Mental Health Bill [Lords]

Ben Spencer Excerpts

2nd reading
Monday 19th May 2025 Commons Chamber

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

I rise to speak in support of the Bill. To begin with, I need to make a couple of declarations. I have a family member who is a consultant psychiatrist. I am now a non-practising general adult psychiatrist with an endorsement and years in psychiatry, and I previously worked as a consultant psychiatrist. I took part in the 2018 Wessely review as a panel member on the tribunal working group, and I was on the pre-legislative scrutiny Committee in the last Parliament.

In a declaration of a more personal nature, this is an area that I feel passionately about. It is a great privilege to speak to this important piece of legislation and reforms going forward. The United Kingdom reforms its mental health legislation every 20 years or so. I did not want to correct the Secretary of State, but the first Mental Health Act was in 1959—I hope that was substantially before he was born, with reference to his earlier comments. The legislation has gone through various iterations from the original Lunacy Act and similar legislation in the 19th century. In the UK, we have always been at the forefront of reform to the law and to provisions and powers in this area.

It is important in this Second Reading debate to focus on what the Mental Health Act is and what it does. Members have talked more broadly about the challenges of delivering mental health care currently, but it is important to reflect that the Mental Health Act is very specific and precise. It is about the regulation of detention—sometimes for assessment, sometimes for treatment—of people with mental disorder, and has a range of powers on aftercare and guardianship. It is focused on detention and assessment, or treatment, of people with mental disorder. We need that because there are times when people with severe mental illness become so unwell that they are unable to recognise their illness. Their illness puts their health at risk—predominantly through self-neglect or non-treatment. It puts their safety at risk, again through self-neglect, as well as through suicide. And, less commonly but critically, it puts them at risk of causing harm to others.

The legal framework allows us to regulate compulsory treatment in that regard. It is absolutely critical that we have those powers so that, when people are so unwell that they do not recognise it and they lose agency, we can, as a compassionate society, take them into hospital and treat them, with a view to getting them back to themselves. I have used the 1983 Act countless times, applying it both to assessments and, as a section 12-approved doctor, to treatments, and I have used it as a responsible clinician. I suspect that I am one of the few Members of this House—certainly in this debate—who has had those roles and responsibilities.

In terms of framing, it is important to reflect that one of the key changes in the 1983 Act, which is such an important piece of legislation, was that it was about restricting powers and ensuring that there were strong procedures for reviewing detentions. As a former health professional in this area, I am certain that all professionals working in it are mindful of the scope of powers that the Act provides. When applying restrictions, people do not use these powers in anger or without a great degree of thought and contemplation. The most intrusive intervention available to us in the health service is to detain and treat people in hospital or in secure hospital settings. Those powers are not taken lightly.

A lot of concern was expressed at the start of the debate—and I am sure it will continue—about the way in which people have been treated in hospital. There have been some very high-profile scandals in which things have not worked well, to say the least, and care and treatment have been atrocious and abusive. However, people working in health and care in the UK are doing so because they want to see the best outcomes for their patients. Sometimes, they are limited in that because of the resources available. They do not use the Mental Health Act with a view to harming people, but with a view to helping them.

Being detained under the Mental Health Act is not a prime facie harm; it is a treatment and a good thing. If someone needs to be detained and treated in hospital, they need to be detained and treated in hospital. If I became so unwell that I needed to be detained under the Act, I would want to be detained. Thankfully, I am not in that position today—[Interruption.] At least I believe that I am not, although the shadow Minister, my hon. Friend the Member for Hinckley and Bosworth (Dr Evans), might have a different view on that. [Laughter.] Should I get to the point where I am so unwell that I cannot consider my own care, I would want the powers of the Mental Health Act to be used quickly, particularly if I were posing a risk to myself, my family and others, so that I can get better and back to living my life.

I pay tribute to Baroness May of Maidenhead, who kicked this off, and to Professor Sir Simon Wessely—a good friend—Stephen Gilbert, Sir Mark Hedley and Rabbi Baroness Neuberger for their work in the 2018 review. There is a lot of good work in the Bill, from the greater focus on advance care planning and the more frequent detention reviews, which I recognise may bring a workforce burden, to the provisions on nominated persons. I will not go into the detail in this Second Reading speech, but I will focus on a few general points on which I think a bit more work needs to be undertaken.

In some ways—I will have to message Sir Simon after this to ask his forgiveness—the Bill is a missed opportunity in that we have are not moving towards fusion law. For the benefit of those who are not all over the detail, at the moment the UK has two pieces of legislation regulating how to treat people in the absence of consent. The Mental Capacity Act 2005 came about from case law in the ’80s and ’90s and was codified in 2005. That Act broadly regulates physical health treatments for people who lack the capacity to consent—we have focused quite a lot on capacity in the recent debates on the Terminally Ill Adults (End of Life) Bill. The principles of the 2005 Act are autonomy and the functional capacity and best interests tests for people who lack capacity, meaning that we test someone’s capacity, and only if they lack capacity can we intervene in their best interests, sometimes by using deprivations of liberty.

The Mental Health Act arose from a very different pathway. In its first days, it was more about the regulation of asylums. The Act is about status and risk. The gatekeeper conditions for the current Mental Health Act are that a patient has a mental disorder of a nature and a degree that requires assessment in hospital because of the risk to their health and to the safety of others. Capacity does not feature whatsoever.

We have two pieces of legislation. One applies to the most severe mental disorders and deals with status and risk, and the other deals with autonomy and best interests. I strongly believe that the two need to be merged. We should use capacity and best interest frameworks to regulate treatment of mental disorder in the absence of consent—there are ways of doing that. I like the fact that we are starting to incorporate a bit more in the Bill.

[Sojan Joseph (Ashford) (Lab)]

Does the hon. Member not think that the deprivation of liberty safeguards, which, unlike the Mental Health Act, help to hold those who lack capacity in an environment that is not secure or locked, such as a hospital, are useful, and that bringing the two provisions together is unnecessary?

[Dr Spencer]

The hon. Member is of course very knowledgeable given his background as a mental health nurse. I would like to see in the Bill a provision setting out that, in order to detain someone for the purposes of health or safety, they must lack decision-making capacity for the detention to be authorised. For the prevention of harm to others, there are reasons to overcome autonomy in decision-making capacity, but I would like to see an additional component specifying that if the detention for assessment and treatment in hospital is purely based on health and safety and not on risk of harm to others, the patient must also lack capacity. Otherwise, people who have full and intact decision-making capacity can nevertheless come into the scope of the powers.

The liberty protection safeguards are a bit of a mess, quite frankly, and the DoLS were clearly a substantial mess. It is interesting that the legislative scrutiny of the Bill points out that it is a missed opportunity not to tidy up some of the interface between the Mental Health Act and the Mental Capacity Act—a point that I will come to a little later in my speech. In terms of parity of esteem, bringing forward fusion law and gelling the Acts closer together needs to be the direction of travel. I hope that we do not have to waste another 20 years until we get the opportunity something like that.

There is something else that we need to reflect on. It comes to my other points about the focus in the Bill, but I will reiterate it. The core focus of the Bill is on reducing detentions of people from black and minority ethnic groups, who are over-represented in detention. One of the key focuses in fixing that must be on socioeconomic deprivation—where we see socioeconomic deprivation, we see severe mental disorder following—but I worry that the Bill is a missed opportunity and will not do what is required to deal with those disparities.

There are three problems with the Bill, and two things that I wish to flag. I am sensitive to the concerns that have been raised about people with autistic spectrum disorders and learning disabilities, and the advocacy regarding such people being in hospital. Being in a general adult ward is a challenging environment as it is, and it is particularly challenging for someone with an ASD or a learning disability. People can get stuck in hospital not really going anywhere. That concern applies to most disorders—I do not think it is unique, given the lack of community support services. I disagree, however, with the focus on ASD and LD above all other conditions. If we want to talk about non-progressive conditions, I do not understand why a brain injury, or Korsakoff’s dementia for example, are not within the scope of this measure. I do not understand why, rather than using the Bill to take people out of section 3 of the Mental Health Act, something like a bolstered treatability test is not used, which is what was in the Act before it was modified in 2007.

[Jen Craft]

I am grateful to the hon. Gentleman, who has brought his wealth of experience to this place. Would he concede that the focus on learning disability and autism is perhaps because those disorders have very specific features? Being in an unfamiliar, over-sensory stimulating or noisy environment, with a break from routine, has an adverse effect on some people precisely because of the nature of their disability, and perhaps more so than for some of the other conditions he has mentioned. Indeed, it seemed something of a weird anomaly that learning disability and autism were classed as mental illness for the sake of the Mental Health Act. I am sure the hon. Gentleman will agree they very much are not.

[Dr Spencer]

I thank the hon. Lady for her intervention. Sensory over-stimulation can be a particular issue for those with autistic spectrum disorders. I have been concerned when I have looked after patients, and I have thought carefully about the challenges, particularly in general adult wards, of catering to the needs of people with autistic spectrum disorders or a learning disability. I would argue that that would apply broadly to anyone in a general adult hospital, irrespective of diagnosis—everyone has particular needs and sensitivities and we need to be mindful of that.

I suspect this is something that the hon. Lady and I will disagree on, but I would consider an autistic spectrum disorder and a learning disability to be a mental disorder. It certainly is under the ICD-10 classification of mental and behavioural disorders. One problem with how this issue is framed in the Bill is, for example, where Rett disorder, which is also a pervasive developmental disorder, would come into it. Does it come under the term “autistic”? Where does a not otherwise specified pervasive developmental disorder come into it? I am not sure whether how the terms in the Bill will operate in real life has been thought through. I do not understand why we are not pushing for such a provision for every disorder and condition that people have when they come into hospital. That is why we are not focused on something like a treatability test, or otherwise.

This has a specific real-life fall-out. If people need to be in hospital after 28 days and there is a deprivation of liberty, that is going to happen. It will not stop happening; with the best will in the world, and even with this Bill, it will keep on happening. People will either be detained under liberty protection safeguards, or they will end up being detained with anxiety related to their ASD or learning disability, which would place them within scope of the Mental Health Act.

A further challenge and disparity in the Bill is that it does not affect forensic provisions. People could be keener to pursue a criminal prosecution of people with ASD or an LD because that would enable a longer stay in detention than 28 days. That is why in the pre-legislative scrutiny we suggested that there should be an option to get a pre-authorisation for detention beyond 28 days by going to a tribunal, which we thought might deal with some of the concerns raised. Personally, I like the idea of pre-authorisation in general beyond 28 days, and it is something that Professor Richardson spoke about in her review back in the late ’90s. The Government recognise that there are challenges with this area, which is why these changes are in the schedules. There is a recognition that, frankly, this is not workable, and we will see as the Bill progresses that there are broader concerns about how it operates.

Another area of concern is nominated persons and parental responsibility. The Bill changes “nearest relative” to a “nominated person”, which means that people can choose who performs that important role under the 1983 Act. The nearest relative or nominated person can discharge someone from the powers of the Act, which would inevitably mean that they would be discharged from hospital—there are powers to bar people, but it is quite a high threshold. This measure is important because it will allow someone under the age of 18 to choose someone who is not their parent to have that important statutory power. We raised this issue in the pre-legislative scrutiny Committee. We could have a situation in which a 16-year-old with competence who is detained under the 1983 Act in hospital chooses their mate, or somebody else—not their parent or someone with parental responsibility—to have the power to discharge them from measures under the Act, which would inevitably mean them leaving hospital. The parent, who in such situations is often responsible in some way for the after care, would lose that power.

I am concerned, as were the Lords, about the impact of that measure on the Children Act 1989. I think there is a serious problem in changing this area of law—we do not have this in physical health—and introducing the ability to give a statutory power to a non-parent. I know the Minister will look into that in the Bill Committee, but I think the Government will have to row back on that. They could easily amend the Bill to say that if someone is under the age of 16, the nominated person must have parental responsibility unless there is a good reason for them not to have it. Sixteen and 17-year-olds are a bit different, especially when people start getting close to 18 and there are other children’s rights, but I cannot see why we should legislate to let someone under 16 choose someone who does not have parental responsibility to have that important power.

The third problem is that the Bill is silent on deprivations of liberty in A&E, which are ongoing. It has been a while since I worked in A&E, but there has always been the challenge of what to do with someone who turns up to A&E if the doctor thinks that they will probably need detaining under the Mental Health Act because they are suicidal or very unwell, and wants to keep them there while the assessment takes place. We can get through it using the Mental Capacity Act 2005, but it is messy. It would be a lot clearer for everybody if we said, for example, that section 5(2) of the 1983 Act, which allows for temporary detention, could apply to an A&E setting. There is a bunch of technical stuff about the interaction between deprivation of liberty and the Mental Capacity Act, but I suspect you will start giving me the evil eye, Madam Deputy Speaker, and telling me to move on if I start—[Interruption.] Madam Deputy Speaker says no, but I suspect that Members across the House might start doing that, so I will move on.

Let me flag two things in the Bill. It allows for a discharge from hospital under supervised conditional discharge to a deprivation of liberty. That is in response to the case of Secretary of State for Justice v. MM, which involves a problem with how the law currently operates. As far as I know, in mental health law we have never had a situation where deprivations of liberty in the community were authorised under the Mental Health Act—someone had to be in a registered hospital. That is a big Rubicon to cross. I see why the Government need to tidy up this area of law, but I am not convinced that we have realised what a big Rubicon this is to cross. The operation of the Mental Health Act has always meant that someone was detained in hospital, but when they are in the community they are in the community. Someone might have certain restrictions placed on them by a community treatment order, or otherwise, but they are not deprived of their liberty in their home or in some other community setting that is not a registered medical hospital. I think that measure needs a bit more reflection.

I believe that the majority of those who will undergo compulsory treatment under detention, certainly for a long period of time, under this legislation will be people with psychosis, such as schizophrenic forms of psychosis, schizophrenia and bipolar affective disorder, but lot of the debate and focus has been on non-psychotic illnesses. That is not to say that those illnesses are less important—they are certainly not less important, especially for those who experience them—but I am concerned that people with schizophrenia always get a raw deal. They are often marginalised by society and in terms of the amount of advocacy they have.

In fact, a lot of the evidence that we reviewed in the pre-legislative scrutiny Committee focused on non-psychotic disorders, perhaps because sadly people often turn their backs on people with psychotic illnesses. Sometimes those people find themselves in a situation where their illness is so debilitating that they cannot advocate for themselves, so there tends to be a bias towards disorders such as dementia, ASD and LD, where there is someone to advocate, such as CAMHS or families who might push a little bit more. I am not saying that any condition is more important—I really want to stress that—but as parliamentarians, we do not necessarily understand that the bulk of the conditions that the Bill focuses on concern psychosis.

Finally, I have spoken a lot about how psychosis can lead to people being detained in hospital and about the impact of that. Psychosis is a pretty terrible disease but it does not need to be: lots of people get better and it is one of the most treatable diseases. The Bill will help people to get better and we cannot lose sight of that.

--- Later in debate ---

[Jen Craft (Thurrock) (Lab)]

The Mental Health Bill is a long overdue update to the Mental Health Act 1983, and I hope it will be the start of a much wider overhaul of a mental health system that is often not fit for purpose and has historically been treated as secondary to the physical health system. It is a system where too often patient voices are ignored, injustices are common and the use of detention is relied upon in the place of person-centred community care. Too frequently, those in acute mental health crisis cannot access the right support. They are refused help in the community, forced to rely on accident and emergency, and detained against their will as their mental health deteriorates. Incidence of detention is three times higher in the most deprived areas. Black British people are detained at 3.5 times the rate of white people, and those with learning disabilities and/or autism are at a unique and increased risk from detention and the impact that it can have on their lives. I will initially focus on that latter group. I declare an interest as the chair of the all-party parliamentary group on learning disability.

Under the 1983 Act, as we have heard, learning disability or autism in themselves can be a reason for detention. The hon. Member for Runnymede and Weybridge (Dr Spencer) said that we will disagree on this, and I am afraid that we will, because I do not think that learning disability or autism are necessarily conditions of the mind. A number of these conditions are genetic and also affect the physical health of a person.

[Dr Ben Spencer]

rose—

[Jen Craft]

I am sure the hon. Member will want to come in on this.

[Dr Ben Spencer]

I appreciate the hon. Member giving way. There is a logical inconsistency, which is that people with autism and learning disability are looked after under mental health services for autism and learning disability. If the argument is, “Well, those conditions should not be within the scope of Mental Health Act”, one could make an argument that they should not be within scope of mental health services full stop.

[Jen Craft]

I thank the hon. Member for his intervention. I would welcome the opportunity to discuss this issue in more detail with him, although we will probably continue to disagree. People with learning disabilities and autism can suffer from mental health conditions as much as the rest of the population, but they have a unique set of challenges. I point out as a note to policymakers in general that they should not conflate learning disability and autism as one and the same thing. That is vital.

At the end of January 2025, 2,065 in-patients in locked mental health facilities were autistic or living with a learning disability. As one of my hon. Friends said earlier, the average length of stay for these patients is nearly five years. For those with a learning disability or autism, a locked mental health ward can be a living hell. For someone with sensory issues, a reliance on routine, a need for a specialist diet or equipment or myriad other needs, being in a busy, over-stimulating environment—often with strip lighting and minimal privacy—often means they are set up to fail from the very beginning.

Terminally Ill Adults (End of Life) Bill (Money)

Ben Spencer Excerpts

Money resolution
Wednesday 22nd January 2025 Commons Chamber

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

Unfortunately, this debate and the circumstances of this money resolution are a manifest example of the concerns I have raised about this Bill and the process of taking it forwards. Many Members talk about debate, and it is important that this issue is debated; however, what is critical is scrutiny—ensuring that we can properly scrutinise the Bill, the work that is put into a very complicated area of law, and what would be, if the Bill were to pass, a manifest change in the relationship between the state and its citizens.

This money resolution is in the name of a Treasury Minister, the response at the Dispatch Box on Second Reading was from a Justice Minister, and we have a Health Minister here today. We cannot say whether the Bill will be paid for by the Ministry of Justice, and what the liability will be. What is the health liability? How much will be in private hands, and how much will not? What about legal aid? There are all these spin-out costs from the Bill.

As a parliamentarian, I like to scrutinise. I want to see impact assessments; I want to see what the spending that I am being asked to vote for looks like, yet we do not have that information. Members have said that the Bill will come back on Report, and the Government are in a hokey-cokey position: sort of in, sort of out—what’s it all about? I am sorry, but I do not think that is good enough for something of such importance to our constituents and for Parliament to get right.

Hospice and Palliative Care

Ben Spencer Excerpts

Monday 13th January 2025 Commons Chamber

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

I thank the hon. Member for Wimbledon (Mr Kohler) for speaking so eloquently in this important debate, and for securing it. I also thank the Backbench Business Committee.

Hospices are fantastic places, and all of us in this country are lucky to have them. People go to hospices not to die, but to live the last few days or weeks of their life. While I am pleased that the assisted dying Bill has led to a renewed interest in hospice and palliative care, I am sad that so much of the focus has been on death and the dying process, rather than on the broader support and care offered by hospices and palliative care providers—sometimes over many years—to people who have illnesses that may be life-limiting, and who require certain types of medical intervention to manage their symptoms. That is a very important part of the work that hospices and palliative care teams do, but as I say, much of the focus is often on the death process, rather than the treatment given to those with chronic conditions.

Speaking as a former consultant psychiatrist, it would be remiss of me not to mention the psychological support and mental health interventions by palliative care teams and hospices. They are experts in pain relief. Palliative care teams brought a lot of relief to me when, as a junior doctor, I tried to manage very difficult situations in patient care. They are experts in analgesic components. It is important to recognise the palliative care teams working in not only hospices but hospital settings and the community to alleviate people’s symptoms.

I pay tribute to the fantastic local hospices and care teams in the Runnymede and Weybridge constituency, at Woking & Sam Beare hospice, which I have visited and is a fantastic place, and at Princess Alice hospice, based in Esher. We also benefit from Shooting Stars, in the constituency of the hon. Member for Twickenham (Munira Wilson). I hope to visit that one day. I thank all the teams who work in those hospices for delivering care and support, but also for keeping the hospices running, and for their vital fundraising.

Many people support hospices in lots of different ways, including through direct donations and organising fundraising events, and I am pleased to have been to fundraising events for Woking & Sam Beare hospice. In fact, a week or two ago, I went to the Chertsey panto, which has been running for 12 years. It supports the Woking & Sam Beare hospice. The performances, if one can call them that, have raised £60,000. The panto has to be seen to be believed; one will never forget the Chertsey panto after one has gone to it. The team who organise and run it are absolutely fantastic. It is a fantastic institution and raises a lot of good money for the hospice.

We also have charity shops. There is a great one in Weybridge that has been raising money for quite some time. I pay tribute to everybody for what they do, no matter how big or small, to support our hospices and our palliative care sector.

[Josh Babarinde (Eastbourne) (LD)]

Will the hon. Member join me in promoting a fundraiser being held by St Wilfrid’s hospice in Eastbourne, called “I’m a CEO…Get Me Out of Here!”? It is trying to get lots of local chief executive officers and MPs to join the hospice staff in the Sussex jungle, to raise cash for the great work that the hospice does.

[Dr Spencer]

The hon. Member will have to explain further what is required from those who commit to fundraising in the Sussex jungle. He is right to pay tribute to those doing great work in support of our hospice sector. Its funding model is part public and part private, which gives hospices a great benefit. As they sit outside the NHS, they have greater flexibility in how they approach care provision. Woking & Sam Beare hospice is 31% funded by public sector money. It has 2,000 staff and, as I said, delivers fantastic care and support.

Much of this debate has been about the future of funding for our hospice sector. Although I am grateful to the Government for the money and support that they have put forward for hospices, sadly they have given with one hand and taken away with the other. The rise in employers’ national insurance contributions is very damaging, and hospices also need to manage increases to staffing budgets as a result of the Agenda for Change. Marie Curie has said that the national insurance component will cost it roughly £2.9 million per year.

Could the Minister say what impact assessment has been done on the national insurance contribution rises for hospices, and on the Agenda for Change? How many hospices in the UK are running a deficit, and how does he expect that to change over the next year and going forward, as a consequence of the decisions made in the Budget? If there is an opportunity to reverse those decisions, does he supporting doing so?

--- Later in debate ---

[Stephen Kinnock]

As I said in a previous answer, hospices face a range of pressures that financial contributions from the Government will help to ease. The funding will, of course, have a knock-on impact on hospices budgets in the round.

In spite of the record-breaking package that we have announced, we are certainly not complacent. There is more work to be done, and through the National Institute for Health and Care Research, the Department is investing £3 million in a policy research unit on palliative and end of life care. The unit launched in January 2024 and is building the evidence base that will inform our long-term strategy. A number of hon. Members requested a long-term strategy and plan, which is sorely missing after 14 years of Conservative neglect and incompetence. I agree that we need a long-term plan, and assure Members that conversations are taking place between my officials and NHS England. The research needs to be based on evidence and facts, which the unit will help us to get.

[Dr Ben Spencer]

It is important that this debate is not a political ding-dong, and I really appreciate the tone that all Members, including the Minister, have taken. On evidence and facts, will he look into the impact of the national insurance contribution rises on hospice care and provision, how many hospices are running a deficit, and how many will likely go into deficit as a result of his policies?

[Stephen Kinnock]

The hon. Gentleman will not be surprised to know that I have a section in my speech on employer national insurance contributions. I will get to it.

A number of colleagues raised concerns about regional variations. Facts and evidence are very important in that context. To address that issue, NHS England has developed a palliative and end of life care dashboard, which brings together all the relevant local data in one place. The dashboard helps commissioners to understand the palliative and end of life care needs of their local population, enabling ICBs to put plans in place to address, and track the improvement of, health inequalities, and to ensure that funding is distributed fairly, based on prevalence.

NHS Backlog

Ben Spencer Excerpts

Monday 6th January 2025 Commons Chamber

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

I thank the hon. Member for North Shropshire (Helen Morgan) for securing this important and timely debate. I must begin by declaring my interests: I am a non-practising NHS consultant psychiatrist and my wife is an NHS doctor.

Christmas and the festive period is always a taxing time for the NHS, especially for those working on call, as indeed it is for all those in the various emergency services and those outside the public sector who are on call. It is important to pay tribute to them for all their hard work over the past couple of weeks.

Much of the correspondence that I have received from constituents over the past few years has concerned the difficulty of obtaining GP appointments. Interestingly, the demand for GP appointments has risen since before the pandemic, following the advent of virtual appointments and different means of contact. Patients are now finding it more difficult to see someone in a general practice, although overall performance in general practices has improved since before the pandemic. It is important that we support our GP practices as much as we can, to ensure that they deliver the high-quality care that our patients expect. Our local practices are fantastic: they are working very hard, in tricky circumstances, to deliver for patients.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

My hon. Friend is, of course, absolutely right. Does he agree that part of our duty is to support our general practices? Our constituents often say, “I cannot see my GP”, but if we probe, we find that it is a question of whether they are prepared to accept a telephone consultation, which is probably just as good for most of them. Radiology was mentioned earlier. The issue for the future, surely, is embracing technology rather than outsourcing. In many cases, AI reading of films and scans is probably as good as, if not better than, a reading by a radiologist in India, Shropshire or anywhere else.

[Dr Spencer]

I entirely agree with my right hon. Friend about the use of AI to improve productivity in the NHS, and with what he has said about general practices.

I generally take a neutral, honest-broker approach when people raise concerns about general practices. Of course it is important for us to ensure that our practices are performing well, to support them, and to respond to our constituents’ concerns more broadly. However, given that the bulk of care is coming through general practice—and I was interested to hear, in recent days, about the renewed focus on patient choice, particularly in respect of secondary and tertiary care—I think that one of the challenges posed by our current general practice system relates to the absence of patient choice. Effectively, general practices, which, as the Minister will know, are private organisations, have a monopoly in terms of the patients who are in their catchment area. It is very difficult for patients to move to different practices when the ones that they are currently using are not meeting their needs: when seeking an appointment with a GP, they are stuck with their own practice, or else they must go through various mechanisms to obtain care elsewhere.

[Mr Richard Holden (Basildon and Billericay) (Con)]

My hon. Friend is making an excellent point about something that is currently affecting my own constituency. South Green surgery in Billericay has recently been told that it is to be closed down, and the integrated care board is not ensuring that we retain what is essentially competition, so a single surgery will be serving one of the towns in my constituency. Does he agree that the Department of Health and Social Care should be leaning in to ensure that we maintain that competition between GPs’ surgeries, so that standards can be driven up wherever possible?

[Dr Spencer]

My right hon. Friend is absolutely right; it is important that patients have information and choice, and that they have the flexibility to move between different practices to suit their needs. My view is that the GP list system does not work. It does not make sense as it currently stands, and it limits the ability of patients to seek the care that they need in a timely manner. As he just mentioned, people get stuck in practices that are not performing or are not working for them, and they have no ability to move out of them.

My right hon. Friend also mentions the role of the ICB/ICS system, which brings me to my final point. As a constituency MP, I find it incredibly frustrating that I have no direct control, power or hard influence, as opposed to soft influence, over the local ICS/ICB system. I can write letters and campaign, and I have spoken in debates in Parliament. I have led a debate on the Weybridge health centre, which is finally going to planning after the drama of multiple consultations. My only ability to direct what is happening on the ICB is through directly asking Ministers questions in Parliament, or by trying to get them to intervene. When the Health and Care Act 2022 was going through in the last Parliament, I raised with the then Minister my concerns about the accountability of our ICSs and ICBs. We have a real problem with what we MPs can do to ensure that our ICBs and ICSs are performing for people locally, because there is a disconnect in the link of accountability.

I believe that the Secretary of State for Health and Social Care and the Ministers on the Front Bench absolutely want to see all our local NHS services performing at their very best. I totally believe that they are in it for the right reasons and want to see better performance, and I want to help them deliver that. But with all the enthusiasm and will in the world, are they going to take the same interest in my local area as I do? We MPs need the ability to cajole and to direct what our local NHS services are doing in order to deliver the best possible care for patients. After all, we are the locally elected representatives and, as we saw in this year’s election and will see in elections going forward, there are always 24 hours to save the NHS.

Cancer Strategy for England

Ben Spencer Excerpts

Thursday 31st October 2024 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Betts. I thank the hon. Member for Wokingham (Clive Jones) for securing this important debate on what is clearly a difficult subject, given how much cancer affects people: as several hon. Members have said, it affects all of us, not just those who are directly affected. I listened carefully to the powerful speeches that he and the hon. Member for Cheltenham (Max Wilkinson) made about the direct impact that they have experienced.

I pay tribute to all the people who work in our NHS, the charity sector, the research sector and all parts of our community that are active in prevention and in supporting, treating and helping people through the journey with cancer. My speech cannot cover every cancer in the limited time I have, but I will focus on the major cancers, so to speak, in terms of prevalence and mortality rates. That is not to diminish the importance of the range of cancers: it is critical that we focus on rare cancers as well as the major ones.

I thank the hon. Member for Wokingham again for his speech and for sharing his personal experience. He did not mention the fact that he has raised more than £800,000 for cancer charities in his work following his diagnosis. It is important that we pay tribute to him for bringing forward this debate.

I was deeply concerned by the story told by the hon. Member for Thornbury and Yate (Claire Young) about the impact on her constituent of the cessation of their treatment as a result of financial measures. I hope that the Minister can meet her or take up the case; I would be interested to hear how that decision was taken. I hope that the family and the individual affected are doing okay with their treatment. My right hon. Friend the Member for Herne Bay and Sandwich (Sir Roger Gale) made important points, to which I will return later, about childhood and teenage cancer.

I was pleased that the hon. Member for Woking (Mr Forster), my constituency neighbour, raised the impact on his constituents in terms of seeking direct cancer care. As he knows, both of our constituencies are served by Ashford for broader cancer support. I would welcome the chance to meet him to discuss how we can help our constituents, particularly with journey times to access cancer care locally.

It is important to focus on data, so I will refer to data from the NHS and from Cancer Research UK. I have a series of questions for the Minister; I know that a lot may not be in his portfolio, but if he cannot answer today I will be grateful for a written response.

Fundamentally, the things that the state can do about cancer strategies break down into prevention, diagnosis, care and treatment, and research. All the major cancers have modifiable risk factors. Of the 44,000 bowel cancer cases a year, 54% are deemed to be preventable, with 11% linked to obesity, 28% linked to diet and fibre, 13% linked to processed meat and 5% linked to physical activity. Breast cancer is the most common cancer in the UK: of the 56,800 cases a year, about 8% are believed to be linked to or caused by obesity. Lung cancer is the third most common cancer: of the approximately 50,000 cases a year, about 80% are preventable and 72% are linked directly to smoking.

Overall, tobacco is the largest preventable cause of cancer. Some 50,000 cancer cases per year are attributable to smoking. In the last Parliament, we introduced the Tobacco and Vapes Bill because we recognised the importance of reducing smoking. Can the Minister tell me when his Government plan to reintroduce that Bill, so that we can start to see its health benefits? Obesity is the UK’s second biggest cause of cancer, after smoking. It is believed to cause about one in 20 cases: 20,000 cases of cancer per year are attributable to obesity. We brought forward an obesity strategy. Will the Minister review it and bring forward an obesity strategy in this Parliament?

On screening and treatment, while cancer outcomes continue to improve in comparison with the OECD, it is worth looking at the data in the Darzi report. One of the most interesting slides shows that over the past 14 years, we have improved relative to the gradient of cancer outcomes, but we started at a very low point. There are lots of questions to be asked about why we started at such a low point back in 2004. The NHS is still recovering from the disruption to cancer care caused by the covid pandemic, but thanks to the hard work of NHS staff, waits of more than 62 days declined between September 2022 and August 2024. Obviously there is still more work to be done.

Community diagnostic centres and surgical hubs made a difference. They were backed by a £2.3 billion investment, the largest cash investment in MRI and CT scanning in the history of the NHS; those scans, tests and checks are now being delivered in 170 CDC sites. As the independent Health Foundation recently pointed out, surgical hubs have helped to build capacity and reduce waiting lists over the past few years. Although it was not mentioned in Lord Darzi’s report on NHS performance, I welcome the Government’s intention to expand surgical hubs. Will the Minister provide more details on how many new surgical hubs will be established? What plans have the Government to expand the CDC network further?

There is clearly more work to be done to improve cancer waiting times and outcomes. The major conditions strategy developed under the last Government was designed to provide more impetus for improving cancer outcomes, alongside those for other major conditions. Developing the strategy involved significant consultation and engagement with cancer charities and professional bodies. Since the election, the Government have decided to scrap the strategy. Can the Minister explain why he made that decision?

Given the time that cancer charities and organisations have put in, can the Minister explain how their contributions will be used to develop the 10-year plan for the NHS? Can he explain why, in the NHS consultation that is now being run, there are no cancer-specific questions? We heard earlier that eight people in 10 want a cancer strategy. Will he respond if similar results emerge from the consultation?

The Government scrapped the children and young people cancer taskforce, and we have yet to hear an alternative approach to improve of outcomes in that area. Will the Minister provide clarity on the Government’s plans on children’s cancers and the reasons why they discontinued the children and young people cancer taskforce?

Research is most relevant to some of the rarer cancers that are often not talked about. We very much welcome the protection of Government investment in R&D, with £20 billion allocated to 2025-26 and core research spending protected. That includes a £2 billion uplift for the National Institute for Health and Care Research. I should mention that my doctoral research fellowship was funded by the NIHR, although it was mental health research rather than cancer research. It is great that we support that fantastic institution.

I am pleased that the Government have kept the current rate of research and development tax relief. However, the Minister will know that a lot of support and research is provided by or directly commissioned from charities, which are a critical part of the cancer care and treatment infrastructure. My understanding is that in yesterday’s Budget, public services were protected from the rise in employers’ national insurance contributions. Can the Minister explain what the impact of national insurance employer contributions will be on charities that provide care and treatment in this area? What conversations has he had with those charities, and what concerns have they raised with him?

In the Darzi report and elsewhere, there is rightly a focus on the diagnostic pathway and on the time it takes to diagnose and treat someone following a query as to whether someone has cancer. When does the Minister expect the huge £22 billion injection in the NHS to produce outcomes? Or does he agree with the comments in Lord Darzi’s report that the NHS does not necessarily need more money for outcomes? It has had a lot of money from the former Conservative Government over the past few years. Does the Minister think that reform is the best way to ensure improvement?

[Mr Clive Betts (in the Chair)]

I call the Minister. It would be helpful if he could finish by 4.28 pm to allow the mover of the motion a couple of minutes to respond.

Oral Answers to Questions

Ben Spencer Excerpts

Tuesday 15th October 2024 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

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

The Prime Minister has repeatedly stressed the importance of preventing people from taking up smoking, as one of his priorities to improve the nation’s health, reduce waiting lists and lessen demand on the NHS, and we agree. The Government like to talk about the record of their first 100 days in office but, according to data from Action on Smoking and Health, 280 children under the age of 16 take up smoking in England each day. That is 28,000 children in England during the Secretary of State’s first 100 days. Why has he not yet reintroduced our Tobacco and Vapes Bill? How many children need to take up smoking before he makes this a priority?

[Wes Streeting]

Perhaps the shadow Minister would like to give us the figures for the entire 14 years that his party was in government. By the way, just to set the record straight, not only did I propose the measures in that Bill during an interview with The Times earlier last year, but if it was such a priority for the Opposition, why did they leave the Bill unfinished? Why had it only had its Second Reading? And why did we go into the general election with that Bill unpassed? I will tell him why: because his party was divided on the issue, and the then Prime Minister was too weak to stand up to his own right-wingers who are now calling the shots in his party. The smoking Bill will be back, it will be stronger and, unlike the previous Government, we will deliver it.

Mental Health Support

Ben Spencer Excerpts

Thursday 10th October 2024 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Dowd. I start by declaring that I am a former consultant psychiatrist and that a family member is a consultant psychiatrist.

Listening to this debate has been a mixed experience. It has been great to hear the wealth of talent and expertise that we have in the House, but at times it has been harrowing to hear people speak about their personal experiences or those of their constituents. That is a reminder to us all of just how substantial the impact of mental illness can be on people—our families and friends. The tone in which this very sensitive debate has been conducted is fantastic.

I thank the hon. Member for Ashford (Sojan Joseph) for bringing forward this debate, for the wealth of experience—22 years—that he brings to this place, and for a very balanced speech in which he acknowledged the catchment investments under the previous Government and raised the importance of waiting lists. When I was first elected, I brought up targets for mental health in a private Member’s Bill, which did not end up going anywhere, on waiting times for getting an in-patient bed when one is requested for somebody with a mental disorder. Of course, we all want improvements in mental health care and treatment, and there need to be improvements in mental health care and treatment. I am sure there will be no disagreement across the House about that.

The hon. Member for Ashford was absolutely spot on to mention housing, work and benefits. It is a testament to his experiences in psychiatric nursing that he went on to mention the surrounding holistic care. One of the challenges of debates on improving mental health services is that we must acknowledge that that involves many other areas of public policy, public provision and cultural factors, and try to broaden that as much as possible.

[Dr Evans]

The former Member for Doncaster, who is now sadly not in this House, was a significant champion for men’s and boys’ health—suicide in particular, which has been mentioned here, is such a problem. My hon. Friend stated the case for mental health being a pan-Government policy area—does he believe that strengthens the argument for having a Minister for men and boys to go across Government and think about all these issues, especially as suicide is the leading cause of death for young men under the age of 45?

[Dr Spencer]

My hon. Friend is absolutely right to point out that, sadly, suicide is the No.1 cause of death among young men. My understanding, although the stats change all the time, is that below the age of 45, suicide is the No.1 cause of death among both men and women. It is absolutely right that we look at sex-specific approaches to intervention. Factors affecting health in men will be different from factors affecting health in women.

I want to go back to the social elements of mental health care, which the hon. Member for Ashford mentioned, and a smoke-free society and banning tobacco. Certainly when I was practising, 50% of tobacco was consumed by people with a severe mental illness. That raises a whole host of concerns and issues about what is happening with tobacco consumption and people with a mental disorder.

My hon. Friend the Member for Hinckley and Bosworth (Dr Evans) was absolutely right, given his experience, about something he has mentioned many times in the House: the importance of delineating mental wellbeing and mental illness. I tend to think about it in this way: we all have mental health, but we need to separate mental wellbeing from mental illness. The two are different and need different approaches, as was echoed by my right hon. Friend the Member for Salisbury (John Glen) and the new hon. Member for Stroud (Dr Opher), who gave rise to a very fertile discussion on his views on the area. The hon. Member for Leicester South (Shockat Adam), who is no longer in his place, rightly pointed out inequalities in detention and outcomes for those from minority ethnic backgrounds. That is a very important issue.

That brings me on to our record in Government over the past 14 years; there are a few things I want to pick out. One is that we set parity of esteem in law through the Health and Social Care Act 2012, which was a big step forward. We still need parity of esteem in outcomes, but nevertheless that was a very important step. We expanded access to psychological therapies and I am particularly pleased by the expansion of individual placement and support, which has been shown to help people get into work, particularly those with a chronic and enduring mental illness. We have seen more people take up maternity care, and we also invested in the mental health estate.

In fact, in my own constituency, we have a new mental health hospital. The Abraham Cowley Unit is being rebuilt, which will provide world-class care for people living in my patch. Perhaps most important of all, given the conversation that we have had today, is the decrease in in-patient and out-patient suicide that we have seen over the years. Of course, I recognise that there are a variety of factors driving that but we should be pleased that things are moving in the right direction on suicides, although there is more to be done.

Today is World Mental Health day and it is a very broad topic, but in my time I would like to focus specifically on one area that, as it certainly was in my former career, is often neglected—psychosis. It particularly affects people suffering from schizophrenia or bipolar affective disorder. It can be a very disabling illness and has been responsible for quite a degree of disability and health concern in the UK. Often debates such as these, and debates in the media, do not focus on psychosis and I think a big part of that comes from the stigma attached to it. People who work in the sector, and those with expertise here, will know that it is an area of great need both in terms of community mental health teams and in-patient settings. The hon. Member for Stroud was absolutely right and I am glad he pointed this out: the 10 to 15 years of life lost following a diagnosis of psychosis is something that we have to fix.

I believe that we also need to improve access to treatments such as clozapine, which is an excellent treatment for schizophrenia. I am pleased to have previously worked with Clozapine Support Group UK in its campaign to try to get more access to clozapine for people for whom it is indicated. We have also seen the reform of the Mental Health Act 1983, which the former Prime Minister Theresa May kicked off with the Wessely review. I was part of the working groups on the Wessely review, particularly looking at helping with the tribunal system, and I was on the pre-legislative scrutiny committee as well. How we look after people detained for treatment in the absence of consent is very important, and I am pleased that this Government have committed to take forward the work on reviewing that Act.

I thank everyone who works in the care and treatment of people with mental illness. As we have heard today, that is a very broad sector; it is not only people who work in the NHS but those who work in the third sector in a variety of organisations and institutions. That is very important work.

[Lee Pitcher (Doncaster East and the Isle of Axholme) (Lab)]

Will the hon. Member give way?

[Dr Spencer]

Very briefly—I have only a couple of minutes left.

[Lee Pitcher]

My cousin died from suicide two years ago. We have talked about a lot of facts and figures today, and we have talked a bit about heart, but I can absolutely tell the hon. Member that a family never recovers from that. My auntie and uncle will never recover from the fact that they lost their child before they themselves went.

All a person can do in that situation is put their energy into something positive, and that is about how to help people going forwards. One of the big things is absolutely those charities that support people, such as the Jackson Hope Foundation. I have gone along and spoken there myself even this last Friday, and I talked about some of my experiences in Parliament really openly and freely. It is a safe place. There are 16 men there talking unbelievably openly about how they feel, and it makes such a difference. I want to ensure that going forwards, whatever we do, learning from those groups feeds into our plans and strategies because it makes all the difference to people.

[Dr Spencer]

I thank the hon. Gentleman for sharing something so personal in his intervention, and for sharing his experience of the impact of suicide. Many Members have shared personal experience in this debate. That is very important.

I am mindful that there will be people in the Gallery or watching at home who may be affected by the topics we are discussing, and I take a moment to point out that there are a variety of services to help people in their recovery, if one can call it that, after a loved one has tragically died from suicide, or to help people who are in crisis, such as local crisis services, the Samaritans or Mind. There is a variety of third sector and charity helplines that can help. Men’s Sheds is one organisation I know of that is very helpful. I am really pleased that the hon. Gentleman raised this issue.

I will finish with a few questions for the Minister. The Government do not have a mental health care and treatment strategy or a psychosis strategy and, following an answer to a written parliamentary question I tabled, I understand that there are no plans for a mental ill health strategy to be brought in. Given today’s debate, I wonder whether the Minister will reconsider that position. What are the Government’s plans on taking forward our suicide prevention strategy, or a specific psychosis or mental ill health strategy—however he wants to cut the cloth?

Secondly, when does he expect the Mental Health Bill to have its First Reading in this place? All Members are going to want to extensively debate and scrutinise that Bill. When does he expect it to come forward? What is his appraisal of the challenges that the Bill needs to answer when it comes to the interaction between the Mental Health Act 1983 and the Mental Capacity Act 2005 and the deprivation of liberty safeguards? What about the MM case on deprivation of liberty in the context of a restricted patient in the community, and the interaction with the Children’s Act 1989 on when children can choose a nominated representative? I realise he may not have the answers to that immediately, but I would be grateful if he could write to me. Community mental health teams are the core of psychiatric teams in the community and our psychiatric care and treatment service. What is his plan to support them?

Finally, what is his appraisal of integrated care systems and their commissioning of mental health services? The hon. Member for Hastings and Rye (Helena Dollimore) mentioned the challenges with her ICS. What is the Minister’s appraisal of that commissioning and how integrated care systems can be held to account to make sure that is being delivered?

[Peter Dowd (in the Chair)]

I want to give the sponsor an opportunity to wind up at the end. I call the Minister.

Medicines

Ben Spencer Excerpts

Monday 9th September 2024 Commons Chamber

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

It is not often that one speaks in this place on changes to the law that will have the direct result of saving lives, but once the draft regulations pass, as I hope they will this evening, we expect them to save many peoples’ lives. Today is a very special occasion. I do not say this to disparage people who work in the public health industry, but at its core, public health is not about flash or pizazz; it is about incremental changes that make a real difference to people’s lives, and have an ongoing, cumulative effect. Naloxone reverses the effects of opiate intoxication or overdose. It stops people from dying of accidental or deliberate overdoses of heroin and other opiate drugs, and opiate medications. It is quite literally a life-saving medication. Accordingly, it is one of the World Health Organisation’s essential medications.

Tomorrow is World Suicide Prevention Day, so I am pleased that we are supporting and debating a motion to expand access to and administration of a vital antidote to opiate poisoning. Suicide is the biggest cause of death in men under the age of 50. The stats vary, but while I was looking for the best and most recent data, I read that around three quarters of suicides each year are by men, and that suicide is the biggest killer of under-35s, impacting people from all walks of life. Many people are affected by such deaths. On World Suicide Prevention Day, we remember all those affected by suicide, and the work that we need to do to reduce suicides through public health measures and mental health service provision and treatment.

The use of highly addictive, lethal opiates, perhaps in combination with other substances, is often responsible for death as a consequence of drug misuse. In 2022, opioids were involved in 73% of drug misuse deaths in England, and 82% in Scotland. The last Government worked very hard to make progress on reversing the upward trend in drug poisoning deaths. Our 10-year, cross-departmental drugs strategy, published in 2022, aimed to prevent nearly 1,000 deaths in England by 2025. The naloxone roll-out has been highly effective in reducing drug misuse deaths by treating the effects of opiate overdoses.

There have been several regulatory changes that have expanded access in the last decade. Under the last Government, the Human Medicines Regulations were approved in 2012 to regulate the supply and use of drugs in the UK. That was followed by further amendments in 2015 and 2019, which focused on expanding access to naloxone for emergency use. The last Government then called on Dame Carol Black to lead an independent review of drugs policy. I thank Dame Carol for her work in this space, and indeed everyone working in this area, and those who contributed to our consultation earlier this year.

One of Dame Carol’s key recommendations was that more individuals supporting drug users be able to access and give out naloxone. I am pleased that she welcomed the proposals to expand access to naloxone earlier this year. When we launched a consultation seeking views on improving naloxone access through named services and professionals, as required by the Medicines and Medical Devices Act 2021, there was strong support. There were over 300 responses, of which a third were from organisations and over 200 from individuals and professionals. More than 80% were supportive of improving access through named services and professionals, and of introducing registration with a naloxone supply co-ordinator.

I am pleased that Ministers have followed the direction of the previous Government in legislating to expand access to naloxone to more healthcare professionals and services, as they want and need it. That will build on work across the UK to reduce the scourge of drug-related deaths caused by opioids. On this legislation, the Government will have the support of His Majesty’s loyal Opposition, and I encourage all colleagues from across the House to give it their backing.

Of course, I have a question for the Minister about training, which is critical. During my psychiatric training at medical school, a key thing instilled into my head about the use of naloxone is that it is a wonderful drug for the first 30 minutes, but then it starts to wear off. It has a short half-life—the time that it takes to leave the body—and then the effects of opiate overdose can start to reoccur, especially when we are talking about long-acting opiates, so although it fixes one problem, another problem is coming down the track. The patient must have adequate treatment quickly so that they do not suffer after effects when naloxone wears off. Can the Minister reassure me that for those involved in the administration of naloxone kits and aftercare—she mentioned families, and broader access for homelessness charities—the training component is as secure as possible, so that everything is done to avoid further drug-related deaths?

[Madam Deputy Speaker (Judith Cummins)]

I call the Liberal Democrat spokesperson.

Healthcare Provision: East of England

Ben Spencer Excerpts

Tuesday 3rd September 2024 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Christopher. I thank you for your comments about self-regulation. In the first Westminster Hall debate of the parliamentary term, especially as it is on healthcare, it is good to start off in the spirit of self-regulation.

I thank the hon. Member for Norwich South (Clive Lewis) for securing the debate, and for his speech, which was a tour de force. It was wide ranging, reflecting on socialist history. From the topics that he covered, and from his history of advocating for his constituents over the years, his deep-seated passion for delivering high-quality health services is clear, particularly as regards the cross-party campaign for a new dental school. He put a very precise question to the Minister, and I look forward to hearing her response. One subject that piqued my interest was the question of the NHS being in service of whom and to what end—particularly with reference to his points about the NHS being the greatest representation of socialism in the modern day. Dare I say it: I believe the NHS exists to serve the people, but the state does not exist to serve the NHS.

I was pleased that my hon. Friend the Member for Broadland and Fakenham (Jerome Mayhew) focused on the importance of productivity and on delivering tangible results to our constituents, as well as to hear about his support for the dental school. He was right to point out that the challenges of the Queen Elizabeth hospital and the rebuild programme, which I will return to.

I enjoyed the speech by the hon. Member for Lowestoft (Jess Asato), who again raised concerns about the James Paget centre and dental care, and the speech from my hon. Friend the Member for Mid Bedfordshire (Blake Stephenson), which covered his campaign for a new GP surgery in Wixams, which he is a very strong advocate for. He also made important comments on the accountability of integrated care systems.

I cannot cover all the speeches made today, but dentistry and delivery were the themes. We are all here because, as re-elected and newly elected Members of Parliament, we are passionate about delivering health services for our constituents. We want success on that both in our constituencies and across the UK.

In some ways, I think it is a bit easier for the Minister to make her speech than it is for me to make mine, and I wish I was on the opposite Benches—although obviously not in the Labour party—to deliver it. I anticipate that she will start by saying that, in some way, the economy is broken or that there are huge financial pressures. She will probably go on to say that the NHS is, in inverted commas, “broken”. I am quite concerned about that language, and particularly about the morale of our NHS workers when such statements are made.

The Minister will then describe her plans. That is where I feel for her, because she will be very pleasant and supportive, and I know she is passionate about the subject—she will recognise that this speech is very similar to the one she gave in a debate on dentistry back in 2022. Unfortunately, she will be evasive about her Government’s plans because she is on a bit of a sticky wicket. The Labour Government have decided that they will review a lot of work that has already been put in to deliver for people in the east of England. Hinchingbrooke hospital is at risk. Queen Elizabeth hospital, James Paget university hospital, Watford general hospital, West Suffolk hospital, Cambridge cancer research hospital and many other projects across the UK are under review, despite all the work that has gone into them over the years. It is on the Minister, because that is how integrated care system accountability works in our system under the Health and Care Act 2022—we are accountable to our constituents, but ICSs are accountable to her—so I ask her to reassure our constituents and the people who have put the work into developing those programmes that they will be delivered as promised by the previous Conservative Government. Will she think again about supporting dental vans to deal, on a temporary basis, with some of the dentistry challenges?

Oral Answers to Questions

Ben Spencer Excerpts

Tuesday 23rd July 2024 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

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

May I congratulate those on the Government Front Bench on their appointments? I should declare that I am a former NHS consultant psychiatrist, my wife is an NHS doctor and I participated in the Wessely Mental Health Act review. While I no longer have a licence to practise, I may gently correct the Minister in that it is possible to provide a prescription without a diagnosis. [Laughter.]

The Opposition are pleased that the Government intend to build on the work of Conservative Governments, kick-started by the former Member for Maidenhead, to reform the Mental Health Act 1983. We will work constructively with them to make such legislation as effective, fair and compassionate as possible. With that in mind, does the Minister intend to make changes to the code of practice to the Mental Health Act now so that non-statutory changes and protections can be enacted while the Bill works its way through Parliament?

[Stephen Kinnock]

I welcome the shadow Minister to his place and congratulate him on his appointment. It is a little bit rich to receive a question like that, given that the Conservatives had 14 years to address the issue; I have been in this position for 16 days. If he looks at the plan that we are bringing forward, he will see that we have more ambition and more boldness in our plans than what we have seen in the last 14 years. We will introduce legislation that will address those extremely important issues for people who have some of the more severe conditions.

To the shadow Minister’s specific point on a code of practice, the first step will be to see the legislative process moving forward. But, of course, we remain open to looking at any solution or reform that will help to address this extremely important issue.