NHS Workforce Levels: Impact on Cancer Patients

Caroline Johnson Excerpts

Thursday 23rd October 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship this afternoon, Mrs Hobhouse. I congratulate the hon. Member for Wokingham (Clive Jones) on securing this debate.

Across the United Kingdom, an estimated 3.5 million people are living with cancer. We all know a friend, family member or co-worker who has battled the disease, and, sadly, we also all know of somebody whose life was cut short by it. Our country faces an ageing population, which will mean more cancer cases in the years to come; the longer we live, the greater the risk.

Troublingly, cancer rates are also rising among those in their 20s, 30s and 40s, so getting cancer care right today will mean the difference between lives saved and lives lost tomorrow. We know that the NHS cannot deliver timely, effective cancer care without the workforce trained to provide it. We owe it to patients fighting cancer today—and the 50% of us who will face cancer tomorrow—to fix the situation.

NHS staff are carrying out more cancer checks than ever before: more than 3 million a year in 2024, compared with less than half that a decade ago. In the last five years, we have also benefited from an increase in the number of clinical and medical oncologists in the NHS as well as of clinical radiology staff. Sadly, however, demand for services is fast outpacing the supply of staff, putting teams under immense pressure. Last year, more than 74,000 people in England were not treated on time for cancer, increasing their risk from the disease.

Formal training for medical staff begins at university. The previous Government increased the number of places at medical school, and increased the number of medical schools by building five new ones. This Government have said that they will increase the number of medical school places. Could the Minister confirm the places that they will fund for next September, bearing in mind that the application date has now passed?

The next step, postgraduate training, faces challenges too. The previous Government, as I said, increased medical school places. They also removed the resident labour market test because of the shortage of doctors. The Secretary of State appeared to understand back in Easter the effect that that was going to start to have, as the newly trained doctors came through their postgraduate training.

Over the last two years, the number of international medical graduates applying for training posts has also increased dramatically. The application ratio for postgraduate training posts has gone up substantially and there is a risk that some junior doctors will not get a job. There is also a risk that international medical graduates who get more of the places will return to their country of origin after they have completed training, so we will have unemployed British trainees and doctors who return after training, leaving us with a shortage of consultants in a few years’ time. That issue has been highlighted by the British Medical Association, of which I am a member. Sadly, it has announced that doctors will go on strike from 14 to 19 November this year, partly as a result of pay and partly as a result of job shortages.

The Secretary of State was vociferous in his criticisms of the previous Government when doctors went on strike. What will he and the Minister do to get the doctors back to work? Cancer treatment requires surgery, oncology, haematology, radiology, pathology and geneticists—every specialty across the NHS, including, sadly, paediatrics and sometimes even neonatologists.

There are also challenges across the nursing sector. We saw nurses this year coming out of nursing college with qualifications, but without the posts to go to. There is also a need for other allied health professionals—pharmacists, radiologists, laboratory staff, mammographers and research assistants. Will the workforce plan reflect this? When will it be published? Will it make projections about the population with cancer and will the Government publish those, too? The Government committed to more MRIs and CT scanners. How many new ones have they got in place? How well are they progressing with their targets?

We have heard about the importance of research today. Scientists are a key part of our cancer workforce. We heard yesterday in the Chamber about the challenges that the life sciences sector is facing. The £1 billion investment from Merck for King’s Cross has been shelved. The more than £200 million investment from AstraZeneca in Speke, near Liverpool, has also been shelved, and other investments are paused or mothballed. The industry is talking about poor Government engagement, employment regulations, increased employment taxes such as national insurance, and how they are increasing the voluntary scheme for branded medicines pricing and access payment rate.

What are the Government going to do to ensure that we have research in this country? Research is a real success. We have the best scientists in the world. We have cutting-edge treatment, trial drugs and novel approaches. Those are all more accessible earlier if they are done in the UK. They also provide good jobs for the British workforce. What work is the Minister doing with the Department for Science, Innovation and Technology team? What representation is she making to the Treasury to ensure that supporting research is part of the Government’s actions as well as messaging? Will the supporting research be part of the cancer plan? What support is the Minister giving to rare cancers, particularly those that are particularly lethal such as pancreatic cancer? What about brain tumours, where survival has shown little or no improvement? What focus will the cancer plan have on those?

I sat on the Rare Cancers Bill Committee. The rare diseases framework points out that one in 17 of us will get a rare disease during our lifetime. The current framework initiated by the last Government runs out in around three months’ time. Do the Government plan to replace it? If so, what with and when?

Sadly, as I said earlier, children and teenagers—young people—also get cancer, and they have particular needs as they go through puberty and young adulthood. The workforce therefore has to have particular strengths because of the work involved. I commend the work of the Teenage Cancer Trust and the work that my hon. Friend the Member for Gosport (Dame Caroline Dinenage) is doing. Can the Minister confirm that young people’s and children’s cancer will form an important part of the cancer plan?

Computer scientists will also be key to the cancer workforce. We have heard about the importance of AI. Computers can already identify skin cancer from benign lesions in many cases. The Health and Social Care Select Committee, which I was part of in the last Parliament, visited Stanford in California. We saw how AI was being used to look at mammograms and how, rather than using two doctors, they used one doctor and an AI computer. That was better than either two computers or two clinicians. What is the Minister doing to ensure that, from early education in schools, we are teaching the right skills to develop the right workforce for the AI of the future?

We are getting better at treating cancer, so thankfully there is life after cancer, but post-cancer care is important too. Some people live with things such as lymphoedema, amputations and stomas as a result of their cancer treatment. What focus does the Minister expect there to be in the workforce plan and cancer plan on those issues?

Palliative care is important for those who cannot be treated successfully and whose cancer cannot be cured, but hospices are in crisis across the country. The Government have given extra money for capital, and some for children, which is of course welcome, but hospices across the country are facing huge costs, particularly from the national insurance measures in the last Budget, and neither fund will cover that for adult hospices. Right across the country, we hear about adult hospices that are closing beds. What will the Minister do about that in her plan? How does she expect us to decide on the assisted suicide Bill when palliative care is facing such difficulty? What about the mental health workforce? It is important that people are supported through their cancer journey.

We had the 10-year health plan, with which came the promise of a workforce plan and a national cancer plan, but across the country the British people are waiting. They watch the Labour Government crafting glossy catalogues of intent but failing to deliver for our NHS. The time for planning and prevarication is over. I look forward to the Minister’s response.

--- Later in debate ---

[Clive Jones]

I thank you, Mrs Hobhouse, and the Minister for leaving me time to sum up the debate. I thank my hon. Friend the Member for North Shropshire (Helen Morgan) for her contribution and her kind remarks, and I thank other Members for their kind remarks as well. I thank all hon. Members who have contributed so much to today’s debate, each having special stories to tell about the areas they represent. All of them are fantastic campaigners for the cancer community.

We can all agree with the hon. Member for Strangford (Jim Shannon): we all hate cancer. In fact, I am sure everybody in this room today hates cancer.

[Dr Caroline Johnson]

Will the hon. Gentleman give way?

[Clive Jones]

I will make some progress.

I must also say a big thank you to all the cancer charities and life sciences companies that have provided valuable insight into the state of the NHS workforce and its effect on cancer patients. The impact of NHS workforce levels on cancer patients is a serious topic that needs to be discussed, and the experience of patients needs to be highlighted. Today has raised key demands for the Government to address.

The Government must increase endoscopy and pathology capacity. They should audit and invest in phlebotomy services, as called for by Leukaemia UK and the Royal College of General Practitioners. They also need to establish a national register of phlebotomy sites. The Government need to provide targeted support for the most deprived areas of the country, which are under immense pressure, and they need to replace doctors who they know are likely to retire in the next few years.

The Government must up their game on cancer. They have been left a very difficult legacy, with no money and no enthusiasm to change the way we deal with cancer, which is a really sad indictment of the previous Conservative Government. Finally, the Government must increase recruitment, training and retention; support primary care referrals; invest in diagnostic infrastructure and education; guarantee access to clinical nurse specialists; and prioritise support for patients with less survivable cancers.

Question put and agreed to.

Resolved,

That this House has considered the impact of NHS workforce levels on cancer patients.

Procurement, Slavery and Human Trafficking Regulations: NHS

Caroline Johnson Excerpts

Wednesday 22nd October 2025 Commons Chamber

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

It is a pleasure to speak in this debate on the draft National Health Service (Procurement, Slavery and Human Trafficking) Regulations 2025. I thank the Under-Secretary of State for Health and Social Care, the hon. Member for Glasgow South West (Dr Ahmed), for bringing forward the regulations and welcome him to his place at the Dispatch Box.

This important issue goes to the very heart of the values that underpin our national health service. It is a vast organisation—one of the largest in the world—with supply chains that reach across many sectors and many countries. With that scale comes a responsibility to ensure that the products and services we rely on to care for patients are sourced ethically, and that the health service does not, even inadvertently, contribute to exploitation or modern slavery.

As an NHS consultant, I know that the idea that any item used in the care of patients, from surgical gloves to hospital linen, could have been produced through exploitation or forced labour is abhorrent to all of us. These regulations seek to strengthen the NHS’s ability to identify, prevent and address such risks—an ambition that I am sure commands support right across the House. Indeed, this work began under the last Conservative Government. The Health and Care Act 2022 passed new regulations to address the risk of modern slavery in NHS supply chains, and in December 2023 we delivered a review into those risks, supported by NHS England, which examined where the greatest risks lay and how they could be mitigated. Although we welcome the direction of travel, there are, however, some important questions about how the regulations will work in practice and how we will ensure that the regulations deliver what is intended in a fair way.

First, what demands do we expect that the regulations will place on the NHS? They apply to all public bodies procuring goods and services for the NHS in England, including NHS England, hospital trusts and integrated care boards. Will each organisation have to make its own separate risk assessment? Has an estimation been made of the time that that is expected to take? How many people are expected to be required for organisations to fulfil the requirement, and what will be the associated cost? Will any mechanisms be put in place to prevent duplication, for example, where suppliers are already reporting under the Modern Slavery Act 2015?

Secondly, I turn to implementation and support. Regulations are not enough on their own; they must be embedded in practice. What steps will NHS England take to support procurement teams in applying these rules consistently and effectively and in maintaining the same standards across all the public sector bodies that are covered by these regulations? The regulations require NHS England to issue guidance, which is welcome, but how comprehensive will that guidance be? With NHS England being abolished, who will produce it? Will there be accompanying training and practical support for procurement teams to ensure consistency across the system? What will happen to a supplier if they are found to be non-compliant? Will the consequences be decided by NHS England centrally, or by individual trusts or ICBs? Will there be independent oversight to assess progress? With all the churn in NHS England and ICBs and the cuts to their budgets, how will they have the time and space to do that?

Next, I turn to the impact on business. The NHS relies on a wide range of suppliers, many of which are small and medium-sized businesses that bring innovation, flexibility and local expertise. Can the Minister confirm that the new requirements will not place undue burdens on suppliers or deter small businesses from bidding for NHS contracts? We must uphold the highest ethical standards, but we must also avoid creating unnecessary bureaucracy that excludes capable businesses from contributing to patient care.

Finally, I turn to the issue of co-ordination across Government. Many NHS goods are sourced internationally from complex and often opaque global supply chains. It is crucial, therefore, that our framework aligns with the broader cross-Government effort to tackle modern slavery, including at the Home Office and the Foreign Office. I would be grateful if the Minister outlined how those links are maintained in practice.

The question of co-ordination is not new. During the passage of the Great British Energy Act 2025, an amendment was introduced in the Lords to stop GB Energy from sourcing panels linked to forced labour. The Government’s initial position was that existing laws already addressed that risk, but later down the road, the Government heeded those calls by introducing their own amendment to block GB Energy from using slavery-linked solar. That episode shows how important it is to have clear and joined-up action across Government when addressing the risks of modern slavery.

The NHS should be a beacon of integrity as well as excellence. Patients and the public rightly expect that the care provided in our hospitals is not, however indirectly, tainted by the exploitation of others. The regulations are a step forward in ensuring that our health service lives up to that ideal. We welcome the intent and the ambition behind the regulations, but we will continue to push to ensure that they work in practice and without unintended consequences.

[Dr Ahmed]

I am grateful for the comments of the Opposition health spokesperson. Proportionality is the theme of the day when it comes to anything that we implement in the NHS at a global scale. The appropriate training will be provided. As the hon. Lady well knows from her time in government, conversations across Departments, particularly on these issues, are always ongoing. We are always willing and able to flex as we learn and as we feel our way through these regulations. The hon. Lady will recognise their importance and primacy when engaging in supplier contract negotiations, and therefore businesses both small and large can feel confident that, if they follow ethical procurement practices, their business is most welcome in the national health service.

I want to end by reminding colleagues that these regulations are not just about what we can do on these isles but what we can do to eliminate modern slavery across the globe. NHS England is one of the biggest buying organisations in the UK. We have a golden opportunity at the moment to leverage its purchasing power to influence supply chains not only in the UK and Europe but right across the world. Today, Parliament can send a clear signal to the world that we will not tolerate human rights abuses and that, if a company wants to do business with the NHS, they must get their house in order. Under this Government, there will be no compromise with the evil of slavery. I ask colleagues from all sides to help us to keep that promise, to back our NHS and its staff and to help us to keep this country’s conscience clean. I commend the regulations to the House.

Question put and agreed to.

Resolved,

That the draft National Health Service (Procurement, Slavery and Human Trafficking) Regulations 2025, which were laid before this House on 9 September, be approved.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 21st October 2025 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

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

I am concerned that the disruption caused by an uncosted, unplanned simultaneous reorganisation of NHS England and the ICBs is affecting patient care. Before the summer, the Joint Committee on Vaccination and Immunisation recommended that the RSV vaccine should be given to those over 80 and those in adult care homes. In July, I asked the Secretary of State to confirm that this vaccine will be available in time for the winter season, and he said,

“I can certainly reassure the shadow Minister on this.”—[Official Report, 22 July 2025; Vol. 771, c. 677.]

The winter vaccine programme started three weeks ago. Why has he not delivered on his promise?

[The Secretary of State for Health and Social Care (Wes Streeting)]

We have.

[Karin Smyth]

As my right hon. Friend has just said, we have delivered on that commitment. The hon. Member talks about the reorganisation being a distraction. If her party had focused taxpayers’ money on patient services rather than ballooning bureaucracy, with costs increasing both among providers and through ICBs, we would not have inherited the mess that we did, and would be able to roll out programmes more effectively. We have committed to doing that.

[Dr Caroline Johnson]

I thank the hon. Lady for her answer, but I would like her to check and perhaps update the guidance for GPs and the websites that continue to say that it is only available to 80-year-olds who turned 80 after 1 September 2024, which is not all people over the age of 80.

Reorganisation is affecting delivery elsewhere, too. The Secretary of State also promised that the continued roll-out of fracture liaison services would be one of his first priorities. How many new fracture liaison services have opened since the general election?

[Karin Smyth]

On the hon. Lady’s first point, this Government, unlike the previous Government, do believe in experts, and we follow the clinical advice that we are given. On her second point, as she is so keen on reading our manifesto commitments, the commitment was to do that by 2030. It is currently 2025. Our reforms to ICBs and providers, bringing NHS England inside the Department of Health and Social Care to make it more democratically accountable for taxpayers, will reverse the shocking increase in funding that the previous Government put into a leaky bucket. We are fixing the foundations of the NHS. We are targeting resources at people in line with our 10-year plan.

Points of Order

Caroline Johnson Excerpts

Tuesday 21st October 2025 Commons Chamber

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

On a point of order, Mr Speaker. I am concerned that the Health team may have inadvertently misled the House. In July, the Joint Committee on Vaccination and Immunisation noted that respiratory syncytial virus vaccines were so effective that they should be extended to all those over 80 and those in adult care homes. The Secretary of State reassured this House in July that the recommendation had been accepted, and provision would be in place for this winter. When I asked about that today, the Secretary of State said from a sedentary position that he had delivered on that promise, and the Minister for Secondary Care then confirmed that. However, Government and NHS guidelines still show that availability of the vaccine has not been extended. How can I ensure that the record is correct?

[Mr Speaker]

First of all, you cannot continue the debate, but you have certainly put that on the record.

Baby Loss

Caroline Johnson Excerpts

Monday 13th October 2025 Commons Chamber

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

Let me first draw Members’ attention to my entry in the Register of Members’ Financial Interests.

I congratulate my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) and the hon. Members for Rossendale and Darwen (Andy MacNae) and for Sherwood Forest (Michelle Welsh) on securing the debate, and on their eloquent and thoughtful speeches. Behind the statistics that I will put before Members, as others have done today, are the broken families with a gaping hole in their lives and a pain that will never go away. There are so many unanswered questions. What would their first word have been? When would they have taken their first steps? Who would they have grown up to become? For families who have lost a baby, these questions, painfully, tragically, will never be answered.

I have been honoured to meet representatives of charities all of which are doing excellent work to support families who have been affected by baby loss, and campaigning for improved maternity services. I pay tribute to those charities—including Bliss, Sands and Tommy’s—and to the royal colleges, and I thank the families in the Maternity Safety Alliance for sharing their very personal and moving stories with me when the shadow Secretary of State and I met them recently.

The last Government worked hard to improve maternity services. A decade ago, my right hon. Friend the Member for Godalming and Ash, then Secretary of State for Health and Social Care, announced an ambition to halve the rates of stillbirths, neonatal and maternal deaths in England by 2030, and he made encouraging progress. The stillbirth rate fell by about 20%, as did the neonatal death rate, and the maternal death rate fell by about a third.

[Gregory Stafford (Farnham and Bordon) (Con)]

Does my hon. Friend agree that the introduction of baby loss certificates following the pregnancy loss review under the last Government was a vital step in recognising bereaved parents’ grief and offering support on their terms?

[Dr Johnson]

My hon. Friend is, of course, right. Those certificates have proved to be of great comfort to many. The hon. Member for Washington and Gateshead South (Mrs Hodgson) talked about her work in that regard, and I thank her for it. I am also grateful for the work of my former colleague Tim Loughton.

One of the reasons I went into politics is the fact that one can make more of a difference as a politician than as a single doctor alone. The changes made by my right hon. Friend the Member for Godalming and Ash mean that, by quite some margin, he has saved more babies’ lives than I have as a consultant paediatrician. I assure the Secretary of State that it is not flattery when I say that he has more capacity than any NHS doctor when it comes to saving babies’ lives. I am pleased to see him here at almost midnight; I know that he cares, and I know that, like all of us, he wants to stop the tragedies about which we have heard so much today. However, I ask him to consider, every day, whether he is really doing all that he can to maximise the opportunity that he has, and, in the spirit of constructive opposition, I have a few questions for him. He said he came in with a plan, but in fact he took a year to create the 10-year plan, which creates a maternity and neonatal taskforce that is tasked with creating another plan. I sincerely hope that it is a good plan, after all this waiting, but I do worry that it has lost time, so can he confirm when it will be published?

Staffing levels have been mentioned in many tragic incidents, and the Secretary of State has promised that he will train thousands of additional midwives. Looking at the figures, an average of 10 fewer students have been accepted on to midwifery degrees in England across his two years in office compared with 2023. Can the Secretary of State confirm when he expects to train the 1,000 additional midwives he promised in his manifesto?

The previous Government increased the number of medical school places and built five new medical schools. As those students begin to qualify, the specialist training places need to be expanded and British graduates need to be prioritised. The Secretary of State seemed to understand that at Easter, but what has he done about it? The applicant-to-place ratio has risen dramatically, and now strikes are threatened, which would threaten the care of women and babies across the country.

We know that reducing baby loss starts before a baby is conceived and that factors such as teenage pregnancy, smoking, obesity and sub-optimally managed chronic conditions increase the risk of stillbirth. We must systemically improve on factors that increase the risk of baby death. I welcome the fact that the Secretary of State has brought through legislation, introduced by the previous Government, to fortify bread flour with folic acid by the end of 2026. That will prevent 200 cases of neural tube defects a year and improve the health of pregnant women. I am also pleased to see that the Tobacco and Vapes Bill is gradually making its way through Parliament. However, given that the Bill completed its Second Reading in the House of Lords on 23 April and is not due to appear in Committee until 27 October—more than six months later—there just does not seem to be enough urgency in the Government’s actions. Can the Secretary of State tell us what he is doing to improve pre-conception advice and optimise the management of chronic conditions in women to reduce the risk of baby loss?

As an NHS doctor, I pay tribute to my colleagues, who welcome almost 600,000 tiny miracles into the world each year. However, as we have heard this evening, care does not always meet the highest standards and too often avoidable deaths occur. Can the Secretary of State assure us that the findings of the ongoing Ockenden review into maternity services will be swiftly acted on? Donna Ockenden’s 2020 review into maternity care at the Shrewsbury and Telford trust found that at least 201 babies and nine mothers could have survived had they had better care. From her report came a £95 million ringfenced fund to improve the care available for expectant mothers, but as we have heard already this evening, the Government have slashed that fund from £95 million to just £2 million, with the rest of the money siphoned off to England’s 42 integrated care boards.

The Government have also reduced ICB budgets and are forcing them to restructure. I am worried that this un-ringfencing of the budget, and the distracting reorganisation, will have a negative impact on efforts to improve maternity services. What is the Secretary of State doing to prevent negative consequences?

Neonatal care can be lifesaving. One in seven babies in the UK requires neonatal care, but unfortunately their fight for life is not always won, and 1,933 babies died in neonatal care in 2023. With that in mind, will the Secretary of State clarify the extent to which neonatal services will be included in the maternity and neonatal investigation due by the end of the year? How will the quality of neonatal care be assessed? The recent NHS estates review of maternity and neonatal care did not appear to include parental accommodation, yet many parents find that their babies are transferred miles away for specialist care. May I urge the Secretary of State to recognise the value of this accommodation and make sure it is widely available?

As many Members have mentioned, black and ethnic minority women are more likely to suffer baby loss or maternal death. Can the Secretary of State update us on what progress he has made on his Government’s manifesto promise to close the maternal mortality gap for black and Asian women?

In the decade since the previous Government launched ambitions to improve maternity safety in the UK, the number of stillbirths and neonatal deaths has reduced by almost a quarter, and the number of maternal deaths has reduced by around a third. These are encouraging signs, and they show good progress. We must build on these achievements, but there is so much more work to be done. Today we have heard many stories of loss and of care failures. Only action will turn the page on baby loss. We all wish for improved maternity and neonatal care, but the Secretary of State is the man with the levers to make that happen—the levers to save hundreds of lives. I urge him to use them urgently.

Defibrillators

Caroline Johnson Excerpts

Tuesday 2nd September 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate the hon. Member for Bishop Auckland (Sam Rushworth) for securing this very important debate. I declare an interest: as an NHS consultant, I have used defibrillators on patients from elderly adults to very young babies—although, thankfully, their use on children is relatively uncommon.

Modern defibrillators are clever devices—they are capable of delivering varying joules of energy and of delivering synchronised shock, in line with the heartbeat, for cardioversion—but in their simplest, most common use, they deliver an electrical shock to the heart, essentially depolarising all the myocardial cells at the same time, allowing a reset moment, which hopefully allows the natural pacemaker to take over with a normal rhythm.

As we have heard this morning, that can be lifesaving. The survival rate for cardiac arrest is poor, and it is lower still for the 30,000 that happen outside hospital settings every year. According to Resuscitation Council UK, 9% of people who have an out-of-hospital cardiac arrest will survive to discharge from hospital, but research suggests that defibrillation within three to five minutes for those patients who need it can increase that figure to 50%. If we want to save lives, improving access to defibrillators is really important. I pay tribute to the community groups supporting and fundraising for their communities—both those mentioned today by various hon. Members, and the very many across my constituency and the wider UK that have not been mentioned.

I want to talk about the last Government’s work in this area. They instituted the community automated external defibrillators fund to allow town halls, parks and post offices to install defibs, and they matched it, based on an application form, to areas of rurality and increased need where there were less likely to be defibrillators. In 2023 the Conservative Government also supplied external defibrillator devices—more than 20,000 of them—to every state school across our country, making them much more available.

Many people, including my hon. Friend the Member for Solihull West and Shirley (Dr Shastri-Hurst), have talked today about the importance of education and making sure that people know how to do CPR. Others have talked about the success of CPR in individual cases. The previous Government added first aid and CPR to the national curriculum in 2020. Has the Minister been advocating for it to remain there, in the light of the current Government’s review of the national curriculum?

The hon. Member for Crewe and Nantwich (Connor Naismith) talked about the catastrophe that can occur when a defibrillator that is supposed to work does not. The 999 call handlers will direct people to the nearest defibrillator that they are aware of, but there is no national Government register of defibrillators. The British Heart Foundation’s The Circuit network collects data, which is provided voluntarily, that it can then provide to 999 call handlers and others. As part of that, it issues reminders to ensure that maintenance is done and that people are checking that the equipment is still in good order. Is the Minister happy with the current processes? Is she aware how many times a year somebody goes to a defibrillator that is not working, and what is she doing to minimise that? Maintenance requires battery and pad changes because of expiry dates, and machines need to be kept clean and checked after use. Is the Minister satisfied with the feedback loop for that? What is she doing to improve it? Medical devices regulations ensure that adverse events are reported. Can she tell the House how many people experience such events and what she is doing to minimise those?

I also want to talk about managed obsolescence. I was talking recently to a resus officer for an NHS hospital in England, who told me that every single defibrillator in the trust, which covers several hospitals, is being replaced because the company that makes the defibrillators that are currently used has stopped making spare parts for them. That has required the trust to buy a raft of very expensive new equipment. What is the Minister doing to ensure that spare parts have to be kept available, and for what period will they have to be available?

I want to talk about the safety of women. We have talked about health inequalities in this debate, but women are 28% less likely to receive CPR in a public venue—a shocking statistic. Why is it the case? Partly it is because when someone is doing CPR and wants to move on to defibrillate, the defibrillator pads have to be put on to bare skin. That means removing the clothing from the patient. It means exposing the chest. It may mean touching the breasts, to move them slightly out of the way to place the pads. People are uncomfortable and concerned about that, in some cases. In fact, in some cases they are concerned about the legal issues they may face if they do it but perhaps get something medically wrong. We need to ensure that that is not the case, and that people are aware. The mannequins that we use do not have breasts; they are essentially male mannequins. We have child and baby mannequins, but female mannequins are not in widespread use. What is the Minister doing to ensure that the 51% of the population who are female have the same access to defibrillation, and to reassure the public so that they are well educated in how to provide defibrillation to female patients and know that they can do so without fear of litigation?

My hon. Friend the Member for Broxbourne (Lewis Cocking) talked about Justin’s Hearts for Herts campaign. One change during my medical career was from ABC—airway, breathing and circulation—to catastrophic haemorrhage ABC in trauma cases. I am pleased to hear that, across my hon. Friend’s constituency, bleed packs are being made available. I want to thank the people from SHOCK Sleaford, North Kesteven district council and the Safer Lincolnshire Partnership, who have just completed fundraising and co-located four bleed packs across my local area. That means that people experiencing catastrophic haemorrhage, perhaps from a farming or vehicular accident, will be able to have their lives saved. Does the Minister have any plans to ensure that such bleed packs are located across the country, to improve the safety of people everywhere?

I was interested to hear what the hon. Member for Mid Dunbartonshire (Susan Murray) said about inhalers. There are arguments for provision of all sorts of things: inhalers and EpiPens come immediately to mind when thinking about how we can improve the safety of people across the country with access to things that can immediately save lives. Finally, as many hon. Members have mentioned in this debate, it is important to ensure that such devices are available without being taxed. Although I know that the Government like to tax, it seems counterproductive and counterintuitive to tax something that is potentially lifesaving, and that could even save the NHS money.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 22nd July 2025 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

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

Respiratory syncytial virus—RSV—is a common reason for attendance at A&E and admission to hospital among older people, and I have raised this repeatedly. Last week, the Joint Committee on Vaccination and Immunisation recommended that the RSV vaccine programme should be extended to the over-80s and those living in adult residential care homes. Can the Minister confirm that these vaccines will be available in time for this winter season?

[Wes Streeting]

I can certainly reassure the shadow Minister on this. The Minister for Public Health has already accepted that recommendation and is working at pace on implementation. May I wish the hon. Lady well in the Opposition reshuffle?

--- Later in debate ---

[Mr Speaker]

I call the shadow Minister.

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

Last month, the Government published their 10-year plan. It took a year to write, and it contains promises to make even more plans—a cancer plan, a maternity and neonatal plan, a workforce plan and an HIV plan—which we are still waiting for. Careful planning is important, but taking too long will delay improvements in care, so when do the Government expect to publish those plans and to start delivering?

[Ashley Dalton]

We are already delivering. The hon. Lady is absolutely right to identify that a number of plans are being brought forward. We take this matter very seriously, and we want to ensure that we get it right. We plan: we plan so that we perform effectively, and we plan for success. The national cancer plan will be coming later this year, and I am sure that we will be able to outline a timetable for all other plans. I assure her that planning is not doing nothing; planning is making sure that we get this right and that we deliver.

--- Later in debate ---

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

Tackling health inequalities requires a strong workforce. I recently met a constituent who is about to qualify as a nurse, but she has been unable to find work. She is not alone; this is a widespread problem. The reasons she has been given include recruitment freezes to save money and nurses brought in from overseas instead. We need more nurses to tackle health inequalities, so will the Secretary of State ensure that trusts are funded to support and employ new nurses, and to prioritise British nurses for British jobs?

[Wes Streeting]

I can certainly assure the shadow Minister that the chief nursing officer and I are working proactively to deal with nursing unemployment. We are also working with the leadership of the NHS to make sure that we are reducing our reliance on overseas workers. Grateful though I am to all the healthcare workers who come from overseas to work in our health and care services—the service would fall over tomorrow if they all left, so we should be extremely grateful—there is certainly an overreliance, and that is what we are addressing. I have to say to the shadow Minister, though, that both those issues are a result of appalling workforce planning, for which the previous Government bear a huge amount of responsibility.

Children’s Health

Caroline Johnson Excerpts

Thursday 10th July 2025 Commons Chamber

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

Before I start, I should declare my interest as a consultant paediatrician and a member of the Royal College of Paediatrics and Child Health, which the hon. Member for Stroud (Dr Opher) mentioned earlier. I congratulate him on securing this important debate.

Getting the right start in life is one of the most important factors in adult health and wellbeing. We must ensure that the NHS is providing the best treatments and preventive care available for children, while prioritising safety and convenience for patients and cost-effectiveness for taxpayers. I have seen significant improvements in paediatric care in my career. We must look broadly at the social and environmental factors that affect children’s health and ask what more we can do to help protect and prevent illness in children. Prevention is better than cure, which is one of the Government’s three shifts, with which I agree and on which I wish to focus today.

Often children brought to hospital to see consultant paediatricians have conditions that have been caused, or further complicated, by social and environmental factors. These are things that medics cannot treat on their own, and, as every professional knows, we must work with parents, families and children to achieve the very best outcomes. One very clear example is the childhood obesity crisis, which many right hon. and hon. Members have mentioned already this afternoon. Research shows that 36% of children in year 6—these are 10 and 11-year-olds—are now overweight or obese. I have seen some extreme cases in my practice—for example, a nine-year-old who weighed over 80 kg—of young patients who have suffered serious illness because of their weight. These are the tip of the iceberg, but they are undoubtedly part of a much broader shift.

We know what causes obesity: lack of exercise and a diet too high in calories. But this is more complicated than that. There are complex problems with roots in broader issues such as poverty and family work patterns. The Government cannot determine what each child eats, but there are things that they can and should do to help support parents and their children. What is the Minister doing to encourage exercise, participation in sport and active travel to school? What is she doing to improve the quality and availability of food for parents and families? What is she doing to improve the quality of school food, to build nutrition education into the curriculum and to help children learn about managing their own health and how to cook healthy food?

I know the 10-year plan includes reference to the reformulation of some products, but there is a risk that manufacturers encouraged to remove sugar from products will simply replace it with sweeteners and other chemicals. What is the Minister doing to ensure that they do not solve one problem and then walk unwittingly into another?

The hon. Member for Lowestoft (Jess Asato) mentioned tooth brushing. We often hear that tooth extractions are the leading cause of hospital admissions among young children. Can the Minister provide details on the steps that she is taking to improve youth dental outcomes, such as broadening access to NHS dentists, pursuing fluoridisation schemes and encouraging the use of fluoride varnish?

Parents have a responsibility here too. According to the chief dental officer, who I spoke to the other day, children who brush their teeth twice a day with a fluoride toothpaste, reduce the amount of high-sugar drinks they consume and reduce the sugar in their diet can significantly reduce the risk of needing fillings and having dental decay.

Another area raised today is mental health. Young people face mental health pressures from home and school worries, friendship concerns and many other factors. In particular, we know that the covid lockdown had a serious impact on children’s development and socialisation. We also know that social media is causing increasing harm to children—whether by contributing to anxiety about body image or personal achievements, or by exposing children to harmful material and ideas. The previous Government’s Online Safety Act 2023 was a welcome step in addressing some of these issues, but the Government rejected a Conservative amendment to the Children’s Wellbeing and Schools Bill to help reduce the use of phones in schools. What more does the Minister plan to do to encourage children away from their screens and back towards a healthier existence with their friends and families?

I also want to discuss neglect. A total of 25,350 children are currently on a child protection plan for reasons of neglect—a marked increase from 20,970 in 2014. Organisations such as the National Society for the Prevention of Cruelty to Children have highlighted the fact that numbers are typically underestimated in neglect cases, but we should not underestimate the harm caused to health and development by neglect. What steps are the Department and the Government in general taking to get a more accurate picture of neglect and to intervene on behalf of the children who are suffering?

One area of improvement is the balance of acute and community care, and, again, the Government have talked about this in their three shifts. We know the Government are keen to move acute care into the community, but does the Minister agree that we should ensure that core community care is available more widely and more quickly in the community first before giving them extra work to do? Too often in my practice I see children with paediatric problems who have been referred to hospitals because of long waits and capacity problems in the community. What steps is the Minister taking to ensure that there is enough supply in the community sector to deal with the problems that children face?

In summary, children’s health is a large and complex policy area. We know that we can make good progress when we treat these complex conditions with new research and novel treatments. We know that most children will get better—in fact, one reason that I enjoy paediatrics is that almost all the patients get better, because they are robust, resilient and great fun. We must help parents do things that help protect children’s health today and prepare those children to manage their own health tomorrow.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I now call the Minister, who has up to 5 pm, although we do need a few minutes at the end for the lead Member to wind up.

Alcohol and Cancer

Caroline Johnson Excerpts

Tuesday 8th July 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Stuart. I congratulate the hon. Member for Lancaster and Wyre (Cat Smith) on securing the debate, and declare an interest as an NHS consultant paediatrician.

We have a complex relationship with alcohol. On the one hand, it is a very social drug that is associated with celebration, religious observance in some cases, and small amounts of alcohol with meals. In other respects, it is an antisocial drug that is associated with violent crime, domestic abuse—particularly in cases of binge drinking—and, in some cases, addiction and dependency.

Does alcohol cause or increase the risk of cancer? Yes. We know it is metabolised into acetaldehyde, which can damage our DNA and reduce our cells’ ability to repair themselves. Alcohol changes chemical signals, particularly of oestrogen and insulin, causing increased cell division, and it increases the ability of the mouth to absorb harmful chemicals. It is therefore associated with seven types of cancer: breast, bowel, mouth, larynx, pharynx, oesophagus and liver.

Risk also increases with consumption: small amounts of alcohol are not as risk-provoking as very large amounts. The medical officers recommend a limit of 14 units of alcohol per week, shared over three-plus days a week, with some drink-free days. One in five people in the UK drink more than that. Risk is dose responsive. Education is important; we heard earlier that only 7% of people know that alcohol is a risk factor for cancer.

I was on the Tobacco and Vapes Bill Committee with the hon. Member for Winchester (Dr Chambers). I personally promoted the Bill very strongly, but smoking is different. It is exceptionally addictive and kills two thirds of users if used correctly, whereas alcohol does not have that level of risk for people who use small volumes of alcohol infrequently, and in most cases does not provide the level of addiction that nicotine does.

Life is full of risk. Obesity, processed food, ultraviolet light and infections all cause forms of cancer. Exercise is good for us, but again, it is not without risks to our health. I am not saying that we should not reduce the use of alcohol, but we must understand the risk in relative terms, and ensure that the population are educated about it and can make informed decisions about their lives.

In understanding that risk, evidence is important, so I have some questions for the Minister. What is she doing to improve the evidence that we have on the risks of drinking and the risks related to different levels of consumption? How does she intend to ensure that the public are able to make educated and informed decisions? The “Fit for the future” document published last week talks of labelling coming in on nutrition and calory content. When does she expect that labelling to appear on packets?

Hon. Members have talked about the number of units of alcohol that people drink. Many people do not understand what comprises a unit of alcohol and how to measure it relative to the different types of alcoholic drink. How does the Minister intend to improve understanding of units of alcohol?

I was shocked by the statistic in the “Fit for the future” document that 4% of people drink 30% of alcohol. That is a really shocking statistic, and it is worth repeating: 4% of people drink 30% of the alcohol in this country. There are, to my mind, two issues for the Minister to consider: how the Government can reduce the consumption of alcohol across the board and how they should treat heavy drinkers and dependent alcoholics.

Turning to the latter first, 4% of people drink 30% of alcohol and one in five drinkers drink more than 14 units per week. The hon. Member for Easington (Grahame Morris) talked about an alcohol strategy; I would like to know whether the Minister plans to develop one. One of the disappointing things about last week’s long awaited “Fit for the future: 10 Year Health Plan for England” document was that it did not contain the cancer plan, the workforce plan, the dental contract information or the HIV plan, which are all set to be published in due course. Perhaps an alcohol strategy could join them.

The previous Government rolled out alcohol care teams, which were designed to provide the patient and their family with hospital-based community support, as well as data collection and research. It was found that, for every £1 spent on alcohol care teams, £5 was saved. Those teams supported excessive drinkers and focused on those with the greatest need. Can the Minister talk about how she intends to support those with alcohol dependency and high levels of drinking?

Advertising is an interesting one. The newspapers trailed a suggestion that the Government would ban alcohol advertising. That was, perhaps, an informal U-turn, as it was trailed in the papers rather than announced to the House. We know from the evidence that alcohol advertising can influence brand choice, but it does not appear to affect overall alcohol consumption. Could the Minister enlighten the House as to whether that is why she dropped that measure? We need to be careful with the hospitality sector, which we know is reeling from the changes to the minimum wage and taxes such as national insurance contributions. We do not want people to be put out of business at the scale at which that is currently happening.

It is important to note that general alcohol consumption in the UK is steadily declining. Between 2019 and 2023, the alcohol sales volume in the UK declined by nearly 10%. Revenue from alcohol duty is also projected to fall by 5% this year, according to data from His Majesty’s Revenue and Customs. That shift is particularly observable among younger adults. Since the mid-2000s, there has been a cultural shift. Gen Z, as it is known, is the most teetotal generation in recent memory, and a quarter of 16 to 24-year-olds do not drink at all.

A study produced by KAM and Lucky Saint found that moderation of alcohol has also become a habit for UK adults, with three out of four adults who drink alcohol stating that they have been actively moderating their consumption across 2024. Although raising awareness of the health risks associated with heavy drinking is an important part of the strategy, we must avoid punishing responsible drinkers and damaging the hospitality industry, which is already under significant pressure.

NoLos, no and low-alcohol products, can currently be sold to under-18s. The Government have talked about banning that, which seems sensible to me when it comes to low-alcohol products, but how will the Government define a no-alcohol drink and when do they intend to introduce a ban? There is some evidence that no and low-alcohol beverages displace higher-percentage alcohol drinks, and therefore reduce alcohol consumption. What are the Government planning to do to increase sales of those products?

The previous Government were planning to change an EU directive preventing wine from being described as wine if it did not contain more than a certain percentage of alcohol. I believe that fell due to the general election. Do the Government intend to bring that proposal back?

Personally, I also welcome policies under which the Government plan to define no and low-alcohol products clearly, so that the public can be well informed on what constitutes “low” and “no” alcohol. I had presumed, before reading this, that no alcohol meant no alcohol, but it does not; it means a very low percentage of alcohol. It is important that people are aware of that.

The Government have rightly emphasised the importance of parity between mental and physical health, and socialising and being part of a community are vital components of positive mental wellbeing. Pubs and social venues play a central role in our communities. In a recent survey, 73% of respondents agreed that pubs in the area have helped to combat isolation; 72% that they have a positive impact in the communities; and 81% that they are important in bringing people together.

Ultimately, with more than 80% of the population consuming alcohol within Government guidelines, our focus should be on helping the minority who drink at harmful levels, and on improving decision making and education for those who drink at lower levels. We must work with industry to avoid policies that jeopardise the survival of community spaces, or lead to higher taxes for the majority of people who drink low levels of alcohol responsibly.

Rare Cancers Bill

Caroline Johnson Excerpts

Committee stage
Wednesday 2nd July 2025 Public Bill Committees

[Robin Swann (South Antrim) (UUP)]

It is a pleasure to serve under your chairship, Mr Stuart. I thank and congratulate the hon. Member for Edinburgh South West on bringing forward this private Member’s Bill, which will have life-changing effects for many individuals across the entirety of the United Kingdom. I applaud him for it, because I know some of the driving reasons behind him doing that.

I have a couple of points to make about the Bill. I am fully supportive of it, but I note the geographical challenge it brings. The Northern Ireland Assembly passed a legislative consent motion for clause 1 on Monday, so we are already stepping into line for this legislation. Much of the relevant work was discussed in the Northern Ireland cancer strategy, which was published in 2022 when I was Minister of Health there. It looked at our specific challenges with regard to research and clinical trials. At that point, cancer charities highlighted that only 15% of cancer patients in Northern Ireland are offered the opportunity to take part in cancer trials, compared with 31% across the rest of the UK. I hope the Bill increases awareness among Northern Ireland patients and cancer sufferers, and their families, of what is out there and their ability to take part.

The other concern often raised by some of my Northern Ireland colleagues—you are aware of this, Mr Stuart—is the EU implications. I can state that novel treatments do not fall under the scope of the EU, so hopefully any medication, treatment or supply that comes forward will be equally accessible and applicable to the entirety of Northern Ireland. The only difficulty and challenge we have in progressing the Bill’s other provisions is the legislation that allows Northern Ireland to use secondary data for cancer registries. I am aware that the current Health Minister in Northern Ireland, who is my party colleague, has a one-clause Bill ready to move forward to rectify that.

I wanted to make that small contribution in support of the work done by the hon. Member for Edinburgh South West in bringing forward the Bill. It has been a pleasure to serve on this Committee.

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

It is a pleasure to serve under your chairmanship, Mr Stuart. I congratulate the hon. Member for Edinburgh South West on bringing forward this very important piece of legislation. I declare an interest as a consultant paediatrician who has looked after a number of children with rare conditions such as teratoma, rhabdomyosarcoma, Wilms’ tumour and retinoblastoma, to name but a few.

One of the issues with rare cancers, which transposes to rare diseases in general, is that they are often diagnosed late, because people do not recognise that they have symptoms of a rare disease and their health professionals are not as familiar with them because they are rare. The presentation and diagnosis are then late and, as such, the treatment is more difficult. That is compounded further because there has been less research on those topics, so it is not clear what the best treatment for those conditions is. On top of that, the patient may have to travel very long distances to see a specialist who is familiar with the condition, adding both logistical difficulty and cost to that patient’s care.

Some steps are in place to try to improve the situation. The orphan drug regime gives market exclusivity for 10 years, and it provides for lower and refunded fees from the Medicines and Healthcare products Regulatory Agency for the services it provides. Nevertheless, it can still be non-commercially advantageous to put money into developing a drug that is going to be used on no more than a handful of people, however beneficial it is for the individuals concerned.

I welcome the Bill, but wish to make a couple of points. First, in principle it is best that trials are first broached with the patient by a member of their healthcare team. Of course, a member of any given healthcare team—I speak as one myself—will never be aware of all the trials available to all patients at any one time. I welcome the Lord O’Shaughnessy review—commissioned by the last Government and accepted by the current one—which talks about getting a consensus on how best patients can be informed of trials. I wonder whether we should have a system in which patients opt out of not the trial itself but being asked about trials. At the outset, they could be asked, “Would you like to receive information on trials—yes or no?”, so that more people can be aware of how they can contribute. When people are diagnosed with something rare, they often want to contribute to helping others who will come after them.

Will the Minister tell us more about the national cancer plan, which was consulted on earlier this year? I welcome the fact that the children and young people cancer taskforce, which was paused, is being reinstituted. Also, how will the Bill apply to repurposed drugs? Sometimes new medicines are developed for a particular condition, but we often find that medicines can be reformulated and used in a different way to provide a different form of treatment to help individuals with a different condition. How will that apply in respect of both the measures in the Bill and the O’Shaughnessy review?

As a paediatrician, I am very pleased that the Bill applies to children. Overall, I think the Bill is great. It offers hope for many in the future. Will the Minister say something about other rare conditions? As well as rare cancers, people get other rare conditions, and they are affected by the same challenges with research and treatment, and by delays in diagnosis and travel.

Overall, doctors are able to save people’s lives, and improve people’s lives, one at a time, but Parliament and research offer the opportunity to do that on a much bigger scale. I am very grateful to the hon. Member for Edinburgh South West for what he is doing today.

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

It is a pleasure to serve under your chairmanship, Mr Stuart. I congratulate my hon. Friend the Member for Edinburgh South West on his Bill reaching Committee stage. That is a huge achievement for any colleague, but especially for one who has served in this place for almost exactly a year to the day. The Government welcome contributions from Back Benchers, we welcome effective scrutiny from Committees, and we value the vital role that Parliament plays in holding us to account.

In April, my right hon. Friend the Prime Minister announced that clinical trials would be fast-tracked to accelerate the development of the medicines and therapies of the future. Through this new drive, patients will have improved access to new treatments and technologies. We see the Bill as contributing to that ambition. We want to go further for patients with rare cancers, and this legislation will act to incentivise recruitment, oversight and accessibility of rare cancer research, so that NHS patients are at the front of the queue for cutting-edge treatments.

Clause 1 will ensure our regulatory competitiveness. It places a duty on the Government to publish a review of the legislation around orphan drugs within three years of the Bill becoming an Act. The review will examine our legal framework and compare our approach to that of our international partners. We want the UK to lead the world in this space, as the prime destination for clinical research.

Clause 2 will raise the profile of research for rare cancers by placing a new duty on the Secretary of State for Health and Social Care to facilitate and otherwise promote research in this area. The Government want to give patients greater choice and control over their healthcare, and rare cancer patients should have access to research if they choose.

The clause also ensures that the Government will develop a bespoke registry service for rare cancers, to be delivered through the “Be Part of Research” programme—our groundbreaking research registry service provided by the National Institute for Health and Care Research—and that we will appoint a national specialty lead for rare cancers, which we will designate within the NIHR research delivery network, who will have oversight of the overall rare cancer studies portfolio in England.

The Government are committed to going further for rare cancer patients, and that means making clinical trials more accessible. Clause 3 will introduce an innovative solution to allow rare cancer patients to be contacted as quickly as possible about clinical research. The clause creates a new power to allow patient data to be shared from NHS England information systems.