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.

Gender Incongruence: Puberty Suppressing Hormones

Caroline Johnson Excerpts

Wednesday 30th April 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Lewell. I start by making a declaration of interest as an NHS consultant paediatrician and a member of the Royal College of Paediatrics and Child Health. My work in the NHS at times involves looking after children who may have gender dysphoria, although it is not specifically for that purpose. I congratulate my hon. Friend the Member for Reigate (Rebecca Paul) on securing this important debate, and on her excellent speech.

Hippocrates’ dictum, “first do no harm”—although it does not actually appear in the Hippocratic oath—captures a core medical ethic, and is an important guiding principle in policymaking. When it comes to children and young people expressing gender dysphoria, we must take a compassionate but firmly evidence-based approach. The causes of gender incongruence are not fully understood, but they are likely to be multifactorial and influenced by both biological and social factors. It is of huge concern that diagnoses of gender dysphoria have risen over fiftyfold, and that vulnerable and same-sex attracted children are over-represented.

There are legitimate licensed uses for puberty blockers, such as in cases of children who enter puberty very young, and in the treatment of certain malignancies. However, using puberty blockers for young people with gender dysphoria represents a significantly different context, both medically and ethically. With most children with gender dysphoria, symptoms resolve without treatment, with many finding that the natural process of puberty leads to a resolution to their distress.

The Gender Identity Development Service began trialling puberty blockers for adolescents with gender dysphoria back in 2011. Preliminary findings in 2015-16 showed no psychological benefit from the treatment and, alarmingly, a deterioration of wellbeing in some children, particularly some girls. The Cass review, published last year, showed that there is insufficient evidence on the long-term effects of using puberty blockers to treat gender incongruence. I ask the Minister: why does the planned trial not look at long-term outcomes?

The Cass review made the risks of these drugs explicit. Puberty blockers can seriously compromise bone density and can lead to adverse long-term neurodevelopmental effects. As for the purported benefits, the review added that,

“no changes in gender dysphoria or body satisfaction were demonstrated.”

The often repeated justification that blockers are for “time to think” was not supported by the evidence, with concern that they may instead alter the developmental trajectory of psychosexual and gender identity.

In May 2024, the last Government passed emergency legislation to temporarily ban puberty blockers for new treatments of gender dysphoria. The current Government have renewed that order twice, continuing restrictions until the end of this year. However, that does not affect cross-sex hormones. Does the Minister plan to commission research on the outcome of masculinising and feminising hormones on young people? Do the Government plan to extend the ban to cross-sex hormones in the fullness of time?

We heard in February that the NHS has announced plans to start offering puberty blockers as part of a clinical trial. There are questions about this trial. Given that most children’s symptoms will resolve anyway, and that the Cass review clearly states there is no method of proving in advance which children will have improved symptomatology and which will not, the trial will be essentially treating a whole cohort of healthy children with drugs to see the effect on the around 15% whose symptoms may not resolve in adulthood. Former Tavistock clinicians, including David Bell, have said that they would not refer patients to the clinical trial.

The Government are taking direct control of NHS England, so it is now the Secretary of State’s responsibility to ensure that any such trial is properly conducted. The gold standard for a medical trial is the double-blind randomised controlled trial. Will the Minister confirm that if the trial goes ahead there will be a control sample? The trial still requires ethical approval from the Health Research Authority. Will the Minister provide an update on when that decision is expected, clarify how the Government are ensuring the impartiality and safety of the decision-makers, and clarify whether provisions are in place to pause or suspend the trial if safety concerns arise?

[Sir John Hayes]

Might my hon. Friend add to her list of questions and ask about the experience of other countries that have looked at these matters? For those countries that have used alternatives to having children in trials, how effective have such alternatives been?

[Dr Johnson]

My right hon. Friend raises important questions that I hope the Minister will answer. It is important to look at the data that we already have. That was the next part of my speech—my right hon. Friend is, as usual, reading my mind.

Given that these drugs have been used on hundreds of patients at GIDS alone, why not look at that data, rather than conduct new experiments on further children? Despite the last Government legislating to ensure that data could be made available for research, several NHS trusts refused to participate fully in the Cass review. What are the Government doing to retrieve that data and to ensure that NHS trusts, which are now more directly controlled by the Government, comply with data-sharing requirements in the future? If the trial does go ahead, how will the Secretary of State ensure the genuine impartiality of those conducting the trial so that we can rely on the results?

In conclusion, this debate is about the wellbeing of young people. Gender-questioning children are not solely defined by their gender incongruence and gender-related distress; they are whole individuals. They deserve holistic care and the same rigorous evidence-based care as any other young patient.

Black Maternal Health Awareness Week

Caroline Johnson Excerpts

Tuesday 29th April 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Furniss. I, too, congratulate the hon. Member for Clapham and Brixton Hill (Bell Ribeiro-Addy) on securing this important debate today. As she said in her opening speech, the UK enjoys some of the best outcomes in the world when it comes to maternity health, but there is always more work to be done to improve our outcomes further. I hope we can all agree that equal access to the best care, for all across our society, should always be our target. That should be based on excellence across the board as standard.

We are considering Black Maternal Health Awareness Week, which is part of National Minority Health Month, and I welcome the opportunity to discuss this topic and exchange views with colleagues from across the House. Colleagues will know that as a clinician myself, I am always guided by data when assessing current healthcare practices and new policy proposals. A 2023 report by the maternal, newborn and infant clinical outcome review programme found that in the period from 2019 to 2021, 241 UK women died during pregnancy or up to six weeks after the end of pregnancy. That equates to a rate of 11.7 women per 100,000 giving birth. Each of those cases represents a tragedy for the woman and baby involved and their family and loved ones, and we must do all we can to prevent them.

The data does, as has been mentioned, also show that women from black backgrounds face a mortality rate much higher than the average; it is equal to 37.2 per 100,000. Women from Asian backgrounds also face a higher rate, at 17.6 per 100,000. Clearly, those figures present a pretty stark picture, but we must exercise care in the interventions that we make, and balance our desire to solve the problem with ensuring that we do that in a way that resolves the problem without risking creating others.

At the outset, it is crucial to ask what the Government are doing to understand the specific causes of these outcome disparities, because if we understand the causes, we will be better able to manage and treat them. The Kirkup and Ockenden reports have already been mentioned. What are the Government doing to ensure that those recommendations are fully implemented, and to develop a strategy to ensure that all women have the opportunity for a safe pregnancy and birth? What kinds of data held by the NHS and the Department of Health and Social Care might cast light on other demographic, economic or geographical patterns that contribute to these numbers, which we may be able to help to resolve?

We know that the most significant factor in predicting death during the maternity period is a pre-existing medical condition, and we know that disparities exist in the incidence of some pre-existing conditions that are relevant between some ethnic groups in the wider population. For example, a 2018 research paper in the American Journal of Kidney Diseases found that rates of heart disease were 20% higher among the black community than those from white backgrounds, and rates of stroke were a remarkable 40% higher. Do the Government know how the rates of pre-existing conditions among ethnic groups are influencing the figures on maternal health, and how are they going to work to reduce the risks of such conditions among these groups to try to improve the care not just during maternity, but during the whole of black ladies’ or ethnic minority ladies’ lives?

Maternal mortality itself arises from a number of conditions and causes. In the period from 2019 to 2021, for example, 14% of maternal deaths were attributed to cardiac disease, 14% to blood clots, 10% to sepsis and 9% to epilepsy or stroke. What are the Government doing to understand the prevalence of those conditions among ethnic groups, how the conditions can be prevented, how they can be identified in black women—indeed, in all women—how they can be better treated to save lives, how they can be better managed to save lives, and what research can be done to ensure that they are, if possible, prevented?

Socioeconomic deprivation has also been mentioned, and it is important to consider the impact of deprivation. In the period from 2019 to 2021, 12% of women who died during pregnancy or in the year afterwards were at severe and multiple disadvantage. That included, in particular, women who had suffered mental health conditions or domestic abuse, or had a history of substance abuse. How do the Government understand these factors and their influence on mortality rates, and what are they doing to help to resolve those issues?

Closer to home, in February 2022 the NHS Race and Health Observatory published “Ethnic Inequalities in Healthcare: A Rapid Evidence Review”. The authors of that report noted:

“Tackling poorer care and outcomes among ethnic minority women and babies continues to be a focus within the…NHS England and NHS Improvement Maternity Transformation Programme Equity Strategy, which includes pledges to improve equity for mothers and babies and race equality for staff.”

The Government’s abolition of NHS England risks placing that ongoing programme of work, like many others, in jeopardy. Will the Minister tell us the current status of the maternity transformation programme and the implementation of the equity strategy under the NHSE and DHSC reorganisation? How is that work being prioritised, given the many other demands on the Department’s time and resources—not least from the reorganisation—that might previously have been spent on improving care?

The previous Government improved the number of midwives per baby and made progress towards the national maternity safety ambition of halving the 2010 rate of stillbirths, neonatal maternal deaths and brain injuries in newborn babies. When will the Government set out their ambition for the next decade? The Labour Government promised more than 1,000 new midwives in their manifesto last year. Will the Minister update us on how many of those 1,000 midwives are now working for the NHS?

The Minister for Care recently stated that the 41 maternal mental health services are now live and will be active in every integrated care system by the end of 2025-26. How will the Government ensure that access to those services can continue when ICSs face such high cuts in funding?

Colleagues have mentioned the possible influence of systemic racism or unconscious bias in maternal outcomes. The NHS has an employed population of 1 million, and it is likely that some bad apples will be found within that overwhelmingly brilliant staff cohort, but I dispute that the NHS overall is a racist organisation. I work in the NHS—I should declare that interest—and I have not seen evidence of structural racism.

The Royal College of Obstetricians and Gynaecologists reported that, as of 2024, 45% of obstetric and gynaeco-logical doctors identify as of a black, Asian or minority ethnic background, and 26% of births were to women of black or other minority ethnic backgrounds. Figures for midwives are harder to assert, because they are collated with nursing staff, but the proportion among nurses is 22%.

[Bell Ribeiro-Addy]

I just want to check whether the hon. Lady understands that structural racism is about not the number of people within an organisation, but the way the organisation is set up and treats different people. Does she understand that having a high proportion of ethnic minority people does not necessarily mean that an organisation such as the NHS—which, I might add, in its senior levels is run by people mostly not from ethnic minorities—does not discriminate against people in a certain way?

[Dr Johnson]

I understand the hon. Lady’s point. I do not dispute that some women, men, boys or children have awful experiences at the hands of bad apples. That will happen within any organisation of that size—the NHS employs more than 1 million people. That is wrong and should be rooted out; it is absolutely clear that that should stop. However, I work in the national health service, and I think the vast majority of people who go to work in it do so to care for the patients in front of them as best they possibly can. Care should be provided on the basis of clinical need and should not be affected by the ability to pay or by any other socioeconomic, ethnic or other demographic data. Although I accept the point that some individuals will have experienced poor care, which is reprehensible, I do not think that is the majority situation by quite some margin. I think most people receive extremely good care in the NHS, and care that is delivered on the basis of their clinical need, not the colour of their skin.

[Bell Ribeiro-Addy]

Does the hon. Lady accept that, given that she is not of an ethnic minority and has not looked at the information given by a number of women from ethnic minority backgrounds who have experienced this, she is not really in a position to say that what they say they experienced does not exist?

[Dr Johnson]

That is not what I said.

[Bell Ribeiro-Addy]

I am just challenging her point. Just because for one or two reasons she may not have seen any institutional racism in the NHS, that does not mean it does not exist. Further, the figures for black maternal mortality are the same in the United States, which has a completely different healthcare system from ours, but they are not the same in countries in Africa or the Caribbean, where black women are the majority. Does she see why that can point only to institutional racism? It is a completely different healthcare system in United States. The only difference is that we are both living in societies where institutional racism is known to be a problem.

[Dr Johnson]

I think we can both agree that any examples of racism are reprehensible and should be rooted out and that, in the examples given, people are speaking truthfully of their perceptions and what they have experienced. No one is denying the experiences of individuals or groups who have experienced poor care and that that poor care should stop. I just do not think that that suggests the NHS itself is a racist organisation, because I do not believe that it is. That is our point of difference. I think the staff who work in the NHS are overwhelmingly not racist. They want to care for people on the basis of clinical need to the very best of their ability, regardless of any ethnic minority status.

[Bell Ribeiro-Addy]

I did not say that the people in the NHS are racist; I said the NHS has a problem with institutional racism. I hope the hon. Member will accept that there are distinctions between those two things.

[Dr Johnson]

I think we have both made our positions clear. I accept that some people will have received poor care and that the people who delivered that poor care need to be hauled over the coals. They need to be called out for what they have done and we must ensure that such care does not happen again. But I do not accept that the NHS is a racist organisation.

Another issue is language barriers. It is well recognised that it is difficult for people who have a language barrier to access health services. Can the Minister tell us what the Government are doing to help with that? In recent years in my medical career I have seen improvements in the delivery of language services, but when I was a more junior doctor an appointment needed to be booked in advance and an interpreter had to attend in person. Sometimes they were available and sometimes they were not. Sometimes other members of staff or family members would be used to interpret, which is a poor standard of care, relatively speaking.

[Michelle Welsh]

Is it possible for the hon. Member to highlight what part of the NHS she worked in? The reported experiences of interpretation and translation nationally are very different from what she is describing, which does not reflect the factual accounts and certainly does not reflect what has been happening in Nottinghamshire.

[Dr Johnson]

I did the junior part of my medical career in Nottinghamshire. I am describing what happened in the junior part of my career, which is about 20 years ago now. My experience 20 years ago was that it was very difficult to get interpreters, and that the people used to interpret were not proper interpreters and not the appropriate people. That should not be happening.

The service is still not perfect, but over time we have seen translation services improve. Many hospitals have instituted new iPad systems where one can choose a country of origin or the language that the person speaks, and a dial-up system of interpreters working from home is used to provide an interpreting system. That is much better—it is more available to the patient than the services we had in the past, which required someone in person—but it is still not perfect. We still see areas across the country where those services and that interpretation are unavailable to people. How will the Minister ensure that women who have difficulties with the English language are able to access interpreters when they need them—not just for appointments, but for out-of-hours emergencies? That is when interpreters are most difficult to obtain, particularly for languages spoken by fewer people in the United Kingdom.

I want to ask about the Government’s plans. The previous Government instituted a three-year plan, which comes to an end next year. When will the Government produce the plan? They talked about their 10-year NHS plan, which they said they would produce in the spring. I believe we are in the spring now—if we look outside, it is a beautiful day; the flowers are out and the lambs have been born. Where is the plan that the Government promised? What targets are they going to set, and when, to improve maternity care for all women, and specifically for black women?

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

It is a pleasure to serve under your chairmanship, Ms Furniss. Before I begin, I thank my hon. Friend the Member for Clapham and Brixton Hill (Bell Ribeiro-Addy) for securing this important debate during Black Maternal Health Awareness Week. It is so important that we raise awareness of the disproportionate challenges faced by black mothers during pregnancy and after childbirth; debates in weeks such as this are critical to that.

I want to pay tribute to the charities that do so much vital work in this space: the Motherhood Group, Five X More, Black Mums Upfront, which is part of Bliss, and Ebony Bonds, to name just a few. I am taking this debate on behalf of the Minister for women’s health and patient safety, Baroness Merron. I also want to thank all hon. Members for their contributions to this debate. I will seek to pick up and answer all their queries, but if they feel I have not done so by the end of the debate, I ask them to please get in touch and I can ensure we respond.

I want to thank the charity Sands for shining a spotlight on some of the most heartbreaking cases of baby loss in the UK, and for giving a voice to so many black and Asian women who have gone through the nightmare of losing a child. One such case was Amber Lincoln from Woolwich in south-east London. She was miscategorised as low risk when she was pregnant, and nearly died from undetected complications after her delivery. A series of individual and systemic failings led to cancellations and delays, and her twins, Anaya and Mael, were born and died at 22 weeks in November 2022, before she could access the care she needed. Amber said:

“If the NHS just listened to me. And just put my appointment through when I was constantly asking. If they had the notes there properly I wouldn't have been treated that way.”

She said the fact she was mixed race led midwives to focus on diabetes and high blood pressure rather than other high-risk indicators. I wish I could stand here and say that Amber was an isolated case, but her story will sound familiar to black women up and down the country, and it shows in the figures. The latest data from MBRRACE-UK shows maternal mortality rates for women from black ethnic backgrounds are more than double those for white women. Black women and their babies are also at higher risk of stillbirth, neonatal death and miscarriage. That should shame us in modern Britain.

Tackling inequalities and racism in maternity services is an absolute priority for this Government. Our manifesto committed to setting an explicit target to close the black and Asian maternal mortality gaps. That commitment has not wavered—we are working hard not only to set a target but to set the actions that will help deliver it. It is crucial we set the right targets and ensure the system is supported to achieve them, which is why the Government are currently considering the action needed that would drive change on the ground, ensuring that targets set are evidence-based, and women and baby-centred.

Our ambition is not just to improve maternal outcomes; we want to improve black women’s experiences of maternity care too. We know that too often black women are not listened to and experience racism and bias. That is completely unacceptable. Importantly, our ambition must also extend beyond maternity services, so that we can tackle wider health inequalities, including the determinants of ill health. I know that health inequalities do not start at the door of maternity services, and nor do they end when women go home.

Here is what we are doing and where we need to go further. We are aware of calls for a national inquiry into maternity care, which we will carefully consider. There have been a number of reviews, inquiries and wider research in recent years that have provided a shared and clear sense of the issues in maternity and neonatal care. The most important priority must remain for us to target resources and efforts to address the existing issues identified and avoid any further delays. The focus must be to address inequalities and the action taken to do so for women and babies.

NHS England is now in the final year of delivering its three-year plan to improve maternity and neonatal services. Central to the plan is the objective to reduce inequalities for all in maternity access, experience and outcomes, and taking steps to tackle and address inequalities for black women. To achieve this objective, all local areas now have in place and are implementing their equity and equality action plans. Those plans detail local interventions tailored to population needs, in order to tackle inequalities for women and babies from ethnic minorities and those living in the most deprived areas. There have been some great examples of local best practice within those plans, ranging from targeted pre-conception health support to tailored support to ensure equitable access to care, and bespoke communications for pregnant asylum seekers and refugees.

As part of the three-year delivery plan, all local areas are working to implement version three of the Saving Babies’ Lives care bundle, which provides maternity units with guidance and interventions to reduce and tackle the inequalities in stillbirths, neonatal deaths, brain injuries and pre-term births. Those local and national interventions are essential steps to improving equity and equality in maternity care.

In parallel, however, it is vital that we continue to work to foster a culture of safety, compassion, honesty and one that is actively anti-racist, which must be led by outstanding leadership. I am pleased that all 150 maternity and neonatal units in England have signed up to the perinatal culture and leadership programme.

For clarity, and I think particularly for the shadow Minister, we recognise that racism and unconscious bias need to be tackled, that they are unacceptable and must be tackled in the NHS.

[Dr Johnson]

Will the Minister give way on that point?

[Ashley Dalton]

I will finish what I am saying and then I will give the shadow Minister an opportunity to come back to me.

To clarify, this work is not only about the behaviours that we must tackle in the NHS; it is also about the systems that we create in the NHS and ensuring that those systems do not consciously or subconsciously discriminate against people on the grounds of their race. That is what we mean and that is why we are putting in place training for leaders in our maternity units. We will ensure that they are signed up to the perinatal culture and leadership programme, to ensure that those systems are as equitable as they possibly can be.

[Dr Johnson]

I thank the Minister for giving way. I think we all agree that racism is wrong and must be weeded out wherever it happens. Could she say, in answer to the question posed by the hon. Member for Clapham and Brixton Hill (Bell Ribeiro-Addy) at the beginning of her speech, whether she believes that the NHS is structurally racist?

[Ashley Dalton]

The shadow Minister will know that that is not actually the question that my hon. Friend asked. She asked about systemic racism. We recognise that racism and unconscious bias can play a part both in the behaviours of some people, which must be tackled, and in the way that systems are structured. That is why the training that we are introducing will help to tackle racism. It is not necessarily the case that there is racism throughout the NHS, but we must do everything we possibly can to make sure that NHS systems are as equitable as they can be.

[Dr Johnson]

I thank the Minister for giving way again. I confess that I thought I heard the hon. Member for Clapham and Brixton Hill say “structural”. However, if the word she used was “systemic”, does the Minister think the NHS is systemically racist?

[Ashley Dalton]

I think that we have to do everything possible to make sure that all the systems in the NHS are as equitable as possible.

We have set clear expectations for escalation and accountability through the three-year plan, and all 150 maternity and neonatal units in England have signed up to the perinatal culture and leadership programme. We are supporting staff to hold up their hands when things go wrong through the Freedom to Speak Up initiative. Our approach to tackling inequalities in maternity and neonatal care must be underpinned by evidence, research and—critically—working with women and their families. As my hon. Friend the Member for Sherwood Forest (Michelle Welsh) pointed out, it is crucial that women’s voices, including black women’s voices, are heard.

My hon. Friend the Member for Clapham and Brixton Hill mentioned funding for research. The National Institute for Health and Care Research has launched a £500 million funding call that challenges researchers and policymakers to come up with new ways of tackling maternity inequalities and poor pregnancy outcomes. The NIHR has also invited applications for funding of up to £500,000 for a research project to understand how biases in medical devices used during the pregnancy and neonatal period might be contributing to inequalities for women and babies.

NHSE is working closely with the NHS Race and Health Observatory on the outputs of the learning and action network programme, which aims to address inequalities for women and babies from black, Asian and other ethnic minority backgrounds. Local maternity and neonatal voices partnerships bring together the voices and experiences of women and families to improve maternity and neonatal care. More than a quarter of the partnership leads are from ethnic minority groups. Women’s voices must continue to be at the heart of our improvements to care.

I will be frank with colleagues: although the measures I have set out are important, I do not believe they will be enough to meet the scale of our ambitions. The Government are committed to ensuring that all women and babies, regardless of their ethnicity, background or location, receive the high-quality, equitable care they deserve. Many of these initiatives began under the previous Government, and although there has been some progress across maternity and neonatal care—for example, good progress has been made in reducing the number of stillbirths and neonatal deaths—we have much further to go to improve care and tackle inequalities.

Looking forward, we are clear that we want to see high-impact actions to tackle inequalities and racism in maternity services. Baroness Merron and the Secretary of State are working closely across the sector to identify the right actions and interventions to deliver the required change.

The shadow Minister asked about data collection. Data on women’s ethnic background is routinely collected by services at multiple points throughout maternity care. The data is used to disaggregate reporting of adverse outcomes, such as maternal mortality, by ethnicity. Differences by ethnicity are also reported as part of the Care Quality Commission’s annual survey, which asks a sample of pregnant women and new mothers about their experiences of NHS maternity services. NHS trusts are incentivised to collect this information through the maternity incentive scheme, which is a financial incentive programme that is designed to enhance maternity safety in NHS trusts. Safety action 2 of the maternity incentive scheme incentivises trusts to submit digital information, including ethnicity data, to the maternity services dataset.

Some of our processes will take time to implement, but we need to understand the immediate actions that can begin to deliver change here and now. I therefore reiterate our commitment to setting an explicit target to close the black and Asian maternal mortality gap. We must get this right. Targets must be evidence based, and that is why it is so important that the data is collected, as I have said, that our targets are women and baby-centred and, crucially, that the system is supported to meet the targets that are set. To this end, NHS England has undertaken a review of the evidence base and conducted extensive stakeholder engagement to identify the key drivers of inequalities for black and Asian women and babies—again ensuring that black women’s voices are heard.

[Dr Johnson]

The Minister talks about the importance of setting an achievable target and working on how it will be delivered, but the Government have now been at this for 10 months, and it was a manifesto commitment. Will she at least commit to a date by which it is likely to be set? Nothing will happen until there is a target and a plan. The Government are spending time deciding when to make a target, and all the while women are waiting.

[Ashley Dalton]

We are working at pace, ensuring that what we do is right and that it is achievable. The shadow Minister will be aware that the Government are developing a 10-year plan for health, and women’s health, including maternity health, will be at the centre of it. We want to ensure that whatever we put in place dovetails with all the other interventions and actions that the Government are putting forward.

The areas identified for intervention so far include the improper management of existing conditions, racism and discrimination, and access to care. We are clear that we want to see innovative and high-impact ideas that will shift the dial. We want to make sure not just that we are coming up with some sort of plan, but that it can be delivered and will be impactful.

Let me assure my hon. Friend the Member for Clapham and Brixton Hill that this issue keeps us up at night. I know that she will continue to hold us to account. I began my speech by referencing Amber’s story. She asked how she could put her trust in a system that let her down so badly, and I completely understand why she felt that way. It is our duty to make sure that women like Amber can trust the system with something as precious as their children, and to prevent what should be one of the most joyful days in their lives from becoming a tragedy.

Hospitals

Caroline Johnson Excerpts

Wednesday 23rd April 2025 Commons Chamber

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

We can all agree that we want a world-class NHS, and that includes having the very best hospitals, technology and staff. I have been delighted to see the brilliant facilities created in my area, including a new A&E in Boston, new mental health wards at Lincoln county hospital, and new operating theatres at Grantham and District hospital. These upgrades mean that patients can receive the best possible care in appropriate settings, and staff can go to work each day proud of their workplace environment. However, we must be alive to the challenges that face the NHS. We live in an ageing society where people have more complex comorbidities. We also have a growing population, so there is more demand for services. In fact, the NHS treats 25% more patients every single day than it did back in 2010. New treatments, technologies and procedures have been developed, saving and improving lives, but they come at an ever more expensive price. We also had the covid pandemic, which I noticed the Minister did not mention.

According to the King’s Fund, in 2023 prices, spending on capital in Labour’s last year in office, 2009-10, was £6.9 billion. In 2023-24, that had nearly doubled to £11.4 billion. Even before the pandemic, capital spending was nearly £1 billion higher than when Labour left government. That helped us to open 160 community diagnostic centres and more than 100 surgical hubs, and to invest more in scanners, beds and operating theatres to deliver a million more checks, scans and procedures closer to home. We were committed to delivering the new hospital programme in full.

There was more to do. The challenges were evolving, the demand for care was growing and the pressure on the NHS was ever increasing. It now falls to the Labour Government to address those problems. I want them to succeed—that is in all our constituents’ interests—but what we have seen so far does not fill me with hope. One of the Health Secretary’s first choices on entering government was to pause the new hospital programme and put its future at risk. That was despite the fact that he and the Chancellor travelled the country throughout the election period, meeting candidates and promising a new hospital in their area. Just like the Government’s promises to the farmers, the pensioners and businesses, those were hollow words.

[Dr Neil Hudson (Epping Forest) (Con)]

The Conservatives committed to restoring and renewing our hospitals. My constituents in Epping Forest depend on the Princess Alexandra hospital in Harlow, and on Whipps Cross hospital in Leytonstone. Despite Labour making clear promises about those two vital hospitals prior to the election, the Labour Government have delayed their rebuilding. It is particularly galling because Whipps Cross has planning permission, and work on the car park has already started. Does my hon. Friend agree that the Labour Government should re-evaluate their priorities and crack on with delivering the rebuilds promised at the Princess Alexandra and Whipps Cross?

[Dr Johnson]

I absolutely agree that the Labour Government should do that, but unfortunately, we have learned that their promises do not mean much at all.

[Daisy Cooper]

On promises not meaning much, the hon. Lady will be aware that the previous Conservative Government promised West Hertfordshire a new hospital. In 2023, they said it was fully funded, yet there is still not a spade in the ground. Can she explain where that money disappeared to, please?

--- Later in debate ---

[Dr Johnson]

The previous Secretary of State made it clear that the hospital was fully funded and would be built. What has changed since then is that we have a new Government who made the choice not to build it. These are choices that the new Government must own.

When the Government came to power, the Secretary of State commissioned the Darzi review, which highlighted the need for more capital investment in the NHS, but decided not to prioritise the delivery of the new hospitals. To govern is to choose, and the Secretary of State has chosen not to deliver the hospitals. We set out our commitment to delivering them on time, with the agreement of the then Chancellor. Of course, spending decisions cannot be made for a future Parliament, but the Secretary of State has chosen not to make the same commitment.

[Ben Coleman]

It may be helpful I correct a couple of “facts” that the hon. Lady has given. In his election literature, my predecessor as Member of Parliament for Chelsea and Fulham made the clear statement that he had secured the funds for the rebuilding and refurbishment of Charing Cross hospital. When I spoke to the chief executive of the hospital, he said that he had received no such reassurance from the Government, and on coming to power we found that no money had been set aside for the guaranteed refurbishment.

Moreover, this did not just apply to Charing Cross hospital. Across the country, the last Government’s claims to have found the funding were discovered not to be true when we came to power. The right hon. Member for Melton and Syston (Edward Argar), who is talking to the hon. Lady at the moment, lives in my constituency, so he is well aware of the accuracy of what I am saying. [Laughter.] I know; I will get complaints about the bins again now. Would the hon. Lady like to reflect on the accuracy of what she is saying, in the light of the facts as I have set them out?

[Dr Johnson]

I am afraid that the hon. Gentleman is not correct. The previous Government, and the previous Chancellor, made a clear commitment to providing the money, and to the hospital building project, but the current Government have not chosen to meet that commitment. These are choices that are being made. For now, patients and staff are being denied the quality facilities that they have deserved for decades. For some hospitals, construction work will not even begin until 2039. Will the Minister write to me, giving the date on which each hospital will be completed?

We can see the Labour Government’s lack of ambition. There are 40 hospitals in waves 1 to 3 of their programme—40 hospitals over 15 years—but there are 515 acute, specialist and community hospitals in England. At this pace, the replacement of the NHS estate will require a cycle of nearly 200 years. That is the equivalent of a hospital built in 1825 not being replaced until this year. That is Labour’s ambitious programme.

We can all see the pressures facing the Chancellor as her economic mismanagement hits the country. We cannot tax our way to growth. Perhaps that is yet another reason why growth forecasts have been cut yet again. How do we know that Labour will not come for those already delayed new hospitals in a year or two, and that there will not be further delays or cancellations? The Government have made it clear that the new hospitals are not their priority. Will the Minister give us that guarantee?

[Andy Slaughter]

May I return the hon. Lady to the subject of Charing Cross hospital for a moment? It used to be the main hospital in my constituency, before it became part of the constituency of my hon. Friend the Member for Chelsea and Fulham (Ben Coleman). The Conservative Government proposed to demolish it, and it took a seven-year campaign by residents to secure a reprieve. It went into the new hospitals programme, and then came out again in 2023, under the Conservatives, because hospitals with reinforced autoclaved aerated concrete were going in. That is the history.

Has the hon. Lady been living in a different world for the last decade? In that time, there has been not just underfunding, but threats to demolish and close hospitals, and then to remove them from a programme that the Conservatives invented. Only now is this hospital in a viable programme, and being given the help and support that it needs to become the world-class hospital that it has been.

[Dr Johnson]

I must confess to not being terribly au fait with the position of Charing Cross hospital in 2012, which was before I was elected. It is not a hospital in which I have worked as a doctor, but I am advised that it was my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt), when he was Health Secretary, who kept it open, and I am sure that local residents will be disappointed that this Labour Government have chosen not to rebuild it until 2035.

Will Labour—in an attempt to fill the black holes of their creation—return to private finance initiative contracts, to bridge the gap between the spending that they want and the fiscal situation that they have created? I saw at first hand the disastrous agreements that were reached, which led to extortionate costs and ridiculous inflexibility. Let me give just one example. I remember being very pleased to have an office of my own for the first time when, as a doctor, I was promoted. I was given a desk, a computer and a large whiteboard. When I asked, “How do I get this put up on the wall?”, I was told, “You can’t have it put up on the wall, because it would cost £800.” That was more than a decade ago. I thought, “Why is it costing £800?” and I said, “I can go and buy some ‘no nails’ from the local hardware store and put it up myself!” I was then told, “You can’t do that, because a deal was negotiated, and it would be against the contract.”

In total, there are about 700 PFI contracts with a capital value of £57 billion, and there is about £160 billion still to be paid for them and their maintenance. During covid, in 2020-21, analysis from The Guardian found that nearly half a billion pounds was being spent purely on interest charges. That is money that is not being spent on patient care, and it is a long-lasting legacy from the last time a Labour Government were in power and trying to get around their fiscal rules. These were fundamentally bad deals. Yet again, we see that when Labour negotiates, the taxpayer loses.

Despite 14 years in opposition, Labour came to office without a plan for what it actually wanted to do for the NHS. Instead, we have seen review after review and consultation after consultation, with very little action or delivery in return for what this means for patients and the taxpayer. The Labour Government hiked taxes on general practices, community pharmacies and even children’s hospices, only to give them some of that money back and expect them to be grateful for it. They cut the winter fuel payment for millions of the most vulnerable people in the country, and then sat back and watched as the number of pensioners attending A&E this winter soared. They caved in to the trade union demands with an inflation-busting pay rise in return for no modernisation or productivity reforms, and the threats to strike again are already back. They scrapped our productivity plan, which we had already fully funded and which would have unlocked billions in savings by the end of the decade.

[Mark Ferguson]

I have a question to which I know the answer. The question is “How many new hospitals were built in the last five years?” and the answer, of course, is “Zero”. Is it not the case that the 40 new hospitals promised by the last Government were not new and were not hospitals, and there certainly were not 40 of them?

[Dr Johnson]

Actually, we use the definition of “new hospitals” that Tony Blair used when he was Prime Minister.

Let us turn to where we are now. We welcome the capital funding to continue the programmes that we started in government for new surgical hubs and diagnostics, but how much of the additional capital funding allocated in the last Budget will be used to carry out repairs in hospitals that should be rebuilt? Let me repeat the question asked by the Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan). Will those delays cost more money, both because work that would otherwise be unnecessary will have to be done to keep hospitals open and because of inflation, which is rising under this Government? How much extra will the national insurance jobs tax cost the contractors building the new hospitals and undertaking maintenance and repairs? Those additional costs will be passed on to the NHS. Will that mean less repair work being undertaken, or will the Government make cuts elsewhere—and if they do, where will those cuts fall? The Chancellor has already hiked taxes on working people and businesses, and today we saw that borrowing has also increased by £30 billion a year, with debt piling up and inflation on the rise. How does the Minister intend future repairs and builds to be funded—through yet more tax rises, more borrowing, bringing back PFI, or cutting other areas of spending?

Ultimately, these are decisions for Governments. To govern is to choose. This Government must own their choices, but sadly it is the public who will have to pay for them.

[Several hon. Members rose—]

Draft Medical Devices (Amendment) (Great Britain) Regulations 2025

Caroline Johnson Excerpts

Wednesday 23rd April 2025 General Committees

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

It is a pleasure to serve under your chairmanship, Sir Edward. We can all agree that we want safety. We want the equipment that doctors such as me use to be safe, reliable and regulated to the highest standards. We also want strong support for the science and technology sector, and patients in the UK to have early access to the best and most innovative medical devices. The instrument removes the revocation dates currently attached to four pieces of assimilated EU law, currently enshrined in the Medical Devices Regulations 2002. By doing so, it keeps those EU regulations in force until new, bespoke UK regulations are introduced.

There was significant concern that allowing that assimilated EU law to expire under the sunset clause would disrupt the UK medical devices regulatory framework and could negatively impact patient safety. In response, the MHRA conducted a public consultation involving device manufacturers, healthcare professionals, patient groups and businesses. Based on the results of that consultation, the MHRA proposed removing the revocation date for those four pieces of EU law. That proposal was welcomed, with 83% of respondents favouring maintaining the status quo.

Opposition Members support these pragmatic measures, and we welcome any legislation that protects patient safety. However, it is essential that the new UK regulatory framework is delivered in a timely manner to provide clarity for industry stakeholders. In that spirit, I would be grateful if the Minister could provide clarity on a few points.

First, the retention of these laws is intended as a temporary transitional measure, with the first phase of the new UK regime—the pre-market regulations—expected in 2026. Is that information up to date, and when can we expect further details on the timeline, publications and upcoming consultations?

Looking ahead to the new UK regulations, particularly those on post-market surveillance of medical devices, are the new UK replacements for assimilated EU regulations expected to diverge significantly from the current EU frameworks when they take effect, or will they remain broadly aligned with them?

Although the amendment regulations extend across the UK, in practice they apply only to England, Wales and Scotland. Northern Ireland remains subject to the 2017 EU medical device regulation and the 2017 in vitro diagnostic medical device regulation. If these frameworks impose additional regulatory or administrative burdens on manufacturers and distributors in Northern Ireland, what steps will the Government take to support those businesses and help protect their competitiveness?

Finally, will the Minister comment on how she expects US tariffs to affect medical devices, including their manufacturers and their availability, in the UK?

[Ashley Dalton]

I thank the shadow Minister for her input, and I will try to respond to the points she raised. The MHRA has published the road map for this process, and I can let her have a copy of it after the debate; it sets out the timeframe for the various steps that need to be taken. Specifically on further SIs, there will be a further SI dealing with two of these issues by the end of the year, and two further SIs in 2026 and 2027.

On Northern Ireland, we are obviously aware that there are concerns and issues that have to be dealt with differently. Once the provisions have been updated, the GB framework will still refer to EU law, but certain domestic requirements may differ from those in other jurisdictions. However, we recognise the benefit of international harmonisation of medical device regulations. Of course, we will ensure that any future legislation meets our obligations under the Windsor framework.

On US tariffs, the Committee will appreciate that there is an ongoing discussion, and decisions have not yet been made by the US. I would not want to pre-empt or second-guess any decisions made by colleagues. Obviously, those tariffs will be taken into account once we have a final view of what they might look like.

[Dr Johnson]

My understanding is that the US Government are reviewing whether the tariffs will affect medical pharmaceutical products. However, some manufactures of medical devices, as per this SI, are concerned that the tariffs that have already been announced affect medical devices. Can the Minister please give more clarity on that?

[Ashley Dalton]

I am not able to give further clarity on that today, but I am more than happy to write to the shadow Minister when we have some more clarity.

I hope I have set out why these regulations, while only a small part of the wider reform programme, are nevertheless important to ensuring a smoothly functioning regulatory environment. They will give manufacturers certainty and ensure that patients can continue to access safe and effective devices. They are just a small part of the reforms that are under way, and I am grateful to members of the Committee for playing their part in bringing them into force.

Question put and agreed to.

Prevention of Drug Deaths

Caroline Johnson Excerpts

Thursday 27th March 2025 Westminster Hall

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

It is a pleasure and a privilege to serve under your chairmanship, Dr Murrison. I pass my condolences to the family, friends and colleagues of Christina McKelvie. I know she meant a lot to many of the people in this room.

Members on both sides will recognise the vital importance of the topic before us today in relation to our health and wellbeing as a nation. Let us be clear: deaths across the UK remain too high and in many cases, trends are moving in the wrong direction. Therefore, I congratulate the hon. Member for Strangford (Jim Shannon) on bringing this important debate so we can talk about it further.

The Office for National Statistics notes that 5,448 deaths related to drug poisoning were registered in 2023 across England and Wales—93 deaths per million people—but those headline figures tell only part of the story, of course, because behind each one is a tragedy for a family.

There is a significant gender imbalance in drug deaths. Of the nearly 5,500 deaths in England and Wales, 3,645 were men and 1,803 were women. There is also an imbalance among the English regions, as the hon. Member for Easington (Grahame Morris) said. The north-east of England remains the region with the highest rate of deaths related to drugs—London has a third of that rate. What steps are the Government taking to understand the epidemiology of drug use? How are they using that information to develop policies to reduce drug use and drug deaths?

Another key demographic trend relates to age. ONS survey data for 2024 shows that 16.5% of people aged 16 to 24 reported using at least one drug in the year to March 2024, and approximately 150,000 in the same age bracket considered themselves frequent drug users. Education will clearly be a vital element of any strategy designed to prevent people from becoming addicted to drugs and going on to cause harm to themselves and their community. Education needs to be clear about the damage that drug consumption does to individuals and society, through antisocial behaviour, environmental pollution and serious organised crime committed by gangs. What steps are the Government taking to ensure schools and colleges provide effective, targeted education to young people? What conversations has the Minister had with education Ministers about that? What are they doing to extend that education to those who are lost to the system—those who are not attending school and are therefore at greater risk of developing addictions and being exploited?

As has been mentioned, we also need to understand the changing patterns of use around particular drugs. Fashions change, and we must confront today’s challenges proactively, rather than yesterday’s ones reactively. Deaths involving cocaine rose by 30% in a single year in 2023, and synthetic opioids such as fentanyl pose another emerging risk. We know that such substances have caused catastrophic harm in other countries, where they are already a fixture of the drug supply chain. What lessons have the Minister and the Government learned from other countries’ experiences with synthetic opioids? What steps are they taking to ensure the risk does not develop into the sort of crisis that we have seen in other countries?

Behind the statistics, there are people who use drugs and people in our communities who suffer the impacts. We need to look at both, and at the patterns of drug use. Inner-city areas suffering multiple forms of deprivation may face greater problems with substances such as heroin. As Members said, the Scottish Government recently opened the UK’s first drug consumption room in Glasgow, with the intention to address that kind of drug use. Long-term evidence about the effectiveness of such rooms is not clear at this stage, so I am pleased that the UK Government’s position is not to implement the strategy more widely. Treatment must be evidence-based, compassionate and effective, and it must not be done in a way that undermines the law, risking more people thinking that drugs are safe or not risky.

[Grahame Morris]

That is the status quo, but should we not be challenging that and looking at the evidence from, for example, prisons? One might assume that someone who is incarcerated due to crimes resulting from drug addiction would receive treatment in prison and rehabilitated, but in practice they are actually worse when they come out, and Buvidal, a long-lasting drug that could be very effective, is not readily available. Does the shadow Minister have any views on that?

[Dr Johnson]

I completely agree that we need evidence-based policy, and that, in whatever policy area we are looking at, we should challenge and probe policies to ensure we are doing things in the right way. Drugs should not be available in our prisons. People should receive treatment if they have gone into prison due to a drug-related offence, or if it is a non-drug-related offence but they are a drug user, but they should not have access to drugs. Prisons are controlled environments, so we should be able to prevent that. The Minister might be able to update us on what the Government will do to reduce the amount of drugs available in prisons.

We must also look at the effects on the local area around drug consumption rooms. What effect does allowing people to use drugs have on the numbers for violent gang crime, acquisitive crime and drug use? The evidence needs to be looked at closely.

There are other contexts in which drug use causes problems. Media coverage in recent years has highlighted the problem of so-called middle-class drug taking in family homes or at dinner parties. That is a different pattern of use, with different problems, and may risk setting precedents and norms, particularly for young children who may witness it, that might have damaging effects in years to come. Such drug use may be occurring in middle-class homes, but it still fuels organised crime and violence elsewhere. What are the Government doing to address the nuances in different habits and social contexts of drug use, and how do those figure in policy development?

We should also think about the prevalence of drug use in contexts such as workplaces. Some workplaces, such as the police, use intermittent drug testing. Police can use stop and search powers to investigate misuse, but there are other opportunities to interrupt harmful behaviour. What is the Government’s position on random drug testing in employment settings?

Regarding people in communities blighted by the effects of drug use, it is important to enforce the law as it is. In 2021, only 20% of drug-related offences recorded in Home Office data resulted in the user being charged or summonsed, and 34% of those offences resulted in an out of court or informal settlement. Some today have seemed to suggest that treatment and law enforcement are an either/or, but both are very important. Minimising the criminal offence could increase drug use, derisk the first trying of drugs among young people, embolden drug dealers and further harm neighbours who suffer drug-related harm. According to ONS data for 2024, 39.2% of respondents to the crime survey for England and Wales said it would be very or fairly easy to obtain illegal drugs within 24 hours. How do the Government intend to reduce the availability of illegal substances?

The last Government implemented a 10-year drug strategy following the publication of the independent review of drugs undertaken by Dame Carol Black in 2020, and they committed an additional £523 million up to 2025 to improve the capacity and quality of drug and alcohol treatment services. This strategy set out aspirations to prevent nearly 1,000 deaths and deliver a phased expansion of treatment capacity, with at least 54,500 new high-quality treatment places for sufferers of addiction.

The present Government need to set out a coherent and viable plan for tackling the problems that the previous Government had begun to address. On 26 November last year, Parliamentary Under-Secretary of State Baroness Merron noted that the Government

“continue to fund research into wearable technology, virtual reality and artificial intelligence, all in a bid to support people with drug addictions.”—[Official Report, House of Lords, 26 November 2024; Vol. 841, c. 594.]

That cost £12 million in the period from the election to 26 November. Will the Minister update the House on the evidence for the effectiveness of those measures? How do they intend to measure the value of the outcomes of that £12 million investment, and does she have any results on how effective they were?

Drug use continues to cause substantial harm to individuals and communities across the UK. The Government must commit to evidence-based interventions and plan the UK’s drugs strategy in a manner that limits the opportunities for individuals to distribute or consume drugs, reduces the likelihood that young people will develop an addiction, and prevents communities from suffering the impact of ineffective policing and sanctions.