Health Bill (Fifteenth sitting)

Debate between Danny Chambers and Caroline Johnson

Committee stage
Thursday 9th July 2026 Public Bill Committees

[Dr Chambers]

New clause 15 would require that the Secretary of State lay before Parliament any trade negotiation requiring NHS spending or funding exceeding £100 million, in the form of regulations subject to the affirmative procedure. New clause 76 would require that the arrangement between the United States and the United Kingdom on pharmaceutical pricing be laid before the House to be voted on.

The Institute for Fiscal Studies has indicated that, by 2036, the UK-US pharmaceuticals deal will have cost as much as £9 billion. That money could be transformative for the NHS. It could be put towards ending corridor care, as the Committee discussed earlier, or towards hiring thousands of ward staff, buying countless radiotherapy machines and starting to deliver high-quality care and help at home for the elderly and disabled.

To make matters worse, Trump’s ambassador hauled in the head of the National Institute for Health and Care Excellence—the expert independent body that considers value for money in the NHS—to rebuke him over his opposition to the deal. It is utterly outrageous that a British public servant has been dressed down by a foreign regime for putting the interests of British patients and the British taxpayer first. It is crazy that billions of pounds of NHS funding is being spent to placate Trump, at the expense of the patient wellbeing. We want to support the British life sciences sector. That should be a domestic matter for the UK Government to address holistically, through negotiations with the sector; it should not be dictated from Washington.

Hiking payments for medicine is the wrong approach for patients who badly need investment in frontline staff, hospitals and equipment. The lack of transparency over the full cost has already created great uncertainty in the sector, and it is astonishing that such a major decision will be made without the say of the British people via a vote in Parliament. The Government refused even to publish an assessment of the impact of the deal, which has raised suspicion and caused some to think that something is being hidden. Through the people who elected us, this House—not the White House—decides on matters of national importance. The Liberal Democrats have tabled these new clauses to allow the House to have a proper vote on the deal.

[Dr Johnson]

I will be relatively brief. New clause 15 would require the Secretary of State to lay before Parliament any trade negotiation requiring NHS spending or funding exceeding £100 million, in the form of regulations subject to the affirmative procedure. New clause 76 would require the arrangements between the United States and the United Kingdom on pharmaceutical pricing to be laid before the House to be voted on.

A key concern is costing. There have been various estimates of the additional cost of medicines. The former Secretary of State, the right hon. Member for Ilford North (Wes Streeting), said that he would not change or cut the NHS budget to pay for that increased cost. Will the Minister tell us the estimated extra cost of medicines, and where that money will come from, if not from the DHSC budget?

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[Dr Chambers]

I appreciate that. Just to reiterate, I am talking specifically about the trade deal with the United States, not about every single trade deal. We completely accept that primary legislation is not necessarily the best way to scrutinise a trade deal, but given the lack of options at the moment, we must use every political mechanism available to create transparency.

[Dr Johnson]

This Government came to power saying that they would be more transparent, but they have not been. It took us months to get numbers out of the Government about the Chagos Islands deal.

[Dr Chambers]

I am grateful to the shadow Minister for that intervention.

Unless something changes significantly by the time we get to vote on new clause 76, which I understand will not be today, we will press it to a vote for transparency’s sake, but we will withdraw new clause 15. I beg to ask leave to withdraw the clause.

Clause, by leave, withdrawn.

New Clause 16

Duty to promote the health and wellbeing of carers

“After section 14Z44 of the NHS Act 2006 insert—

‘Duty to promote the health and wellbeing of carers

(1) Each integrated care board must exercise its functions with a view to improving and maintaining the physical health, mental health, and wellbeing of carers within its area.

(2) In exercising its duties under this section, an integrated care board must have regard to—

(a) reduction of health inequalities experienced by carers,

(b) prevention of deterioration in carers’ physical and/or mental health,

(c) involvement of carers in decisions relating to the care of persons for whom they provide care, and

(d) the need to ensure carers are able to access appropriate preventative and other health services and support.

(3) An integrated care board must take reasonable steps to ensure that NHS bodies and providers of NHS services within its area—

(a) consider the health and wellbeing needs of carers in care planning and discharge processes,

(b) involve carers appropriately in decisions relating to care and treatment, and

(c) provide carers with information about support available to them for their health and wellbeing.

(4) In preparing a Joint Forward Plan, an integrated care board must include—

(a) an assessment of the health and wellbeing needs of carers within its area,

(b) steps the integrated care board proposes to take to improve outcomes for carers, and

(c) measures for reducing inequalities experienced by carers.

(5) In this section, “carer” has the meaning given by section 10 of the Care Act 2014 and includes a young carer within the meaning of section 96 of the Children and Families Act 2014.’”—(Dr Chambers.)

This new clause would introduce a duty for integrated care boards to promote the health and wellbeing of carers.

Brought up, and read the First time.

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[Dr Johnson]

I beg to ask leave to withdraw the motion.

Clause, by leave, withdrawn.

New Clause 28

Appeals against health and social care provision in EHC plans

“(1) The Special Educational Needs and Disability Regulations 2014 (S.I. 2014/1530) are amended in accordance with subsections (2) and (3).

(2) After regulation 42, insert—

‘42A Other matters relating to EHC plans against which appeals may be brought

(1) In addition to the matters set out in section 51(2) of the Act, a child’s parent or a young person may appeal to the First-tier Tribunal against the matters set out in paragraph (2), subject to section 55 of the Act (mediation).

The matters are—

(a) a decision of a local authority, following an EHC needs assessment, that it is not necessary for health care provision or social care provision to be made for the child or young person in accordance with an EHC plan;

(b) where an EHC plan is maintained for the child or young person—

(i) the child’s or young person’s health care or social care needs as specified in the plan;

(ii) the health care provision or social care provision specified in the plan.’

(3) In regulation 43 (appeals), after paragraph (2) insert—

‘(3) When determining an appeal on the matters set out in regulation 42A(2)(a), the First-tier Tribunal has the power to order that—

(a) health care needs, or health care needs of a particular kind, which relate to the child or young person's special educational needs are specified in the EHC plan in accordance with regulation 12(1)(c);

(b) social care needs, or social care needs of a particular kind, which relate to the child or young person's special educational needs or to a disability are specified in the EHC plan in accordance with regulation 12(1)(d).

(4) When determining an appeal on the matters set out in regulation 42A(2)(b), the First-tier Tribunal has the power to order that—

(a) the health care needs specified in the EHC plan in accordance with regulation 12(1)(c) are amended;

(b) the social care needs specified in the EHC plan in accordance with regulation 12(1)(d) are amended;

(c) health care needs, or health care needs of a particular kind, which relate to the child or young person's special educational needs are specified in the EHC plan in accordance with regulation 12(1)(c) where those needs have not been specified in the plan; and

(d) social care needs, or social care needs of a particular kind, which relate to the child or young person's special educational needs or to a disability are specified in the EHC plan in accordance with regulation 12(1)(d) where those needs have not been specified in the plan.

(5) When determining an appeal on the matters set out in regulation 42A(2)(a), the First-tier Tribunal has the power to order that—

(a) health care provision, or health care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(g);

(b) social care provision, or social care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(h).

(6) When determining an appeal on the matters set out in regulation 42A(2)(b), the First-tier Tribunal has the power to order that—

(a) the health care provision specified in the EHC plan in accordance with regulation 12(1)(g) is amended;

(b) the social care provision specified in the EHC plan in accordance with regulation 12(1)(h) is amended;

(c) health care provision, or health care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(g) where that provision has not been specified in the EHC plan; and

(d) social care provision, or social care provision of a particular kind, is specified in the EHC plan in accordance with regulation 12(1)(h) where that provision has not been specified in the EHC plan.

(7) When the First-tier Tribunal makes an order in respect of health care needs or health care provision, it must send a copy of the order to the responsible commissioning body.

(8) When sending a copy of an order, the First-tier Tribunal may also send a copy of the decision which disposes of any appeal brought under section 51(1) of the Act or under regulation 42A to the responsible commissioning body.

(9) The responsible commissioning body must respond within 5 weeks beginning with the date of the order to—

(a) the child's parent or the young person, and

(b) the local authority that maintains the EHC plan.

(10) The time limit specified in paragraph (9) does not apply where the First-tier Tribunal directs that a different time limit is to apply for the responsible commissioning body's response.

(11) A response under paragraph (9) must—

(a) be in writing,

(b) state what steps, if any, the responsible commissioning body has decided to take following its consideration of the order, and

(c) give reasons for any decision not to follow the order, or any part of it.

(12) The local authority must send a copy of the response received from the responsible commissioning body under paragraph (9)(b) to the Secretary of State within 1 week beginning with the date it was received.

(13) When the First-tier Tribunal makes an order in respect of social care needs or social care provision, the local authority must issue the amended EHC plan to the child's parent or the young person within 5 weeks beginning with the date of the order.

(14) The time limit specified in paragraph (13) does not apply where the First-tier Tribunal directs that a different time limit is to apply.

(15) The local authority must send a copy of the amended EHC plan under paragraph (13) to the Secretary of State within 1 week beginning with the date on which this is issued to the child's parent or the young person.’

(4) The Special Educational Needs and Disability (First-tier Tribunal Recommendations Power) Regulations 2017 (S.I. 2017/1306) are revoked.

(5) In consequence of the revocation made by subsection (3), the following 15 provisions of the Special Educational Needs and Disability Regulations 2014 are also revoked—

(a) regulation 10(3)(e);

(b) regulation 14(2)(e);

(c) regulation 201(11)(e);

(d) regulation 21(10)(e);

(e) regulation 22(5)(e);

(f) regulation 25(2)(e); and

(g) regulation 31(3)(e).”—(Dr Chambers.)

This new clause extends the powers of the First-tier Tribunal so that when it is determining an appeal it may order that Education, Health and Care plans must include health and social care needs and provision, rather than just making recommendations on these matters.

Brought up, and read the First time.

[Dr Chambers]

I beg to move, That the clause be read a Second time.

New clause 28, tabled in the name of the Chair of the Health and Social Care Committee, my hon. Friend the Member for Oxford West and Abingdon, extends the powers of the first-tier tribunal so that, when it determines an appeal, it may order that education, health and care plans must include health and social care needs and provision, rather than just making recommendations on those matters.

I am sure all Members are probably in a similar situation in that EHCPs, in their various forms, are one of the main reasons we get contacted by constituents; they certainly fill up my inbox. Following the Education Committee’s report, “Solving the SEND Crisis”, which identified significant gaps in accountability and engagement from the DHSC and health services in the special educational needs and disabilities—or SEND—system, the Health and Social Care Committee held a one-off evidence session to build on those findings, looking at the delivery of the health aspects of EHCPs.

The Health and Social Care Committee followed up a recommendation that the Education Committee had made that the powers of the SEND tribunal service should be extended to allow it to issue binding recommendations to health services, not just education providers. SEND tribunals are independent national tribunals that decide appeals against local authority decisions about the special educational needs of children and young people, including decisions made about an EHCP. Currently, they can make binding recommendations in relation to education provision, but not in relation to health and social care needs.

The Education Committee argued:

“This would ensure that when a failure to deliver a health provision specified in an EHC plan occurs, health bodies are legally obligated to take corrective action.”

When the Health and Social Care Committee raised that with witnesses in its evidence session, several were supportive of placing this duty in legislation, although they noted that it would require other reforms to workforce and commissioning arrangements to be successful. New clause 28 would provide a level playing field between education bodies and ICBs, so that ICBs are also under a legal obligation to comply with recommendations from SEND tribunals.

[Dr Johnson]

I should say that I am a member of the Education Committee. As the hon. Member for Winchester says, new clause 28 would extend the powers of the first-tier tribunal so that, when determining an appeal, it may order that EHCPs must include health and social care needs and provision, rather than just making recommendations on those matters.

It is clearly important that children with special educational needs get the support they need. We are all very aware, from our inboxes, that that does not always happen. I do not know whether putting this into legislation would make it happen, or whether it would need much more work than one clause, but clearly it is a very important aim and I support the principle of it. I would be grateful for the Minister’s comments on how she thinks this could work in practice and whether it is legislation or a more widespread plan that is required.

Health Bill (Thirteenth sitting)

Debate between Danny Chambers and Caroline Johnson

Tuesday 7th July 2026 Public Bill Committees

[Dr Chambers]

I would not always object to that, because the whole point of the new clause is that such a contract would come to Parliament and then might well be approved if it turned out to be the best system and in our national interest. The thrust of all three new clauses is to ensure that we do not get exposed and make ourselves vulnerable, which could affect the functioning of the NHS and compromise people’s data. A future Government could set up their own AI system in the UK. How would data be used by that system? We are looking at future-proofing people’s privacy and future-proofing the ability of our country to deliver a service properly.

There is also an economic opportunity. We should always prioritise domestic suppliers where possible, and even cultivate them, and help them to innovate and develop, because spending potentially tens of millions of pounds with foreign companies will not do anything to grow our own economy. Given the world-beating talent in our country, we see no reason why the long-term effect of domestic options to foreign systems could not be developed with sufficient Government support. As such, where a contract is signed with a foreign supplier, new clause 4 would require the Secretary of State to take steps to support domestic alternatives. We recognise the complexities involved with NHS procurement, and our new clauses represent one vision built on the core principles of domestic resilience and digital sovereignty.

I have a few questions for the Minister, which I would appreciate some comments on. How do the Government intend to build trust in the single patient record to make sure that it is not undermined, rather like the federated data platform has been? Does the Minister agree that the poor reputation of Palantir and distrust has been an important element in the slow roll-out of the federated data platform? Has she considered undertaking a risk assessment with a national security focus of current NHS digital and tech contracts? Does she agree that, in an ever more turbulent world, building domestic capability in this area is central to the security of our country?

Does the Minister agree that the domestic life sciences and tech sector is more than capable of developing and scaling many of the systems that we rely on foreign companies for at the moment? The Government have very much positioned AI and technology as the NHS’s white knight. We agree that the potential is huge, but do the Government not think that the NHS needs a long-term digital strategy to support a joined-up development and roll-out of these systems and technology? An analogy to this is how the defence investment plan and future defence procurement can help prioritise and boost economic growth in the UK. We think this is another way that economic growth could be nurtured.

[Dr Johnson]

I rise to discuss new clauses 3 to 5 and 43, which I am sure that the Whips will not let me forget. I understand the sentiment behind the Liberal Democrat new clauses. The hon. Member for Winchester is keen to ensure that uses of NHS data are limited to uses for which people can consent, uses in relation to their care or specifically approved research. Having heard examples of this data being tracked or leaked by accident, the hon. Gentleman is keen to ensure that that does not happen. He is particularly concerned about the risk of that happening in another jurisdiction where we have less control of the system. I am not sure that the new clauses have been properly thought through, however.

New clause 3 says:

“Within six months of the passing of this Act, the Secretary of State must conduct and lay before Parliament a risk assessment of all contracts between NHS organisations and suppliers based outside of the UK.”

That is “all contracts”. In subsection (2), it says that the Secretary of State must “pay particular regard” to contracts with technology companies, but not only to those. I am being a bit pedantic here, but has the hon. Member for Winchester considered the wording of “all contracts”? The NHS does not just provide drugs and medical technology; it provides bedding, blankets, pillows, bananas for people to eat at lunchtime, bedpans and loo roll. There is a whole range of things procured as supplies by the NHS that may or may not be procured from overseas. It would be cumbersome and completely unnecessary to include all of those.

Even with the tech companies themselves, there is a risk for small contracts for small pieces of tech to create a huge amount of bureaucracy. I am not sure that it would specifically improve data quality or data protection. It is reasonable that the Minister would consider risk assessments, and I hope that she would automatically consider them before contracts that are particularly sensitive or contain patient data, but I am not sure that the new clause works.

Moving on to new clauses 4 and 5, the hon. Member talked about Palantir. It may even have been his intention for these new clauses to target one specific American firm, but the actual impact would erect costly barriers to trade. The NHS contracts IT functions to firms based in other countries when the business case is strong. It uses Microsoft, an American company that offers software, cloud services and Outlook for emails; Oracle for standardising and automating financial processes; Sectra, a Swedish company, for transferring medical images and reports; and Dedalus, an Italian company, for migrating services to the cloud. To echo the point made by the hon. Member for Bury St Edmunds and Stowmarket, should the NHS prioritise a British company over an international company if the service has better functionality and a lower cost and is safe?

The hon. Member for Winchester spoke about the vibrant life sciences and tech sector in this country, but if we close off our markets to those from overseas, will others not do the same? Would he want those life sciences companies to be unable to export? There is a barrier to free trade here.

[Dr Chambers]

This is not about closing off markets or shutting off the potential to use foreign companies if they are most appropriate. It is about prioritising and investing in UK technology and our economy to solve some of our domestic problems while also providing security. Saying that we are closing off domestic markets is misunderstanding the thrust of the new clause.

[Dr Johnson]

I think it is about balance. I agree that we need to ensure that the data is kept safely. Using British technology where we can is a good thing, but we have to be reasonable about it. For example, there are alternatives to Microsoft Outlook, but how much more would that cost the NHS and how much would it affect patient care? There is a balance to be struck. I understand what the hon. Gentleman is trying to do in protecting our data. That is an extremely important issue, and I am sure the Minister will tell us about the work she is doing to ensure our data is kept safe.

New clause 43, in my name, is about private providers’ data. We often do freedom of information requests about, for example, surgical procedures, but one in 10 procedures are performed in private settings and are not subject to FOI, which means that less data is available to the public. Data from private independent providers is less transparent than that of standard NHS provision. This is a probing amendment to find out the Minister’s thoughts about how to ensure people can access transparent data on operations performed in local independent hospitals, particularly as the Government have signalled their intention towards more and more of those being provided.

Health Bill (Twelfth sitting)

Debate between Danny Chambers and Caroline Johnson

Committee stage
Tuesday 7th July 2026 Public Bill Committees

[Dr Danny Chambers (Winchester) (LD)]

This subject is of particular interest to me. For quite a few years I was a trustee of a charity that supported evidence-based medicine and quality improvement. The hon. Lady talked about a no-blame culture. We now tend to use the term “just culture” but it is the same kind of thing: we must have a safe space for people to come forward, like in the airline industry. We want to encourage reporting not only of mistakes but of near misses so that improvements can be delivered without tragic incidents having to take place. If we are to create a culture in which people will come forward to admit even potential mistakes and near misses, they cannot in any way fear punitive punishment under regulations. Does the hon. Lady agree that folding HSSIB into the CQC will make it difficult to create a culture in which people feel confident enough to want to come forward with and overtly discuss mistakes and errors?

[Dr Johnson]

The hon. Gentleman is right. When someone comes forward, they need to have trust in the system. If they think that coming forward will harm their job or career, or perhaps their colleagues’, they may be more reluctant to do so. There is a difference between a mistake and a reckless act. If people behave recklessly and badly, that needs to be dealt with for the sake of accountability, but if an individual is aware of a mistake, or aware of a loophole through which a mistake could have been made if only something else had not happened at that moment, they need to come forward and say so. It would be much more difficult for them to do so if there was a culture of fear.

Dr Benneyworth made it clear to the Committee that

“we are still working in a culture of fear”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 24, Q40.]

and that makes it difficult for people to come forward. People come forward now because they know that HSSIB is independent, but they will be less likely to come forward when HSSIB is an office in the CQC that is independent in name only. The Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), said that

“people cannot sit at desks near other people who are making decisions and at the same time be perceived as entirely independent. The perception of independence cannot be legislated for—the perception is everything”.—[Official Report, 1 June 2026; Vol. 786, c. 915.]

Health Bill (Eleventh sitting)

Debate between Danny Chambers and Caroline Johnson

Committee stage
Thursday 2nd July 2026 Public Bill Committees

[Dr Chambers]

The hon. Gentleman makes an interesting point. I suppose this is another chance to use the developing single patient record to ensure that we close the gap. The record could be formed in such a way, and the process put in place, to ensure equity in the system, with mandatory markers.

Amendment 72, also tabled by my hon. Friend the Member for Epsom and Ewell, would require prior membership of the armed forces to be visible to all relevant healthcare workers under the establishment of a single patient record. It would also require the Secretary of State to publish a report on making prior armed forces membership visible on the single patient record.

There are just over 1.85 million armed forces veterans in the UK, 13.6% of them women and 86.4% men. The transition from serving in the armed forces to civilian life can mean that many of those individuals struggle with mental health issues, such as post-traumatic stress disorder. The issues are often specific to the service the individuals have given. Some stats show that more than half of England’s Army veterans have some sort of health problem. I should point out that veterans do not only have mental health problems. Specific back and knee problems are much more common among infantry soldiers because of the type of training they have done over many years.

The amendment seeks to make prior armed forces membership visible to all relevant healthcare workers, and to make the Secretary of State consult on the merits of doing so, so that when a GP is treating a patient, they are aware of that person’s service history without having to ask about it specifically.

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

I have a couple of questions about amendment 71 for the hon. Member for Winchester. First, can he comment on why the amendment refers to firearms, which have stricter licensing conditions than shotguns? Also, the GP should be aware, because all relevant medical information should filter back to them, that the person has a firearms licence, which, as I say, has stricter criteria. It is essentially harder to get a firearms licence than a shotgun licence. I am interested to hear the hon. Gentleman’s thoughts on that.

On amendment 72, I have a large veteran population in my constituency, and I am very grateful to all those who have put their lives on the line to keep us safe, both today and in the past. I can see that there may be benefits to the amendment in respect of the delivery of the armed forces covenant and aspects of veterans’ care, but I am curious about how it is written. Proposed new subsection (3A) of proposed new section 250E of the National Health Service Act 2006 says that

“regulations must make provision for prior membership…to be visible to all relevant healthcare workers under the establishment of a single patient record”,

but proposed new subsection (3B) requires a report on the potential merits of doing that. It seems slightly counterintuitive to do it and then decide whether it is a good idea, rather than decide whether it is a good idea, consider the pros and cons, and then do it afterwards. I am interested to understand why the hon. Gentleman thinks the amendment is drafted in that way.

Health Bill (Tenth sitting)

Debate between Danny Chambers and Caroline Johnson

Committee stage
Thursday 2nd July 2026 Public Bill Committees

[Dr Chambers]

Amendments 60 and 61 would introduce a primary care investment standard that required integrated care boards to increase spending on primary care services at least in line with the growth of their total programme healthcare funding. We have discussed the importance of primary care in previous sittings, so I will be brief now, because we have a lot to get through.

The primary care investment standard would be similar to the mental health investment standard. It would set a clear benchmark to which to hold the Secretary of State. Primary care is the very frontline of a health service, and it is vital to stop the rest of the health system becoming overburdened, with issues such as corridor care and long ambulance handovers often a direct result of the system’s failure properly to shift resources and focus into primary care and community care, so that we can catch diseases early and prevent people from going into hospital.

If people cannot get GP or dentist appointments, they turn up to A&E. That transfers the load to what is not only not the most efficient part of the NHS for dealing with routine issues, but the most expensive part of the NHS. That is hugely expensive, as well as not ideal for the individual. Although more than 90% of patients’ direct experience with the NHS is through primary care and GP practices, less than 10% of the NHS budget in England is spent on primary care.

Despite years of all Governments promising to shift patient care out of hospitals into the community, the proportion of the NHS budget spent on general practice has fallen to its lowest point in the past 10 years. The Royal College of General Practitioners’ 2025 practice manager survey revealed that although 61% of practice managers said that they need to expand the GP workforce to meet their patients’ needs, 62% said that the lack of funding in general practice is a major barrier preventing them from hiring the number of GPs they need.

It has been revealed that 22 out of 27 of the first round of neighbourhood health centres are already doing some of those functions; they are simply being rebadged and slightly expanded. We know that in the NHS, money is key, and there are constant important and competing demands for the limited amount of funding. Protecting funding streams for primary care would ensure that the Government actually provided the funds to back up their ambition of shifting care into the community. The benchmark that amendments 60 and 61 would set for the Government is modest, but it would have a huge impact if we could successfully transform the NHS by shifting care into the community. We hope that the Government will view this as a spend-to-save initiative as well. One question is always where the money comes from, but having fewer demands on A&E, the most expensive part of the NHS, would save money in the long run.

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

The amendments would introduce a primary care investment standard, requiring the ICBs to increase spending on primary care services at least in line with the growth of the total funding that they receive. The Secretary of State would be able to implement financial penalties if ICBs failed to comply.

As the hon. Member for Winchester said, we do not need to talk about the importance of primary care, because we all know it is very important and quite efficient. The Darzi report said that primary care is one of the most financially efficient parts of the NHS. The challenge is that demand is increasing across the whole system, and unless overall funding is increased, then giving primary care a bigger share must mean giving somebody else a smaller one.

My other concern is about how the hon. Gentleman thinks this will be measured. Is measuring inputs rather than outputs really the right way to run the health service? We have tested almost to destruction the idea of just giving more and more money, which I suppose is why the Government have introduced this Bill: to try to reform things and make them more efficient. We can argue about whether they are doing that well or not, but that is the thrust of what they are trying to do.

I think the idea behind the amendments is interesting, but I would be interested to hear more about how the hon. Member thinks the standard would work, and in particular whether he thinks it could be justified if there was huge unmet demand in the secondary care or mental health sector. The balance of need may change over time, and if it does, then legislating for a set proportion to go on this or that type of care, rather than on delivering this or that type of outcome, might not be the right approach.

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[Dr Chambers]

I would happily speak for several hours on the multifaceted reasons why young people in particular are struggling with mental health. One of my passions is ensuring that people get intervention and support before they require clinical care, but at the moment that is not happening. For a whole variety of societal reasons, including young people applying for 300 or 400 jobs and not even getting a response, more and more people are ending up on mental health waiting lists.

The mental health investment standard has been widely hailed for bringing about positive change in the health service. It protects funds and provides certainty for services that are seeing dramatically rising demand and, importantly, it provides certainty about future finances. Placing it on a statutory footing in primary legislation would make it more transparent and prevent it from becoming a political football. It would also help to stop the watering down of targets that seems to have happened over the last few years. Claire Murdoch, NHS England’s national mental health director, essentially resigned over those changes.

To pick up on the point made by the hon. Member for Bury St Edmunds and Stowmarket, the Milburn report and the report by the Children’s Commissioner this week showed that the number of children referred to mental health services in England has risen by over 10% in just one year—it is now at more than a million. The pressures on NHS services and funding are clear. If funding is not protected, there is a real risk that it will be cut due to competing demands.

One thing I found when speaking to staff at Winchester’s A&E department is that when mental health patients turn up, having been unable to get support and often having already been on a waiting list, sometimes for more than 18 months, the average time they spend in A&E is more than 18 hours, during which some of them require constant supervision. So, we are badly supporting people with mental health issues in the most expensive part of the NHS. We cannot afford to let the mental health crisis in this country continue slipping out of control, and funding for NHS mental health services is an essential part of stopping that.

New clause 33 would require the Secretary of State to

“conduct and publish an annual review into the number and length of delays for patients’ receipt of mental health treatment across rural and urban areas.”

Something I found interesting growing up on a farm and working as a vet is the almost unrecognised mental health issues in rural areas. That is partly because many people who work in rural vocations have minimal contact with people outside their workplace. Sometimes the vet and the postman might be the only people that a farmer sees in one, two or three weeks. There are a lot of questions about why disparities in accessing treatment in rural versus urban areas exist. Alternative approaches are needed, and some of the ideas floated have included mental health support officers for rural GP surgeries, or training vets up as mental health first aiders, because they might be a point of contact for a farmer and recognise when they are struggling.

Different communities require help in different ways, and farming communities often feel overlooked. They are vital for keeping the nation fed and fit and healthy, but they have a job that involves working from before 5 or 6 in the morning until late at night. If services are provided that do not fit with that person’s lifestyle and job restrictions, they can often struggle to access them, which, when coupled with having virtually no mobile signal and poor broadband, means that people in rural areas are sometimes cut off in more ways than one.

The Mental Health Act 2025 had a fairly limited focus on providing care to those with the most acute mental health problems. We need to look at preventive measures to ensure that people are supported through difficult times in their lives. These new clauses will require a report from local authorities so that we can ensure that they are providing tailored support to those in need. The Liberal Democrats strongly believe that early intervention and preventive services are key to tackling to mental health issues. These new clauses would urge mental health service providers to look beyond putting out the fire. This is about moving from crisis management to ensuring that people are supported in their local communities so that they do not reach the point of crisis. We need to treat mental health as seriously as we treat physical health. I know the Minister agrees with that; we think these new clauses will enable the Government to deliver on that ambition.

[Dr Johnson]

Amendments 9 and 10 have some similar issues to the last two Liberal Democrat amendments. They referred to the primary care investment, while these amendments refer to the mental health investment standard, which seeks to define the proportion of NHS money spent on mental health and maintaining it at a static position. Essentially, similar arguments apply.

In 2016, the mental health investment standard was brought in, albeit not on a statutory footing, to ensure that mental health got the attention it deserved and that the resources provided to it were higher, because the number of people with mental health problems was increasing. There was good sense to that.

However, the challenges to the NHS evolve over time. If the standard were to be fixed in statute, what effect would that have? Would that create an upper limit on spending on mental health at a time when mental health was increasing in prevalence as a problem? Would it increase the lower threshold when the reverse was the case? The Government need flexibility. I would hope that the Government make the right decisions, but that is the democratic process, and they need the flexibility to make the decisions that are appropriate for the time, rather than having this fixed in place.

If we look at current waiting list figures on the Government’s referral to treatment dashboard, in general, the number of people waiting has risen in the last month for which figures are available. If we look in particular at people who require an admission to hospital for a procedure or operation, the numbers are higher over the last month, and also over the last year, for all types of admissions. Not all mental health figures are covered in the dashboard, but those that are have improved slightly in the last month. The point I am making is that things fluctuate over time, and the Government need flexibility to deal with that.

Let me turn to new clauses 33 and 34. As a rural MP, I have some sympathy with the point that the hon. Member for Winchester made about rural healthcare. It is more difficult to get to the major, tertiary centres that provide the most up-to-date treatments. People might have to travel quite long distances to get to the doctors they need to see or to visit in-patients. Of course, those individuals also face transport costs, as we discussed in a previous sitting.

I note for the record that I am a member of the Royal College of Paediatrics and Child Health and the British Medical Association, and an NHS consultant paediatrician. Last week, the Children’s Commissioner published a report that found that 60,000 children were waiting for more than two years for support; the Royal College of Paediatrics and Child Health has also sounded the alarm about the number of children attending A&E because of mental health service issues. In that sort of the situation, the Government might want to move money from A&E services to mental health support to prevent A&E admissions. They may also need to do the reverse, in order to treat those A&E admissions in the first place. Flexibility is required.

New clause 34 would create a duty for the Secretary of State and any relevant body or authority carrying out functions under this Act or the Mental Health Act 2025 to

“promote mental health wellbeing among the people of England.”

That is a statement of his job, and a statement of the obvious; if the Minister is responsible for the mental health services of the country, of course he has a duty to make sure that they do their jobs properly.

It is a nice amendment—it is one of those things that it is politically difficult to vote against—but I would ask the hon. Member for Winchester what practical effect he thinks it would have on mental health. Does he think the Secretary of State is not thinking about mental health? I do not sit on the same side of the House as the Secretary of State, but I think he is interested in mental health and wants to do his best job. Does the hon. Member for Winchester think that is not the case? What does he think the new clause would achieve in practice?

--- Later in debate ---

[Dr Chambers]

I agree that there is no need for carers to see irrelevant or extremely historical information in the single patient record. Currently, however, there are a lot of carers who, for various reasons, such as not having legal power of attorney, cannot access the information that they need.

We also sometimes find that the people who are carers, who are potentially the spouse of the patient and are themselves elderly—because a lot of people receiving care are elderly—do not understand the information that they are being given. There can be a situation where the person providing care does not fully understand why the patient is getting some medication, or the best way to treat them. We hear that quite a lot.

We understand that the Bill is not designed to set out all the specifics of what the single patient record will look like—that key point was made in the interventions by the hon. Members for Farnham and Bordon and for Ashford. However, although we do not know exactly what it will look like, as it is being created, drafted and thought through, we would love the Minister to confirm to us that carers will be able to see the appropriate parts of the single patient records of those they care for, so that they can oversee their medical care and flag any issues.

There are some specific advantages to having a single patient record when travelling between hospital trusts. For example, being able to quickly see what historical medication the patient has had, especially when it comes to antimicrobials, and the results of tests that were performed in other hospitals and healthcare settings, is absolutely vital to ensure that we do not allow antimicrobial resistance to increase at an unnecessary pace. Often, patients do not understand the type of antibiotic they are on, or remember the name of it, and that is a specific but big issue, because it can generate antimicrobial resistance. There are a few more issues that I could speak to, but I will sit down.

[Dr Johnson]

I rise to talk about amendment 8. I essentially understand what the hon. Member for Winchester is trying to do—to make sure that carers are provided with the information that they need to provide the best possible care—and I think we would all agree with that ambition. However, I have a couple of questions for him. The Bill, as drafted, discusses “making” information

“available to people other than a patient on the patient’s behalf”.

I am not quite clear why would that not encompass a nominated carer.

My hon. Friend the Member for Farnham and Bordon made an important point about privacy. The single patient record will encompass a patient’s entire medical history, medical notes and medical information, but every person who provides that patient with medical or social care does not need to see all of that, and in some cases, the patient may not want them to. My hon. Friend gave a good example of that; another example would be an elderly lady who does not want her carer to see that she had a termination at 23. There are lots of things that are private to people that they do not want others to see. I am interested in the Minister’s comments on this issue. Access to the record is seen as a binary choice, but in some respects, it needs to be a much more nuanced affair than that, while still allowing someone access to the areas of the record that are required for them to complete their duties.

[Dr Chambers]

The hon. Lady is making very good points. The whole thrust of the argument is that there is little detail around how the single patient record will be created and implemented. This is a perfect opportunity to work out how we can empower carers while preserving patient confidentiality where necessary. If we do not focus on that in the early stages of the SPR’s implementation, before it has even been designed, we will miss the opportunity to ensure that carers have an easy way to get the right information. We should not miss that opportunity.

[Dr Johnson]

I understand the hon. Member’s point, but we need to start with the patient at the centre and ask what is best for patient care. It is about what the patient wants to share with their carers. The patient may make an informed decision not to share information that is potentially useful, but if they have capacity, they are free to do that. It is about starting with the patient.

I have huge sympathy with the principle of what the hon. Gentleman is trying to achieve, but I am not sure that that is not already included in proposed new section 250E(2)(c)(i) of the NHS Act 2006, which mentions “making” information

“available to people other than a patient on the patient’s behalf”.

The important thing is that patients make the decision if they have the capacity to do so, or that someone acting with power of attorney has done so on their behalf.

Amendment 65, which is also in this group, talks about support needs. I have some sympathy with that as well. When I see a patient in clinic—I am a paediatrician, so they are all children—I look at the notes, which say they have a particular issue, and I go out into the waiting room and call the child’s name. There is nothing on the record, necessarily, to tell me that the patient and the mum are deaf, or that the other parent is deaf and may not be able to hear me calling them in the waiting room. So I have sympathy with the idea that the record would flag up reasonable adjustment needs; I think there is a place for that.

There is something called the reasonable adjustment flag on the NHS Spine, and perhaps the answer is to use that rather better than is happening at the moment. With carers, as the hon. Member for Winchester said, or with parents or legal guardians looking after children, we should consider whether reasonable adjustments also need to be made for the parent, guardian or carer who is likely to bring the patient to be seen.

[Gregory Stafford]

As I expressed in my intervention on the hon. Member for Winchester, I have a lot of sympathy for what he is trying to achieve with amendment 8. Whether by accident or design, he has allowed us to have a real think about—

Health Bill (Ninth sitting)

Debate between Danny Chambers and Caroline Johnson

Committee stage
Tuesday 30th June 2026 Public Bill Committees

[Dr Johnson]

Clause 39 broadens the Secretary of State’s ability to delegate or jointly exercise health service functions with NHS bodies and local government. Currently, section 7A of the National Health Service Act 2006 enables the Secretary of State to arrange for any of their public health functions to be exercised by relevant bodies, such as NHS England, ICBs and local authorities. Section 65Z5 sets out how relevant bodies may jointly exercise delegated functions, and section 65Z6 sets out how funds may be pooled for such purposes. Section 65Z7 sets out that NHS England may issue guidance for exercising functions under those two sections and that relevant bodies must have regard to any guidance. Section 75 then sets out that the Secretary of State can make regulations to enable NHS bodies and local authorities to enter into arrangements related to the delivery of health functions.

Clause 39 deletes section 7A, removing the separate power for the Secretary of State to delegate public health functions. It amends section 65Z5 to create a wider power that allows the Secretary of State to arrange for any health service-related function in England to be exercised by or jointly with relevant bodies, local authorities, combined authorities, combined county authorities or other prescribed persons. It removes outdated references in section 65Z5 linked to NHS England and updates the wording so that arrangements can be made with a wider range of persons and not just bodies.

Clause 39 also replaces section 65Z6 so that where functions are exercised jointly, the parties can use joint committees and pooled funds. It provides that pooled funds can include payments from relevant bodies and the Secretary of State, and can be used for expenditure connected to jointly exercised functions. It amends section 65Z7 so that guidance on joint working and delegation is issued by the Secretary of State rather than NHS England. It makes consequential amendments to provisions on directors of public health and local authority public health functions, reflecting the removal of section 7A. It also makes consequential amendments to section 75 partnership arrangements and the Local Government Act 1974, again removing references to section 7A.

Once again, it is necessary to move functions to the Secretary of State when NHS England is abolished—somebody else needs to do the work. The changes introduce more flexibility for joined-up working between the Secretary of State and other entities in the health system, which could support integration and the shift to place-based care, with localised approaches to prevention, integration and service planning in line with the Government’s 10-year plan.

However, the power is very broad, relating to any function in the health service. The Secretary of State could arrange for functions to be exercised by or jointly with any person prescribed, which could mean anyone. How will it be possible to determine who is responsible for things that have gone wrong when joint committees are established and funds are pooled? The Minister has spoken a number of times during our sittings about the importance of clear accountability. In the event that the work, funds and activities are pooled, how will it be made clear who is responsible and therefore accountable for the activity that occurs?

Melanie Williams, the then president of the Association of Directors of Adult Social Services, told the Health and Social Care Committee that we spend

“a lot of time debating about who pays, rather than having a conversation about how, in the longer term, we can invest in people’s outcomes to enable better health and wellbeing.”

Is it the Government’s intention to decide the allocation of money for social care and health providers, or that whoever they decide will work together?

The Government have said that this is all about the devolution of power. This morning, we discussed the abolition of integrated care partnerships, on which ICBs and local authorities work together on projects that they choose locally. The Government are now introducing another power that will enable the Secretary of State to direct them to work together on things that he or she chooses. That does not sound terribly like the devolution of power. Could the Minister explain that to me?

I shall leave new clause 26 to the Liberal Democrats. Government new clause 20 ensures that there is a complete list of authorities that may be included. I think some were missing from the first iteration. I just make the point that the more actors there are in the mix, the harder it may be to see who is responsible overall. We also need to discuss how to maintain the balance between clinical need and political priorities in the choice of what healthcare is provided.

[Dr Danny Chambers (Winchester) (LD)]

New clause 26, tabled by my hon. Friend the Member for Oxford West and Abingdon (Layla Moran) and the hon. Member for Worthing West (Dr Cooper), who both sit on the Health and Social Care Committee, would require the Secretary of State to review the arrangements under section 75 of the National Health Service Act 2006 and consider whether to require NHS bodies and local authorities to enter into new arrangements with one another if that is likely to lead to an improvement in how their functions are exercised.

A recurring theme of Health and Social Care Committee inquiries is the impact of financial flows and how they frustrate attempts to deliver truly integrated care—an issue we discussed in earlier sittings. We all recognise that closer arrangements are needed to properly address discharge delays, which directly lead to corridor care or even unnecessary admissions to hospital. It seems that a consensus has been reached, yet the action to back that up is not there. We feel that, through this Bill, the Government are moving away from closer integration.

Melanie Williams, the then president of the Association of Directors of Adult Social Services, told the Health and Social Care Committee that the NHS and local authorities

“spend a lot of time debating about who pays, rather than having a conversation about how, in the longer term, we can invest in people’s outcomes to enable better health and wellbeing.”

She highlighted concerns about the funding of intermediate care and community health services through aftercare under section 117 of the Mental Health Act 1983 and NHS continuing healthcare.

Section 75 of the 2006 Act provides a legal mechanism for NHS bodies and local authorities to pool budgets and jointly commission health and social care services. The Select Committee has heard evidence of positive examples of such arrangements being used to commission integrated services. It also heard that the use of section 75 arrangements is inconsistent.

In October 2023, the Government launched a call for evidence to explore how section 75 could be better utilised to support integration. A summary of responses published in December 2024 identified several areas for improvement, including the need for stronger inter-organisation relationships, clearer governance and financial structures, and better data sharing. The Health and Social Care Committee recommended that the Government expand the use of section 75, including the range of services that it will be used to support.

This Bill is a missed opportunity for the Government to reform or promote the use of section 75 arrangements, or to provide an alternative mechanism that they believe would be more effective in addressing the challenges that funding flows present to the integration of health and care services. That is why the Select Committee suggested this new clause to prompt a review of section 72 and the introduction of guidance to support pooled budgets and jointly commissioned health and social care services.

Health Bill (Eighth sitting)

Debate between Danny Chambers and Caroline Johnson

Committee stage
Tuesday 30th June 2026 Public Bill Committees

[Dr Johnson]

Clause 24 puts neighbourhood health plans on a statutory basis. Currently, section 116A of the Local Government and Public Involvement in Health Act 2007 requires local authorities and partner ICBs to prepare a joint local health and wellbeing strategy once they have received their integrated care strategy. Essentially, that means that the ICBs and local authorities produce their overall strategy, then it devolves down, and then the joint health and wellbeing strategy looks at how it will be delivered. The local authority and its partners must give regard to the integrated care strategy, the NHS England mandate and any guidance issued by the Secretary of State. The strategy must be published and local people and the local Healthwatch must be involved in its development.

Section 116B of the 2007 Act places a duty on local authorities and partner ICBs to have regard to various strategies when exercising their function, specifically, a joint strategic needs assessment, an integrated care strategy and a joint local health and wellbeing strategy. NHS England also has regard to these when providing healthcare for a specific area.

Clause 24 changes the JLHWS to a neighbourhood health plan. In many ways, that aligns with the shift in the Government’s 10-year health plan from hospital to community. As they have described it, more care in the neighbourhood will allow hospitals to focus on the more specialist care that may be needed, so more people can be cared for closer to home, which seems a reasonable aim.

However, if local authorities and partner ICBs have to give regard to what the centre is doing when developing neighbourhood health plans, to what extent does the Minister envisage that being directed? Local authorities and partner ICBs giving regard to the centre could mean there being a very loose requirement from the centre to provide for the local population, and then they get on with it; it could also be very prescriptive—my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) has talked about the pros and cons of having targets—with a whole litany of targets in the plans. Whether that squares with the Government’s claim to be devolving power, or whether it strikes as a centralising power, depends on how that is done and to what extent the Secretary of State plans to direct it. I would appreciate it if the Minister could talk about that.

As has been said, Sir Andrew Dilnot told the Committee that

“we cannot really address many of the fundamental problems facing the NHS if we do not sort out social care.”––[Official Report, Health Public Bill Committee, 16 June 2026; c. 84, Q131.]

The Government have asked Baroness Casey to review social care, but they have developed this measure in the meantime. Is that because they have been talking to her and know that it is the sort of thing that she will recommend—or are they putting the cart before the horse, as my hon. Friend the Member for Farnham and Bordon suggested?

Later in the Committee’s considerations, we will come to Healthwatch, its benefits and the concerns that I and, I am sure, many other Committee members have about its abolition. What mechanisms does the Minister envisage there being for local people—local patients—to contribute to the neighbourhood health plans? A local Healthwatch currently contributes to the equivalent, the joint local health and wellbeing strategy, as a way of ensuring that it captures patient and community voices. How will that be done otherwise?

Some 80% of the Government’s new neighbourhood health centres that will deliver these plans are expected to be funded through public-private partnerships. Does the Minister have any comments on that, particularly in the light of the expensive private finance initiative that the last Labour Government entered into and left us stuck with?

In March 2026, the Government produced a neighbourhood health framework policy paper, which identified the goal of reducing non-elective admissions for those with severe frailty. Given that goal, why are the Government not on track to deliver the fracture liaison service improvements that they promised?

The policy paper also commits to what it calls

“a diversion rate of at least 25% by March 2027 for at least 10 high volume specialties”.

What is a “diversion rate”? It essentially requires more GP referrals to be rejected, so let us be clear about what that means. When someone, either hon. Members or constituents, goes to see their GP, they are referred to a consultant for care; I should declare an interest as a consultant in the NHS. The consultant will then review that referral and decide whether they think it is clinically appropriate to see the patient, whether a different specialty may be more appropriate, or whether they can give advice or make suggestions about treatment that could be given in primary care instead.

When a patient is given an appointment in secondary care, it essentially means that the GP has decided that they clinically need it, and the consultant has decided that they clinically need it too. If the Government want a diversion rate of at least 25% by March 2027 for at least 10 high volume specialties, are they suggesting that patients who the GP and consultant agree clinically need an appointment should not get one? If so, why?

[Dr Danny Chambers (Winchester) (LD)]

It is an honour to serve under your chairship, Sir Jeremy. I have been itching to speak on this new clause, tabled in the name of my hon. Friend the Member for Epsom and Ewell (Helen Maguire)—I am not sure how to pronounce that, but I am sure it is a very beautiful place; I have never been. It would ensure that a certain range of primary care providers were consulted by integrated care boards in the development of the healthcare plans.

The recent King’s Fund report, as well as many others, showed that over 90% of NHS contact with patients is in primary care in all its forms. New clause 70 relates to new clause 60, also tabled by my hon. Friend, which is about having GP representation on integrated care boards. This is an extension of that, so that dentists, pharmacy contractors and providers of ophthalmic services can all feed into integrated care boards’ healthcare plans. That is how most people come into contact with the NHS, which means that those providers have a close and deep understanding of the healthcare issues facing the demographics in their communities.

[Dr Johnson]

New clause 70 talks about a certain range of primary care providers being consulted by the ICB. Can the hon. Member clarify whether it is his intention for all providers of those services in a defined area to be consulted, or would it be a representative selection? If it is the latter, how would they be chosen?

[Dr Chambers]

The hon. Lady makes a good point. The purpose is to ensure that those who are deeply embedded in community care are consulted by the ICBs, so that they do not miss obvious localised issues in their demographics when developing care plans.

Just to give a brief example from a surgery I held recently, Joanne Cook is an occupational therapist who is campaigning for occupational therapists who have received specific training to be able to prescribe, and crucially de-prescribe, medications, in the same way that trained paramedics can. Often, occupational therapists see patients on a daily basis. They give them intimate and regular care, and are even better placed than GPs to notice small changes and adjust medications to keep people out of hospital.

If integrated care boards are not drawing on the experience, knowledge and data from primary care providers in all their forms, any healthcare plans they come up with will not be relevant to those demographics. We will not be keeping people out of hospital or treating them as effectively in the community, and the whole system will not be as efficient or as targeted as it could be. I would appreciate it if the Minister considered accepting the new clause.

Non-stun Slaughter of Animals

Debate between Danny Chambers and Caroline Johnson

Monday 9th June 2025 Westminster Hall

[Dr Danny Chambers (Winchester) (LD)]

It is an honour to serve under your chairmanship, Mr Dowd. I congratulate the petitioners on bringing this important subject to Parliament.

I start by making something absolutely clear: the Liberal Democrats, and I personally, fully respect the right to freedom of religious belief and expression, and this debate must not be used as a smokescreen for antisemitism or Islamophobia. Too often, discussions about religious slaughter are hijacked by those with an agenda that has nothing to do with animal welfare. That is unacceptable. This debate must be grounded in science, evidence and animal welfare, not in prejudice, and our focus should be on improving welfare standards through respectful dialogue and evidence-based policy, not fuelling division or targeting communities.

To declare my very obvious conflict of interest, I am a veterinary surgeon. As a veterinary student, I had to spend a lot of time in abattoirs learning about the process and about public health. As a vet, I have had to issue emergency slaughter certificates for farms. I was on the policy committee of the British Veterinary Association, and we looked at farm assured schemes and welfare standards at different stages of animals’ lives on farms. As a veterinary profession, we have always been clear in talking purely about stunned and not stunned, and not bringing in kosher, halal or other types of religious slaughter, because doing so would muddy the waters and play into the hands of people who are trying to hijack the animal welfare agenda with antisemitism and Islamophobia.

The science is clear: the evidence shows that stunning animals before slaughter is the most humane method available. Stunning renders animals unconscious and insensible to pain prior to slaughter, and slaughter without stunning causes avoidable pain and distress. That is why, from a veterinary and animal welfare perspective, we want to see a reduction in the amount of non-stunned slaughter and a great uptake of stunning techniques that are compatible with religious practices. It is encouraging that almost 90% of halal meat in the UK is already pre-stunned. That is a clear example that animal welfare and religious observance can go hand in hand.

[Dr Caroline Johnson]

When doing research for this debate, I found that the RSPCA states that 65% of all halal meat is pre-stunned; the rest of it, presumably, is not. Can the hon. Gentleman explain the difference, and why some meat would be classified as halal when it has been stunned and some would not?

[Dr Chambers]

If the RSPCA has different figures, I would ask it to explain where its figures come from. Not all non-stunned meat is halal. Some of it is shechita slaughter, and the hind quarters are not considered kosher, so they would go into the normal food chain. That could be why there are some discrepancies, but I am not familiar with how the RSPCA generated its figures, so I would take it up with the RSPCA.

I acknowledge that, as many hon. Members have rightly pointed out, there are failures in stun slaughter as well. That is sometimes due to bad practices and inadequate training in abattoirs, and is one reason why I was pleased to be part of the successful campaign to put CCTV in all abattoirs. We should ensure that legal standards are upheld, that anyone breaking those standards is held to account, and that adequate training is given.

I share the concerns about slaughter in which pigs are stunned with CO₂. I eat pork, but I am aware that such slaughter is a welfare concern in the veterinary world. We are looking at how we can improve that experience for pigs.

Tobacco and Vapes Bill (Sixth sitting)

Debate between Danny Chambers and Caroline Johnson

Committee stage
Tuesday 14th January 2025 Public Bill Committees

[Dr Johnson]

I thank my hon. Friend for his intervention. Last Tuesday, we heard in evidence from various medical sources, and both the Select Committee and our processor Bill Committee heard in evidence that nicotine is, of itself, harmful, and that the chemicals added to vapes are harmful. In some cases, they are extremely harmful. I will talk more about vaping chemicals later. Indeed, sometimes the products do not contain what they are expected to contain, and that can be worse still. I will return to that subject later, too.

Nicotine is highly addictive and can permanently affect the development of the adolescent brain. We have heard how the industry targets young people, and that is because the adolescent brain is particularly vulnerable. Nicotine can permanently affect its development. Nicotine also fulfils all the criteria for drug dependence. Giving it up is very difficult, and withdrawal symptoms can include cravings, irritability, anxiety, trouble concentrating, headaches and other mental symptoms. Symptoms associated with nicotine and dependence are often not recognised by novice smokers, particularly if they are young.

[Dr Danny Chambers (Winchester) (LD)]

On the subject of how nicotine affects the brain and brain development, one thing we have not really touched on—and we have touched on many physical health issues—is the incidence of smoking among people with mental health issues. One submission was from the Mental Health and Smoking Partnership, which said that 45% of people with a serious mental health issue smoke, and around 25% of people with clinical anxiety. It would stand to reason that the impact on a young person’s brain could also start to lead to serious mental health issues, as well as all the physical health and development issues.

[Dr Johnson]

The hon. Gentleman is right to raise the importance of managing nicotine dependence for those with mental health conditions. We know that smoking, in particular, is more likely to take place among people with mental health conditions or those who are in mental health in-patient units. I am sure we will go on to discuss the issue of vending machines.

Last May, in the previous Bill Committee, we heard evidence from the Mental Health Foundation about the myth that tobacco helps with anxiety, and how that myth needed busting. We also heard about the importance of giving extra support to people with mental health conditions to enable them to kick the habit of nicotine—whether that habit is smoking or vaping—because it will help both their physical and mental health. However, it can be more challenging for them to complete. I am grateful to the hon. Gentleman for raising that important issue.

Returning to clause 10, a study considering the effects in adolescents of nicotine dependence after the initiation of smoking cigarettes found that the symptoms of nicotine dependence can appear only a few days after initiation. Given that oral nicotine pouches contain similar or higher levels of nicotine, similar symptoms may appear following initiation of oral nicotine pouch use, which is why it is particularly important for children that we pass clause 10 and ensure that children are protected from these nicotine products.

Tobacco and Vapes Bill (Third sitting)

Debate between Danny Chambers and Caroline Johnson

Committee stage
Thursday 9th January 2025 Public Bill Committees

[Dr Johnson]

Wisdom or age, but I shall be cautious not to answer too closely.

[Dr Danny Chambers (Winchester) (LD)]

I accept the view that having to provide ID will be inconvenient and frustrating for some people, but all the expert witnesses on Tuesday pointed out that many smokers do not wish the younger generation to continue smoking. I think that most of them would probably be of that view that the slight infringement of their civil liberties in having to carry ID is a small price to pay for the knowledge that they are preventing smoking from being taken up.

[Dr Johnson]

The hon. Gentleman is right that the measures have broad support. Certainly, the pollsters who have investigated people’s views of this legislation—that proposed by the previous Government and the legislation as it is now, with some tweaks to it—have found the public to be overwhelmingly positive. We legislate because we are elected by those people. On the basis of their opinions and given that policing in this country is done by consent—