Puberty Blockers

Danny Beales Excerpts

Tuesday 23rd June 2026 Commons Chamber

[Sarah Owen]

I thank the hon. Member for his intervention and his kind words at the beginning; that is the right tone, which we need to set, and information is key. People need to be able to make informed decisions—whether it is the child or a parent—and there needs to be independent information so that people can make fully informed decisions.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

My hon. Friend is making a powerful and moving speech. Further to her point, does she not agree that the Opposition’s motion to prevent a clinical trial would not give people information, options and choices? It would cut down information, options and choices. She mentioned a constituent in her 80s who clearly did not grow out of her gender dysphoria, and this motion would close off lifesaving and life-changing treatment for the 7% of people who do not grow out of gender dysphoria.

[Sarah Owen]

I thank my hon. Friend for his powerful intervention; absolutely, information and scientific evidence are key, and this trial will be conducted by experts with patients’ best interests at heart. We have heard from the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson), and I am sure that, as a doctor, she cares about her patients as much as all the doctors and clinical specialists that will be involved in these trials.

Last year, the Women and Equalities Committee held a one-off inquiry into the safety and effectiveness of puberty blockers. We stuck to the science. There were different views on our panel of witnesses, but I wanted to demonstrate something that has, sadly, not happened very often around this topic, which was that we could discuss it in a sensitive, respectful way, based on fact, not opinion—not for social media clips or for likes on a particular outlet’s sidebar of shame, but for the good of the people we represent.

We also examined the use of puberty blockers for other medical purposes—something that has not been discussed today when talking about the risks, or perceived risks, of puberty blockers. It is commonplace to use puberty blockers for certain cancers, for endometriosis and for children experiencing premature sexual maturity, also known as precocious puberty. When it comes to cancers such as prostate cancer, the professors on the panel described the need to essentially “turn off” testosterone. This is now a commonplace treatment for prostate cancer.

Another use of puberty blockers is for endometriosis. We already know the disgraceful delays in diagnosis and treatment for endometriosis and adenomyosis, with women waiting at least 10 to 13 years just for a diagnosis. They are living in pain for far too long, but experts are using puberty blockers, again, to essentially “turn off” menstruation and oestrogen for women with severe endometriosis.

--- Later in debate ---

[Joy Morrissey (Beaconsfield) (Con)]

The reason I am in the Chamber today is the protection of children—that is why I care about banning social media, and it is why I am here to speak about puberty blockers. We protect young people under the age of consent from alcohol, heroin and sexual abuse, because they are children under the age of 18. This puberty blockers trial for 11-year-olds makes me ask whether we are putting sufficient safeguards in place for those young people, and whether they have the cognitive ability to understand what they are doing. Do they have the cognitive development to understand that, when their brain is fully developed, they will have made an irreversible choice, one that will last for the rest of their lives?

We talk about these children giving consent. What about a class action lawsuit? Members have referred to 7% of people being happy to continue with the therapy. What will happen when these children are 18 or 25? Inevitably, a percentage will decide that they do not want to continue in the gender they chose as a child and want to go back to the gender they were before. What are they going to do? Are they going to sue the Government? Are they going to sue the clinicians for conducting the trial, because they were forced and coerced into something that they did not fully understand?

[Danny Beales]

I thank the hon. Member, my constituency neighbour, for giving way on that point. There is a lot of “what about” in her remarks; will she reflect on Dr Hilary Cass’s comments that the trial will lead to less harm than would otherwise be the case? Why does she believe that Dr Cass is saying that? Does she doubt her expertise in this instance?

[Joy Morrissey]

My doubts come from why, for example, we are not allowing the data linkage study to be fully completed before proceeding with the new trial. That study would find out what has happened to all the children who have already taken puberty blockers. I wanted to ask the Liberal Democrat spokesperson, the hon. Member for Mid Sussex (Alison Bennett), that question, but I was not able to make that intervention; I do not know whether that had anything to do with the £1.5 million donation from Ferring Pharmaceuticals that the Lib Dems took before the 2019 election. I do not know whether that had anything to do with it, but there has to be some level of declaration if a political party has taken donations from a pharmaceutical company that is promoting this drug. That is relevant to how one represents oneself in the Chamber.

There is no justification for proceeding with the Pathways trial before the data linkage study is complete. Puberty is how a child transitions from childhood to adulthood, and anything that affects that process is going to have long-term effects. Those effects are going to be felt, not in one or two years, but in 10 years. The brains we have as adults, at the age of 24, are very different from the brains we have as 11-year-olds—our frontal cortexes are not fully developed. This is not just about the effect on these children’s psychology; what effects do these drugs have on humans over the long term? We do not know that, so why not look at the data linkage study? It does not have to be perfect, but it will allow us to protect the children going into this trial, so that the trial is as well-run as possible.

Pathways Study: Puberty Suppression

Danny Beales Excerpts

Monday 22nd June 2026 Commons Chamber

[James Murray]

I agree with the shadow Minister that most children and young people who are questioning their identity and gender are likely to resolve those questions on their own, and I think Dr Cass would agree with that. As I said in my opening remarks, for the majority of children who question their gender, we should let them be; they will resolve the matter through their friends and family and their own development. We are talking here about a small subset within a small group of children who need further support. I also agree with the shadow Minister that the situation before Dr Cass did her review—the situation that had developed in the last few years before the turn of the decade—was totally unacceptable, and we should be clear that that was wrong.

The shadow Minister asked about protecting the young people involved in the trial from harm. As I set out, there is intense scrutiny, and there are robust mechanisms to prevent the children involved from being harmed. She mentioned the MHRA recommendation for the lower age limit. Initially, there was no lower age limit, but a scientific dialogue between the MHRA and the trial sponsor led to publication last week of the updated protocol, which recommended the minimum ages of 11 and 12.

The gateways to younger people and children becoming involved in the trial are significant. There must be not just consent or assent from the children, and consent from their parents or guardians, but approval from the NHS care team, the national multidisciplinary team and others before anyone can be involved. As I set out, I feel uncomfortable and uneasy when considering this matter, but I think that the right way for us to move forward is to have the clinical evidence on which to base decisions. I have received reassurances about there being the highest possible level of scrutiny and protection from harm for young people involved in the trial, and that is the basis on which, on balance, I think it is right for it to proceed.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I thank the Secretary of State for his statement. The Conservative party committed to and commissioned the Cass review, and today’s statement takes forward Dr Cass’s recommendations in full—guided not by ideology, but by evidence. Some Members who are critical of that approach have said in this place that these young people just need love. I agree that we should show trans people and trans young people more care and compassion—far too often, those things have not been demonstrated in public discourse in recent months and years—but trans people and trans young people also need and deserve high-quality, evidence-based and timely healthcare. I therefore welcome today’s statement and the Secretary of State’s commitment. Will he say that this Government are still committed to rolling out gender clinics in every region?

[James Murray]

As my hon. Friend will know, the recommendations in Dr Hilary Cass’s review set out how to establish better services for young people in the future. The focus of today’s statement, the clinical trial, is just one part of the wider work on how best to support young people who need extra support in this situation. It was welcome that there had been, at least until recently, a cross-party consensus that Dr Cass was finding the right way through this difficult matter.

Mental Health: Parity of Esteem

Danny Beales Excerpts

Wednesday 17th June 2026 Westminster Hall

[Liz Twist]

I do agree, and I will expand more on that theme.

Parity of esteem means tackling mental health with exactly the same respect, funding and clinical focus as physical conditions.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I thank my hon. Friend for securing this important debate, and I know that she is a strong advocate for mental health in her role on the APPG. In the NHS, it is vital that funding for mental health keeps pace with funding for physical health care, and the mental health investment standard has been a crucial policy in driving parity of investment. Does she agree that it is vital that the mental health investment standard is retained in the NHS?

--- Later in debate ---

[Preet Kaur Gill]

I thank the hon. Gentleman for mentioning the wraparound care in Winchester citizens advice bureau. We need the local health ecosystem to partner with initiatives in the voluntary or charity sector such as that one, and acknowledge their impact, fund and support them. Some may think that things such as debt are basic, but their impact on mental health cannot be overestimated. I am sure that officials will want to meet the hon. Gentleman and others to look at the landscape across the country, because there are some fantastic initiatives that we need to recognise, partner with and support.

The Government are taking action to elevate the status of mental health. For 2026-27, NHS mental health spending is forecast to increase to a record £16.1 billion, representing a real-terms increase of around £140 million compared with the previous year. Alongside that, the mental health investment standard remains in place. Integrated care boards are required to protect mental health spending in real terms over the next three years, ensuring that mental health continues to receive the investment needed to improve services and outcomes.

Investment alone is not enough. We must transform how care is delivered. That is why the 10-year health plan sets out our vision for a neighbourhood health service, which my hon. Friend the Member for Blaydon and Consett mentioned. That is about bringing care closer to people’s homes, communities creating genuinely patient-centred services, and moving away from a fragmented system that often leaves people navigating multiple services without the support they need. I hope the ICBs are engaging hon. Members in all parts of the House to feed into the design of the neighbourhood health centre model and asking about the unmet needs and service gaps in their constituencies and regions.

[Danny Beales]

The Minister is being kind with her time, as always. As part of our inquiry into mental health services, the Health and Social Care Committee visited the 24/7 neighbourhood mental health centre pilots and Trieste, where the model originated. They have clearly been hugely successful already. The Minister mentioned the broader neighbourhood healthcare changes; can she assure us that the learnings from those hubs will be spread across the country? Will there be a clear road map for rolling out these services to every area?

[Preet Kaur Gill]

My hon. Friend is absolutely right; this is a great pilot, and there are some real, huge successes. The Government must learn from the impact that the hubs will have, and of course we want to roll them out. That is why we are piloting six community-based health centres across England in Tower Hamlets, Lewisham, Whitehaven, York, Sheffield and Birmingham. Those centres provide round-the-clock open access treatment and support for adults with severe mental health needs and work closely with primary care and community services to provide joined-up care.

All hon. Members across the House will recognise that it is not appropriate for someone who is facing crisis or poor mental health to be sat in A&E; that just exacerbates their condition and situation. The community-based health centre pilots show that a different model can work. In May, my noble Friend Baroness Merron visited the community-based mental health centre in east Birmingham, where she met staff and service users to hear directly about the service’s impact. The visit demonstrated the important role that community-based mental health support has in providing earlier intervention, improving experiences of care and helping people to access support before reaching crisis point.

I know that my hon. Friend the Member for Blaydon and Consett is particularly interested in how the reforms will benefit her constituents. Although her constituency is not home to one of the six core or the 16 associated community-based mental health pilot sites, a range of community-based support is already available locally. Gateshead Connects hubs provide accessible community drop-in spaces that offer mental health and wellbeing support alongside practical advice on issues such as housing and finances. Residents can access NHS talking therapies through services based at Blaydon primary care centre, and community mental health support networks operating across County Durham provide peer-led groups and safe spaces for people living in and around Consett. Those local services reflect the wider direction of travel in our 10-year health plan, which will bring support closer to people’s homes, strengthen community-based provision and ensure that people can access help earlier, before their needs escalate into crisis.

Significant progress has also been made in building a stronger crisis care pathway. That pathway includes the NHS 111 mental health option; the expansion of crisis cafés, about which we hear from so many hon. Members, as well as sanctuaries and crisis houses; and the roll-out of crisis tech services across England. We have completed delivery of the mental health response vehicle programme, with 88 vehicles now operating across local systems. There is now full national coverage of 24/7 mental health liaison teams in acute hospitals, and we are investing up to £120 million to increase the number of sites with mental health emergency departments to 85.

The Government have also delivered on our commitment to modernise the legal framework that underpins mental health care. The Mental Health Act 2025 brings mental health legislation into the 21st century and ensures that people receiving treatment have greater choice, autonomy and involvement in decisions about their care.

My hon. Friend says that parity of esteem must extend to children and young people, and she and many other hon. Members spoke about cases of children facing crisis. The children and young people’s modern service framework is being developed and remains on track for publication in autumn 2026. The framework will support a more integrated approach to physical and mental health.

Hon. Members rightly spoke about access to services and waiting times. It is unacceptable that some people are waiting far too long to receive the mental health care that they need, particularly children and young people and those experiencing a mental health crisis. ICBs must do more. No child should be left waiting. The Government have delivered three years ahead of schedule our commitment to recruit an additional 8,500 mental health workers across the NHS, in the hope of easing pressures on services and improving access to care. We are also expanding NHS talking therapies and continuing the roll-out of mental health support teams in schools and colleges to achieve full national coverage by 2029. We know that we need to go further.

Wheelchair Provision: Independent Review Body

Danny Beales Excerpts

Tuesday 21st April 2026 Westminster Hall

[Daniel Francis (Bexleyheath and Crayford) (Lab) [R]]

I beg to move,

That this House has considered the potential merits of establishing an independent national review body overseeing wheelchair provision.

It is a pleasure to serve under your chairship, Dr Murrison, and I thank the Backbench Business Committee for agreeing to this morning’s debate. I declare an interest as co-chair of the all-party parliamentary group for wheelchair users, alongside Baroness Tanni Grey-Thompson; as the chair for the all-party parliamentary group for access to disability equipment; and as the parent of a wheelchair user.

Through the APPG’s work, we have heard directly from stakeholders and service users about the unacceptable delays that wheelchair users face in accessing suitable equipment, often with reduced health outcomes as a result. Too often we also hear that service users are confined to using completely inappropriate wheelchairs as that is, frankly, their only option. The issues I will discuss today in patients accessing disability equipment are also all too evident to me as chair of the APPG for access to disability equipment. I pay tribute to the Wheelchair Alliance and Whizz Kidz for their dedication in their advocacy for wheelchair users across the UK and for their support in preparing for today’s debate. I am grateful to have secured the debate and, as Members know, I am the parent of a wheelchair user and have lived and breathed the issues that so many wheelchair users face in accessing wheelchair provision.

The wheelchair quality framework, published in April 2025, outlines that wheelchairs provide

“a significant gateway to independence, wellbeing and quality of life for thousands of adults and children. They play a substantial role in facilitating social inclusion and improving life chances through work, education and activities that many people who do not need wheelchairs take for granted.”

While I welcome the framework for introducing some minimum standards and expectations, in my experience—and I will come to that later—it is the case that the user deals with the contractor, not the integrated care board. The ICB appears to have little or no idea, quite often, what the actual experience for users is when dealing with the contractor.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I thank my hon. Friend for securing this very important debate. I know this is a subject on which he has much knowledge, experience and passion. ShopMobility, a group of volunteers who provide mobility aids at the shopping centre to get people out and about in the town centre, have recently reported to me that many of their customers are coming to them waiting for wheelchair provision from the contractor, sometimes for more than six months. I have also had young people with cerebral palsy and other conditions unable to get basic repairs to their existing equipment. Does he agree with me that these are simply unacceptable levels of services for what is vital equipment, not optional extras? Is that not exactly why, as he says, we need an independent review body to scrutinise the poor performance of the contractors and commissioners?

[Daniel Francis]

Absolutely; I completely agree. I will refer later to the position that we now know of, how ombudsman complaints have risen exponentially in recent years, and to the experience of many people, including that of my own daughter, who has quadriplegic cerebral palsy, in the kind of delays that my hon. Friend has outlined.

In the 2024-25 financial year, there were 630,000 wheelchair users registered in England, with 70,600 of them under 18 according to NHS data. However, that figure does not include those who have purchased their wheelchairs privately, or those unable to obtain the right equipment through the NHS. In 2018-19, the Wheelchair Alliance estimated there were a total of 780,000 users. That was an estimate due to lack of robust evidence to back those assumptions. There is no set location on NHS health records to identify whether someone is a wheelchair user. With many users purchasing their wheelchairs privately, or being provided a wheelchair through a charity, NHS data does not provide an accurate picture and we remain in the dark about the true number of wheelchair users in England. Unfortunately across the country we are seeing countless examples of wheelchair users being systematically failed by their service providers, and I am sure we will continue to hear horror stories throughout this debate. Wheelchair users face long waiting times, poor fitting and unsuitable equipment, and complex and fragmented access pathways, with reports of a postcode lottery in accessing wheelchair provision.

Meningitis Outbreak

Danny Beales Excerpts

Tuesday 17th March 2026 Commons Chamber

[Wes Streeting]

I am extremely grateful to the right hon. Gentleman for raising that question and making that point. It sometimes feels that barely a month, if not a week, goes by in this job when I am not regularly exhorted to make a political decision overriding clinical advice. I think that is the wrong thing to do and it sets a dangerous precedent, particularly when others in this House might be minded to make ideological judgments about science and medicine that are neither good science nor good medicine. There is an important principle to defend here, which is that where we are making clinical decisions, they should be based on good, high-quality clinical advice on the basis of robust evidence and data. I give him the assurance that I will continue to follow clinical advice, and he is absolutely right to raise this particular point of principle.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I, too, welcome the Secretary of State’s statement and join him in expressing our sympathies with and condolences to the families who have lost young people in recent days.

Obviously, parents and students are very concerned at the moment, and there are reports online that private pharmacies are selling vaccinations for several hundreds of pounds. Can the Secretary of State assure this House that NHS England and the Department of Health are monitoring any possible price gouging on vaccinations and that there is no profiteering following these tragic events?

I echo the comments of the Chair of the Health Committee. We recently looked at vaccinations, and there have recently been a number of outbreaks of different diseases across the country, some of which are associated with declining vaccination rates—although that is not directly related to this incident. Will the Secretary of State update us on his thoughts about whether the last Government’s 2023 vaccination strategy needs a fresh look in order to deal with both uptake and responses to outbreaks?

[Wes Streeting]

I thank my hon. Friend for the excellent work he does as a member of the Select Committee, and reassure him that we are taking the Committee’s letter and advice very seriously. I think he is right to ask us to look again at the 2023 strategy.

I also reassure my hon. Friend that to price gouge or profiteer in this situation would be a totally immoral and irresponsible thing to do. More generally, we are not advising the public to pay for a vaccine. If it is decided that any vaccination is required, that will be offered on the NHS. The menB vaccine is already offered to infants, and the menACWY vaccine, for adolescents and young adults, is free on the NHS. That is the advice. I understand that people may wish to make individual choices, but the advice stands, and I would urge people not to allow themselves to be ripped off by those trying to exploit understandable public anxiety.

Medical Training (Prioritisation) Bill

Danny Beales Excerpts

2nd reading
Tuesday 27th January 2026 Commons Chamber

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I thank the Secretary of State and the Minister for the Bill, which delivers on the promises made previously in this place in response to the proposed industrial action a couple of months ago. It is welcome to see the pace with which the Government have moved in progressing these important changes. It shows their commitment to backing doctors and medical professionals in this country.

There is a lot to welcome in the Bill’s provisions. Members have talked at length and with a lot of personal and professional expertise about the challenges of the medical training system. As a member of the Health Committee—alongside the Chair, the hon. Member for Oxford West and Abingdon (Layla Moran), and others who have spoken—we often hear about the need for a proper workforce plan to address the NHS’s long-term issues with training and development, which frankly have failed staff and patients.

It is important to reflect on, as others have, the important and vital contribution that doctors and nurses from around the world have made. That is the case in my constituency at Hillingdon hospital, and in GP and community-based health services. My mum recently had a stroke and, fortunately, recovered from it at University College London hospital in central London. As ever, it was doctors, nurses, speech therapists and allied healthcare professionals from almost every country around the world who helped and supported her to recover. I am sure that they will continue to serve our national health service with dedication and commitment, and I am sure that the whole of this House is thankful for their service.

As we have heard, however, it is absurd that thousands of British doctors trained by our NHS at great expense, funded by the British taxpayer, are currently unable to find jobs in the NHS after graduation. In a time of crisis for the NHS, we do not have a penny to spare, and every pound needs to go even further. It is a great waste of talent and capacity, and it is not fair to young doctors in the system, who are being beaten to entry-level NHS positions by doctors from overseas with decades of experience.

[Vikki Slade (Mid Dorset and North Poole) (LD)]

I wonder if the hon. Member has given any thought to residents such as George and Dennis in my constituency, who are both British citizens, brought up here, but went to work abroad either because they are dual citizens and wanted to be able to learn in two languages, or because of the covid delays. They will not be included in these measures. Does the hon. Member think they should be included within the second tier of graduates from places like Iceland and Liechtenstein? Does he have any views on whether we should be excluding British citizens?

[Danny Beales]

I am about to turn to a specific issue about British citizens, so I hope I will pick up on the hon. Member’s points. More generally, there is nothing progressive about a system that promotes a brain drain from some of the most deprived and underdeveloped communities in the world, with significant health needs. To have doctors and nurses come from those systems on an industrial scale, and to take away the resources spent in those systems on education and training for our benefit in a western, developed country, is not progressive. It is important to welcome the provisions in the Bill that address those challenges.

As the hon. Member for Mid Dorset and North Poole (Vikki Slade) raised, I will press the Secretary of State—and the Minister for Secondary Care, who is now in place—on the specific language of the Bill, which seeks to prioritise graduates from medical schools in the United Kingdom, rather than UK citizens who are medical graduates.

Like other Members, I have been contacted by a number of my constituents who will be affected by these provisions. That includes Alisha, a British citizen who was schooled and grew up here; her family live in Ickenham in my constituency, and she is a first-year medical student at Queen Mary University of London’s campus in Malta, which my hon. Friend the Member for Stevenage (Kevin Bonavia) mentioned earlier. When she enrolled last year, she was given a guarantee by the university that she would face no disadvantage compared with students on the London campus.

We have heard that there can never be any guarantees; that there is not a legal contract that this Government make with individuals; and that this House is sovereign, and can make different decisions. But I think there are issues of fairness around the retrospective applications of decisions that we make that can affect people’s lives, particularly at crucial points, such as when studying or getting a job—decisions that have major impacts on someone’s future life chances.

Alisha studies a British curriculum and she will be awarded the same degree qualification as her peers on the London campus. However, if the Bill’s current wording is interpreted strictly geographically instead of institutionally, it would mean that she is categorised as an international medical graduate, despite being a British citizen, studying a British medical degree at a British university.

I ask the Secretary of State to take away this point and, with officials, to look at this specific issue in greater detail and at modelling and sharing the number of UK citizens projected to be affected this academic year by those changes. If, as has been suggested by Queen Mary University, this is a matter of 40 or 50 individuals, I ask the Secretary of State to look at whether further changes could be made to ameliorate the impact on UK citizens, at least in a transitional way, that would not bind us in future academic years. I also ask that officials have discussions with Maltese counterparts about our important and ongoing strategic relationship in health and other key areas.

To conclude, there is much to welcome in this Bill. I know that medical colleges and societies strongly support many of the provisions. I hope that they will be the start of a broader process of a comprehensive workforce plan that will address the many challenges in workforce planning, training and development and the numbers of bottlenecks that exist throughout the workforce system so that we have a training and development system for medical professionals in this country that delivers both positive results for patients and better and fairer outcomes for those applying to study, learn and train.

Community Audiology

Danny Beales Excerpts

Thursday 18th December 2025 Westminster Hall

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I beg to move,

That this House has considered community audiology.

It is an honour to serve under your chairmanship, Mr Vickers. I thank those who have joined us for the debate and the Front-Bench teams for giving up their time to put in the final shift of this sitting just before Christmas. I realise that I may not be on many people’s Christmas card lists after detaining them to the bitter end, but I appreciate their giving up their time and responding to this important debate. I am grateful to the Backbench Business Committee for securing this debate on community audiology, an under-discussed topic and a very important one in our communities.

Hearing and hearing loss are often the subject of stigma and shame, and sometimes light-hearted jokes in the media and film. Hearing loss is a serious issue—it is not a mild inconvenience—and it can be life-changing. It has a profound impact on the lives of millions of people across England and on the effective functioning of our health and care system more broadly.

Audiology services diagnose, treat and support people with hearing loss and deafness. They are critical to the quality of life and health of a significant proportion of constituents in all our communities. In 2024, 5.8% of people in England reported deafness and hearing loss. Although 94% of hearing loss is related to ageing, that is by no means the only patient group affected. In particular, I note that children’s audiology services are incredibly important to the life chances of children who are born deaf.

Untreated hearing loss has far-reaching consequences for physical and mental health, independence, employment and social participation. People with hearing loss are 2.5 times more likely to experience mental ill health related to social isolation and difficulties finding employment. Elderly people with hearing loss are 2.4 times more likely to experience falls, which in turn increases the risk of hospital admission, loss of independence and long-term care needs.

Untreated age-related hearing loss is one of the single largest modifiable risk factors related to dementia. Evidence suggests that treating adult-onset hearing loss between the ages of 45 and 65 reduces the incidence of dementia by 7%. In the context of an ageing population and the growing prevalence of dementia, that statistic alone should place hearing services firmly within our prevention agenda.

There are significant economic implications to poor service provision. The UK loses an estimated £25 billion a year in lost productivity and unemployment as a result of untreated hearing loss. On average, a person with hearing loss will see around £2,000 less a year than a non-disabled person, and 40% of people with hearing loss will retire early due to the challenges of communicating at work.

The demand for audiology services will only increase over the next few decades. The incidence of hearing loss increases by approximately one percentage point for every year of life. That means that at the age of 50, around 50% of people will experience some level of hearing loss, while 80% will by the age of 80. As our population ages, the pressure on audiology services will grow. As we embark on our mission to rebuild our NHS so that it is a first-class health service fit for the 21st century, it is crucial that we get our approach to audiology services right and in line with the Government’s three key shifts.

Audiology is exceptionally well suited to a nationally directed, community-based model for care, for five key reasons. First, most audiology services are low-risk procedures that can be easily carried out in community-based settings. Currently, 50% of national referrals to hospital ear, nose and throat teams are for uncomplicated non-surgical procedures such as earwax removal and age-related hearing loss. That is difficult to justify clinically or operationally, and sending those patients through complex hospital pathways places unnecessary pressure on ENT services, contributes to longer waiting times and is an inefficient use of specialist capacity. Instead, such procedures can be managed in a safe and effective way by audiologists in community settings.

Just this morning, as if perfectly set up for this debate, I met a constituent at the Christmas present-wrapping event for the fantastic ShopMobility charity in Uxbridge. This gentleman shared with me his wife’s experience in accessing audiology services in our community. His wife faces a more complex hearing issue—not something run of the mill that could be dealt with on the high street—that requires specialist intervention. She has been waiting around a year for a specialist appointment and follow-up at NHS ENT services to have the issue resolved. Shifting less complex cases out of secondary care settings would mean more capacity, more appointments and quicker health for my constituent’s wife, and many more people like her.

Secondly, delivering audiology services in community settings is far more cost-effective. Research by the University of York found that NHS adult audiology pathways delivered by community providers cost between 15% and 25% less than the same pathways delivered by an NHS hospital-based service. There is an obvious financial case for reform to a community-based model.

Thirdly, because audiology services are commissioned at a local level by integrated care boards and have in some cases already been transferred to community services, community audiology is not a new concept. We already have many good examples of good practice to build on, but unfortunately provision is variable and patchy. Thirty of the 42 ICBs in England already commission community-based services, with NHS services delivering assessment, hearing aid fitting, rehabilitation and long-term aftercare in primary care settings, community hospitals, outreach clinics and high street locations. Those services are delivered in partnership with GPs and private providers such as Specsavers. For example, the ICB in my constituency in north-west London commissions community audiology services, with self-referral across our whole area, providing a more consistent and accessible model than many parts of England have today.

Fourthly, delivering audiology in community settings assists the preventive healthcare agenda. People are not always forthcoming about seeking help for hearing loss. On average, it takes around seven to 10 years to acknowledge hearing loss and seek help, meaning that by the time most people present to services, the impact on their health and wellbeing can already be significant. Any barriers or difficulties in getting help can put people off asking for it, further delaying treatment and increasing their personal risk of things such as dementia, falls and mental health challenges, which I have outlined already.

Lastly, audiology provision in the community, especially models that enable patient self-referral without a GP appointment, are better for patients. They empower patients and support the early identification of hearing loss. They reduce travel time and other geographical barriers to access, particularly for older people and those with mobility issues. Community audiology services are particularly impactful for deaf children and their families. Children with hearing loss issues require more frequent appointments than adults—for example, to replace ear moulds for hearing aids as they grow—so community provision with appointments closer to home is particularly helpful for those families.

Taken together, the case for driving a quick shift to community-based audiology is clear. However, despite the opportunities, there remain several structural barriers to the rapid roll-out of community audiology services in every area. The recent Kingdon review of children’s audiology services set out many of the barriers in great detail. Its findings, which I would argue are relevant to audiology services in our country more generally, can be summarised in the words of the introduction: audiology is

“a ‘Cinderella’ service…often overlooked, undervalued and underfunded.”

The most significant issue is that the current system is fragmented and inconsistent, with a clear lack of national oversight. That is apparent from the fact that, astonishingly, the Kingdon review found that there is no national audiology lead in the Department of Health and Social Care, resulting a lack of ownership and accountability for the performance of services. It found that communication between the DHSC and NHS England on known service issues did not meet expected standards. I hope that the merging of the functions of NHS England and DHSC will be a key opportunity to resolve those challenges.

There is patchy coverage of audiology services throughout the country, with a significant postcode lottery of access. NHS audiology services are commissioned locally by ICBs, with tariffs set locally. Although local commissioning can support responsiveness to local needs, in this case it has resulted in wide variation in availability, quality and value for money. As I have said, only 30 of 42 ICBs commission adult community audiology services. In around half those areas, coverage is only partial, and in 12 ICBs no service is commissioned at all. In those areas, patients who are concerned about their hearing must first visit the GP and then be referred to a hospital-based service.

As I have set out, the lack of community provision leads to longer waits, poorer services and more expensive provision in some areas of England. NHS England’s 2023 guidance encouraged direct access and self-referral to audiology services to reduce pressures on GPs, yet evidently not all ICBs have implemented that guidance. Local commissioning and tariff setting has also created substantial inconsistencies in tariffs. In some areas, audiology service tariffs have been set below the cost of delivering care, which has forced some providers to reduce and compromise service quality by, for example, cutting follow-up appointments, outcome measurement and rehabilitation support.

In some areas, local commissioning within limited financial envelopes has resulted in activity caps based on financial envelopes rather than patient need, resulting in predictable waiting list growth. Some services have reportedly been asked to reduce throughput or pause the issuing of hearing aids entirely in order to remain within their contractual limits. This practice undermines the principle of care based on clinical needs and risks storing up greater costs for the future.

The lack of national oversight has produced issues with quality assurance. While many independent and third sector providers deliver high-quality services, there is clearly variation in quality of service, and currently no mandatory system-wide quality assurance requirement for all NHS-funded audiology provision. That lack of oversight has also led to certain services falling through the gaps of NHS provision. The starkest example is earwax removal, about which I am sure many of us will have had emails from our constituents. It is perhaps not the sexiest of issues, and not one that we often like to talk about. I will hold my hand up: I have had earwax removal several times—historically from my GP, and more recently in private Specsavers-based settings—so I can speak at first hand about the impact of these services, or the lack of them.

Historically, wax removal was carried out by GPs and nurses in GP practices. Following a change to the GP contract in 2012, it was no longer designated as a core service, and now, over a decade later, the majority of GP practices no longer provide it. As a result, patients who cannot self-care or self-fund their treatment in a private setting often have no option other than to refer themselves to specialist hospital ENT services when the problem gets much worse, unless they live in one of the very small number of ICB areas that do still commission the service as part of the community audiology pathway. Wax removal is a simple, basic procedure, and it is nonsensical that it is not always delivered in the community.

Data collection and oversight is also extremely poor. NHS England recently decided to stop referral-to-treatment waiting time reporting for audiology services, which has removed visibility of the full patient pathway. Diagnostic data suggests that audiology is now a poorly performing diagnostic service, with over 70,000 people waiting and some regions experiencing delays of more than 40 weeks. Without consistent data, commissioners and providers, and policymakers such as us, simply cannot understand where pressures are greatest and where intervention is needed most.

Like many areas of community services, audiology services are also seeing significant workforce planning issues. There are fewer than 10,000 audiologists and hearing therapists in the UK, and work by the National Deaf Children’s Society and the British Academy of Audiology found that 48% of audiology services have seen a decline in staffing since 2019, equating to an overall reduction of around 8% of the total workforce.

The Kingdon review described the audiology workforce as having been “neglected for years”, with low status, poor professional representation, limited governance and insufficient investment in research and training and development. Coherent workforce planning could be facilitated by the introduction of a single professional register for audiologists, as well as a much more consistent approach to professional development, training pathways and retention measures. This is incredibly important given the predicted increase in demand for services, and I hope that audiology services, and community and primary care workforce issues more generally, will feature centrally in the Government’s promised new workforce plan, as we seek to shift activity away from secondary care towards primary and community-based care.

I welcome the steps the Government have taken to move forward improvements in audiology services. The commissioning and publication of the Kingdon review was a very helpful step. The 10-year health plan for England, published in July, committed to enabling self-referral to clinical audiology, using the NHS app where appropriate, which is welcome. NHS England is supporting providers and ICBs to improve audiology services through capital investment, upgrading audiology facilities, expanding testing capacity via community diagnostic centres, and direct support through the national audiology improvement collaborative.

All those developments are welcome, but clearly there is much more to do. We now need a coherent national framework that gives audiology the strategic attention it deserves. That should include, first, a national commissioning framework for audiology services, including standardised tariffs and activity planning to reduce unwarranted variation and ensure that services are commissioned on the basis of patient need rather than short-term financial constraints locally.

Secondly, the framework should mandate system-wide quality assurance for all NHS-funded audiology services, regardless of provider, building on existing frameworks. Thirdly, it should require a clear national direction on the movement of audiology services into community and neighbourhood health models, setting out how services should integrate with primary care, ENT, social care and broader support services. Fourthly, it should require the reinstatement of referral-to-treatment waiting time reporting for audiology, so that performance is transparent and improvement efforts can be properly targeted.

Fifthly, the framework should require sustained investment in the audiology workforce, including for expanded training places, improved retention measures and the implementation of the Kingdon review’s recommendations on professional registration and governance. Finally, it should require action to ensure equitable access to core interventions such as earwax removal, so that access to basic hearing care is not determined by postcode or ability to pay.

Audiology services may not often feature prominently in political debate, but they matter deeply to millions of people. They matter to older people striving to remain independent, to working-age adults seeking to stay in employment, and to children, whose language, development and life chances depend on early and effective intervention. Community audiology offers a practical evidence-based opportunity to improve access, quality and value for money, but realising this opportunity will require national leadership, clear standards and some sustained investment.

I thank all Members and the Front-Bench teams for being here. I hope the Minister can address the issues in his response. If we are serious about prevention, reducing health inequalities and delivering care closer to home, then community audiology must be part of the conversation. I hope that, as we do so often in this place, we can all say “Hear, hear!”, not only as a mark of agreement, but as a promise of a better future for hearing services in every part of our country.

[Hon. Members]

Hear, hear!

--- Later in debate ---

[Danny Beales]

We certainly heard about some issues today that I did not expect to be on the agenda. The waxiness or not of dogs’ ears will certainly stay with me for a while. I am glad that the hon. Member for Winchester (Dr Chambers) clarified that he is a vet. I wondered whether checking dogs’ ears was a particularly Lib Dem thing to do to, so I am glad he clarified that he does it professionally rather than personally.

We have had contributions from experts across the health sector and experts by experience of hearing loss, and I think we covered many of the key issues for audiology, such as workforce challenges and occupational hearing loss, as well as rural areas, regional variation and unacceptable delays. My hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) made a powerful point about the importance of quality assurance of services. Yes, we want more community access, but it needs to be quality community access.

I thank the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), and the Minister for their kind remarks. I thank the Minister for visiting what he called the fantastic development of neighbourhood health services in Hillingdon. We are fortunate in that, as well as the developing neighbourhood hubs, we have an ICB community-based audiology service. Hillingdon is very fortunate in having community audiology services, and I hope such services will be provided in all ICB areas.

I welcome the Minister’s recognition of the importance of self-referral and the Government’s continued commitment to it. I also welcome his recognition of the need to deal with the issue of variation across the country. In his response, he mentioned the key opportunities in developing the workforce plan, which we expect in the spring, and this Government’s broader neighbourhood health agenda, and I hope that audiology will feature strongly in those developments.

Thank you, Mr Vickers, for your time and the Clerk for their time. I wish everyone a merry Christmas and a happy new year.

Question put and agreed to.

Resolved,

That this House has considered community audiology.

Puberty Suppressants Trial

Danny Beales Excerpts

Wednesday 17th December 2025 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call Health and Social Care Committee member Danny Beales.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

The hon. Member for Sleaford and North Hykeham (Dr Johnson) asks, “Why?” Well, it is because trans people exist and their health needs exist. As the Secretary of State has clearly outlined, an independent review made a series of recommendations. There were clearly failures of healthcare, and a further recommendation was that a clinical trial should address this issue. I believe that the Conservatives supported the Cass review, but when it comes to implementing this part of it, they suddenly have collective amnesia about what Dr Cass recommended. Does the Secretary State agree that, in the absence of a trial, there will still be access to these drugs? We know that young people are seeking out private provision. They are seeking unregulated providers of these drugs, so is not a clinical trial both appropriate and the best and safest way of managing any potential risks?

[Wes Streeting]

The risk that my hon. Friend sets out was one of the considerations that I had to when weigh up—first when upholding the temporary ban, and then when making the ban permanent. I do worry that, outside of a trial, we may continue to see unsafe or unethical practice. I think we will be doing a service to medicine in this country as well as internationally if we have a high-quality trial with the highest standards of ethics, approvals, oversight and research from some of our country’s leading universities and healthcare providers to ensure that, for this particular vulnerable group of children and young people, we are taking an evidence-based approach to health and care.

Transgender People: Provision of Healthcare

Danny Beales Excerpts

Tuesday 16th December 2025 Westminster Hall

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

It is an honour to serve under your chairmanship, Mr Turner, and I thank my hon. Friend the Member for North Warwickshire and Bedworth (Rachel Taylor) for bringing us this debate. I am proud to call her a colleague and a friend. She is an exemplary part of the LGBT movement, and I am proud to associate myself with her and her comments in this debate.

We have heard already about the extraordinary length of waiting lists for gender-affirming care. Based on current appointment rates, a trans person can expect to wait an average of 25 years across the UK for an initial appointment to start gender-affirming care. That is simply not good enough, and we would never accept this in any other patient category in our NHS. We have heard much in this debate about the delays in receiving this care and the devastating impact that has on the lives of transgender people. With that in mind, I would like to ask the Minister whether waiting times for transgender patients are included within the current target to cut waiting times to 18 weeks by the end of this Parliament. Can she commit specifically to decreasing the length of waiting times for gender care by the end of the Parliament?

The second issue that I want to raise—which we have heard about already—is the operation of NHS gender care services more generally, and shared care as an important component of them. Once a gender clinic deems a trans person’s medical transition complete, it discharges them from its care to that of the GP, who will then authorise hormone prescriptions and contact the clinic about any issues. However, GPs in my constituency —and many that we have heard about in this debate—are increasingly refusing to enter into shared care agreements. The rate of such rejections has gone up from 5% to 21% in the last 12 months. Will the Minister therefore commit to clarifying the roles and responsibilities of different NHS services for the provision of gender-related healthcare? It is unacceptable that those who have waited years or decades for initial appointments, who have jumped through all the hoops possible to get NHS gender care, and who are finally in receipt of NHS prescriptions from NHS doctors, are then in practice unable to receive a prescription because their GP has unilaterally decided not to perform blood monitoring tests and provide that shared care support.

It is vital, as has been said, that we ensure access to a range of health services beyond gender-specific needs, whether sexual health services, reproductive health services, or primary and secondary care more generally. The voluntary and community sector, including trans-specific groups, perform a vital role in providing services, brokerage, networking and support in the health service but they are often poorly funded. I encourage the Minister to see what the NHS can do to support trans-led health organisations within it.

Unfortunately and increasingly, a hostile environment is being developed across much of the media. It seeks to erase the existence of trans people from our past, present and future. It is vital that we speak up about their existence, and about the experience of our constituents. I have been contacted by many of my constituents who are trans to detail the impact that the media, political and public discourse is having on their lives. I welcome this debate as part of resetting that discourse in this place and in our society. Fundamentally, this is about treating all people with dignity and respect, and about recognising that trans people exist, as do their health needs.

[Karl Turner (in the Chair)]

We have four minutes remaining for three speakers.

NHS: Winter Preparedness

Danny Beales Excerpts

Monday 15th December 2025 Commons Chamber

[Wes Streeting]

It is as if the ghost of Christmas past has come to visit: one of my predecessors is here to remind the BMA of what it used to have to deal with. Perhaps the BMA will be a bit more content with the ghost of Christmas present—and that is before we are threatened by the ghost of Christmas future—[Laughter.] I am being slightly tongue in check, but the right hon. Gentleman asks a serious question, and I will treat it seriously.

We put in evidence to the pay review body process. The pay review body will make its recommendation, which we will consider. We are in active discussions with Agenda for Change unions about whether we can reach an agreement on future years, including exploration of the prospect of a multi-year offer. I have made the same approach to all health unions, including the BMA and resident doctors. The challenge with resident doctors is that their expectations are some way from affordability. They are asking for a 24% pay rise on top of the 28.9% they have already had. That is not acceptable. As the right hon. Gentleman’s question implies, I have a responsibility to the entire NHS workforce, particularly the Agenda for Change staff, who have not done as well as doctors. Addressing that is not only a practical issue for me, but a moral one.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

First, I associate myself strongly with the Secretary of State’s comments about today’s regrettable decision by the BMA and its members.

In the light of the pressures of flu and RSV, does my right hon. Friend think it is time to ask the Joint Committee on Vaccination and Immunisation to look again at its recommendations on the ages at which the two vaccines are made available? Specifically on RSV in infants, does he think it is time to ask NHS England to look again at the decision to switch from an infant-based delivery model to a maternal-based delivery model on the ground of cost, without taking into account the lower infant RSV vaccination uptake now?

[Wes Streeting]

I thank my hon. Friend for his support and questions. We will indeed reflect on our performance after this winter, just as we did after last winter. He raised interesting points about the way in which we deliver vaccines. As for the questions about eligibility and timing, we rely on the expert advice of the JCVI, which will also look at the data on how this winter has panned out. We look forward to receiving its recommendations in due course.