Parkinson’s Disease

Graham Stuart Excerpts

Wednesday 21st May 2025 Westminster Hall

[Paul Davies (Colne Valley) (Lab)]

I beg to move,

That this House has considered care for Parkinson’s patients.

It is a pleasure to serve under your chairmanship, Mr Stuart. Like many colleagues across the House, I was proud to mark Parkinson’s Awareness Month last month. This annual observance is more than a symbolic gesture; it is a vital opportunity to raise awareness, challenge misconceptions, and advocate for the thousands of people across the UK who live with Parkinson’s every day. It is also a time to reflect on the progress we have made and, more importantly, the work that still lies ahead.

Parkinson’s is a condition that touches every corner of our society. It affects over 150,000 people in the UK, and that number is expected to rise to 172,000 by 2030. In my constituency of Colne Valley, there are an estimated 253 people living with Parkinson’s. These are not just statistics; they are our neighbours, our friends and our family members, and behind each number is a story of resilience, of daily challenges and of hope.

Parkinson’s is a progressive neurological condition. It is complex, degenerative and life-limiting. It affects movement, speech, cognition and mental health. There is no cure, and while treatments exist to manage symptoms, their effectiveness often diminishes over time. The condition manifests differently in each person: some may experience tremors and stiffness, while others struggle with depression—

[Graham Stuart (in the Chair)]

Order. The sitting is suspended for 15 minutes for a Division in the House.

--- Later in debate ---

[Paul Davies]

I absolutely agree—the role they play is vital in terms of supporting this community. To be truthful, the people I have met in those groups are inspirational, as is the work they do, so I thank them for that.

NHS England’s medicine safety improvement programme, running from 2024 to 2027, is a welcome step. It aims to ensure that time-critical medications are administered promptly in hospitals, but we must ensure that the programme is fully implemented and that its findings are acted upon across all NHS trusts. Timely medication is a basic right for Parkinson’s patients, and we must treat it as such. In England, people with Parkinson’s still face prescription charges, unlike in Wales, Scotland and Northern Ireland. These charges can be a significant burden, especially for working-age patients, who may already face reduced income due to their condition. Research shows that eliminating these charges could reduce hospital admissions and save the NHS money, but Parkinson’s remains absent from the list of conditions exempt from charges—a list that has not been meaningfully updated in more than 60 years. It is time for a review. We must ensure that no one is forced to choose between their health and their finances.

New treatments such as Produodopa, which was approved for NHS use in 2024, offer hope for those with severe symptoms. This medication could be life-changing for patients whose symptoms are not well managed by the existing treatments. However, due to staffing and funding constraints, many hospitals are unable to offer it. We must ensure that all patients who need innovative treatments, such as Produodopa, can access them, and that the NHS is equipped to adopt new therapies quickly and equitably. Innovation must not be a postcode lottery.

I will now turn briefly to my constituency. Since being elected, I have had the privilege of meeting Dr Chris Ryan and Mrs Liz Ryan MBE. Over a cup of tea in February, they shared their experiences and highlighted the urgent need for better Parkinson’s care in Kirklees. Liz, who received an MBE for her services to education, continues to be a pillar of our community despite her diagnosis. Together they have organised local events, including a Parkinson’s choir that brings joy and support to many.

Following our meeting, I wrote to Kirklees council and Calderdale and Huddersfield NHS foundation trust to ask what more can be done. I also contacted the Department of Health and Social Care regarding regular consultations and better medication management, and the Minister informed me that the neurology service specification is being updated, and will be published later this year. Although remote consultations are helpful they are not always suitable for Parkinson’s patients, who require regular, holistic in-person care. I urge the Government to consult with Parkinson’s UK during this review.

I also had the pleasure of attending the Big Sing for Parkinson’s on World Parkinson’s Day. The event was organised by the “Movers & Shakers” podcast, and it was a celebration of community, resilience and hope. As I said earlier, it was absolutely inspirational; to witness that community, and the strength of community spirit and determination to drive through with their lives, was incredible. The group also published the Parky charter, outlining five key needs for people with Parkinson’s—needs that are still unmet. This year, two Big Sings were held: the one I attended in Huddersfield, and the other in London. They brought together people in solidarity and song.

As we move forward, let us remember that Parkinson’s Awareness Month is not just about raising awareness, but taking meaningful action. It is about listening to those with lived experience, supporting families and carers, and ensuring that our health system is equipped to meet the needs of every person living with Parkinson’s.

Parkinson’s is a condition that demands our attention, compassion and action. By addressing workforce shortages, supporting patients from diagnosis, ensuring timely medication, removing financial barriers, and embracing innovation, we can dramatically improve the lives of those living with Parkinson’s.

[Graham Stuart (in the Chair)]

We have five Back-Bench speakers. I will call the Front Benchers at 5.23 pm, so I will let hon. Members make a judgment on that. We will start with the ever-succinct and effective Ed Morello.

[Edward Morello (West Dorset) (LD)]

It is a pleasure to serve under your chairship, Mr Stuart—especially after that flattery. I congratulate the hon. Member for Colne Valley (Paul Davies) on securing this important debate.

Parkinson’s, as has been said, is the fastest growing neurological condition in the world. But behind every statistic is a family, a carer, a friend—someone whose daily life is shared by this illness. My constituents have written to me about their experiences of loved ones living with the disease. The stories they have shared are heart-breaking, with long waits for specialist care, difficulties accessing the right medication on time, and exhausting battles for financial and social support. I know I speak for many here when I say that we must do more.

Parkinson’s is a progressive condition, with more than 40 possible symptoms affecting movement, sleep, mental health, speech, eating and swallowing. Nearly half of those living with it will experience anxiety or depression, and more than half will develop psychotic symptoms as the condition progresses. Across the country, there are long waits for specialist care, a lack of multidisciplinary teams with Parkinson’s experience, and serious difficulties in accessing vital medication in a timely and consistent way.

We urgently need to overhaul the way that care is provided for people with Parkinson’s, particularly in rural areas. That begins with primary care. GPs are the front door to the NHS, yet we know that continuity of care is beginning to be eroded. That is why the Liberal Democrats are calling for everyone with a long-term condition such as Parkinson’s to have access to a named GP—someone who can understand their history and needs, and can advocate for timely referrals and co-ordinated care.

This is not just about funding more; it is about funding smarter. Primary and community care can prevent some hospital admissions and provide medication and essential support for those who cannot easily travel. That is especially important in rural areas like mine, where distance, isolation and sparse public transport already pose significant barriers to treatment.

Care services are struggling with conditions like Parkinson’s and have been stretched to breaking point by Government decisions and a lack of funding. Weldmar Hospicecare in West Dorset is a lifeline for so many families. Earlier this year, NHS Dorset announced a £400,000 cut to its fast-track funding, starting next April. Weldmar also faces a £600,000 increase in costs as a result of rising national insurance contributions and other pressures. It already raises 60% of its NHS-commissioned care through charitable donations, and that is unsustainable in the long term.

The same goes for our community pharmacies, which are vital for people with Parkinson’s, especially in rural communities. They are not just dispensaries; they provide healthcare consultations, medical reviews and early advice, often acting as the first point of contact for worried patients. Yet the funding model they rely on is outdated and inadequate, leaving many rural pharmacies on the brink of collapse. If we are serious about reducing health inequalities, we must ringfence funding for essential services and not allow it to disappear into ever-wider budget allocations.

We owe it to everyone living with Parkinson’s, and to the families, the carers and the health workers supporting them, to do better. That means listening to the voices of those people affected, ending the postcode lottery and making sure that no one, wherever they live, faces this devastating disease alone.

[Graham Stuart (in the Chair)]

Admirably delivered.

Eating Disorder Awareness

Graham Stuart Excerpts

Tuesday 1st April 2025 Westminster Hall

[Several hon. Members rose—]

[Graham Stuart (in the Chair)]

Order. I remind Members that they should bob if they wish to speak in the debate. I will bring in an informal guide for Members: if everyone speaks for about four minutes, we can hopefully get everybody in.

--- Later in debate ---

[Josh Dean (Hertford and Stortford) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stuart. I thank the hon. Member for Bath (Wera Hobhouse) for securing this important debate, and my hon. Friend the Member for Camborne and Redruth (Perran Moon) for his deeply moving and courageous speech.

As with many mental illnesses, eating disorders often present first in children and young people. Like other hon. Members, I am alarmed by the NHS England statistics that show that in 2023, 12.5% of 17 to 19-year-olds in England were living with an eating disorder. According to YoungMinds,

“Young people can use their behaviour around food and eating to try to cope with…difficult thoughts, feelings and experiences.”

YoungMinds also states:

“Over time, these kinds of thoughts and behaviours around food become very fixed and difficult to change—and may start to take over daily life.”

Early intervention for a young person struggling with an eating disorder is clearly critical if we want to support them to live a healthy, fulfilling life.

I was politicised at school by the disparities in the mental health support received by my peers, and we know that young people today are at the sharp end of the mental health crisis. I, too, have had friends who struggled with eating disorders and disordered eating, and during the general election last year I was contacted by a young woman who had waited four years for her first child and adolescent mental health services appointment. Sadly, that has become the norm, rather than the exception, for young people with mental illnesses.

I welcome this Government’s commitment to cutting NHS waiting lists and investing in talking therapies. I also welcome the commitment this Government have made to getting mental health support into our schools and delivering a network of Young Futures hubs with trained youth workers and drop-in mental health support, so that we can address eating disorders and mental health conditions early, and support our young people.

I have a few specific questions for the Minister, and I would be grateful if he could address them in his response. First, could he set out what the Government are doing to improve the early identification of eating disorders? For example, in 2023, Place2Be called for every professional working with children and young people, including in the healthcare workforce, to be trained to identify young people with potentially impairing eating behaviours. Has the Department had considered that?

Given the huge impact of the pandemic on the mental health and wellbeing of young people, could the Minister further set out what action the Government are taking to specifically support individuals who developed an eating disorder or mental health condition during that time? Finally, could the Minister set out what cross-departmental work the Government are undertaking to ensure a joined-up approach to supporting young people with eating disorders?

Those struggling with eating disorders deserve support and they need action, and we must treat eating disorders as the emergency that they represent. I was particularly moved by the words of the hon. Member for Bath, given her important work on the issue over a number of years, about the frustration of seeing things get worse, not better. I reflect on my experience as a young person going through school and watching my peers struggle with eating disorders and mental health conditions. Now I come into this place to represent my community, knowing that young people today are struggling so much more. That makes the urgency of the task even greater, so I thank the her again for her work and for securing the debate.

[Graham Stuart (in the Chair)]

Last but not least on the Back Benches, I call Luke Charters.

Access to Dentistry: Somerset

Graham Stuart Excerpts

Tuesday 1st April 2025 Westminster Hall

[Graham Stuart (in the Chair)]

I will call Anna Sabine to move the motion, and I will then call the Minister to respond. I remind other Members that they may make a speech only with prior permission from the Member in charge of the debate and the Minister—that is often forgotten. There will not be an opportunity for the Member in charge to wind up, as is the convention for 30-minute debates.

[Anna Sabine (Frome and East Somerset) (LD)]

I beg to move,

That this House has considered access to dentistry in Somerset.

It is a pleasure to serve under your chairmanship, Mr Stuart. My grandfather might not have been a toolmaker, but he was dentist. He worked near Slough, and as a child I loved visits to the dentist because we got to play in the electric chair and dissolve bright pink mouthwash tablets in plastic cups, and we always got a Lambrusco and lemonade afterwards, which was of course entirely appropriate.

That regularity of dental treatment means that, at 45, I am lucky enough to have no fillings at all, and I am not particularly scared of dentists. Many children growing up today in my constituency of Frome and East Somerset are not so lucky: one in five children in Somerset has tooth decay by the time they are five. Although we know that difficulty in accessing an NHS dentist is a nationwide challenge, data reveals that the south-west is particularly neglected. The most recent Office for National Statistics data shows that it has the worst access problems of all regions in England, with 99% of people without a dentist failing to secure the NHS treatment they needed in the last month.

Furthermore, only 32% of adults in Somerset saw an NHS dentist in the two years to June 2024, which is much lower than the national average of 40%. The picture for children in Somerset is equally shocking: only 42% were seen by a dentist in the year to June 2024, well below the national average of 55%, and way below pre-covid averages.

Oral Answers to Questions

Graham Stuart Excerpts

Tuesday 25th March 2025 Commons Chamber

[Ashley Dalton]

The system we inherited has been failing to meet the needs of children with SEND for far too long—that became clear in what happened at the Accy Vic. Through the 10-year health plan, we will consider all those policies, including those that impact on children and young people. We are working closely with the Department for Education to support the delivery of the opportunity mission. I also hosted a roundtable recently with children and young people, including those with SEND, so that they can feed directly into the 10-year plan. They will be at the heart of our thinking and planning on these issues.

[Graham Stuart (Beverley and Holderness) (Con)]

Mr Speaker, your heart would have been gladdened last week to see colleagues from across the House coming together to support my debate calling for the Down Syndrome Act 2022 to be implemented three years on. The Minister for Secondary Care said in response that Down syndrome-specific guidance would be produced, which is welcome. Will the Minister ensure that the consultation group is restricted to organisations that represent Down syndrome people only, and will she promise that, after three long years, that statutory guidance will finally be issued before the end of this calendar year?

[Ashley Dalton]

Work to develop the Down Syndrome Act statutory guidance is being taken forward as a priority, with a view to publishing it for consultation by the summer. It does involve people with Down syndrome, as part of a wider group.

Down’s Syndrome

Graham Stuart Excerpts

Wednesday 19th March 2025 Westminster Hall

[Graham Stuart (Beverley and Holderness) (Con)]

I beg to move,

That this House has considered Down’s syndrome.

It is a pleasure to serve under your chairmanship, Mr Turner. I assume that the Minister responsible for this area of policy is still the Minister for Care, the hon. Member for Aberafan Maesteg (Stephen Kinnock)—the Minister for Secondary Care is nodding. I understand that he has to be somewhere else, but it is great to see the Minister in her place.

I organised the debate to call on the Government to implement the Down Syndrome Act 2022, which received Royal Assent three years ago, as Members will be interested to note. Here in the mother of Parliaments, an Act was passed with the democratic engagement of Members from both sides of the House, but three years later it has still not been implemented. It is therefore about time that it was; we need it.

The first requirement—the first command—of the Act is that the Government should issue guidance because of the specific needs of people with Down syndrome. They were supposed to issue such guidance for local authorities, health authorities, education authorities and everyone else engaged in the support of people with Down syndrome.

Various versions of draft guidance have been produced, but none of them even completely covered what was required, let alone adequately. In 2022, the then Minister for Care and Mental Health, my former right hon. Friend the Member for Chichester, assured us that the guidance would be “fit for purpose” so we can ensure that people with Down syndrome can access “the support they need”, and that the final guidance would be published in the next year. The previous Government did not fulfil that pledge, and as we sit here today, people with Down syndrome still have not seen that historic Act fully in force.

As I said, the draft versions of the guidance so far, according to my understanding—although I do not claim any great expertise—are flawed in a number of ways. Instead of recognising the unique needs of people with Down syndrome, they simply reduce Down syndrome to a subset of a type of learning disability. That limited perspective does a disservice to those with Down syndrome.

For instance, individuals with Down syndrome often require tailored speech and language therapy, yet the most recent version of the guidance, published in December, makes only vague references to specialist therapy. My friend, my former right hon. Friend Sir Liam Fox, who was the driving force behind the Act, put it perfectly. He said:

“This legislation was specifically for those with Down Syndrome as a definable collection of predictable medical conditions and specific life challenges.”

The Act says that it is

“to make provision about meeting the needs of persons with Down syndrome; and for connected purposes.”

In trying to cater for all individuals with learning disabilities, the guidance misses the mark, failing to provide for the very people it was meant to support when the Act received Royal Assent three years ago.

There are reasons to be optimistic. The Prime Minister has rightly pledged to lead a Government of builders, not blockers. Members on both sides of the Chamber, from all political backgrounds, can all stand united in a shared consensus that the guidance needs to be built and issued, and that we need to get the blockers out of the way. We can agree that people with Down syndrome must be recognised as having specific needs, not just generic ones, and that support must be in place to ensure that they have equal access to opportunities to thrive in all aspects of life.

What is truly disappointing is that the blockers of progress are not really elected representatives or indeed Ministers, but, I fear, civil servants—those entrusted with carrying out the will of Parliament. Too many of them have obstructed the efforts of Ministers in two different Governments to implement the Act. Despite repeated promises, we still have not seen the creation of an effective cross-ministerial taskforce. I hope that the Minister will comment on that, because if there is blockage and resistance within the Government machine, Ministers need to come together. There would not have to be a permanent taskforce, but there should be one, two or perhaps three meetings at maximum where Ministers get together and ensure that the will of Parliament is brought to fruition.

Engagement with key stakeholders has been less than adequate. When the stakeholder group was formed to lead on this work, there was no consultation with Sir Liam Fox, the promoter of the Bill that became the Act, or with Rachael and Ken Ross, the founding officers of the National Down Syndrome Policy Group, who also should have been included, and who were a driving force behind the thinking around the Act. That is not good enough—it is not a party political point. The Prime Minister has my full support to ensure that the Minister here today and her colleague the Minister for Care are empowered to do what they were partly appointed to do, which is to fully implement the Act.

I will say a little more on Down syndrome, which is a genetic condition caused by a chromosomal anomaly. While most people have 46 chromosomes, individuals with Down syndrome have three copies of chromosome 21 in each cell, rather than two. There are an estimated 47,000 people living with Down syndrome in the UK, making it the most common chromosomal condition. The good news is that people with Down syndrome are achieving more than ever before: attending mainstream schools, gaining meaningful employment and making invaluable contributions to our communities, as well as living longer.

There is a risk, however, that we see that progress as a reason to rest on our laurels. Instead, it shows the huge potential of people with Down syndrome, if only we can unlock it, and the urgent need to do more. There should be no limit to our ambitions for people with Down syndrome, which is why we should not wait one day more than we need to in order to deliver the guidance promised in the Down Syndrome Act.

The first step towards meaningful change is the improvement of healthcare. People with learning disabilities die, on average, 24 years younger than those without, and are twice as likely to die from treatable conditions. Whether due to significant delays in diagnoses, unsafe hospital discharges or poor co-ordination between the NHS and other services, one thing is clear: many of those deaths are preventable. Doctors certainly do not mean to harm people with Down syndrome. Instead, it is likely that poor healthcare results from a lack of specific knowledge and training needed to give people with Down syndrome the tailored support that the condition requires.

Following the passage of the Act, NHS England issued statutory guidance in 2023, mandating that every integrated care board appoint a named executive lead at board level to drive better outcomes for people with Down syndrome. That was to provide accountability within the system, so we could say that the Ministers are responsible, not civil servants. However, in the implementation —in the delivery on the ground across the country—of course civil servants are responsible. That is why it was an explicit part of the campaign around the Act, and an explicit promise from a Minister at the Dispatch Box, that we would see people appointed—not so that they could be hidden, but so they could be publicly available, contacted and asked what they are doing within their area.

That was so that we could challenge not only the health system, but schools on what they are doing and why, in so many parts of the country, a Down syndrome child is automatically assumed to need to go to a specialist school when a lot of the evidence is they do better in mainstream—but only, of course, if the people in the schools have been given the support and skills to deliver that improvement. A few days ago, however, when I sought to find out who those named accountable individuals are to allow the Down syndrome community to hold the Government and the system to account, I was able to find a publicly nominated lead in only three of the 42 ICBs in England, and two of those leads are called David Jarrett.

I ask the Minister, what is going on? Can we make sure that those leads are publicly named and prominent on the websites of ICBs; that lists are issued and kept up to date; and that everyone in the Down syndrome community can easily find out who is responsible for the delivery of those services? That would ensure that not only health, but the wider community of public services is a servant of people with Down syndrome, rather than turning a person with Down syndrome into a supplicant.

After healthcare, I turn next to education, which is crucial to the life chances of people with Down syndrome. As I have said, research suggests that people with Down syndrome often achieve better outcomes in mainstream education than in specialist schools, provided that it is appropriate for their specific needs. Officials in the Department for Education are best placed to offer guidance on that, which highlights the importance of an effective cross-ministerial taskforce.

The Minister will have already discovered in her relatively short time as a Minister—we all know what it is like—that Departments other than where such Acts are made tend to be quite resistant to them. Sometimes the only way to cut through and make sure that sufficiently senior civil servants take on board these Acts of Parliament and do what they are obliged to do on a statutory basis is for Ministers to be called together to issue such an instruction and push the system to do what it is supposed to do. Otherwise those Departments will sit in their own lane, following the particular priorities of their Secretary of State, and utterly ignoring their statutory obligation to deliver on an Act of Parliament.

Some progress has been made, but there is more to do. Statistics from NHS Digital reveal that only 6% of working-age adults with learning disabilities who receive long-term social care are employed. In other words, 94% are not. When we meet the people who are and see what they can do, we ask, how many more are there? If only we put in place the right co-ordinated system, how many more could have much more fulfilling lives?

We should get the incentives aligned. If there are fears now about a person with Down syndrome losing benefits, it might not be them deciding—they may not even be spoken to—but members of their family or their social worker might decide, “Oh, it is best to take no risks and just keep them on benefits,” rather than supporting them into a job where they can be full members of society, contribute and benefit from that activity.

Even more troubling, 68% of those who are employed work less than 16 hours a week. Those figures are not just numbers; they reflect the deep systemic barriers that still limit opportunities for people with Down syndrome in the workforce. Despite a range of initiatives, it is clear that we need stronger, sustained efforts to ensure that people with Down syndrome can access fulfilling long-term employment. Only then will we truly break down the barriers to their independence and potential. I hope that it is by now clear to the Minister why we must break down those barriers, and why it is critical that the will of Parliament, in the form of an Act of Parliament that is now three years old, is upheld and implemented, and that change is delivered without further delay.

The time for action is now, so I would be grateful if the Minister could answer the following questions. When will the promised cross-ministerial taskforce be created? At the very least, could she speak to her colleague the Minister for Care and push for one? I know that it is hard to get Ministers to turn up for some other Department’s cross-ministerial taskforce, so it often takes personal contact, an agreement that it is not going to run on forever, and someone saying, “Look, this is important. Let’s get this over the line. Please come along.” We need to get the right Minister at the right time, with sufficient seniority around the table and a real will to enact change and make a difference. If that could come out of this debate, it would be fantastic.

Will the Minister ensure that the consultation group contains only Down syndrome-specific organisations, so that the legislation supports people with the condition, as is set out in the Act? There has been a tendency to open up consultations to everybody engaged with learning disability, so people with little or no understanding of the specifics of Down syndrome have been engaged in the consultations run by civil servants. The whole thing has run into the ground and lost the specific focus of the Act.

The National Down Syndrome Policy Group informed me that the draft guidance issued to sector groups contained significant omissions. I always find it much easier to commit to meetings on behalf of colleagues than to commit myself, so I hope I can tempt the Minister to do so. Will the Minister commit the Minister for Care to meeting Rachael and Ken Ross—I would also love to attend—as soon as possible? They are the founding officers of the National Down Syndrome Policy Group, and they do exceptional work for people with Down syndrome. They are in the Public Gallery alongside Millie, who recently gave evidence to the all-party parliamentary group. Millie is always available to correct any of us when we get our policies wrong, as she will attest. Given that it has been three years, will the Minister provide a clear date—an aspiration from the Government —for when we will get comprehensive guidance? When can we get it ready, in a final version, to go through all the sign-off processes of Government? When can we expect it to be officially issued? Those are not just procedural questions; they are vital to ensuring that the promises made to people with Down syndrome are delivered, and that we move forward with the urgency and specificity that this issue demands.

Hon. Members in this Chamber will speak for themselves, but I am sure they all stand with the Minister in this effort. On behalf of the 47,000 people with Down syndrome across the country, we urge the Minister to ensure that a suitable and proper version of the guidance is produced quickly, and that is truly reflects the experiences and needs of people with Down syndrome, specifically. If alongside that exercise someone wants to produce separate, more generic guidance, that is fine; but can we ensure that the guidance described in the Act is delivered for people with Down syndrome, and that it is published and fully implemented without delay?

A great opportunity lies ahead for all of us. We can be part of delivering meaningful, lasting change for thousands of people, now and for generations to come. I am sure support will come from hon. Members on both sides of the Chamber, and I hope we will send the Minister out from this debate determined to ensure that her colleague, the Minister for Care, does the right thing.

--- Later in debate ---

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mr Turner. I congratulate and thank the right hon. Member for Beverley and Holderness (Graham Stuart) for securing this debate, and for giving us all the chance to mark World Down Syndrome Day on Friday. No one has done that better than my hon. Friend the Member for Thurrock (Jen Craft) this afternoon. Her child is the beating heart of her family, and that joy is absolutely with all of us. She has spread that joy today and we are grateful to her.

I am also grateful to the right hon. Member for Beverley and Holderness for his support for the Down Syndrome Act. As he highlighted, I was pleased to support the Act with his right hon. Friend and my constituency neighbour at the time, the former Member for North Somerset, Sir Liam Fox. It was a marvellous thing to be part of. As my hon. Friend the Member for York Central (Rachael Maskell) said, it was a simple but quite brilliant piece of legislation. I am always grateful to the hon. Member for Hinckley and Bosworth (Dr Luke Evans) for quoting my comments from different times at the Dispatch Box; hopefully they were all carefully chosen.

This Government want to see a fair Britain where everyone lives well for longer. I absolutely recognise the importance of the Down Syndrome Act in helping to achieve that. The Act gives people with Down syndrome the building blocks they need for a healthy life, and we have heard about some of those today: access to the health and care services they need, receiving the right education, securing living arrangements that work for them and being supported into employment were mentioned by the hon. Member for Carshalton and Wallington (Bobby Dean) and my hon. Friend the Member for York Central, as well as the Lib Dem spokesperson, the hon. Member for Chichester (Jess Brown-Fuller).

By raising awareness and understanding of the needs of people with Down syndrome, we can help ensure that every person with Down syndrome has the opportunity to live a full and fulfilling life. Today’s debate is an excellent opportunity to come together to mark World Down Syndrome Day. I commend those in the Public Gallery, and the many people who have been in contact with or are known to Members. This year’s theme is “improve our support systems”, which is incredibly important. It is something that we are striving to achieve through developing the statutory guidance under the Down Syndrome Act.

We are committed to ensuring that people with Down syndrome receive the care and support they need to lead the lives they want to in their community. However, as we have heard this afternoon, there is significant work to be done to make that a reality. The Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), is working hard to implement the Act. Under the Act, the Secretary of State for Health and Social Care is required to give guidance to relevant authorities in health, social care, education and housing services on what they should be doing to meet the needs of people with Down’s syndrome.

As Members have highlighted, the Act was formally commenced on 18 March 2024 by way of regulations. That brought into force all the provisions of the Act, and it was a necessary step towards the publication of the guidance. I do not think it has been mentioned today, but shortly after that point we had the general election, and I appreciate that the delays are frustrating for campaigners and people involved. The Minister for Care has written to sector partners and the all-party parliamentary group on Down syndrome with an update on the guidance and next steps. That includes our intention to put the guidance out for consultation by the summer.

Engagement with people with Down syndrome, their families and supporters, sector colleagues and experts has been invaluable throughout the development of the guidance. Over 1,500 responses were received to a national call for evidence, which is being used to inform the guidance, in addition to sector engagement and a review of the evidence to gain a better understanding of the specific needs of people with Down syndrome and how those can be best met by relevant authorities.

On 26 November 2024, the Minister for Care convened a roundtable of partners to discuss how we can improve life outcomes for people with Down syndrome, and the opportunities that the guidance presents in support of that. We are grateful for the collective efforts and insights of individuals and organisations across the country, which have enabled us to make great strides in our development of this important piece of guidance. We recognise that some time has passed since the Act became law in April 2022.

[Graham Stuart]

Several colleagues have mentioned the need for specificity—if the Minister is coming on to that, then great. Would it be fair to say that it is the intent of the Government—I am not looking for cast-iron promises, because we know how challenging these things are—that we should see the guidance issued before the end of this year, all things being well?

[Karin Smyth]

We want to ensure that the guidance is published as soon as possible, and we appreciate patience while we make that happen. It is important that we continue to work with people and organisations with lived experience to develop the guidance. We hope that the update we provide will assure everyone of the priority attached to that important piece of work.

As for the scope of the guidance—with regard to other genetic conditions or learning disability—a commitment was made during the Bill’s passage through Parliament to consider the links and overlaps with other genetic conditions and/or a learning disability. Therefore, the guidance will be Down syndrome-specific, in line with the Government’s statutory duty—which we are clear about—under the Act. It will also include references to where it could have wider benefit. We want to take the opportunity of the guidance to help as many people as possible and to provide examples of good practice to support relevant authorities to implement improvements in practice.

On employment, we heard through engagement with our partners that employment is crucial to improving life outcomes. People with Down syndrome can bring many skills and strengths to the workplace. We want every person with Down syndrome who can and wants to work to have the right support and opportunity to do so. That is why a dedicated chapter on employment will be included in the guidance.

On implementing the guidance, we know that ultimately much depends on how the guidance is put into practice across our communities. To support implementation, NHS England published statutory guidance on 9 May 2023 to require that every ICB had a named lead for Down syndrome. I think that the right hon. Member for Beverley and Holderness said that there was only one, and I recognise the name, because it is my own area—well done, them. That might not have happened, but it was said in 2023.

The executive lead on Down syndrome will lead on supporting the chief executive and the board to ensure that the ICB performs its functions effectively in the interests of people with Down syndrome. We recognise the importance of ensuring that people with Down syndrome are able to make complaints, if they have concerns about the quality of and access to care. We expect the named lead to ensure that concerns are acted on at the local level.

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[Graham Stuart]

We have had 10 speeches in this debate, which is fantastic. I think we all agree that the stand-out speech was that of the hon. Member for Thurrock (Jen Craft). It is great to have the whole House coming together in this way—a number of colleagues focused on that—and to have the pledges from the Minister. I think we can move forward with enthusiasm and engage with the Minister for Care. Led by the co-chairs of the APPG, my right hon. Friend the Member for East Hampshire (Damian Hinds) and the hon. Member for Mid Cheshire (Andrew Cooper), we can ensure that we have a streamlined meeting or meetings to ensure that the Minister’s time is best used, the voices of the community are heard and the guidance is swiftly produced.

Question put and agreed to.

Resolved,

That this House has considered Down’s syndrome.

Health and Adult Social Care Reform

Graham Stuart Excerpts

Monday 6th January 2025 Commons Chamber

[Wes Streeting]

I warmly congratulate Professor Richard Field on his clinical leadership, which has made a difference to countless lives, not only in my hon. Friend’s part of London but because of the national example that he set, which many others followed. That confirms my strong conviction that the best innovations will come from great clinicians. It is our determination to make sure that senior leadership in the NHS and in government back great clinical leadership and innovation, and take the best of the NHS to the rest of the NHS.

[Graham Stuart (Beverley and Holderness) (Con)]

The Secretary of State said that 12,000 patients had to stay in hospital beds because of a lack of social care, yet we have it kicked down the road once again. What will Louise Casey tell us that we do not already know about the tough political trade-offs that have led successive Governments to fail to create a truly coherent health and social care system, and what will he do to make sure that we meet needs today, as he exemplified in November?

[Wes Streeting]

Once again, the arsonist is complaining that the fire brigade is not doing a quick enough job. We are a bit sick of it on the Government Benches, but we are at least rolling up our sleeves, getting on with the job and making improvements, and we will continue to do that. I heard the same complaints about Darzi: “What can Darzi tell us that we did not already know?” Quite a lot, actually. The Conservatives should hang their heads in shame for it.

Income Tax (Charge)

Graham Stuart Excerpts

Tuesday 5th November 2024 Commons Chamber

[Lauren Edwards (Rochester and Strood) (Lab)]

This Budget will improve the lives of so many of my constituents in Rochester and Strood. They will see the benefit in their wage slips, see the things they care most about in their community, such as the local pub and their high street, supported, and see their public services finally invested in again.

Investment in the NHS through this Budget is key. It was the No. 1 issue raised on the doorsteps in the election and is perhaps best exemplified by the struggle to book a GP appointment. The simplest of tasks—for someone to seek help from a medical professional when they are ill—was made into what felt like an impossible task after 14 years of Conservative government. I reminded voters many times during the election that the NHS is always safer in Labour’s hands, so I am delighted to see that our first Budget sets us up to meet that promise so quickly. As others have mentioned, we have a record-breaking £22 billion increase in day-to-day spending, a £3.1 billion capital boost to pay for new technology and improve our buildings, and a landmark public consultation to set out a long-term plan for how the NHS develops over the next decade.

I am proud that we are a Government who have been transparent and honest with people about our priorities to fund that investment. The Chancellor has delivered a Budget that protects working people and instead asks big businesses and the well off to contribute. The Budget does not dodge the tough choices just to get through the next media cycle, but instead is informed by Lord Darzi’s thorough point-in-time assessment of the state of the NHS that was handed back to us by the Conservatives. It lays the foundation to take the NHS from the analogue to digital, from hospital to community-led care and from treating sickness to focusing on prevention and promoting good health.

Those approaches will take different forms across the country, but I draw the Minister’s attention to the potential for an elective care centre in the former Debenhams store on Chatham High Street in my constituency. I have written to the Secretary of State about this proposal, and I would welcome a conversation about its merits, particularly as it is a good example of the invest-to-save model that is promoted so well in the Budget. It would not only free up space at the Medway Maritime hospital and help tackle waiting lists, but would have further benefits by supporting town centre economic regeneration.

I welcome provision in the Budget for a £600 million increase in local government spending to support social care. Like many MPs, I have a background in local government and I understand all too well how much the uplift is needed.

[Graham Stuart (Beverley and Holderness) (Con)]

Will the hon. Lady give way?

[Lauren Edwards]

I have only 20 seconds left, so apologies, but I will not. We all know that the social care sector needs to be transformed, and I hope that over time we can move to a more fully integrated health and social care system in this country. Future Budgets may be able to apply the same exemptions to charitable care homes as happens for the NHS. That would be to the benefit of places such as Frindsbury House in my constituency, which is run with great care and compassion by the Mortimer Society.

[Andrew George (St Ives) (LD)]

I have three minutes and three quick points, on which I hope I have the attention of the Chief Secretary to the Treasury. My first point relates to the NHS. I welcome the introduction to the debate by the Secretary of State for Health and Social Care today. Certainly the Government have inherited the worst crisis in NHS history, and they have a massive challenge on their hands. I like how the 10-year plan has been framed in relation to moving from hospital to home, from sickness to prevention and so on.

The Prime Minister was right when he said that those with the broadest shoulders should bear the greatest burden, but the way this Government are raising tax through national insurance is, I am afraid, hitting some of those who will be struggling most. I hope that he will look again at that and how the Liberal Democrats have framed it. We propose to raise the money by reversing the tax cut for big banks and increasing taxes on the oil and energy giants and large social media multinationals. Surely that would be a far better way.

In responding to questions on the impact of the national insurance rise on GPs, hospices and care providers, the Secretary of State clearly recognised that a mistake was made, and I suspect that the impact was overlooked. [Interruption.] The Chief Secretary is shaking his head, but he really needs to address those issues, because a crisis will continue to occur.

[Graham Stuart]

Will the hon. Gentleman give way on that point?

[Andrew George]

I will, although the right hon. Gentleman has only just walked into the Chamber, so I think it is rather cheeky of him.

[Graham Stuart]

Cheekiness accepted. The hon. Gentleman is quite right that the £600 million extra is for both children and adult social care, whereas adult social care alone is expected to have a £2.4 billion hit, so does he agree that if the NHS, however well funded, cannot move its patients into social care, that investment and expenditure will not work?

[Andrew George]

I do, although that is rather rich of the right hon. Gentleman when he knows that he and his party left the country in this state.

Another issue is the housing emergency, which we have not debated much today. I welcome the additional £500 million that the Government announced, which will supplement the affordable homes programme to 2026. That is much needed. I hope that the Chief Secretary will also address the large number of shovel-ready projects that have planning permission and pre-development work in place. I must declare an interest as a former chief executive of a registered provider. I hope that the Government will look at the impact of the significant construction inflation we have seen over the last four years, which is holding up many developments that could be addressing housing need in our communities. Only 9,500 social homes were built last year. We need a great deal more if we are to address the serious housing emergency.

I have a final question for the Chief Secretary—if I may have his attention for a moment—about the announcement of two layers of business rating that will apply to the retail, hospitality and leisure sector. Many holiday home owners have managed to abuse the system by using small business rate relief. I hope that such second homeowners will not have further opportunities to take advantage of loopholes. Will he investigate that and ensure that money goes into first homes rather than second homes? I am afraid that there is a loophole in the system.

--- Later in debate ---

[Mr Tom Morrison (Cheadle) (LD)]

The Liberal Democrats have long been pushing for the Budget to be a Budget for the NHS, so it was pleasing to see so much investment in our national health service. The boost in capital expenditure is particularly welcome, because Cheadle’s local hospital, Stepping Hill, is in dire need of support and investment. Only a few weeks ago, Stockport NHS foundation trust released figures showing that the maintenance bill required to bring the hospital up to scratch was over £130 million, up from £80 million just five years ago. The cost of the previous Government is there for all to see.

Last year, the hospital’s out-patients building was condemned and demolished. In March, the intensive care unit was temporarily closed because the ceiling was coming in. Since January, almost 10,000 people have had to wait for longer than 12 hours in A&E. Some 70% of Stepping Hill’s estate is now classed in the highest risk category. In fact, when I was there just a few months ago, the incredible nurses talked me through how on rainy days they had to place buckets down to ensure that water coming through the roof was caught. That is utterly shameful and my constituents are suffering.

One constituent contacted my office shortly after I was elected to tell me about their experience. After waiting months for a simple surgical procedure, the partial collapse of the ICU led to their surgery being delayed. It was then confirmed again as delayed. Then, after it was rearranged, there was a further delay because there were not enough beds for aftercare. Each time, the delay seemed to be imposed last minute and out of the blue, which of course drives uncertainty and worry not just for my constituent but for their friends and family.

I want to put on record that this is not the fault of the doctors and nurses. The doctors, nurses and other NHS staff do an incredible job in the worst circumstances, and they are suffering also. They are being forced to work in these conditions. They are the ones who have to break the bad news to patients when their surgeries and appointments are cancelled, although it is rarely their fault. Every day those staff show up and deliver the best service that they can for their patients. The fault lies with the Conservatives. For 14 years they sat back and watched as Stepping Hill, like many other hospitals, crumbled.

[Graham Stuart]

Will the hon. Gentleman give way?

[Mr Morrison]

I will carry on; I am nearly done.

For 14 years, the Conservatives ignored health professionals and patients who were crying out for their hospitals to be fixed. As those cries were ignored, the problems became worse and worse. We are now facing a repair bill of £130 million, and without urgent action that will only become more expensive, so the new Government must act now. I am delighted that there is a commitment to our hospital, but they must act now and give the patients, the staff and my constituents the hospital that they need. If they delay further, costs will only rise and even more parts of the building will crumble.

[Ms Marie Rimmer (St Helens South and Whiston) (Lab)]

This Budget will deliver to communities such as mine. May I begin by welcoming the mineworkers’ pension scheme resolution? It means that £1.5 billion of miners’ pension payments to their fund will be distributed among 112,000 former miners and their families. It is absolutely right that an injustice has been corrected, for those people have waited far too long. It is also shameful that the last Government failed to budget for the resolution of the Post Office Horizon and infected blood scandals, and I applaud our Chancellor for correcting that now. I urge the pensioners who will not receive the winter fuel allowance—those who are just missing out—to apply for universal credit; in St Helens, £6.5 million remains unclaimed. I regret that we have been unable to remove the two-child cap, or deal justice to the WASPI women.

Let me now turn to the issue of local authority funding for adult and children’s social care. Local councils bore the brunt of austerity; successive Government cuts since 2010 have left them in dire straits, which disproportionately affects the people who are most likely to access social care. There have been increasing pressures to find savings, which has not only cut services and jobs but seriously limited the ability to invest in cost-effective preventive services. Some 73% of the budget of St Helens borough council is spent on adult and children’s social care. I welcome the Chancellor’s 3.2% real-terms increase in local government funding, including the £600 million to support social care—

[Graham Stuart]

Will the hon. Lady give way?

[Ms Rimmer]

No.

It is good that, in the short term, a Labour Government will target additional grant funding at the councils that are most in need, but that needs to be the start of a process that will reverse years of financial decline. For too long, local council funding formulas have worked against underprivileged communities, and the areas that need funds the most often do not receive their fair share. Sadly, that creates a downward spiral, with an ever-increasing percentage of local government funding being spent on social care. This is not sustainable.

As I have said, 73% of our council’s budget is spent on social care. Moreover, the 48 members of the Special Interest Group of Municipal Authorities are unable to invest in their local areas in the same way as their counterparts because of the funding formulas. One in four households in England live in a SIGOMA council area. At present, social care services are a postcode lottery, and that needs to be addressed. We need a methodology that takes actual needs into consideration, and ensures that the funding follows. However, I applaud the Chancellor for providing £250 million for children’s social care and £600 million for adults.

--- Later in debate ---

[Kevin Bonavia (Stevenage) (Lab)]

I want to start by saying that we cannot and should not ever underestimate the power and strength of the message that having our Budget delivered by the first female Chancellor in history sends to young women and girls across the country. There should be no limit to their ambition.

In Stevenage and across the country, 14 years of Conservative rule have left a crippling cost of living crisis, record NHS waiting lists, rapidly reducing school funding and worsening public transport. I could go on, but I represent a town of aspiration. The people of my town have had their ambitions and hopes dampened by decline and held back by a broken Britain. However, this Budget sends a clear signal that Labour has started the work of getting politics to work for working people again.

One of the Labour manifesto’s most fundamental promises was to fix the foundations of our broken public services. I recently attended a local older persons day hosted by Stevenage borough council, where we talked about pensioners’ priorities. The Budget maintains the triple lock, which will be worth an extra £470 for pensioners next year, on top of the more than £900 they are receiving this year from the same commitment.

I spend a lot of time speaking to carers in my area who are looking after loved ones in testing circumstances. This Budget delivers the largest increase in the carer’s allowance since its introduction, starting the work of recognising the huge sacrifice they make. However, I know that this work will be complete only when we fundamentally reform our broken social care system, and I very much look forward to that.

[Graham Stuart]

Will the hon. Gentleman give way?

[Kevin Bonavia]

I am afraid not.

I represent a constituency with multiple borough and district councils that have borne the brunt of 14 years of Government cuts. This Budget delivers £1.3 billion extra for local councils to provide essential services that are vital to our communities.

Fifty per cent of patients in my local NHS trust wait longer than the target treatment times, and 31% wait over four hours to be seen in A&E. Despite the heroism and hard work of NHS staff, something simply has to change. The Secretary of State for Health and Social Care has made the brave decision to stand up and fight for our NHS, boldly supported by our Chancellor. I greatly welcome the shift in focus from sickness to prevention, from analogue to digital, and from hospital to community. This crisis cannot be fixed in one Budget, and it may even take a few Budgets, but at least now there is hope where there was none before.

--- Later in debate ---

[Joe Robertson (Isle of Wight East) (Con)]

This is not a Budget for growth. On the Treasury’s own figures, growth will decline from 2% next year for the rest of the decade. On the OBR’s analysis, this Budget is inflationary. It is not on small businesses that the responsibility should land. Small businesses employ people. Small and medium-sized businesses drive the UK economy. If we tax them, we tax growth. If we tax their greatest assets—the people who work for them—then we take away employment opportunities for hard-working people.

I will talk more substantively about the dire impact of the Budget on health and social care, including health and social care providers that are not part of the NHS. The increase in employer’s national insurance contributions will cause great difficulty and hardship for GP practices; charities, including hospices; dentists; pharmacies, which are crucial providers of health services; and social care providers. Those organisations, charities and businesses thought that they might have a friend in a Labour Government, but I assure Government Members that they do not feel as though the Labour Government are a friend right now. I have been speaking to those in GP practices in my constituency on the Isle of Wight. One said:

“Our increase in tax from this Budget is the equivalent of the salary of a practice nurse. There will be no new practice nurse for us.”

[Graham Stuart]

Does my hon. Friend agree that no one would think less of the Government if they listened to these arguments, heard the message and changed? For instance, there is the message about social care being hit by £2.5 billion of extra costs. The £600 million that has been given to local authorities will not cover those costs. If the Government simply listened and changed, people would think much better of them, and we would have a social care system that supported the NHS, rather than one that stops the NHS being able to do what it needs to do.

[Joe Robertson]

I agree with my right hon. Friend. In fact, there has been one common theme running through this debate: GP practices, charities such as hospices, dentists, pharmacists and social care providers are all being taxed by this Government. At a time when they need Government most, these providers find increased pressure on their ability to employ and provide services to the British people. There would be no shame if the Labour Government were to do something about this gross problem with their own Budget.

Moving on to social care, the Secretary of State for Health and Social Care said that there would be no more money for the NHS without reform, yet the Chancellor provides £22 billion for day-to-day spending unattached to reform. She and the Secretary of State are giving the equivalent of just 2.5%—£600 million—of that £22 billion for social care. That is a tiny fraction, yet the biggest reform that our NHS needs is fairer funding for social care. Money would be better spent on relieving the pressure on hospitals, and getting people out of hospital beds who do not need or want to be there, but who have nowhere safe to go to. Through this Budget, social care providers not only face the full burden of increased national insurance contributions, as employers, but receive a small fraction of the funding that the NHS receives. I urge the Government to go back to the drawing board and provide for our GPs, dentistry, pharmacies, hospices and social care.

--- Later in debate ---

[Jack Rankin (Windsor) (Con)]

The theme of this debate is public services, but there has been a distinct lack of discussion from Government Members about what delivers the finances necessary to fund those services; this is the Budget, after all. The answer is simply the productive economy, and small businesses in particular.

The Government talk a good game about wanting better funded public services, and each and every one of us in this House would be hard pressed to find a constituent who disagreed, but the Government’s measures—particularly the jobs tax in the Budget, but also their wider agenda in the Employment Rights Bill, through which we are moving to French-style labour laws—are an attack on where that money comes from.

We must always remember that every single penny spent by the British state has to be earned in the private sector. Chucking money at an unreformed public sector while ballooning public sector pay, and doing that on the back of the productive economy and small business, shows a distinct lack of real world, private sector experience among Government Members. My first memories are of my parents going to night school on alternate evenings to get the qualifications they needed to set up their small business. Their aim was simple: to give my brother and me opportunities that they could never have dreamed of. In doing that, they paid hundreds of thousands of pounds—I ended up with quite a prosperous upbringing, I admit—into the Government exchequer. They created apprenticeships and skilled jobs in a tough part of urban Greater Manchester. They not only transformed our lives but improved the lives of children around them, and created opportunities for local people while paying for public services through their taxes.

[Graham Stuart]

Does my hon. Friend agree that the absence on the Government Front Bench of anyone with any experience of running a business, when businesses create the wealth that pays for public services, may explain why the Budget is so financially illiterate?

[Jack Rankin]

I thank my right hon. Friend. That absolutely shows, as we see from the Office for Budget Responsibility forecasts mentioned by my hon. Friend the Member for Isle of Wight East (Joe Robertson). Putting up taxes unsustainably may mean adrenaline into the public sector from an injection of cash, but the medium and longer-term result will be lower growth, which will mean that public services are just getting a larger slice of a smaller pie.

It is clear to me that the tax burden is higher than is necessarily sustainable. Tax rises now will not necessarily flow into greater revenue, particularly in the medium term. I ask the Government to check their approach, support small businesses first and foremost, and focus their public service efforts in the first instance on productivity reforms.

--- Later in debate ---

[Kevin McKenna (Sittingbourne and Sheppey) (Lab)]

Thank you, Madam Deputy Speaker, for calling me to speak in this debate about the Budget—a Budget I am very proud to support as the first Labour Budget in 15 years.

I also thank the various Members who have made their maiden speeches in this debate, particularly because like myself, so many of them have worked in the NHS. Many of us have felt the urge to get selected for, and elected to, this House because of our experiences over the past 14 years. I understand that among Opposition Members, there is a feeling that Labour Members do not understand business, but I can tell them that we understand the public sector, public services and our communities—and actually, that is a disservice to all the Members on the Labour Benches who have run businesses. It is particularly important to me that a couple of Labour Members have previous experience as NHS managers. In his report, Lord Darzi made it very clear that one of the problems the NHS has faced is an undervaluing of the management side, as opposed to the clinical side, so those Members’ voices will be really important in this debate.

This Budget gives us solid foundations for investment and rebuilding this country—of that, I have no doubt. This Budget is also what people in my constituency have been crying out for, because they know that our public services are frayed to a point that is almost beyond repair. Honestly, that is what people in my constituency keep telling me. Unlike some Members, who have apparently had some very negative responses to the Budget, I can tell those Members from canvassing at the weekend and from what is in my inbox that I have seen a really positive response to this Budget. People are really glad to see that the investment has started, and frankly, there is a sense of reality—a recognition that this is not going to be a quick fix.

On the health service and social care in particular, I applaud the fact that the Secretary of State has not just commissioned the diagnostic investigation from Lord Darzi, but has now commissioned a 10-year plan for the NHS.

[Graham Stuart]

Will the hon. Gentleman give way?

[Kevin McKenna]

I do not think so.

That plan will be needed to get the NHS back on its feet, and as a counter to some of the comments about national insurance and burdens on businesses, the Secretary of State was very clear that he is going to look at the NHS allocations to GPs and other people supplying the NHS—that comes with the plan. Beyond that, it is really important to recognise the damage that has been done to businesses over the past 14 years by all the other costs that have been accrued. The mental health crisis damages recruitment and retention, and businesses have had to cope with all those extra costs across the board.

Government Policy on Health

Graham Stuart Excerpts

Monday 9th September 2024 Commons Chamber

[Wes Streeting]

I am delighted to see my hon. Friend here representing Bishop Auckland. The people of his constituency will be struck by the fact that this afternoon the Conservative party has chosen to create a mountain out of a molehill about a former Health Secretary coming in to lend his advice and experience to a Labour Government. On covid corruption, my hon. Friend is absolutely right to be angry, as indeed the country is, too. That is why my right hon. Friend the Chancellor of the Exchequer has been very clear that, when it comes to cronyism and corruption in covid contracts, we want our money back and the covid corruption commissioner is coming to get it.

[Graham Stuart (Beverley and Holderness) (Con)]

There is just one standard and it applies to whichever party is in power, and that should be respected. All this whataboutery relating to what may have gone on under a Conservative Government! Anyone who has done something wrong should be pursued. Anyone in authority should be accountable. It is the failure of accountability, a failure of recognition, by the right hon. Gentleman that lets down the House today. Can he confirm to the House that Alan Milburn did not have access to official sensitive papers? Anyone who visits a Minister—they come in all the time—sits on one side of the table and the official sensitive documents are on the other side. Can he confirm that Alan Milburn did not have access that no other visitor would have?

[Wes Streeting]

In the meetings that I asked my right honourable friend to attend—I need to make sure that I get this absolutely right—I tend to think that I saw him on the other side of the table in the corner. I cannot guarantee that he sat at that point in every single one of the meetings, but he certainly was not sitting next to me. With regard to the papers for the meetings that he attended, they were discussion papers about the challenges facing health and social care. They were not Government decision papers or recommendations for Ministers. There is a distinction between those two things. I decide who attends meetings in the Department, and, when it comes to wide-ranging policy discussions, I decide what reading material people receive.

Automated External Defibrillators: Public Access

Graham Stuart Excerpts

Thursday 18th November 2021 Westminster Hall

[Maria Caulfield]

The hon. Gentleman makes an excellent point. Some of the developments have been over the past two years and, during covid, they have not necessarily had the publicity they deserve. We all have a role in promoting initiatives. There is work to be done so that people are aware of the apps and initiatives.

In our communities, defibrillators are available at airports, shopping centres, train stations and community centres. School-age children are at low risk, but it can still happen, as I said earlier. As a result, and thanks to the work of the Oliver King Foundation, huge pressure was placed on the Department for Education, so defibs are now available for schools and other education providers across the UK to purchase through the NHS supply chain. They can get those important pieces of equipment at reduced cost. As of January this year, more than 5,000 defibs had been purchased through the defibrillators for schools programme, so we are getting defibs out into our schools.

Since May 2019, the Government have required all new and refurbished schools in Department for Education school building programmes to have at least one defib in their buildings. We are pushing that out for new and refurbished schools, but that does not cover all schools in the network.

[Graham Stuart (Beverley and Holderness) (Con)]

To get defibrillators into the community, I established the Community Access Defibrillators for East Yorkshire campaign. I formed a committee and worked with the highly estimable Warren Bostock of the Yorkshire ambulance service, challenging him with the question: “What would a complete network look like?” His initial response was, “How long is a piece of string?”, but he came up with rules and a map showing all the communities that did and did not have defibrillators—60-plus did not—and over the past two or three years we have been working on that. We now have that figure down to fewer than 20 and hope that in the next 12 months we will have it down to zero. Colleagues might be interested to hear the history of that, to get a template that can be applied elsewhere. If we have clarity about where we ought to have defibrillators, we can ensure that we have them there. In parallel, if we work on awareness and confidence, as discussed, we could save even more than the 4,000 lives that the Minister so rightly highlighted earlier.

[Maria Caulfield]

I thank my hon. Friend for his hard work in his community. There are some excellent examples of where defibrillators have been rolled out. Many communities now have them, but if we have them mandated in public buildings, we can address the gaps outside them with excellent work such as my hon. Friend’s. That is the point that the hon. Member for Strangford is making with his forthcoming private Member’s Bill.

We are also providing training, and CPR training is so important. From September of last year, all state-funded schools have been required to teach first aid as part of the new subject of health education, which was introduced alongside relationship education. Primary school children are taught basic first aid now, and pupils in secondary schools are taught further aid, such as administering CPR and the purpose of defibrillators, so hopefully the next generation will be far more confident than perhaps we are in performing CPR and using defibrillators.

Separately, Sport England has announced that it is working with the Football Foundation in support of the Premier League initiative to put £3 million into providing defibs for grassroots football clubs. A number of people mentioned Christian Eriksen. We also had the case of Fabrice Muamba in 2012. Very often in sports facilities, these are crucial pieces of kit that can save lives. We heard about the supporter at Newcastle who also benefited.

This is an incredibly important issue. I want to reassure the hon. Member for Strangford and all hon. Members here today that we absolutely take it seriously. It is an absolute priority to improve the lives and healthcare outcomes of people who suffer cardiac arrest outside a hospital. I hope that the work in the last two years, although perhaps it is not as well known, as the hon. Member for Delyn points out, shows that we are making key progress in some of the really important areas. But there are gaps in provision. We have heard that what matters is not just where defibs go but that they are outside, with 24-hour access. There are tricky issues such as whether to have a code on a defib. All these things need to be nailed down. I am happy to work with colleagues. This work does not involve just the Department of Health and Social Care; some of it needs the Department for Levelling Up, Housing and Communities, the Department for Education, or the Department for Digital, Culture, Media and Sport. It is a cross-Government approach, and I am happy to work with Members to bridge any gaps that still exist.

Cities and Local Government Devolution Bill [Lords]

Graham Stuart Excerpts

Monday 7th December 2015 Commons Chamber

[Norman Lamb]

I continue to argue strongly that we should have a democratically elected second Chamber, and we sought to achieve that during the coalition Government. Sadly, Conservative Members managed to block that long-overdue reform. [Interruption.] I think the hon. Member for Nottingham North (Mr Allen) is agreeing with me from a sedentary position. But we are where we are, and because Conservative Members ensured during the last Parliament that we still have to put up with an unelected second Chamber, it will just have to do the job as best it can. It is a revising Chamber and I hope that it will again make the argument that 16 and 17-year-olds should have the right to vote. I hope that I have responded adequately to the hon. Member for Gainsborough (Sir Edward Leigh).

David Willetts made the case strongly that there had been a break in the generational contract. I believe that it is incumbent on all of us to address that serious issue and to ensure that all political parties start to show a real interest in the interests of young people. If 16 and 17-year-olds had a vote at local and national levels, there is no doubt that the parties would focus more attention on their interests.

[Graham Stuart (Beverley and Holderness) (Con)]

The right hon. Gentleman said that the interests of young people are not properly reflected, partly because they do not vote, but he then said that giving the vote to even younger people who were even less likely to vote would somehow change the way in which the Government operated. I just do not understand the logic of that. Will he also tell us what is so special about 16? Why not choose 15? Is this about paying tax? We have to draw the line somewhere. What is the principle on which he is basing his argument?

[Norman Lamb]

On the hon. Gentleman’s last point, I of course accept that this is an arbitrary line. The current age at which people can start to vote is also arbitrary. We have chosen to make it 18. My argument is that we can reduce it because people aged 16 and 17 have rights and play a significant part in society. For example, they can join the armed forces, they can work and pay taxes on their income and they can marry. Those are all significant rights and responsibilities, and if they have such rights and responsibilities they ought surely to have a say in the election of our national Government and in the election of local authorities as well.

[Graham Stuart]

If the right hon. Gentleman were charged with a serious offence, would he really want 16 and 17-year-olds serving on the jury and deciding on his guilt or innocence? I certainly would not. We are talking about a certain level of maturity, and the line we have drawn is an appropriate one. If we would not want a 16-year-old sitting on a jury deciding whether or not we went to jail for 10 years, I suggest that we would not want to let them play a part in the election of the Government of the country.

[Norman Lamb]

With all due respect, I think that that is a distraction from the issue we are debating today. I repeat my argument that if 16 and 17-year-olds are able to join the armed forces, pay taxes on their income and marry, which are big responsibilities and rights, they ought to have a say in the election of their Government, either at national level or locally.

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[Mr Chope]

I instinctively think that the hon. Gentleman is right. I say that not only because I have on my wall at home a picture of his constituency that was presented to me by his council when I was a junior local government Minister—a picture that I chose—but because I think that his experience means that he understands the complexity of these issues and their potential impact on ordinary people.

The Government can sometimes give the impression that they get rather intolerant of those us who want to raise issues such as this.

[Graham Stuart]

I have tried to follow this closely but I may not have understood amendment 56, which I am trying to square with the assurances from the Minister. If his assurances are right, why would the Government support amendment 56, which will allow the imposition of this if only one affected local authority says so?

[Mr Chope]

My hon. Friend makes a good point, and perhaps the Minister will reply to it. If we are talking about genuine consensus—in other words, agreement between local authorities—then we do not need amendment 56, which is designed to enable the Government to intervene when some local authorities do not do as the Government think they should be doing. That is essentially what this is about. We might as well face up to the reality that this is a very centralising part of the Bill because it brings power back to the Government to enable them to change the structures of local government boundaries in areas such as Dorset.

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[Mr Chope]

Absolutely. I am very supportive of that amendment, but I have not yet had a chance to talk about it because I am so concerned about amendment 56 and amendment (a). I am not going to restate the case about the referendum, but I think it is a necessary safeguard.

If we look at the history books we see the unintended consequences that can flow from local government reorganisation. It was only because Wandsworth council started a campaign to abolish the Inner London Education Authority that education was given back to the inner-London boroughs, which were then able to gain economic growth as a result of having good-quality education within their boundaries. The same thing happened with the Greater London Council. The Greater London Council was interfering in the lives of the boroughs in inner London and outer London, so those in charge of the boroughs at the time persuaded the Conservative Government to abolish it. As a result, parks such as Battersea park are run by the local authority—Wandsworth council—rather than by a remote authority for Greater London.

If we are not going to put proposals like this to the electorate, we must have the necessary safeguards. None of this stuff was in our manifesto. There was no suggestion that a Conservative Government were going to restructure local authorities so as to try to squeeze out small councils that are closest to the people. If we are not going to test this in a general election and amendment 56 is going to be on the statute book until the end of March 2019, it is all the more important that we should be able to have the safeguard of a referendum—the very safeguard that the Poole People party and the Liberal Democrats have sought, in vain, from the leaders of Poole, Bournemouth, East Dorset and Christchurch Borough Councils.

We are on the threshold of a big spat at local government level between different councils at different tiers and different councillors with different personalities and political parties. This threatens completely to preoccupy local government for the next three or four years. We will look back and say that this all started with the Government wanting to interfere in areas where they should not be interfering at all. They should be trusting local councillors and local people to decide what is best for them. They should not be taking away from Dorset County Council or East Dorset District Council, for example, the power to veto any proposals to change the boundaries in which they operate.

I very much hope that the House will not accept amendment 56 as proposed to be amended by the Government but will push them back to their previous position, which was that this is genuinely for local councils and local people to decide, and the Government are not going to interfere.

[Graham Stuart]

I will try to keep my comments brief, because contrasts are always a pleasant thing. It is a pleasure to follow my hon. Friend the Member for Christchurch (Mr Chope), who spoke powerfully about this issue.

[Jon Trickett]

And lengthily.

[Graham Stuart]

And at length, it has to be said.

I want to tell the House about something that happened in the East Riding of Yorkshire. For many years, people who think about these things have looked at the boundary of the city of Hull and thought it is too constrained and has too little of the hinterland within it. A lot of people thought that it would make sense for it to be expanded, but East Riding of Yorkshire Council is a very successful council and the residents are relatively happy with it. The city of Hull announced that it would set up a commission to look at the boundaries—in effect, at the possibility of Hull expanding outwards. It did so with little or no involvement from East Riding of Yorkshire Council. The response of the council was to call a referendum for the surrounding communities of Hull to see what they thought. This was a one-off referendum: nothing else was going on at the same time. One might think that the arcane issue of boundaries could occasionally capture the public imagination, but generally people would just accept a sensible top-down solution given to them by leaders and Governments and so on.

We need to be careful. I do not have the figures to hand, but, off the top of my head, there was a 75% turnout and a Ceau?escu-esque election result—96% said that they did not want the expansion to go ahead. I mention that in the context of amendment 56 and the argument that, because not all councils are quite in line, perhaps all they need is a little push to get a sensible result. We should be remarkably sensitive to how strongly the population can feel about such things.

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[Sir Greg Knight]

Does the experience of the East Riding and Hull referendum lead my hon. Friend to be in sympathy with amendment 56 or against it?

[Graham Stuart]

It leaves me in a position of having profound doubts about amendment 56. I really appreciated the Minister’s interventions setting out what the Government want to do. The police reorganisation under the previous Labour Government was top down and people did not like it. It is not that we are neutral—my hon. Friend the Member for Christchurch was wrong to say that the Government have always said they would be neutral. The Government have a position and a vision, but I think it is much smarter to offer reassurances and tell people that, whatever we think, we are not going to push it on them, because we have seen that that does not work. People have to consent to it. There will be difficult council leaders who we will think are being a pain because of their own individual interests, but we should bind our hands and restrain ourselves from just pushing them aside. We need to listen and say to everybody, “Unless you can bang heads together yourselves and get a consensus, we’re not going to come piling in, because we’ve seen where that ends up.”

It might be a Labour Government’s instinct to think that they know better than the people, but it should be a Conservative Government’s instinct to recognise that they do not know better and that even if, in their opinion, the people are wrong—and history might show that they were wrong—it is the people who get to decide, and if they feel strongly about something that should be respected.

[Mr Chope]

Will my hon. Friend give way?

[Graham Stuart]

My hon. Friend has had a fair crack and I am going to sit down.

[Mr Steve Reed (Croydon North) (Lab)]

This group includes a number of new clauses and amendments, so I want to focus primarily on those in my name and those of my hon. Friends, although I will also touch on some of the others as I go along. I do not want to detain the House for too long and there is quite a lot of ground to cover, so I shall try to romp through it at a reasonable pace.

New clause 10 proposes votes at 16. The Government seem to be a little confused on this issue: the Secretary of State has said that there is a debate to be had; the Minister for the northern powerhouse says there is not; and the Prime Minister is against it altogether. Yet we know that the Government are considering it for the European Union referendum and that they supported it for the Scottish referendum.

There are more than 1.5 million 16 and 17-year-olds in the UK. They can get a job or an apprenticeship, get married, pay taxes and join the armed forces, but apparently they are not responsible enough to be able to vote for their local councillor to take decisions about the local services in the area where they may well have bought a home and live with their family. The Bill is the ideal place to bring about change. Incremental change is how the British constitution develops, and allowing votes for 16 and 17-year-olds in local elections seems to me to be a good place to start.

The Electoral Reform Society argues that lowering the voting age will improve registration rates. Nearly 90% of eligible 16 and 17-year-olds registered for the Scottish independence referendum, and a high proportion of them took part in it. Research in other countries suggests that the turnout rate for 16 and 17-year-olds is higher than that for 18 to 34-year-olds. Establishing the habit of getting involved and voting in elections at an early age makes a lot of sense if we want people to continue voting throughout the rest of their adult lives. The Scottish referendum set the precedent. It is unreasonable to extend the vote in one part of the Union and not in another. Local elections suffer from low turnout, so that is a good place to start, but if the Minister thinks that this is not the time to introduce the change, perhaps he can answer the question: if not now, when?

On new clause 11, the Government have been very unclear about plans to devolve fire and rescue to mayors or police and crime commissioners, but we know that the Home Office is pushing for it and it is included in the Greater Manchester devolution deal. Our new clause calls on the Secretary of State to publish a review of how the Bill affects fire and rescue services. As we have seen over the weekend, and as we heard in the flooding statement earlier, the fire and rescue service is doing an incredible job, despite extremely severe cuts that have limited its capacity and reduced the number of jobs by almost a third. The cross-party Local Government Association believes there is “no pressing need” for police and fire services to merge. Any changes of the kind being considered will heighten public concerns about safety. The new clause would simply add a level of scrutiny and oversight to the provisions, so I hope that the Secretary of State and, indeed, the Minister will welcome and support the proposal.

Since 2010, local government has faced cuts of 40%, and last month’s spending review imposed a further 56% reduction in central support to councils. We know there will be changes to business rates once they are localised, and we were promised details in the autumn statement about how an equalisation mechanism would work, but no such details were given. Councils have simply been left to plan their future budgets in the dark, despite cuts on a scale that they have never been asked to deal with before. The LGA has warned that local authorities are struggling, and that is even before the spending review hits them. Lord Porter, the Conservative chair of the LGA, says:

“We know we’ve got probably 12 or 14 councils that are very close to the edge now.”

They need to know what is going to happen to them in future if they are going to be able to avoid falling off the edge of that particular financial cliff.

The funding settlement is deeply unfair. The 10 most deprived communities have suffered cuts that are 18 times higher than those made to the least deprived communities. Councils with the highest rates of children in care have suffered cuts that are three times higher than those made to councils with the lowest number of children in care. Although Labour councils are disproportionately hit by the cuts, they are also the ones that are protecting front-line services. Tory councils have shut half their youth services since 2010.

The unfair funding settlements are made worse by England’s local government finance arrangements, which are among the most centralised anywhere in the industrialised world. Councils lack the freedom to innovate so that they can spend on local priorities. Even London, which currently is more devolved than anywhere else in the country, is reliant on central Government funding for three quarters of its revenue. That is far higher than 30% in New York and just 25% in Berlin. London is the world’s greatest city, and yet this Government insist on keeping it on far too tight a financial leash. The Communities and Local Government Committee concluded that local authorities in England

“have limited control over local taxation and, as a consequence, rely…disproportionately on central Government funding.”

Our new clause 13 does not prescribe a particular settlement, but calls on the Secretary of State to publish plans for a package of fiscal and financial devolution that addresses three areas. First, on business rate retention, councils need an equalisation mechanism to ensure that those communities with the least capacity for economic growth are not left to sink. Labour supports the localisation of business rates, but it has to be done in a way that incentivises areas to grow, without penalising areas that have less capacity to do so at the time or in the future.

Ministers promised at the Dispatch Box that details of the equalisation mechanism would be made available during the autumn statement, but that did not happen. It still has not happened and we have not been given a date by when it will happen. We simply cannot allow rich communities to get even richer while everywhere else struggles to provide basic services. The new clause calls on the Secretary of State to introduce an equalisation mechanism to ensure that the least well-off are not hammered by the change.

[Graham Stuart]

The hon. Gentleman, as an expert in this area, will be aware that people in rural areas are on average poorer than people in urban areas. He will also be aware that his Government—the Government of his predecessors—left a system in which there was 50% more support per resident in urban areas, which are wealthier than rural areas, than in rural areas, and that it is more expensive to deliver services in rural areas. It is no surprise that we are not seeing the same reductions in services in rural areas as in cities, because such services do not exist in the first place. His party left it that way. Are Labour Members now committed to a fairer system?

[Mr Reed]

The hon. Gentleman seems to support my case for a fair equalisation mechanism, which I am pleased to hear.

Secondly, on greater local control over tax rates and discounts, England has one of the most centralised funding arrangements anywhere in the world. Whitehall takes the key decisions on council tax, which means that it is barely local at all. The previous Secretary of State capped rises, while the Chancellor is now encouraging councils to push up council tax to make up for his cuts. Labour wants the Government to publish plans to introduce greater local freedom over tax rates, banding, valuation and discounts.

Thirdly, on multi-year finance settlements, every successful organisation needs to be able to plan for the future, and local authorities cannot plan complex services without knowing what level of funding is available to pay for them. As powers are devolved from Westminster, local authorities need to know that they have the resources to exercise those powers properly. Local enterprise partnerships could operate more effectively if they had longer-term funding streams. Indeed, the regional development agencies, which LEPs replaced, could make single, three-year funding agreements, while LEPs have access to a smaller budget, with too many small funding pots and with constraints on their use. We want to make sure that combined authorities do not suffer from the same problem. Our new clause 13 calls on the Secretary of State to publish plans to allow for multi-year funding agreements, which would give combined authorities the resources and time to ensure financial stability, and allow them to make better long-term decisions about local services.

On new clause 14, we welcomed in Committee the proposal that new sub-national transport bodies must consult adjoining authorities before taking decisions. On transport, the Government have recognised that the devolution of powers to combined authorities concerns neighbouring authorities that do not wish to, or cannot, join a combined authority. That is an important principle, but it extends to areas beyond transport, and the Minister’s response to our amendment in Committee was disappointing. The Minister said it was not “necessary or appropriate”, so perhaps he will reconsider and support this new clause. For example, local authorities on the periphery of the Greater Manchester combined authority have concerns about health service decisions that will affect them, but which they are unable to influence. We want to give them the right simply to be consulted. If the Government are prepared to concede that such authorities should be consulted on transport, then why not on health or other key services?

Whatever the Government say, they are imposing mayors by making them a non-negotiable condition of devolution for metropolitan areas. We believe that the spirit of devolution demands that local areas should choose their own model of governance instead of having it imposed from the centre. If areas want a mayor, that is fine, but it should also be fine if they do not want a mayor. Government amendment 7 and related amendments are disappointing. They will allow the Secretary of State to impose a mayor on a combined authority even if one or more constituent councils do not want one. It is no surprise that the Local Government Chronicle wrote about amendment 7 under the headline, “Boost to government powers to impose elected mayors”. The Government are acting in opposition to their own claims to support local decision making in that respect.

If the powers are agreed to this evening, they must be used with extreme caution. Where a potential combined authority is divided on the details of a deal, which it may well be, local co-operation must be the preferred way forward. I would welcome a statement by the Minister or the Secretary of State to that effect. Our amendment 58 would reintroduce the change made in the Lords, stipulating that devolution deals cannot be made dependent on having a mayor. That view has support from Members on both sides of the House, as we have heard again this evening.

On amendment 59, we discussed the general power of competence earlier. The Localism Act 2011 introduced the general power of competence, which was intended to give local authorities more power and freedom to innovate. That is a good idea, but LGA research shows that the power is

“limited by significant constraints set by central government”,

and that local government needs far more independence from interference by central Government. The constraints the LGA identifies are financial, structural and regulatory. Our amendment encourages the Secretary of State simply to review the power of general competence to learn how to make it more effective and to encourage greater take-up than the disappointing level so far.

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[Graham Stuart]

I am struggling to square the amendment with what the Minister has just said. There is no talk about streamlining or tests. The amendment simply states that if one council is in favour, all the others can be pushed aside. That is what the amendment says. Our job is not just to listen to reassurances from Ministers, however brilliant, but to look at the words of the Bill, and the Bill appears to give great power to the Secretary of State. If he has that power already, I do not see why we need it in an amendment; if he does not have it already, I am a little reluctant to give it to him.

[James Wharton]

I hear what my hon. Friend says, but it remains the case that a council or group of councils can now, regardless of the Bill, ask the Secretary of State to implement a proposal for structural change through the traditional processes of the Local Government and Public Involvement in Health Act 2007, even where not all councils agree or where there are competing proposals for different councils. He has those powers, but only as part of a convoluted and lengthy process. This is not about forcing unwanted change on areas just because we have the power to do so; it is about enabling the flexibility to deliver the right devolution deals for areas and in a timely and flexible way. I know that hon. Members have raised concerns, but there are none the less statutory tests that have to be satisfied in doing that. This place would need to approve any change, but the fast-track process, with its significant safeguards, is a welcome one.

The new process would still require the Secretary of State to lay before Parliament a report on the fast-track process, including on matters he has taken into account when deciding to use it, and I reiterate that it could not be used without Parliament’s approval. Having carefully considered and weighed the arguments; having listened to the comments of my hon. Friend the Member for Carlisle and others; and having considered the need to ensure flexibility if we are to make devolution last, we have decided to support the amendment. We have tabled a manuscript amendment so that it is for a trial period and not something that would necessarily last in perpetuity; none the less we welcome the flexibility in the amendment.