this afternoon about the fact that trans people—they are the subject of this debate—have unique health needs and specialist services to support them. This Government are improving specialist gender services for children, young people and adults in England. I recognise that those wishing to access gender services are waiting far too long for a first appointment. We are determined to change that, which is why NHS England has increased the number of adult gender dysphoria clinics in England from seven to 12, with the roll-out of five new pilot clinics since July 2020. These clinics are helping to tackle long waits, but we know that waiting times for these services can be distressing and are having a real impact on people’s wellbeing. To support those facing long waits, the Department of Health and Social Care has tendered for a new Waiting Well pilot. That will run for 12 months and provide those on the waiting list for the gender dysphoria clinic in the south-west region with access to support and information before appointments. The aim is for the pilot to launch in early 2026 and to inform plans for a national offer, subject to effective evaluation.

It is vital that transgender people are able to access the high-quality healthcare that they deserve. As we have heard, NHS England has asked Dr David Levy to carry out a review of adult gender services, because that was a specific recommendation from the Cass review of children and young people’s gender services. As an independent chair, Dr Levy will examine the model of care and operating procedures of each service, and is carefully considering feedback and outcomes from clinicians and patients. To respond to a number of questions this afternoon, that includes issues relating to shared care prescribing and monitoring of hormone medication. Dr Levy has been supported in his review by independent senior clinicians and professional bodies. I expect the review to be published shortly, and I know that my right hon. Friend the Secretary of State will inform the House as soon as that has happened, but let me assure Members here, and people listening to or reading about this debate, that we will use the review as a basis to improve NHS adult gender services.

Issues relating to children have been raised this afternoon. I know that children and young people’s gender services are a sensitive topic that elicits strong opinions, some of which we have heard today. Let me be very clear: we will take an evidence-based approach when it comes to the health and wellbeing of all children and young people. Their safety is our primary concern. We are committed to implementing the recommendations of the Cass review, to ensure that children who access these services receive the same high-quality care as any other child or young person accessing NHS services. We believe that the Cass review remains an excellent, evidence-based report. I urge all hon. Members to use it as their guide when making assertions, including in their understanding of gender dysphoria. We welcome that report and accept its work; it is our guidance for navigating healthcare for transgender young people.

It is still my understanding that the report is not supported by the Green party, and not properly supported by the Liberal Democrats, so when we talk about evidence, colleagues perhaps need to check and go back to the source report, because we are determined to follow the evidence and great work done by Hilary Cass.

NHS England has opened three new services in the north-west, London and the south-west, as we have heard. Those services operate under a fundamentally different and new clinical model, in which children and young people get the tailored and holistic care they need from multidisciplinary teams of experts in paediatrics, neurodiversity and mental health. A fourth service in the east of England is expected to open early in the new year. NHS England aims to open service provision in every region of England by 2026–27. That will help to further reduce waiting times and bring these services much closer to the homes of the children and young people who need them.

On puberty blockers and the pathways trial, the Cass review was clear that better quality evidence is critical to understanding the effects of puberty-suppressing hormones. That is why the NHS has removed them from children’s gender services, and why the Government have indefinitely banned them in private supply.

Dr Cass also recommended a clinical trial to understand the effects of these hormones, which is why the pathways trial has been established. In this controlled study, puberty suppression will be offered solely within the context of the comprehensive assessment and psychosocial support now offered by the NHS. The trial has undergone comprehensive review, has received independent scientific, ethical and regulatory approvals, and will soon open to recruitment.

I know that many hon. Members have strongly held views about this research. However, I want to be really clear that safeguarding the children and young people participating in this trial is our absolute priority. In response to the hon. Member for South West Devon (Rebecca Smith) on detransitioning, I will add that NHS England has called for evidence from people with lived experience and from professionals; I understand that the consultation closes on 28 December.

[Nadia Whittome]

Will the Minister give way?

[Karin Smyth]

I will finish.

I met Dr Sullivan recently to understand her report and how it impacts on the Department of Health and NHS England. My understanding is that each Department is looking at the recommendations of her review, and that it is important to have accurate data. I will ensure that the hon. Member for Sleaford and North Hykeham (Dr Johnson) gets an answer on whether there will be a formal Government response.

This Government were elected on a manifesto to bring down inequality. We are doing so through a number of different measures—on the soft drinks industry, free school meals, the generational ban on smoking and Awaab’s law. In her Budget, the Chancellor lifted half a million children out of poverty at the stroke of a pen.

We are determined to ensure that no one falls through the cracks of our health system, and we will give transgender people the care they deserve. I hope the actions I have set out today demonstrate our commitment to that goal and our focus on improving healthcare provision for transgender people, across all ages, based on good clinical scientific evidence. We will cut waiting lists for gender services, along with all other waiting lists, and ensure that healthcare is always evidence-based, improving health outcomes for trans people and the wider community.

NHS Pensions: McCloud Implementation

Karin Smyth Excerpts

Thursday 11th December 2025 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

On 1 July 2025, I issued a written statement on the implementation of the McCloud remedy for affected NHS pension scheme members. I informed the House that a number of deadlines by when the NHS Business Services Authority was required to provide remediable service statements to members would be missed. I explained that I was commissioning Lisa Tennant, independent chair of the NHS pension board, to lead a review of the capacity, capability and delivery plans of the NHS Business Services Authority’s McCloud remedy functions.



The review has now provided me with an interim report on the capability and capacity of the authority to enact the remedy and recommendations for its effective delivery. Key findings include that significant progress has been made in remedy delivery planning but that governance arrangements must be strengthened with enhanced assurance measures put in place, and detailed capacity planning and supplier arrangements need to be finalised. A final report will be published in line with the Government’s commitment to transparency.

Since my previous statement, the NHS Business Services Authority has been undertaking a significant replanning exercise for the delivery of the remedy. This exercise has now entered its final stage and the authority and my Department are implementing recommendations from the interim report. It is anticipated that the review will conclude its assurance of the revised delivery plan early in 2026. After this point, I will publish the final report and set new statutory deadlines by when the authority must provide remediable service statements, based on a complete and robust plan which has been independently assured and endorsed by the authority’s board.

The revised plan will continue to prioritise retired members who are likely to be facing financial detriment as a consequence of the discrimination identified by the McCloud judgment. RSS and remedial pension savings statements continue to be issued. The authority expects that their capacity to produce RSS will increase materially when software to automate a significant proportion of the calculations required comes online in spring 2026.

I want to reaffirm this Government’s commitment to delivering the remedy for public service pension scheme members affected by the discrimination caused by the coalition Government’s decision making. I will continue to keep this House informed of progress in the implementation of the remedy for the NHS pension scheme.

[HCWS115]

Cancer Services: North-west London

Karin Smyth Excerpts

Thursday 4th December 2025 Written Corrections

[Karin Smyth]

Thanks to our investment and modernisation of the NHS, the Government are putting cancer services on the road to recovery by opening up community diagnostic centres on evenings and weekends, building new surgical hubs and investing in new radiotherapy machines… This year, an extra 193,000 patients received a timely diagnosis or the all-clear compared with the previous year.

[Official Report, 25 November 2025; Vol. 776, c. 194.]

Written correction submitted by the Minister for Secondary Care, the hon. Member for Bristol South (Karin Smyth):

[Karin Smyth]

Thanks to our investment and modernisation of the NHS, the Government are putting cancer services on the road to recovery by opening up community diagnostic centres on evenings and weekends, building new surgical hubs and investing in new radiotherapy machines… This year, an extra 193,000 patients received a timely diagnosis or the all-clear compared with the year before the election.