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.

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.

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—]

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.

Tobacco and Vapes Bill

Caroline Johnson Excerpts

Report stage
Wednesday 26th March 2025 Commons Chamber

[Madam Deputy Speaker (Judith Cummins)]

I call the Opposition spokesperson.

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

It is now a truth universally acknowledged that smoking is bad for one’s health. It is the leading cause of preventable death in this country, responsible for over 80,000 deaths every year. When we say that number, it is easy to allow it to trip off the tongue as another statistic without really realising just how many people it represents. For each of them—such as my Nana Burton, who was a smoker and who died of lung cancer—there is a personal story of damaged health and often an early and preventable death.

The Conservative party introduced a Bill based on a similar premise to this one in the last Parliament, although the Government have made significant changes since to the legislation, including taking a power that could be used to ban smoking and vaping in pub gardens, as well as a licensing scheme for tobacco products.

On amendment 85, while we have received repeated assurances that the Secretary of State intends to use the measures in the Bill only to improve public health, we must still examine whether the legislation is proportionate and reasonable. As far as I can see, it gives the Secretary of State enormous powers to extend the smokefree legislation to any place with minimal oversight and without needing to provide a reason. There were whispers last summer that the Government were considering banning smoking in pub gardens, before they hastily withdrew this provision in the face of public backlash. If only they would withdraw more of their policies in the face of public backlash, because perhaps then we would not be in the situation we are in now.

The Bill empowers the Secretary of State to extend smokefree and vape-free regulations to more places—essentially, to any place—with the aim of reducing exposure to second-hand smoke and promoting public health. However, on Second Reading the Government did not accept our amendment that it should apply only to places that have a provable significant risk to public health to justify such a ban. For that reason, I commend amendment 85 once again, which would restrict the Secretary of State to being able to designate only open or unenclosed spaces outside a hospital, a children’s playground, a nursery school, a college or a higher education premises as a smokefree area. Those are the areas the Secretary of State has said he wants to target, and the amendment would prevent any targeting of other areas, such as pub gardens, by the back door. While he claims that that is not his intention now, that may not remain the case for the rest of this Government’s time in office, nor indeed for any future Government. That is the risk in allowing these measures to stand, and for those reasons I encourage the House to support amendment 85.

3.15 pm

On new clause 18 and amendment 89, the new Bill also gives powers to the Secretary of State to introduce a new licensing scheme for retailers selling tobacco, vaping or nicotine products. However, we know that licensing schemes will come at a cost, to businesses and local authorities that will administer them, and in enforcement. That does not make it the wrong thing to do, but we would need to make sure that any licensing scheme is not excessively burdensome or expensive. New clause 18 and amendment 89 would therefore require the Government to consult on the new licensing scheme for tobacco sales before it came into force. That would mean that the views and impact on businesses including small businesses are heard, and ensure that councils and trading standards have the capacity to deliver such a scheme. Ultimately, there is a balance to strike between the requirements on business and public health, and a public consultation would ensure that the Government are more likely to get that balance right.

On new clause 19, another concern we have heard from those who oppose the Bill is about the impact that the legislation would have on the black market. His Majesty’s Revenue and Customs estimates that the illicit market in tobacco duty and related VAT was £2.8 billion in 2021-22, with the tobacco duty tax gap remaining broadly unchanged since 2015, while in 2023 the Chartered Trading Standards Institute estimated that a staggering one in three vape products were non-compliant. Given warnings that increasing the age requirement for tobacco products and prohibiting more vaping could expand the black market economy further, it is sensible to take precautions to tackle the issue.

[Sir Ashley Fox (Bridgwater) (Con)]

Specifically on new clause 19, does my hon. Friend agree that it is inevitable that the generational smoking ban will lead to an increase in the illegal tobacco market and that that is a highly regrettable consequence of the Bill?

[Dr Johnson]

That is certainly a significant possibility, and that is the reason for moving the amendment, as my hon. Friend will understand.

Illegal products can include smuggled and counterfeit cigarettes, vapes with nicotine levels way above the legal limits, and products containing illegal and potentially dangerous ingredients. They can be more harmful and may not include the appropriate labelling requirements and health warnings that genuine products have to carry. Regardless of whether colleagues support or oppose this Bill as a whole, I am sure we all agree that a black market is unacceptable. We have therefore put forward an amendment that would require the Government to produce annual reports on the rate of sale and availability of illegal tobacco and vaping products and their impact on public health and safety.

[Sir John Hayes (South Holland and The Deepings) (Con)]

My hon. Friend has rightly taken a fierce line on illegal tobacco sales in Lincolnshire. Does she acknowledge that those illegal tobacco sales are often linked to serious and organised crime? The shops that sell them are often linked to money laundering—and are usually foreign owned, by the way—and the damage they do is extreme. Will she join me in urging further action by Government to support trading standards and the local police, who are doing such a fine job in trying to clamp down on this industrial-scale crime?

[Dr Johnson]

As is usually the case, I find myself agreeing with my right hon. Friend, and that is of course why we have tabled the amendment: it will give us the evidence that we and the enforcement authorities require to make sure that the black market is reduced.

[Jack Rankin (Windsor) (Con)]

Does my hon. Friend accept that there is not a risk that a black market will open, because a significant black market in tobacco already exists? In 2021, some 23.6 billion cigarettes were sold under duty, whereas in 2024 the figure was 13.2 billion, a 44% reduction. Yet an Action on Smoking and Health survey has found that smoking has reduced by only 0.5%. The black market is already here—it is not a new thing that will be created—so the Bill presents an even greater risk.

[Dr Johnson]

My hon. Friend makes a fair point. We know the black market exists, but the amendment would enable the Government to understand the scale of that black market and the changes in it, so that regulation could be enforced more robustly.

On amendment 90, as currently drafted the legislation will ban all forms of advertising of nicotine and non-nicotine vapes, nicotine products and sponsorship that promotes those products. Adverts will no longer be permitted on posters, billboards or the sides of buses, and sports teams will be prevented from being sponsored by a vaping company. As a Member of Parliament and a children’s doctor, I have been very concerned by the sharp increase in children addicted to vaping and, more recently, the other nicotine products such as pouches that have begun to flood the market. Schoolteachers have reported that children are unable to concentrate or even to complete a whole lesson without visiting the bathroom to vape.

Action to tackle the rise in vaping is welcome, and I support steps that restrict the appeal of vapes to young people, including through flavours and packaging. However, as the Minister mentioned in her opening speech, vaping can be a useful smoking cessation tool for adult smokers trying to quit; in my view, that should be their only purpose. Within the context of proposed advertising restrictions, amendment 90 would ensure that vapes that are targeted solely as a quit aid, to help adults stop smoking, can continue, in recognition of their role in bringing down smoking rates.

Finally, new clause 20 would introduce a requirement on online vaping products to operate an age verification policy, as is currently the case in Scotland. Whether someone is buying vaping products online or in store, robust provisions must be in place to ensure that the purchaser is of legal age, and businesses must have a robust policy in place. As we have seen through recent tragedies, the age verification process for online sales on age-restricted products has not always been effective. The new clause would be an important step towards protecting children from accessing products online that they should not be able to buy.

In closing, the Conservative party has a strong record of action on tobacco control. It was under a Conservative Government that plain packaging was introduced for all tobacco products and that minimum pack sizes for cigarettes and rolling tobacco were introduced—policies that have been demonstrably effective at reducing smoking rates. I have personally campaigned passionately on the issue of tobacco and vapes for over two years, and I am pleased that some of my original amendments to the Bill have made it beyond Committee stage and are with us today. I was also glad to see some of the new Government amendments introduced on Report that were born of debates we had in Committee, which have strengthened the Bill.

Our amendments are designed to highlight some of the difficulties in the Bill. We oppose the Government’s power-grab—creating powers to ban smoking and vaping wherever they choose by regulation, but without consultation or enough notice. We have concerns about how the Bill will operate in practice, especially the burden on small businesses, and the potential for unintended consequences, such as a growth in the black market for tobacco products, so we ask that the Government seriously consider our amendments today.

[Preet Kaur Gill (Birmingham Edgbaston) (Lab/Co-op)]

I welcome the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire (Ashley Dalton), to her role. It is a great pleasure to speak in the debate and to support this genuinely world-leading piece of public health legislation, which will help to consign smoking to the history books.

Unless we act to help people to stay healthy, the rising tide of ill health in our society threatens to overwhelm our NHS. Paring back public health, as the last Government did, was the definition of penny wise, pound foolish. It is vital that we tackle the causes of ill health, not just the symptoms, so that we can save the taxpayer billions of pounds and, most importantly, save lives.

We know that prevention is better than cure. As we have heard today, smoking remains the single biggest preventable cause of ill health in our country, causing 80,000 deaths a year. It is responsible for one in four cancer deaths, and it is a factor in over 70% of lung cancer cases. In my own constituency alone, nearly 12,000 people smoke. They are more likely to leave the workforce due to ill health. Many will suffer strokes, heart attacks and conditions such as chronic obstructive pulmonary disease. On average, they will lose 10 years of life expectancy.

However, the real tragedy is how many thousands of those smokers will have started when they were children, when they did not know any better, and have simply never been able to quit. Most smokers report wishing that they had never started, which is why it is incumbent on us all to support this legislation to help stop the start. According to ASH, in my constituency alone the cost of smoking exceeds £90 million every year, including £56 million in lost productivity, £4 million drained from the NHS and £30.7 million in social care. The costs of smoking to our society are enormous, and that is why it is time to stub it out.

Even today, in 2025, hundreds of young people a day take the first drag of a habit they will never manage to kick, and will regret for the rest of their lives. I was proud to lead the Opposition’s response to the last Government’s Bill through Committee in the last Parliament and, as I said then, there is no freedom in addiction. It is a shame that the leader of the Conservative party allowed her ideology to blind her from that fact when she voted against the legislation in the last Parliament, and against this Bill in this one. Where the last Government failed to get their Tobacco and Vapes Bill over the line, this Government will get the job done.

I am proud that the Government have vastly improved on the legislation that the previous Government drew up. First, the introduction of a new licensing regime to cover tobacco and nicotine products, including vapes, is hugely welcome. That was a key recommendation of the Khan review in 2022, which the last Government largely ignored and which retailers and the public overwhelmingly support, according to surveys conducted by ASH. The status quo, where there was no requirement to obtain a licence to sell those products, is a major gap in enforcement, particularly when we consider that the sale of alcohol is licensed, while nicotine and tobacco are not.

Secondly, I am pleased that the Government are taking forward an amendment I tabled in Committee during the last Parliament, for the introduction of £200 on-the-spot fines for retailers selling products to under-age people. In 2019 to 2020, 50% of the councils that undertook test purchasing reported that cigarettes or tobacco products were sold to children who were under 18 in at least one of their premises. That proves that the current regime is not enough of a deterrent. The introduction of new on-the-spot fines, which are double the amount proposed by the previous Government, will be much easier to issue and much harder to ignore. Does the Minister agree with me that double the fine is double the deterrent?

Thirdly, I commend Ministers on the action they are taking on vapes. Under the last Government, youth vaping trebled in two years. An estimated one in three vapes on the market were illicit, and products often contained harmful chemicals, heavy metals or even drugs. Gaping loopholes were left to sit on the statute book for years, putting children at risk. The promulgation of dangerous illicit vapes in shops, schools and on our streets is a real concern. Recently, in Birmingham, trading standards officers and the police led raids on retailers under Operation Cloud, when they seized nearly £6 million-worth of illicit vapes, tobacco and drugs. One raid alone, the biggest ever in Birmingham, clawed £1 million-worth of goods out of criminals’ hands. That shows the extent of the problem of the illicit market and the incredible job that council trading standards teams do to keep the public safe.

I thank the Government for getting behind trading standards with a £10 million boost to support their work next year. In particular, I welcome the new Government’s introduction of clauses to this Bill to set up a testing regime for vapes, a proposal that I championed in the last Parliament. It is shocking that under the current rules, unlike with tobacco, there is no testing regime for vaping products. That means that dodgy products can be rubber-stamped by the British regulator and wind up on our shelves, undermining the valuable enforcement work that trading standards do to identify and seize un-notified products.

As testing of vapes marketed at young people has shown, a significant proportion of vaping products are not what they say they are. Some market themselves as 0% nicotine when they are not, leading to accidental addictions; others contain harmful substances, such as heavy metals and even anti-freeze, as evidenced by research undertaken by Inter Scientific. That is why during the last Parliament I tabled amendments that would have established a new testing regime for vapes. Unfortunately, the Conservatives voted them down. I commend Ministers for introducing powers that the previous Government snubbed. Nearly 3 million people have quit smoking using vapes. Clearly vapes have a role to play in the transition to a smokefree future, but if they are to be used as stop-smoking aids, we need confidence that the products people buy are safe, which is what routine testing would do.

Finally, I commend the Government on the amendments that have strengthened this Bill; they close the loopholes on vape vending machines and ban vape advertising, promotions and sponsorships. The new clauses will ensure that these products are kept away from the impressionable eyes of young people, so that the next generation are not simply substituting one nicotine addiction for another. There were significant holes in the last Government’s plan, and I am glad that the new Government are slamming them shut.

The health crisis facing our country has never been confined to the running of its hospital wards, doctors’ surgeries and dental practices. We are a sicker nation, and that public health challenge needs confronting. Life expectancy was extended by three and a half years over the course of the last Labour Government, but in the 14 years under the Tories, it grew by just four months. In this Bill, we see the epitome of the future-facing approach that only a Labour Government can deliver. By stopping the start and ensuring that the next generation never develop an addiction to nicotine, we can protect their health and wellbeing and protect our NHS for many years to come.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 25th March 2025 Commons Chamber

[Mr Speaker]

This question is about sex and gender. Do not worry; I am sure that the Secretary of State has the message.

I now call the shadow Minister.

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

Given the findings of the Sullivan review on patient and health safety, which came about as a result of inaccurate and poor data collection, can the right hon. Gentleman confirm what meetings he has had with Secretary of State for Science, Innovation and Technology to discuss the reliability of the data on sex that is intended to be used by the digital verification platform in the Data (Use and Access) Bill?

[Wes Streeting]

I am grateful to the shadow Minister for her question. I speak to the Science Secretary on too frequent a basis—on a daily basis. He and I are both looking very carefully at the findings of the Sullivan review and working through its implications for both the health and care services, for which I am responsible, and for the Government digital and data services, for which he is responsible.

[Dr Johnson]

The UK Health Security Agency, for which the Secretary of State is responsible, publishes health statistics. This includes data on sexually transmitted infections, which is published by sexual orientation and sex. However, a footnote states that women are defined in the dataset as “women and trans women”, which does somewhat undermine the value of the data. What will the Secretary of State do to ensure that data is not just collected properly, but published and presented in a way that is most clinically useful?

[Wes Streeting]

The shadow Minister raises a good example of how conflation of sex and gender identity is not helpful both in terms of data analysis and of recognising health inequalities. It is also not helpful in making sure that we understand variances between people based on their different backgrounds and characteristics and that we provide targeted, personalised and effective healthcare that deals with healthcare inequalities. That is why we are carefully studying the recommendations made by Professor Sullivan, with a view to making sure that we are meeting the needs of everyone, including the trans community, who I understand, not least because of the way that the debate has been conducted in recent years, are anxious about the implications of the report. However, I genuinely think that the report will lead to better, more inclusive and fairer outcomes for everyone, including the trans community.

NHS England Update

Caroline Johnson Excerpts

Thursday 13th March 2025 Commons Chamber

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

I thank the Secretary of State for advance sight of his statement. It is disappointing, once again, that it was not made to the House first; in recent days, there have been numerous media briefings about this potential restructure.

Under new leadership on the Conservative Benches, we believe in a leaner and more efficient state. That means using resources effectively, reducing waste and preventing duplication, spending money where it is most beneficial. After all, the public understandably want to see the focus on patient care and not on backroom managers. Therefore, we are supportive of measures to streamline management, and we do not oppose the principle of taking direct control, but we need to know what steps will be taken to meet targets while all the upheaval happens. We need to know the specifics of what is being planned.

What are the timeframes for the abolition of NHS England? By what date will it be completed? How many people will be moved into different roles? How many people will lose their jobs altogether? How much money is that expected to save? Labour runs the NHS in Wales, which has the highest waiting lists and the longest waiting times in Great Britain. What lessons has Labour learnt from its failure in Wales?

NHS England, as the Secretary of State said, has just lost much of its leadership. Is that because they no longer had confidence in the Secretary of State, or because he did not have confidence in them? Perhaps he can tell the House whether Alan Milburn will keep his job in the upheaval. We also need to be clear that moving people into different roles will not fix the challenges that face the NHS.

The Secretary of State has spoken about taking direct control. That may help him ensure that the NHS stops wasting money on expensive diversity, equity and inclusion staff, and ensures that it provides dignity and privacy for female staff and patients, but what does it mean for clinical prioritisation? Will conditions that are less common and have less glitzy campaigns and fewer celebrity backers suffer because the Secretary of State now has political considerations? Does the Secretary of State have the bandwidth for this, given he has such a busy role already? How does the centralisation of power measure up with the commitment to give more powers to regional bodies and local integrated care boards?

In the first six months after entering office, the Government announced 14 reviews, consultations and calls for evidence, all of which require more staff. Are those jobs at risk, or are other pre-existing roles set to be cut? This announcement comes the same week as Labour’s Employment Rights Bill passes through the Commons. Is the Secretary of State getting a move on because he knows that red tape and bureaucracy will dramatically increase afterwards and make the decisions he has to take more difficult to deliver?

A drive to improve efficiency in the civil service and the management of the health service is welcome, but what about the NHS itself? The Government slimmed down our productivity plan and delivered a 22% pay rise in return for no modernisation or reform. How will those decisions improve efficiency? I asked the Department what proportion of people with a nursing qualification working in the NHS are in patient-facing roles, but the Minister said that they did not know. How can he use the skills and resources effectively if he does not know where those skills and resources are?

The Prime Minister is making a lot of noise about productivity and cutting waste, but he still refuses to set a target for cutting the civil service headcount. Thanks to the decisions he and the Chancellor took at the Budget, the size of the state is growing rapidly, not shrinking, while changes to national insurance contributions have diverted funding away from the frontline into compensating the Treasury. Ultimately, any restructure will be challenged by the Government’s continued failure to tackle immigration. While steps to improve efficiency in the healthcare service are welcome, these words ring hollow across Government.

[Wes Streeting]

I will take the more serious questions from the shadow Minister first. On timeframes, we will work immediately to start bringing teams together, as we have done with the one-team culture we have been building over the past eight months. I want the integration of NHS England into the Department to be complete in two years.

The shadow Minister asks about the reduction in the number of officials. NHS England has 15,300 staff; the Department of Health and Social Care has 3,300. We are looking to reduce the overall headcount across both by 50%, which will deliver hundreds of millions of pounds of savings. The exact figures will be determined by the precise configuration of staff, and we will obviously keep the House updated on that.

The shadow Minister asks about clinical leadership. One change we will be making with the transformation team is to have two medical directors succeeding Professor Sir Stephen Powis, whose departure from NHS England was planned long before these changes. There will be one medical director for primary care and one for secondary care, underpinning our commitment to the shifts we have described. I must say, there are enormous improvements to be made in clinical leadership for patient outcomes, patient safety and productivity, and I am demanding stronger clinical leadership to drive those improvements to productivity. Frankly, many consultants and clinical teams on the frontline will welcome that liberation—they are hungry for change.

The shadow Minister asks about the workforce data and complains that we have not been able to give her the precise answers. I agree: it is frustrating not having that precise information at my fingertips. I would gently remind her, though, on this as on so many things, that her party was in power for 14 years. She cannot very well complain eight months in given that they left us a woeful, embarrassing data architecture and infrastructure.

The shadow Minister asks about efficiency. Once again, she refers to the resident doctors deal as if it was a failure. The actual failure was leaving doctors on the picket line, not on the frontline, and wasting huge amounts of taxpayers’ money, with cancellations and delays to patients’ appointments, operations and procedures. We stopped that within weeks of coming into office. The deal does include reforms to improve productivity—if she is any doubt about the results, she should look at the fact that despite winter pressures, NHS waiting lists have fallen five months in a row.

Once again, we get the facile points about my right hon. Friend Alan Milburn, who is the lead non-executive board member for my Department. I honestly do not know why he bothers to pay for a mortgage; he lives rent-free in the Conservatives’ heads. They need to move on. By the way, just for the record: Alan Milburn has a record on the NHS that the Conservatives cannot even begin to touch.

The shadow Minister asks about confidence. I am delighted to be introducing a new transformation team. Different leadership challenges require different leadership skills. As I say, I have been really pleased to work with Amanda Pritchard for the past eight months, including on this transition; people should have no doubt about the confidence I have in her skills, talents and abilities, and I think she has a lot still to contribute to our NHS. We do not need to ask about confidence in the Conservative party; it is reflected in the scarce numbers on the Opposition Benches.

What is the lesson from Wales? The lesson is that when there is a Conservative Government in Westminster, the national health service suffers in England, Wales, Scotland and Northern Ireland. That is why we are creating a rising tide to lift all ships. I am sure we will see improvements across the United Kingdom. SNP Members, who are not in their place, do not have any excuses now. As I said before the election, all roads lead to Westminster, and the biggest funding settlement since devolution began is going down the road to Holyrood. There are no hiding places there for the SNP. If people want real reform of the NHS in Scotland, they should vote for Scottish Labour under Anas Sarwar and Jackie Baillie.

People can see here in Westminster the difference that new leadership provides. The shadow Minister laughably referred to new leadership in the Conservative party. Well, it is certainly leaner and meaner, but it is the same old Conservative party. The only thing that the Conservatives have shrunk is their own party. The only jobs that they have laid off are those of their poor party staff. The only thing that they are capable of changing—[Interruption.] Well, come to think of it, I do not think that there is anything they are capable of changing. Instead they look over their shoulder at a party leader who cannot even manage a five-aside team, let alone a country. The Conservatives are just so diminished as a party. I appreciate that it must be so painful for them to watch a Labour Government doing the things that they only ever talked about: reducing bloated state bureaucracy; investing in defence; reforming our public services; and bringing down the welfare bill. The public are asking: “What is the point of the Conservative party?” I bet they are glad that they chose change with Labour.

Ambulance Response Times

Caroline Johnson Excerpts

Thursday 6th March 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Jardine. I thank the hon. Member for Glastonbury and Somerton (Sarah Dyke) for securing a debate on this important subject. I pay tribute to the ambulance services and to paramedics and their colleagues, who are on the frontline of our healthcare service, today and every day. Regardless of the weather, or whether it is a bank holiday, they are always there for all of us.

In my medical career, I have been required to deliver full intensive care to children, and particularly babies, who were being transferred across the county in East Midlands ambulances throughout the night and day. I have hurtled along in the back of an ambulance as it travelled down country roads, around corners and down the hard shoulder of motorways, so I understand some of what ambulance crews do. That has given me a deep appreciation of their work, and highlighted to me some of the unique challenges and pressures they face, particularly in our rural areas.

Before I was elected, I had two experiences of delayed ambulance services. On one occasion, I was driving up the A1 when the gentleman in the car in front of me skidded on some water and went into a tree. I am sorry to say that the ambulance took a very long time to arrive, and he died shortly afterwards. There was a fire truck, police officers and an incident manager, but there was no ambulance service. I do not think it would have made a difference to the outcome, but in other cases it might have.

On another occasion, I was sat in traffic when a police officer knocked on the window, which is always slightly worrying. They were looking for a doctor because they had been waiting so long for an ambulance for the people in the accident that was causing the traffic. It took a further 40 minutes from me arriving at the scene for the ambulance to arrive�I am not clear how long the people at the scene had been waiting before. So this issue was a great priority for me before I became a Member of Parliament.

In my first question at Prime Minister�s Question Time, in January 2017, I thanked the East Midlands Ambulance Service for its brave and stellar work serving the people of Sleaford and North Hykeham, and asked for ambulance service response times to be a priority. I also raised the issue in my first meetings with the then Prime Minister and Health Secretary. I understand that response times have improved somewhat, at different periods with different initiatives but overall, as we have heard, they are not where we need them to be.

In January, a constituent wrote to my office detailing the difficult experience of waiting too long for an ambulance to arrive. This 85-year-old gentleman came downstairs at 10 am to find his 82-year-old wife, who suffers from advanced dementia, lying on the hardwood floor, covered in blood, crying and confused. He managed to get her into a chair, calm her down and call 999. The operator could not hear him properly because the phone service was bad, his wife was crying and trying to get out of the chair, and he was struggling. Eventually, he was told the ambulance would be there in 12 hours. The ambulance did eventually arrive, and his wife is now in a stable condition, but that was a traumatising experience for her and the 85-year-old man. I was sorry to read that harrowing tale, and tales like it are too common across the country. I am interested in what the Minister will do to improve the situation; it is easy to say that things are not where they need to be, but it is important to consider how one can improve them, and that is what I hope to hear from her.

Of course, the pandemic threw everything off kilter, and demand for ambulance services rose significantly, with almost 3 million calls in March 2020. In 2022-23, an extra �150 million was allocated to improve ambulance response times through extra call handler recruitment and retention. In January 2023, to improve performance further, the last Government published an urgent and emergency care plan, which set out ambitions to improve average ambulance response times for category 2 incidents to 30 minutes over 2023-24, with further improvement in 2024-25 to get back towards pre-pandemic levels. The plan aimed to increase ambulance capacity by making over 800 new ambulances available during 2023-24, including 100 new specialist mental health vehicles for those who require different types of service. However, in December 2024, under this Government, ambulance response times rose to an average of three hours and two minutes for category 3 calls�category 3 covers elderly people who suffer falls but not a head injury. What steps will the Government take with NHS England to reduce those response times so that people are not waiting hours in pain and discomfort?

I have said to the Minister that it is important that we talk about how we can improve things, as well as about what the problems are. It is crucial that we all do that, and one suggestion from my hon. Friend the Member for West Suffolk (Nick Timothy) was co-located blue-light services�I am sure he is aware that the first such services were opened not long ago in Lincolnshire. The blue light hub tri-service centre, in the Lincoln constituency, is a co-located site, and co-location is leading to improvements in services. Although that is not my constituency, I am sure the hon. Member for Lincoln (Mr Falconer) would be open to an approach if my hon. Friend wished to see the site.

It is important to look at risk all along the pathway. We have talked about handover delays, but there is a whole pathway from the moment someone calls 999 to the transfer journey, the wait to get into A&E and then the wait in A&E. The risk is clearly highest at the point where someone has called 999 but does not yet have access to on-site or in-person medical care. To improve that, we need more ambulances on the road and fewer sat outside A&E.

I have some questions for the Minister. Ambulances are double-crewed�there are two people in the ambulance �but do two staff need to stay with the patient? If two ambulances have arrived, each with two staff and one patient, could two of the four crew go off in one of the ambulances to see more patients? That would avoid a situation where there are two staff per patient in the ambulance, when many patients are not that unwell medically. Nursing in intensive care is only one to one, but we are providing higher levels of care than that with these staffing ratios. Is that necessary?

We also have a delay in handover�in getting people out of the ambulances�because the A&E is said to be full. The front door is open, but the back door, for people coming in an ambulance, is in effect closed. If patients got out of the ambulance and walked round the building to the front door, they could go in and be triaged as normal. It does not make sense. Some of my medical colleagues have gone to see people in the ambulance and discharged them from there, without their needing to come into the hospital at all. So there are clearly people with a level of medical acuity that would potentially allow the crew, with guidance and training, to discharge them into the front door of the hospital instead.

On another question, if some people are well enough to be discharged from ambulances, are the public sufficiently aware of what constitutes a necessity when it comes to calling an ambulance? How many ambulances that are called are necessary? One would not wish to deter anyone who is frightened and concerned for their wellbeing from calling an ambulance if they feel they need one, but education on when one is needed might be useful.

As has been alluded to, staff retention is also important. One o constituent�a single mum with children�left her role as a paramedic because she was struggling with working hours that overlapped with getting her children ready for school in the morning. She was able to cover most other aspects of childcare�such as picking them up from school�with after-school clubs and the like, but she struggled in a morning, and her flexible working request was refused. I recognise that there must be balance, and that all hours of the day must be covered by ambulances, but has the Minister thought about how working practices and hours could be changed?

The Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), mentioned resources in rural areas. That is important because response times will necessarily be increased by the geography, so greater levels of resource perhaps need to be provided to rural areas, in recognition of the fact that if we want response times in them to fall, we need a higher level of ambulance availability.

Another significant factor causing delayed ambulance response times is staff sickness, which is not necessarily an issue of NHS funding. Ambulance services in England report the highest level of sickness absence rates of any other profession across the NHS. Against a national average absence rate of 4.3% over an eight-year period, ambulance staff showed an average absence rate of 6.2%, with year-on-year increases. There are stark regional differences in sickness rates, with the West Midlands Ambulance Service consistently maintaining a lower absence rate�around 50% lower than its counterparts in London or the east midlands. The NHS would benefit from sharing best practices between trusts, which would make a real difference, ensuring a healthier workforce and, ultimately, better patient care. The issue is also costly financially, and an independent review published by Lord Carter in 2016 estimated even then that a mere 1% reduction in staff absences could save ambulance trusts up to �15 million a year. That figure would clearly be even higher now.

I also want to raise the issue of air ambulance services. Air ambulance charities deliver lifesaving treatment every single day and complete more than 25,000 lifesaving missions across the country every year�an average of more than one every 10 minutes. I commend the work of all those involved, and particularly Lincs & Notts Air Ambulance, which operates in and around my constituency, the crew who airlifted my husband from Silverstone to Coventry last year and looked after him so well.

In the last Parliament, the previous Government gave significant support to air ambulances. The Department of Health and Social Care�s three-year capital grant programme in 2019 allocated �10 million to nine charities across England. That funding supported air ambulance charities to move towards 24/7 operations and improved seven airbase facilities across England. However, services are now under threat from the Chancellor�s rise in national insurance and taxes. Lincs & Notts Air Ambulance will need to find another �70,000 just to pay the national insurance rise�this is an entirely charitably funded organisation. Can the Minister justify that policy, given the vital work that air ambulance charities do across the country?

On 19 November, my right hon. Friends the Members for Newark (Robert Jenrick), for Gainsborough (Sir Edward Leigh), for South Holland and The Deepings (Sir John Hayes) and for Louth and Horncastle (Victoria Atkins), my hon. Friends the Members for Rutland and Stamford (Alicia Kearns) and for Grantham and Bourne (Gareth Davies), the hon. Member for Boston and Skegness (Richard Tice) and I wrote to the Chancellor to ask about exemptions from the national insurance hike for air ambulances. Despite raising the issue at Treasury questions and in a point of order, and despite repeated chasing from my office, we have not had the courtesy of a proper response to our letter from the Government, although they have suggested that they are now asking the Department of Health and Social Care to respond to the letter. That is a huge discourtesy to the House, and I would be grateful for the Minister�s assurance, because the letter is apparently with the Department of Health, that we will receive a response by the end of the week. That is quite a reasonable request.

Finally, it is fair to say that ambulance crews are doing a sterling job, but that response times are not where we need them to be. I look forward to hearing the Minister tell us how she will improve those services for our constituents.

--- Later in debate ---

[Ashley Dalton]

The hon. Member will be delighted to know that I am coming to that point next.

We are working on reducing delays and getting hospital handovers back to within 15 minutes, ensuring that no handover between hospital and ambulance services takes longer than 45 minutes. We want to improve the range and co-ordination of services to avoid unnecessary ambulance conveyances, including through improving access to urgent community response and hospital at home services, and continuing to build on ambulance services and the great work that they do to increase the hear and treat rates so that people can be advised on what they can do and what services they can access that might mean they do not need that ambulance. We will also be driving consistency and commissioning practices across England for ambulance services. I will say a little more about the rurality element in a moment.

We are taking the first steps in the reform and improvements that we want to see in services, and we will shortly set out further plans in the urgent and emergency care services plan. We know that there is no solution for ambulances that does not include tackling the challenges facing adult social care. Health and care services need to be more joined up.

Today, there are approximately 12,000 patients in hospital beds who have no criteria to reside. They do not need to be there but cannot be discharged for reasons of capacity. Over the last month, on average, 276 of the patients with no criteria to reside were in the Somerset integrated board area. That is why the Government are making available up to �3.7 billion of additional funding for local authorities that provide social care. We are funding more home adaptations through the disabled facilities grant this year and next, so that people�s homes can be safer, reducing the risk of their needing an ambulance. We are reforming the better care fund to ensure that the pooled NHS and local authority funding spent on social care contributes to wider efforts to reduce emergency admissions and delayed discharges.

[Dr Caroline Johnson]

Social care is clearly very important, but what assessment has the Department made of the effect of national insurance contributions on social care provision as a whole?

[Ashley Dalton]

The hon. Member will be aware, because we have discussed the matter many times in Westminster Hall and the main Chamber, that the funding has been made available to the statutory sector bodies for employer national insurance contributions for public sector pay, and the negotiations for the delivery of commissioned services locally and within the NHS will take place locally. I am sure that we will be able to point her to some more detail on that issue, which has been discussed at length by colleagues.

We have announced the largest ever increase in the carer�s allowance earnings limit since the benefit was introduced in 1976. It is worth approximately �2,000 a year for unpaid carers. We are also introducing fair pay agreements to empower worker representatives, employers and others to negotiate pay and terms and conditions in a responsible manner. That will help to address the recruitment and retention crisis in the sector. It is not all about ENICs; it is about making sure that our social care service is resourced in order to make sure that social carers are recognised for the powerful and important work that they do. We have appointed Louise Casey to help to build a national consensus on the long-term solution for social care.

The social care cross-party talks, to which the Liberal Democrat spokesperson referred, have not been called off; they have been merely delayed. As I told her in the Chamber just yesterday, it is very much about making sure that we have the right people in the room and that they can attend. It is our intention for the talks to go ahead very soon. They have not been called off; they have been merely postponed.

Of course, we need further reform. We are bringing it forward through the 10-year plan this spring to accompany the additional investment in the NHS. The Government will publish that plan for radical reform in the NHS, with those three big reform shifts: from hospital to community, from analogue to digital and from sickness to prevention. The reforms will support putting the NHS on a sustainable footing so that it can tackle the problems of today and of the future.

The shadow Minister asked about the configuration of ambulance services. As I am sure she is aware, decisions on service configuration must be made by those who are experts in delivering it.

We have also talked about the key issues of rurality. A range of adjustments are made in the core ICB allocations formula to account for the fact that the costs of providing healthcare may vary between rural and urban areas. Some of the differences, such as the tendency for rural populations to be older, are naturally captured within the formula. We continue to review the formula for the impact of the characteristics of local areas, such as rural, urban and coastal, in the development programme.

I encourage all hon. Members to raise these matters with their local ICBs, which are responsible for commissioning the right configuration of local services. The NHS has increased the availability of local data on ambulance response times performance, with category 2 ambulance performance now published at ICB level, which has increased the transparency of the important data. I encourage hon. Members to use that data to direct conversations with their ICBs.

We have also talked about air ambulances. I am sure that all hon. Members recognise the contribution that they make, as the Government do. The Government support the long-standing independent air ambulance charities model for the successful operation of helicopter emergency medical services in England, which gives the sector the independence to raise funds through commercial activity and sponsorship from corporate partners. The NHS continues to support air ambulance services, including through thorough training and the provision of NHS clinicians.

Communities right across the country, including the constituents of the hon. Member for Glastonbury and Somerton, are struggling with poor services and crumbling NHS estates. We are putting record capital into the NHS. We will bring down ambulance response times. We will get waiting lists back down to what they were in 2010. It will take time, but we will deliver an NHS and a national care service that provide people with the care they need, when and where they need it.