Department of Health and Social Care

Caroline Johnson Excerpts

Tuesday 24th June 2025 Commons Chamber

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

I congratulate the acting chair of the Health and Social Care Committee, the hon. Member for Birmingham Erdington (Paulette Hamilton), on securing this important debate. It is almost one year since the Labour Government took office. They came to power promising that they had a plan to improve our NHS. However, what they actually had was a plan to get a plan by launching a consultation asking professionals and the public for ideas. The consultation was launched in October last year, and I understand that more than 220,000 people have contributed, but despite it being promised for spring, there is still no sign of it. Will the Minister commit to publishing a plan before the summer recess?

While the Secretary of State considers what the plan should say, over in No. 11 we have seen the Chancellor follow the usual Labour playbook: higher spending, higher borrowing and higher taxes. There will be more funding for the NHS, yet as the chief executive of NHS England noted, the NHS budget is now equivalent to the entire GDP of Portugal, reaching £226 billion in 2028-29. That is around 50% of public spending. It is said that 18th-century Prussia was an army with a state attached to it; 21st-century Britain is at risk of becoming a health service with a country attached to it. This is not the Government’s money; it is taxpayers’ hard-earned cash, yet the Government have provided no clarity—no meaningful detail and no credible plan—on how such vast sums will be used.

In the autumn Budget, an additional £10.6 billion in extra funding was promised for 2025-26. However, Julian Kelly, NHS England’s former chief financial officer, told the Health and Social Care Committee that most of it will be consumed by pay settlements, the national insurance hikes and non-pay inflation. Today, 64% of NHS spending goes towards personnel wages and pensions, which is a far higher proportion than in other comparable systems, but the NHS still faces staff shortages and expensive agency costs. Will the Minister confirm how much of the overall funding will go to salary increases? How much will be diverted into covering the national insurance increases for hospitals, social care, pharmacies, GPS, NHS contractors and social care providers?

As we speak in this Chamber, resident doctors and nurses are balloting for industrial action. Strikes would only add to the disruption and delay in care for sick and vulnerable people. Do the Government have a plan to minimise the impact of strikes, should they occur?

Let us look at one proposal that the Government have announced: the scrapping of NHS England. This Government by press release announced NHSE abolition without adequate planning. Ministers have dodged basic questions about costs, staffing changes and structural reform. There is, once again, no plan. The details that we know about do not inspire confidence. NHS England has asked the ICBs to reduce their costs by up to 50% by October 2025. ICBs will have to cluster, with the number expected to fall from 42 to 27 in two years. Many have warned that services will be cut, and redundancy payments linked to those restructurings could reach £1 billion in 2025-26. Has the Minister costed that in the Department of Health and Social Care revenue settlement?

The Government promised to restore the 18-week hospital waiting time within this Parliament. However, their departmental modelling shows that only 80% of patients may meet that standard for routine operations. Will the Minister confirm that the Government will deliver that promise?

Moving on to capital spending, the Minister says that she wants to continue the new hospitals programme, albeit more slowly than we would have done, and invest in technology, but capital budgets remain flat in real terms. The chief executive of the NHS Confederation says that this leaves

“a major shortfall in capital funding”.

The Nuffield Trust said that

“it will be difficult for the NHS to invest in the technology and facility upgrades it needs to meet the government’s…targets.”

Will the Minister explain how they will prioritise, and what will be delivered?

The Government have said that they want to shift funding from hospitals to primary and community care. Will the Minister confirm or deny reports that the NHS 10-year plan will delay the planned increase in spending on primary community care until 2035, instead of 2029, as was originally promised? A key part of community care is social care, but as Daniel Elkeles, the chief executive of NHS Providers, noted,

“social care…hasn’t been given the focus it needs”,

and that is

“a significant blocker on progress for the NHS.”

Cross-party talks on reform have quietly been abandoned in favour of an independent commission led by Baroness Casey, but that process is not due to complete until 2028. Yet again, we see headline-grabbing announcements from the Government, with no delivery plan and no real reform, leaving patients, staff and families waiting for the care they desperately need. The Government aim to deliver £13.8 billion in efficiency savings by ’28-29, with more than £9 billion of that total expected to come from DHSC alone. Will the Minister clarify where, within the Department, those savings will be found, and what impact assessments have supported those decisions?

The Government say that prevention is better than cure, and I agree. A good example is the “Act FAST: face, arms, speech, time” campaign, which we will all be familiar with, but just last week, in an answer to a written parliamentary question, the Minister admitted that

“the Government have made reductions in the Department and NHS England’s communications and campaigns.”

Can the Minister tell us which public health campaigns are to be affected?

Finally, the dental contract requires reform. The Government started negotiations a year ago, yet the Public Accounts Committee has noted:

“NHSE and DHSC do not yet know what reform might look like or to what timescales it can be delivered”.

Will the Minister tell us when the Government expect to conclude negotiations and get on with dental reform? In summary, the Government need to stop governing by headline. They need to publish a robust evidence-based plan, and start delivering.

Care Settings: Right to Maintain Contact

Caroline Johnson Excerpts

Tuesday 24th June 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Butler. I declare my interest, as an NHS consultant.

I know from my own professional experience that hospitals and other care settings can be distressing places for patients and their relatives. Even with our excellent NHS staff on hand, patients want more assurance and familiarity while they undergo care and treatment. For many, that support comes from the family and friends who visit them during their hospital stay, or while they are in a hospice or receiving care in a care home. I pay tribute to the very many excellent staff who work in those settings and provide care around the clock and during public holidays, and put themselves out to care for others.

For residents, care homes are just that: their home. They should be entitled to have relatives and friends visit them as they would in any other home. Visitors also improve care. An inability to visit one’s relative in hospital leads to an increased feeling of not knowing how they are this morning—whether they are getting worse or better, whether they are in pain or are comfortable, or whether they can reach what they need to get. Relatives fear not being able to help the resident, and worry about whether they are lonely or stressed because they are not there to support them. That adds to the relatives’ stress.

The patient or the person in the care home knows that staff are busy and may not want to bother them for small things, such as reaching a book or their glasses, passing them a drink—which is so important for hydration—helping them eat a meal, moving the curtains so the sun is not in their eyes or providing an extra blanket. Instead, many wait hours for their relative to come. Sometimes, they just want a cuddle and to hold hands with the person they love. Clearly, that is in the best interests of their health and wellbeing.

Relatives know the person they are seeing the best, and are able to identify changes in condition that may go unnoticed by staff. I remember visiting a relative of mine who was getting better following surgery and was stepped down from the high-dependency unit to the ward. When I arrived, I realised that he looked grey, pale and unwell. He was indeed in shock and required urgent fluid resuscitation. I shudder to think what would have happened had that not occurred at the beginning of visiting time.

It was with those things in mind that the previous Government introduced the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and, in particular, regulation 9A. Like others, I pay tribute to my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) for doing so. The regulations were designed to ensure that patients staying in hospital or residential care settings could receive visitors in a fair and consistent way. They also aimed to ensure that care home residents would not face barriers or discouragement if they wanted to take their visitors outside, and they made provisions for those attending non-residential hospital or hospice appointments to have guaranteed rights for friends or family members to accompany them.

However, now that these regulations are in place, we need to ensure that they are working effectively and that systems are in place to detect any attempts to water down or remove the rights that they provide. I want to raise the exceptional circumstances limitation with the Minister. Members will know that the regulations grant visiting rights unless there are exceptional circumstances. The CQC guidance states that providers should base this assessment

“on the health, safety and welfare of people using the service or other people involved. This should include giving consideration to the appropriate balance of a person’s rights, the needs of people using their service and any identified risks”.

If concerns have been raised about current levels of compliance with visiting regulations, we must begin by identifying how and why this caveat in the rules is being used. Can the Minister tell us what kinds of circumstances private providers deem to be exceptional? Who is making these decisions and who is overseeing that process? The CQC guidance also states that where additional precautions or restrictions are needed, they should represent

“the most proportionate and least restrictive option”

that is available. Is the Minister confident that this principle is being followed, and what is she doing to provide transparency for patients and their carers about decision making?

In summary, can the Minister tell us how many times the exceptional circumstances provision has been used in the last year by each institution and how many visits or accompanying visits have been blocked as a result? Is she monitoring such blocking? What steps is she taking to ensure that those with reduced mental capacity have their rights to visits upheld?

It is important that these rules are followed. The vast majority of care settings provide excellent care, but the concern is that the better care settings are more open than others, and as the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) said, sometimes, visiting times may be restricted to cover up poor care, adding to the stress of the patient or resident and their carers. It is important that the Minister does what she can to improve the education and training of staff, and change the culture of settings so that everyone is able to receive the visits they need.

Some providers are even using the realms of infection control measures to exclude visitors. Surely, if infection control measures are frequently being used to restrict visiting, that is a red flag that the infection control measures in that institution are not providing adequate safety for residents. What steps is the Minister taking to ensure that staff follow the requirements placed on them and to make sure that individual providers are not being selective in their adherence to the rules?

It is clear from what we have heard today that more needs to be done to ensure that patients receive the visits and accompaniments that they are entitled to. If we are serious about putting patients and residents first, more needs to be done to guarantee them the social and emotional support that they need to be comfortable, as well as the best treatment or palliative medical care available.

As others have already said, the CQC is not able to prosecute for breaches of regulation 9A, although it can take action such as civil enforcement measures. Does the Minister believe that is a strong enough incentive for providers to meet their obligations, or does she recognise that increased enforcement powers might be needed to ensure that the rights of patients are protected? What other schemes has the Department considered to help providers to better facilitate contact and visiting arrangements?

I will finish by saying that I work as an NHS consultant paediatrician, and in paediatrics we always have open visiting for parents. Parents are really helpful in providing the care and looking after the children as part of a teamwork approach between parents and staff. Can the Minister say why such visiting arrangements are not available for people of all ages when they are at their most vulnerable, because I cannot see why they should not be? Indeed, I think that it would help quite dramatically.

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

Thank you, Ms Butler, for chairing this important debate at such short notice, and I thank my hon. Friend the Member for Liverpool Walton (Dan Carden) for securing it.

The Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), has asked me to pass on his apologies; he is unable to represent the Government in this debate as he is currently in session on the Mental Health Bill Committee. However, he joins me in thanking my hon. Friend the Member for Liverpool Walton not only for securing this debate, but for all the work he has done in advocating for relatives and friends to have the right to visit care home residents and patients in hospitals and hospices.

I also thank all those who have shared their personal stories and those who are in the Public Gallery today. I can say without hesitation that the Minister for Care and I agree with my hon. Friend on the importance of visiting in care settings. Contact with family and friends is a crucial part of a person’s care. Indeed, there is evidence that supporting people to be actively involved in their own care, treatment and support can improve outcomes and experiences for people receiving care. No one should be denied reasonable access to visitors when they are in a care home, a hospital, or a hospice. That includes receiving assistance from a care supporter or simply going for a walk with a family member or friend.

Before the covid-19 pandemic care homes, hospitals and hospices set visiting policies based on their specific local circumstances. During the pandemic, restrictions on visiting were implemented to prevent the spread of covid-19. Those restrictions were in response to clinical advice and were designed to protect people living in care or in hospital, who were often among the most vulnerable to the virus. Visiting and accompanying is one of the fundamental standards against which the Care Quality Commission assesses quality of care.

The Government recognise how important visiting is for the health and wellbeing of residents in care homes and patients in hospitals and hospices. We have monitored the position since the new fundamental standard was introduced in 2023. We know that the majority of health and care providers are facilitating visits and recognise their importance. The capacity tracker, a digital tool where adult social care providers self-report data, shows that 99.3% of care home providers are facilitating visits. That figure has been stable since September 2022. However, we also know that there are times when it is necessary for movement in and out of care settings to be temporarily restricted.

[Dr Johnson]

Can the Minister clarify what constitutes a visit in those circumstances? Would an hour’s visit once a week count, or is there a specific timeframe that qualifies?

[Ashley Dalton]

I do not have that data to hand, but I will make sure that it is provided to the shadow Minister afterwards.

While there is sometimes the need for temporary restrictions or modifications to minimise significant risks, the Government hope that such instances are a rarity. It is our aspiration to ensure that visiting policy and practice strike the best possible balance between individual wellbeing and public health needs. I have been really moved by, and taken note of, the evidence put forward by many Members that that may not always be the case.

The right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) talked about her experience with her mother, and brought to life the value that family and friends bring to the emotional wellbeing of the person being cared for and how, as partners in care, they play a key role in delivering that care.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 17th June 2025 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

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

Last health questions, I asked about delays to crucial medications in A&E and the Secretary of State said he was interested to hear more, but his office said he would delegate it to a Minister and we still have not been offered a date, so could I encourage him to look into that, please? The U-turn on winter fuel will help the elderly to stay warm and healthy this winter, but another way to help elderly people would be to protect them from the respiratory syncytial virus. Will the Government extend the vaccination to the over-80s?

[Stephen Kinnock]

I thank the hon. Lady for that question, but I did not quite catch the word she used. The virus was called? [Interruption.] Oh—RSV, yes. We are certainly looking at increasing the coverage of the RSV vaccination. I do not have the statistics to hand at the moment, but I would be happy to write to her on that point.

[Dr Johnson]

Many of those on waiting lists are elderly and have chronic conditions; rather than seeing consultants at regular intervals, which may coincide with them being relatively well, they are often kept on open appointments so that they can call when they are ill. This is efficient and responsive care. Is the Minister aware that this provision is being stopped in some areas in order to improve figures? I will quote from a letter about an elderly patient:

“I regret cannot keep him on my waiting list under the open appointment”

for treatment, and,

“I have explained the politics of everything and where we are at.”

Being re-referred to a GP each time is expensive and a waste of time. Can the Minister explain why doctors are being asked to make decisions for political reasons, instead of clinical ones?

Terminally Ill Adults (End of Life) Bill

Caroline Johnson Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Patricia Ferguson]

My hon. Friend makes a valid point. The point of my amendment, as I will come on to, is that we need to ensure as much scrutiny as possible in this regard.

From what I have outlined, this is clearly an exceptionally important post, which carries great responsibility and significant power; indeed, it seems the postholder will require the judgment of Solomon to be able to fulfil their role. It is therefore surprising that, as the Bill stands, there is no requirement for pre-appointment scrutiny by the relevant Select Committee, despite the profile of the post and the controversy it will inevitably attract.

Considering that such pre-appointment scrutiny is required for the chair of the Competition and Markets Authority, the chair of the BBC, the chair of the Charity Commission, the Information Commissioner, the chair of the Care Quality Commission, the health service commissioner for England, the chair of the Judicial Appointments Commission and the chair of the UK Statistics Authority, the omission of such scrutiny in this case is clearly a serious oversight, which my amendment seeks to remedy by ensuring that the correct Select Committee has the power of scrutiny.

In my view, we need to guard the rights and privileges of Parliament jealously. We must ensure that Parliament is involved in the scrutiny of this legislation going forward as much as we possibly can. The Bill itself requires this to be as rigorous and transparent as is possible. No matter what side of the debate we are on, it is important to ensure that the Bill is as strong and as good as it possibly can be; we owe it to the people who send us here—the people who have been writing to us in such great numbers. My amendment seeks to strengthen the Bill in respect of the voluntary assisted dying commissioner.

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

I refer right hon. and hon. Members to my entry on the Register of Members’ Financial Interests—I am an NHS consultant paediatrician.

The debate so far has focused primarily on ethical considerations, legal frameworks and who will be eligible—the who, the when and the why—but I want to focus my remarks on the how. As a doctor, I know that various drugs in different combinations can be fatal; in other words, there is more than one way to kill people. Which would be the best drug, if that is what we wished to do? Which would be the most comfortable, and how do we know?

Some forms of assisted dying use neuromuscular blockades, which, in common parlance, means that they paralyse the body. Imagine a situation where someone in a lot of pain is given such a drug; from the outside they would look relaxed and peaceful as their muscles relaxed, but inside they would be in a lot of pain, and unable to express that to anybody else. Do we want people to be comfortable and to know that they are comfortable, or only to appear comfortable to us? Clearly, we want them to be comfortable inside as well. We therefore need to have drugs that are properly understood and regulated for this purpose.

Assisted dying is often portrayed as safe, peaceful and controlled, but the reality in comparable countries where it has been legalised so far is more complicated. Technical difficulties frequently arise, leading to complications causing greater suffering, requiring intervention and potentially leading to a prolonged and painful death.

A report in The BMJ by Dr Suzy Lishman, former president of the Royal College of Pathologists—who, I should say, works at the same trust as me—showed that there is a lack of reliable data on the effectiveness and safety of the drugs used, largely due to inconsistent reporting in jurisdictions where such dying is legal. In Belgium it is estimated that only 52% of euthanasia cases are reported to the Federal Commission for the Control and Evaluation of Euthanasia.

During a Select Committee visit in the last Parliament to Oregon to discuss assisted dying, which I and two other hon. Members from the Labour Benches went on, we heard about the complications being unknown in 71% of cases. No healthcare professional was present when the drugs were given so we could not really know, and we did not even know if the drugs had been taken in some cases. Where we did, we found a history of seizures, vomiting and prolonged deaths. On having been given the drugs, patients in nine cases in Oregon in 2023 had reawakened later. How they felt in the intervening time is difficult for us to know.

In Washington, a 2018 report found that 31% of patients took more than 90 minutes to die. I also remind hon. Members that an absence of evidence that things are not going well is not evidence of an absence of things going wrong.

[Anna Dixon]

I thank the hon. Lady for so eloquently describing some of the variation in the use of drugs in the case of assisted dying. In normal practice we have a yellow card scheme, which allows for any adverse events from ingestion of prescribed medication to be reported. Is it her understanding that, under the current proposals, that would not happen for assisted dying? Is she also aware of a review that shows a great variation in the range and dosages of drugs used?

[Dr Johnson]

I think one of the key problems with this form of intervention, compared with others, is that we cannot ask the patients afterwards how that felt. We cannot get their feedback, because they are dead. If we are going to give them things such as neuromuscular blockers or sedatives, we may not be able to tell what they feel. There are physiological ways in which we can monitor patients and get some idea—perhaps in their heart rate or blood pressure—but we will not be doing that. That is, therefore, one of the reasons for my tabling the amendments, to ensure that the drugs are properly regulated by the MHRA, so that we know that they have been properly tested on the purpose for which they are to be used.

[Sadik Al-Hassan]

Will the hon. Lady give way?

[Lizzi Collinge]

Will the hon. Lady give way?

[Dr Johnson]

I do not have much time and I do not want Madam Deputy Speaker’s cough to return. [Laughter.]

If one examines the litany of drugs involved in other jurisdictions where assisted dying is legal, it makes for troubling reading. It is often an ad hoc cocktail of lethal substances, including sedatives, analgesics, cardiotoxic agents, neuromuscular blockers and antiemetics. There is no internationally agreed drug regime. Jurisdictions such as Oregon, Canada and the Netherlands use varying combinations of barbiturates, sedatives, opioids and antiemetics. In 2020, the official Oregon report stated that, compared with single barbiturates,

“All drug combinations have shown longer median times until death”.

As the Bill currently stands, doctors will have to consider prescribing untested drugs or drug combinations, which could potentially breach the General Medical Council prescribing guidance that a doctor must be satisfied that the drug serves the patient’s needs. To address some of those concerns, I have tabled several amendments.

Amendments 96 and 97 ensure that no drug can be approved under the Act unless there is a scientific consensus that it is effective and does not cause undue pain or side effects, and that it has been specifically licensed for that purpose by the MHRA. I cannot really understand why anyone would disagree with that.

Amendment 98 clarifies that the Secretary of State is not compelled to approve any drug if, after consultation, it is concluded that no substance is appropriate or safe enough to meet the standard.

Amendment 99, alongside amendment 100, mandates that before any regulations are laid before Parliament, a comprehensive report must be provided. That report must include time to death, possible complications including pain, and any likely side effect of the proposed substances. Again, I cannot see why that would be controversial, because surely we all want everybody to be fully informed and make fully informed decisions, and that is part of making an informed decision.

Amendment (b) to new clause 13 requires any medical devices for self-administration be approved by the MHRA and that the Secretary of State consult the MHRA before making any regulations. That is a basic safeguard that we would expect in any medical intervention, and it should be a non-negotiable condition here.

Finally, amendment 42 removes a time limit and therefore the pressure on the Secretary of State. I understand other people’s concerns about that. There is often a narrative that it will lead to patients being able to die at a time and in a place of their choosing. However, the regulations in the Bill require the doctor to stay with the patient from the moment the drug is given until they are dead. We have heard that that could take quite a long time. Do we really have enough doctors to do this at people’s homes at a time of their choosing? At the moment, I do not think we do, and I do not see how, in a short period of time, that will be achievable either.

[Mr Alex Barros-Curtis (Cardiff West) (Lab)]

I stand in support of new clauses 20 and 21, along with amendments 89 and 90 and 92 to 95, all of which are in the name of my hon. Friend the Member for Spen Valley (Kim Leadbeater). Colleagues need not fear—I will not speak to all of them.

I am a proud Welsh MP, and a lot of the debate today has centred on differences or confusion about the distinction on devolution on aspects of the Bill. Focusing on new clause 21 and consequential amendment 90, I pay tribute to my hon. Friend the Member for Spen Valley and to the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) for their work together on this issue to ensure that people in Wales can access the assisted dying process in the Welsh language, if that is their preference.

In the last few months, I have met with many constituents about this Bill, including medical professionals and palliative care consultants. One of their overarching concerns is a fear that the language barrier may inadvertently impact on the ability of a relevant person in Wales properly to access and understand the assisted dying process. I am grateful to those constituents, including Dr Siwan Seaman and Professor Mark Taubert.

Accordingly, new clause 21 and amendment 90 are important. They seek to replace clause 47 and provide Welsh versions of the forms for the first or second declaration, the report about the first or second assessment of a person, and the final statement. Further, they stipulate that where a relevant person informs the voluntary assisted dying commissioner that they wish to communicate in Welsh, the commissioner must take all reasonable steps to ensure that that wish is respected and that communications by the relevant assisted dying review panel are in Welsh. These are important amendments, as they are about accessibility and respect, ensuring that language is never a barrier to compassionate end-of-life care. They uphold the principle of linguistic equality, which is well-established in public services in Wales, and I trust that that should not be controversial to colleagues when they come to vote later on.

As a Welsh MP, I am pleased to see the inclusion of amendments 92, 93, 94 and 95. While they may appear to be small amendments, they are important. As my hon. Friend the Member for Spen Valley said, they fully respect the devolution settlement by ensuring that Welsh Ministers have all necessary powers on devolved aspects of the Bill—health—while retaining the powers of UK Ministers over aspects that are not devolved. I think that was slightly misunderstood earlier by some in this debate.

Taken together, the amendments provide clarity and legal certainty and offer reassurance to patients, clinicians and Government agencies in Wales. That principle should be uncontroversial. I know from my own discussions with the Welsh Government and the Welsh Health Minister that he is extremely grateful for the interactions he has had with my hon. Friend the Member for Spen Valley, and he is confident this measure is workable from the Welsh perspective.

New clause 5 seeks to mandate that the Secretary of State must, within six months, publish a report setting out the impact of this legislation on the civil procedure rules and probate proceedings. During the debate and the streams of evidence we have heard, I do not recall a suggestion that this Bill is likely to result in any serious changes to those specifically referenced matters. On the contrary, England’s CMO, Professor Sir Chris Whitty, warned against creating a “bureaucratic thicket”, saying that the best safeguards are the simplest ones. Let us keep that at the centre of our minds when we consider this legislation and avoid inserting amendments that are no doubt well-intentioned but would create such a thicket.

I conclude by sharing one story from a constituent of mine who was focused very much on safeguards, which has been the debate on all these amendments and new clauses.

--- Later in debate ---

[Stephen Kinnock]

I can confirm that it is absolutely the policy intent of the sponsor for that to be a backstop. The Government are working on that basis to ensure that it is a backstop and not a target.

Amendment 42 seeks to remove the four-year backstop. Although that is a matter for Members to decide, we note that if both that amendment and amendment 94, tabled by my hon. Friend the Member for Spen Valley, were accepted, nobody would have the power to commence reserve provisions in Wales. That would create major workability concerns for the service in Wales.

[Dr Johnson]

The advocates of the Bill talk about the point of choice and autonomy in the decision about when and where a person will die. Can the Minister confirm whether we have enough doctors to provide a service for people to die at home at the time of their choosing?

[Stephen Kinnock]

I refer the hon. Lady to the impact assessment, which is of course not a forecast but a set of scenarios. In it, detail is given on expected numbers and the capacity of the system to deal with the service.

Amendments 13 and 82 to 85 relate to the appointment of the voluntary assisted dying commissioner and panel members. The amendments would put the process for the appointments out of kilter with standard practice for public or non-judicial appointments and could significantly limit the pool of individuals available. Amendment 86 would give the panel the same powers, privileges and authority as the High Court, which are significant in scope and are set out across different court rules and legislation. It is unclear how those would apply to panels in practice. They may be unworkable given that the panel is not designed to be a court.

New clause 4 and amendment 28 would put various responsibilities on the chief medical officers for England and Wales. Imposing duties in primary legislation on an individual civil servant may cause difficulties in the future if the role does not exist or if the title changes. It is usual practice for duties in primary legislation to be conferred on the Secretary of State, who may decide to delegate to the chief medical officer.

I would like to briefly respond to a number of questions directly asked of the Government. The hon. Member for South Antrim (Robin Swann) asked about medicines regulation in Northern Ireland. The amendments will not affect the application of EU law; they will instead ensure coherence between the different legislative frameworks. The sponsor will lead engagement with the devolved Governments, supported by officials.

The hon. Member for Richmond Park (Sarah Olney) asked about the equality impact assessment. The EQIA considers the nine protected characteristics alongside socioeconomic background, geography and mental health. The hon. Member for West Worcestershire (Dame Harriett Baldwin) asked about the Suicide Act and advertising. I can confirm that encouraging or facilitating suicide will remain a crime under the Suicide Act. On advertising, new clause 14, if passed, would oblige the Secretary of State to make regulations prohibiting certain forms of advertising that promote voluntary assisted dying services. The exemptions to that, which may be provided under subsection (2), will not cut across the criminal offences elsewhere in the Bill or in the Suicide Act.

I hope that those observations were helpful to Members in their consideration of the technical workability of the amendments that we have debated today.

NHS Funding: South-west

Caroline Johnson Excerpts

Wednesday 11th June 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Dr Huq, and a privilege to contribute to this important debate. I congratulate the hon. Member for Torbay (Steve Darling) on securing the debate at such a timely point, following today’s spending review.

The focus on NHS funding, particularly in underserved regions such as the south-west, is welcome, so that every area of the UK is properly equipped to meet the healthcare needs of all communities. I, too, represent a predominantly rural constituency, so I am keenly aware of the unique challenges in healthcare provision facing remote areas. Geography should not be a barrier to treatment, but for many in the south-west and beyond, it still is.

We heard in the spending review today that the NHS will receive a substantial cash uplift. We must ensure this money is spent in the most effective way possible. We do not have the allocations yet, but can the Minister enlighten us on whether there will be an amount allocated particularly for rural healthcare. The spending review document talks about efficiencies of £9 billion to be achieved by the Department of Health and Social Care. Can the Minister elaborate on how those efficiencies will be achieved?

Much has been said already about the financial pressures facing integrated care boards. The Government’s proposal to restructure NHS clusters in the south-west into larger conglomerates is presented as a move towards greater efficiency, but care must be taken that this does not come at the expense of local responsiveness or patient outcomes. NHS England is legally required to assess the performance of each ICB annually and publish its findings. However, the Government have decided at the same time to abolish NHS England—a decision they took without a proper impact assessment.

[Fred Thomas (Plymouth Moor View) (Lab)]

The hon. Member mentions patient outcomes, but in Plymouth we have patients awaiting assessments for attention deficit hyperactivity disorder being left in limbo and unable to move forwards. Does she agree that the current refusal by some GPs to enter into shared care agreements is effectively blocking access to a diagnosis for adults pursuing ADHD assessments through the right to choose?

[Dr Johnson]

I would need to look at that separately and come back to the hon. Member on it, although he should perhaps direct his question to the Minister, as she has control at the Department at the moment.

The problem with cutting both the ICBs and NHS England is that it risks destabilising the very structures that are designed to deliver care simultaneously. The chief executive of NHS England has stated that legislation will be required to change the duties on ICBs. When do the Government intend to introduce the health Bill and, when they do so, can the Minister rule out the removal of the duty in the Health and Care Act 2022 requiring integrated care systems to commission dental services?

In paragraph 5.12 of the spending review, the Government say that 92% of patients will start consultant-led treatment for non-urgent health conditions within 18 weeks, but The Times has reported that the figure is closer to 80%. Can the Minister please clarify where the 92% figure has come from, and if she is unable to do so today, will she write to me?

Much of this debate has been about infrastructure. Since the last general election, Ministers have pledged to deliver the new hospitals programme in full, without caveats or conditions. However, in Torbay, for example, the rebuilding has been pushed back, with construction now expected to begin between 2033 and 2035. Thanks to the efforts of my hon. Friend the Member for South West Devon (Rebecca Smith), Ministers have given the greenlight to rebuilding Derriford hospital’s new accident and emergency facility. Can the Minister confirm if there are plans to bring any of the other projects forward?

Let me turn to national insurance contributions. The Royal College of General Practitioners has described the national insurance increase as,

“the straw that breaks the camel’s back, forcing them to make tough decisions on redundancies or even closing their practice”.

The Government’s promise to recruit more GPs is welcome, but hiking national insurance puts that pledge in jeopardy, as GPs will have no choice but to cut staff numbers. This is a false economy, so will the Minister use any of the money allocated today to help those services, such as GPs, air ambulances, hospices, pharmacies and others, that are affected by the national insurance contribution rise?

It will not have escaped Members’ notice that, despite the Chancellor promising that the NHS plan would arrive by spring, we are now at the start of summer—indeed, the Government promised that they had one before the election last year. Will the Minister provide some clarity on when we can expect this long-awaited plan?

Access to NHS Dentistry

Caroline Johnson Excerpts

Thursday 22nd May 2025 Commons Chamber

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

I congratulate the hon. Member for Great Grimsby and Cleethorpes (Melanie Onn) on securing this debate. Dentistry is important. Dentists do not just deal with our teeth; they deal with our mouth and gums, they identify physical diseases that include cancer and they prevent sepsis. Last month, I visited The Dental Design Studio in Sleaford to celebrate its 20th anniversary of great dentistry and I met some fabulous, committed professionals. Somewhat unexpectedly, given the venue, I was asked to help judge a cake competition. Members and my dentist will be pleased to know that I brushed my teeth very well afterwards.

Access to NHS dentistry has been a problem for a very long time. When I moved house in 2001, there was no NHS dentist available and I travelled two hours to Redcar to see the wonderful dentist Mr Dixon for many years until he retired. After that, there was no dentist at all. Are we therefore short of dentists? No, we are not. The Conservative Government increased the number of new trainee places and the number of new dentists, and although the population increased, there are still more per capita than in 2010. As the Minister for Care has said,

“The issue is not the number of dentists…but the paucity of dentists who are doing NHS work.”—[Official Report, 25 March 2025; Vol. 764, c. 766.]

I encourage the Minister for Secondary Care to consider more dental places, because we see that one in 15 of the youngsters who want to become a dentist is turned away and, as such, they go overseas to train or train to do something else. Will she commit to a dental school not just in Norwich, but in other underserved areas, such as Lincoln?

The main problem, as many have identified, is the 2006 contract with the UDA bands for procedures, and there are several issues with that. First, the amounts vary between practices based on historical volume data; secondly, there is a disincentive to treat new or high-need patients; and thirdly, the UDA simply do not cover all the costs. The Conservatives improved that a little bit, ironing out some of the bizarre UDA contract terms and setting a new, higher floor for minimum UDAs. Yet there is much more to do, as we have heard today, to reform it completely. How are the Government getting on with that? Will the Minister give us an update, please? As the Public Accounts Committee notes,

“NHSE and DHSC do not yet know what that reform might look like or to what timescales it can be delivered”,

beyond a vague assertion that some reform is imminent.

[Alex McIntyre]

Will the hon. Lady give way on that point?

[Dr Johnson]

I will not because there is not much time at all.

I met Eddie Crouch from the BDA recently, who talked about the national insurance costs. Before today’s announced pay rise, dental practices were facing a 9.5% increase in staff costs, again pushing more of them further to private practice. Will the Minister ask the Chancellor to exempt NHS dentists from the national insurance contribution rise? There has also been discussion about compelling dentists to do a proportion of their work in the NHS, either by compelling dentists who are newly trained or by incentivising with the use of student loan repayments. Have the Government considered that?

We have many overseas trained dentists—some are British students who were trained overseas, some are foreign nationals—but the overseas registration exam has 2,000 people on its waiting list. Somewhat bizarrely, those who pass can work in the private sector, but not in the NHS without supervision. That seems somewhat incoherent. Does the Government have confidence in the exam or not? It is illogical to allow a person to practise as a private dentist but not in the NHS. It is also a clear disincentive to NHS practice. What good discussions have the Government had with the General Dental Council about this issue?

My right hon. Friend the Member for Herne Bay and Sandwich (Sir Roger Gale) has repeatedly raised the issue of Ukrainian dentists. There are 200 Ukrainians dentists in the UK. Why not assess them and allow them to work? It is better for them and for us.

Dentists form part of a wider team of hygienists, nurses, technicians and therapists. What are the Government doing to help people in each of those roles practise at the top of their skill range to provide greater dental care? What are the Government doing to support rural areas since they cancelled the mobile dental vans? What are they doing to ensure they deliver the 700,000 promised appointments a year, since they have delivered hardly any of them so far?

[Sam Rushworth]

Will the hon. Member give way?

[Dr Johnson]

I will not give way because there is very little time.

It has been clear today that the NHS is not fit for purpose when it comes to dentistry. The Government need to get grip of this, and soon.

Chronic Urinary Tract Infections

Caroline Johnson Excerpts

Wednesday 21st May 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Desmond. I congratulate the hon. Member for Sutton and Cheam (Luke Taylor) on an excellent speech that graphically explained how this condition has a horrific impact on those who suffer with it. I also congratulate him on securing this important debate to raise awareness.

As we have heard, urinary tract infections are common infections affecting the bladder and kidneys, and the tubes connected to them. Anyone can get them, but they are particularly common in women. The NHS estimates that 14 million people in the UK experience some kind of urinary incontinence, too, a figure that is expected to rise due to an ageing population. Most urinary tract infections, although painful, clear up in a few days and can be treated with antibiotics.

The earlier a urinary tract infection is identified, and the earlier a patient can receive appropriate treatment, the more they will be able to manage their condition, maximise their quality of life and reduce the risk of chronic infection. For many, UTIs are not a fleeting inconvenience but a chronic, recurrent, life-limiting illness. Short-term antibiotic treatments fail, standard urine tests might not detect infections, and persistent symptoms can severely diminish a patient’s quality of life. I hope this debate will raise awareness of the issue of chronic UTIs, which some patients have said have shaped their whole lives.

We know that women are 30 times more likely to get a urinary tract infection than men, and that UTIs are agonising and occasionally fatal. NHS data shows that there were over 1.8 million hospital admissions involving UTIs between 2018-19 and 2022-23. UTI rates increase when women reach 45 and are in the perimenopause. Studies suggest that over half of all women will experience a UTI at some point in their lives, with many enduring recurrent infections. There are several physiological and hormonal factors that make women more susceptible to UTIs, including that they have a shorter urethra than men. Hormonal fluctuations during menopause lead to a decrease in protective vaginal flora, making older women more prone to infections. Pregnancy’s shifts in hormones and pressure on the bladder also exacerbate vulnerability.

The Chronic Urinary Tract Infection Campaign estimates that up to 1.7 million women suffer from chronic UTIs, yet as we heard, this is a neglected area of research—indeed, women’s conditions in general are not as researched and treated as they ought to be. The last Government recognised the need to target women’s health conditions specifically and launched the women’s health strategy in 2022, which was successful in tackling issues that disproportionately affect women. Will the Minister commit to the continuation of that programme?

I want to briefly discuss children—I should declare that I am a children’s doctor in the NHS. The hon. Member for Sutton and Cheam talked about his constituent, who was three when symptoms first occurred. Urinary tract infections are common in children; symptoms vary in severity and treatment requires different approaches depending on age, sex, and each individual patient’s condition. There are NICE guidelines on this issue, which also recommend imaging for children with UTIs, including a DMSA scan and an ultrasound depending on their condition. Can the Minister say what she has done to assess the number of children being treated for UTIs, the waiting times for scans, and whether there are sufficient radiology staff to both perform and report these procedures within the timeframes recommended by NICE?

The Government have recently pointed to research being carried out by NHS England, along with the industry, to horizon-scan for new innovations in point-of-care tests for diagnosing UTIs, in order to guide better treatment options. With the impending abolition of NHS England, will that research continue, and if so, who will now be responsible for leading it? In 2023, the Department of Health and Social Care, NHS England and the UK Health Security Agency launched a campaign to raise awareness of UTI symptoms and available NHS treatments. Will the Government continue that initiative, to ensure ongoing public awareness of UTIs and prevent hospital admissions? Has the Minister evaluated that campaign’s success in improving early detection, reducing hospital admissions and reducing the incidence of chronic UTIs?

For those suffering from UTIs, their first point of contact with the healthcare system is often their local pharmacy. Those services are conveniently located in the heart of many communities and are staffed by highly skilled professionals with years of experience under their belts. As we have already heard, the previous Government launched the Pharmacy First initiative, through which community pharmacists can treat women aged 16 to 64 with uncomplicated UTIs, offering rapid treatment and advice. A report from the Company Chemists’ Association in January 2025 found that nearly a third of all Pharmacy First consultations each week are for urinary tract infections.

What assessment has the Minister made of the impact of Pharmacy First on people affected by UTIs and other common conditions? My hon. Friend the Member for Farnham and Bordon (Gregory Stafford) has called on the Government to provide financial incentives for GPs to work with community pharmacies to support referrals into Pharmacy First. As the spending review draws near, will the Government consider that proposal, so that more people affected by UTIs can access support from Pharmacy First?

At the time of its inception, concerns were raised about the Pharmacy First initiative, relating to an increased risk of antimicrobial resistance to standard antibiotics. Now that it has been running for a year, does the Minister have any assessment of whether that is a risk that we should continue to be concerned about? The Chronic Urinary Tract Infection Campaign estimates that 20% to 30% of patients do not improve with initial antibiotic treatment. What research are the Government planning to carry out to see what further treatment can be offered to those patients?

The hon. Member for Sutton and Cheam raised the issue of NICE and SIGN guidance. I can say as a clinician that both are very useful to doctors and other clinicians in guiding their practice, and they are written by experts in the field. Does the Minister plan to speak to those running NICE about whether specialists in this field could come up with some consensus-based, evidence-based guidance on chronic UTIs? As we have heard today, that could support patients who are suffering terribly.

I want to touch on continence care. Adopting a personal, clinician-led approach to product provision can allow users to manage their conditions and lead to improved outcomes for both patients and the wider healthcare system. What steps are the Government taking to prioritise patient dignity and outcomes in continence care? The Government have also stated that support for those affected by UTIs is currently commissioned by integrated care boards. However, we know that ICBs are facing budget reductions of 50%, and many are planning to merge over the next two years. Can the Minister confirm whether the responsibility for supporting those affected by UTIs will remain with ICBs, or whether she intends for this function be transferred elsewhere?

To close, UTIs can be managed with increased public awareness of symptoms and treatment, early diagnosis, preventive measures, research and improvements in NHS care. We have heard how life-changing that could be for many, particularly women. All those factors could reduce the burden of chronic and recurrent infections and ensure that every patient receives the care they deserve. I hope the Minister will take all this into account, because she could help to alleviate the suffering of many women and other people.

NHS and Care Volunteer Responders Service

Caroline Johnson Excerpts

Monday 19th May 2025 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement regarding the volunteer and care service.

[The Minister for Secondary Care (Karin Smyth)]

I thank the hon. Member for giving me the opportunity to speak about this topic and highlight the important role that volunteering plays in our health and social care system. The NHS has always benefited from the generous contribution made by volunteers, who play a vital role in supporting our patients, staff and services. We are grateful to the thousands of volunteers who donate their time to support the NHS in a wide variety of roles, from helping patients to leave hospital faster and settle in at home, to supporting emergency cardiac incidents and providing companionship to patients during end-of-life care.

The national NHS and care volunteer responders programme was first established as part of the covid response, and then adapted to respond to other organisational pressures. However, a model that worked well in that national crisis is no longer the most cost effective way of facilitating the important contribution of our much valued volunteers, so NHS England has recently taken the decision to close the current programme. Instead, a new central recruitment portal for NHS volunteers will be fully launched this year, providing opportunities for the current pool of volunteer responders to continue to play their part. Volunteers will have had that information emailed to them recently.

NHS England will also work with NHS providers that draw on the support of the volunteer responders programme to ensure that they are helped in developing other volunteering interventions that meet their service needs.

The roles of 50,000 additional volunteers who are recruited and supported by NHS trusts directly will be unaffected by the closure of this programme. That is in addition to many more thousands of volunteers who support the NHS either directly or indirectly via other local and national voluntary sector organisations.

Successive volunteering programmes in the NHS are primarily run locally by individual trusts and integrated care systems identifying the best opportunities for volunteering interventions that meet their specific service needs. That means local NHS action to build relationships with voluntary sector organisations and co-developing volunteering programmes and pathways that support patients, staff and NHS services. There will continue to be opportunities to strengthen and encourage innovation in NHS volunteering at national level. The Government recognise the need for sufficient and agile volunteering capacity and capability of support in particular scenarios, such as pandemics and flu seasons, when the health and care sector is particularly stretched.

[Dr Johnson]

Thank you, Mr Speaker, for granting this urgent question. At the start of the covid pandemic, NHS volunteer responders were set up to support vulnerable people. Following its success, the previous Government expanded the scheme into adult social care, forming a joint NHS and care volunteers programme. That service has mobilised more than 750,000 ordinary citizens who have completed more than 2.7 million tasks and shifts, including more than 1.1 million telephone support calls, 1 million community response tasks and almost 400,000 steward shifts. I saw at first hand as a volunteer and doctor during the pandemic that NHS and social care teams benefit from volunteer support, and I put on record my thanks to all those who give up their time to support those around them.

Out of nowhere, the Labour Government have decided to cancel this service at the end of the month. No tasks allocated after 31 May will be completed, seemingly leaving patients in the lurch. Has the Minister thought about the real-world implications of the additional pressure placed on NHS local authorities, the loss of institutional knowledge and the impact on vulnerable patients? What alternative measures are being put in place to support the people who were supported by volunteers? The Minister said that something would be put in place later this year, but when? Why leave a gap? The telephone helpline is open only until 31 May, so what happens if people need support after that?

Will the Minister explain why the decision was taken so suddenly and which Minister signed it off? The volunteer website says that the decision was taken due to financial pressures, so can the Minister tell us how much the scheme costs? What is that cost as a proportion of the total NHS budget?

The Public Accounts Committee report published last week on the reorganisation of NHS England was damning. The Secretary of State said he would

“devolve more resources and responsibility to the frontline, to deliver…a better service for patients.”—[Official Report, 13 May 2025; Vol. 763, c. 1286.]

However, cancelling the volunteer programme takes services away from the frontline. This seems to be yet another example of Labour rushing into decisions without thinking them through properly, and yet another promise broken by this Government at the expense of the most vulnerable people.

[Karin Smyth]

The hon. Lady is right to highlight the tremendous effort that went into establishing the programme very quickly at a time of great crisis, and to thank the hundreds of thousands of volunteers across the country who took part and stepped up. It was a huge effort to get the scheme running and we were all very grateful for it. Everyone learned a great deal from that; as I outlined in my initial response, we will be taking forward those lessons as we look at the role of volunteering in the future.

The hon. Lady says that the changes have come out of nowhere; they have not. We are looking critically across the piece as we fix the foundations of our NHS and ensure that it is fit for the future. We are looking at the most cost-effective means of delivering the same outcome, which is why we will be moving to a centralised portal for part of this work. We have emailed people about that; some people may not have scrolled to the bottom of that email, where there is an option to push a button to register their details, so that they will be updated as new systems come online and we can make sure that we do not lose that great volunteering spirit. That is about digital techniques for the future, using the most cost-effective means and developing clear outcomes.

--- Later in debate ---

[Karin Smyth]

I thank my hon. Friend for what he has said, and I thank the Butterfly Volunteers. Supporting people at that really important end of life stage is hard and critical work, and I commend them for it. The local link is also critical: we need to ensure that people can be directed from the national system to local systems, through NHS England and perhaps—if it is appropriate, Mr Speaker—through the House. It is in the interests of local Members of Parliament for us to ensure that what we have learnt from the national scheme is continued into the local scheme, and, as my hon. Friend says, we need the local co-ordination and infrastructure about which we have heard this afternoon.

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

On a point of order, Mr Speaker. Notwithstanding the response to the urgent question that you were kind enough to grant, we still have no idea how long the gap in the service will last, or what will happen to the most vulnerable people who are using it. What other parliamentary mechanisms could I use to secure the answers to these questions?

[Mr Speaker]

I think that, in fairness, I cannot allow the debate to continue, which is what I think the hon. Lady is trying to tempt me towards. What I would say, however, is that I am sure that the good offices around her will give some very strong advice. I am sure that the Table Office and others will be able to advise her on how she can pursue this matter, and I am sure that those on the Front Bench have heard her point of order.

Draft Medical Devices and Blood Safety and Quality (Fees Amendment) Regulations

Caroline Johnson Excerpts

Monday 12th May 2025 General Committees

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

It is a pleasure to serve under your chairmanship, Sir Desmond. The draft regulations will make amendments to the Medical Device Regulations 2002, the Blood Safety and Quality Regulations 2005 and the Medical Devices (Northern Ireland Protocol) Regulations 2021.

The core changes made by the draft regulations will include modifying the fees charged to manufacturers, suppliers and relevant stakeholders involved in medical device approval and blood safety monitoring. These amendments will align with updated economic assessments on the operational needs of regulatory bodies. They follow an impact assessment evaluating both the financial implications and the potential benefits for healthcare providers and patients. The fee amounts set out in the draft regulations represent increases of between 9% and 16% in the majority of fees, but some fees, primarily those relating to clinical investigations, will rise more. The fees are being set in line with the consultation document issued by the MHRA on 29 August 2024.

I have a few questions for the Minister. First, the impact assessment states that the main benefit of the regulations will be the additional income gained by the MHRA, but can she elaborate further on the benefits for patients and innovators?

The impact assessment also states that staff costs are the major cost for the MHRA. Will the MHRA pay the rise in national insurance contributions announced at the Budget, or will it be exempt? If it is exempt, will that mean that it does not pay the extra fees, or will it be recompensed after the fact? If it is to be recompensed after the fact, will that be based on exact figures or on an estimate? Where recompense has been based on an estimate, as has happened in schools, it has fallen very far short of what is necessary.

It is critical to ensure that fees do not deter innovation, particularly among smaller medical device manufacturers, which rely on sustainable costs to continue to produce lifesaving technology. How will the Government ensure that the fee increases do not deter innovation, particularly for small and medium-sized medical device manufacturers? Could the Minister elaborate on how the fee adjustments compare with similar regulations in other countries? What measures are being taken to ensure that UK manufacturers remain competitive?

The aim of the draft regulations is to increase the fees in line with cost recovery. What is the Minister doing to ensure that the MHRA is efficient and that costs are kept to a minimum? Is she satisfied that the regulatory service provided for the money is adequate?

Page 3 of the impact assessment has caused me some confusion. It states that

“the MHRA assumes a 2.2% pay increase for each of the next three years (2024/25 to 2026/27)”.

I note that that is below inflation, which is currently running at 2.6%. Is it realistic to expect below-inflation pay rises, particularly with this Government? Does the Minister think that that figure will stand? If the fees do not provide for full cost recovery, who will foot the bill? Will the MHRA have to reduce services, or will the taxpayer have to provide more via direct grant to the MHRA?

Finally, what provision is there for surveillance to monitor the impact of these fee changes on healthcare providers and patients, and whether they are enough, too much or not enough for the MHRA to cover its costs?

--- Later in debate ---

[Karin Smyth]

I thank the hon. Members for Sleaford and North Hykeham and for Chichester for their comments, which I will try to address.

As I think everyone agrees, the MHRA provides essential services that play a crucial public health role, and it is important that it recovers its costs, which is what these fee increases are set to do. The main benefit of the draft regulations will be that patients and innovators have the faster and better-delivered service that has been committed to. I meet the MHRA regularly, and I will be meeting with the new chief executive and chair later this week to make sure that the improvement that we have seen recently continues. I know that the whole House is interested in that, because, like all regulators, the MHRA is a huge contributor to the growth that we want to see as part of our growth agenda. I expect patients and the industry to see the impact.

Recovering the fees is crucial. It is also right that the regulated bear the cost of regulation, rather than it falling to UK taxpayers to subsidise it. By supporting the draft regulations, we will ensure that the MHRA continues to contribute to the Government’s health mission, balancing the responsibilities to maintain product safety and to champion innovation. It has made progress in responding to the recommendations set out in Baroness Cumberlege’s independent medicines and medical devices safety review. It has listened carefully to the people who gave evidence and to the findings of the independent review team, which are a matter of concern to many Members and constituents across the country, as the Liberal Democrat spokesperson, the hon. Member for Chichester, quite rightly highlighted.

The MHRA is committed to bringing about the changes that have been identified and to achieving ambition to be a regulator that absolutely delivers for UK patients, as well as delivering at speed to give confidence to the industry. We absolutely do not want to deter innovation; that is why in the draft regulations we are making some changes to support SMEs, which may find regulation more burdensome. We will keep that under review.

We expect the organisation to look closely at staff costs and make sure, like all organisations, that it produces the efficiencies needed to deliver a good service.

[Dr Johnson]

Before the Minister concludes, could she answer my questions on national insurance and on below-inflation pay rises? If not, will she commit to answering my remaining questions by letter?

[Karin Smyth]

I am happy to answer any questions, but as far as I am aware, they are NHS-employed staff, so they will be dealt with in the usual way. I am happy to write to the shadow Minister with any specifics if that is helpful.

In conclusion, the draft regulations are important to ensure that the MHRA has the resources that it needs to continue delivering reliable services and its public health role. I commend them to the Committee.

Question put and agreed to.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 6th May 2025 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

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

Taking medicines on time is important, especially for those with conditions such as diabetes and epilepsy. Dr Acheson, an A&E consultant who has time-critical medicines for his own Parkinson’s disease, understands that well. He has been running a quality improvement programme to ensure that time-critical medicines are given on time in A&E. Will the Secretary of State lend that project his support and commit to reviewing how time-critical medicines are delivered on wards?

[Wes Streeting]

I thank the shadow Minister for her constructive question. I would be delighted to hear more about that initiative. She is absolutely right about timely access to medicines, and through a combination of service reform and the modernisation of technology, we can assist clinicians and patients to help them to manage their medication and ensure that people get timely access to medicines.

[Dr Johnson]

I thank the Secretary of State for that answer, and I would be delighted to meet him to discuss it further.

Unfortunately, when Labour negotiates, Britain loses. The Government capitulated to union demands with nothing in return. It is therefore of no surprise to anyone that within months, they are back in dispute with resident doctors and the British Medical Association has announced a ballot for strike action. What will the Secretary of State do to protect patients and taxpayers?

[Wes Streeting]

I will tell the hon. Lady what we are not going to do: we are not going to see £1.7 billion wasted on strikes by resident doctors or 1.5 million cancelled operations and appointments, which is exactly what happened on the Conservatives’ watch. Within three weeks, we ended the strike by resident doctors and we have cut waiting lists by 200,000 as a result. As I have said to resident doctors, their pay offer will be fair and neither staff nor patients want to go back to the bad old days of strikes under the Tories. They had an unwilling and incalcitrant Government under the Conservatives, who were unwilling to work with resident doctors, but we want to work with them to deliver better care for patients.