Allied Health Professionals
Caroline Nokes Excerpts(1 week, 1 day ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Joy Morrissey (Beaconsfield) (Con)
On a point of order, Madam Deputy Speaker. The Government placed a written ministerial statement on today’s Order Paper to update the House on the much-troubled Ajax armoured fighting vehicle programme. However, the media have reported within the last two hours that, according to urgent briefing from the Ministry of Defence, the statement will now be delayed until later next week due to the need to seek further interdepartmental approval across Whitehall. Given that the strategic defence review was published months late, the defence investment plan, including vital new equipment programmes, is still unpublished nine months on, and now the MOD is putting out WMSs on the Order Paper and then refusing to publish them, the Department is clearly in a state of chaos. Can you advise me on how we can force the MOD to clarify this utterly confusing situation later today, or on Monday at the very latest?
Madam Deputy Speaker (Caroline Nokes)
I thank the hon. Member for giving notice of her point of order. This House is entitled to expect that when a written statement is to be delivered to the House, it will be done promptly on the day the Government have given notice that it will be made. Those on the Government Front Bench will have heard her point of order, and may wish to verify what is happening about the written statement. The hon. Member may wish to take advice from the Table Office on the steps that she can take to obtain clarity on the substance of the matter.
Women’s Health Strategy
Caroline Nokes Excerpts(2 weeks, 1 day ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
The Minister for Secondary Care (Karin Smyth)
With permission, I will make a statement on the Government’s renewed women’s health strategy.
The NHS was founded on the principle of equality and the right care for everyone, whenever they need it, but there is no getting away from the fact that it has failed to live up to that founding promise. For too long, women have been left to navigate a confusing system, fighting to get the basic care they deserve, and under-represented in health research. Above all, women’s voices and choices have been dismissed, and it is truly shocking how often women have been ignored when telling medical professionals about their pain. From pelvic mesh to endometriosis, we are expected to put up with pain as our lot in life, as if it were normal. But it is not normal, and since coming into office this Government have taken a number of measures to improve women’s health.
We have taken action to bring down gynaecology waiting lists, introduced menopause questions into routine health checks, made the morning-after pill available for free at high street pharmacies, stood up a rapid and independent investigation into maternity services, and introduced Jess’s rule, so that GP teams have to “reflect, review and rethink” if a patient presents three times with the same or escalating symptoms.
The blunt reality is that the NHS is failing women and girls on even the most basic measures of healthcare. Indeed, we do not treat all women equally either. The wealthiest 10% of women live almost 10 years longer than the poorest 10%, while the most deprived spend over a third of their lives in bad health—something I see starkly in my constituency of Bristol South. Disabled women experience poorer outcomes, and we should recognise the additional disadvantage faced by black and Asian women, who face the double discrimination of racism and misogyny all at once.
Our renewed women’s health strategy will address those and other glaring injustices. It will give women and girls faster care from a health system that actually listens. It will make it simpler and faster for them to access the care they need the first time they ask for it, and it will make sure that the latest innovations work for women, ranging from reproductive and maternal health to menopause and chronic conditions. Of course, every day women are receiving outstanding, compassionate care from our dedicated NHS staff, but being ignored, gaslit, humiliated and disrespected are all-too-common experiences for far too many. More than eight women in 10 say there have been times when healthcare professionals did not listen to them. Our mission is to dismantle the culture and ingrained behaviours that allow that medical misogyny to fester and grow, and that starts by listening to women.
Women’s voices and choices are the golden thread that runs through this renewed strategy. Their voices will be heard, as we work to reduce variation in how GPs listen to and respond to women, using patient survey data in a quality improvement programme. Their voices will be heard as we capture whether women have been treated with respect, kept informed, and involved in decisions about their own care. Their voices will be heard, as we co-develop new standards of care for procedures such as hysteroscopy, so that every woman has informed consent and a real choice over her pain relief.
Yesterday, my right hon. Friend the Secretary of State announced that we will do the first trial of a scheme known as patient power payments, which will cover gynaecology services. Women will get a say on whether the NHS provider should get full payment for the services women receive, based on the quality of their experience. It means that if a woman is not happy with her experience, a portion of the tariff paid to that provider would be redirected to fund improvements in the same services instead. In other words, women will have the power to kick medical misogyny where it hurts: in the budget.
All this is building on the evidence and expertise that informed the original strategy. I wish to acknowledge the intended ambition of that work, not least because it was based on the contributions of thousands of women. However, the changes that were promised have not translated into consistent improvements in access, quality of care or outcomes. Take gynaecology services. The waiting list for gynae care was north of 600,000 when we took office. Today that figure is finally moving in the right direction, but we cannot make as much progress as we would like because the system simply was not designed with women in mind.
I pay tribute to Baroness Merron, who has led this work on behalf of the Government. As she made clear in her foreword, this system was not designed in such a way—to be fair to Nye Bevan, in 1948 he was largely thinking about working men who were dying early in their sixties from the awful consequences of poor work, with some support for maternity services. We need to change that. We will support integrated care boards to introduce a single point of access for all non-urgent referrals to gynaecology and women’s health services, to speed up access. We will redesign the most common clinical pathways for heavy periods, menopause and urogynaecology, to remove unnecessary delays. Women with fibroids and endometriosis will be listened to at first presentation. They will be seen faster, and offered clear information through our new virtual hospital, NHS Online.
Women’s health pathways are being prioritised in NHS Online, and menopause and menstrual health services will be among the first to go live when it becomes operational this year. There will be a relentless focus on reducing women’s pain, improving standards, and reducing variation in both procedural and chronic pain management, including for chronic pelvic pain. We will launch a new programme to help young girls grow up understanding their menstrual health and know when to seek help.
From gynaecology to pain relief, our renewed strategy takes forward the work of the previous Government, and goes further and faster to fill the holes they left. It has only been made possible by the record £26 billion in funding for the NHS that was secured by my right hon. Friend the Chancellor, the first woman to hold that office. All that will be underpinned by an NHS that finally listens with respect, dignity and compassion to the voices and choices of every woman and every girl, every time. That is not least with the creation of the women’s voices partnership, which is a new space for organisations representing women, giving them a direct line to Whitehall to inform national decision-making. The partnership will have a particular focus on those women who are most excluded from traditional services, and through it we will ensure that women’s voices help to shape the long-term direction of NHS reform.
Unlike the original strategy that was based on an outdated model of care, this renewed strategy maps across the three shifts in our 10-year plan for health. The shift from sickness to prevention will mean that women can better understand and act on their risk of conditions such as breast cancer and diabetes. The shift from hospital to community will mean services designed around women’s lives, with much faster access to diagnosis and treatment. The shift from analogue to digital will mean that women will avoid long waiting lists for painful conditions through NHS Online. Within two years we will launch a new challenge fund, backing the most promising women’s health technology start-ups, with a focus on tackling health inequalities in community settings. We are embedding new sex and gender policies into studies through the National Institute for Health and Care Research, so that findings are genuinely representative and no woman is left behind by science.
As every woman hearing this statement knows, to fully exercise power over our lives we need to be at the top of our game, both mentally and physically. We also know that women’s health has been neglected for too long. It therefore falls to this Government to restore the founding promise of our national health service, and to deliver the right care for everyone when they need it. From the classroom to the clinic, our renewed women’s health strategy promises a fairer, healthier future for women and girls everywhere, acting on women’s voices and choices, transforming NHS performance in services that matter most to women, supporting all women to live healthier lives, and creating an approach to research and development that works for and empowers women. We are designing the system to fit around women’s lives. This will not be a strategy that sits around gathering dust on a shelf, because women are counting on us, and we will not let them down.
Karin Smyth
My hon. Friend is a fantastic champion in this area. We are so pleased to have her clinical experience and no day goes past without her representing her own speciality of physiotherapy and AHPs more generally. She is absolutely right that those professionals have led the way in looking at women’s care and it is important that women feel confident with that physiotherapy advice. I think that she will be pleased to see the developments that will come from the women’s health strategy and those that will come when we bring forward our workforce plan, which will have AHPs front and centre working in women’s neighbourhood healthcare.
Dr Danny Chambers (Winchester) (LD)
The Liberal Democrats welcome the strategy, and its specific recognition of the socioeconomic and racial disparities in women’s healthcare, which it is important to put front and centre. We also appreciate the specific recognition of endometriosis and similar conditions. My partner, Emma, suffers from endometriosis, and on many occasions I have seen her unable to stand up or barely get off the sofa, having been told for years that her symptoms are completely normal and that there is nothing wrong with her. Given that at least one in 10 women suffer from endometriosis and there are over 500,000 people on gynaecology waiting lists, clearly her experience is not unique.
The picture around maternity safety is deeply troubling. Maternal mortality has increased by over 20% in the past 15 years, and there have recently been some high-profile media discussions about women and babies being let down, sometimes with devastating consequences. That is why the Liberal Democrats have been calling for one-to-one midwifery care and specialist doctors on every unit.
I welcome the Government’s specific commitment on treatments for morning sickness. My hon. Friend the Member for Lewes (James MacCleary) has campaigned on that issue for a long time, and it is right that we end the postcode lottery for these medicines. The condition can be debilitating for some people, and it is not fair that women have different experiences simply because of where they live.
Given that this is not the first women’s health strategy to be brought to this place—the previous Government brought one through in 2022—and the fact that many women we speak to do not feel that there has been any meaningful change, a lot of people are saying that we cannot just keep announcing strategies while women are waiting for basic care. Given the failure of the last Government to deliver meaningful change, can we have reassurances that this will not simply be another strategy announcement and that women will feel a difference in the care that they receive?
Resident Doctors: Industrial Action
Caroline Nokes Excerpts(1 month ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
The Secretary of State for Health and Social Care (Wes Streeting)
With permission, Madam Deputy Speaker, I will make a statement on the proposed industrial action by resident doctors.
Yesterday evening, the British Medical Association called its latest round of strikes for 7 to 13 April, immediately following the long Easter bank holiday weekend. The announcement came just hours after its resident doctors committee rejected an historic deal that would have boosted pay, created jobs, improved career prospects and put money back in the pockets of its members. This was deeply disappointing after months of highly constructive and good-natured talks between the Government and the leadership of the RDC. In that context, the fact that the BMA’s immediate response was to call such extensive strike action, rather than return to the table, speaks volumes about what we are up against.
I will set out how we have reached this regrettable position. Since the start of this year, the Government have been holding extensive and intensive discussions with the BMA resident doctors committee leadership, who engaged in good faith. I have spoken personally to or met with the chair several times, and those engagements were, of course, on top of the near-daily dialogue that his team held with officials from my Department.
Together, we got further than many thought possible. As a result of our discussions, a landmark deal was put formally to the full resident doctors committee on 22 March. Based on our engagement with the BMA officers, we were optimistic that it would be received positively, although I was aware of the officers’ preference that it should be a deal over two years rather than three years, and that they had expected the independent recommendation of the Review Body on Doctors’ and Dentists’ Remuneration—the DDRB—to come out slightly higher than it did. Regrettably, despite the deal having been designed with and supported by the BMA leadership, the committee itself rejected it yesterday.
I will run through what the RDC has unilaterally rejected on behalf of the 81,337 resident doctors in this country. The headlines of the deal are: reform of the pay structure, so resident doctors would benefit from more frequent pay rises at each stage of their training; pay rises over three years baked in, linked to the independent DDRB recommendations, as requested by the BMA; and reimbursement of Royal College exam fees from April this year, which resident doctors currently pay out of pocket. They can be as much as £2,200 for psychiatry, £2,300 for paediatrics and £3,700 for ophthalmology. Other headlines are: contract reform for locally employed doctors to ensure they also benefit from greater job security, equal opportunities for pay progression, and improved terms and conditions; and up to 4,500 more specialty training places created over the next three years, including 1,000 for this year’s applicants.
Alongside the deal, the Government have just passed the Medical Training (Prioritisation) Act 2026, so that domestically trained resident doctors no longer compete on equal terms with overseas graduates for specialist jobs. The Act will reduce the competition ratio for jobs from almost 4:1 to almost 2:1. The deal also follows the 28.9% pay rise already delivered by the Government.
As a result of the proposed package, resident doctors would have seen an average pay rise of 4.9% this year; starting pay for new graduates entering the profession this year would have been nearly £12,000 higher than four years ago; the lowest-paid foundation year ones and foundation year twos would have seen a pay boost of at least 6.2% and 7.1%, respectively, this year; and there would have been 1,000 more resident doctor jobs in a matter of days from this April.
Along with pay decisions that I have already taken, the package would have meant that, this year alone, resident doctors would have been, on average, 35.2% better off than four years ago. There are not many, if any, professions in our country for which that is true. The DDRB recommendation is 3.5%, which is significantly less than what is on offer as a result of pay structure reform.
The BMA has pointed to the war in Iran as reason to reject the deal. I will spell out the consequences of what this country is facing. The Government want to see de-escalation and a swift resolution to the conflict, with a negotiated agreement that puts tough conditions on Iran, specifically in relation to its nuclear ambitions. However, we are planning on the basis of a prolonged conflict, because that is the prudent thing to do. In that eventuality, there would be an impact on the economy and on the public finances. Were that to happen, a future offer to resident doctors would not look better than what is on offer today.
The Government’s tolerance for costly and disruptive action that undermines a critical public service is fast diminishing. In three years’ time, I do not want resident doctors to look back on this moment with regret as they turn down three years of guaranteed pay rises, more money in their pockets through reimbursement of exam fees, and more jobs. The BMA is choosing more strikes. As a direct result of its decision, and despite our best efforts, resident doctors will be worse off. Indeed, on the very day that 1,000 more specialty training places would have opened up for resident doctors with this deal, the BMA will be on strike, demanding more job opportunities.
Let me turn to the impact on patients and the NHS. Yesterday, the British social attitudes survey revealed that patient satisfaction has increased for the first time since before the covid pandemic. Dissatisfaction has seen the sharpest decline since 1998. Patient satisfaction with access to GPs has gone from 60% when this Government came to office to more than 75% today. Wating lists are the lowest they have been for three years, four-hour performance in A&E is the best for four years, and ambulances are arriving faster than they have for half a decade. All of this has been achieved despite the BMA’s strikes, so I want to reassure patients that the NHS’s recovery will continue.
In the most recent round of strikes, the NHS team pulled together and delivered 95% of planned elective activity. I am confident that we will see the same outstanding efforts if further action is taken. But to the BMA, I say: we can achieve so much more, and the improvements can be so much faster, if you take this deal and stop your strikes. Strikes have a significant financial cost. Every penny spent on keeping the show on the road during strikes is a penny that cannot be spent on improving staff pay and working conditions or better care for patients. The impact on the other staff working in the NHS, who are left to pick up the pieces, is severely felt.
So I am asking the BMA’s resident doctors committee to reconsider. I will meet again with its officers. I also repeat my offer to meet with the entire committee, who have thus far refused to meet me since I became Secretary of State. Indeed, they are the only group of people I have offered to meet who have declined, which I find extraordinary in these circumstances. The deal on the table shows what we can achieve when we work together. In contrast to my predecessors, I have shown good intent from the outset. I have listened to the complaints that resident doctors have about their working lives—I agree with them, and I want to work with them to improve their working conditions as we improve the NHS.
But when it comes to making a deal, the reality is that it takes two to tango. The BMA has until next Thursday to reconsider before we have to call time on the extra jobs, and the focus of the NHS and my Department turns to minimising the disruption from this unnecessary and unwarranted strike action, which would also consume the money set aside for this deal. But there will be a cost to the NHS, to staff and to patients. This was an historic opportunity, developed in tandem with the BMA leadership. I urge the committee to reconsider. I urge the BMA to call off its industrial action. I commend this statement to the House.
Wes Streeting
I thank my hon. Friend for his support in trying to influence a more constructive approach, for the advice that he has given me and members of the resident doctors committee, and for the experience that he brings to these exchanges. He is right to praise Jack Fletcher for the constructive approach that he and his officers have taken. It has not been easy, but I know that officials have enjoyed the constructive engagement, and I thank enormously the officials who have worked tirelessly on this. I think all those involved in the discussions, on both sides of the table, are disappointed by the outcome, and that is why I urge the BMA to seize the offer before it is too late.
My hon. Friend talks about other changes, such as to placements and rotations. I think that BMA officers recognise my desire to not only do this deal, but to create a new business as usual with the BMA, where we have people around the table on a regular basis looking at what we can do to improve the health service for patients and staff and to make real progress on those issues. We cannot do that if we are in conflict. That is the tragedy of the position we find ourselves in. I think we have built trust through engagement and dialogue with the BMA committee officers. It is only disappointing that members of the committee are not prepared to get around the same table as me, because if they did, they might realise the sincerity and the opportunity.
Helen Morgan (North Shropshire) (LD)
People across the country will be extremely concerned about the prospect of further strikes, having faced so much disruption already in recent years. It is important to recognise that the strike is a symptom of an NHS still coming to terms with the damage caused by the previous Conservative Government. Doctors are burnt out from working in high-pressure environments under poor conditions—often trying to save lives on corridors with no space or privacy. However, we all know how difficult public finances are, and that is now being compounded by Donald Trump’s reckless war in the middle east. Therefore, a further 26% pay rise is not affordable or realistic at the moment, and it is time the BMA recognised that.
There is much more the Government could be doing to support both staff and patients. The BMA has a mandate to strike until August, yet patients struggle to get GP appointments and suffer months of pain while stuck on waiting lists. How will the Secretary of State stop the situation dragging on throughout the year and causing yet more harm to patients?
We must also show staff and patients that things will get better. Lib Dem plans to recruit and retain more GPs, offer one-to-one midwife care and fix the social care crisis would offer the NHS the hope that is needed by easing pressure on staff and patients. Will the Secretary of State consider fixing crumbling hospitals as a priority, to give staff and patients the working conditions and dignity that they need and deserve?
At Shropshire’s major hospitals, it is common to see ambulances queuing up outside, unable to offload their patients, while staff inside are struggling to cope with patients in corridors. Will the Secretary of State commit to ending the misery of corridor care by the end of this Parliament? I welcome his intention to build additional training places, but will he outline a timetable for publication of the workforce plan, because that is critical for the future of our NHS?
Wes Streeting
It is frankly breathtaking hypocrisy. It rather looks like doctors in their ivory tower saying one thing, and lecturing us about what is and is not affordable, but when it comes to how their subs are spent and how their own union behaves towards its own staff, not being prepared to pay them. I have been very complimentary about the officers who have been engaged with Ministers and my officials in recent weeks to try to get this deal over the line; so have BMA staff. I am stunned by the BMA’s unwillingness to practise what it preaches. I will not be joining resident doctors on the picket line. I should have declared, Madam Deputy Speaker, that I am GMB member, so if there is one picket line that I will be visiting during the doctors’ strikes, it may well be that one.
Madam Deputy Speaker (Caroline Nokes)
I call the Chair of the Health and Social Care Committee.
Layla Moran (Oxford West and Abingdon) (LD)
This is clearly the wrong move again. It is really stark; we keep hearing from patients across the country about how much they want the NHS to improve, but this is another blow to them, and they may even wonder if it is safe to go into their local hospital during the strike period.
I am grateful to the Secretary of State for coming to the Committee and talking about corridor care. The really interesting thing about that session was that the hospitals that have turned things around did so because of leadership from the top. Their executives and board members were going into hospitals out of hours and on weekends to speak with resident doctors, nurses and patients, to see what things were like on the ground. When was the last time the Secretary of State did that? This is not a “gotcha” moment—I have not done that recently, but I want to. If we are to lead a change in culture in the NHS, we should all show how we would do it, and should urge board members and executives to do the same, in every hospital across the country.
Palliative Care
Caroline Nokes Excerpts(1 month, 3 weeks ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Madam Deputy Speaker (Caroline Nokes)
I call Rachael Maskell, who will speak for about 15 minutes.
Several hon. Members rose—
Madam Deputy Speaker (Caroline Nokes)
Order. If Members confine their remarks to five or six minutes, we will get everybody in, but I do not intend to introduce a formal time limit yet.
Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
I thank my hon. Friend the Member for York Central (Rachael Maskell) for this important debate. I pay tribute to her political expertise in this area and for everything she has done.
Dame Cicely Saunders—much quoted in this debate—was the founder of the hospice movement in this country. She understood that medicine is not only about curing illnesses; it is about dignity and ensuring that people are supported compassionately at the most vulnerable moment of their lives. It was her work that transformed how we think about care at the end of life, and today hospices all over the country continue that legacy. In my own work as an ear, nose and throat surgeon dealing with patients with advanced cancers in the head and neck, I am well aware of the importance of hospices.
I also pay tribute to Dr Eric Wilkes, who was a brilliant general practitioner and founder of the hospice movement in Sheffield. He was one of my teachers and one of the first people to understand the importance of integrating end-of-life care into community and hospital settings at St Luke’s hospice. The term “palliative care” was invented only in 1990—some 20 years or so after I first met Dr Wilkes—and the Sheffield model has been completely crucial to this development.
I would like to talk about palliative care in my constituency of Bury St Edmunds and Stowmarket, and in particular the remarkable work of St Nicholas hospice, its wonderful chief executive Linda McEnhill and all her staff. The hospice provides essential support for those approaching end of life and for their families and loved ones. What makes that hospice a little unusual is that it sits right on the campus of West Suffolk hospital, an arrangement that facilitates help for the patients in the hospice from all the services within the hospital. If, for example, a patient falls and fractures a leg, or needs an ear surgeon, support is available rapidly and nearby. Most hospices simply do not have access to that level of clinical support, and that is a real advantage for the Bury St Edmunds hospice.
St Nicholas hospice also illustrates a wider challenge facing palliative care across the country. As we know, demand for hospice services is increasing. St Nicholas lately increased its capacity by about 33% to meet the needs of patients and families in the local community. To expand, more staff need to be recruited, so we must do something to increase training capacity across the hospice service, particularly because we must ensure that we have a seven-day service. If we need to increase the service from a five-day service to a seven-day service, we need two sevenths more people.
Palliative care is a crucial part of a healthcare system. The problem, as we have heard on many occasions, is that hospices rely on charity and legacies. That is obviously admirable, but it raises an important question—one that I think was first asked by Baroness Finlay in the other place. We do not expect a maternity service to require charitable funding. If we needed a new maternity service, we would expect the NHS to put it up. Yet for some reason, if we need a hospice, we expect a charity to raise the funds for it and to run it. Being born and coming to the end of life are just inevitable parts of life, so I think we need a paradigm shift—a philosophical change—in the way we think about palliative care, which must be regarded as a core part of our national health service. If we genuinely believe that dignity at the end of life matters, let us make palliative care core.
Madam Deputy Speaker (Caroline Nokes)
That brings us to the Front-Bench contributions. I call the Liberal Democrat spokesperson.
Brain Tumour Survival Rates
Caroline Nokes Excerpts(2 months, 3 weeks ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Helen Maguire
The hon. Lady brilliantly describes the real nub of the problem.
One of my constituents got in touch to tell me that in the space of a few months, four people that she knew received a brain tumour diagnosis. With symptoms ranging from seizures to changes in behaviour, the diagnosis process for brain tumours can be dramatic, lengthy and hard fought. That is why we urgently need improvements in diagnosis. The national cancer plan aims to make great strides in speeding up diagnosis, but I was disappointed that the Government did not take up the Liberal Democrats’ calls for 8,000 more GPs, to ensure that everyone can get seen quickly and be referred for treatment.
Once a referral is successful, the brain tumour should be treated. To see delays because of equipment shortages is a disgrace. The Government have pledged funding for 28 new radiotherapy machines, which is a step in the right direction, but the Liberal Democrats have long called for 200 new, fully staffed machines, so that we can end radiotherapy deserts and stop delays to vital treatment. Will the Minister set out when we can expect funding for more machines?
Brain cancer has a more complex element; it does not occur in stages like other cancers, but is defined by grades. The grading system can also differ, depending on the type of brain tumour that the patient has. The national cancer plan has looked to offer some relief to patients by giving a commitment that a clinical nurse specialist or other named lead will support them through diagnosis and treatment to hopefully make the path clearer. I look forward to seeing how the Government intend to support this ambition by providing enough staff through the 10-year workforce plan. While we are waiting for that plan, will the Minister give some clarity on how he plans to implement the commitment to providing 5,000 learning and training opportunities per year for the first three years of the plan for people in cancer-critical roles?
It is important that I mention benign brain tumours. Just because they are not cancerous, it does not mean that people do not experience a life-changing impact from being diagnosed with them. Those living with benign brain tumours must also receive the right treatment, care and lifelong support.
I really hope that we are at a turning point in cancer care, especially for brain tumours, which kill more children and adults under the age of 40 than any other cancer. I am pleased to see many organisations, including Brain Tumour Research, welcome the national cancer plan, especially the proposed access to clinical trials and increased research. There is a lot of ambition in the plan that must be accounted for, so will the Minister confirm that the annual summary of progress for the national cancer plan will be presented in the House every year for proper scrutiny?
Dr Ahmed
Sacking people is above my pay grade, so I will revert to the Secretary of State’s opinion on that, but my hon. Friend can certainly be reassured that we will hold them accountable, just as she will hold me accountable. She might give me the sack at this rate, so I had better be careful.
We are grateful for the continued campaigning on rare cancers. We look forward to working further with partners to deliver improvements in outcomes for brain cancer patients, and we know that the improvements promised through this plan rely on good research.
That research has already begun, with over £25 million invested in the NIHR brain tumour research consortium, which aims to transform outcomes for adults and children —and their families—who are living with brain tumours, ultimately reducing the number of lives lost to cancer. Furthermore, we are partnering with Cancer Research UK to provide £3 million to co-fund the CRUK brain tumour centres of excellence. This will ensure that we accelerate the move from foundational research to delivering innovative treatments for patients. These investments have the potential to shift the dial and the UK’s position as a leading location for brain tumour treatment research.
As reaffirmed in the national cancer plan, this Government are proud to support the Rare Cancers Bill, introduced by my hon. Friend the Member for Edinburgh South West, which passed its Second Reading in the other place last month. I thank my hon. Friend the Member for Mitcham and Morden and other hon. Members for their support and their moving contributions to the debates on the Bill. This important legislation will make it easier for researchers to connect with patients living with rare cancers, including brain tumours; streamline recruitment into clinical trials; and ensure that our regulatory system delivers for patients. As set out in our 10-year health plan, we will ensure that the UK is a global leader in clinical research. This Bill will accelerate the clinical trials needed to deliver the most effective cutting-edge treatments and the highest-quality care for patients facing a rare cancer diagnosis. I look forward to seeing it progress towards Royal Assent.
I once again thank hon. Members for giving me the chance to set out our plans on rare cancers. I hope I have reassured them that we are determined to improve survival rates for patients, and ensuring that everyone has access to the highest-quality care and the highest-quality research. The national cancer plan embodies these ambitions and sets out how we will achieve them. Through our significant research investments and our support of the private Member’s Bill on rare cancers, in 2026 we will begin to shift the dial on outcomes for brain tumour patients.
Medical Training (Prioritisation) Bill
Caroline Nokes ExcerptsTuesday 27th January 2026
(3 months ago)
Commons ChamberRead Full debate Medical Training (Prioritisation) Act 2026 View all Medical Training (Prioritisation) Act 2026 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts Amendment Paper: Committee of the whole House Amendments as at 27 January 2026 - (27 Jan 2026)
Neil Duncan-Jordan (Poole) (Lab)
As the final contributor from the Back Benches, I shall try to strike a slightly different tone from the rest of the debate.
Over the past few days, I have been contacted by a number of constituents who are likely to be affected by today’s emergency Bill. One of those is Dr Khan, a resident doctor at Poole general hospital’s emergency department. He trained overseas and has been working in the NHS for almost three years. He also has a young family living in my constituency. As an international medical graduate working in the NHS, he is concerned that the proposed emergency legislation on UK medical graduate prioritisation will have a negative impact on people like him. Although I support a sustainable domestic medical workforce, implementing these changes mid-cycle in 2026, after applications have closed and commitments have been made, is, I believe, a breach of procedural fairness.
My constituent has raised further concerns that I would also like to share. The technical proposal to use immigration status such as indefinite leave to remain or citizenship as a proxy for NHS experience is both blunt and unnecessary. The Oriel application system already specifically collects data on whether an applicant has more than six months of NHS experience, and this existing evidence-based metric should be used to prioritise those already contributing to our health service rather than relying on immigration status.
Many of Dr Khan’s colleagues have relocated to this country and planned their lives based on the rules in force when the applications opened in late 2025. To change the rules now, while we are in the middle of the interview window, will cause immense personal distress and undermine our long-standing commitment to fairness.
There is also a genuine risk to the workforce. Our NHS relies heavily on our international staff, and today’s Bill risks damaging the UK’s reputation as a fair employer. It could lead to an exodus of skilled professionals that the NHS, in my view, cannot afford to lose.
When the Minister responds, will she consider providing clear transitional protections for the 2026 cohort who are already here? Will she further consider that any new criteria should be implemented prospectively for 2027 and that any measure of NHS experience should utilise the data already collected, rather than blunt immigration-based proxies?
A few days ago, I submitted a written question on the impact that the proposed changes to rules around indefinite leave to remain for health workers would have on the viability of the NHS 10-year workforce plan. The response from the Department was that no such assessment had been made. I fear that we are now making the same mistake again. Those who are already here and making a contribution need to be acknowledged for their service. I would welcome any assurances that the Minister could give to Dr Khan and all those like him who are already a valued part of our NHS.
NHS Urgent Care: Staffordshire
Caroline Nokes Excerpts(3 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
John Slinger (Rugby) (Lab)
I note what my hon. Friend says about his integrated care board. I have very positive meetings with my ICB, but a similar situation is affecting the town of Rugby, which I represent. The urgent treatment centre is nurse-led, and we very much want there to be a doctor-led treatment centre. A review is under way, but my constituents and I are simply not aware of its end date. That causes the kind of concern around services that you talk about—
Mental Health Bill [Lords]
Caroline Nokes ExcerptsMonday 8th December 2025
(4 months, 3 weeks ago)
Commons ChamberRead Full debate Mental Health Act 2025 View all Mental Health Act 2025 Debates Read Hansard Text Read Debate Ministerial Extracts Amendment Paper: Commons Consideration of Lords Message as at 8 December 2025 - (8 Dec 2025)
Madam Deputy Speaker (Caroline Nokes)
I confirm that nothing in the Lords message engages Commons financial privilege.
Schedule 2
Nominated persons
Tom Hayes
I have written more mental health investment standard funding applications than I care to remember. Although investment is obviously important, one major challenge with that stream of funding was that I had to apply on an annual basis. There was no certainty around multi-year settlements, so I was repeatedly setting up projects for which I could not find the funding to keep them going. That created more disruption in mental health support. We need to have stable, continuous funding settlements that actually meet the need that has been identified by the data and patient experience. That is what the Government are delivering, and to latch on to a particular funding stream and claim that somehow it is not being provided with support, when actually there is the wider of goal of tackling mental health through different methods—
Madam Deputy Speaker (Caroline Nokes)
Order. The hon. Gentleman will know that there is ample opportunity for him to contribute to the debate. That was a very long intervention.
Dr Evans
I am grateful to you, Madam Deputy Speaker, for stepping in on that basis. We have had plenty of chances to debate this Bill, both in Committee and many times in the mental health debates that I am partial to. We could go through why the last Government changed the interventions of NHS England and brought in integrated care boards to allow for a joined-up structure to be put in place. We now see a new iteration coming forward but, yet again, we do not know how much it will to cost to get rid of NHS England. We do not know the redundancy packages for the ICBs and how much they will cost. That is fundamental.
One thing we do know is that, as the chair of the Royal College of Psychiatrists has said, the change to the investment standard alone will cost the sector £300 million. That is investment that could have made a difference to mental health provision. I do not want to get into the heated politics any further, and I do not want to delay the House any further this evening, but the Government’s position on the mental health investment standard is crucial when it comes to delivering this Bill.
I thank the Minister for his constructive approach, and for the way in which he has taken ideas forward and looked through the Bill in fine detail. I know he cares deeply about getting this right, as do many Members of this House. It is imperative to ensure that compassionate, modern care is delivered to those who need it most when it comes to dealing with serious mental health conditions.
Dr Danny Chambers (Winchester) (LD)
I thank Members across the House for the constructive way in which they have all contributed towards this long-awaited Bill. In the last 40 years, attitudes to mental health and the treatments available have changed significantly, so these reforms and updates are very much needed and very much supported by everyone here.
On Lords amendment 19B, we welcome the important addition. All children and young people deserve appropriate care and support when undergoing treatment for mental health problems, including the safeguarding of a nominated person. Each and every child going through the system deserves to be properly represented by a responsible adult, so we are grateful for the amendment and we are pleased to lend it our support. While we understand that the remit of this Bill very much focuses on in-patient mental health care, we cannot ignore the wider context in which this Bill needs to operate. Even the best in-patient system will struggle if we fail to invest in the preventive and early intervention services that keep people well in the first place.
The hon. Member for Hinckley and Bosworth (Dr Evans) mentioned the difference between mental wellbeing and mental health issues, and ensuring that we protect people’s mental wellbeing before they go on to develop mental health issues. If we are serious about preventing people from reaching crisis point, we need to ensure that the many community-based initiatives, which the Minister and others have spoken about, are strengthened. That is why we will continue to champion walk-in mental health hubs, having a mental health professional in every school and a sort of mental health MOT check-up at key points in individuals’ lives.
It has been an honour to contribute to this Bill. I want to thank the Minister for his meaningful engagement with all Members across this House for the best part of a year. My one ask of him tonight is to again consider restoring the suicide prevention grant to voluntary, community and social enterprise organisations, because I keep meeting charities and organisations that have benefited from it. It is really important that we support community organisations that can help identify when someone is reaching crisis point, because so many people who take their own lives are not in contact with NHS services.
Finally, I pay tribute to all the frontline workers in mental health in clinical and community settings. Nurses, counsellors, psychiatrists, doctors, therapists, support staff, carers and charities prop up a system that is complicated, underfunded and challenging to work in, and we want them to know that we appreciate all the efforts that they continually make. The Liberal Democrats will keep pushing until mental health is given the same urgency, care and attention as physical health.
Budget Resolutions
Caroline Nokes Excerpts(4 months, 4 weeks ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Debbie Abrahams
I absolutely agree. It is a shame that we need food banks at all—this is the state of what we have inherited, unfortunately.
I commend the Health Secretary for the work that has been done to increase capital investment in the NHS, which will boost NHS productivity. A recent Health Equity North report, “Health for Wealth”, showed that by reducing the inequalities between the north and the south, and by improving health in the north, we can increase productivity by £18 billion a year. On health inequalities, I hope we can focus on the weighting given to resource allocation.
My final point is about the commitment to index pre-1997 accrued pensions for inflation, capped at 2.5%, where scheme rules allow. This means that pensioners whose pension schemes became insolvent through no fault of their own, and that have failed to keep pace with inflation, will now have the situation rectified. That will benefit more than 250,000 pension protection fund and financial assurance scheme members, and I give credit to the Pensions Action Group and the Deprived Pensioners Association, and to the Pensions Minister for listening to me.
This is a very good Budget. It gives hope, particularly to my constituents and others like them, so I am very grateful.
Dr Andrew Murrison (South West Wiltshire) (Con)
I will start on a positive note by commending the lines on productivity in the Red Book, and the recent comments that various Ministers have made about that. Productivity has to be the No. 1 objective in getting our NHS to where it needs to be to deliver for our constituents. I have to say to the Health Secretary that objectives two and three are probably dentistry and adult social care, and on those, I have heard less positive news.
Dentistry in particular is still struggling as a result of the units of dental activity created by Gordon Brown back in the day—a system that has bedevilled the provision of dentistry in this country and is in urgent need of reform. Without that reform, we will make no progress at all on one of the principal issues in the health service that concern my constituents at the moment.
I think that a degree of humility is important when we talk about the NHS, and I say that with all due respect to the Health Secretary, because otherwise he will be setting himself up for a fall. Reform in the NHS is fiendishly difficult, and we all remember the ghost of PFI, which still stalks the corridors of our hospitals and clinics and will do so for some time to come.
The day before the Chancellor of the Exchequer gave her pre-Budget speech, her boss—the Prime Minister, no less—took the very unusual step of personally moving the Second Reading of a Bill. The Bill was admittedly a very important one indeed, and the Prime Minister might have thought, perfectly understandably, that it was too important to be delivered by his Justice Secretary. It was the Public Office (Accountability) Bill, which begins its Committee stage today.
At the heart of the Bill is a new duty of candour, and despite its name, it extends well beyond the holders of public office. It carries a legal obligation to act transparently, creates new criminal offences of misleading the public, and contains new codes of conduct based on the Nolan principles of selflessness, integrity, objectivity, accountability, openness, leadership and honesty, and it imposes appropriate sanctions. Lying is a very strong test, Madam Deputy Speaker, and you would call me out of order if I applied it to any right hon. or hon. Member, but this Government, through their Bill, are insisting on another test. They are insisting on a test of candour, and a duty of candour is a noble principle, but nobility cannot be confined to one area of the public realm; it has to be universally applicable, and it has to be applied from the top.
Now, I am not accusing anyone of lying, but it should be abundantly clear that in preparing for this Budget, the Chancellor of the Exchequer did not approach her duties with the candour that she and her colleagues are demanding of others—which the public have a right to expect—and that is incorporated, in principle at least, in the Bill that the Prime Minister introduced on Second Reading just a few days ago. I suggest that before that Bill comes back to the Floor of the House, the Chancellor might like to reflect on the duty of candour as far as it applies to Ministers. I feel that a new clause that would make it more difficult for her and her successors to stray into the kind of shenanigans that we have seen over the past couple of months would be greatly welcomed by the House.
Madam Deputy Speaker (Caroline Nokes)
Order. I think that the right hon. Gentleman means to be discussing the Budget, not the Bill that is in Committee.
Dr Murrison
I am grateful for your guidance, Madam Deputy Speaker.
What has unfolded since September reflects badly not just on the Chancellor of the Exchequer, or the Prime Minister, or the Government, but on all of us. On 17 September, the OBR—
Ian Lavery (Blyth and Ashington) (Lab)
I am listening to this debate and I am discombobulated—I really, really am. The shadow Minister, the right hon. Member for Daventry (Stuart Andrew) spoke for 20 minutes, but he never mentioned why his party—and others—absolutely opposes withdrawing the two-child cap. In this country, we have kids suffering from scurvy, beriberi and rickets, among many other diseases caused by malnutrition. And you know what? He has opposed lifting children out of poverty. You’re an absolute disgrace.
Madam Deputy Speaker (Caroline Nokes)
Order. Mr Lavery, you will be aware that you have just called me an absolute disgrace with that phrase. I am taking it badly.
Ian Lavery
Madam Deputy Speaker, I would never dream of calling you a disgrace—you are far from that—but I was pointing at the two Gentlemen on the Opposition Front Bench, the right hon. Member for Daventry and the hon. Member for North Bedfordshire (Richard Fuller).
Getting back to the reality, why did the right hon. Gentleman not mention why the Opposition oppose that, in a country where we are one of the richest economies in the world? Why are we not feeding the kids? Why are we not making sure that kids in every constituency in this country are fed when they get into school and get equal opportunities to fill their bellies and learn, and get better opportunities later on? Why? Why did the Conservative party and the media in the press over the weekend continually have a go at the Labour party about “benefit street”? Typical. Reverting to type. Well, I’ll tell you something, Madam Deputy Speaker: 3,000 kids in my constituency of Blyth and Ashington will benefit greatly as a result of just that one policy. I am proud that we looked at that and that we have done exactly what we have done. I just cannot believe people oppose it. I used to have loads of respect for at least one of those on the Opposition Front Bench.
With the time I have left, I would like to mention the efforts of Labour Front Benchers on the inclusion of the BCSSS—the British coal staff superannuation scheme—and the pensions for many mineworkers who worked underground. As the Labour party promised in the 2024 manifesto, the mineworkers’ pension scheme has now agreed to pay the money back from the special reserve fund to the pensioners themselves. It is a great move. People will remember this. For 14 years, the Conservative party refused to pay a single ha’penny to miners who had worked their socks off in the pursuit of black coal for this country.
There is a lot to do. We need to look at a wealth tax. We need to make sure that these billionaires and millionaires are not left out. And if they want to go to Dubai, Madam Deputy Speaker, then bye, bye—nick off to Dubai!
Max Wilkinson (Cheltenham) (LD)
Just this weekend, The Telegraph reported a secret plot to reverse Brexit by taking this country into a customs union with the EU. Sign me up for that, because we would generate plenty of investment and renewal if we did. If only that were the case. As everyone on the Government Benches and in this House knows, there is an alternative to some of the pain in the Budget. The Labour party knows that it does not really need to hike taxes on hard-pressed households or batter businesses. There is a better way.
Depending on which economist we ask, the impact of Brexit has been a hit to GDP of as low as 4% or as high as 8%. What is the Government’s answer? A deal with Europe amounting to a boost to GDP of about 0.3% and a trade deal with India amounting to about 0.13%. Let us not forget the deal with Trump’s America that might be worth something or not very much at all, yesterday, today or tomorrow, depending on how well the President’s Happy Meal is going down.
Those piddling trade deals are used as evidence for not pursuing closer integration with the economic bloc that covers 41% of our exports and 51% of our imports. Such freedoms we have gained: the freedom for Britain to punch itself in the mouth for ever while Reform and the Conservatives tell us that the pain we feel is the sweet taste of freedom champagne and liberty oysters. At least the Government now acknowledge that there is a problem, but the delusion continues while they argue that anything other than the obvious is the solution.
What is the result of that delusion? British businesses are mired in post-Brexit regulation. The cost of living is up, the size of the state has ballooned, much to the annoyance of the Conservatives who told us it would get smaller, tax is at record levels and our economy is more vulnerable to international shocks. We are all poorer, apart from the hon. Member for Clacton (Nigel Farage), who is not here but whose profitable grift continues.
Madam Deputy Speaker (Caroline Nokes)
Order. May I just point out that the hon. Member might like to withdraw the choice of word he used to describe the actions of the hon. Member for Clacton?
Max Wilkinson
He is making a lot of money on social media, Madam Deputy Speaker, and I am happy to clarify that.
To compound the problem, we have the sort of Budgets that this Government are giving the nation. Last year, they decided to make it more expensive for businesses to employ people. The Government also tell us that their No. 1 priority is growth but persist with needless and harmful trade barriers and increase the cost of employing people. That is at best absurd and at worst a dereliction of duty.
A short time ago, deep into the weeks of endless leaks and speculation, I met concerned local businesses. They wanted the Government to do something to ease the tax burden, to tread carefully when raising minimum wages—they did not say they were against them, though—and to make it easier for their businesses to grow. The opposite has happened. Despite the spin applied last week, here is the feedback. Edward Anderson, who runs three pubs in Cheltenham, tells me his combined business rates for the three premises will increase by £27,000 a year from April. Andrew Coates tells me that the rates across his three premises will rise by £34,500, on top of the impact of the minimum wage rises costing him £25,000. Why?
On occasion, those of us who ask the Government difficult questions about sensitive and divisive matters are shouted down and told we are ignoring the problem. On this matter, it is the Government who are ignoring the problem, and Ministers know it. Without properly dealing with the consequences of Brexit by striking a new trade deal with Europe—a customs union leading to single market access and stronger realignment in future—this country will continue in the slow lane. If this Government continue to be wilfully ignorant of the impact of their actions on the private sector, this country will continue in the slow lane. If the No. 1 priority for this Government truly were prosperity, they would unleash the opportunity of a trade deal with Europe and make it easier to do business here.
Procurement, Slavery and Human Trafficking Regulations: NHS
Caroline Nokes Excerpts(6 months, 1 week ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)
I beg to move,
That the draft National Health Service (Procurement, Slavery and Human Trafficking) Regulations 2025, which were laid before this House on 9 September, be approved.
I am here on behalf of the Minister for Secondary Care, my hon. Friend the Member for Bristol South (Karin Smyth). It is an honour to represent the Government as we bring forward this important secondary legislation, and it is right that it should be given the full scrutiny of the House today.
Slavery is one of the greatest evils in human history. This Government cannot and will not accept that we could be supporting forced labour or human trafficking through our supply chains, however inadvertently. Before I continue, I acknowledge the cross-party support on this issue, both in this House and in the other place. I pay tribute to all hon. and right hon. Members and peers of the realm, such as Lord Alton, who have worked tirelessly to put modern slavery at the forefront of our national conversation.
I begin by setting out why we need the regulations. Many people are taken aback when they are told that there are more enslaved people now, in absolute terms, than at any point in human history. It is estimated that around 50 million people worldwide are living in some form of modern slavery. Globalisation has provided near-limitless opportunities for trade in goods and services, but also, unfortunately, in human beings. Though we on these isles would like to think that we are insulated from the highways of human trafficking, we are not.
In late 2023, the previous Government published a review into NHS supply chains that covered 60% of medical consumables. It accounted for £7 billion of spend across 1,300 suppliers, representing 600,000 products, and a fifth of those suppliers were deemed to be high risk. Imagine my horror when I read that some of the tools of my trade—surgical instruments, facemasks—could be contaminated by modern slavery. As someone who still practises as a surgeon, I know that I share that revulsion with my colleagues across the national health service. I ask my colleagues in this place to keep all our NHS staff in mind over the course of our proceedings.
The review also recognised the wider benefits to the NHS of a better understanding of how our supply chains work, noting how we could improve the quality of products supplied and the resilience of supply. It gave us clear recommendations for us to act on and today I am proud to come to the House with landmark modern slavery legislation to put those policies into practice. This is a first on these isles and I sincerely hope that our colleagues across the devolved Governments can follow suit soon.
I now turn to what the regulations will do. The NHS is one of the largest public sector procurers in the world, with an annual spend of £35 billion, doing business with over 80,000 suppliers. We have a duty to ensure that no products we procure could be tainted by forced labour, and an opportunity to use our immense purchasing power for global good.
The regulations we bring forward today will require all public bodies to assess modern slavery risks in their supply chains when procuring goods and services for the health service in England. They give effect to a duty established by the Health and Care Act 2022, which requires the Secretary of State to eradicate modern slavery wherever it is found in NHS procurement processes. We are asking public bodies to take reasonable steps to address and eliminate modern slavery risks, especially when designing procurement procedures, awarding and managing contracts and setting up frameworks or dynamic markets.
Reasonable steps may include enforcing robust conditions of participation in our supply chains, with assessment criteria built into every stage of that process. They may include monitoring suppliers’ compliance and reassessing risk throughout the lifetime of a contract. They can also include writing terms that require immediate mitigation where instances of modern slavery are discovered. The regulations will also require public bodies to have regard to any relevant guidance issued by the Department of Health and Social Care or NHS England for consistency and accountability across the system. The updated version of the guidance has now been published by NHS England and is publicly available.
Colleagues might be worried about legislative overlap. They might ask themselves why we need new regulations when modern slavery is already illegal, but these regulations have been carefully drafted to fit with existing statute, and I can assure the House that contradictory duties have been avoided. We are building on existing measures, such as the Modern Slavery Act 2015 and the Procurement Act 2023, not replacing them. We are bringing all NHS England’s procurement into scope and creating a stronger legislative footing for enforcement. The point is to introduce a single, enforceable risk management approach to modern slavery across the NHS, and we will continue to review our arrangements to ensure that they remain effective for years to come.
I do not pretend that this will be easy. If there was a button somewhere in Whitehall or inside the national health service that could eliminate modern slavery at a stroke, I do not doubt that all of us would push it, but our supply chains are vast, making it difficult to fully assess the scale. Although the 2023 review was just a snapshot in time, it is likely that more than a fifth of our supply chains are still at high risk of modern slavery. Items include cotton-based products, surgical instruments and PPE gloves—all products that are vital for the day-to-day functioning of hospitals and clinics up and down the country. That is why we will back NHS organisations with clear guidance and support to root out the scourge of modern slavery wherever we find it.
There is an argument that we could procure these items on the cheap if we could just turn a blind eye, but that way of thinking is abhorrent and fundamentally un-British. We cannot simply weigh such things on the scale of a tradesman behind a counter, and we must remember our historical responsibility in eliminating slavery wherever we find it. But even if we could do that, ethical supply chains have been proven to be cost effective in the long term. There is a strong case that they help to avoid litigation and, more important, supplier collapse. Even if that were not the case, I know the will of the British people, and I have not a shred of doubt that decent people across our country will not think modern slavery a price tag worth paying. This place, the mother of Parliaments, is here to answer a call today and to send a message to all enslaved people across the world: what is happening to you is unjust, but we have not forgotten, and we will do our utmost to ensure that our money does not go to those that exploit you and keep you in chains.