Compassionate Use Medicine Schemes: VAT

Karin Smyth Excerpts

Thursday 11th June 2026 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the effect of VAT on the availability of medicines through compassionate use schemes.

[The Minister for Secondary Care (Karin Smyth)]

It is very important for patients to have access to innovative medicines as quickly as possible, especially where there is unmet clinical need or no alternative treatment. We are working to streamline the decisions of the National Institute for Health and Care Excellence and the Medicines and Healthcare products Regulatory Agency so that NHS patients benefit from the latest medicines as soon as they are proven to be safe and effective.

Early access and compassionate use programmes can play an important role in enabling patient access to medicines ahead of routine commissioning decisions. However, we should be clear that these programmes are commercial decisions taken by pharmaceutical companies: companies choose whether and how to provide medicines free of charge to patients and the NHS before the medicines go through licensing, post-trial access or a funding decision.

The tax system is, as Members know, a matter for the Chancellor, so I will not get into details about that at the Dispatch Box, but under long-standing VAT rules, supplies of goods free of charge can still be treated as taxable “deemed supplies” where input tax has been recovered. That means that VAT can apply even where no payment is made, reflecting established principles of the tax system. We recognise the concerns raised by industry and others about the potential impact of this treatment on the provision of free-of-charge medicines. We are working closely with the Treasury and His Majesty’s Revenue and Customs to explore options to address these issues, as witnessed by my hon. Friend the Exchequer Secretary to the Treasury, who is here with me on the Front Bench. We will carefully consider the legal, fiscal and operational implications of any potential changes. Until then, we will continue to engage constructively with industry, the NHS and all our partners to make sure that British patients, who we have in our thoughts at all times, have access to innovative medicines.

[Dr Johnson]

I declare an interest as a consultant paediatrician. One of the worst moments as a paediatrician is when all treatments have failed and there is no suitable clinical trial. At that point, in those dark moments, compassionate use schemes can be a glimmer of hope, and new unlicensed medicines with clinical potential have been provided free to the patient, and free to the NHS. Last year, however, the Government started charging VAT on the deemed value of those drugs, meaning that companies had to pay tax to give the drugs away. When hearing that “every meeting” with Labour MPs was about

“who can we tax in order to pay benefits to others?”

few would have imagined that that would include potentially lifesaving, charitably given drugs for sick adults and dying children.

Following lobbying by my hon. Friend the Member for Hornchurch and Upminster (Julia Lopez), the Government have paused enforcement while they review the situation, but they have said that liabilities remain, and they are taking too long. Bayer has now withdrawn from the scheme, and others could follow. Patients are at risk. Does the Minister recognise that that makes trials in the UK less attractive, and that HMRC’s pause is not enough? How much money do the Government expect to raise with this VAT? How did the Government find time to reduce VAT on fairground rides at Alton Towers, but not to sort out this problem? How many patients have missed out so far? Does the Minister recognise that this delay could cost lives, and who was the Minister who signed this off? Was it the Health Secretary when he was a Minister in the Treasury?

I understand that the Government say this situation is not new, and that it may apply to a law dating back over 30 years. I gently point out, however, that the application is new, and that the levers to change it—and change it quickly—lie in this Government’s hands. Patients need them to act swiftly.

[Karin Smyth]

I pay tribute to the hon. Lady’s service as a clinician, and she is right to say that, at times, for patients facing such situations, compassionate use schemes are a glimmer of hope, but I think the rest of her comments were ill deserved. I understand the desire of the Opposition to attack a new Secretary of State because he was in the Treasury, but I will move on to the actual issues, because patients care about this. The rules had been in place for a long time when this Government took office, and we have not changed them. We have inherited this system, and we are looking at how we can improve it.

The previous Government could have abolished VAT on such medicines, but they chose not to do so. What is more, since we have been in office, we have struck a deal with the USA that not only guarantees 0% on pharmaceutical tariffs, but changes the old formula that we use for medicines. For the first time in 20 years, the Government are spending more to ensure that our patients are first in the queue for innovative medicines. The previous Government could also have raised the threshold, but they chose not to do so. Now, for example, patients facing Duchenne muscular dystrophy, children as young as 12 who need a brain cancer drug, or those who have a type of rare and aggressive stomach cancer, are being treated.

We recognise the importance of the UK remaining a leading location for life sciences, investment and innovation. That is precisely why we are engaging with industry and partners across the Government to understand and address concerns, including the issue of VAT payable on donated medicines. In considering a way forward, it is important to safeguard the robust and fair system by which routine access to medicines commissioned by the NHS is determined. A range of options are being considered. No decisions have been made at this stage, and I will not pre-empt any.

[Dr Scott Arthur (Edinburgh South West) (Lab)]

I thank the Minister for her response—I am sure she is working hard to resolve this issue. As the hon. Member for Sleaford and North Hykeham (Dr Johnson) explained, a pause was introduced. That was welcomed by charities such as Sarcoma UK, which asked for that pause to be made permanent. If the Minister is working hard to get the Treasury to understand the impact that the VAT charge is having on patients, will she invite a Treasury Minister to meet charities such as Sarcoma UK to hear first hand about the impact of charging VAT?

[Karin Smyth]

I commend my hon. Friend’s work in this area on behalf of patients. As I said, no decisions have been made and we are continuing to work on this issue. The Exchequer Secretary to the Treasury is with me on the Front Bench and will be happy to keep engaging with all interested parties.

[Mr Speaker]

I call the Liberal Democrat spokesperson.

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

I was deeply shocked to hear about the change in HMRC’s policy. It is extremely worrying that pharmaceutical companies must now pay VAT on drugs available through compassionate use and early-access schemes. In April, HMRC told the pharma industry that it would pause enforcing VAT bills while the Government considered measures to support the industry in supplying patients who desperately need these drugs. The changes have been mired in uncertainty and misunderstanding, and there has been poor communication from HMRC from the start.

The Government must ensure that they create a workable long-term solution for the pharmaceutical industry to support these patients who are in desperate need. Patients must not lose access to medicines as a result and HMRC must communicate with pharma and patients effectively. For patients of all ages with rare cancer types, schemes such as these are the only way to access potentially life-extending treatment. Has the Minister spoken to cancer charities about the real-life effects that the changes will have? We should be making it easier for patients to access life-extending drugs, not harder. Will the Minister confirm that patients will not be denied lifesaving drugs as a result of these changes?

[Karin Smyth]

I thank the Liberal Democrat spokesperson for her comments. She knows that we engage with the sector all the time and, as I said in my earlier response, we will continue to work with bodies across the life sciences sector and with patients, the NHS, HMRC and the Treasury. A range of options are being considered and no decisions have been made.

[Jerome Mayhew (Broadland and Fakenham) (Con)]

The Minister is responding to this urgent question because the Government have decided to charge VAT on donated medicines used for compassionate EAM schemes. The Minister says, “Well, that is not our fault—the scheme has been around for 30 years”. That may be true, but they have decided to apply the rules for the first time. Why have the Government decided to impose VAT now?

[Karin Smyth]

It is important for hon. Members to recognise the deep concern caused to patients with unmet clinical need, who rely on the glimmer of hope provided by these medicines, when they hear these sorts of exchanges. These are long-standing rules and we continue to engage on the issue.

[Sir Ashley Fox (Bridgwater) (Con)]

It is utterly shameful that this Government are presiding over the imposition of VAT on drugs donated for compassionate use. The Minister referred to the previous Government. VAT was not put on those drugs under the previous Government, but it is being put on them under this Government. Was it the Health Secretary who signed this off when he was in the Treasury?

[Karin Smyth]

The hon. Gentleman’s last comment reveals exactly why he is raising this issue.

[Jim Shannon (Strangford) (DUP)]

Hon. Members have raised concerns for compassionate reasons and on behalf of their constituents who feel the pain. Compassionate access schemes are a critical lifeline for terminally ill patients, often stepping in when the NHS has exhausted all standard funding avenues. Any move by HMRC to levy, to barter or to impose deemed supply VAT on free clinical treatment places an unacceptable risk on voluntary patient provision. I say this kindly, but will the Minister ensure that the Treasury works collaboratively with the devolved health Executive to create a permanent and water-tight VAT exemption, so that no patient, regardless of their postcode, is left behind and compassion is a UK-wide attribute, not a postcode lottery?

[Karin Smyth]

The hon. Gentleman works very hard in this area. He is right to use the word “compassion”, because that is exactly how we must approach the issue for patients who have an unmet clinical need and are desperate for innovation. That is why we are putting our collaboration and work with the life sciences sector front and centre and working closely with HMRC. My hon. Friend the Exchequer Secretary to the Treasury is on the Treasury Bench listening attentively to the issues and we will continue to work together. They are long-standing rules. As the hon. Gentleman would acknowledge, we have made huge progress in this area for patients in this category, particularly with our revision of the National Institute for Health and Care Excellence threshold, and we will continue to do so, on behalf of the patients we all want to help.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 9th June 2026 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

We inherited a decades-old system whereby patient voice was divorced from decision makers, with more than 20 organisations offering a place for patients and users to share feedback. The Health Bill will put the views of patients and users at the heart of decision making, ensuring that that directly informs those responsible for commissioning locally, and we will create a new patient experience directorate in the Department to ensure that patient and user insight directly shapes national policymaking.

[Steve Darling]

The abolition of Healthwatch will see the NHS and the Government effectively marking their own homework. Can the Minister please give some assurances about how the Government will ensure that the voice of those with learning disabilities, complex needs and dementia is heard?

[Karin Smyth]

The hon. Gentleman makes an important point about the variety of needs that local commissioners need to take account of. That is exactly what the Health Bill will try to do, not by outsourcing that role to an outside body but by putting those views at the heart of what all commissioners do, which includes making sure that under-represented or often unheard voices do have a voice.

[Munira Wilson]

When Boots decided to close two pharmacies in Hampton, leaving a large number of elderly and vulnerable residents without local pharmacy provision, Healthwatch Richmond played a crucial role in ensuring that we got a new community pharmacy in the area. That locally led patient voice cannot be replaced by officials in Whitehall or our local ICB, which is about to suffer cuts of over 50% in its operating budget. If the Minister is really serious about championing patients, will she think again?

[Karin Smyth]

The hon. Lady raises an interesting example of somewhere where local commissioners have failed to provide a service or recognise when a service disappears. They can do that by using very different voices, rather than outsourcing that responsibility. Through the Health Bill, we have to make sure that commissioners do their job properly, which includes taking account of patient voice at a very local level.

[Rachael Maskell (York Central) (Lab/Co-op)]

Replacing Healthwatch will mean that, ultimately, patients will not have confidence in the commissioners. We have just heard one example, and I can offer many examples from York. Healthwatch York, which is phenomenal and is led by Siân Balsom, has produced reports that have brought about change. I plead with the Government to review clauses 64 and 65 of the Health Bill to maintain Healthwatch. It should not be an either/or. We need commissioners to engage with the patient voice, but we also need Healthwatch to have the independence to advocate for patients.

[Karin Smyth]

I thank my hon. Friend for her comments about her local healthwatch. There are certainly examples of where this approach works well in local communities, and we need to understand those. However, it does not work well everywhere, and it means that local commissioners are not empowered and are not held accountable for their job of making sure that the patient voice and experience is held locally. There is also nothing to stop ICBs undertaking that role as they see fit in their local communities in the future, rather than our dictating how they should do it through one particular body.

[Mr Jonathan Brash (Hartlepool) (Lab)]

While I support the Government’s desire to drive out bureaucracy from the NHS and simplify systems for patients, Healthwatch Hartlepool has done an outstanding job in ensuring that patients’ voices are heard as systems and services are improved. What can the Minister do to ensure that local expertise is retained in any new system?

[Karin Smyth]

I thank my hon. Friend for his comments. If that works well for his local system, there is nothing to stop it. How the ICB undertakes its role has to be determined locally to make it most effective for local circumstances, and it can undertake that role as it sees fit.

[Graham Stuart (Beverley and Holderness) (Con)]

11. What assessment he has made of trends in the level of unreported removals from waiting lists.

[The Minister for Secondary Care (Karin Smyth)]

Over 85% of waiting list removals are made as a result of patient care, and since the end of the pandemic, unreported removals have been below pre-pandemic levels. Record levels of elective activity are being delivered by NHS staff, enabling us to cut waiting lists and meet our interim target of 65% of patients being seen within 18 weeks—the highest performance in over four years.

[Graham Stuart]

People in Beverley and Holderness want high-quality and speedy care, not massaged waiting list numbers that suit Labour narratives. Of course, Mr Speaker, you will remember that the last Labour Government had form on this as well, because the National Audit Office repeatedly found that the numbers were manipulated when waiting lists were similarly put on a pedestal. The Minister has the new Secretary of State by her side. Can she reassure people in Beverley and Holderness that we will have genuinely improved healthcare, rather than widespread manipulation and the cleansing of waiting lists to suit political purposes?

[Karin Smyth]

If anyone has forgotten, the last Labour Government left the NHS in a better state than it was in under successive Governments. That is not in dispute in terms of waiting list targets or, indeed, patient satisfaction. The right hon. Gentleman might want to look again at the record.

The point that the Conservatives seem to be intent on following up forever is an important one. Some 85% of the activity is a result of direct patient care. Validation, both clinical and clerical, is a long-standing routine practice of waiting list management. At roughly 15%—it was slightly higher before the pandemic—the rate is no different now from what it has been before, so it is not the case that something different is going on here. What we are doing is making sure that the right hon. Gentleman’s constituents—I appreciate that there are many other local problems in his system at the moment—can be clear that we have the right people on the right list for the right care in the right place by the right clinicians. That is what we are determined to do.

[Lewis Atkinson (Sunderland Central) (Lab)]

I commend the Minister for her work in reducing waiting lists for GP referral to first treatment, and they are genuinely coming down. She will be aware, however, that that statistic does not capture the entire picture, particularly for people who require subsequent follow-up care—for example, women with endometriosis or women waiting for breast reconstruction following mastectomies. Could she say a little about any plans she has to capture those waiting lists?

[Karin Smyth]

My hon. Friend is someone who does understand the way waiting lists are managed and so on. We do not have any plans to add any new targets to those to which we have already committed to give confidence to the British public that we can fix the NHS and get waiting lists down. However, he raises an important point about how we support patients to understand where they are in the system and where their care will be provided. Part of our commitment in the elective reform plan, which we outlined last year, is that patients are kept up to date about where they are being treated and why they are being referred to perhaps a more local service, and we will continue to try to do that.

[Mr Speaker]

I call the shadow Minister.

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

Last month, the Health Service Journal reported that the elective waiting list target was met largely—largely—because a record number of patients were removed from waiting lists in March without receiving treatment. Can the Minister tell the House how many patients were removed in March and what happened to them, and whether she is satisfied that they definitely did not need treatment?

[Karin Smyth]

As I have said, I am still a bit perplexed about why the Conservatives are perpetually highlighting their inadequate management of the health service, and the idea that patients are simply referred to a waiting list and then left there for a couple of years, which is what happened on their watch. It is important that patients know why they are on a waiting list, and obviously that they get the best clinical care as quickly as possible.

I do not have to hand the exact figure for March, which will be published as part of the normal process of publishing the waiting list figures. However, I can tell the hon. Gentleman that completed pathways were 5.9% higher in the 21 months from July 2024, when we took office, to March 2025 than in the previous 21 months. Patients, as they deserve, are getting the right care in the right place under this Government.

[Dr Evans]

It is not just the Conservatives who are raising this issue; it is patients and the Health Service Journal. The answer is that 350,000 people—a city the size of Coventry—were wiped off the waiting list with no treatment, and that is 100,000 more than the month before. If there is genuinely nothing to hide, the Government should not worry about putting out the figures. Will the Minister commit to a review to find out what has happened to those 350,000 patients, or does she believe that waiting list targets should be met by removing patients from the figures rather than actually treating them?

[Karin Smyth]

This is an established way of managing waiting lists and waiting times. We are making sure that there is adequate clerical and clinical validation of the lists, and that patients are treated where they need to be, which may often be closer to home and in more local circumstances. Of course, we have committed to greater transparency than there was under the previous Government, and we will continue to provide that. I did not quite follow the hon. Gentleman’s question, but I am obviously very happy to look at anything arising from it. We are confident in the data that is coming out—as I have said, this is standard practice—and the figure is roughly 15%, as it has been over many years.

[Mr Luke Charters (York Outer) (Lab)]

12. What steps his Department is taking to improve the provision of NHS health visitors.

--- Later in debate ---

[Lewis Cocking (Broxbourne) (Con)]

15. What steps he is taking to improve accountability in the health service.

[The Minister for Secondary Care (Karin Smyth)]

The NHS modernisation Bill will clarify and strengthen accountability in the NHS. It ends the fragmented accountability that we inherited on coming into government, and the reforms will restore clear democratic accountability, with the Secretary of State directly accountable to Parliament and the public. We will enhance local autonomy, ensuring NHS organisations are good partners and deliver for their local populations.

[Lewis Cocking]

We need more local accountability in the NHS. In Broxbourne we have seen thousands of new houses built, but when I and local Conservative councillors have pushed for new healthcare facilities to cope with the new demand, we have been refused. Can the Minister explain who will be accountable for that under the Government’s new system?

[Karin Smyth]

The hon. Gentleman highlights a situation familiar to many of us. One of the many problems that we inherited from the last Government was the fragmented landscape, so I thank him for his question. A key part of the responsibility of integrated care boards is commissioning for their populations to improve access to healthcare and reduce inequalities. For the first time, ICBs will be held accountable through the outcomes framework.

[Helena Dollimore (Hastings and Rye) (Lab/Co-op)]

Jules Fielder from Hastings was diagnosed with stage 4 terminal lung cancer after doctors missed her symptoms, mistaking them for tennis elbow. As a non-smoking young woman, she did not meet the stereotype of what lung cancer patients often present with, but she was determined to channel her own tragedy into change. She campaigned for better, earlier awareness of symptoms among clinicians and members of the public, and she took that message to everyone she could. Together, we convinced Boots to roll out on-shelf awareness labels in the cold and flu medicine section to raise better awareness. Sadly, Jules passed away last month. Will the Minister join me in paying tribute to all of Jules’s campaigning, and commit to continuing her vision in the Department of Health and Social Care by ensuring we use every possible avenue to raise better awareness and catch cancer earlier?

[Karin Smyth]

I thank my hon. Friend for raising that example of tremendous public service in the face of adversity. We are sorry to hear of Jules’s passing, and our thoughts are with her friends and family. My hon. Friend highlights the way in which people can access and determine outcomes and the fact that it is the responsibility of those working in local health services—in this case, the ICB in particular—to involve people and use their experience to drive the change that we want to see as part of the Health Bill.

--- Later in debate ---

[Peter Swallow (Bracknell) (Lab)]

T2. One of the biggest barriers to accessing community healthcare in Bracknell Forest is constituents not being able to get routine diagnostic procedures done at their local GP or health centre, and instead having to travel. One constituent with cancer was told that he had to go to Guildford for a simple blood test. How will the introduction of a single patient record help to break down some of those barriers?

[The Minister for Secondary Care (Karin Smyth)]

The single patient record will give clinicians timely access to a single trusted record so that decisions can be made more efficiently, avoiding duplication, allowing them to spend more time with patients. The system makes all information on a patient accessible in a single place and will allow the sharing of patient data among different settings, as my hon. Friend outlines, and provide more flexibility in where services are made available.

[Mr Speaker]

I call the shadow Secretary of State.

--- Later in debate ---

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

T9. There is overwhelming evidence that marketised health systems, as the NHS has become, increase health inequalities. Will the Health Secretary consider amendments to the Health Bill that will tackle the rising inequalities in existing health policies, including allowing local NHS organisations to determine if they need additional private sector capacity?

[Karin Smyth]

I commend my hon. Friend for her experience in this area. She tempts me to look at amendments in that space, but we do not have plans for that at the moment. The changes we made to NHS England placed the responsibility regarding health inequalities in all our policies firmly at the Secretary of State’s door. I am happy to talk to my hon. Friend about her other ideas on that. The Bill transfers that responsibility to the Secretary of State and we have no plans to make any changes in that area.

[Alison Griffiths (Bognor Regis and Littlehampton) (Con)]

T7. Thousands of people in West Sussex are unable to access an NHS dentist and many constituents in Bognor Regis and Littlehampton tell me that they have been unable to secure an appointment for years. What specific steps is the Secretary of State taking to increase NHS dental capacity in coastal communities, and when does he expect patients to see a measurable improvement?

Maternity Nurses, Nannies and the Infant Sleep Industry

Karin Smyth Excerpts

Monday 8th June 2026 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I thank my hon. Friend the Member for Altrincham and Sale West (Mr Rand) for securing this debate and acknowledging the concern that has been raised recently in the field and by the media. We are all deeply saddened to see the impact of those giving poor advice on infant sleeping. Public safety is and has to remain the top priority.

As my hon. Friend said, being a new parent is a difficult time; I certainly recognise that helping an infant settle into a regular sleep pattern can be difficult for new parents and carers. It is a worrying and stressful time, as he said. Rogue advice from so-called experts can have a devastating effect on those who seek reputable advice and guidance.

Before I talk about regulation of the infant sleep industry, I want to clarify that the Department for Education is responsible for the regulation of nannies and childcare services, which my hon. Friend mentioned. The early years foundation stage statutory framework sets the standards and requirements that early years providers must meet to ensure that children have the best start in life and are kept healthy and safe. All early years providers are already required to meet the safer sleep requirements set out in the statutory framework, which currently links to the NHS safer sleep guidance. The Department for Education plans to update the wording in the early years foundation stage statutory framework so that the requirements are set out directly in the framework itself. That is due to come into effect from September 2026, subject to the usual parliamentary and legislative processes. The Department for Education has already written to providers informing them of the proposed new wording and to remind them that they must meet the current requirements.

The “Best Start in Life” campaign provides parents and carers with NHS safer sleep advice through a range of communication channels, including social media, the website and an email programme. Recently, we have collaborated with experts such as Rosey Davidson, a paediatric sleep consultant, to support the promotion of safer-sleep guidance, reaching approximately 40,000 parents through one post alone. The healthy babies programme supports new parents and families by offering integrated, preventive and universal support, including for perinatal mental health, parent-infant relationships and infant feeding, in the 1,001 days from pregnancy to age two. By delivering those services through a physical and digital Best Start family hubs network, we are ensuring that parents and carers have access to joined-up, family-centred advice and support that is delivered in communities where there are high levels of need.

In January, NHS England published a post-natal toolkit to improve the post-natal care experience for women and their families. The toolkit supports integrated care boards, their place-based partners, and health and care providers to work together with service users and professionals to improve the post-natal care experience and both short-term and long-term maternal and infant health outcomes. Additionally, NHS England has published guidance for GPs on the post-natal appointment that women should be offered six weeks to eight weeks after giving birth. That provides an important opportunity for GPs to listen to women in a discreet, supportive environment.

Qualified health visitors and their teams also have an important role, as my hon. Friend said, in supporting infant health, wellbeing and parenting confidence. They promote safe sleeping for babies and provide safe advice to parents. Services such as health visiting are being strengthened by providing over £13.4 billion of public health funding for local government over the three years from 2026/27 through a consolidated ringfenced public health grant.

“Maternity nurse”, “night nurse”, “baby sleep consultant” or other terms for these roles are not regulated professions. Often, those working in a sleep industry role will refer to themselves as a “nurse” to indicate that they are suitably qualified to advise. That can mislead the public by providing an impression that such individuals are qualified and professionally registered to provide a particular level of care, advice or care intervention that they do not hold, which puts the public and babies at risk.

In May 2025, the Government announced our intention to protect the professional title “nurse” within this Parliament. Protecting the title “nurse” will make it a criminal offence for someone to call themselves a nurse unless they are registered as a nurse with the Nursing and Midwifery Council, or part of one of a number of exempt professions, such as dental nurses and veterinary nurses. These new protections will also apply to longer professional titles that include the word “nurse”, such as “maternity nurse” and “night nurse”. To ensure that we get these changes right, we will shortly be publishing a call for evidence on the protection of the title of “nurse”.

I invite everyone present and those interested in this debate to share their views, which will inform the future legislation underpinning the Nursing and Midwifery Council that will implement this change. We want to hear from those working in healthcare, but also those in other fields such as childcare and care for animals as well as the general public, to understand what exemptions should apply and to ensure that those who may be affected by this change can feed in their concerns. We are also seeking views on protecting other titles such as “nursing” and “health visitor”.

However, ultimately this is about patient and public safety. When someone seeks treatment, support or advice from a “nurse”, there is a legitimate expectation that the individual is suitably qualified and professionally registered. Our proposed changes will make it a criminal offence for someone who does not hold such qualifications and professional registration to claim to be a nurse.

This is an important subject and I am grateful to my hon. Friend for raising it, and I know there is further interest across the House. I hope people will respond to the call for evidence, and we will of course continue to work with colleagues to make sure this is a safe place for parents.

Question put and agreed to.

General Medical Council

Karin Smyth Excerpts

Thursday 4th June 2026 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I thank the right hon. Member for North East Cambridgeshire (Steve Barclay) for raising this extremely serious matter very powerfully on behalf of his constituent Elizabeth, following the tragic loss of her son Jack. Our thoughts are with her and the rest of the family. We Members of Parliament find ourselves dealing with tragedies, but we are able to give our constituents a voice, and that is a great honour—a sad one, but one we take very seriously. I commit to working with the right hon. Gentleman as we move forward.

As the right hon. Gentleman said, the General Medical Council is there first and foremost to protect patients and maintain public confidence in the medical profession. It is the regulator of all medical doctors, anaesthesia associates and physician associates practising in the United Kingdom. It defines standards for ethics, competence and patient safety, and it has a duty to investigate concerns about doctors’ performance or conduct.

The right hon. Gentleman mentioned the Verita review, so let me start there. In January last year, Cambridge University hospitals trust commissioned Verita, an objective investigations company, to undertake a review of the hospital’s governance. Meanwhile, the Kennedy report into the missed opportunities surrounding Dr Stohr’s case is still ongoing. Verita’s report was published in October 2025 and made 23 recommendations. The broad themes that emerged from that investigation were: first, that doctors needed more oversight, clinical supervision and performance management; secondly, improving safety governance through better board-level visibility and escalation pathways; thirdly, proper oversight of clinical reviews, and ensuring that they are acted on promptly, and that changes are made; and finally, a change in medical culture and behaviour, so that staff feel empowered to hold their hands up when things go wrong. The trust has accepted the findings, published an action plan and apologised to affected families, as I understand it. We expect the hospital to implement the findings of the review in full, because Jack Moate’s family deserve absolute transparency from the authorities, and they have the right to know that lessons will be learned when things go wrong.

The right hon. Gentleman wrote to the Department on 15 May, and his letter makes it very clear that this is one of the worst and most distressing cases that he, in his long experience, has ever encountered. Having read that letter, I agree with him, and I know he does not use those words lightly. I can confirm that the GMC has now done the right thing and launched an investigation into the conduct of Kuldeep Stohr.

The GMC is an independent body, and I cannot go into all the specifics of an individual case, as the right hon. Gentleman will know from his time as Health Secretary. It would be wrong for me to give any further commentary on a live investigation, not least because that could prejudice the outcome and be a barrier to Jack’s family getting justice. Suffice it to say that I am just as appalled as the right hon. Gentleman is that this has gone on for so long.

It has taken almost a decade of missed opportunities for the families to start getting the answers they deserve. I understand that the former Minister for patient safety, my hon. Friend the Member for Glasgow South West (Dr Ahmed), met some of the families in November. He also intended to go to Cambridge to meet families and representatives of the trust. Today I can confirm that the new Minister for patient safety, my hon. Friend the Member for Birmingham Edgbaston (Preet Kaur Gill), is willing to meet the right hon. Gentleman and the Moate family to discuss the shocking circumstances of their case. I hope that they can take some comfort from knowing that although my hon. Friend is new in post, she takes these issues very seriously, she has been a champion for her own constituents who faced patient safety failures in her local trust, and she will be following this case very closely indeed.

It may be helpful for me to outline the broader principles that govern the GMC and its regulatory framework. When an allegation is made about a doctor, the GMC has a duty to investigate and, where necessary, take action to safeguard the health and wellbeing of the public. In serious cases, it can refer a doctor to the Medical Practitioners Tribunal Service. These procedures can result in doctors being removed from the medical register. That strips away their right to legally practice medicine in this country. The MPTS is a statutory committee of the GMC. It operates separately and independently, which is crucial to maintaining public confidence in its findings. The tribunals have a legal duty to protect the public, and we have clear expectations of them.

This year, we are taking action to modernise the regulation of all healthcare professionals in the UK. In March, we published a consultation on reforming the General Medical Council legislative framework. The reforms would make the process for assessing a doctor’s fitness to practice swifter and fairer, and, as we have heard, the consultation runs until 23 June. The right hon. Gentleman tempts me to consider making amendments to the Health Bill. Given his experience, he will understand that I will not commit to doing that, but I can commit to discussing the matter further, and I encourage him and others, including my hon. Friend the Member for Lichfield (Dave Robertson), who raised the shocking al-Fayed case, to engage with that consultation. We will consider the outcomes of that consultation before we bring legislation to the House, but we expect to lay the General Medical Council order before Parliament later this year, subject to those conversations. I am happy to ensure that the right hon. Member for North East Cambridgeshire and my hon. Friend the Member for Lichfield have any further meetings that are necessary with me or with officials, given the tight deadlines that will have to be met under that timetable.

I will touch on the Mann review, which the right hon. Gentleman also highlighted. As we all know, the NHS was founded on the principle of treating everyone equally and with respect. We have been crystal clear that racism and discrimination betray everything the NHS stands for and its ability to provide safe, world-class care. That is why the former Secretary of State, my right hon. Friend the Member for Ilford North (Wes Streeting), asked the noble Lord Mann to conduct a review into antisemitism and other forms of racism in the NHS. As the right hon. Member for North East Cambridgeshire said, this morning Lord Mann published a series of robust and practical recommendations, and we support every one of them.

The right hon. Gentleman read out some shocking stories from his time as Health Secretary. I cannot comment on them now, but I assure him and other hon. Members that in the weeks and months ahead, we will work with all organisations that have been named in the review, including the GMC, to ensure partners across the system are supported in delivering meaningful change based on the recommendations. I know that the GMC is as committed to rooting out racism from its ranks as we are, and we will leave no stone unturned to get this done.

Trust is the glue that holds our institutions together. The public have an absolute right to know that they can trust their doctor, and when things do go wrong, they have a right to swift and transparent justice. I cannot begin to imagine what Jack’s family, and especially his poor mum, are going through. I thank them for their consideration in discussing this with us, and I know that there are many other families involved. The system that we build has to do right by families like theirs. I commit to working further with the right hon. Gentleman and others in this place to do just that.

Question put and agreed to.

Health Bill

Karin Smyth Excerpts

2nd reading
Monday 1st June 2026 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I was going to say that sometimes it is the hope that kills you, but instead I will say that it is a pleasure to close the debate on behalf of this Government.

Let me begin by commending the many fantastic speeches that we have heard this evening. My hon. Friend the Member for Middlesbrough and Thornaby East (Andy McDonald) made some excellent points about spinal cord injury and specialised commissioning. His comments apply to many people, and I take them on board. My hon. Friend the Member for Beckenham and Penge (Liam Conlon) talked about the experience of Alex Savage and his work with the Tessa Jowell Foundation; we thank Mr Savage for that, and mourn his passing. The Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), made a number of valuable points, and I will continue to engage with her and her Committee. I also note the points made by my hon. Friend the Member for Calder Valley (Josh Fenton-Glynn). My hon. Friends the Members for Thurrock (Jen Craft) and for Bexleyheath and Crayford (Daniel Francis) talked about the experience that they bring to this place in relation to SEND, supporting disabled people—particularly children—and joining up services. My hon. Friend the Member for Dudley (Sonia Kumar) drew on her experience of designing services for the future around people and patients.

As ever, I thank my hon. Friend the Member for Sunderland Central (Lewis Atkinson)—another excellent manager from the service—for the expertise that he brought to the debate. My hon. Friend the Member for Cannock Chase (Josh Newbury) made some excellent points about professionals in NHS England, and about communications professionals as well. We know that it is difficult, and we want to use their expertise as we go forward. My hon. Friends the Members for Gloucester (Alex McIntyre), for Rossendale and Darwen (Andy MacNae) and for Stockport (Navendu Mishra) talked about mental health, obesity prevention and their local services. I thank the former Secretary of State, my right hon. Friend the Member for Ilford North (Wes Streeting), for his support for my work in presenting the Bill, and I am relieved that he is still here in support this evening. That is good to know. A week is a long time in politics.

As I often tell people—you have heard it before, Madam Deputy Speaker—I have Lord Lansley to thank —or blame—for my being at this Dispatch Box. I left the NHS and stood for the Bristol South constituency because I could see the coming catastrophe of those coalition reforms. In 2010, patient satisfaction was an all-time high; in 2024, it is at an all-time low. In 2010, the last Government inherited the shortest waiting lists in history; in 2024, they left the waiting lists at record highs. In 2010, the NHS was efficient and delivered value for money; by 2024, we had dropped down international rankings despite a massive increase in headcount at the centre. That is the scorecard that the last Government left for the 2012 reorganisation.

In preparing for this debate, I have looked through my past comments since becoming an MP. In 2016, I said that despite being a non-executive director and manager in the NHS, I could not easily navigate the plethora of bodies in the health and care field. From 2016, it got worse. Each crisis or scandal brought more so-called independent bodies, but no more efficiency, effectiveness or, crucially, safety. We on the Public Accounts Committee were desperately trying to get clarity on accountability for spending, but we did not get it. In 2019—this is on the record—I did an interview with the Health Service Journal in which I highlighted how the role of Parliament in nodding through the estimates bore no relation to financial accountability or spending in my local NHS, and how it was impossible to follow through on funding allocations for facilities for my constituents, or even to understand the decision making of local commissioners, trust boards, regions, NHS England, the Department or the Treasury. When I sat on the Opposition Benches, I watched Tory MP after Tory MP chastise their own Government about what was happening in their constituencies, which was met with a shrug of the shoulders to say, “It’s all down to NHS England.”

The Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson), talked about ICB accountability, but there is none. Many MPs come to me and say that they cannot get a response from their ICBs. At the moment, some people cannot even get a response to their emails. It is shocking, as my hon. Friend the Member for Lichfield (Dave Robertson) outlined so clearly. The Conservatives’ approach was to hand £200 billion of taxpayers’ money to one body, and more taxpayers’ money to a host of others that were charged with delivering, monitoring and checking a health system in which there is a lot of monitoring, a lot of checking and no end of tick boxes but, crucially, too little delivery of the high-quality services that the British public deserve and the staff want to give.

That cavalier approach changed with this Labour Government, why is why we are bringing forward this Bill. We are abolishing NHS England, devolving commissioning budgets to ICBs, putting patient voice at the heart of the new directorate, and making local commissioners in councils and ICBs embed patient voice and experience in their commissioning, rather than outsourcing their responsibility and then ignoring it. The system does not work, and Members know it. Patients deserve better.

This is the biggest transfer of power to local systems that we have seen. Most significantly, this Government are delivering on giving power to patients, who are frankly astonished to find in 2026 that their records are not joined up in the NHS. My hon. Friend the Member for Portsmouth North (Amanda Martin) made an excellent point about the impact that that has on veterans. Although we have a patchwork of local workarounds that benefit a few people—in Manchester, Bristol or the north-east, for example—patients across England have the right to their own record, and for their clinicians to have access in order to deliver the care they need. That point was well made by my hon. Friends the Members for Glasgow South West (Dr Ahmed), for Ashford (Sojan Joseph), and for Bury St Edmunds and Stowmarket (Peter Prinsley), all of whom gave us real examples of patient experience. As my hon. Friend the Member for Stroud (Dr Opher) says, it is about time that we had single patient records. We heard about the impact on patients from my hon. Friend the Member for Basingstoke (Luke Murphy), who spoke about the sad passing of his father.

A lot of questions have rightly been asked about the single patient record and data, including by the hon. Member for South Northamptonshire (Sarah Bool), my hon. Friend the Member for Morecambe and Lunesdale (Lizzi Collinge), the hon. Member for Newton Abbot (Martin Wrigley), and my hon. Friends the Members for City of Durham (Mary Kelly Foy), for Worthing West (Dr Cooper), for Bournemouth West (Jessica Toale) and for Wolverhampton North East (Sureena Brackenridge). We want to make sure that we get this right. They should know that although the Bill establishes the legal framework for the SPR, much of the detail will be in secondary legislation. I can assure the House that all Members will have a chance to scrutinise the regulations in due course. However, we firmly believe that pursuing a single patient record is the right thing to do. We have found that patients and staff support it, as long as it is built with the strongest safeguards for security and privacy. We hear their concerns, and we will make sure that those safeguards are built in.

The single patient record will protect personal data by default. It will be considered critical national infrastructure, with the highest standards of cyber-security and information governance, so that only the right people can access the right information at the right time and for the right reasons. There will be audit trails of who has accessed a patient’s data, and UK GDPR and the Data Protection Act 2018 will apply. The Bill does not create new legal gateways for purposes other than direct care. It does allow data to be used for research, population analysis and service improvement, but only where there is a separate legal basis for doing so.

Let me pick up on the issue of accountability, which is very important to me personally. I agree that it is important to get this right, and we need to work both nationally and locally. I am old enough to remember the world before 2012. For 60 years, the Secretary of State had overall responsibility and accountability for this service. I think the comments about local accountability were well made by the hon. Member for Runnymede and Weybridge (Dr Spencer) and my hon. Friends the Members for Birmingham Erdington (Paulette Hamilton) and for York Central (Rachael Maskell). Let me be clear: the Bill puts more power, not less, in the hands of local organisations. ICBs will be responsible for commissioning a wider range of services, including primary care, and they will hold a large proportion of the NHS budget—over £179 billion, as before—but at the same time the public expect Ministers to be accountable for the NHS they pay for.

Therefore, Ministers should have the tools to hold ICBs to account and direct the system where necessary. That is why the Bill provides the Secretary of State with a power of direction, but with important safeguards on appointing specific individuals and directions to intervene in decisions about services provided to a particular person. If a NICE recommendation on a drug or treatment exists, this takes precedence over a direction. The powers in the Bill will ensure the Secretary of State is able to create the conditions for ICBs to succeed with effective and proportionate forms of intervention, where necessary.

Another major point made this evening was about Healthwatch. I think there is an important philosophical point about independence, the perception of independence and effective decision making, which we will discuss in Committee and it will be important to do so. However, as the Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), outlined very well, we have had these bodies for 50 years. Patients are saying that the system does not work and are not reporting to it, so the system does not work. I listened carefully to the hon. Member for St Neots and Mid Cambridgeshire (Ian Sollom) and my hon. Friends the Members for Blaydon and Consett (Liz Twist) and for Dartford (Jim Dickson) about getting the balance right, and we will discuss those really valuable points.

Currently, the patient voice sits isolated in separate organisations, which criticise the status quo but are not able to change it. That is why we want a new director of patient experience in the Department to ensure that voices are heard as part of every decision. Locally, it is the job of the commissioner—and I have been a commissioner—and of a good commission organisation to include the patient voice and experience in all its decision making. That is where the difference is made, and such organisations should not be outsourcing those decisions. That is the difference, but a debate is to be had, and we have to assure people on the perception issue. We want to ensure local ICBs incorporate the patient voice and experience appropriately—including digitally excluded people, as the hon. Member for Meriden and Solihull East (Saqib Bhatti) said— into their decision making. How that happens is not set in stone. It is our job to set the destination, not exactly how we get there. If an organisation can provide a good service locally for the patient voice and experience, the ICB could continue to contract with it.

Briefly on HSSIB, I hear the points from the hon. Member for Harwich and North Essex (Sir Bernard Jenkin), whom I have met, and my hon. Friend the Member for Shipley (Anna Dixon) and other Members have raised these issues. The Dash review is very clear—I recommend Members to read it—and it is why the new CQC will combine its regulatory functions with the depth of HSSIB’s investigatory capability to the benefit of both. As was rightly raised by the hon. Member for St Ives (Andrew George), the safe space is important to enable people to share concerns in confidence, and that is safeguarded in the Bill. I understand that there is a perception issue, but we must ensure that that is real. The CQC has also raised some operational issues with implementing the integration of HSSIB, and we are working with it to ensure that, when passed, the measures concerned will be implemented effectively.

To conclude, the Bill is only one part of our modernisation agenda, but it is a crucial one, because for decades Governments have failed to grapple with this fragmentation. Like capital and the workforce, the problem was put in the “too difficult” box and left to this Government to solve, but solve it we will. The single patient record will finally mean patients get the joined-up, proactive care they deserve. By voting for this Bill, we can have a fresh start in NHS history. I commend it to the House.

Question put and agreed to.

Bill accordingly read a Second time.

Health Bill: Programme

Motion made, and Question put forthwith (Standing Order No. 83A(7)),

That the following provisions shall apply to the Health Bill:

Committal

(1) That the Bill shall be committed to a Public Bill Committee.

Proceedings in Public Bill Committee

(2) Proceedings in the Public Bill Committee shall (so far as not previously concluded) be brought to a conclusion on Thursday 16 July 2026.

(3) The Public Bill Committee shall have leave to sit twice on the first day on which it meets.

Consideration and Third Reading

(4) Proceedings on Consideration shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which those proceedings are commenced.

(5) Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.

(6) Standing Order No. 83B (Programming committees) shall not apply to proceedings on Consideration and Third Reading.

Other proceedings

(7) Any other proceedings on the Bill may be programmed.—(Jade Botterill.)

Question agreed to.

Senior NHS Workforce Pay

Karin Smyth Excerpts

Thursday 21st May 2026 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

I am pleased to announce that we are publishing our response to the recommendations made by the independent Senior Salaries Review Body for the 2026-27 financial year.

I hugely appreciate the incredible work of talented staff across our NHS, and that is why I am formally accepting the headline pay recommendation of 3.0% for senior leaders across the NHS in England, to give them a well-deserved pay rise. This award relates to:

Over 3,200 very senior managers (VSMs)

Over 400 executive senior managers (ESMs)

These awards mean that the Government are delivering a well-deserved pay rise, on top of those in preceding years, underlining the extent to which we value our senior leaders. Eligibility for pay awards for VSMs is linked to their organisation’s performance as determined by the NHS oversight framework segment to which they are assigned: https://www.england.nhs.uk/publication/nhs-oversight-framework/

I am grateful to the Chair and members of the SSRB for their thoughtful consideration of the evidence presented to them. Their report recognises the vital contribution that NHS leaders make to our country. The SSRB has examined the economic picture and evidence on recruitment, retention, motivation and morale to reach their recommendations.

The SSRB made a further two recommendations, which are not directly related to headline pay. I recognise the challenge of recruiting those at the top of the Agenda for Change pay scale into VSM roles. To help address this, I am therefore pleased to accept the recommendation to deliver training and support knowledge-sharing for remuneration committees and chief people officers. However, we will do this over a longer timeframe than envisaged by the SSRB, to allow sufficient engagement with relevant stakeholders in the design and delivery of the training. Following engagement with stakeholders, we will deliver this training within this financial year.

I can also confirm that I am accepting, in principle, the recommendation to withdraw the very out-of-date executive senior managers pay framework. It is not feasible to withdraw and replace the framework ahead of April 2027. Any changes to ESM pay setting and reward will need to be carefully sequenced and considered alongside the ongoing DHSC/NHSE transformation.

We will continue to implement commitments to improve the support NHS staff receive and their experience at work. Ensuring the NHS is a great place to work is fundamental to improving patient experience: from reducing the backlog in elective care to ensuring timely access to GP appointments.



Next steps

We have listened to the workforce and understand the difficulties they face when pay awards are not delivered on time. I am pleased to be announcing the pay awards earlier than the previous year. We will continue work across Government to keep bringing forward the pay round for all public sector staff.

The SSRB report will be presented to Parliament and published on gov.uk.

[HCWS66]

NHS Pension Scheme: McCloud Implementation

Karin Smyth Excerpts

Thursday 21st May 2026 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

On 11 December 2025, I issued a written statement on the implementation of the McCloud remedy for affected NHS pension scheme members. I updated on progress in planning for the delivery of the remedy and reaffirmed my commitment to deliver the remedy to the coalition Government’s discrimination. I also committed to keeping the House informed of progress.

The NHS Business Services Authority has now developed and aligned its plans for the delivery of the McCloud remedy. An independent review, led by Lisa Tennant, has considered those plans and the NHSBSA’s capacity, capability and functions to deliver the remedy. Lisa Tennant is now preparing a final report, which I intend to publish in due course.

The independent review has found that significant progress has been made in the NHSBSA’s planning for the remedy, including the comprehensive analysis of steps that will need to be taken to provide each individual member with their remedy choice and to enact it. Given the level of complexities in the membership of the NHS pension scheme, this has been a substantial undertaking. The review also highlights a number of dependencies that are critical to delivering the remedy. These include:

Procuring external suppliers to bolster NHSBSA’s capacity to manually calculate remediable service statements for some members;

The release of software to automate statements as far as possible, enabling future retirees to make their remedy choice at the point of retirement, and to further automate calculations for members who are already retired.

I remain committed to setting deadlines that prioritise the delivery of the remedy to members who are likely to be facing financial detriment as a consequence of the discrimination identified by the McCloud judgment. The deadlines must be realistic and achievable. They must also ensure that the scheme’s ongoing performance is maintained and protected alongside the delivery of the remedy. I expect these dependencies will have advanced sufficiently, or been appropriately mitigated, to enable me to issue new statutory deadlines with confidence before summer recess.

Subject to the dependencies outlined above, the NHSBSA’s plans currently forecast that:

Retired members whose remedy period 1 April 2015 to 31 March 2022 benefits are still affected by the discrimination identified by the McCloud judgment—in that some or all of the accrual for that period is 2015 scheme accrual—should receive their remedy choice by the end of December 2027;

Retired members whose remedy period benefits are no longer affected by this discrimination—in that all of their accrual for the period is 1995 to 2008 scheme accrual—should receive their remedy choice by the end of June 2030;

All active and deferred members who are due a remedial pension saving statement should have received this by the end of March 2027.

I have asked the NHSBSA to take steps to communicate to members when they can expect to receive their remedy choice, and which deadlines, when issued, will apply to them.

The NHSBSA continues to issue remediable service statements and remedial pension saving statements in line with its delivery plans. To date, 10,462 remediable service statements have been issued to retired members who are most likely to be facing financial detriment. Of those, 5,804 have been returned and 5,368 decisions have been enacted. A further 11,457 have been calculated and are scheduled to be issued in alignment with the NHSBSA’s delivery plan. In addition, a remediable pension savings statement has been issued to 121,824 members, and 19,952 are outstanding.

[HCWS55]

Health and Social Care

Karin Smyth Excerpts

Tuesday 28th April 2026 Written Corrections

The following extract is from the statement on the Women’s Health Strategy on 16 April 2026.

[Karin Smyth]

The waiting list for gynae care was north of 600,000 when we took office. Today that figure is finally moving in the right direction, but we cannot make as much progress as we would like because the system simply was not designed with women in mind…

Women’s health pathways are being prioritised in NHS Online, and menopause and menstrual health services will be among the first to go live when it becomes operational this year.

[Official Report, 16 April 2026; Vol. 783, c. 1049.]

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

[Karin Smyth]

The waiting list for gynae care was nearly 600,000 when we took office. Today that figure is finally moving in the right direction, but we cannot make as much progress as we would like because the system simply was not designed with women in mind…

Women’s health pathways are being prioritised in NHS Online, and menopause and menstrual health services will be among the first to go live when it becomes operational next year.

Allied Health Professionals

Karin Smyth Excerpts

Thursday 23rd April 2026 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I add my thanks to my hon. Friend the Member for Thurrock (Jen Craft) for introducing the debate and to my hon. Friend the Member for Dudley (Sonia Kumar) for bringing it forward and setting out her role as a physiotherapist.

I am grateful for the opportunity to set out the practical contribution of AHPs to delivering this Government’s priorities for health and care. I agree with many hon. Members who have spoken that the 10-year health plan, “Fit for the Future”, and the forthcoming 10-year workforce plan, due in the spring—we are now in the spring, so hopefully very soon—provide a real opportunity to optimise the AHP contribution for the years ahead, including by supporting AHPs to work at the top of their skills. As a Department, we are clear that the three shifts that patients and the public need—more care in the community, a stronger focus on prevention and better use of digital and data—must be delivered in day-to-day services. AHPs will be central to making that happen.

As we have heard, AHPs make up the third largest workforce in the NHS. They include physiotherapists, occupational therapists, radiographers, speech and language therapists, paramedics, dietitians, podiatrists, and arts therapists, among others. They work across hospital, community, primary care, mental health and education settings, bringing regulated, evidence-based practice that supports faster access, better outcomes and better value for the taxpayer.

The contribution of AHPs is not confined to any single service line. AHPs assess, diagnose, treat and rehabilitate. They support self-management and they work in multidisciplinary teams spanning health, social care and education. That combination—clinical autonomy alongside team-based working—is exactly what we need to redesign services around neighbourhoods and around people’s day-to-day lives.

First, on the shift to community, AHPs work across neighbourhoods, primary care and community services, including in people’s homes. They prevent avoidable admissions and they help people leave hospital sooner and recover well. Physiotherapists, occupational therapists and speech and language therapists support rehabilitation and independent living. Paramedics are increasingly part of urgent community response and neighbourhood teams, helping people get the right care, first time, closer to home.

Secondly, on the shift to prevention, prevention is fundamental to AHP practice, as we have heard. AHPs support earlier intervention for long-term conditions. They play a key role in falls prevention, respiratory disease and musculoskeletal health, and in improving population wellbeing. That work helps people stay well and independent, and it reduces pressure on urgent and emergency care and on hospital waiting lists. That contribution aligns directly with the Government’s work and health agenda.

By providing early intervention and rehabilitation, AHPs help people with long-term conditions, disability or injury to remain in, return to and thrive in work. We heard no better example of the role that they play than in the very moving speech by my hon. Friend the Member for North Durham (Luke Akehurst). I thank him for sharing his experience and I hope he is still enjoying playing with his son. It is good to have him in the Chamber being able to articulate that experience, which is not easy to do. Whether supporting recovery after illness, managing pain and fatigue, or enabling reasonable adjustments and independence, AHPs reduce avoidable time away from employment and help more people to remain economically active, benefiting individuals, employers and the wider economy.

Thirdly, on the shift to digital, AHPs are helping to lead the adoption of digital tools to improve access and continuity. That ranges from imaging and diagnostic technologies led by radiographers, to virtual rehabilitation, remote monitoring and data-enabled triage. Alongside shared care records, these approaches can support safer, more efficient and more personalised care. Remote consultations should be used where appropriate.

Across each of those shifts, AHPs also make an important contribution to mental health and wider wellbeing. Occupational therapists support recovery and independence, speech and language therapists help to address communication needs that can affect engagement, and arts therapies, which we heard about, including art, music and drama therapy, offer clinically led support. As was well articulated by many, including by my hon. Friend the Member for Cannock Chase (Josh Newbury), those skills in neighbourhood teams can help to provide earlier, more joined-up care, including for children and young people.

I place particular emphasis on children and young people, as my hon. Friend the Member for Thurrock did so ably, including those with special educational needs and disabilities. AHPs play a vital role in early identification, assessment and intervention, supporting communication, mobility, sensory needs, mental wellbeing and participation in education and community life. Speech and language therapists, occupational therapists, physios and others work alongside families and schools so that children can develop, learn and thrive, meeting their needs before they escalate.

For children with SEND, timely access to AHP support is fundamental. Delays affect speech and language development, social interaction and educational attainment, and they can place additional pressure on families and carers. That is why work is already in train with the Department for Education, NHS England, integrated care boards and partners in local government to strengthen community speech and language therapy and other AHP provision. Our aim is earlier support closer to home and better, joined-up services.

I recognise that many hon. Members will understandably focus on the current access and waiting times, particularly for speech and language therapy. We as constituency MPs all recognise that. As my hon. Friend the Member for Thurrock said, that is critical to achieving the Government’s ambition.

More broadly, in neighbourhoods, AHPs support people of all ages to avoid deterioration and to recover well through rapid assessment, rehabilitation and support management. That point was well made by the hon. Members for South West Devon (Rebecca Smith) and for Mid Dorset and North Poole (Vikki Slade). Working alongside GPs, community nursing, social care, mental health services and the voluntary sector, they help prevent complications, reduce frailty and improve long-term condition management, easing pressure on acute services, as my hon. Friend the Member for North Warwickshire and Bedworth (Rachel Taylor) rightly said. I thank her for her support for George Eliot hospital as it improves its services for her constituents.

Delivering those shifts depends on having the right AHP workforce in the right place. That includes those smaller AHP professions such as podiatry, orthoptics, and prosthetics and orthotics whose specialist skills are essential to prevention, independence and quality of life. Through our work with system leaders and professional bodies, we will continue to support education and training routes to improve retention and enable new ways of working across systems so that people can access specialist expertise when they need it.

As part of enabling AHPs to work at the top of their skills—that is what we want—we are also taking forward work to increase their ability to prescribe medicines where it is safe and appropriate to do so. That point was well made by the hon. Member for Richmond Park (Sarah Olney); others noted that duplication issue. I confirm to my hon. Friend the Member for Stourbridge (Cat Eccles)—I thank her for her expertise in operating department practitioners—that that does include ODPs.

We must also address variation in access, including in rural and underserved areas. Neighbourhood delivery models, stronger integration with local authorities and the voluntary sector, and sensible use of digital services can all help broaden reach while maintaining safe, personalised care for those who need face-to-face support.

AHPs bring the clinical skills and professional leadership to redesign pathways, strengthen neighbourhood teams and intervene earlier so that people receive effective care in the right place at the right time. My focus as the lead Minister for the workforce plan in the Department of Health and Social Care is to support systems to deliver those priorities. As part of that, I work closely with the chief allied health professions officer—it was news both to her and to me that there is concern about her ongoing role—and will continue to do so. I thank her for her help so far—indeed, including in preparing for this debate.

The 10-year plan set the direction to rebuild the NHS, but it absolutely depends on all our staff to deliver it. The long-term workforce plan produced by the previous Government essentially looked at supply, but it did not look at future service models, it did not look at the role of technology, it did not ensure sustainability for the future and it did not base itself on future workforce models. That is some of the reason why we have problems with, for example, bottlenecks and frustration—particularly for young people coming out of their training—in not being able to get into the right roles in the right places. That is part of the problem that we need to address with the workforce plan, which we will bringing forward in the spring, so that we ensure patients and the public have the services they deserve, and particularly so that young people and children get the best start in life. I look forward to bringing forward those plans.

I have been asked again for several meetings—it is always nice to be popular for meetings—and I look forward to working with people as we bring forward that plan. We are working closely with all representatives of the sector—I know that there is a lot of interest in this work—and I very much look forward to working with hon. Members in the House as we go forward with delivering the plan.

[Jen Craft]

I really appreciate the Minister giving way—I know that she was concluding her speech. She obviously cannot reveal the contents of the workforce plan before it is published, but particularly on paediatric care, can I ask specifically for reassurance that there is something in mind for the plan when it comes to servicing the SEND Experts at Hand provision? That will be key to delivering the White Paper aims and key to young people’s life chances. We hope to be able to see that soon.

[Karin Smyth]

I was literally on my last words, so let me go back. My hon. Friend tempts me to reveal more about the workforce plan. As I said, we are not waiting for the plan to work with our colleagues across the Department for Education, NHS England, locally in ICBs and so on to ensure that we deliver on that ambition. We will of course set out the overarching plan and where we want to have people in the future. I look forward to working with her and others on how that will work. We certainly want to engage with colleagues across the piece.

As my hon. Friend knows, the SEND White Paper—we all know this through our constituency work—is central to that and to the Government’s wider ambitions. We are due to publish the plan in the spring; I look forward to doing so very soon. I look forward to working with hon. Members on that, and I thank them for the debate and their contributions this afternoon.

Maternity Commissioner

Karin Smyth Excerpts

Monday 20th April 2026 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship, Ms Jardine. I thank my hon. and learned Friend the Member for Folkestone and Hythe (Tony Vaughan) for responding so ably on behalf of the petitioners. That thousands of people wanted us to talk about this subject, many of whom will be watching—many are in the Public Gallery—demonstrates how important the issue is and how it touches so many of our constituents. I am grateful to my own constituents for signing the petition.

I place on record my thanks to Theo Clarke, who is also in the Gallery, who did a lot of work in this area when she was an MP, based on her own experiences. I agree with the hon. Member for Sleaford and North Hykeham (Dr Johnson) that, by detailing injuries and raising some of the taboos, she did a great service to other women. I also thank Louise Thompson, also in the Gallery, for the time and effort that she has put into campaigning for improvements in maternity care following her own experiences. All the organisations that work on behalf of women, bringing forward their stories to national attention, do a great service—it is not an easy thing to do, and we thank them for it.

The hon. Member for Esher and Walton (Monica Harding), and my hon. Friends the Members for Morecambe and Lunesdale (Lizzi Collinge), for Altrincham and Sale West (Mr Rand) and for Shipley (Anna Dixon) all highlighted their constituents’ experiences. To be clear, the Secretary of State leads on this work directly, and a meeting has been set with Louise and Theo to discuss the issue of a maternity commissioner more thoroughly. I encourage both Theo and Louise to continue to engage with the national investigation chaired by Baroness Amos. Their campaigning, along with that of so many others, has led the Secretary of State to directly provide the leadership himself, ensuring that the issue gets attention. We look forward to Baroness Amos’s recommendations.

As many Members have said, the vast majority of births are safe, and there are some outstanding examples of care in the NHS. But where things do go wrong, it can have a devastating impact on women and their families, who are at their most vulnerable when giving birth. We are fighting systemic issues, entrenched inequalities in maternity care, a failure to learn from mistakes, and culture and leadership issues.

It is appalling, as we have heard again in this debate, how in the 21st century in Britain there could be such a difference in outcomes for mothers from different ethnicities and for those from deprived backgrounds, not least in constituencies such as mine. That was a point ably made, as ever, by my hon. Friend the Member for Clapham and Brixton Hill (Bell Ribeiro-Addy), who, in leading the APPG, does an amazing amount of work to highlight the issue. I confirm to her that we remain committed to setting a target to close that mortality gap, and will be informed by Baroness Amos’s recommendation. The issue of deprivation and ethnicity differences was also raised by my hon. Friends the Members for Rochdale (Paul Waugh) and for Worthing West (Dr Cooper). That issue is why the Secretary of State has launched the national investigation into NHS maternity and neonatal care, chaired by Baroness Amos. She is bringing together the findings from past reviews and local rapid reviews, and new evidence from families and staff, into one clear national set of recommendations.

As my hon. and learned Friend the Member for Folkestone and Hythe said, previous issues and scandals have produced many recommendations, including, as we have heard, well over 700 recommendations on maternity care since 2015. As my hon. Friend the Member for Shipley reminded us, some of the information from those investigations has been available for well over a decade.

We know what needs fixing, but changes to processes and procedures here and there are not enough. There is a risk that some recommendations might fix the symptoms, but not the underlying causes. Many colleagues have talked about culture. I agree with my hon. Friend the Member for Rossendale and Darwen (Andy MacNae): we cannot keep going round in the same cycle. There is an underlying cultural issue, and systemic change needs to happen. I commend my hon. Friend for the work that he does on the APPG and for sharing the loss that he and his family suffered. That loss is informing that work.

My hon. Friend the Member for Mansfield (Steve Yemm) also talked about that culture and the need for deeper questions. Other Members talked about the need to speak up. I agree with my hon. Friend the Member for Morecambe and Lunesdale, who highlighted the importance of that culture of encouraging people to speak up.

[Anna Dixon]

Does the Minister agree that training obstetricians and midwives together as a team is an important part of creating that unified culture that we know is so important to underpin safety for mothers and babies?

--- Later in debate ---

[Karin Smyth]

I agree. That is an important point about the culture in clinical roles and clinical leadership within the secondary care setting and across the entire pathway of supporting women. As part of our 10-year plan, we want to put patients across all parts of the NHS front and centre by building services around people instead of expecting people to build their lives around services.

In February, Baroness Amos published her interim report to share the insights she has gathered so far. She and her team have met with hundreds of families as part of the local investigations, and a national call for evidence from women and families has recently concluded. The surveys were open for eight weeks, hearing from women and families across the country about their experiences of maternity and neonatal care. Over 11,000 responses have been submitted.

A separate call for evidence for those who work in the maternity and neonatal pathway was also held recently. The workforce call for evidence received more than 9,000 responses from across 124 trusts. Baroness Amos’s final report, including one coherent single set of national recommendations, will be published in June.

Some of the women and families who have fed into the national investigation will have suffered terrible loss and harm. This subject is just about the hardest that any woman could ever talk about, and I want to thank all of those who have had the courage to share what they have been through. I thank again my hon. Friend the Member for Sherwood Forest (Michelle Welsh) for the inspiration that she has provided by, first, getting herself here, and then continuing to use her voice and doing it so well during her time in Parliament.

All those women and their families deserve to know that their voices will be heard and that action will be taken. That is why the Government have launched their new maternity and neonatal taskforce, chaired by the Secretary of State. It will be the taskforce’s job to translate the investigation’s final recommendations into action. The taskforce will also hold the system to account for improving outcomes and experiences for women and their families. It is all very well coming up with more reports, but we have had enough of those. The taskforce will develop an action plan so that recommendations from the investigation do not gather dust on a shelf. The taskforce held its first meeting on 24 March and it was very positive and constructive.

The terms of reference have been agreed, with meetings every six to eight weeks going forward. The taskforce is made up of experts and key partners from across the maternity and neonatal sector as well as from the wider health sector. It includes representatives from harmed and bereaved families, frontline clinicians, academics and royal colleges—those who can speak directly to health equity and international expertise. The voices of families, and women in particular, are paramount throughout this process. The taskforce will be supported by several expert reference groups, at least five of which include representatives from harmed or bereaved families. I agree with my hon. Friend the Member for Sherwood Forest that it is important that we get this right and work across this field, so that this becomes a once-and-for-all piece of work.

I think we all want to end the cycle of recommendations that do not deliver, and we have heard a lot about that this afternoon. That is what the taskforce is designed to do. It will ensure that the systemic and national changes we need to see are achieved following the investigation’s final report and recommendations, but we are not sitting on our hands until we get to that report. A number of initiatives are already in place to improve experiences and outcomes in maternity and neonatal care. We have already recruited more than 800 more midwives and begun investing more than £140 million to address critical safety risks on the maternity estate, and we are rolling out programmes to tackle discrimination, racism and avoidable brain injuries. We will improve the NHS consistently week on week, month on month and year on year.

The renewed women’s health strategy, which was published last week, will tackle head on the injustices women face. In that strategy, we acknowledged much of what we have heard during this debate, including the existence of medical misogyny, the fact that women are not listened to and the fact that the culture needs to change. As my hon. Friend the Member for Ribble Valley (Maya Ellis) noted, it is important that women have choice.

The strategy sets out how we will focus relentlessly on delivering women’s priorities. The challenge for this Government over the next couple of years is not just to build on the progress we are already making but to accelerate it. I want women who signed the petition to know that we have heard them loud and clear. We know that there is so much more that needs to be done, but I ask that they do not judge us on the strategies we publish or the people we appoint—we must be judged by our results. Baroness Amos has given us the blueprint for making things better, and the taskforce will hold us to account. We will not just have one person driving action; there will be 18 of them.

In the meantime, we will not make significant commitments that pre-empt the outcome of the investigation, which we will have in just two months’ time. If Baroness Amos wants to recommend, for example, a maternity commissioner, then we will consider that carefully. The taskforce, with the Secretary of State chairing it to drive accountability, will deliver the action that we all need to see.