Death Certification Reform: Introduction of Medical Examiners

Maria Caulfield Excerpts

Monday 15th April 2024 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I wish to inform the House that the Government will today lay before Parliament regulations which will reform death certification in England and Wales. Under these reforms all deaths will legally become subject to either a medical examiner’s scrutiny or a coroner’s investigation. The changes coming into force on 9 September 2024 will put all the medical examiner system’s obligations, duties and responsibilities on a statutory footing, and ensure they are recognised by law.

The changes will provide greater transparency on the circumstances surrounding a death. Medical examiners will always offer a conversation to the bereaved, providing an opportunity for them to raise questions or concerns with a senior doctor not involved in the care of the deceased. This will help deter criminal activity, improve practice and ensure the right deaths are referred to coroners for further investigation.

The introduction of medical examiners is part of a broader set of reforms to death certification, coronial and registration processes which will allow for the efficient flow of information between medical practitioners, medical examiners, coroners and registrars in the new system.

This is the most significant set of reforms to death certification in 70 years and we have allowed additional time to prepare for implementation. We are working closely with our partners in government, local registration services, coronial services and the health service to ensure that the appropriate operational processes are in place to deliver these changes in September 2024. There will be further communication regarding legislative changes and operational guidance between now and September 2024.

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Managing Covid-19: Updated Guidance

Maria Caulfield Excerpts

Monday 25th March 2024 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

On 21 February 2022, the Government published the “Covid-19 Response: Living with Covid-19” guidance, which set out a plan to live with covid-19, while protecting people at higher risk of serious illness. In March 2023, the Government announced further changes towards managing covid-19 like other respiratory illnesses. New changes from 1 April 2024 are the next stage in delivering this approach.

The latest changes are an important milestone in our journey to living with covid-19. After several years of dedicated resources and focus, covid-19 is now recognised as an established and ongoing health issue in the UK, and the approach to managing it will now be even further aligned with other established respiratory pathogens. Protecting people at higher risk remains the Government’s priority.

Vaccines for those at higher risk of serious outcomes from covid-19 remain central to the Government’s approach. Last autumn’s covid-19 vaccination campaign saw over 70% of all people aged over 65 years living in England receive a covid-19 booster. In care homes, over 80% of residents received a booster, providing vital protection over the winter months. Today, due to a combination of immunity acquired from natural infection or vaccination, covid-19 is now a relatively mild disease for the vast majority of people.

This spring, a covid-19 vaccine will again be offered to those most at risk of serious illness, in line with advice from the Joint Committee on Vaccination and Immunisation. The NHS will also offer more people access to covid-19 treatments, expanding the eligible cohort from the existing 3.9 million people to an additional 1.4 million people at the highest risk of severe illness.

The continued effectiveness of vaccines and treatments to protect people at high risk means that we can transition to an approach where covid-19 is managed in line with other respiratory illnesses, such as flu. From 1 April 2024, changes will be made to covid-19 testing to align with other respiratory infectious diseases.

Testing from 1 April 2024

While the virus causing covid-19 continues to evolve, new variants have not required a return to large-scale public testing. Given the high levels of vaccination among groups at higher risk, wider access to treatments and the reduced impact of outbreaks, the Government are now able to remove some of the highly targeted testing that remains in place from the height of the pandemic.

From 1 April 2024, routine provision of free covid-19 lateral flow device (LFD) tests for the management of outbreaks in higher risk settings will come to an end in England. However, free testing to determine the cause of an acute respiratory infection outbreak, where deemed appropriate by a local UK Health Security Agency (UKHSA) health protection team, in higher risk settings will remain to test for a wide range of respiratory viruses.

Routine asymptomatic covid-19 LFD testing on discharge from hospital into care or hospice settings will also end to align with the approach for other respiratory illnesses, though NHS trusts will have local discretion to re-introduce this or other forms of testing as clinically appropriate following risk assessment, involving local authority public health teams, UKHSA health protection teams and care providers as necessary in decision making.

Acute health providers should have trusted processes in place with local care home and hospice providers to facilitate safe discharges, as set out in the hospital discharge and community support guidance. Together with the care home or hospice, hospitals should assess the risk in the period before planned discharge, seeking advice on proposed changes to testing arrangements from local authority public health teams or UKHSA health protection teams if needed.

Care providers and hospices will also continue to have the ability to discuss and raise any concerns about discharge arrangements through existing local mechanisms. Where a care provider or hospice is providing services commissioned by a local authority or the NHS and has concerns about a planned discharge that cannot be resolved with the acute hospital provider, this includes the ability to contact the relevant commissioner.

Limited testing, including symptomatic testing of staff working on in-patient wards focused on treating profoundly immuno-compromised individuals, will continue in line with locally derived protocols to protect those most at risk. Symptomatic testing of patient-facing hospice staff who work closely with people who are at high risk from severe outcomes if suffering from covid-19 will also continue as outlined in guidance, in line with similar NHS settings.

The cohort of people eligible for covid-19 treatments can continue to access free covid-19 LFDs from their local pharmacy. These people, who are at highest risk of becoming seriously ill, are encouraged to test in order to gain timely access to treatments. A full list of those who are eligible, and information on how to access tests, is available on the NHS website.

Guidance on a range of infection prevention and control measures in adult social care has now been combined with acute respiratory infection guidance and has been updated to reflect these changes. This guidance, as well as guidance for hospices and other non-clinical settings, has been updated to reflect the latest evidence and expert consensus. It is technical guidance to support settings in operationalising the changes to the services they are directly responsible for from 1 April 2024.

Guidance published on 1 April 2022 for individuals in the community with symptoms of covid-19 or respiratory illness continues to set out the actions we can all take to help reduce the risk of catching covid-19 and passing it on to others.

The future approach to pandemic preparedness

The covid-19 pandemic has highlighted the public health and economic risks posed by pandemics. The Government are continuing to work closely with partners to reduce the impact of a future pandemic. Together, UKHSA and the Department of Health and Social Care are developing plans to prevent and/or respond efficiently and effectively in the event of a pandemic.

These plans will build on learning from covid-19, and the findings of the covid-19 inquiry, once published. The exact nature of a future pandemic may vary, and so preparedness is considering all modes of transmission and tackling “Disease X” in readiness for unknown future threats.

The Government have already taken steps to prepare and develop capacity to respond, including through the Moderna-UK strategic partnership and the Vaccines Development and Evaluation Centre. Through UKHSA, we retain strong surveillance systems, world-leading genomic sequencing capabilities, and stronger baseline data and analysis functions that will help detect and characterise pandemic threats.

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Kettering General Hospital: Redevelopment

Maria Caulfield Excerpts

Friday 22nd March 2024 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I congratulate my hon. Friend the Member for Kettering (Mr Hollobone) on securing this important debate. He tirelessly campaigns for Kettering, particularly for the new hospital there, and firmly holds Ministers’ feet to the fire on this issue.

I reassure my hon. Friend that the Government remain absolutely committed to a new hospital for Kettering, and that a number of milestones are being met. As he pointed out, the trust is currently developing its refreshed strategic outline business case, supported by the new hospital programme team, to make sure that it aligns with our national approach of standardising all our new hospitals to the Hospital 2.0 model. We expect a submission to the Department for the wider hospital work later this year.

[Mr Hollobone]

I thank the Minister for the start of her response, which has been very constructive. I support the Hospital 2.0 programme and its standardised design of the 40 new hospitals—that is great. Kettering General Hospital has already submitted its first two business cases for the main scheme. Instead of having to resubmit them all over again, please could it simply submit an addendum, so that it does not have to reinvent the wheel?

[Maria Caulfield]

I absolutely take my hon. Friend’s point, particularly given the issue he raised about RAAC being discovered on the maternity and gynae floors. I will take that point to the Hospitals Minister in the other place and the team, and I will put in his request to meet the Minister to discuss this. I understand the frustration that comes when some work has been done already, and that it takes time for the trust, which urgently wants to get on and construct the new hospital. I will certainly take that away after the debate.

I reassure my hon. Friend, his constituents, the patients who use Kettering General Hospital and the staff who work there that the new hospital will be in place as soon as possible and will meet the 2030 deadline. I recognise the urgency. As part of the works, the energy centre is crucial to the development of the wider hospital scheme. We heard very eloquently from my hon. Friend this afternoon—he has also explained this to me and other Ministers—that this is not just a crucial part of the new hospital plans, but that the current system was only ever meant to be a temporary measure; he described how fragile it is, so I recognise the urgency of starting work on the new energy centre.

My hon. Friend will know that early works have commenced on site. Ground clearance and site surveys are under way to prepare for the cabling that is needed to provide the energy centre’s power once it is completed. Hoardings will shortly go up to allow more extensive works to start on site. I can reassure my hon. Friend that his constituents will start to see progress on that very shortly. The trust has made progress, recently reaching a new connection agreement with National Grid and agreeing the reserve capacity needed for the energy centre. That is a vital step in securing the new hospital’s energy requirements for the future and in dealing with the imminent problem of the temporary energy facility that is keeping the hospital going.

The final piece of the jigsaw to get the construction of the energy centre under way is the full business case that the trust needs to submit. I can reassure my hon. Friend that that we are working with the new hospital programme team on this. We expect the case to be submitted in June. The Hospitals Minister has committed that, subject to it meeting the cost threshold and certain criteria, we can estimate a turnaround time for approval of two weeks, so hopefully we will start to see the construction of the energy centre this summer. I hope that gives my hon. Friend and his constituents reassurance.

[Mr Hollobone]

I thank the Minister for her reassurance. The purpose of these debates is to put pressure on the Government—that is the way Parliament works—but would she join me in applying gentle pressure on the trust? The sooner it can get the full business case in, the sooner the thing can be approved and the funds can start to flow.

[Maria Caulfield]

Absolutely. I have spoken to the Hospitals Minister on the specific issue of Kettering, and he is in agreement; if the trust can keep us updated with the timeline and let Ministers know as soon as it submits the business case, he has given the commitment to try to turn it around within a couple of weeks. I would gently say to the trust that it is in its interest to get the case to us as soon as possible.

[Mr Hollobone]

I thank both my hon. Friend and the Hospitals Minister for their involvement. It is right, is it not, that this two-week turnaround is a novel feature of the new hospital programme? It is a groundbreaking approval process that will turn the application round that quickly. Where Kettering leads, others surely will follow.

[Maria Caulfield]

Absolutely. I take hon. and right hon. Members’ feedback about their frustration at how clearing the red tape in this process sometimes takes longer than the construction. My hon. Friend is right: this will be a novel way forward and could open the door for other trusts that are proactive in securing approval for their business cases in a more timely manner.

In addition to the energy centre, the Government are releasing funds to support the trust overall for the new hospital that we wish to build at Kettering, both for the development of the business case more widely and for some early critical works to prepare the site for main construction. By the end of this financial year—which is early next week—the scheme will have received over £5 million in development funding. That includes the release of over £1.9 million in fees to support with the design, planning permission and a business case for a new multi-storey car park. Further funding has also been released to support the development of business cases for the reprovision of accommodation, which will be needed during construction, the data centre and construction area and access roads, which will also be required.

I hope I have reassured my hon. Friend that we are doing extra work, in addition to the energy centre. We expect to receive the full business case and submissions over the course of this year. Again, we urge the trust to be as swift as it can with that, so that we can make some assessments and decisions as quickly as possible. Of course we will keep my hon. Friend updated as the scheme progresses and as further funding is released to the project, because we want to stay on track to complete the main construction of the new hospital by 2030.

In the short time I have, I want to update the House on the wider hospitals programme, because I know that hon. Members are often interested in the progress we are making. I am pleased to say that four of our new hospitals are now open to patients: the Northern Centre for Cancer Care in Newcastle, the Royal Liverpool Hospital, the Louisa Martindale, also known as the 3Ts hospital, in Brighton, and the Northgate and Ferndene Hospitals in Northumberland. A further four hospitals are expected to be open by the end of the next financial year: Salford Royal major trauma centre, the Dyson cancer centre in Bath, the national rehabilitation centre in Loughborough, and the Midland Metropolitan University Hospital. A further 18 hospitals are in construction or well under way towards completion. We also have other capital programmes, including over 100 rapid diagnostic centres that are open, 100 new surgical hubs that are either open or in construction, and 160 mental health crisis centres—all capital projects that will transform healthcare up and down England.

In conclusion, I again thank my hon. Friend the Member for Kettering. He has raised this issue, quite rightly, to hold our feet to the fire. He is fighting tooth and nail for his constituents to get the new hospital up and running by 2030. The energy centre will be the first major part of that construction. If the trust can get us the business case by June, the Hospitals Minister has committed to try to turn that round within a couple of weeks. That will be the start of the wider programme for the new hospital at Kettering. We will absolutely keep my hon. Friend updated, and the new hospital programme team will continue to do all it can to meet the challenges of delivering such a large infrastructure project, to ensure that staff and patients have world-class facilities in Kettering.

Question put and agreed to.

Down Syndrome Act 2022: Progress on Implementation

Maria Caulfield Excerpts

Thursday 21st March 2024 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

Today, on World Down Syndrome Day, I am pleased to provide an update on the Government progress on implementation of the Down Syndrome Act 2022. The Act seeks to improve life outcomes for people with Down syndrome and imposes a duty on the Secretary of State for Health and Social Care to give guidance to relevant authorities about how to meet their needs.

On 18 March 2024, we formally commenced the Down Syndrome Act 2022 by way of regulations, which bring into force all the provisions of the Act and is a necessary step towards the publication of guidance. This progress follows over 1,500 responses to our call for evidence from people with Down syndrome, their families and carers, professionals, and organisations, and we will be publishing our summary of these findings shortly. We have created easy-read and accessible content to ensure everyone can fully engage and be a part of the process to develop the statutory guidance.

This year’s global World Down Syndrome Day theme is to “End the stereotypes”. Working with people with personal experience, voluntary sector organisations and other experts to develop the guidance has brought a wealth of information to better understand the needs of people with Down syndrome and how we can address those needs. By raising awareness and understanding of the needs of people with Down syndrome, we can help to ensure every person with Down syndrome has the opportunity to live full and fulfilling lives.

Engagement with people, professionals and organisations representing different genetic conditions has been an important consideration in developing the guidance, particularly identifying where tailored services and support for people with Down syndrome would benefit those with similar needs. We have also worked closely with the Department of Education on adding a question in relation to Down syndrome to the school census to provide helpful information to support implementation of the Act and facilitate better planning for local authorities.

I would like to thank all those people with personal experience, national and local charities, integrated care board leads for Down syndrome and others that have fed in their views and informed our work to develop the guidance. I am grateful to my right hon. Friend for North Somerset (Sir Liam Fox MP) for introducing his private Members’ Bill which is now the Down Syndrome Act, and to hon. Members for their continued support for this work.

We look forward to issuing the draft statutory guidance for public consultation later this year.

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Mental Health: Government Responses to Reports

Maria Caulfield Excerpts

Thursday 21st March 2024 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

Today the Government have laid before Parliament their response to the Joint Committee on the Draft Mental Health Bill.

The Government would like to thank the Joint Committee on the Draft Mental Health Bill, its Chair Baroness Buscombe, its members from both Houses, and staff, for its careful and considered work scrutinising the draft Bill. We are also grateful to all the stakeholders who gave or provided oral or written evidence, and many experts by experience and members of the public who have so generously given their time.

We have carefully considered the Joint Committee’s report and the Government response addresses each of the Committee’s recommendations in turn. We welcome the Committee’s support for the draft Bill and will consider some amendments to the draft Bill, as well as further steps that can be taken without the need for primary legislation, in response to the Committee’s recommendations.

It remains our intention to bring forward a Mental Health Bill when parliamentary time allows, and the Government continue to take forward non-legislative commitments to improve the care and treatment of people detained under the Act.

We are continuing to pilot models of culturally appropriate advocacy, investing up to £1.5 million to provide tailored support to hundreds of people from ethnic minorities to better understand their rights when they are detained under the Mental Health Act.

NHS England has also launched the patient and carer race equality framework, for all NHS mental health trusts to embed across England. This mandatory framework will support trusts and providers to work with their local communities, patients and carers to agree and implement concrete actions to reduce racial inequalities within their services.

Today I am also announcing the publication of our Government response to the rapid review into data on mental health inpatient settings.

On 23 January 2023, the Government launched a “rapid review” into mental health patient safety, chaired by an independent expert, Dr Geraldine Strathdee.

This review was commissioned in response to significant concerns about the treatment and safety of patients at a number of mental health inpatient settings. It considered how data and information can provide early alerts and be improved to identify risks in order to prevent patient safety incidents and support efforts to improve care in mental health inpatient settings. The review’s report and recommendations were published on 28 June 2023. I would like to thank Dr Geraldine Strathdee for her extensive work and valuable contribution in leading the review.

We have carefully considered the recommendations and have today published the Government response to the report, setting out how we are taking forward each recommendation. There has already been good progress towards implementation of a number of the recommendations and I have established a steering group, co-chaired with an external expert Professor Sir Louis Appleby, to work with healthcare system partners to take forward the key deliverables for each recommendation. We intend to provide an update on progress by July 2024.

The Government response to the review has been published on gov.uk.

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Clinical Indemnities Reform

Maria Caulfield Excerpts

Thursday 7th March 2024 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

In December 2022, I reported on the steps we are taking to respond to the findings of the inquiry into the issues raised by disgraced surgeon, Ian Paterson. Today, I am reporting further progress on recommendation 10 of the inquiry report, which identified shortcomings in the clinical negligence cover system.

Clinical negligence cover is the system that enables patients to receive compensation if they are harmed during treatment through the cover held by regulated healthcare professionals such as doctors, nurses and dentists. The inquiry highlighted that Paterson’s private patients were unable to access compensation for the harm caused by his actions due to gaps in clinical negligence cover in the independent sector. These gaps do not occur in the NHS where cover is via a state scheme.

The Government’s implementation update on the inquiry’s recommendations included proposed policy options for recommendation 10. One of the policy options was to make the system more transparent through safeguards, such as the introduction of a code of practice for medical defence organisations which provide a particular type of clinical negligence cover called discretionary indemnity that many healthcare professionals purchase. Unlike regulated insurance, where terms and conditions are set out contractually, discretionary indemnity allows for discretion to be applied to accept or refuse claims.

Following engagement with patients and the wider sector last year, I am pleased that medical defence organisations propose to implement a sector-led code of practice by end of 2024. The aim of this code is to provide greater transparency around this system of discretionary indemnity.

For example, there will be more information on how decisions are made to assist healthcare professionals to pay patients compensation. The code will include an escalation procedure with an independent review of disputed claims assistance decisions. Importantly, the code will now offer healthcare professionals information on the basis of any decisions to decline claims.

We welcome the code as a meaningful step forward. The Department of Health and Social Care will evaluate its implementation, including the long-term impact on patients and healthcare professionals, to determine whether further intervention is required. I will provide an update on further steps to reform the clinical negligence cover system, such as addressing cover for criminal acts or when a healthcare professional has otherwise worked outside the terms of their cover, in due course.

Alongside this update, the report on a survey that the Government commissioned IFF Research to carry out into healthcare professionals’ clinical indemnity arrangements will also be published. A copy of the report will be placed in the Library of both Houses.

[HCWS318]

Suicide Prevention Grant Fund

Maria Caulfield Excerpts

Monday 4th March 2024 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

On 25 August 2023, my Department launched a £10 million suicide prevention grant fund to support voluntary, community and social enterprise organisations in delivering suicide prevention activity in England.

I am pleased to today confirm the 79 successful organisations which have been awarded funding from the scheme. I would like to put on the record my thanks to all those organisations that applied, and for all the suicide prevention activity that is delivered on a daily basis, up and down the country.

The list of provisional awardees was published today at https://www.gov.uk/government/publications/suicide-prevention-grant-fund-2023-to-2025 and can be found below.

The commitment is part of this Government’s plan to make health and care services faster, simpler and fairer.

I look forward to seeing the important and innovative activities that will follow as a result of this funding, in some of the most at-risk regions in England and to the groups who most need it. This is an important milestone in delivering the new “Suicide prevention strategy for England: 2023 to 2028” which we published in September 2023 and can be found at https://www.gov.uk/government/publications/suicide-prevention-strategy-for-england-2023-to-2028/suicide-prevention-in-england-5-year-cross-sector-strategy

The voluntary, community and social enterprise sector plays a critical role in providing support to people experiencing suicidal thoughts or approaching a mental health crisis, as well as intervening early to prevent people reaching these points. Ultimately, their work saves countless lives and this grant will help ensure that they can keep doing that.

This grant builds on the record sums of money this Government have invested to transform and expand NHS mental health services as well as the successes of a previous grant fund of £5.4 million in 2021-22. That fund supported over 100 voluntary, community and social enterprise organisations, with overwhelmingly positive results, including helping to address demand after the covid-19 pandemic, improving access to services for people in need, and helping identify those in need, quicker.

Conversion Practices (Prohibition) Bill

Maria Caulfield Excerpts

2nd reading
Friday 1st March 2024 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I congratulate the hon. Member for Brighton, Kemptown (Lloyd Russell-Moyle) on bringing forward this Bill on such an important issue in an area where the Government are keen to make progress.

First and foremost, let me be clear that so-called conversion therapy practices are dangerous and abhorrent and any new legislation in this area must seek to identify those practices as a particular threat to the LGBT community and confirm the illegality of harmful processes intended to change someone’s sexuality. The Government remain committed to an approach that protects everyone from harmful conversion practices, including the transgender community.

LGBT people should be free to live their lives without threat or fear for simply being who they are. Lesbian, gay, bisexual and transgender people are valued and important members of society and harmful conversion practices are inherently wrong and have no place in this country, first because they are abhorrent and, secondly, because they simply do not work. On this, we find strong and welcome agreement across the House and I am pleased that we have been able to have a balanced debate with differing views in all parts of the House. It is important that we lead by example in this place, because there is a wider debate across the country and we have to show that we can debate these sensitive issues in a responsible way.

However, the Government position is that unfortunately this Bill carries a lack of legislative clarity which risks unintended consequences, and the Government are well aware of the complexity of this issue from our own extensive work. I am sure the hon. Member for Brighton, Kemptown will not mind my saying that there have been honest meetings with Ministers and challenges have been discussed, and it is clear that he has wrestled with challenges in his Bill which has gone through various iterations. The Bill as it stands is a genuine attempt to overcome these challenges, but its clauses raise considerable concerns and I will come on to them in detail shortly.

The Government have rightly taken time to carefully consider our own position on these pitfalls and will be publishing a draft Bill on this topic for pre-legislative scrutiny—[Interruption.] I am coming on to that. We expect publication to be after the publication of the Cass review, which will be in the coming weeks.

[Elliot Colburn]

As we have heard throughout the debate, Dr Hilary Cass has said that there is no reason to delay a Bill on conversion therapy; she has said multiple times that there is no reason to await the Cass review to move forward. None of the promises made to bring forward a Bill ever mentioned the Cass review previously. It feels like there are more excuses about why we need to delay this. When was a decision made to now wait for the Cass review, because that is news to many of us?

[Maria Caulfield]

I welcome that valid intervention. I direct my hon. Friend to the Cass website, which says in frequently asked questions:

“The Cass Review was commissioned as an independent review of NHS gender identity services for children and young people. Its terms of reference do not include consideration of the proposed legislation to ban conversion therapy.”

However—[Interruption.] If I may finish, it also says:

“No LGBTQ+ group should be subjected to conversion therapy. However, through its work with clinical professionals, the Review recognises that the drafting of any legislation will be of paramount importance in building the confidence of clinicians working in this area.”

So the review has found evidence that may influence our conversion practices Bill, which is why we are waiting for the report.

[Dame Angela Eagle (Wallasey) (Lab)]

Does the Minister accept that if the Bill were to get a Second Reading, any of the Government’s worries about the current wording could be resolved in Committee? Those concerns are not a reason not to give the Bill a Second Reading today.

[Maria Caulfield]

The hon. Member for Brighton, Kemptown has made that argument as well, but we feel it is important to get the details right at the start of the legislative process rather than towards the end.

[Sir William Cash]

Would the Minister be good enough to give some indication of what such a draft pre-legislative Bill would look like? The arguments presented from our side of the equation demonstrate manifestly that it would be impossible for the Bill to overcome its difficulties in relation to criminal law and the like in Committee.

[Maria Caulfield]

I take my hon. Friend’s point. That is why the Government propose to publish our Bill and take it through pre-legislative scrutiny in both Houses before it follows the normal processes in Committee. We will be able to shape the legislation in a way that deals with many of the concerns that have been raised today.

As the House is well aware, this policy area is complex and nuanced. It is clear from today’s discussion that colleagues are listening and thinking carefully about the challenges the Government have encountered in preparing legislation in this space, notably ensuring that legislation is clear, balanced and respects freedom of speech, belief and religion, and does not cause unintended consequences for parents, clinicians, teachers or religious groups.

[Sir Liam Fox (North Somerset) (Con)]

Both sides have talked about the harm caused by many of the practices we have discussed, yet there is nothing in the Bill stating that intent to harm should be a prelude to any prosecution. Does my hon. Friend accept that if that were to be put into the Bill, it would remove many of the fears about the net being cast so widely that those who unwittingly cause offence might face such measures?

[Maria Caulfield]

My right hon. Friend makes a valid point. Some of the fears are about the unintended consequences of this legislation, and I am sure that amendments to the Bill would allay some of those fears. As it stands, although the hon. Member for Brighton, Kemptown has made tremendous efforts to address some of the issues, the level of care and attention required to legislate responsibly means that we need to look at the subject from a wider perspective.

[Peter Gibson]

We have had so many promises from the Government about bringing this legislation forward—it has appeared in two Queen’s Speeches. We were promised the legislation in January 2023, but it is now 1 March 2024. If the Government want the House to debate their legislation, will the Minister publish it so that we can discuss it?

[Maria Caulfield]

My hon. Friend is right. I have not spoken from the Dispatch Box before about this particular subject, but my colleagues the Minister for Equalities and the Minister for Women and Equalities have been focused on trying to overcome some of the concerns raised today that could stop any legislation, whether it is this Bill or the Government’s Bill, getting through both Houses. Time has been taken to address those concerns so that we can come together to legislate against conversion practices.

[Dawn Butler]

For clarification, is the Minister implying that every time there is a new Minister we start again from day one? Is she able to give a timeframe for the Government Bill—by May, June or July?

[Maria Caulfield]

As a Government we speak together, but I am just expressing my frustration on behalf of colleagues. I acknowledge that this has taken a long time, and I want to explain why. I tried to indicate earlier that we are expecting the Cass review in the coming weeks, and we aim to publish the Bill for pre-legislative scrutiny very soon after that.

Let me come to the Government’s concerns about this Bill and address some of the issues raised. We have concerns about four areas: the proposed definition of conversion practices, the inclusion of the term “suppression”, the proposed parental exemption and the territorial extent of the provisions. I will take those in turn.

First, we are concerned that the definition of conversion practices in clause 1 is simply too broad. A conversion practice is outlined as a

“course of conduct or activity”.

Even with the provisos that an act must be repeated and underpinned by a predetermined outcome in order to be in scope, that remains a very broadly drawn offence that lacks legislative clarity. The hon. Member for Brighton, Kemptown has produced explicit exemptions in clause 1(2) to clarify that certain actions are out of scope, but the Government are concerned that those exemptions are insufficient and there remains a risk that some reasonable behaviour would be caught.

[Lloyd Russell-Moyle]

I do not want to delay the Minister, because we want to get on with this now. She will acknowledge that I twice presented these clauses to the Government. Twice the Government came to me and said, “We will get amendments to you within a week.” I agreed that I would accept any Government amendment. Twice the Government came back saying, “No, we don’t have any amendments yet for you because we can’t find anything that we’ve signed off.” I worry a bit about bad faith, and I hope that if we accepted the amendments that she is proposing, she would be supportive, rather than produce just another list of questions.

[Maria Caulfield]

I take on board the hon. Member’s point, but the final Bill was published only this week. I take on board his point about future amendments should the Bill get to Committee. I appreciate that he intends his Bill to be a framework into which exemptions can be built, but when creating a broad new criminal offence that could be altered in future by powers, we believe that robust protections and scrutiny must come at the beginning of the legislative process, not the end.

Secondly, the risk is further heightened by the inclusion of “suppression” within the scope of the offences under clause 1(2). For example, if a religious leader supports an individual who wants to manage their same-sex attraction in order to align with their individual religious belief, where the individual consensually seeks out religious counselling, this Bill would still criminalise that support. That is just one tiny example of what we mean.

Despite the hon. Gentleman’s best efforts to the contrary, the Bill risks creating a chilling effect on clinicians—we have heard some of those concerns today—by positioning healthcare regulation within the context of criminal law. The impact on healthcare professionals may well be the single biggest challenge within legislation in this area. That is part of the reason why we consider pre-legislative scrutiny from the breadth of medical experience available across Parliament in both Houses to be so critical. As I said in response to my hon. Friend the Member for Carshalton and Wallington (Elliot Colburn), that concern is cited by the independent Cass review, the final report of which is expected in the next few weeks.

Our third concern is about the Bill’s attempt to exempt parental behaviour in clause 1(2). The Government are clear that parents should be able to have exploratory and even challenging conversations with their children, and it would be absolutely wrong to criminalise them.

[Nick Fletcher]

I thank the Minister for the help she has given me recently with regard to the issues facing men and boys, which is a subject close to my heart. I am equally supportive of women and girls. Does she agree that this Bill—or any Bill that criminalises free speech—will have a huge effect on women and girls across this country? We will get to a point where parents will be unable to say to their sweet little girl who comes home from school, having seen the abhorrent material in relationships, sex and health education, “No, you’re not a boy; you’re a lovely little girl, and you’re going to grow up to be a lovely little girl.” Does she also agree that the Bill will put biological males in single-sex spaces, which again is abhorrent, and take away podium places from girls?

[Mr Deputy Speaker (Mr Nigel Evans)]

Order. Interventions should be short.

[Maria Caulfield]

The point I was making is that parents have a right and that we, when legislating in this area, must be careful to ensure that we do not criminalise legitimate conversations in the family setting. Sadly, we have seen cases—for example, those involving female genital mutilation—where a lack of parental responsibility has led to the abuse of children. We are concerned that, by not covering that in this Bill, there is potential for conversion practices, which could be abusive, to continue.

[Alicia Kearns]

I am slightly confused, because the Government are saying that this Bill protects parents too much, but those speaking against it are saying that it will criminalise parents. I am not sure where we will go, but I presume that Government lawyers know slightly more than those who are opposing the Bill from the Back Benches.

[Maria Caulfield]

That is the point I am making: this is a sensitive area, where there are arguments both for and against on all sides. We absolutely believe in parents’ legitimate right and freedom to bring up their children in any way they see fit, but we have to be careful about that tipping into abuse. We have seen that happen, for example with FGM.

Our final concern is about the territorial extent of the Bill. Clause 5 says that it will apply to the entire United Kingdom, which poses issues because, as the hon. Member for Brighton, Kemptown knows, justice is a devolved matter in Northern Ireland and Scotland. Indeed, as many Members here today will be aware, the Scottish Government are currently consulting on their own legislative approach to banning conversion practices. The requirement for the Director of Public Prosecutions to approve any prosecution is at odds with the Bill’s territorial extent, which I would say wrongly covers Scotland and Northern Ireland. The Crown Prosecution Service operates in England and Wales only, because Scotland and Northern Ireland have their own criminal justice systems, which means that the requirement to have CPS approval would not apply there. A separate provision creates equivalent requirements for the Northern Ireland equivalent of the CPS, but there is no explicit provision for its Scottish counterpart. Those are the four main areas where we have issues with the Bill.

[Lloyd Russell-Moyle]

First, the Minister has to recognise that the Bill will be brought into force in Scotland or Northern Ireland only if there is the consent of the legislators and Ministers in those two places. Secondly, the argument she has just given is legally incorrect, because in Scotland there is already a requirement for the Crown Office and Procurator Fiscal Service to give authorisation for private prosecutions. That is why it is not needed in the law. I would have thought that Government lawyers had told her that in the briefing. It is disappointing that they do not seem to know the law.

--- Later in debate ---

[Maria Caulfield]

I am sorry that the hon. Gentleman feels that way, but we have to be clear about the territorial extent of the Bill. We have concerns about that, because the Bill should relate only to England and Wales, but it does not.

[Miriam Cates]

The Minister has made an important point about the problems with the requirement for DPP permission, but is there not an even more significant problem with that? Although it seems like a safeguard, in reality—looking at the CPS website—all that means is that a Crown prosecutor has to give permission. Any Crown prosecutor—even an activist Crown prosecutor—could agree to such a prosecution and thus create case law that criminalises parents in future.

[Maria Caulfield]

We have set out our four concerns, which include the territorial extent of the Bill.

I have set out why the Government will not support the Bill today. I want the hon. Member for Brighton, Kemptown to know that I am really grateful for the work he has done in this space, and I hope that we can continue to work together on this issue, particularly on the legislation. Today’s debate has further highlighted the need for careful consideration before legislation is passed, so that unintended consequences can be avoided. It has also demonstrated the importance of taking action that is balanced and measured in order to protect those at most risk of harm, but also to protect the freedoms and rights of everyone. That is the kind of balance that can be achieved only with bespoke legislation, and although we absolutely pay tribute to the hon. Gentleman, we will not support this Bill.

[Several hon. Members rose—]

International Women’s Day: Language in Politics

Maria Caulfield Excerpts

Thursday 29th February 2024 Commons Chamber

[The Minister for Women (Maria Caulfield)]

I start by thanking my right hon. Friend the Member for Basingstoke (Dame Maria Miller) for securing this important debate, and all hon. Members for their contributions. The use of language, particularly in politics, is such an important topic. Members have shared very personal experiences, including the hon. Member for Pontypridd (Alex Davies-Jones), my right hon. Friend the Member for Aldridge-Brownhills (Wendy Morton), the hon. Member for Newport West (Ruth Jones), and the hon. Member for Swansea East (Carolyn Harris), who has been criticised for her hair colouring. My criticism is that my hair looks like it was borrowed from my hon. Friend the Member for Lichfield (Michael Fabricant), so I share her frustration at that abuse.

Why does this abuse matter? My right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) put it very eloquently: it stops women from speaking freely, not just women in this place but women in our communities. At the moment, we have very toxic debates around issues such as biological sex, with people losing their jobs and facing prosecution just for wanting to have an honest debate. I am pleased that Members on all sides of the House have said this afternoon that it is important to have a sophisticated level of debate on very sensitive issues, but also about the general level of abuse that women face up and down this country. As the hon. Member for Bath (Wera Hobhouse) said, what is classed as banter by some people is very much abuse for others.

The hon. Member for Brent Central (Dawn Butler) always campaigns very hard on the issue of how abuse of women is reported in the media. We have met to discuss this, and I am frustrated that progress has been slow. I can assure her that I have met ministerial colleagues, but also the Domestic Abuse Commissioner, and I will follow up after this debate. It is really important that when women are murdered in our communities, it is not reported as a crime of passion. It has to be reported as it is: it is murder and abuse. That language makes a difference to how those crimes are then treated.

It is true—this was the focus of what my right hon. Friend the Member for Basingstoke set out—that the situation has an effect on our democratic accountability and who stands for election. We want more women, and more women from the real world, standing for election. However, the Fawcett Society found that 93% of women MPs said that online abuse or harassment has had a negative effect on how they act as Members of Parliament. It stops talented women coming forward for all parties, and we are losing good hon. Members. My hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) is one example of a woman leaving this place. We heard earlier in this parliamentary term from Rosie Cooper that the reason she stood down early was the abuse and threats she received. We have lost good Members such as her, which is very sad for Parliament.

We are potentially in an election year, so it is as important as ever that our language is measured—in this place, and in our political parties. Every single political party can play a role, and nobody standing for election should suffer intimidation for holding or aspiring to hold elective office. We have introduced measures to try to make the experience fairer. Since 2022, anyone who intimidates a candidate, campaigner or elected representative can be barred from elective office for five years. It is great that we are passing legislation like that in this place, but it needs to be enforced, because abuse is too often seen as something that just goes with the job. No one—not my hon. Friend the Member for Finchley and Golders Green (Mike Freer), nor my right hon. Friend the Member for Bournemouth East (Mr Ellwood)—should have their office burned or people protesting outside their home simply for representing their constituents.

The debate reflects the wider debate in society about violence against women and girls. Sadly, the hon. Member for Birmingham, Yardley (Jess Phillips), had to read out her list again this year, and one of the women she mentioned was my constituent Chloe Bashford, who was murdered in horrific circumstances in Newhaven. The hon. Member for Vauxhall (Florence Eshalomi) commented on two tragic deaths in her constituency of women who were also on that list. We have made significant progress, having published the tackling violence against women and girls strategy and the tackling domestic abuse plan, but that is not going fast enough. We all have a role to play, not just the Government; it is the role of all agencies, from the police to the courts, to absolutely make sure that femicide is taken seriously and dealt with when people come forward to give evidence and share their stories.

Our Domestic Abuse Act became law in 2021. That legislation is making a difference. Abusers are no longer allowed to directly cross-examine their victims in the family and civil courts, and victims have better access to special measures in courtrooms. However, conviction rates are still too low. We also supported the Protection from Sex-based Harassment in Public Act 2023, and the hon. Member for Bath brought in the Worker Protection (Amendment of Equality Act 2010) Act 2023, which addresses harassment in the workplace. That is for everyone, but we know that women are affected by that in more ways than most.

The final piece I want to address is the role of the media, given the upcoming election. It is really important that debates and votes in this place are reflected fairly. One example is the sewage vote, which was an attempt to end the use of sewage outflows in this country. We Conservative Members voted to dismantle our sewage system and have a long-term plan to end sewage discharges, but that was often portrayed in the media as voting against stopping any restrictions on sewage, which has resulted in multiple death threats and abuse for Conservative Members. When journalists ask why MPs are abused so much, I would say that journalists’ language, and the way that they portray what happens in this place, is as important.

[Caroline Nokes]

I will not get the Minister to say this, but I will say it for her. Can we also look at those who write Commons sketches? I am particularly thinking of Quentin Letts, who is a bit prone to going after people like me for being too pony club posh, and my hon. Friend the Member for Gosport (Dame Caroline Dinenage) for having pink nail varnish. The list is endless, and it is never about what we say, but about what we look like.

[Maria Caulfield]

Absolutely. We need to remind each other that we all have a role to play—not just MPs but wider society. The fundamental issue is that if female MPs are being targeted and harassed, that will be reflected for women up and down this country; if it is seen as okay to target elected representatives for what they look like or what they say or how they vote, that will be reflected in wider society. There is a democratic system in this country: if people are not happy with who represents them, they go to the ballot box and they decide. What is not acceptable is for Members of Parliament, local councillors, police and crime commissioners, Members of the Senedd, the Scottish Parliament, the Northern Ireland Assembly and others, even down to school governors, who are taking difficult decisions, which would have been taken long before if they were easy, to be intimidated in how they vote. If that is tolerated, violence against women and girls will be tolerated, perpetuated and accepted too.

I thank everyone for such a positive debate. We have got to speak up, we have got to stand up and we have got to take part and not let the haters win.

Children and Young People: Mental Health Support

Maria Caulfield Excerpts

Tuesday 27th February 2024 Written Statements

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I wish to inform the House that the Government have provided additional funding so that 24 early support hubs across England are able to help children and young people receive quicker mental health support.



The Government are taking the long-term decisions needed to make our healthcare system faster, simpler and fairer. Mental health support for our young people is a key part of that.



We announced in October 2023 that £4.92 million from HM Treasury’s shared outcomes fund would be available to support hubs and an evaluation to build the evidence base underpinning these services.



Following evaluation of excellent commercial tenders from hubs across the country, I am very pleased to be able to let you know that the Government are now providing an additional £3 million, meaning a total of 24 hubs will receive a share of almost £8 million in 2024-25. This is more than double our original target of funding 10 hubs, and organisations across the length of England—from Gateshead to Truro—will now benefit.



This investment in frontline services means that thousands of children and young people will receive earlier, open-access mental health interventions in local communities.



Crucially, alongside boosting 24 hubs, the funding will also enable us to evaluate the impact of the services and inform any potential expansion of the model in the future. The evaluation aims to report its findings by summer 2025.



As this new investment shows, we want to intervene earlier to prevent children and young people from developing severe or enduring mental health conditions. That is why we are also continuing at pace with the roll-out of mental health support teams to schools and colleges in England. There are currently around 400 mental health support teams in place across England, covering over 3 million children or around 35% of pupils in schools and colleges, and we are extending coverage to at least 50% of pupils in England by the end of March 2025.



I know that we still have a long way to go to ensure that all young people struggling with their mental health get the support they need at the right time, but today’s new investment is a positive step to support children and young people’s mental health, and one that should be celebrated.