World Stroke Day

Caroline Johnson Excerpts

Tuesday 28th October 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Vaz. I congratulate the hon. Member for Twickenham (Munira Wilson) on securing this important debate.

Strokes are life-threatening medical emergencies that affect more than 100,000 people in the UK every year, taking over 38,000 lives and leaving many survivors with life-changing disabilities. A study in The Lancet Healthy Longevity estimated their annual cost to be £8 billion, comprising public spending on care and lost economic productivity. The number of cases is rising—in England, stroke admissions increased by 28% from 2005 to 2024—and, as the Stroke Association has said, demographic reality makes it all the more urgent for the Government to take action today to improve stroke care and reduce modifiable risk factors. As we have heard, when stroke care is delayed, the typical victim loses 1.9 million neurones for each minute they are untreated. Of course, delay is measured not just in brain cells, but in lost independence, lost potential and, all too often, lost lives.

The Government cannot just acknowledge the challenge; they must act. The previous Government designated stroke as a national priority area in the 2019 NHS long-term plan, with several commitments to improve prevention, treatment and care. We set out to increase the proportion of people receiving clot-removing thrombectomy to end their stroke, improve post-hospital stroke rehab models for patients, and enhance the Sentinel Stroke National Audit Programme. That important work was led by a network of 20 integrated stroke delivery networks, which were established in 2021, with a national service model setting out best practice. The previous Government also invested more than £57 million in mechanical thrombectomy, and by the end of 2023, 24 centres were open and delivering mechanical thrombectomy across England. Do the Government have a delivery plan to create more of those centres, or do they think there are enough?

Prior to the general election, the previous Government began work on a major conditions strategy to improve the prevention, diagnosis and treatment of six major conditions, including stroke, but rather than see it through, this Labour Government chose to take an axe to progress, pausing the scheme in August 2024 and, a year later, announcing a service framework for cardiovascular diseases in the 10-year plan. Have the Government incorporated the strategy’s findings in the 10-year plan? The plan mentions stroke just twice, and only in the context of smoking and obesity.

I am pleased that the Government have shown an interest in reducing modifiable risk factors. Prevention is always better than cure. Those categorised as obese face an elevated risk of stroke—64% higher than those of healthy weight—and one in five children leaves primary school obese. We spoke about obesity in this morning’s debate, but I did not get answers to most of my questions. I appreciate that the Minister is covering for someone this afternoon, but will he undertake to get answers not just to the questions asked in this debate, but to those asked in this morning’s?

I am encouraged to see Ministers showing an interest in furthering the previous Government’s work to tackle smoking, a habit to which one in four strokes is directly attributable, but it seems to be taking quite a long time. Just yesterday, health leaders warned that more than 120,000 young people have started smoking since the Tobacco and Vapes Bill was introduced. Will the Minister assure us that the Government will prioritise the Bill and pass it without delay?

High blood pressure remains the single biggest risk factor for strokes, and it is generally asymptomatic, which is why it is so important that tests are carried out in locations that are convenient for people. Last year, community pharmacies in England delivered more than 140,000 blood pressure checks and diagnosed nearly 11,000 cases of hypertension. As the Government complete the latest round of pharmacy negotiations, will the Minister commit to expanding that service further, so that pharmacies can detect more cases and prevent more strokes?

The Government’s delay to the NHS workforce plan is particularly concerning. We need enough doctors to train to perform thrombectomy and care for patients, and enough physios, occupational therapists, nurses, speech therapists and so on to support rehabilitation. After the Government cancelled the major conditions strategy last summer, their 10-year plan promised a service framework, as I said. Given that they have now delayed the workforce plan, the cancer plan, the neonatal and maternity plan and the HIV plan, will the Minister assure the House that they will not also delay the service framework for cardiovascular disease? We need action and not just words, so will the Minister explain what the Government have done materially to improve early stroke diagnosis since they came to office?

Stroke care is not only about medical interventions. For many survivors, recovery starts when they return home and have to re-learn to walk, speak and carry out daily tasks, so access to physiotherapy, occupational therapy, speech and language therapy and other support is vital. How do the Government plan to improve that provision, and what are they doing to provide psychological support to the families of stroke victims and victims themselves, especially in cases where there is a change of personality or emotional disturbance?

Prevention is better than cure. Work on smoking, obesity and high blood pressure are important. In the event of a stroke, every minute counts. Every minute the Government spend perfecting plans instead of putting things into action is a minute of suffering that could have been spared.

--- Later in debate ---

[Dr Ahmed]

My hon. Friend must have read my mind. As I was saying, our plan is only for England. Hon. Friends have already articulated the fact that in Scotland, despite the best efforts of clinicians in Glasgow, Edinburgh and Dundee, there has not been the ability—or the intent from the Scottish Government—to bring forward a proper 24/7 stroke thrombectomy service. That means that the time of day that Scottish patients have a stroke determines the outcome. They are literally being dealt a roulette wheel of care: 20th-century care out of hours and 21st-century care within office hours. It is simply unacceptable, and the UK Government stand ready to assist the Scottish Government in any way, shape or form they require to make sure that access to the highest quality of care is as available to patients in Scotland as it is to those in England.

[Dr Caroline Johnson]

I am grateful to the Minister for answering the question and talking about universal services being available from next year. Can he confirm whether they will be 24/7 and what he means by “universal”? If someone is living in a rural area, what is the greatest distance or time they should expect to travel to get to their local thrombectomy centre?

[Dr Ahmed]

What I mean by “universal” is indeed 24/7. As the hon. Member well knows, there are always challenges in delivering stroke care and heart attack care to rural communities. She, as a clinician, knows that we try our best, through the ambulance service and other forms of repatriation, to try to make sure there is equitable access wherever we can achieve it.

I thank my hon. Friend the Member for Stratford and Bow again for her kind words about the very small part that I played in her husband’s diagnosis. I am glad that he continues to do so well. I want to pay tribute to some of the charities involved in this space, because they have been instrumental in the innovation in stroke care over the past 20 to 30 years. I thank the Stroke Association, Different Strokes and Chest, Heart and Stroke Scotland for the incredible work that they do, including in my own constituency.

As the fourth largest cause of death for adults, stroke has a devastating impact on patients, families and the wider community. About one third of people who suffer a stroke will be left with some form of long-term disability. This is an important inequalities issue, as has already been discussed in this debate. Cardiovascular disease hits hardest in the most deprived parts of our country, including in parts of my own constituency, where people are more likely to smoke and less likely to have access to decent food and open green spaces. This Government were elected on a manifesto to tackle the biggest killers, including cardiovascular disease, and our health mission is committed to reducing deaths from heart disease and strokes by a quarter in the next 10 years.

I want to set out our reforms to the NHS, especially those which are part of our 10-year health plan, which will drive down rates of disease while helping people to live well for longer. Many Members in this Chamber are familiar with our three shifts: moving more care into the community, advancing the cause of digital health, and prioritising prevention over treatment.

On prevention, as much as I love my job as a surgeon I am still rooting for the public health Minister to put me out of business. She is taking forward strong preventive measures in her brief, through our Tobacco and Vapes Bill and by beefing up the NHS health check, which is England’s flagship cardiovascular prevention programme. That programme helps to target the abnormalities common to heart disease, to stroke, sometimes to diabetes and to kidney disease, and in many cases even to dementia through behavioural and clinical interventions. Each year, the programme engages 1.3 million people, preventing around 500 heart attacks or strokes. To improve access and engagement, we are developing the NHS health check online so that people can use it at home. That is being piloted by three local authorities until December.

We have already begun trialling more than 130,000 lifesaving heart health checks in the workspace—in offices, shop floors and commercial areas—all across the country. That will also help to reduce the risk of stroke. The hon. Member for Sleaford and North Hykeham asked about community pharmacy. Community pharmacy can and will continue to provide free blood pressure check services for anyone over the age of 40.

On rehabilitation, the stroke quality improvement for rehabilitation programme has increased the percentage of patients discharged from hospital to community stroke services from just under 66% when this Government took office to almost 70%. There is much more to be done, of course, but I believe that we are moving in the right direction.

As hon. Members are aware, the NHS fell behind in the last 14 years—certainly behind the private sector—in using digital technology. That was an appalling inequity, so let me come to our shift from analogue to digital. Half of all people who experience a stroke in England are now recovering thanks to revolutionary scanners that mean patients can avoid the risk of serious disability. The world-first technology that is coming online will analyse CT scans of stroke patients arriving in hospital, identifying them within 60 seconds. That means that the average time between a patient arriving at a hospital and starting life-saving and life-changing treatment is shortened from 140 minutes to only 79, resulting in less disability and a greater quality of life. I am pleased to update the House that since the roll-out last summer, the tool has been used to interpret the brain scans of more than 60,000 patients.

This Government believe that working people have the right to expect the same level of rehabilitative services as the wealthy. That is why we are so gladdened by the new state-of-the-art rehab gym hub at Montagu hospital in Doncaster, which is a perfect example of the best of the NHS that we wish to bring to the rest of the NHS. The suite relies on robotic therapies, which are otherwise provided only in private healthcare. The machines combine robotics with gamified, interactive activities to enhance both physical and cognitive recovery following a stroke—an example of what the seamless integration of physiotherapy and investment in digital health can achieve for stroke patients.

We are also forging partnerships with medtech companies to deliver the next generation of healthcare for patients. Reneural, which has partnered with Hillingdon Hospitals NHS foundation trust, is bringing virtual reality stroke rehabilitation to patients, and enabling therapists to remotely deliver and monitor stroke rehabilitation. Our shift from analogue to digital is supporting both in-hospital and community-based therapy, and, in many ways, allowing equality between rural and urban communities.

I am not saying that everything is perfect—far from it—or that there will not be bumps along the way. However, in a few short months, we have improved the outcomes of more than 60,000 patients, which is a testament to the actions of this Government. Through focus, and by delivering on the promises of digital and bringing the best of the NHS to the rest of the NHS, we can, and we will, do better for stroke patients and their loved ones.

Obesity and Fatty Liver Disease

Caroline Johnson Excerpts

Tuesday 28th October 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship this morning, Mr Efford. I congratulate the hon. Member for Worthing West (Dr Cooper) on securing this important debate, and I thank the British Liver Trust and others who provided information and reading material in advance of today’s debate.

Fatty liver disease, as has been said, is often asymptomatic in its early stages. Even when symptoms do occur, they can initially be non-specific symptoms such as tiredness and feeling generally unwell. Initially, the fat deposits in the liver; in the next stage the fat causes inflammation, which causes metabolic dysfunction-associated steatohepatitis. It can then progress to fibrosis and then cirrhosis. As mentioned earlier, liver deaths have increased substantially in the last 50 years, but early detection can help to prevent them. What is the Minister doing to ensure that liver function tests and fibroscans are more available? Does she regret having to delay her workforce plan? Will that have an impact on the treatment of liver disease?

As many have said, fatty liver disease is caused by obesity. Two thirds of adults are now overweight or obese, but obesity starts in childhood. As an NHS consultant paediatrician, I have in my time seen a 12-year-old weighing 120 kg and a nine-year-old weighing over 90 kg—around three times the weight of an average nine-year-old. That has a serious cost in terms of life expectancy, taking three to 10 years off a person’s life. It also has an economic cost to the state of about £11.4 billion on the NHS, estimated at £75 billion per year when taking into account the wider economic factors.

We all know someone who has struggled with their weight and who has had huge success recently, including Members of this House who have talked about it in other debates, using Ozempic, Wegovy or Mounjaro. That is great, but do we want a future where a substantial proportion of the population are dependent on medication to maintain their weight?

[Ben Coleman]

If I may bring the hon. Member back to childhood obesity, does she agree that there is a serious problem with sugar being pumped into so much baby food? Does she therefore welcome what the Government have finally done after many years of the issue’s sitting unaddressed? They are giving the industry 18 months to take the sugar out of baby food and to stop marketing basically unhealthy products, which no one should buy, as healthy or healthier. Does she welcome what the Government are doing here?

[Dr Johnson]

I certainly think it is wise to ensure that people get off to a good start in infancy and that unhealthy products are not advertised as healthy if they are not, although the definition of healthy is somewhat elusive and difficult to pin down. It is also important that we do not routinely feed little babies under one high-sugar foods, although I do not want to see them fed artificial sweeteners, either. It is about making things less sweet, so the reformulation will need to be done carefully. That is my personal view.

Going back to the medications, we know they can be very helpful for some and can improve their health. They may be able to help with fatty liver disease as well, although they are not licensed yet. Can the Minister update us on when the Government expect applications to be approved and whether the NHS is ready to deliver for all eligible patients? We have heard about the prevalence and burden of the condition across the country and the number of people affected. What is she doing to ensure that the NHS is ready so that, when these drugs are licensed, it has the capacity, workforce and money to provide them?

We have seen that drug prices can change quite dramatically. In August, Eli Lilly announced a huge price increase for Mounjaro. What plans does the Minister have to guard against that? Will she update the House on negotiations on the voluntary scheme for branded medicines pricing and access?

We understand she is reviewing the National Institute for Health and Care Excellence quality threshold; when does she plan to reach a conclusion? We have seen investment in this country’s life sciences sector by companies such as Merck and AstraZeneca being withdrawn from the United Kingdom or paused due to the environment created by the Government. We need urgent action to support that sector. Will the Minister update the House on discussions she has had with industry and the Treasury on that?

Medications are part of the issue, but there are also surgical implications. Many people who have lost large quantities of weight require surgery for excess skin, which can cause further medical problems. What is the Minister doing to ensure there is an assessment of demand for post-weight loss surgery? Are surgeons and capacity available to deliver it where medically indicated?

As many have said, prevention is better than cure. We know that fewer than one in three people eat five portions of fruit and veg a day, and that that is falling. We also know that starting early is important and have talked about children and infants. What is the Minister doing to ensure that school food is healthy and good for children? What work is she doing with the Department for Education on food choices and preparation, particularly advice on food that can be made in advance or quickly? We know that many young people will become adults in households where there are two working parents, where one of the largest challenges is not just the money needed to buy food, but the time required after returning from work to prepare and deliver it to children before they do their homework and go to bed.

We have talked about reformulation. The soft drinks industry levy has reduced sugar per 100 ml by 47.4%, but I am concerned that is leading to an increase in artificial sweeteners rather than a reduction in the sweetness of the product, ultimately meaning that people are still hooked on the sweetness. What does the Minister think of that? Some hon. Members talked about the advertising ban on less healthy food. Will the Minister tell us why that has been delayed until next year?

Why have the Government added the brand exemption? Do they think the addition of the brand exemption will make it harder for new market entrants, compared with well established brands? If I whistled the short tune for one food brand—I will not—it would be immediately recognised, without further introduction. That would be more difficult for advertising new entrants to the market.

The 10-year plan talks about mandatory healthy food sales reporting. Will the Minister update us on what she defines as healthy? There are also mandatory targets on healthiness of sales. What does that mean and when will it be implemented? We understand there is a planned update to the nutrient profile. Some are concerned that the free sugars that that includes mean that items such as date paste will fall under unhealthy sugars. Will the Minister provide information on that? Has she made an assessment of the Conservative Government’s step of informing people by adding calories to menus? What effect has that had on consumption and food portion sizes in the restaurant sector?

Exercise is also important. We know that physical exercise strengthens joints, increases weight loss and helps in the reduction of diabetes, depression and dementia. The previous Government gave £1 billion to support the sports and leisure industry during the pandemic so that it could continue, and had a school sports action plan, guaranteeing at least two hours of PE and supporting after-school clubs.

The current Government have pledged £400 million for new sports facilities, but delivery of that money seems to be at a standstill. Will the Minister update us on that? Many grassroots sports facilities need that money. Will she also update the House on what the Government are doing to improve girls’ attendance in sports? We know that teenage girls in particular are not taking the advised amount of exercise.

In summary, we need an NHS pathway to detect liver disease in the early stages so that it can be treated; an NHS that is ready to deliver the new treatments that are becoming available; and action to tackle obesity to prevent liver disease in the first place. There has been an emphasis throughout the debate on what the Government can do to prevent obesity and on state culpability in that regard. It is important that people recognise that they have agency and do not need to wait for the Government to do something about this. People do not need to wait for the soft drinks industry levy or for changes to regulations. They have the agency to help themselves; they can do that.

[Ben Coleman]

Will the hon. Member accept that there is now a general body of opinion that it is time to stop blaming people for not having the willpower not to eat bad food when they are constantly bombarded with advertising and marketing? Some £6.4 billion a year will be spent by the food industry on advertising and marketing to people, and in many areas it is very difficult to get food that is both affordable and healthy. Is it not time to stop blaming people for being fat and to support them to tackle obesity in the ways that I and many of my hon. Friends here have described? Is it not time to stop sticking up for the food industry and to start sticking up for ordinary people?

[Dr Johnson]

I do not think it is sticking up for the food industry to suggest that people have agency over what they eat. I will give an example. I saw a very small patient—about five years old—who was very obese. I asked the mum what sort of things the child was being fed, and the answer was, “Well, Doctor, he eats lots of crisps all the time.” But there is a simple point there: where was he getting those crisps from? He was getting the crisps from the cupboard without asking, but the crisps did not get in the cupboard because the five-year-old put them there. It is a question of making sure that what is available is healthy and what is being fed to children is healthy.

I have seen even in the last few weeks patients who have low vitamin D levels, critically low vitamin B12 levels and critically low iron levels as a result of the diet that they are getting. It is not just a case of, “It’s all the Government’s fault. The state must make sure that everyone eats healthily.” People have a responsibility of their own as well. This is about working together.

There are wider policy impacts as well. The hon. Member for Chelsea and Fulham (Ben Coleman) talked about food pricing and food security. This Government want to cover Lincolnshire—the breadbasket of the UK, where a third of the country’s fruit and vegetables are produced—in glass solar panels. That is what his Government want to do, so there is a wider policy framework about food affordability. Food inflation is going up hugely under this Government, so they need to look in the mirror and see what they are doing to reduce food prices for people. We need to work together: it is a combination of what the Government can do and what the individual can do.

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.

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.

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.

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.