GP Contract

Luke Evans Excerpts

Monday 16th March 2026 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the changes to the GP contract in 2026-27.

[The Minister for Care (Stephen Kinnock)]

When we came into office, we found GP services in an appalling state—underfunded, understaffed and in crisis. Since July 2024, this Government have been fixing the front door to the NHS, investing more than £100 million to fix up GP surgeries this year, making online booking available to patients across the country and recruiting 2,000 more GPs who are now serving patients on the frontline. Following investment in advice and guidance, we have seen 1.3 million diverted referrals since April 2025. Those are people who would have otherwise been added to the electives waiting list. A lot has been done, but there is a lot more still to do. We are determined to make the system fairer for coastal communities and deprived areas, so we have launched a review into the Carr-Hill formula to close the gap on health disparities and ensure that funding is targeted on the basis of need. We will shortly update the House in the usual way on our Carr-Hill review.

Last year’s GP contract saw the biggest cash increase in more than a decade, and this year we are investing an additional £485 million, taking the total investment made through the contract to more than £13.8 billion this financial year. Investment must always be combined with reform, so the new contract will improve access for patients by requiring that all clinically urgent requests are dealt with on the same day. It will provide a mechanism to hire even more GPs via a new practice-level reimbursement scheme, and it will support the shift from treatment to prevention, as set out in our 10-year plan, through incentives to boost childhood vaccination rates, better care for patients living with obesity and requiring GPs to share data with the lung cancer screening programme.

These ideas were not cooked up by someone sat behind a desk in Whitehall. What is happening is that we are taking the best of the NHS to the rest of the NHS, working with pioneering practices that have been doing these things for a long time. Today we can see that our policies are working, and after years of decline in general practice, we are getting the front door back on its hinges. Patient satisfaction with general practice is finally moving in the right direction. According to the Office for National Statistics, almost 77% of people described contacting their GP as easy in January this year, up from just 60%, where it was languishing in July 2024. I know that when he gets up, the hon. Member for Hinckley and Bosworth (Dr Evans) will hugely welcome, as will his hon. Friends, the progress that we are making.

[Madam Deputy Speaker (Judith Cummins)]

I call the shadow Minister.

[Dr Evans]

The Health Secretary and his team have perfected the sales pitch for NHS reform. The problem is that the detail never seems to arrive. We have seen a 10-year health plan with no delivery chapter, and a plan for the abolition of NHS England with no price tag; the Health Secretary has announced 10 new “straight to test” referral pathways, but could not name a single one; and now we are seeing a new GP contract with more questions than answers.

Calling something modernisation does not make it reform. If the rules and the delivery are unclear, it is simply confusion with branding. “Advice and guidance”, for example, appears in practice to create a single point of access for referrals. GPs will no longer be able to refer patients directly to a consultant, even when they believe that it is clinically appropriate. Will the Government publish the clinical evidence supporting that approach? Who will carry the legal responsibility if, in a GP’s professional judgment, a patient needs to see a consultant but must first go through “advice and guidance”? If advice and guidance becomes mandatory as an extra layer before referral, are the Government not, in essence, managing the waiting list by keeping patients in primary care rather than treating them in secondary care? Waiting lists will look shorter on paper, but patients are simply waiting elsewhere in the system. Can the Minister clarify exactly where those patients will appear in the official waiting list figures? The contract also requires patients whose cases are deemed “clinically urgent” to be dealt with on the same day, but it does not define “urgent” or explain what “dealt with” means, and that really matters.

Let me therefore ask the Minister three clear questions. First, when will the Government publish the clinical definition of “urgent”—a patient’s sick note is urgent for the patient, but not clinically urgent—and what counts as a patient’s being “dealt with” on the same day? Secondly, the Minister has talked about access, but how can practices guarantee same-day responses when demand is uncapped and definitions are not published? Finally, with advice and guidance being required as a mandate beforehand, how will we ensure that patients are protected, and where will they appear on the waiting lists?

[Stephen Kinnock]

I thank the hon. Gentleman for the GP-related questions, for which I was grateful when he finally got to them.

On clinical evidence for advice and guidance, I think that the evidence speaks for itself. We introduced advice and guidance in the last contract with an £80 million investment, and it has been a stunning success. Take-up across the country has been huge, and—this is the statistic that matters most of all—1.3 million referrals that would otherwise have gone to electives have been dealt with by GPs. [Interruption.] The hon. Gentleman, who is chuntering from a sedentary position, seems not to care about what actually matters for patients, but through advice and guidance they are able to get a response from their GPs within about 48 hours. I can assure him that it takes a great deal longer to secure an out-patient appointment. If he is looking for statistics on advice and guidance, let me give him that one again: 1.3 million referrals have been taken off electives and dealt with by GPs. That is part of the hospital-to-community shift.

The hon. Gentleman asked for a definition of “urgent”. We trust our clinicians. We know that general practitioners are experts in their field. They know when they see an urgent issue, but they also know that that the symptoms might be a more acute manifestation of chronic obstructive pulmonary disease, or that a child’s rash suddenly looks more dangerous than it did the day before. We trust our GPs to make those decisions, and it is a real pity that Opposition Members do not seem to do the same.

The hon. Gentleman also wanted a statistic in relation to access. In July 2024, patient satisfaction with access to a GP was languishing at a miserable 60% after 14 years of Tory neglect and chaos. Today it stands at 76%, which is a 16 percentage point improvement. The hon. Gentleman asked for statistics; perhaps he should take that statistic and deal with it.

Disability Equipment Provision

Luke Evans Excerpts

Wednesday 11th March 2026 Westminster Hall

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

It is lovely to see such a thoughtful, thought-provoking debate, with cross-party unity on the question of how we can better support our constituents who are suffering. It could be with a stairlift, a shower, a home aid or an adaption. When I was a GP, I saw what difference that can make to people. More recently, I visited Mounts & More in Stoke Golding, a company of specialists who support wheelchair users. Margaret and her family started Mounts & More in Market Bosworth in 1996; it fits mounting systems, such as for augmentative and alternative communication, to wheelchairs. The company’s best example is of Professor Stephen Hawking—it fitted the specialist holding position for such equipment. It also drives innovation and the small business side of things that we so long for in the UK.

I am keen to dive straight into some of the questions asked, as time is short, but before I do so, I pay tribute to the hon. Member for Aberdeenshire North and Moray East (Seamus Logan) for being so succinct in his well thought out speech. He is a rare parliamentarian in that he had only a single question for the Minister. I congratulate him on that. He raised a significant point about strategy. The Government say they do not have a plan to bring forward an equipment strategy, and they tend to point towards the ICBs as the commissioners on this.

There is going to be some difficulty, though, if the ICBs are cutting their staff by 50%. I do agree with the Liberal Democrat spokesman, the hon. Member for Epsom and Ewell (Helen Maguire), who asked whether there is an opportunity to look at what can be done in the forthcoming health Bill. I would be grateful if the Minister would set out whether this is a consideration when it comes to dealing with support for people with disabilities.

I have another question for the Minister on the disabled facilities grant. The Government have done a review, which is welcome, and recently published their look at the issue. As more and more people become infirm—the good news is that they are living longer, the bad news that they have more disabilities—the need will go up. It is not clear from the information that has been published just how that will be monitored. How will we ensure that the funding is going to the right place and working? There is a calculator on the website that says how it will be redistributed, but I point out that clarity on accountability will be hugely important. I would welcome input from the Minister on what that will look like.

[Sir John Hayes]

On that specific point, the Government have said that that additional money for the grant will provide about 5,000 additional home adaptations. It would be really useful if the Minister, when he responds, could describe how local authorities will access that funding, how those 5,000 adaptations will be distributed across the kingdom and what kind of adaptations we are talking about. Are we talking about adaptations to new build houses or long-standing traditional houses in the private or public sectors? A bit more detail on that would be very welcome.

[Dr Evans]

My right hon. Friend has hit the nail on the head. This is part of the problem in how we get different parts of the system to work together to get a full understanding of the situation; that is most important for those who are affected, but also for the commissioners who are trying to make the decisions on where the equipment goes. I hope the Minister has heard that and will be able to work it into his response.

I was very pleased to hear the hon. Member for Bexleyheath and Crayford (Daniel Francis), the chair of the APPG, raise the very important issue of the insolvency of NRS Healthcare. For those who do not know, NRS Healthcare accounts for about 40% of coverage, covering 15 million people and 21 local authorities across the country. Its insolvency showed a weakness in the way we deliver our supply.

I wrote to the Government back in the summer to try to find out what was being done and what lessons had been learnt. I received a generic response early on in August, saying that things are being kept under review. It stated:

“The Department continues to monitor the situation closely and will support LAs to learn lessons and consider the implications for future resilience in this market.”

I followed up very quickly and wrote back in September to ask more questions, but unfortunately I have not as yet received a response. I have with me a copy of the letter that was sent asking questions, particularly about what lessons have been learnt in this case and, more importantly, what is being done to implement more resilience in the supply chain. I would be grateful if the Minister could take a look.

If such a thing were to happen again, given the stark economic situation we are facing, which I appreciate is outside the scope of this debate, it would have knock-on effects for some of the most vulnerable in our society. I would be grateful if the Government would set out exactly what they are doing to make sure the supply chain is secure.

Finally, I want to raise concerns about the better care fund. The Government have been clear in the 10-year health plan about their promise to reform the fund, which has been very useful in bringing pooling together. However, we have already noticed that NHS England has already reduced the amount of additional voluntary funding it was putting in by £388 million. The example given by my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) goes to the heart of the question: looking from the top down, how do we make sure these things are all integrated? How do we understand what ICBs, councils, the NHS and charities are doing through their provision?

I would be grateful if the Government could set out where they see that better care funding fitting in and when we will actually see the outcome of the changes they propose. It appears that there have been delays in the national neighbourhood health service guidance and delays in the better care fund. Without that structure and without joining it all together, it is very difficult for those scrutinising the system and, more importantly, those working in and using the system to understand exactly what to expect and when. I would be grateful if the Minister would be kind enough to set that out.

I thank Members for their thoughtful contributions today, because, at the end of the day it is really important to shine a spotlight on those constituents who suffer the most and get on with it the most. They are the most pragmatic, fantastic people, and their support is paramount.

--- Later in debate ---

[Dr Ahmed]

I am grateful to the right hon. Gentleman, and to those who raised this matter earlier in the debate. It does trouble me deeply that we have a situation in which equipment is going unused when there is that need in another part of the system. I actually feel that quite acutely. Hon. Members may know that I am a vascular surgeon; at times, unfortunately, some of my job involves having to amputate people’s limbs for end-stage vascular disease. I see for myself that transition from someone being able-bodied to needing assistance, and, where that assistance is not available, the impact that has, especially when people know there is this lack of productive exchange of equipment in the system highlighted by hon. Members today. I am therefore very happy to take the issue forward with my officials to see what can be done further to marry the demand and the supply together in the country.

Regarding wheelchair provision, NHS England has developed policy guidance and legislation to support ICBs to commission effective, efficient and personalised wheelchair services. I again nod to the remarks from the hon. Member for Aberdeenshire North and Moray East on making sure we get better, more efficient and personalised service provision.

In April 2025, NHS England published the wheelchair quality framework, developed in collaboration with the NHS England national wheelchair advisory group. The framework is designed to assist ICBs and NHS wheelchair service providers in delivering high-quality provision that offers improved access, outcomes and experience. NHS England introduced personal wheelchair budgets, including legal rights, in 2019, providing a clear framework for ICBs to commission personalised wheelchair services that are outcomes-focused and integrated. Those budgets give people greater choice over the wheelchairs that they are provided with. Additionally, the model service specification for wheelchairs sets out that wheelchair assessments should take place in the most suitable environment based on the needs of that individual.

NHS England is aware, as am I, that several complaints have been made about the quality of services commissioned by some ICBs. NHS England is working through the appropriate regional teams to gain intelligence from those ICBs on quality concerns and contracting arrangements, to fully understand the issues being raised.

[Dr Luke Evans]

Will the Minister give way?

[Dr Ahmed]

In the interest of time, I will not, but I think I know where the hon. Gentleman wants to go with this, with the NRS. I will be happy to write more fully—

[Dr Evans]

It was a different point.

[Dr Ahmed]

Well, I have not got time. I will write more fully regarding his correspondence. I am genuinely disappointed, if it is true, that he has not been responded to since September.

In addition, the 10-year plan makes a commitment to reviewing the complaints regulations. NHS England and the Department are developing those together to achieve better accountability. The Government are also taking wider action to support disabled people through the 10-year health plan. On neighbourhood health, the neighbourhood health service will support disabled people to have choice and control over their care. That includes increasing the uptake of personal health budgets, which provide individuals with that greater choice and control over how their health is assessed and their wellbeing needs are met.

One aim is to have a neighbourhood health centre in each community, bringing the NHS, local authority and voluntary sectors together to create a holistic offer that meets people’s needs in the place that they are. We expect these services to be designed in a way that reflects the specific needs of disabled people, with a focus on personalised, co-ordinated care. I particularly think that this is an opportunity, as we move care from hospital to the community, to address some of the concerns raised in the debate today.

On social care, the Government are also driving forward improvements for disabled people. We are enabling people to have more choice and control over their care—through greater use of direct payments, for example. We are also expanding care options to boost independent living at home and have recently confirmed £723 million for the disabled facilities grant in 2026-27. The total DFG budget across 2025-26 and 2026-27 is £150 million more than the total budget across the previous two years. That represents an 11% increase and will support more disabled people to get the vital home adaptations that they might need.

The Better Care Fund, which took effect in April 2025, is a framework for ICBs and local authorities to make joint plans and pool budgets to deliver better joined-up care. That can include the provision of assistive technology and equipment, such as wheelchairs. This financial year, ICBs and local authorities plan to spend £440 million on assistive technology and equipment, and we have introduced care technology standards to help them to choose the right support. In addition, as we move from hospital to community, commissioners can, if they wish, think about better co-commissioning, transcending traditional boundaries between local authorities, social care and the NHS.

I am grateful to the hon. Member for Aberdeenshire North and Moray East for securing this important debate and I want to respond to a question he asked. Whether we call it a strategy or a framework, there is a real opportunity at this time of change in the NHS—including the development of a national quality board at NHS England, which will come into the Department of Health and Social Care once NHS England is abolished —to genuinely think about how we define “quality” for disabled people and about the equipment and the spaces that they use. Again, I will be very happy to discuss that with my colleagues in charge of the quality board. I will write to the hon. Gentleman with specifics that we can perhaps tease out after this debate today.

We recognise the life-changing impact that having timely access to suitable disability equipment can have on the lives of disabled people across the United Kingdom, in every nation. The Government are dedicated to ensuring that all disabled people have access to the services and support that they need to live a fulfilling life; the presence of disability Ministers in each Department is certainly progress in that regard. Our work to reform health and social care, alongside the new plan for disability, will also help us to achieve that.

NHS Capital Spending

Luke Evans Excerpts

Wednesday 4th March 2026 Westminster Hall

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

I, too, associate myself with the comments about the hon. Member for West Lancashire (Ashley Dalton) on her stepping down as a Minister. She was a formidable opponent and will be sorely missed. I am sad to see her step back, but she has made the right decision for her, as in this place we should all do.

I thank the hon. Member for Carshalton and Wallington (Bobby Dean) for securing this debate. He was absolutely spot on when he said we do not scrutinise the process of NHS capital spending nearly enough. I was taken by what he said on that point, but less surprised that not many solutions came forward, although that is key to having this debate, because it is hugely technical.

I will use an example from my constituency for both the pros and the cons, the good and bad stories about capital investment. I was elected in 2019 and Hinckley is my biggest town. Healthcare is an important priority for my constituents and talk of improved hospital services there has been ongoing for 30 years now. On the good side, we were lucky enough to be picked to have a community diagnostic centre, a £24 million investment, and I was lucky enough to open it last year. That shows what good can come of capital investment. Under the previous Government, at August 2024, there were 165 similar good news stories of community diagnostic centres being opened across the country, not to mention the 108 surgical hubs that have not been talked about, but that are increasing patients’ ability to be seen and treated quickly, helping to deal with the waiting lists.

I also come with a negative story related to the same hospital. We were looking for a second project, a £10 million day case investment, but unfortunately, despite funding having been secured, delays in the system and difficulties with changing need have meant that that has been cancelled. The NHS papers specifically on that case state:

“The STP Capital business case for the Hinckley Day Case Unit received national approval in March 2024”—

but then struggled. The papers go on to say:

“However, since business case approval there have been further key changes… Changing financial context nationally and local financial challenges… Increased capital costs of the scheme circa £2m compared to that approved by the board… Programme delays resulting in a significantly reduced capital resource”.

They go on to explain that further delays to the programme occurred due to

“Cost pressures that exceeded the STP capital allocation…Since the approval of the STP Capital Business case in 2024, delays can be attributed to…The planning application phasing (considering the contention surrounding the demolition of the Hinckley District Hospital…The delay in submitting the planning application to allow the development of a robust design to address the Local Planning Authority’s concerns”.

We can already see the difficulties in how need is being allocated across Leicestershire and how planning and inflation interfere. That is the process issue at the heart of making these capital decisions.

That leads us to the bigger picture that confronts the Government today. As has been mentioned, funding is important, so what is the best document we can look at to see what the Government are trying to do? The 10-year plan is clear:

“We will continue to use private providers to improve access and reduce waiting times, to return the NHS to its constitutional standards. As we outlined in our Plan for Change, we will not let spare capacity go to waste on ideological grounds. We will continue to make use of private sector capacity to treat NHS patients where it is available, and we will enter discussions with private providers to expand NHS provision in the most disadvantaged areas.”

The Opposition agree with that, but I am not sure that all Government Members will, so I am interested to know whether all the Minister’s hon. Friends are aligned with it. I agree with the concern that the previous Government’s private finance initiatives, which brought in £13 billion of investment for new hospitals, cost the taxpayer more than £80 billion in repayments. We are still paying for that now.

Turning back to the NHS 10-year plan, a section called “Harnessing new investment” states that

“we will learn from previous experience with the Private Finance Initiative…In other cases, however, PFI was a costly mistake which represented poor value for money. Contracts were too complex and lacked proper transparency.

As the government considers new sources and models of private investment, we do so with this experience in mind.”

How do we know that? Where is it set out that the Government have learned this time? In the same section, the Government tell us they will “evolve” their

“infrastructure finance models and…consider the use of Public Private Partnerships…where there is a revenue stream, appropriate risk-transfer can be achieved, and value for money for taxpayers can be secured.”

Those are not small tests; they are the fundamental ones that we must ensure are in place, so my simple question is this: what is different this time? How will we assure value for money, and who will make that decision? How will we see genuine risk transfer being assessed, rather than simply pricing it into decades of payments? How will that work?

The 10-year plan also states:

“We will codevelop this with the National Infrastructure and Service Transformation Authority (NISTA), building on the successful NHS Local Improvement Finance Trust programme, and will look to drive competition in the market to incentivise others, including third party developers, to improve their offer to deliver better services at lower cost to the taxpayer.”

That is great—but LIFT is used only for small practices, so what model will come forward for everything else? The plan states:

“We will engage with the market on this programme and support NISTA in its wider market testing of a new PPP model.”

What is that model? Can we see it? What does it look like?

I note from the Minister’s answers to written questions that 120 neighbourhood health centres will be operated by 2030; 70 will be new buildings, 50 will come from refurbishment and, of those, 80% will be funded through PPPs. However, there are no plans to publish the business case. That raises legitimate questions. Why are the Government hiding this? We have been here before, and the country is nervous about this, so why can we not see what is being brought forward? If a new model is genuinely different, transparency should not be a threat; it should be a strength. Why will Parliament and the public not see it?

[Luke Taylor]

It would be remiss of me not to ask at this point, while the hon. Gentleman is speaking about transparency and funding for hospital projects, about the previous Government’s imagined 40 new hospitals. I invite him to give some transparency as to where the money to fund that hospital programme was supposed to come from and where it ultimately disappeared to. My residents are still suffering from the impact of his Government’s not providing that money. Can he expand on what happened to that money, which never arrived?

[Dr Evans]

I am grateful for the chance to put this on the record. The health infrastructure plan 2019 had the £3.7 billion, which was the seed funding to look into the projects to bring things forward. That also dealt with the first wave—the three hospitals that were brought forward to allow the second and third waves to come on. The hon. Gentleman will also know that, as the Government and the Opposition have stated, all big national infrastructure is done through a series of spending reviews. The money—£20 billion—was committed through those stages on the basis of that plan. The Government throw the same argument back at us when it is convenient for them to say, “We are not increasing defence spending because it needs to come in a spending review.” Both sides are playing politics, but there was money allocated in that plan. I appreciate that the hon. Gentleman was not in Parliament at that time, but he can ask the House of Commons Library to look at it so that he understands it, and he can then pass that on to his constituents to answer that question.

If we have a new model, we in this House need to be able to scrutinise it. GPs’ rents and rates are reimbursed, but there is concern that if we have further PPPs, similar to the previous PFIs, GPs may be on the hook for ongoing premises costs. We must have crystal clear guarantees, so they understand what they are and are not accountable for.

The 10-year plan states:

“We will also work with NISTA to consider the opportunities for health that could be achieved through private financing of revenue-raising assets (such as key worker accommodation and car parks)”.

That will set alarm bells ringing, as it looks like the Government will use key workers, or staff and patients coming into car parks, to generate funds. I would be grateful for clarity about what the Government actually mean by that statement, because this is a contentious issue. People know that we need to have funding coming into the health services, but where will those streams come from and what will they look like? If the 10-year plan is looking at revenue-raising assets, I am keen to understand exactly what that looks like.

Overall, there is a desire in the 10-year plan, which is shared across the House, to improve healthcare. Nobody disagrees with that, but the criticism of the 10-year plan is that there is no delivery chapter. I am grateful to the hon. Member for Carshalton and Wallington for securing this debate so that the Opposition can ask questions about what delivery will actually look like when it comes to improving the health of the nation.

--- Later in debate ---

[Karin Smyth]

The Chancellor has made her key decision to put us back on track, announcing in the Budget that capital health spending would increase by £15.2 billion by the end of the spending review period in 2029-30. That funding will be used as intended; in previous years, as we heard, capital funding was diverted to cover day-to-day costs. We have tightened the Treasury rules; we have changed them, because that is what Government can do—who knew! As a result, capital funding will now be fully focused on repairing, upgrading and expanding NHS buildings and facilities to support long-term productivity. This settlement represents record levels of capital investment into healthcare, and it will support the three shifts set out in the 10-year health plan: moving care out of hospitals into the community, replacing outdated systems with modern digital services and focusing on preventing illness rather than just treating it.

Of course, rebuilding NHS infrastructure cannot happen overnight. I assure hon. Members that the Government do understand that long-term certainty over capital funding is needed for the NHS to move from these short-term fixes to more strategic investment. That is another key decision made by the Chancellor. That is why, through the 2025 spending review, we have delivered a four-year capital health settlement, extending to 2029-30. That is backed by a further five years of certainty for estates maintenance funding. I am genuinely grateful to hon. Members for recognising that that is a massive change that we have engineered into the system, and I think we are all seeing the benefit.

That change means there is a £30 billion commitment in capital funding over five years to support the day-to-day maintenance and repair of the estate, with a further five years of funding certainty, as set out in the 10-year plan. For the first time, NHS trusts have also been given multi-year operational capital allocations, with clear funding set out until 2029-30, and indicative funding for a further five years. This is an unprecedented opportunity for local health systems to plan with confidence over a nine-year period, and I continue to encourage all Members to engage with their integrated care boards, which will be prioritising schemes over that period.

Within the £30 billion, the estates safety fund will continue, providing £6.75 billion of investment over the next nine years to target the most critical building repairs, alongside £2 billion to continue supporting NHS England’s RAAC programme across the spending review. Additionally, £21 billion in operational capital over the five-year spending review will empower NHS organisations to invest in local priorities, including hospital infrastructure. It will take time to build up capacity and capability, but this marks the beginning of our rebuilding of an NHS that is fit for the future.

I also assure Members that this Government recognise the pressures faced across the system and are committed to bringing performance standards back to what patients expect. That is why we are investing to expand hospital and emergency care capacity, helping to reduce waiting times and improve care for patients. Over the next four years, there is £1.9 billion for urgent emergency care to support A&E departments, as well as to support ambulance services in reducing handover times.

There is also £1.5 billion for diagnostics, including funding to expand the hours of community diagnostic centres, shifting care from hospital to the community. The hon. Member for Hinckley and Bosworth noted that those centres were started under the previous Government, but we have ensured they have expanded hours and that there are more of them. Crucially, they are not built as add-ons, but are fundamental to the pathways experienced by patients in the system and ensure we have good value for taxpayers’ money.

There is £473 million for mental health services, including for people with learning disabilities and autism. I think we would all agree that the mental health estate needs recognition. There is more than £280 million for community care, supporting services closer to home, and more than £139 million for electives across the next two years. To move away from paper-based systems towards modern digital services, the autumn Budget confirmed £300 million in capital investment in technology, building on the combined revenue and capital investment announced at the spending review of up to £10 billion by 2028-29.

We are transforming healthcare by shifting care out of hospitals and into the community. Over the next four years, we are investing more than £400 million to upgrade primary care buildings and deliver neighbourhood health centres, as part of our commitment to those 250 neighbourhood health centres through the rebuild programme.

[Dr Evans]

Will the Minister give way?

[Karin Smyth]

I will finish these points and answer some of the issues that have been raised.

The first 120 neighbourhood health centres will be operational by 2030 and will, as we have heard, be delivered through a mixture of public and private partnerships. I thank the hon. Member for Carshalton and Wallington for being one of the few to acknowledge that that is difficult—there is some controversy around it—but I am a strong supporter of the previous local improvement finance trust schemes and of the scheme at Southmead hospital in my local area, which was one of the better PFI schemes, and delivered unprecedented levels of care to the people of Bristol, including myself. It is important that we learn the lessons of the past, and we absolutely have, including those in the NAO report. Working with NISTA, as has been outlined, we will continue to pursue this issue and bring forward cases.

I do not want to rehearse the lack of funding for the new hospital programme.

[Dr Evans]

Will the Minister give way?

[Karin Smyth]

No, I will not, because I want to get through my final comments.

We put the new hospital programme on a sustainable footing. I understand that local people across the country were led up the garden path and told something was going to happen. I think we all recognise that the money was not there and that the programme was not on a sustainable footing. We have backed it with the appropriate investment, which is rising to £15 billion over each consecutive five-year wave from 2030, averaging £3 billion a year. The exact profiles of funding will be confirmed at future spending reviews, and that is weighted to ensure that the schemes profiled most are caught in that.

We are progressing wave 1, and I will continue to liaise with hon. Members on progress. My message every week to any NHS trust, to any Member of Parliament, to NHS England and to the team running the new hospital programme is that we need to deliver these hospitals. There is a large queue behind them, and we have heard about some of them today. I also understand that a number of colleagues do not have a hospital being progressed in the scheme. The Government are keen to get on with building these hospitals. As hon. Members have said, a lot of this is about trust and commitment. I want hon. Members and anyone paying attention to know that I am clear about the importance of getting on with this programme, delivering on the ground and ensuring that the programme is robust.

Finally, alongside increased capital funding, we are improving how that funding is managed. As we have heard, the old processes did not work: a local scheme went to the ICB, to the region, to NHS England, to the Department, to the Treasury and back again, with huge amounts of sign-off but no control or accountability, and with no one locally understanding what was happening. We are transforming that, bringing together a team and streamlining the process, ensuring it is well governed. That will ensure that things happen more quickly, and we are already seeing that. With underspends this year, we have got the money out and into schemes already in the system. We are getting more DEXA scanners. That is how we ensure this happens on the ground.

It is up to ICBs to prioritise proposals, and we are working more closely with them to support them to bring things forward. I urge all hon. Members who have spoken today, including my hon. Friend the Member for Harrow West (Gareth Thomas), the hon. Member for Torbay (Steve Darling), my hon. Friend the Member for Rushcliffe (James Naish), the hon. Members for Taunton and Wellington (Gideon Amos), for Sutton and Cheam (Luke Taylor), for Eastbourne (Josh Babarinde) and for North Devon (Ian Roome), to keep working with their local systems on particular schemes. I am happy to keep talking to people.

To the hon. Member for Taunton and Wellington, let me say that I have met NHS England about looking at maternity in the area, which I know is a huge concern, and I am happy to meet him. I will get back to the hon. Member for North Devon about some of the numbers he outlined, which are not familiar to me. On another point that was made, we are ensuring that we are building in contingency for the future, because we live in volatile times.

Motion lapsed (Standing Order No. 10(6)).

Pharmacy First: Withholding Payments

Luke Evans Excerpts

Thursday 12th February 2026 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the withholding of Pharmacy First payments to pharmacies.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)]

It is a pleasure to take the traditional Department of Health and Social Care urgent question before recess—I would not miss it for the world.

Since coming into office, we have reversed the decade of cuts to community pharmacy with the biggest uplift for the sector in years and frozen prescription charges to help our constituents with the cost of living, and women can now get the morning-after pill free of charge across the country. Earlier this week, I spoke to the National Pharmacy Association’s winter reception to pay tribute to its members for their work and to assure them that I have their back, as does the Minister for Care.

The hon. Member for Hinckley and Bosworth (Dr Evans) raises the important issue of payments made via Pharmacy First. As he knows, pharmacy contractors receive a monthly fixed payment if they meet certain requirements. We agreed to reduce the claim window, in conjunction with Community Pharmacy England, as part of our deal for 2025-26 to introduce a new Pharmacy First fixed first payment of £500. That has supported a broader range of pharmacies and has meant that more pharmacies have become eligible for payments. We are in discussions with Community Pharmacy England to consider where improvements to the claiming process can be made, address concerns raised by contractors and aim for a more consistent approach to remuneration. We will also consult with Community Pharmacy England shortly on the contractual framework for next year.

There are issues relating to contractors being suspended from providing Pharmacy First that are for separate consideration. When concerns are raised, NHS England can suspend individual contractors from providing the service pending a full investigation. There are a number of reasons why that might be necessary, but the measures are there, first and foremost, as the House will appreciate, to protect patient safety. I am a clinician, as is the hon. Member for Hinckley and Bosworth, and I am sure that he will agree that patient safety should be at the forefront of everything we do.

Finally, funding for the core community pharmacy contractual framework has been increased to over £3 billion—the largest uplift of any part of the NHS in the last two years. As part of this year’s contractual framework, we have agreed to keep the current cost control mechanism linked to Pharmacy First that we inherited from the previous Government to ensure that the money is spent within that envelope. I thank the hon. Gentleman for his question.

[Dr Evans]

It is a regret that I have had to summon the Minister here to answer questions, and surprise, surprise—

[Mr Speaker]

Order. May I just say that you did not summon the Minister? I granted an urgent question. Think about the language you choose, Dr Evans, and think that we have given you something.

--- Later in debate ---

[Dr Evans]

I of course withdraw that remark, Mr Speaker, and I thank you for summoning the Minister on my behalf. It seems to have had the desired effect, because the outstanding parliamentary questions have, strangely enough, been answered this morning. I hope to get some clarity as this is really important.

The issue has been explained simply by the chair of the National Pharmacy Association:

“The work was done. Patients were treated. The NHS benefited. Yet payments are being withheld on a technicality.”

What makes that worse is that many pharmacies do not even realise that some of the money is missing. He goes on:

“Statements appear ‘successful’, yet Pharmacy First payments are absent. Contractors are only discovering the issue long after the window has closed, when it’s already too late.”

Will the Minister tell the House how many pharmacies the Government think are impacted? What is the total value of the outstanding payments? What steps are the Government taking to rectify this, and would they consider a late payment mechanism to help solve the issue?

There is a wider concern. Payments are administered by the NHS Business Services Authority. The chair of the NPA labelled the behaviour of NHSBSA “outrageous”. That already follows repeat concerns about NHSBSA’s performance, including multiple serious delays in NHS pension processing and several urgent questions on the Floor of the House. Does the Minister still retain confidence in NHSBSA? Given the ongoing concerns from multiple fields, will he commission a review of the operational performance of the entire NHSBSA?

Community pharmacies are already under intense pressure from this Government, with tax rises on employment and business rates and with increases in costs, and now they appear not to be being paid for work already done. I hope the Minister will act quickly to put this right.

[Dr Ahmed]

As the hon. Gentleman will know—or should know—the current remuneration method was agreed in conjunction with the sector. The adjustment was agreed with the sector’s representative body, Community Pharmacy England. Advance notice of the change was provided to those contractors by letter and in an article published by the NHS Business Services Authority in May 2025. In addition, Community Pharmacy England knows that, should this be a priority issue for it to negotiate in the next contract, we will take that on board and use it as an option.

There are of course always extenuating circumstances, such as IT not working. Officials have reassured me that, following discussions with Community Pharmacy England, we have introduced specific provisions in the drug tariff that will allow pharmacy contractors to receive payment for claims that were delayed due to IT issues outside of its control.

I can appreciate why the hon. Gentleman wants to expand the remit of the urgent question across primary care—well, let me tell him. I know he had neck surgery recently; I did not realise they put a brass neck in him as well when they did it. He knows what kind of NHS decline and decay over which he and his Government presided over the past 15 years: primary care where people are left wandering around asking for GPs, and the Conservatives left GPs on the scrapheap, unemployed. This Government ensured, when they came into office, that—

ADHD Diagnosis

Luke Evans Excerpts

Tuesday 20th January 2026 Westminster Hall

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

It is a pleasure to respond on behalf of His Majesty’s official Opposition. I thank the hon. Member for Sefton Central (Bill Esterson) for getting so many MPs here to talk about such an important topic. His tribute to Matty Lock was truly epic. The only thing I am sad about is that we could easily have filled a 90-minute debate. Perhaps he can take note of that for the next time that he applies for such a debate.

Time is short, so I will skip to the most important questions. This debate is about ADHD diagnosis, and there is no disagreement among Members on both sides of the House about the challenges that we face. We have seen the numbers go up, so the question is: what are the Government prepared to do about it, and how can the House work to facilitate them in that?

Before the general election, the previous Government worked with NHS England to establish the independent ADHD taskforce, with the aim of developing a data improvement plan. As we have heard, there have been two iterations of that. The Minister confirmed in a written ministerial answer to the hon. Member for Broxtowe (Juliet Campbell) on 17 November that the Government are considering those recommendations. Will the Government respond to the taskforce’s recommendations today? If not, when will they do so? If so, will they take on all the recommendations, or will they challenge some?

I commend the Government on commissioning their own independent review into autism and ADHD. They are often linked and there can be co-morbidities, which are important to consider. As we have heard, there is no distinct timeline for that—summer is a long period of time—so I would be grateful if the Minister can set out exactly how the Government define “summer”. How will that intertwine with the work that the taskforce has already done? Will that work get superseded, or will the two pieces of work dovetail together?

Finally, I want to talk about accountability and delivery. I understand that NHS England has identified reducing long waits for ADHD assessments as a priority in the medium-term planning framework. With NHS England set to be abolished, it is unclear how those priorities will be maintained and enforced. Will the Minister confirm that reducing the long waits for ADHD assessment will remain an explicit national priority for the NHS? How will the Government enforce that, given that NHS England is being taken away, and ensure consistency across integrated care boards?

I welcome the acknowledgement in a recent written answer that data on ADHD waiting times at ICB level is currently not held centrally, but that there is an intention to publish it in 2026 or 2027. That transparency matters, so will the Minister confirm that the plans to publish ICB-level ADHD waiting time data will continue regardless of the structures of the NHS after the change? Will he provide an indicative timeline for the delivery? Is it 2026 or 2027?

Will the Government publish more data about Right to Choose that shows what is and is not successful, and what is good practice and what can be improved? That is one of the ways to deal with the postcode lottery. At the heart of this debate is the fact that behind the numbers is a person, a child or a family seeking answers, support and stability. It is our duty in this House to hold the Government to account for delivering that for all across the nation.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)]

It is a pleasure to serve under your chairship, Ms Vaz. I thank my hon. Friend the Member for Sefton Central (Bill Esterson) for securing what is, by all acknowledgement, an important debate on ADHD. I thank other hon. Members for their valuable contributions today, particularly my hon. Friends the Members for Hertford and Stortford (Josh Dean), for Sheffield Hallam (Olivia Blake) and for Warrington South (Sarah Hall), and the hon. Member for Yeovil (Adam Dance) for sharing personal experience that has been invaluable to this House. In this debate, we have heard moving testimonies and I want to thank all hon. Members who have shared personal and family experiences. I personally express my welcome and my deepest sympathies to Christine and Richard, the parents of Matthew Lock. I thank them for being in the Public Gallery for this debate, and thank them for all the invaluable work that they have done with the Department and with NHS England to raise awareness of the issues surrounding ADHD and suicide through the charity that they set up in Matthew’s memory.

We have learned, through this debate, the intersection between ADHD, other mental health conditions and suicide risk. Every suicide is a profound tragedy that leaves families, friends and communities devastated. That is why, in addition to our approach to ADHD, mental health and autism, we are committed to delivering the suicide prevention strategy for England, which aims to address the risk factors contributing to suicide to ensure that fewer lives are lost. We will work across Government to improve support to those who are suffering, and those who have been bereaved by suicide.

We know that people with ADHD have co-occurring neurodevelopmental conditions. We must not only intervene early but assess people with suspected neurodevelopmental conditions—about which I will say more later—and ensure that, following diagnosis, people have the right support to meet their needs, including their mental health needs. The Government have already taken significant steps to stabilise and improve NHS mental health services but, of course, there is so much more to do. Transforming the system always takes time but we are committed to delivering a new approach to mental health.

The 10-year health plan sets out the ambitious reform that we wish to undertake to make the system fit for the future. In line with that, we will go further to ensure that NHS mental health services deliver the care that people deserve and rightly expect. The publication of the “Staying safe from suicide” guidance in 2025 means that all mental health practitioners must now follow the latest advice in understanding and managing suicide. Associated training is now available to all NHS and non-NHS mental health staff.

Following the tragic loss of their son Matthew, Richard and Christine have been keen to ensure that other families are made aware of the increased risks of addiction and suicide that are associated with ADHD. NHS England has worked closely with Richard and Christine to revise content on the nhs.uk website, and has included separate, tailored content on ADHD for adults, children and young people. The website also specifically highlights the increased risks of suicide and addiction in those with ADHD, it signposts anyone who might be struggling to find urgent help and support, and has updated wording to reflect lived and clinical experience. I extend my thanks again to Richard and Christine for all their input to that work. I invite them into the Department to meet me alongside my colleague, the mental health Minister, to see how we can go further faster.

We know that too many patients are facing long waits to access services including ADHD assessments and support. I know that such issues are affecting our constituents up and down the country, as has been reflected in this debate, and I understand the devastating impact that that has on individuals and families. Lord Darzi’s report laid bare the growth in demand for ADHD assessments nationally. That has been so significant in recent years that it risks completely overwhelming the resource available. I thank everyone who has taken part in sharing evidence for Lord Darzi’s report, and with the subsequent ADHD taskforce established by NHS England. We know, from the taskforce’s report, that there are quality concerns with assessments. There has been rapid growth in remote assessments and in use of the independent sector. We are urgently looking into those concerns. That is why work is currently underway to improve ADHD services in both the short and long term to meet the needs of those waiting for an assessment, or those needing treatment for a diagnosis.

[Dr Evans]

On that point, the Minister mentioned the taskforce. It did produce its report, with its recommendations, and the Government have not yet responded to those recommendations. Will the Minister give a timescale for when he is looking to do so?

[Dr Ahmed]

I have met the chair of the taskforce: we discussed the outcomes, and the need—as the hon. Member mentioned in his remarks—for work on those outcomes to dovetail with the prevalence review. I think that would be the most appropriate way to provide a holistic response. We, of course, respect the findings of the report, which is an excellent scientific piece of work looking at the data underpinning the diagnoses.

[Dr Evans]

To clarify, if it is going to dovetail, is he suggesting that the recommendations will come out in the report in the summer, all in one lump, or will we see the recommendations of the taskforce come out before we see the full report of the newly commissioned work?

[Dr Ahmed]

At present, the hon. Gentleman will have to ask my colleague the mental health Minister about the specifics, but my understanding is that the prevalence review will be a wider piece of work that will be partly informed by the ADHD taskforce report. It would be better to respond to them as a combination rather than as individual reports.

The House will know that on 4 December 2025 the Secretary of State announced the launch of the independent review into prevalence and support for mental health conditions, ADHD and autism. It will bring together the most respected researchers, clinicians and voluntary organisations in the country, alongside, crucially, people with lived experience, who will be directly engaged to scrutinise the evidence and support the development of recommendations. Part of that will be about how we address and label reporting, and I would expect that we come up with a better definition and a better way of reporting than we have at the moment.

The Government’s 10-year plan sets out the core principle of early intervention and support, and will make the NHS fit for the future. Through the NHS medium-term planning framework, published in October 2025, NHS England has set an expectation that local ICBs and trusts improve access, experience and outcomes for ADHD services over the next three years.

I heard the call from hon. Members for much more integration between community mental health services, GPs and other healthcare bodies. It is our expectation that through the NHS reform Bill and the disbanding of NHS England, as well the production of independent health authorities and strategic commissioning, the health service will be better able to serve the needs of children requiring assessment for mental health conditions and ADHD. We will end up having a helicopter view, which is currently not possible.

Oral Answers to Questions

Luke Evans Excerpts

Tuesday 13th January 2026 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

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

Community pharmacies are a vital part of the primary care infrastructure, including in Epping Forest. Using NHS Organisation Data Service data, can the Minister tell the House how many pharmacy contracts ceased in England last year?

[Stephen Kinnock]

I thank the hon. Gentleman for his question and congratulate him on the addition of the facial hair. I am glad to see that he is joining that particular club—I think it is the only club we may both be a member of!

The Government are aware of the pressure on pharmacy; it is a major challenge that we are facing. We gave pharmacy a 19% uplift in the last spending review. Of all the sectors in my portfolio, that was the one that received the largest uplift. We are also looking to secure better progress with the use of technology, and we are looking at the medicines margin and the dispensing fee, recognising the significant financial pressures that pharmacies are under. Through reform and investment, we believe that we can turn the corner and rebuild pharmacy in our country.

[Dr Evans]

I appreciate the Minister’s answer. However, the answer to my question is: 650 contracts across England and Wales. He only had to look at the newspaper headlines from yesterday to see that—this is his Department and his portfolio.

The chair of the Independent Pharmacies Association, Leyla Hannbeck, has specifically warned that higher business rates and increases in national insurance contributions, which are both set by the Government, are to blame and are driving up costs, while pharmacy income—which, again, is set by the Government—remains fixed. Does the Minister accept that those tax decisions taken by his Government directly increase the costs and contribute to the loss of pharmacy contracts, and will he therefore raise this matter with the Chancellor immediately?

[Stephen Kinnock]

I think there is some dispute over the number that was on the front page of the Express. We are looking into that number and will certainly come back to the hon. Gentleman on it. On his broader point about the decisions that the Chancellor took at the last Budget, I suppose I have a question back to him: would he be cutting the £26 billion that this Labour Government are investing in the NHS, and if not, how would he be paying for it?

Community Audiology

Luke Evans Excerpts

Thursday 18th December 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Vickers, and I wish you and your team a merry Christmas. I thank the hon. Member for Uxbridge and South Ruislip (Danny Beales) for inadvertently creating what seems like a medical symposium; I feel as if I am back at one of my Christmas grand rounds—they often used to pick something a little bit strange and wacky to debate. I did not quite expect to be talking about spaniels’ ear canals, but I enjoyed the flashback none the less.

The hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) rightly talked about couples. When I was a GP, I saw couples become yin and yang, supporting each other on the basis of who had the hearing loss, who had the brains and who had the dexterity. If one of those problems is not sorted, there can be real impacts for the others. We should consider that when we deal with patients. The hon. Gentleman’s point about drawers of waste was a personal hobby horse of mine too—though it was not hearing aids, but often medication brought back to me, or seeing thousands of bandages or eye drops left over when I went on home visits, for example. That is a really important point and the NHS is not very good at picking up on it.

I thank the Father of the House, my right hon. Friend the Member for Gainsborough (Sir Edward Leigh), for raising the issue of stigma. My grandfather was particularly bad and stubbornly did not want to get a hearing aid, and even when he did get it, he would not wear it. My right hon. Friend also joked about his wife not hearing him, which reminded me of “Captain Corelli’s Mandolin”; at the start of the film, the pea is taken out of the ear, but at the end, because of all the nagging, he is desperate to get the pea reinserted.

My right hon. Friend also raised the issue of workforce, which is incredibly important when it comes to trying to solve some of these problems. The hon. Member for Uxbridge and South Ruislip set out clearly and coherently both the landscape and where we find ourselves. That is really important because, when people think about care delivered close to home, hearing loss services are among some of the most visible examples on the high street and in our community settings across the country. I visited the Specsavers on Hinckley’s high street, as well as the pharmacy in Newbold Verdon, only a couple of months ago to see what they provide.

There is a real opportunity to bring care towards people, which makes high streets a good bellwether for this Government’s ambition on prevention and community care and how that is being translated into practice. There are three issues I would like to press the Minister on. The first is the funding pressures on the ICBs, the second is access and self-referral, and the third is national oversight and data.

On access and self-referral, under previous NHS operational planning guidance, ICBs were asked to increase direct access and self-referrals into audiology services. That was a good move; it meant that people concerned about their hearing could go straight to specialist care without needing to see a GP first. In many areas, that has been a success. However, as we heard during the debate, 12 ICBs that commission hearing loss services still require a GP referral. That adds delays for patients and places unnecessary pressure on general practice, not necessarily for any clinical benefit. Against that backdrop, it is a little disappointing to see that self-referral was not included in the most recent operational planning guidance for 2025-26, nor in the medium-term planning framework. The question is why. Would the Minister explain why self-referrals seem to have been deprioritised, and what concrete steps the Government are taking to ensure that access to audiology does not depend simply on where someone lives?

On funding pressures and core services, Members have rightly highlighted the significant variation in access to routine audiology services, particularly earwax removal. In too many parts of the country, people are either being pushed back to the ENT departments or told to pay privately. I am glad that we have an eminent surgeon in the Chamber, the hon. Member for Bury St Edmunds and Stowmarket; from a GP’s perspective, I understand why some were reluctant to go back to having their ears syringed and I often dealt with complaints about why it was not suitable, as suction is the gold standard.

The question is how we provide that in a way that is deliverable to the community and provides to the patients, but is also at least cost-neutral for primary or secondary care. There is a conundrum there. That situation will be made worse, as the Father of the House pointed out, by our ageing population. When ICBs are under pressure and their budgets are changing—they are being cut by 50%—how do we ensure that that it is deliverable? That poses the question of how sustainable it is to place the responsibility of the full range of audiology services on ICBs, considering they are under constraints, and how will the Government square that circle. There is also the opportunity of public-private partnerships and neighbourhood centres to help to deliver audiology services. That could come as sites or services. I would be grateful if the Minister could set out what his vision is in this space, considering we are trying to take a leftwards shift.

There are also opportunities for new thinking. As I mentioned, I went to see a pharmacist. What supports have been put in place for new providers to come in? Pharmacists seem keen to be able to take on more services, and they often have sites directly in the heart of our communities—the closest place to our residents. Is there some consideration of what can be done to innovate in that space?

On data, oversight and accountability, one of the most striking features of audiology is how difficult it is to assess the performance nationally. The Government were right to set out their ambition to meet the NHS standard that 92% of people should wait no longer than 18 weeks from referral to treatment, and in most specialties we can clearly see how the system is performing against that ambition. However, in audiology it is harder, especially as the referral-to-treatment waiting time data, which was paused during the pandemic for understandable reasons, has since been retired by NHS England.

Looking ahead, given that the Government have confirmed their intention to bring forward legislation to abolish NHS England, with the statutory functions being taken into the system, will the Minister consider looking again at reinstating the referral-to-treatment waiting time data for direct audiology as a way to monitor the leftward shift that the Government are pushing for? If so, will that be done at ICB level or under the Department of Health and Social Care?

I would be grateful if the Minister could clarify two points. First, when does the Government expect to introduce the legislation in 2026? Secondly, it would be helpful to understand when we can expect the workforce plan: we were told that it was coming in the summer, then the autumn and, now that we are on the last day of business before Christmas, I expect it is coming in the new year. Knowing when that plan is coming, and how audiology will play a part in that, is really important.

Given the Kingdon review only came forward in November, it is unfair of me to ask whether the Government have fully assessed it yet. The review had 12 recommendations and also pointed out the oversight, and there is a question about how that will be resolved. With all the changes to ICBs, NHS England and the Kingdon review, I would be grateful to know when we will likely hear whether all recommendations have been accepted and will be resolved.

Audiology may not always attract attention in this House, but it is a vital part of our community healthcare and a real test of the Government’s commitment to prevention and access. I hope the Minister can provide clarity on the questions I have asked today. I wish you, Mr Vickers, your team, your colleagues, everyone in this House and my constituents a very merry Christmas.

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Mr Vickers. I start by thanking my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) and congratulating him on securing this important debate. Having now been in the same room as a specialist in ear, nose and throat, a former GP and a vet, I am not sure that I am entirely qualified, and I approach this debate with some trepidation. I certainly enjoyed the debate and, as the Father of the House rightly said, it was a privilege to be able to hear some of the insights, direct experience and expertise of hon. Friends and Members.

My hon. Friend the Member for Uxbridge and South Ruislip has also been doing a huge amount of good work in promoting the flu vaccine ahead of winter, in his constituency and more widely, and I pay tribute to him for that. It was a pleasure to visit his constituency a few weeks ago, where I met the incredible team at the Pembroke centre in Ruislip Manor to hear about how they are delivering, designing and developing their thoughts about neighbourhood health hubs and the neighbourhood health service, which will be a pivotal part of our 10-year plan.

The Royal National Institute for Deaf People estimates that one in five people in the UK—almost 12 million adults—are deaf, have hearing loss or experience tinnitus, and by 2035 that figure is projected to rise to over 14 million. For people with cognitive disabilities, hearing loss can have a real impact on their quality of life, causing confusion for people with dementia, making communication and social interaction more difficult and increasing loneliness and isolation.

That is why our community audiology services are so important. They represent a comprehensive range of hearing care delivered in local, accessible settings, such as GP surgeries, community clinics and community diagnostic centres. They help people of all ages, offering assessments, hearing aid fittings and support for those with tinnitus and balance issues. They advise on equipment such as amplified telephones and alerting devices, while working alongside occupational therapists to support people to stay independent. They form part of a wider team with speech, language and other community services, acute care, and the ear, nose and throat department for issues that cannot be managed in the community.

Community audiology services face challenges, particularly on waiting lists and inequality of provision. Members across the Chamber raised some of those points. The Father of the House rightly pointed out that there are 6.7 million people who should use a hearing aid but do not. We must overcome the stigma associated with hearing loss.

The hon. Member for Honiton and Sidmouth (Richard Foord) was right to talk about the connection between hearing loss and the propensity for falls. My hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) shared his tremendous expertise as an ear, nose and throat surgeon, and I thank him for his insights about the Hear for Norfolk project, which is a very interesting model indeed. Perhaps we can follow up on it in the new year.

The hon. Member for Winchester (Dr Chambers) gave a remarkable exposition on hearing loss in dogs—I have to say that I did not have that on my bingo card for this afternoon—from which we all learned a tremendous amount. He also made a number of important points about hearing loss in humans, and we absolutely take them on board.

The hon. Member for Hinckley and Bosworth (Dr Evans) rattled off a number of questions for me, and I desperately tried keep track of them. I got some of them and did not get others, so I will happily write to him on the points that I am unable to address now. He raised an important point about self-referral, which of course depends on local commissioning arrangements. There is inequality and unwarranted variation in the ability to self-refer. We want more self-referral. We think there are opportunities in upgrading the functionality of the NHS app. Our objective is absolutely to be able to do this without having to go through a GP. There are some technology-related solutions, but I want to assure him that there is no conscious decision from the Government to deprioritise self-referral; I just think that there are some variations.

The old chestnut that we are constantly trying to crack is around devolving to ICBs the power and agency that they should have because they are closest to the health needs of their population, while ensuring that they are clear about the outcomes, frameworks and standards that we expect. We honestly hold our hands up and say that we have not got that right in all cases, but we are committed to self-referral as a principle and as a really important part of the shift from hospital to community.

On ICB budgets, we have secured £6 billion through the spending review process for capital upgrades. A lot of that will help us to ramp up what we are doing on community diagnostics. That is one way to square the circle around the investment that we need on the ground for ICBs to be able to do more in terms of the services they provide by improving the equipment, the kit and the technology they have. Part of the answer to the hon. Member for Hinckley and Bosworth’s question relates to capital investment really helping to boost the services provided.

The workforce plan is coming in the spring of 2026. I absolutely hear what the hon. Member says about the need to move forward on that. It has been a complex process. Obviously some of the changes and restructuring around what we are doing on NHS England have also had an impact on the process of putting the workforce plan together, but I am reliably informed that that will be in the spring of 2026.

Timely access and effective support to services can make all the difference to someone’s quality of life, wellbeing and independence. As part of our effort to shift care from hospital to home, this Government want to support people to live independently in the community, and community audiology will play an essential part in making that happen. Community audiology is commissioned locally by integrated care boards. Funding is allocated to ICBs by NHS England. Each ICB commissions the services it needs for its local area, taking into account its annual budget, planning guidance and the wider needs of the people that it serves.

This year, my right hon. Friend the Chancellor confirmed the Government’s commitment to getting our NHS back on its feet and fit for the future, with day-to-day spending increasing by £29 billion in real terms over the next five years. By the end of this Parliament, the NHS resource budget will reach £226 billion. That funding will support the growing demand for community health services, including audiology. It will help integrated care boards to expand diagnostic capacity, invest in local estates and equipment, and sustain the workforce needed to deliver high quality hearing care for patients of all ages. For the first time, we have published an overview of the core community health services, which include audiology, for ICBs to consider when planning for their local populations and commissioning processes.

Our medium-term planning framework for the next financial years sets out our ambition to bring waiting times over 18 weeks down, develop plans to bring waits over 52 weeks to zero, and to increase capacity to meet growth in demand, which is expected to be around 3% nationally every year. We are asking systems to seek every opportunity to improve productivity and get care closer to home, from getting teams the latest digital tools and equipment they need so they can connect remotely to health systems and patients, to expanding point-of-care testing in the community. Systems are also asked to ensure that all providers in acute, community and mental health sectors are onboarded to the NHS federated data platform and use its core products.

Our 10-year health plan sets out how we would make the shift from analogue to digital by making the NHS app the digital front door to services. We will make it easier for patients to access audiology services through self-referral. This will transform the working lives of GPs, letting them focus on care where they provide the highest value-add. This is how we will make sure everyone can self-refer—not just the most confident and health-literate. Patients can access NIH-funded audiology services directly without having to wait for a referral from their GP. That means improved access to care and shorter waiting times.

My hon. Friend the Member for Uxbridge and South Ruislip and other hon. Friends stood, as I did, on a manifesto to halve health inequality between the richest and poorest areas of our country. I know he will agree that access should not be based on where we live. A key part of our elective reform plan, published at the start of the year, is transforming and expanding diagnostic services so we can reduce waiting times for tests and bring down overall waits. NHS England is working closely with services to improve access to self-referral options, aiming for a more consistent offer right across the country.

[Dr Luke Evans]

I am grateful that a comprehensive plan is coming forward. One problem we have is joining the leadership up. The Kingdon review, which was launched in May and finished in November, made 12 recommendations that will help align with all the missions the Minister is bringing forward. Can he tell us when the Kingdon review will be accepted and analysed by the Government, and their position on the recommendations, because it is a key thread to delivering all the ambition that he has rightly put forward?

[Stephen Kinnock]

I can—we are absolutely committed to responding to the Kingdon review next year. We are working on pulling together our response to the report. It is extremely important, and there are serious lessons to be learned from it. We think Dr Kingdon has done an excellent piece of work, and we are very keen to build on it and take it forward.

Community diagnostics, such as local hearing assessment clinics and testing in community settings, are being rolled out more widely through the expansion of our community diagnostic centres. We are opening more of these centres—12 hours a day, seven days a week, offering more same-day tests, consultations and a wider range of diagnostics. I am very proud that we now have 170 CDCs across England.

Almost 2 million audiology assessments have been carried out by NHS staff since this Government took office, including 136,000 tests in October—the highest number of audiology tests for a single month in the history of the NHS. This is a crucial step in supporting the NHS to meet its constitutional standards and deliver quicker care to patients. I also want to salute the work of the Welsh Government, who have been pioneers in many respects with their plan, published this week, showing how Wales is also leading in audiology services on care in the community, training and infrastructure.

The hon. Member for Hinckley and Bosworth asked about the Kingdon report, and in this debate on audiology services, I must take this opportunity to thank Dr Camilla Kingdon for the excellent review that she chaired into failures in children’s hearing services. As I have just told him, the Government are committed to responding to the recommendations made by Dr Kingdon, and we will publish a comprehensive response next year.

Community audiology services face challenges, with long waits and inconsistency in access to services, but we are taking action through the medium-term planning framework, by expanding community diagnostic centres and as an integral part of our 10-year plan. My hon. Friend the Member for Uxbridge and South Ruislip and I come from a political tradition based on solidarity, and this Government stand for a health service that leaves no person behind. I know that he shares my determination to get timely access to community audiology services for all 12 million of our compatriots who need them.

I thank my hon. Friend once again for bringing forward this extremely important debate, and I thank all Members who have spoken. It only remains for me to wish you, Mr Vickers, as well as your entire team and everyone else in the Chamber, all the very best for Christmas and the new year.

Mental Health Bill [Lords]

Luke Evans Excerpts

Consideration of Lords message
Monday 8th December 2025 Commons Chamber

[Stephen Kinnock]

Yes, we absolutely do agree. As the hon. Gentleman will hear as I proceed with my speech, we have three options in respect of what will happen in exactly the scenario that he has mentioned, and that has been very much the spirit of the amendment on which we have agreed with the other place.

We will put patient feedback and outcomes front and centre by improving the transparency of reporting across in-patient and community mental health services. We will introduce an early warning system so that we can intervene earlier, using patient and staff feedback and clinical information to identify services that are at risk of providing poor-quality care. That is alongside our commitments to roll out mental health support teams in schools and colleges to full national coverage by 2029, to employ an extra 8,500 mental health workers by the end of the Parliament, and to pilot new 24/7 neighbourhood mental health centres across the country. Once implemented, this long-awaited and transformational Bill will give patients greater choice and autonomy and enhanced rights and support, and will ensure that everyone is treated with dignity and respect throughout their treatment.

Let me now briefly outline some of the commitments made by my ministerial colleague Baroness Merron in the other place. In response to the amendment tabled by Baroness May, the Government announced plans to launch a consultation on emergency police powers of detention. The consultation will look at in particular, but will not be limited to, sections 135 and 136 of the Mental Health Act 1983, as well as exploring joint working approaches across organisations. We have committed ourselves to working with stakeholders as we define the scope of the consultation.

In the other place, following engagement with Baroness Berridge, the Government tabled amendments in lieu regarding the appointment of a nominated person for a child under 16 who lacks competence. The amendment states that if no local authority has parental responsibility, an approved mental health professional—an AMHP—must appoint a person who has parental responsibility, a person named in a child arrangements order as a person with whom the relevant patient is to live, or a person who is a special guardian. If there is no suitable person with parental responsibility who is willing to act, the AMHP must consider the child’s wishes and feelings when deciding whom to appoint.

This amendment clarifies whom AMHPs should appoint as the nominated person, and gives priority to those with parental responsibility. We intend to use the code of practice to outline what factors and nuances an AMHP should consider when making the appointment decision. If the AMHP later discovers that another of those on the list is more suitable to act as the nominated person, the legislation allows him or her to terminate the appointment of the nominated person and appoint the special guardian instead.

I thank Members on both sides of the House for their support for the Bill, and look forward to hearing their contributions.

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

I have talked about roads and bridges throughout the duration of the Bill. We have now reached the end of the long road that was, of course, embarked on by Baroness May in 2018 with the independent Wessely report, which was the foundation of this legislation. It constitutes a cross-party, cross-departmental look at how we can improve the lives of people with the most serious mental health issues.

I was pleased to hear the Minister start to talk about the difference between mental health and mental wellbeing. That is fundamental when it comes to dealing with our policies and how we will take the country forward, because while not everyone has a serious mental health problem, everyone has problems with their mental wellbeing. Ensuring that we have that distinction worked out will be vital to providing the right support for the right people in the right place, and, ultimately, that is what the Bill is dedicated to doing. I have talked in the House about why that is so important. This Bill, above all others, deals with the most vulnerable people in society—those who are seriously mentally unwell—so I am pleased that we have reached a stage at which we can take it forward and put it into law.

I was also pleased to hear the Minister comment on the amendment from the other place, and the concerns raised by Baroness Berridge. I understand the points that he has tried to make and the clarifications that the Government have tried to introduce in relation to the amendment. He has said that he will look at the code of conduct in respect of the seriously difficult positions in which mental health professionals might find themselves during an evening of dealing with a parent who is contesting with a child the question of who is to be the nominated person. I am glad that the Government are looking at the code of practice, and we will not be dividing the House tonight.

That being said, as with the 10-year plan that the Government have brought forward, there is a synergy here. The synergy is this: Members on both sides of the House agree with the thrust of the 10-year plan and this Bill, but the problem is that there is no delivery chapter. That was the Opposition’s concern when the Government were taking the Bill forward. As the Minister conceded in Committee, it will be a challenge, but without a delivery plan it becomes very difficult.

[Tom Hayes (Bournemouth East) (Lab)]

Before I was elected, I ran mental health and complex needs services for five years. I saw a landscape that had pretty much been devastated under the Conservatives, and one way in which it had been devastated was through the loss of Sure Start. The Institute for Fiscal Studies produced a report this year that showed that Sure Start led to a 50% reduction in hospitalisations for 12 to 14-year-olds. The shadow Minister talks about the ways in which we can deliver better mental health. Does he agree that Labour’s roll-out of a revamped Sure Start is just one of the many ways in which we are helping to improve children’s mental health?

[Dr Evans]

The hon. Gentleman makes a very good point, but he has also missed the point. He gives me the opportunity to point out that one way in which the previous Government dealt with this issue was by bringing forward the mental health investment standard, under which the proportion of spending on mental health had to mirror the spending on physical conditions. That was starting to lead to real change. Alas, under this Government, there is a concern that the standard has not been met. We know that the proportion of mental health spending has fallen under this Government, according to the written ministerial statement that they put out.

That leads me on nicely to the point that I wanted to raise: how will we fund the models that are coming forward? That is the crux of the matter that people outside the House will be looking at; it is a direct question, and it is the only one that I have in this debate. We on this side of the House have raised this issue in the debates we have had on both palliative care and mental health, and I raised it with the Minister only last week. The Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), has raised this question again and again. Are the Government committed to the investment standard or not? Is it something that they have dropped? The House and the wider public need to know, so that we can plan for service provision. If the Government are dropping it, that is on them, and they need to explain the reasons why they are doing so. Maybe there is alternative investment, but as a starting point, the investment standard will be crucial in dealing with the mental health challenge, which is growing despite the pandemic and all the investment that has already gone in.

[Tom Hayes]

I have written more mental health investment standard funding applications than I care to remember. Although investment is obviously important, one major challenge with that stream of funding was that I had to apply on an annual basis. There was no certainty around multi-year settlements, so I was repeatedly setting up projects for which I could not find the funding to keep them going. That created more disruption in mental health support. We need to have stable, continuous funding settlements that actually meet the need that has been identified by the data and patient experience. That is what the Government are delivering, and to latch on to a particular funding stream and claim that somehow it is not being provided with support, when actually there is the wider of goal of tackling mental health through different methods—

[Madam Deputy Speaker (Caroline Nokes)]

Order. The hon. Gentleman will know that there is ample opportunity for him to contribute to the debate. That was a very long intervention.

[Dr Evans]

I am grateful to you, Madam Deputy Speaker, for stepping in on that basis. We have had plenty of chances to debate this Bill, both in Committee and many times in the mental health debates that I am partial to. We could go through why the last Government changed the interventions of NHS England and brought in integrated care boards to allow for a joined-up structure to be put in place. We now see a new iteration coming forward but, yet again, we do not know how much it will to cost to get rid of NHS England. We do not know the redundancy packages for the ICBs and how much they will cost. That is fundamental.

One thing we do know is that, as the chair of the Royal College of Psychiatrists has said, the change to the investment standard alone will cost the sector £300 million. That is investment that could have made a difference to mental health provision. I do not want to get into the heated politics any further, and I do not want to delay the House any further this evening, but the Government’s position on the mental health investment standard is crucial when it comes to delivering this Bill.

I thank the Minister for his constructive approach, and for the way in which he has taken ideas forward and looked through the Bill in fine detail. I know he cares deeply about getting this right, as do many Members of this House. It is imperative to ensure that compassionate, modern care is delivered to those who need it most when it comes to dealing with serious mental health conditions.

[Madam Deputy Speaker]

I call the Liberal Democrat spokesperson.

[Stephen Kinnock]

With the leave of the House, I will make some brief concluding remarks. I am very grateful to Members of this House for their contributions both today and throughout the passage of this Bill. I believe that by drawing on the lived experience of both Members and our constituents, we will be able to strengthen the intended impact of this legislation on people with serious mental illness and their loved ones. The passage of this Bill has seen the best of parliamentary commitment and co-operation, and the conduct of Members and peers has been collaborative and well-intentioned throughout.

For too long, mental health reform legislation has sat on the shelf. This Government made a manifesto commitment to modernise the Mental Health Act 1983, and we have delivered that within our first Session, providing an opportunity to transform the way we support those with severe mental illness and providing patients with greater choice and autonomy. I am reminded of what a patient in the 2018 independent review said:

“I felt a lot of things were done to me rather than with me”.

This Bill takes forward many of the changes put forward by the independent review, the recommendations of which were rightly shaped by the views of patients, carers and professionals.

Many have asked about next steps and implementation. Post-Royal Assent, our first priority will be to draft and consult on the code of practice. We will engage with people with lived experience and their families and carers, staff and professional groups, commissioners, providers and others to do that. The code will go to public consultation, as well as being laid before Parliament before final publication. Alongside the code, we will develop the necessary secondary legislation. We will then need time to train the existing workforce on the new Act, regulations and the code. We estimate full implementation will take around 10 years due to the time needed to train the workforce and the need to ensure that the right community support is available. This timeframe necessarily spans multiple spending review periods and multiple Parliaments, so we are limited in the detail we can give about future spend and timelines. But we have committed to an annual written ministerial statement on implementation. This commitment will last for the 10 years or until the Bill is fully implemented, whichever is sooner.

[Dr Evans]

I appreciate that the Minister cannot commit to a financial spending envelope now, but is it not the case that the mental health investment standard is something that the Government could commit to?

[Stephen Kinnock]

Yes, I was just coming on to that, because the hon. Gentleman raised it in his speech. We are protecting the mental health investment standard in real terms, as it will rise in line with inflation. Our position is quite straightforward. We feel that for far too long the NHS has been run by a series of input-based targets which micromanage frontline leaders, while failing to ensure improvements in patient experience and care. We are bringing the era of command and control to an end, setting frontline leaders free to innovate and run their services as they know best.

I also remind the Opposition spokesman that we are investing £473 million in capital funding in mental health nationally over 2026-27 to 2029-30. That funding will: support the establishment of a 24/7 neighbourhood mental health service; deliver mental health emergency departments, known as crisis assessment centres; expand neighbourhood mental health services; eliminate inappropriate out-of-area placements; and increase crisis accommodation for people with learning disabilities and autism. I gently say to the hon. Gentleman that when we see a rising tide lifting all the boats, we are connecting our mental health spend to that rising tide. We are then seeing a rise in real terms on what this Government are spending on mental health across the board.

I am very happy to again meet the hon. Member for Winchester (Dr Chambers), the Liberal Democrat spokesman, and look at that particular issue. He raised it in Committee. I hope that some of the things I have just set out will help very much on the tragedy of suicide in our country. We are very conscious of how much we need to do to combat that.

I put on record my thanks to all Members and noble peers who have paid such a close interest in the development of the proposals, along with the officials and parliamentary staffers who have supported us to do so. The officials involved in the Bill are too many to mention, but I would like to pay tribute to colleagues in my private office, Emily Cowhig and Penny Sherlock, who have done such sterling work on the Bill, supporting me and the entire team throughout.

Transforming mental health care for the most vulnerable patients with serious mental illness requires the Bill to pass into statute. I am therefore grateful to hon. Members for their support in enabling us to do so.

Lords amendments 19B and 19C agreed to.

Terminal Illness: Mental Health Support

Luke Evans Excerpts

Wednesday 3rd December 2025 Westminster Hall

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

The old adage we often hear is that there are two certainties in life—taxes and death. We spend a lot of time in this House talking about the former and very little time speaking about the latter, even though we know it will affect us; I have argued that both as a doctor and in this House since I was elected.

I take my hat off to the hon. Member for Altrincham and Sale West (Mr Rand) for securing this debate. It is so important and it will affect all of us. We are informed by the work of our constituents, so I also put on record my thanks to Mike for his incredible story and for the memory of Sarah that he has brought to this place, at the highest level, so that we can have this debate about how we can improve the condition of those in their time of greatest need.

In the few minutes I have, I will distil this debate into three areas: first, the location of mental health care, secondly, the workforce and, thirdly, the plan. On the first point—I have raised this with the Minister before—hospices often provide a lot of mental health support, but they are struggling. Many are closing beds and many are in deficit. Together for Short Lives estimates that the national insurance contributions increase costs an average hospice at least £130,000. After a previous debate on hospices, I asked the Government in a letter of 10 November, to which I have not yet had a response, whether they will consider an impact assessment on the state of hospices.

The National Audit Office’s report into hospices states:

“DHSC and NHS England do not know what proportion of the total amount of palliative and end-of-life care provided in England is delivered by the independent adult hospice sector, and therefore how reliant they are on the sector.”

That is an important point in understanding the fabric and make-up of provision, as well as the postcode lottery in provision, which the hon. Member for Dewsbury and Batley (Iqbal Mohamed) pointed out. If we want to improve provision, we need to understand what is there in the first place.

To do so, we need to provide a workforce, as I also said in the letter. A letter I received from the Government on the topic of hospices stated:

“This summer, we will publish a refreshed NHS long-term workforce plan to deliver the transformed health service we will build over the next decade so that patients can be treated on time again.”

I raised this issue in the November debate. We are now into December, and winter, and we still do not know when the NHS workforce plan will come forward. I would be grateful if the Minister could respond to that point. It is especially important given that, in the last Budget, the Government cut the proportion of spending on mental health care. At the time, the president of the Royal College of Psychiatrists said:

“It is illogical that the share of NHS funding for mental health services is being reduced at a time of soaring need and significant staff shortages.”

The previous Government brought in the mental health investment standard, but it is not clear whether this Government are adhering to it or keeping it in place. It will be important in ensuring that we have the investment to provide both the places and the workforce.

I welcome the bringing forward of the palliative care framework, which Opposition Members and many others on both sides of the House have asked for. I am pleased that the Government have set that out, because it will be the framework that provides the care we need across the country. It is also timely, given that the Terminally Ill Adults (End of Life) Bill is going through Parliament. An amendment to the Bill, which was nodded through with support from both sides of the House, will ensure that there is a financial plan for what palliative care should look like. It will be imperative that considerations about mental health care for the terminally ill are involved in that framework.

In his November debate, the hon. Member for Strangford (Jim Shannon) raised the issue of a 24/7 palliative care helpline, which many across the House and many charities have asked for. In the debate—before we had heard about the framework—I asked whether that would be looked at as part of the framework, because that 24/7 point of contact could form part of the mental health support that families get when they are struggling and in their time of need. I would be grateful if the Government would consider that.

I appreciate that this is not in the Minister’s brief, but I would also be grateful if he could set out how the palliative care framework will be put together. Who are the stakeholders? How can people like Mike and interested Members contribute to ensuring that we get it right? We want this House to do it only once; we want to get the framework right for England, and hopefully across the home nations as well, so it will be incredibly important that all stakeholders are involved.

We in this House need to ensure that others can hold what those who are struggling find too heavy to hold. That is the essence of what we are trying to do, whichever side of the House we are on or whether, like Mike, we are outside this House. We are trying to make sure that when someone is in their time of need, and when they feel the burden is too heavy, they can hand it on to someone else, who will help to carry that load.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)]

It is a pleasure to serve under your chairmanship, Sir Jeremy, and I start by sincerely thanking my hon. Friend the Member for Altrincham and Sale West (Mr Rand) for securing this debate. I also welcome Mike and his family to the Public Gallery, and pay tribute to Mike for all his efforts.

My hon. Friend raises an important issue that can affect so many people—all people perhaps, at some point—about ensuring that when someone is diagnosed with a terminal illness, they can receive the mental and emotional support that they need in the place that they need it. We want to be a society where every person receives high-quality, compassionate and personalised care from diagnosis through to the end of life. The Government are determined to shift more healthcare out of hospitals into the community to ensure that patients receive personalised care in the most appropriate setting.

Palliative care and end-of-life care services, including those provided by hospices, have a big role to play in that shift. Palliative care services are included in the list of services that an integrated care board must commission, promoting a more consistent national approach and supporting commissioners to prioritise palliative care and end-of-life care. To support that process, NHS England has published statutory guidance stating that ICBs must work to ensure that there is sufficient provision of care services to meet the needs of their local population. It also includes references to mental health, wellbeing and support for those with palliative care and end-of-life care needs.

Of course, there are many examples of voluntary initiatives, such as grief or bereavement cafés, or the Good Grief community, which aims to support people at the end of their life and their families through a programme of events and courses, and the provision of resources that often include pre-bereavement advice and support.

I know that my hon. Friend the Member for Altrincham and Sale West feels passionately about mental health support for those with palliative care and end-of-life care needs, and that he has been supporting Mike’s campaign for improved mental health services and support. I offer him my deep appreciation, as well as a meeting with the Minister for Care and end-of-life care officials, so that we can engage him around the palliative care and end-of-life care modern service framework that was recently announced, which we hope to publish in the spring.

The Government are also transforming the current mental health system, ensuring that people get access to the right care at the right time in the right place. That is why we are increasing our investment in mental health support by £688 million in cash terms.

The hon. Member for Hinckley and Bosworth (Dr Evans), who spoke for the official Opposition, talked about impact assessments. I gently say to him, in the context of this convivial and constructive debate, that when we came into office we had an impact assessment by virtue of the Darzi review, which highlighted in stark terms the difficulties that the NHS in its totality is under after 14 years—the difficulties that we inherited. I also point out that our real-terms investment of £26 billion is an increase to the NHS budget that will translate into, among many other things, a new national cancer plan. That will examine not only the process of getting the best treatments to patients, but improving communication, improving pathways, and instilling better and more bespoke mental wellbeing support into some of those pathways.

[Dr Evans]

The Minister is indeed right to say that there was an injection of cash, but the proportion of funding being spent on mental health was actually cut. The written ministerial statement is very clear that that proportion went from 8.78% to 8.71%, which the royal college said was about £300 million of investment. Can he confirm from the Dispatch Box—if he cannot, he can write to me later—whether the Government are still committed to the mental health investment standard, or is that commitment going to change? Currently, it is unclear whether they are still committed.

[Dr Ahmed]

The mental health investment standard is something that we expect ICBs to meet. I will gently push back on what the hon. Gentleman is saying because, as we have been so succinctly reminded in this debate, investing in mental wellbeing is about more than just headline figures. For instance, we need psychology in oncology, in children’s health, and in other forms of cancer care. The provision of such services is not always recorded in the way that the hon. Gentleman would wish it to be recorded, but there are still formats and sub-types of mental health support.

The Government are also keen to press ahead with our 10-year plan, and we are setting out ambitious plans to boost mental health support across the country while delivering the shift from hospital to community. As part of that process, we wish to open around 85 mental health emergency departments, reducing pressure on busy A&E services, which are the last places that people with mental health needs should be, and ensuring that people have the right support they need in a calm, compassionate environment.

We will also use new integrated health organisations to break down barriers between services, which I also think is really important in the context of this debate, and to ensure integrated and holistic care, addressing both physical and mental healthcare needs, with more freedom to determine how best to meet the needs of those local populations. That will build on the work that has already begun to bring down waiting lists. As I said, we are investing an extra £688 million this year to transform mental health services. On staffing, I am pleased to say that almost 7,000 extra mental health workers have been recruited since July 2024, against our target of 8,500 by the end of this Parliament.

We are also expanding talking therapies, and we have committed to continuing that expansion over the coming years. More adults already benefit from better access to those therapies, and the aim is for over 900,000 people to complete a course of treatment with improved effectiveness and quality of services by March 2029. Anyone who develops a common mental health condition, such as anxiety or depression, in any context, including terminal illness, can self-refer to talking therapies. [Interruption.]

Oral Answers to Questions

Luke Evans Excerpts

Tuesday 25th November 2025 Commons Chamber

[Wes Streeting]

A clock stop would be in place from the moment the patient saw the consultant. The reason we have had to do waiting list validation is that, in addition to driving waiting lists up, the Conservative party presided over a total shambles where patients were often waiting in duplicate slots on the waiting list, removed from waiting lists unnecessarily or waiting far too long. That is the mess we inherited from the Conservative party.

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

What’s the answer?

[Wes Streeting]

It is no use shadow Ministers heckling from the sidelines. When they had the chance, they drove waiting lists up, and they drove the NHS into the abyss.

--- Later in debate ---

[Mr Speaker]

I call the shadow Minister.

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

When it comes to hospital provision, the Conservatives believe that we should continue to use private providers to improve access and reduce waiting times. We believe the Government should not let spare capacity go to waste on ideological grounds; we should continue to make use of private-sector capacity to treat NHS patients where available. Does the Minister agree?

[Karin Smyth]

I am sure this is leading somewhere else but, broadly, yes, I think I do.

[Dr Evans]

I am pleased to hear that the Minister does, given that it is her current policy. The last time the Government brought in private finance, they brought in the private finance initiative, which brought in £13 billion of investment. The problem was that it cost the taxpayer a whopping £80 billion, and hospitals are still paying decades on. This time around, will the Government give a cast-iron guarantee and complete confidence to the public that this is not Labour’s version of PFI mark 2?

[Karin Smyth]

Yes, I can give the hon. Gentleman that guarantee. The last Government could have learned the lessons of some of the PFI schemes that were very costly and did not run. Why did they not learn those lessons? Why did they not take action to reverse some of the decline? Why did they not take control of the system and do something about it? We have learned the lessons from those schemes, thanks in part to the great work done by parliamentarians on Committees such as the Public Accounts Committee. The new system to build the new neighbourhood health centres, which are fundamental to our drive to shift care out of hospital, will be different and will be publicly owned; they will revert to the public. The schemes are fundamentally different, and I am very happy to talk about it in more detail.