NHS Capital Spending

Bobby Dean Excerpts

Wednesday 4th March 2026 Westminster Hall

[Bobby Dean (Carshalton and Wallington) (LD)]

I beg to move,

That this House has considered NHS capital spending.

It is a pleasure to serve under your chairship, Mr Western. I am grateful to have secured this debate on NHS capital spending. This subject goes right to the heart of how the NHS functions, and yet it is not discussed enough in this place. I had a look through some ministerial statements and questions in preparation for this debate, and I found that we often talk about staffing, specific illnesses, waiting times and other operational performance issues, but the simple truth is that all these challenges will be much more difficult to deal with until we improve NHS buildings, equipment and technical infrastructure. I get it: it feels much more impactful and immediate to talk about lifting nurses’ pay or commissioning a new medicine, and those things are important. But however arduous the process, or however far beyond our electoral terms the output of capital investment may be, it is vital for the long-term healthcare of our constituents that we fight for these slow returners, too.

[Lisa Smart (Hazel Grove) (LD)]

My hon. Friend is starting to make a compelling point. In my local area, Stepping Hill hospital has a reported repairs backlog of £138 million. That means, in practice, that only four of the 14 lifts are working, staff are having to physically take meals upstairs to patients, and family members with a mobility issue cannot visit their relatives on higher floors. Does he agree that, while we are talking about bricks and mortar, we are also talking about people and their quality of life?

[Bobby Dean]

I am grateful for the point my hon. Friend made, and I will come to make very similar points about the impact that maintenance backlogs are having.

It is partly because of the slow payoff of capital investment that we are in this mess. The last Conservative Government completely undermined the NHS’s future by overpromising, underdelivering and sacrificing long-term investment to plug holes in their mismanagement of the public finances. While capital underspends being plundered for revenue black holes is not a total innovation, it did accelerate under the Conservatives, with the most acute period seeing more than £4 billion raided from the capital budget in the five years up to 2019 to cover deficits in day-to-day spending. I note that that was prior to the pandemic, when operational pressures were clearly stress-tested to the limits, and I have no doubt that that under-investment left us more exposed than we otherwise would have been during that period.

The outfall is staggering. If we had simply matched existing levels of capital spend, more than £30 billion of additional capital would have flowed into the NHS. Instead, we watched buildings decay, equipment age, diagnostics fall behind and maintenance backlogs soar.

[Caroline Voaden (South Devon) (LD)]

Medical devices and equipment are increasingly becoming pressure points as trusts rely on ageing, life-expired kit. Torbay and South Devon NHS foundation trust has had fantastic results in bowel surgery from a free trial of a robotic surgery system that it was offered, but it cannot afford to buy the system because it has to replace other equipment that is on its last legs. Does my hon. Friend agree that the Minister should set out how the Government will ensure that NHS capital policy supports not just buildings and maintenance backlogs, but clinical equipment and the technology needed to deliver safe, high-quality, innovative care for patients?

[Bobby Dean]

My hon. Friend makes an excellent point: this is about not just buildings, but equipment and digital and technical infrastructure, all of which are crucial to getting the NHS to operate in the way it should. She also highlights how we need to upgrade ageing equipment to a very basic level, let alone take advantage of all the opportunities that the latest innovations in new equipment could provide us with, if we were able to purchase those.

I mentioned that maintenance backlogs are soaring. They have doubled from around £6 billion in 2015 to over £13 billion in 2024. The critical thing to stress is that it did not have to be this way. The UK invested around a third less in health capital during the 2010s than other comparable nations. According to OECD data, the UK has 10 CT scanners per 1,000 people compared with an average of nearly 20 per 1,000 across Europe. We have 8.5 MRI scanners per 1,000, compared with an average of 12 per 1,000 across other EU nations, and our bed capacity is pitiful. We operate at around 2.4 per 1,000 people, compared with an OECD average of 4.4. The issue has not only been a lack of money; it has also been a lack of certainty and flexibility.

The approvals process for capital bids is slow and cumbersome. Even when capital is available, trusts often receive final sign-off so late in the year that they physically cannot begin procurement, get survey work done and start construction in time. The money therefore goes unspent not because of poor planning locally, but because the system itself creates delay.

[James Naish (Rushcliffe) (Lab)]

On that point, my local authority is currently sitting on £50 million of developer funds that it was paid, but those funds are not being spent in the local community because there is not the total money needed to invest in health, infrastructure, schools and other things. Does the hon. Member agree that that is something we must look at, to make sure that money set aside for development is spent with urgency in our communities?

[Bobby Dean]

The hon. Gentleman highlights the complexity in putting together large capital projects. Funding is not often from one source. It is from multiple sources, and everybody providing the capital needs to have greater flexibility for the schemes to become deliverable, or the funds end up getting clawed back and put elsewhere, as has been done in the past.

The yearly cycle that I speak about is important because, in the past, capital departmental expenditure limits rules—Treasury CDEL rules—have meant that any unspent capital must be returned to the Treasury at the year end. Not being able to carry it forward punishes good financial management, prevents multi-year planning and leaves trusts scrambling to spend money before deadlines, rather than investing it strategically. The result is a system where underspends exist at the same time as record levels of urgent capital need. Trusts want to invest and start work, but the system ties their hands.

The effect of all that has not been abstract. The buildings maintenance backlog includes high-risk failures: operating theatres closed due to ventilation problems, leaks near electrical systems, sewerage failures and outdated wards where modern clinical standards simply cannot be delivered. A 2022 British Medical Association survey found that 43% of doctors reported that building conditions negatively impacted patient care.

[Alex Brewer (North East Hampshire) (LD)]

My hon. Friend is giving a powerful and important speech. Half the residents in my constituency are served by Basingstoke hospital, which was included in the now infamous promise of 40 new hospitals by 2030. Now it seems completion could be as late as 2046. The delay means another 20 years of spending taxpayers’ money on a building with leaking windows, exposed wiring, an uninsulated roof and countless other physical problems, with a bill that goes up and up every year to maintain that crumbling building. Does my hon. Friend agree that asking taxpayers to pay twice is a waste of public money, and Basingstoke hospital and others should have their rebuilds brought forward?

[Bobby Dean]

I do agree with my hon. Friend. I will come on to the new hospitals programme, as my constituency stands to benefit from it, too—if it comes soon enough. In the meantime, as she says, we are paying twice to pay for the repairs and patchwork, and never keeping up with the investment we need.

Ageing diagnostic equipment also means fewer scans, longer waits and more delayed diagnosis. Last year I had the pleasure of visiting my local hospital’s nuclear medicine unit, where I was shown a new machine that was driving down diagnosis times from hours to minutes. Obviously that is a fantastic sign of good capital investment, but when I spoke to the trust I was shocked to discover it is one of the only hospitals in the country with that particular piece of kit, and I thought to myself how much more productive the NHS would be if such equipment was rolled out routinely across the country as soon as it became available.

Then there is the infamy of poor IT systems. More than 13.5 million clinical working hours are lost every year due to poor IT. We have all heard shocking stories of hospitals running on Windows operating systems that we were talking to a paperclip on 20 years ago. As the age of artificial intelligence promises to transform the workplace, it would be great if the NHS could catch up with the last decade or so.

I recently met an AI developer who thinks they have come up with a solution to the elective surgery booking system. His system auto-calls patients and offers them a choice of appointment, making hundreds of calls in just minutes. They say it beats the old system on two counts. Patients usually receive a date by post without a choice, but the trial in the midlands saw “did not attend” numbers drop by 50%, which they put down to patient choice in the appointment time, and delivery was guaranteed because they had answered the phone. Think of the potential productivity gains if such technology was picked up at scale.

I have explained a little about the past state of NHS capital spending and will now turn to where the Government are today. Part of the reason for this debate is to find out where the Government think they are. It is worth saying that the Government’s stated intention has been a step in the right direction. There has been more certainty, more money and more flexibility. After the initial one-year capital settlement for 2025-26, with assurances that things would continue, the spending review confirmed capital budgets through to 2029-30. Those decisions will provide some stability, though it is still uncertain whether the Treasury clawback system remains in place on an annual basis or over the spending review period.

There was a substantial uplift of money in the year 1 allocations, but that is followed by a relatively flat commitment going forward, albeit at a higher level due to the initial uplift. I do not think we should be churlish about that—an increase in investment is inarguably good—but equally, we should not kid ourselves that investment is now at the required level. It does not fully address the inadequacy of past investment, nor does it bring it in line with international comparators. The King’s Fund has described the failure to reverse the historical underfunding by the previous Conservative Government as “extremely disappointing”. The NHS Confederation is asking for the commitment over the spending period to be doubled in real terms, from £3.1 billion to £6.4 billion.

There has also been greater flexibility, with Treasury approval now only required for capital projects in excess of £300 million, up from the previous, pitiful £50 million. The new delegated authority will cut out layers of bureaucracy and speed up delivery on the ground for ward refurbishments and equipment purchases. It will not address issues inherited in the largest NHS capital schemes, however, which brings me on to the new hospitals programme.

The programme was imagined by former Prime Minister Boris Johnson—I say “imagined”, because for some time the only place it existed was in his imagination. Conservative leaflets in my patch were emblazoned with a promise that the money had been secured for a new hospital building that would be delivered by 2024. I am sure that experience holds true for many in this room. When 2024 came, hardly a brick had been laid across the country. When the new Government came in, they told us no money had ever been allocated for those schemes.

The programme was reset by this Government, with an updated timetable and revised waves of projects. My local hospital’s building was put into the second wave, meaning that work will not begin until the 2030s, which was a bitter disappointment. Since the announcement of delay, things have gone a little quiet overall. A year or so on from the announcement, people are wondering how the programme is getting on. There are rumours that are some in the first wave are not keeping pace and could already be underspending allocations. Mostly, that is put down to the adaptation period of the hospital 2.0 model, an attempt to homogenise design across the country that is broadly welcome.

Any delays will spark questions about what will happen to that allocated spend. Hospitals such as mine will want to be at the front of the queue for any reallocation, if such an opportunity should arise. I have already mentioned my local hospital, but there is no clearer case of capital neglect than St Helier hospital in my constituency. It is as old as the NHS itself, overcrowded and cramped, and the specialist emergency care functions are simply not up to modern-day clinical standards.

Let me be clear: staff at St Helier are working heroically and patients are safe, but they are in a building that is not designed for 21st-century emergency care, with patients routinely treated in corridors. Key recommendations for improving service delivery simply cannot be implemented because there is physically not enough space. Despite tens of millions having been spent on basic repairs in recent years, the building is deteriorating faster than the trust can fix it.

The new hospital programme promised to resolve many of those issues with a new building for emergency and maternity care but, with that delay well into the 2030s, my constituents are left facing another decade of care in a building that is visibly past its lifespan.

[James Naish]

I am based on the outskirts of Nottingham, and already this year we have had three critical incidents at Queen’s medical centre, which is the main hospital in the city. They have all been based around A&E, and they were all the exact situation that the hon. Member describes. A&E has capacity for 350 patients, but it has routinely been seeing over 500. Does he agree that, in addition to the pressures he describes, there is a reputational risk to the NHS when such incidents are being declared because of physical capacity issues?

[Bobby Dean]

I agree with the hon. Gentleman, and I am sure that, like me, he hears constituents say that they do not want to attend their local A&E because they do not trust that they will be seen in time. I am sure that the figures he is describing are an undercount of the people who should be in there. Like me, he will have received emails about corridor care for some time. I had hoped that corridor care was a peak crisis moment and that it would subside, but it has become the norm and that is extremely worrying. It is not acceptable for patients, it is not fair on staff, and it is not a sustainable way to run our NHS.

If the Government are to reconsider which schemes should be in which waves of the new hospital programme, let me assure the Minister that my local trust is ready to go. Plans have been drawn up, land has been secured, and teams can move at pace. We need this, we want this, and we are ready. If that is not possible, but other pots of capital to be reallocated still remain, I make a separate plea: extend St Helier’s emergency department now. That is a smaller ask than delivering a whole new building, but it will make a big difference. The only thing more full than the corridors at my local hospital right now is my inbox, which is filling up with constituents describing their traumatic experiences.

St Helier hospital emergency department sees around 250 patients a day, with routine overcrowding leading to the trust being placed into national oversight measures. Kirsty, one of my constituents, was left anxiously waiting for her 83-year-old mum to be seen, witnessing elderly patients crying, vomiting, screaming and walking around in severe pain in the corridors. The father-in-law of Muhammad, another constituent, waited over 13 hours only to return home without seeing a doctor at all. Others have shared deeply personal details of their stories; their conditions were explained to them alongside countless others in the same corridor. It is undignified, unjust and unsafe.

The trust has come up with a plan. It believes that it can redesign the existing estate, creating a new urgent treatment centre and expanding the same-day emergency care service. By doing so, it would dramatically increase the number of patients it can see. The urgent treatment centre would be able to handle up to 30% of patients—up from 14%—and SDEC could get to 20%, up from 8%. That would prevent unnecessary overnight stays, free up hospital beds, speed up ambulance transfers, and reduce delays for patients needing hospital admission. The plan would also address £15 million of the trust’s ageing estates backlog. It is immediately deliverable; the trust believes that work can begin as early as autumn 2026. It would make an incredible difference, so I ask the Minister to make use of any influence she has over the matter to help the proposal get over the line.

Before I conclude, let me raise one further point about NHS capital expenditure that I suspect will not make me popular, but that I believe is right. The Government have tentatively re-entered the world of public-private partnership models with their announcement of neighbourhood health centres late last year. We all know how disastrous that model of financing was in the past, with the long-term costs to the taxpayer far outweighing the short-term benefits. Britain was among the first in the world to pilot such a scheme, and it failed fast.

It must be said, however, that other nations have learnt the lessons of our failures and successfully delivered social infrastructure at scale, on budget and on time. Indeed, I believe that is one of the reasons why we have fallen behind so badly. As a member of the Treasury Committee, I recently guested on a Public Accounts Committee inquiry into PPP, which concluded that if we get procurement, contract management, and the risk allocation of projects right, then we can massively accelerate the delivery of infrastructure in our country in a way that delivers real value for money for the taxpayer.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate the hon. Member on securing the debate. To summarise what he is saying, we need to better spend the money that is currently being deployed in the NHS. Does he agree that this has to be the underpinning feature going forward? More and more money has been poured into the NHS; we all think it is a fantastic organisation and praise those who work in it, but we need to spend that money better and modernise the monolith that is the NHS.

[Bobby Dean]

I agree with the hon. Gentleman, who hits on one of the central points of this debate. We can continue to pour money into the operational side of the NHS, but if we do not get the capital expenditure right and improve the equipment, systems and buildings, we will always be pouring good money after bad.

I know that PPP is fraught with political risk, particularly for a Labour Government who are scarred by what happened in the past, but I urge them to look at the National Audit Office’s report and the experience of others internationally. They should also listen to the NHS Confederation, which is pushing them to go further and experiment with different financial models for delivering the infrastructure that we need at scale.

NHS capital has been insufficient, uncertain and inflexible for far too long. The new Government have good intentions to improve on all three, but now is the first moment at which we can start to look at their delivery. After what I have outlined today, I would like to put several questions to the Minister. Will she update us on the current level of capital underspend under this Government? Where in the system is the underspend occurring, and what is being done about it? Will the Government allow trusts to carry forward any unspent capital to future years? Will that exist beyond the current spending review period? What assessment has the Department made of the delivery of the new hospital programme, and will any schemes be reconsidered for movement between the waves? Will the Minister outline whether the Government plan to reform the capital allocation system to allow multi-year planning and reinvestment of trust surpluses permanently?

The NHS cannot function without modern, safe and efficient infrastructure. No Government can deliver improvements in performance or productivity without addressing the capital crisis at the heart of our system. I urge the Minister to use this moment to reset the capital regime and put it on a footing that prioritises long-term investment, accelerates delivery and gives patients and staff the facilities they need and deserve.

[Several hon. Members rose—]

Brain Tumour Survival Rates

Bobby Dean Excerpts

Monday 9th February 2026 Commons Chamber

[Charlie Maynard (Witney) (LD)]

I thank the hon. Member for Mitcham and Morden (Dame Siobhain McDonagh) for securing this really important debate. She has been excellent in driving forward this issue, and is so determined. She demonstrates how to go after an issue and pursue it relentlessly. That is great, but ultimately, as she points out, words are pointless. We have a real problem here, and our loved ones are being taken down far too effectively.

My sister Georgie is alive, and I am very grateful for that. She was diagnosed with GBM two and three quarter years ago, and has had surgery, chemo and radio. The survival rates are not good. I resent the fact that we always have to churn out our own stories in this Chamber; that, it seems, is what counts. Yes, I am going to churn out my own story, but it is irritating that I have to. She has been brave as hell and utterly determined, and is up there with the hon. Member for Mitcham and Morden. Like her, Georgie takes no prisoners. She has gathered people to her cause and has never taken no for an answer. That is obviously to her credit, but more importantly, it has made a difference to this debate. Well done, Georgie.

I also give a shout-out to the hon. Member for Edinburgh South West (Dr Arthur), whose Rare Cancers Bill has made a real difference, and to Labour Front Benchers. I know that I am on the Opposition Benches, but I do not really care, because this issue is too important for us to mess around. I do not know about the Secretary of State, but I think he is interested. I do know about the Minister for cancer, who has her own story, and who stood up in front of a room of angry people. Those of us affected by brain cancer do anger quite effectively, and she has withheld it, despite having her own cross to bear. She has worked extremely hard in this area, and I am very grateful to her for that.

I am not going to rehash all the points that the hon. Member for Mitcham and Morden made so well, but we obviously have some very bad issues. Pinned in front of me in my office is a chart, with arrows going from left to right, which basically shows how survival rates for different cancers have changed over the last 40 years. Up at the top, there are testicular cancer and thyroid cancer, and down at the bottom left, with virtually no arrows, are pancreatic, brain, oesophagus and a number of other cancers. People do not believe that they will be able to change that situation; they are not spending any money on them, because they are really difficult. There is no point pretending that these cancers are not really difficult, and brain cancer is particularly difficult because of the blood-brain barrier. The body does everything it can to stop things getting into the brain, which is mostly good for us, but when it comes to treating a brain tumour, it is bad for us.

I am grateful for the national cancer plan, but we need more, and we should be taking steps to deal with that issue. The plan says:

“Some rare cancers, such as brain and pancreatic cancer, have stubbornly low survival rates—and few treatment or diagnostic breakthroughs. We need new diagnostic tools, research into biomarkers, and targeted therapies to achieve any major changes to survival.”

What we need on the back of the plan is a comprehensive, actionable strategy, with specific, measurable goals and targets, each with clear deadlines, so that we can ensure accountability in critical areas such as workforce recruitment and retention, infrastructure development, and incentives for pharmaceutical companies to develop drugs for cancers on which so little progress has been made. I get that the Minister has just published a plan, but I look to him to take this further and set out as concrete a set of goals as possible, with a clear timeline.

I will go through a few headings. On participation and research, the regulatory landscape is too restrictive. It often pushes families to seek treatment abroad, where clinicians have greater freedom to investigate novel therapies. A lack of accessible, up-to-date information is contributing to missed opportunities to partake in research. Although some registries exist, such as the National Institute for Health and Care Research’s “Be Part of Research”, they are often difficult to navigate—there are over 120 types of brain tumour to search for—and they quickly become outdated. The cancer plan states:

“We will make increasing research into rare cancers a priority for DHSC”—

the Department of Health and Social Care—

“and NIHR (with the support and oversight of our new national lead for rare cancers research).”

I would welcome the Minister providing further details on how he and his team plan to effect that.

[Bobby Dean (Carshalton and Wallington) (LD)]

My hon. Friend is talking about the importance of research and the low survival rates. This is, of course, a global problem and a global battle, but Britain has a unique opportunity to lead on this. Just last week, a £1 billion project was approved at the London Cancer Hub, centring around the Institute of Cancer Research and the Royal Marsden, two world-leading operators that want to expand this. Can he talk a little bit about how Britain has the opportunity to lead the world in discovering solutions to rare blood cancers?

[Charlie Maynard]

I thank my hon. Friend for that excellent intervention. I am going to talk out of two sides of my face here, because on the one side, the UK has a lot going for it, but on the other, it does not. Since Brexit, clinical trials in the UK are down 60%, which is really bad news. That is just business logic talking. Businesses say, “Why would I do my trial in the UK, when the market there is six times smaller than the EU’s? I’ll do it in the EU.” We are living this, and some of us are dying as a result. However, we just plough on, saying, “Never mind. That’s a bit of a mistake, but there we go.” It would be a delight to find a way through that, and to get our clinical trials up and running, exactly as my hon. Friend says. I do not have the answer to that one, apart from the obvious; I am really looking for that.

I come to whole genomic sequencing. The Minister understands the issue better than me; I remember him mentioning it when I was having a coffee with him just after I joined the House. I really like what the team are doing, so well done to them. However, brain cancer patients lack the legal right to request whole genomic sequencing of their tumours. Instead, healthcare decisions on genomic testing are made solely by clinicians. As a result, many patients are systematically excluded from genomic testing, which significantly limits opportunities for tailored treatment options, and potentially affects their prognosis. The Government really need to rectify this injustice. We are after whole genomic sequencing for everybody who has brain cancer.

Vaccine programmes do exist, and it is now time—I do not often do this—for me to be polite about the Conservative Government. They launched an ambitious initiative aimed at improving outcomes for all cancer patients: the NHS cancer vaccine launch pad, which is a great achievement. As the Minister has said, it is

“speeding up access to clinical trials for cancer vaccines and immunotherapies”.

However, brain cancer is not included on that platform, despite ongoing efforts to expand its scope to cover this disease. Furthermore, it remains unclear whether the pharmaceutical industry is fully aware of the platform. My question is: why are brain cancer patients still left out of this programme?

On workforce and infrastructure, the key to achieving the Government’s cancer plan is encouraging multidisciplinary teamwork among oncologists, neurosurgeons, artificial intelligence professionals, imaging experts and immunologists. The Government need to clarify how many—I am looking for numbers—new research, fellowship and training positions will be introduced across neuro-oncology, neurosurgery, neuropathology and radiography. What are the plans for setting up laboratories and trial facilities at major centres, and when are they expected to be up and running?

On tumour tissue, we have a real mess, and I am looking to the Minister for help in sorting this out, because it is a real thicket of legal and medical complexity. Tumour tissue excised from the brain really matters, but how is it stored, what consents are used, and what control does the patient have over it, not only when they are alive, but after their death? What are the rules around tumour tissue, because we have a whole load of tumour tissue around the UK that is locked down and not accessible for research? I think many of the families would be absolutely delighted if that tumour tissue was used for research. I ask the Minister to have a look at that. What I am really asking is for the Secretary of State or the Minister to convene a series of meetings with all the key parties—the Human Tissue Authority, the Medicines and Healthcare products Regulatory Agency, the NHS and anybody else he thinks needs to be in the room—to work through that issue.

We have made great progress on organ donation; the law changed a few years ago, and consent is now given by default. We have good laws on what happens to egg and sperm tissue, so can we try to get our laws for cancer tumour tissue up to date? I am wrapping up. Will the Minister give a commitment to improving public and patient awareness of consent, including for tissue use in research and treatments; ensure that clear, consistent national messaging is developed with experts, patients and carers about how consent works in cancer care; and ensure that there is support for the public giving advance, informed digital consent, rather than doing so at moments of crisis?

Baby Loss

Bobby Dean Excerpts

Monday 13th October 2025 Commons Chamber

[Bobby Dean (Carshalton and Wallington) (LD)]

I thank the co-sponsors for securing the debate and for all colleagues’ powerful contributions so far tonight. Many of those contributions have focused on preventable baby loss, calling for lessons to be learnt and for more to be done, which I fully support. However, I would like to take this opportunity to shine a light on the many occasions when baby loss is not preventable, but where I believe there is still more that could be done as a society.

Earlier this year, my wife and I had an early miscarriage. It was our first pregnancy and we were extremely excited when we got the positive test result. We were very quick to tell all our friends and family. We had no negative signs ahead of our 12-week scan, but during that scan it became quickly apparent that something was not right. We were asked whether it was possible that it could have been nine weeks. Then a second staff member came in and shortly after we were told that there was no heartbeat. We were moved to another room where we asked all the questions that I am sure many ask in this situation. Was there anything we could do? Is there anything we could do differently next time? We were reassured that, actually, it was extremely common, there was nothing we could have done, and that it happens to around one in four or five people.

On our journey home, we felt a bit silly for not knowing that fact and for not being prepared for how common that type of miscarriage was. We wondered why we had not been told in our early antenatal appointments that it was a possibility. We also wondered why we had not heard that so much from friends and family, or seen it in conversations on the TV. After that, we pledged that we would talk about it more.

After that moment, we were faced with some morbid choices: a natural miscarriage, the opportunity to take some pills, or some sort of surgical procedure. We were given a leaflet to think about it and off we went. We did not actually have the opportunity to make that choice, because shortly after we found out the miscarriage started to happen naturally. I can only say that I was not prepared for the level of brutality that that would entail. We were told that it might be like period pains, but it was much more severe than that for my wife and the volume of blood was unsettling. I could not believe it was normal while it was happening.

We started googling and looking online for advice, and we were lucky to find blogs by Tommy’s and other organisations that have been mentioned today, which provided us with some reassurance. However, we still ended up going to A&E because we were concerned about the blood loss. They gave us some reassurance, and we managed to go home with some medication and to get through that event. The follow-up from that traumatic incident in our lives was a simple phone call; we had to report a negative pregnancy test a few weeks later, and that was the end of the support.

Before I run out of time, I must add that we were keen to get on, and we have since got pregnant again. We have jumped that 12-week hurdle, and we are now aware that the chances of miscarriage have greatly diminished, so we are in a better place than we were. However, we are still wondering about what more can be done to provide reassurance to people in that really troubling moment.

I ask the Secretary of State whether we can record every miscarriage so that we can get firmer statistics about how often this happens. I ask him also to look at whether we can provide access for people 24 hours a day so that they do not have unsettling moments wondering if they need to attend A&E, and whether the mental health support that is in place after a third miscarriage could be in place from that very first moment, because it is a deeply traumatic event for anybody to go through. I think we need to talk about it as a society much more, so that the next couple is prepared.

Down’s Syndrome

Bobby Dean Excerpts

Wednesday 19th March 2025 Westminster Hall

[Bobby Dean (Carshalton and Wallington) (LD)]

It is a pleasure to serve under your chairmanship, Mr Turner. I thank the right hon. Member for Beverley and Holderness (Graham Stuart) for securing the debate today and for articulating the key points of the Act so well. I cannot move on without also thanking the hon. Member for Thurrock (Jen Craft) for her inspiring contribution. She really did her community proud today.

This issue came to my attention because I have a constituent called Lucienne who sits on the National Down Syndrome Policy Group and runs a local group called Get On Downs. I was at its annual celebration this morning—we had tea and cake, we threw balls around a ball pit, and I wore funky socks as demanded by the event—unfortunately, you cannot see them, Mr Turner, but I am still wearing them. I got to meet Noah, Lily, Stephen and Charlotte, all people living with Down syndrome and thriving in that loving space. I asked Charlotte what she would like me to say to the Minister, and she said she would like me to tell the Minister that she is fantastic—so I have done that.

I also spoke to parents there, who told me about the relief of having that space, including for themselves, so they could talk to other parents and share experiences. They also had some serious points to make about the Act, which they were all aware of. A common theme was the education system and that the specific needs of Down syndrome children are not being met, even though the smallest of adaptations and interventions can make such a massive difference. Schools are not aware of that and we need to get the guidance sorted for them.

I also heard a story about someone moving on to post-16 education and the demands on them to take maths and English to a particular level, when what they actually need is the vocational skills. They want to become an animal carer and wish they could just have access to a vocational course without the hard maths and English requirements. I also heard about the need for more support to stay in work. Charlotte did Christmas cover in retail, but companies were not looking to keep her on.

There were warm words for Lucienne—or Lu, as she is known—and she was described as a “life saver” for setting up that local group. She has also set up an amazing initiative with the local hospital trust. The healthcare information provided at birth can be daunting, warning about some of the things that parents of children with Down syndrome will have to face. Lu wanted to flip that on its head and provide care packages to new parents of children with Down syndrome that congratulated them and talked about all the joys ahead of them. I want to recognise that brilliant initiative.

It is fitting to give the last word to Lu, and these are the questions that she wants to ask the Minister. What is happening with the guidance, and why the delay? Will the Minister agree to meet the National Down Syndrome Policy Group? Can the Minister reassure us that the draft guidance will be Down syndrome-specific? Lu wanted to labour the point about the specific learning profile that requires specific interventions. She asks, “What is the point in a Down Syndrome Act if it is not specific to people with Down syndrome?”

Maternity Services: Gloucestershire

Bobby Dean Excerpts

Wednesday 9th October 2024 Westminster Hall

[Bobby Dean (Carshalton and Wallington) (LD)]

I thank my hon. Friend the Member for Cheltenham (Max Wilkinson) for introducing this debate. The experiences that he and others have shared about maternity services in Gloucestershire are similar to those in my constituency.

In Carshalton and Wallington, the Epsom and St Helier trust has an overall good rating from CQC. However, its maternity services have recently been downgraded to requires improvement, and, more worryingly, the safety element of those services was downgraded from good to inadequate following the inspection. A critical reason for the downgrade was the state of the building, which makes it hard for staff to perform their jobs efficiently and for patients to have the comfort of quality services. Some examples highlighted in the report were that the bereavement room was not soundproofed, the ensuite facilities had a shower curtain instead of a door, and, at the time of inspection, the two operating theatres opened directly on to the delivery suite corridor and were not secured, allowing anybody using the service to gain access to potential deliveries and surgeries.

A hospital that is crumbling, where three quarters of the building is not up to standard and where infection control is tricky because of the cramped conditions, risks tragic consequences for maternity care. It is an exhausting atmosphere for staff to work in and has led to low morale. What we need is urgent investment in the hospital’s infrastructure. A new building was promised by the previous Conservative Government, but so far it has turned out to be unfunded and we are waiting to see what happens with the forthcoming review. I am due to meet the Health Secretary in the next couple of weeks, and I will make it clear that it is essential to deliver a new building for both A&E and maternity services. Preferably that site will be at St Helier, which serves a densely populated area with greater deprivation levels and higher health inequalities, which are particularly pertinent to maternity care.

The building is not the only issue; the phoneline is also an issue. I have noted other hon. Members’ remarks, and as one Member mentioned, having the ability to pick up the phone and speak to somebody to get simple advice after a baby is born is critical, and that is not functioning properly in our hospital either. Another point I wish to make, on staff retention and recruitment levels, has been well made already. Our staff, too, are hard-working, dedicated and doing their best, but they are under immense pressure, which is leaving them feeling burnt out and fatigued. The bottom line is that there are simply not enough staff members to go around.

The CQC report for the St Helier trust highlighted a shortage of midwifery staff with the necessary qualifications in lots of critical areas, and it further noted that not all staff had completed all the mandatory training. We have spoken to the chief executive officer of the trust about that, and he explained that it is not because staff are unaware of the problem, but because they are simply so stretched that getting them through those courses while trying to maintain a minimum level of care for people coming through the hospital has proved impossible. Childbirth, of course, waits for no one, and in that high pressure, life and death situation, it is a matter of working with the available staff or having no staff at all. If we can get the recruitment and training of midwives right, we can go a long way towards solving the conundrum.

The consequences of understaffed and underfunded maternity care are dire. In recent years, there has been a stark increase in maternal mortality, rising from around eight deaths per 100,000 to over 13 per 100,000. Women from lower socioeconomic and ethnic minority backgrounds are disproportionately affected, being twice and three times more likely to experience maternal mortality, respectively. Those last statistics are particularly harrowing in constituencies such as mine. It is an urban constituency, and we have a higher than average number of women from both ethnic minority backgrounds and more deprived areas.

Improving maternity care must be a key priority for this new Government as they seek to address the overall crisis in our healthcare system. Giving birth has been one of the most dangerous medical procedures for women throughout history and nobody wants to give birth in a crumbling and potentially unsafe hospital where there are not enough qualified staff to help them.

If the Government are serious about improving women’s equality and closing the gender healthcare gap, the UK’s serious decline in maternity care needs to be addressed. That is why the Liberal Democrats have called for the UK Government to ensure that the commitments made in the NHS workforce plan are backed by adequate funding and include the expansion of the wider maternity and neonatal workforce. In the meantime, I will continue to fight for the upgrade in maternity services that my area so desperately needs.

Medicines

Bobby Dean Excerpts

Monday 9th September 2024 Commons Chamber

[Bobby Dean (Carshalton and Wallington) (LD)]

It is good to a hear consensus building across the House on naloxone because, as we have heard from other Members, it is a lifesaver. Since its roll-out in the UK, that highly effective antidote to opioid intoxication has doubtlessly saved hundreds of lives and prevented many more harmful overdoses, as organisations working in my community have known for some time.

On the day that my local branch of Cranstoun—the harm reduction charity—received its first supply of naloxone, staff members noticed that someone was overdosing in the reception area. They were still unpacking the pallet, but they were able to get access to the medicine, administer it, bring the person back around, and then help them further. Within an hour after that vital medication was received, it potentially saved a life in my borough. The local staff describe naloxone as a game changer. That is why I and the Liberal Democrats welcome this motion to expand access to that vital treatment.

Naloxone is not a difficult drug to administer: just 30 minutes of training can be enough to equip somebody to treat a person in need. Naloxone is also low-risk. The person administering it does not need to know for sure what drug someone is on: if they have taken an opioid, Naloxone will help; if they have taken something else, it will likely do no harm. The combination of it being easy and safe to use, along with its life-saving potential, means that, as long as the correct training is given, it is common sense to get naloxone into as many hands as possible. That is particularly true given the frightening rise of the use of synthetic opioids, such as nitazenes, in our country. Most people are aware of the dangers of one particular opioid—heroin—but the crackdown on supply in Afghanistan means that a new synthetic alternative is rapidly taking its place in the market. Nitazenes are estimated to be anywhere between 30 and 500 times as potent as heroin. That is scary. If we do not act fast, we could be dealing with a national emergency comparable to the fentanyl crisis sweeping across the United States. Although I welcome the measures, this urgency means that I must encourage the Government to think quickly about going further.

The expanded roll-out of naloxone to police, prison, probation and youth justice services is welcome, but I ask the Minister to monitor the success of that expansion closely, to listen to the organisations on the ground, and to keep under review whether it is practical and desirable to expand access even further. For instance, some charities have called for taxi drivers and nightclub door staff to be able to access if they want it. That would have to go alongside the appropriate training, so that they can recognise the effects wearing off in 30 minutes. If that training is in place, we should expand access further still. If we build the evidence base, we can be led by it and ensure that harm reduction measures reach as many people as possible.

Going further also means taking a whole-system approach to drugs policy—from appropriate sentencing to investment in addiction services and other specialist support for users. We have tried the tough talk and the war-on-drugs route in this country, but they have left us with one of Europe’s worst drug-related death rates. If we transferred the departmental lead on drugs policy from the Home Office to the Department of Health and Social Care, it would go a long way towards our recognising that our drugs policy should ultimately be driven by the desire to reduce harm and save lives. The Liberal Democrats support this measure to improve access to naloxone, and I thank the Minister for bringing it forward.