Hospitals

Helen Morgan Excerpts

Wednesday 23rd April 2025 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

I beg to move,

That this House regrets the appalling state of repair of NHS hospitals across the country; notes that the NHS maintenance backlog rose to £13.8 billion in 2023-24; further notes the sustained pattern of cannibalising NHS capital budgets to keep day-to-day services running; condemns the previous Government’s record of starved repair budgets and exploding maintenance backlogs, which made sewage leaks, cracked walls, crumbling ceilings and sinking floors commonplace; further condemns the previous Government for launching the New Hospital Programme with no realistic plan to fund or deliver it; further regrets that almost half of the selected hospitals are now not set to begin construction until after 2030; calls on the Government to reverse the delay to the New Hospital Programme and create a crumbling hospitals taskforce to bring construction dates forward; and further calls on the Government to end the vicious cycle of false economies and rising repair backlogs by putting hospitals across the country on a path towards sustainable funding.

The appalling state of our hospital buildings is a national scandal. Everybody in this country should be in control of their own lives and health, which means everybody getting the care they need when and where they need it, but that can never be realised while so many patients are treating in grossly inadequate settings. From Shropshire to Cornwall, Cambridgeshire, Watford and Devon, patients are losing their dignity because of decisions taken by the Conservatives, and the Labour Government’s failure to rectify them.

The Conservatives’ record is one of starved repair budgets, serious leaks, crumbling ceilings and bucket-strewn wards. It is an outrage that millions of people are waiting for treatment, yet overcrowded hospitals have had to close operating theatres because they are no longer fit for use. Patients and hospital staff deserve the dignity of safe, modern and clean environments, but instead the previous Government shamefully chose to raid the repair budget to plug the gap in day-to-day costs, as our hospitals fell apart, and the new Government, who were elected on what increasingly looks like false hope, are pursuing a false economy in delaying the desperately needed new hospital programme.

As with so much of their agenda, the Government promised so much but are delivering so little and betraying those who put their faith in the Labour party. Farmers who were fed up with the Tories taking them for granted have been hit with a tax grab on their families’ futures. Employers, who were promised growth and no new taxes, have been whacked with a national insurance increase. Patients, who were promised new hospitals, have had them taken away.

[Andy Slaughter (Hammersmith and Chiswick) (Lab)]

I was with the hon. Lady almost up until that point. I congratulate her on opening the debate. It is absolutely true that the new hospital programme did not deliver new hospitals and was unfunded under the Tories. However, it is being funded now under Labour. Money is being invested in my local hospitals, in the Imperial College Healthcare NHS trust, and it is preparing for major rebuilds. Will she perhaps give the new Government a little credit for what they have done, and correctly identify the shambles that we were left with?

[Helen Morgan]

The hon. Member will be aware that there were not 40 new hospitals—they were not all hospitals and there were not 40 of them. The issue here is that the start dates for work on many hospitals that need urgent rebuilding have been pushed back into the 2030s, long beyond the life of this Parliament. The people who are served by those hospitals were promised new facilities and have not had them. That is devastating for those communities.

If the Conservative approach was contemptible, Labour’s approach has been to procrastinate. The cost to the NHS of papering over the cracks and keeping hospitals running past their natural lifespan is enormous. That is why the Government must reverse the delay to the new hospital programme at once and urgently deliver the new hospitals that patients have long been promised.

[Mark Ferguson (Gateshead Central and Whickham) (Lab)]

I wonder if the hon. Member can explain to me how spending £22 billion extra on the national health service this year can in any way be described as procrastination.

[Helen Morgan]

It is important to recognise that the additional investment in the NHS amounts to about £10 billion a year—according to Office for Budget Responsibility numbers, which I am sure the hon. Gentleman has looked at—because of the cost of national insurance hikes and of compensating other public sector employers for those hikes. The £22 billion figure is somewhat misleading. The point that we are making is that it is a false economy to keep those buildings going, to keep repairing a crumbling estate, to keep patching up and putting a sticking plaster on those problems. Those buildings need to be demolished and rebuilt, so that approach is a false economy. It would be much better to build new buildings up front and save on future repair costs. We need to ensure that no one is treated in broken, uncomfortable and unsafe facilities. Repairing and replacing crumbling, substandard hospitals is not only vital for delivering better care and treating-more patients, but crucial for rebuilding the economy after years of Conservative economic vandalism.

How much would all this cost? In my county of Shropshire, the cost of the maintenance backlog across all sites has reached about £75 million. I am sure that everyone here would agree that £75 million is a lot of money—indeed, it is so much that it is the total amount of Government capital investment for hospices this year—but in terms of hospital maintenance it is a drop in the ocean. Torbay hospital needs more than £50 million to clear the backlog, Watford hospital has a backlog of £63 million, and Hull royal infirmary requires an eye-watering £70 million. Across England, the figure is a colossal £13.8 billion—and that is just to bring our existing hospital estate to the minimum standard.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

The hon. Member is right that a huge amount of money needs to be spent. A lot of that goes back to the fact that, as Lord Darzi tells us, £37 billion less was spent on hospital buildings in the 2010s than was necessary. Will she remind me who was in government for the for half of the 2010s?

[Helen Morgan]

The hon. Gentleman will be aware that, when one comes into government and has to clean up the mess left behind by the previous Government, one has to make difficult choices. It is the job of the Opposition to point out where they would make those choices or take different options. We would invest to save money in the long run, rather than fritter money away on a repair bill for buildings that need to be demolished. It is not sensible to pour good money after bad when the right thing to do is invest in a new fit-for-purpose and modern estate that does not have endless and extortionate maintenance requirements.

[Several hon. Members rose—]

[Helen Morgan]

I will make some progress.

At North Devon district hospital, the ducting of the ventilation system that serves the operating theatres has not been changed since it was installed in 1979, and cannot be replaced because of ceiling height and asbestos. As a result, all operating theatres have been non-compliant with NHS England buildings guidance since 2007. The good people of Devon clearly need a new hospital, and they were promised that they would have one by 2030, only for the Labour Government to take it away and decide that the change those people need will not be delivered for another decade.

Even hospitals with comparatively few maintenance problems, such as the Royal Shrewsbury hospital, which serves my constituents and has a £35 million backlog, are clearly a long way short of being up to standard. I will not go into detail again about the catalogue of issues in Shropshire—the ambulance delays and station closures, the waiting times for check-ups, scans and surgeries, or the substandard state of cancer care—but they all combine to put huge pressure on hospitals, where staff and buildings are straining under the load.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady and the Liberal Democrats for securing this debate. One issue that they have not mentioned in their motion is car parking at hospitals, which is an ongoing problem for disabled people and patients who miss or delay their appointments as a result of a lack of spaces. Does she agree that car parking is central to addressing the issues that she is setting out?

[Helen Morgan]

Car parking is a real problem, particularly where public transport is poor—it plagues my constituents—and when it is unrealistically expensive for people who need to use hospital facilities. I thank the hon. Member for that point.

The NHS crisis impacts on patient outcomes. My constituent Emma was left in the “fit to sit” area for 48 hours despite having been diagnosed with suspected sepsis, 96-year-old Mary waited outside in an ambulance for 11 hours, and 82-year-old Paula spent 24 hours on a trolley in a corridor. That is the reality in hospitals up and down the country. I think we all agree that that is a disgrace and it must be rectified.

[Ben Coleman (Chelsea and Fulham) (Lab)]

Will the hon. Lady give way?

[Helen Morgan]

I will make some progress.

One of the main reasons those problems have not been rectified is successive delays from successive Governments. Shropshire is, again, a prime example. This is not related to the new hospital programme, but none the less, £312 million was granted for the hospital transformation programme in Shropshire back in 2018. Seven years later, while the country has been through five Prime Ministers and eight different Health Secretaries, Shropshire is still waiting for that transformation to take place. Opposition from both the Labour and Conservative councils that serve the area, along with the ridiculously lengthy process that capital expenditure has to go through to be signed off, means that desperately needed improvements have been horribly delayed as construction costs rise. As a result, the original plans have been scaled back and their value diminished.

[Daisy Cooper (St Albans) (LD)]

My hon. Friend mentions the inordinate delays that occur with regard to applications for capital funds. I have watched with horror as my local hospital trust in West Hertfordshire has had to submit business case after business case while watching the costs rack up. Does she agree that one way to spend the allocated money more efficiently would be by devolving those budgets to local hospital trusts, rather than having a centralised programme that drives up the costs?

[Helen Morgan]

I could not agree more. That is exactly the situation we saw in Shropshire. Once again, the people who will suffer are the patients.

Last year, less than £900 million of the £13.8 billion required to eradicate the repair backlog for hospitals was invested—just 6.5%. It does not take an accountant to work out that at that rate, it will take 15 years to clear the current backlog, let alone the further deterioration of the crumbling buildings. Investment in eradicating the repair backlog fell sharply from £1.4 billion in 2021 to £895 million in 2023-24—a fall of 37%. I am afraid that, just like their approach to fixing social care, the Government’s continued lack of imagination and ambition is leaving our NHS less productive and less stable, which risks leaving millions languishing on NHS waiting lists.

[Several hon. Members rose—]

[Helen Morgan]

I will give way to the hon. Member for Chelsea and Fulham (Ben Coleman) because he has tried to intervene before.

[Ben Coleman]

I am most grateful to the hon. Lady for her delayed response. I am struck by her lack of response to two of my colleagues. She did not acknowledge to my hon. Friend the Member for Hammersmith and Chiswick (Andy Slaughter) that in my constituency of Chelsea and Fulham, the Imperial College Healthcare NHS Trust is getting money from the Government as a precursor to rebuilding the hospitals promised to it. More importantly, she did not address the point made by my hon. Friend the Member for Calder Valley (Josh Fenton-Glynn) that we are all reaping the whirlwind of the decisions taken by the Conservative-Liberal Democrat coalition Government. The Liberal Democrats made a choice to go into that Government, to take on roles including as Chief Secretary to the Treasury and as Health Ministers, and to make those cuts and destroy the NHS. We are now reaping the whirlwind of the decisions that she and her colleagues made. Is it not a little bit cheeky of her to make some of the points and claims she is making today?

[Helen Morgan]

I am pleased that the hon. Gentleman’s hospital is being dealt with, but I am sure that the residents of Torbay will not feel the benefit of that. I am slightly surprised that he thinks that the decade since the Liberal Democrats were in power has had no impact whatsoever. I did address the point that when a party comes into government and has to clear up the appalling mess left by the previous Government, there are difficult choices to be made. His party knows that. Labour Members, for example, have voted to retain the two-child benefit cap and keep a quarter of a million children in poverty—something that no one in my party has ever voted for.

The last time I opened a Liberal Democrat Opposition day debate was in October, and the topic was primary care. I explained how the Government’s failure to invest in primary care was a false economy that increased pressures and costs in the critical parts of the system. The management of our hospital buildings displays that same false economy. Just as spending money on critical care instead of prevention and public health is a poor approach to managing a health service, waiting for the roof to collapse is an irresponsible way to manage NHS buildings. As problems are ignored and investment is poorly targeted, it is the patients and the hard-working staff striving to help them who are forced to suffer.

This is not just about the new hospital programme. Across the country, there are thousands of GP surgeries that need urgent improvement if they are to provide the care that patients deserve. More than 2,000 hospital buildings across England were built before the foundation of the NHS in 1948, while the state of GP surgeries varies wildly. Many surgeries are simply no longer fit for purpose, having been built in the 1950s. Prescott surgery in my constituency, for example, has long been recognised as somewhere that needs to drastically increase in size because the population of the village has increased drastically itself. Despite the land and the community infrastructure levy funding being available, there is no sign of a new surgery being built. As the delay continues, the costs are rising and the challenge grows for both the council and the integrated care board, which are already under immense pressure to cut their costs.

Instead of pursuing fantasies like the Conservatives or false economies like the Labour party, the Liberal Democrats would invest to save by starting construction now, and ending the epidemic of cancelled operations, closed-off wards and huge sums wasted on emergency repairs. That would save the taxpayer money in the long run and benefit patients much sooner.

[Andy Slaughter]

The hon. Lady is being a little bit unrealistic. I have three world-class hospitals in my constituency: Charing Cross, Hammersmith and St Mary’s Paddington. The repair bill is £874 million, but the rebuild or new build cost would be £4 billion. Yes, we are refurbishing parts of Charing Cross and putting a lot of investment into preparing for that work, but the idea that suddenly the hon. Lady is going to come up with tens, if not hundreds, of billions of pounds is unrealistic, is it not?

[Helen Morgan]

The plan that we have put forward involves £10 billion over 10 years, and I will come to that in a moment. The real issue is that we cannot pick one hospital and say that it is indicative of an NHS that is being dealt with appropriately. Hospitals across the country are falling apart. For example, Stepping Hill, in the constituency of my hon. Friend the Member for Cheadle (Mr Morrison), is not in the new hospital programme, yet it is falling apart at the seams. We need to address the whole estate fairly urgently.

Our 10-year guaranteed capital investment programme would provide long-term security and fix our crumbling hospitals and creaking GP surgeries. It would provide an extra £10 billion for our crumbling buildings over the next decade, improving outcomes for patients, boosting productivity and cutting day-to-day costs for the NHS. Providing certainty is crucial. As it stands, managers have to raid precious budgets not just to plug leaking pipes, but to plug staffing gaps when winter pressure arrives. That is why we would also end the reactive approach to the annual winter crisis through our winter taskforce. Instead of the average £376 million of emergency funding announced late into the winter each year for the last seven years, our winter taskforce would manage a ringfenced fund of £1.5 billion over the next four years. That would help hospitals to plan their budgets and build resilience in wards, A&E departments, ambulance services and patient discharging.

[Mr Andrew Snowden (Fylde) (Con)]

The hon. Lady is talking about the day-to-day budgets of the NHS, in particular the costs of paying off previous debts. She talked about the work that needed to be done during the coalition years and in the decade and a half since then, in response to interventions from Labour Members. Does she agree that one of the biggest messes that needed to be cleared up then, which is still being felt in NHS budgets, is the disastrous private finance initiatives of the Blair and Brown years?

[Helen Morgan]

There have been successive failures in NHS management that all parties need to hold their hands up for—that is a fair point. We should, though, focus on the task in hand rather than continually going back decades, either to the coalition Government or to the Blair Government before that. That is not helpful to our constituents, who want a solution now.

[Ben Coleman]

On that point, will the hon. Lady give way?

[Helen Morgan]

No. I have been very generous with my time and I am going to make some progress.

We are also campaigning for a review of outdated Government finance rules that prevent NHS trusts from investing the funds that they have raised into their own buildings. Even NHS managers struggle to access common-sense investment in their facilities due to overly complex rules and glacial processes. Trusts are prevented from using unspent funds on improving their buildings. We need root-and-branch reform, combined with our 10-year programme of investment, to bring our local health facilities up to scratch.

In conclusion, the recent history of the NHS is one of short-term decision making and of the failure of successive Governments to grasp the nettle of long-term sustained investment in the things that matter: hospital buildings, GP services, dentistry, pharmacy and, crucially, the unspoken crisis of social care. The outcome is an organisation that is spending millions of pounds to go backwards. It truly is a false economy.

This Government have spoken warmly of the need to reform the NHS and improve productivity, and we support them in that, but we cannot expect to retain staff and provide high-quality care when so many doctors and nurses are negotiating leaking roofs and sewage backing up on the wards. Dealing with the new hospital programme is a matter of urgency, and I urge the Secretary of State to, at long last, grasp the nettle.

[Mr Speaker]

I call Stephen Kinnock—is it?—to move the amendment; I have a different name in front of me.

--- Later in debate ---

[Mark Ferguson]

If we want the tone to be constructive, we should be constructive about the fact that Labour is going to be building hospitals, when no hospitals were constructed over the last five years. The reality is very clear: hospitals do not simply appear; we cannot wish a hospital into existence. They require two things: money and time. If we wish that there were more new hospitals in this country, we should go back in time to 10 to 15 years ago. That would have been a fantastic time, when borrowing was much cheaper than it is today, to have invested in hospitals in all our communities. Unfortunately, the cancellation of the building schools for the future project was basically the first act of the coalition Government, and there was a lack of investment in schools and hospitals. As the shadow spokesperson the hon. Member for North Shropshire (Helen Morgan) has said today, we are cleaning up the mess that has been left. That was the characterisation of the early 2010s, but it is very much more realistic today. The shadow spokesperson accused the Government of a lack of imagination. Well, there has been no lack of imagination here; there has been magical thinking from the Liberal Democrats, who apparently believe that a taskforce will generate the billions of pounds necessary to build hospitals immediately.

[Helen Morgan]

Will the hon. Gentleman give way?

[Mark Ferguson]

I am keen to make progress.

I have repeatedly made this point to Conservative Members, who I do not feel are taking the advice, but I will repeat it to the Liberal Democrats, who I equally do not think will do so. I have a huge amount of experience in opposition—a lot of us on the Government Benches have a lot more experience of it than we ever wanted. If we are really serious about what this country needs, we cannot just say that we want to have hospitals now and expect them to be delivered if we simultaneously oppose revenue-generating measures in the Budget. I am afraid that what this motion is about, which has been revealed by many of the speeches, is opportunism.

We all want more investment in the NHS and that is what this Government are delivering. A great point was made by my hon. Friend the Member for Calder Valley (Josh Fenton-Glynn) when he said that it is not simply a matter of buildings, but a matter of people too. The best maternity facility in the country is in my constituency at the Queen Elizabeth maternity hospital, yet it is in a very old building. I want a new building for that maternity hospital. I want far better resources for the staff. I hope that it will come in time, but they are doing a fantastic job with what we have got. We need to support those in the NHS rather than knocking them down.

--- Later in debate ---

[Sean Woodcock (Banbury) (Lab)]

For years, my constituents in Banbury have lived with the consequences of a health system that has been allowed to fall apart bit by bit, service by service. Our mental health services, especially for children and adolescents, are severely under-resourced. Families are waiting far too long for help, even in the most serious cases. Our maternity unit in Banbury was downgraded under the Conservatives, so those having complex or emergency births have to travel to Oxford or Warwick, with all the risk that that brings, especially when delays are caused by our inadequate transport infrastructure. There is no overnight surgery or day-care surgery available locally, and patients fall through the cracks because of poorly co-ordinated services between Oxfordshire, Warwickshire and Northamptonshire.

Under the Conservatives, and with the support of the Liberal Democrats in coalition, money was diverted away from vital health services into a disastrous and unnecessary reorganisation of our national health service. The result is what we are seeing now: fragmented care, overstretched services and communities like Banbury being left behind. My constituents are not going to be pleased by Governments making promises that they cannot keep and when they have no realistic plan or funds to deliver them.

[Helen Morgan]

Multiple Government Members have made that point, but surely they can see that promising to build a hospital in a decade’s time when they may not be in power is a meaningless promise.

[Sean Woodcock]

I suggest that our decade of national renewal will ensure that the hospitals that we have promised will be delivered. I am confident about that because things are changing. The new hospital programme has been put back on a firm footing, with every project backed by real funding and a realistic plan, which is equally important.

Crucially, this Government are not stopping there. Labour’s 10-year health plan is about improving how the whole system works with patients. That means better co-ordination between GPs, hospitals, mental health services and social care, and ensuring that wherever people live, even if that is on the border between counties, which is an issue close to the hearts of people in my constituents, they are not passed from one part of the system to another without support. It also means doing more locally, with more care available close to home, so fewer people have to travel longer distances to get basic treatment, and earlier invention, so that problems are picked up before they become emergencies.

We have already seen progress. We have cut waiting lists by over 200,000, delivered over 3 million extra appointments, recruited more GPs and invested £26 million in mental health crisis centres to alleviate the pressures on A&E services. Some £2 billion will be spent on technology and digital improvements to increase productivity and ensure patients are seen faster. We are starting to turn things around and doing so in a way that puts patients first, without making undeliverable, unrealistic promises that damage trust in politics and the power of politics under our democratic system. For too long, people in Banbury have been left wondering if their NHS would be there when they needed it. After 14 years, they can see that help is finally on the way. With this Labour Government, things are changing practically and with purpose.

Access to Dentistry: Somerset

Helen Morgan Excerpts

Tuesday 1st April 2025 Westminster Hall

[Anna Sabine]

Yes. That is one of the things I have talked about extensively—or rather I have been talked at extensively by my dentist friend about the way in which we manage staff and who does which bits of work in dentistry. It is really important that the Government engage with the British Dental Association about that to understand some of the complexity of how the contracts are working at the moment and what could be improved.

If we do not deal with people’s dental pain, we get more pressure on the NHS in the long term: cancers go undiagnosed, and people are forced to use 111 or A&E. It cannot make sense that people have to use 111 to organise their dentistry if they do not have an NHS dentist. People are simply being pushed around the system instead of being treated and instead of illness being prevented. I absolutely understand and appreciate the financial situation the Government inherited from the Conservative Administration, but I am concerned that not enough is happening fast enough on dentistry.

[Helen Morgan (North Shropshire) (LD)]

The previous Government tried to tackle this problem by offering golden hellos to dentists in rural areas to encourage the uptake of NHS dentistry, but in reality that did not work. What we really need the new Government to do is to advance at pace with renegotiating the dental contract. Does my hon. Friend agree that if the new Government can get on with that rapidly, we might see an improvement in rural areas and, indeed, the whole UK?

[Anna Sabine]

I do agree. Golden hellos are all very well, but the challenge—as I hear from dentists in my constituency—is that once dentists leave NHS dentistry and go into the private sector, which more and more are doing, nothing will ever get them back again. That is a loss that we do not recover from.

NHS Pensions

Helen Morgan Excerpts

Tuesday 1st April 2025 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

The delays will be deeply worrying and will make financial planning very difficult for those affected, all of whom are people who have dedicated their working lives to supporting the NHS and tirelessly saving lives. NHS workers and their families are being left in the dark by Government delays and may as a result miss out on using their full allowances, which is unacceptable—they deserve better.

The revised delivery plan prioritises members based on their likelihood of facing financial detriment, so clearly some financial detriment is expected for those who are impacted. Can the Minister estimate what the likely financial detriment is of missing the statutory deadline, or how much compensation, as she just mentioned, is likely to be paid? Can she tell us why the NHS Business Services Authority has failed to meet the deadlines? In response to a written question from my hon. Friend the Member for St Albans (Daisy Cooper), the Minister said that there are 112 people working on it. Will she confirm whether that is likely to be sufficient to ensure that future deadlines are met?

[Karin Smyth]

I thank the hon. Lady for her question. I do not have to hand the exact number of people working on this, but I will make sure that I respond to her on that point in writing. We are ensuring that individuals do not face detriment as a result of these delays. The NHS cost claim back compensation scheme provides resources for direct financial losses incurred by the NHS pension scheme members impacted by the McCloud remedy, including professional service fees and certain HMRC interest charges that may arise, as I outlined in my statement. HMRC has also confirmed that self-assessment late filing penalties will be waived on appeal in certain circumstances where a member receives a delayed pension savings statement as a consequence of the implementation of the McCloud remedy.

Tobacco and Vapes Bill

Helen Morgan Excerpts

Report stage
Wednesday 26th March 2025 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

I thank the Minister for her opening remarks and add my broad support for the improvements that the Government have made to the Bill. I will restrict my comments mainly to amendments 1 and 2, which have been tabled in my name and the names of my hon. Friends the Members for Winchester (Dr Chambers), for Eastleigh (Liz Jarvis), for Chichester (Jess Brown-Fuller) and for Mid Sussex (Alison Bennett). I will also comment on new clause 1, tabled by my hon. Friend the Member for Bath (Wera Hobhouse), to which I have added my name.

Amendments 1 and 2 would direct the moneys raised from fixed penalty notices to public health initiatives chosen by the relevant local authority. The Liberal Democrats agree with the Secretary of State and the Government that prevention is better than sickness and cure, and that public health initiatives are crucial in making those key shifts in healthcare that we all hope to achieve. The Secretary of State hopes to create a smokefree generation for those born after 1 January 2009, but there will be existing smokers who may well wish to stop, and who may need help from a public health initiative or a smoking cessation programme to do so. The Conservatives cut public health budgets by a quarter since 2015, meaning that fewer people have had help to quit. That is not what anybody hopes to achieve through this legislation or, more broadly, the reforms to the NHS.

Research by University College London showed that in parts of England, smoking rates have begun to rise again, and they have been flatlining as a whole since 2020. Between 2020 and 2024, the rates rose by 10% in southern England and fell by 9.7% in the north. Overall, an estimated 7.5 million adults in England are smokers. UCL concluded that the disparity between north and south reflected the concentration of dedicated tobacco control programmes in northern regions and their positive impact, and their relative absence in the south. As the shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson), mentioned, there is also evidence of significant black market activity in the United Kingdom. Cessation activities have therefore become even more important to deprive the criminal gangs involved of funds, and to ensure that people are free of their grip. Given the impact of public health initiatives, I sincerely urge the Government to accept Liberal Democrat amendment 1, and consequential amendment 2, which are in line with the Government’s objectives, and would improve health and save taxpayers money in the long run.

Amendment 84, which is also in my name, is very similar to the Opposition’s amendment 85. It would restrict the ability of the Secretary of State to unreasonably designate a place as a smokefree area. If they do not mind me saying so, the Conservatives have been a bit sloppy in drafting their amendment, because they have managed to remove protections in existing law for areas where there is a significant risk of second-hand smoke in smokefree areas. The Liberal Democrats’ amendment 84 has an added safeguard: if the chief scientific officer—that is not easy for me to say—advises that there is a significant risk of second-hand smoke, an area can be designated as smokefree. The amendment also retains mention of the areas that the Secretary of State has indicated that he will designate as smokefree, including NHS premises, schools, educational establishments and children’s playgrounds.

The Secretary of State has indicated that he will not designate other areas as smokefree, particularly if it would have a detrimental impact on our already struggling hospitality industry and much-loved village pubs. We take him at his word on that commitment, but I hope that the Minister can imagine a future in which a different Secretary of State is less inclined to honour a promise made by someone else at the Dispatch Box. It is right and in good order that in that scenario, Parliament should get a vote on the change of heart. I urge the Government to consider this amendment carefully and ensure that the legislation matches the promises made at the Dispatch Box.

New clause 1, which I have also added my name to, would require the Secretary of State to review and report back on the presence of contaminated vapes, and to find ways to reduce their prevalence. My hon. Friend the Member for Bath has campaigned on this issue following findings by the University of Bath that one in six vapes in English schools contained the drug Spice, which can have serious side effects in children, including cardiac arrest. It seems reasonable that the Department of Health and Social Care and the Secretary of State should try to find a way of addressing that issue.

I intend to push amendments 1 and 2 to a vote to ensure that there is additional funding for public health measures. I very much hope that hon. and right hon. Members will support me in this common-sense move to improve public health.

[Mary Kelly Foy (City of Durham) (Lab)]

I begin by declaring an interest as the co-chair of the all-party parliamentary group on smoking and health. I will speak to my amendments and one or two others.

The Tobacco and Vapes Bill is world-leading health legislation that will create the first smokefree generation, protecting children and young people from the harms of smoking. In the City of Durham alone, some 5,500 children start smoking each year. Most of them will go on to wish that they had never started. This Bill will end that. It will stop the start and ensure that every child has a smokefree future. Recent data from UCL has shown that the rates of smoking are falling fastest in the north-east. This can at least partly be attributed to hard work and amazing regional programmes such as Fresh, which works so hard to tackle inequalities in our region. The same data also shows that progress is not guaranteed; in some areas, smoking rates appear to be increasing. The case for action is clear.

New clause 13, in my name, would put a duty on the Secretary of State to publish a road map to a smokefree country every five years. It was a Labour Government who introduced the first-ever smoking strategy in 1998, “Smoking Kills”. It is 2025, and smoking still kills. This world-leading Bill is to be celebrated for many reasons, but the rising age of sale will not impact the 6 million people who are currently smoking in the UK. Smoking is not spread equally across our society; the most affluent 10% are set to become smokefree this year. However, at the current rate, the most deprived will not achieve that until 2050. It is vital that the Government ensure that no one is left behind as we create a smokefree future. Having a clear plan for achieving that, and targets for reducing smoking not only for the whole population, but for pregnant women, those struggling with their mental health and those in occupations with high rates of smoking, will save lives. Will the Minister meet the all-party parliamentary group following the publication of our report to discuss how we can turbocharge reductions in smoking and create the smokefree generation?

New clause 19, tabled by the Conservatives, would require the Secretary of State to publish reports on the illicit market. Let us be clear that His Majesty’s Revenue and Customs already publishes annual data with a detailed analysis of the illicit market, so it is difficult to see what the Department of Health and Social Care could do in addition. There are no additional data sources available that would yield any different results.

Finally, amendments 82 and 83 would remove the exemption for performers. Since 2007, it has been against the law to smoke inside. However, that does not apply to actors smoking in performances for artistic reasons. There is a play on in London’s west end that tells the story of the American oil lobbyist and master strategist Don Pearlman. Don Pearlman was a heavy smoker who died from complications arising from lung cancer. The actor playing the lead role smokes on stage. The exemption should be removed, because actors deserve to have their health protected at work as much as everyone else. Audiences and other actors also deserve to be protected from second-hand smoke. Performances at the National Theatre already require that smoking in performances be substituted for vaping or other alternatives. There is no reason why all performances should not follow suit.

Amendments 85 and 86 deal with smokefree extensions. I know that there will be further consultation and debate on the regulations creating extensions to smokefree places and vape-free areas, but can the Minister confirm that there will be exemptions if it is shown that the use of vapes in certain settings aids smoking cessation efforts? I am thinking of, for example, mental health settings. The Mental Health and Smoking Partnership has pointed out that vapes are a valuable tool in such settings to help patients quit. Will the Minister undertake to visit a mental health trust to hear directly about people’s experiences? It is vital that we all work with trusts to provide clear guidance on how to navigate these changes. Particular attention must be paid to how the policies in the Bill, and those that will come into effect after it, such as the disposable vapes ban in June, will interact with each other.

Today’s funding announcement is welcome, but we have gone down to the wire, given that the funding was due to end at the end of this month. Can we be reassured that, following the spending review, services can expect consistent, long-term funding that will allow them to plan their activities and hire staff on longer contracts?

The Bill presents us with a historic opportunity to transform public health in this country, and, after working tirelessly on it for more than a decade, I am proud to support it. However, we must remain vigilant to ensure that no one is left behind. All aspects of the Bill, from the smoking cessation measures to protections for workers in the arts, must be fully realised if we are to create a truly smokefree generation.

Oral Answers to Questions

Helen Morgan Excerpts

Tuesday 25th March 2025 Commons Chamber

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

Shrewsbury and Telford hospital trust has some of the longest waiting lists in the country for cancer and A&E, among other areas. It has been receiving national mandated support from NHS England’s recovery support programme. NHS England also provides support to hospital trusts that are struggling with excessive waiting lists through its Getting It Right First Time programme. Given the announcement to abolish NHS England, will the Secretary of State reassure my constituents that there will be continued support for hospital trusts such as Shrewsbury and Telford with unacceptable waiting times, and a clear pathway to improvements for patients who deserve better?

[Wes Streeting]

Yes is the short answer. Removing the duplication, waste and efficiency that came with having two head offices for the NHS will lead to better, more effective and streamlined decision making, but that will not in any way detract from the support that the hon. Member describes. In fact, we should see more support and, crucially, more investment going to the frontline as a result of the savings, efficiencies and improvements that we are making.

--- Later in debate ---

[Mr Speaker]

We are not going to get everyone in unless we pick up the pace. The Liberal Democrat spokesperson will set a good example.

[Helen Morgan (North Shropshire) (LD)]

In last night’s “Panorama” programme, the Secretary of State was reported to have said that he did not need to wait for a review to put more money into social care, which we agree with. If that is the case, will he explain why the Casey commission will take three years, and will he instead commit to getting it done this year in order to fix the social care crisis straightaway?

[Wes Streeting]

Phase 1 of the Casey commission reports next year and the final Casey report is due by 2028, but the Chancellor has already announced an increase in funding for social care in the Budget, through means that the hon. Lady’s party regrettably seems to oppose.

Ambulance Response Times

Helen Morgan Excerpts

Thursday 6th March 2025 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve with you in the Chair, Ms Jardine. I thank my hon. Friend the Member for Glastonbury and Somerton (Sarah Dyke) for securing this important debate and for opening it with, as usual, a thoughtful and well-researched contribution.

It is no surprise that Members have largely been in agreement in this debate, and they have made useful contributions, so I will quickly run through them. The hon. Member for Ilford South (Jas Athwal) importantly highlighted the issue of burnout and the impact of the current situation on hard-working staff in the ambulance service, and the hon. Member for West Suffolk (Nick Timothy) highlighted the huge regional variations and the inequality of service for people who live in very rural areas.

The hon. Member for Redditch (Chris Bloore) told a story�which would be familiar to people in Shropshire�of long handover delays; my hon. Friend the Member for South Devon (Caroline Voaden) mentioned the importance of dealing with stroke patients and seeing them quickly; and the hon. Member for Wolverhampton West (Warinder Juss), with whom my constituents and I share the West Midlands Ambulance Service, highlighted some of our concerns with that service as a whole.

I was first elected in the North Shropshire by-election back in December 2021. All that time ago, when my colleagues and I were out canvassing, it was extremely apparent that ambulance service delays were the No. 1 issue for my constituents. Every canvassing session we did, somebody heard an absolutely heartbreaking story of an ambulance delay that had led to a much worse outcome for a loved one, or possibly even a death. In all honesty, it was a shocking campaigning issue to have to focus on.

Almost a year later, after being elected, I completed a shift with West Midlands Ambulance Service in Shropshire, and I was blown away by the professionalism, dedication and hard work of the ambulance crew. But suffice it to say, the delays were still as appalling as they had been a year before.

Since then, there has been huge political turmoil, and that has not helped the situation. There have been four Prime Ministers, six Secretaries of State for Health and Social Care, and two Governments, and I am afraid to say we are still not seeing the improvement that we need. This winter, handover and waiting times reached the point where in some ambulance services people suffering heart attacks were at times advised to drive themselves to hospital. That is an unacceptable situation.

The most recent available data for my local ambulance service in Shropshire�the rural element of the West Midlands Ambulance Service�goes up to December 2024, and it still paints a stark picture of the distressing reality facing my constituents and people across Shropshire. The mean waiting time for category 1 callouts was 12 minutes 19 seconds, while the target is seven minutes. For category 2 callouts, the mean waiting time was 50 minutes and 36 seconds, while the target is 18 minutes. Those categories include callouts to people suffering from heart attacks and suspected strokes. For category 3 callouts, the mean waiting time was well over 200 minutes, and the target is an hour. After a long campaign, �21 million was secured to boost emergency care, and there has been improvement, but response times are still totally unacceptable.

At times, as many as 16 ambulances have been queuing outside the Shrewsbury and Telford emergency departments that serve my constituents. More than one in three ambulances have to wait for more than an hour to hand over a patient, and the longest wait was an astonishing 17 hours. Even this week, as we approach the spring, a constituent told me they had stopped to help an elderly lady laying on a cold pavement with a suspected stroke and had had to wait nearly an hour and a half for an ambulance or first responder to arrive. All the while, the lady�s breath become more and more shallow. This crisis is real, and it has not significantly improved.

Let us look at the national picture. The Darzi report found that each day in 2024 around 800 working days were lost to handover delays. However we cut that�14,000 paramedics a year; 112 years�it is just not acceptable. It is no surprise that people have lost faith in emergency health services as a result of the last Government�s appalling neglect of the NHS. The paramedics, nurses and doctors in our emergency departments go above and beyond, but they are stretched to breaking point and are unfortunately starting to leave the service because of burnout. We are campaigning to end excessive handover delays by increasing the number of staffed hospital beds and by tackling the impact of degrading corridor care.

Let me focus for a moment on social care. Crucially, A&E delays are often caused by an inability to admit patients because thousands of people are stuck in hospital every day when they would be better cared for elsewhere. Bed occupancy is well above safe levels in hospitals, and one in seven hospital beds are occupied by somebody who would be better cared for either in a care home or in their own home. Meanwhile, local authorities such as Shropshire are spending as much as 80% of their budget on social care. They are at risk of issuing section 114 notices as they are unable to cope any longer.

It is really important that we get on with the cross-party talks on social care and with the Casey review. We in the Liberal Democrat party absolutely welcome that, but we urge the Government to speed up the timetable and crack on with it as soon as possible, because 2028 is too late for a long-term solution for social care. The cross-party talks that fell through last week need to be reinstated. I urge the Minister to encourage the Secretary of State to do that as soon as possible.

Let us focus for a moment on the rural problem. Imagine an ideal scenario in which the issue of handover delays has been resolved, the urgent and emergency care plan has been successfully implemented and the 10-year plan has sorted out other issues across the NHS. For those who live near Oswestry, Whitchurch or Market Drayton in my constituency, the nearest community ambulance station has closed and the nearest station or hospital is well over 20 minutes away�that is, if the traffic is clear. Otherwise, if the response time targets for category 1 or 2 calls is to be met, they are reliant on a spare ambulance roaming free in the community, waiting for that call to come in. That is unrealistic. We would expect and hope that, in between calls, paramedics would go and have a cup of tea and a sit down, to decompress from some of the awful things they have seen that day, if they do not have a patient to go to immediately. Hopefully, they go back to the ambulance station in between call-outs.

The implementation of this centralised model across the country is detrimental to the people who live a long way from an ambulance station. It may well be efficient in urban areas, but it certainly is not working in rural ones. I hope the Minister will commit to reviewing the service that is received in rural places. There are thousands of people in large market towns. For example, Oswestry has nearly 8,000 residents, Market Drayton has more than 12,000 and Whitchurch has nearly 10,000. These people expect to receive an ambulance within the target time. I must urge the Minister to commit to looking at ambulance station provision in those areas. I also repeat my colleagues� calls for the Government to publish accessible, localised reports on response times and to create an emergency fund to reverse the closures of community ambulance stations that have already taken place.

The Midlands Air Ambulance Charity does fantastic work across the west midlands and is one of the busiest air ambulance charities in the country. It does not have an NHS contract; it is entirely reliant on the contributions of people living locally. I wonder whether the Minister might consider putting air ambulance services on a statutory footing, because we are so dependent on them, particularly when specialist hospitals might be a long way away and air ambulance crews supply specialist support to stabilise patients where they are found, at the roadside or in their home.

The situation is unacceptable, and I look forward to seeing the urgent and emergency care plan, which I hope it will consider the needs of rural areas. I must urge the Minister to look at social care, because that is one of the key things we need to do to fix the crisis in the NHS.

[Christine Jardine (in the Chair)]

I call the Opposition spokesperson.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Ashley Dalton)]

It is a pleasure to serve under your chairship, Ms Jardine. I am grateful to the hon. Member for Glastonbury and Somerton (Sarah Dyke) for securing the debate. I thank all the hon. Members who have taken part, including my hon. Friends the Members for Redditch (Chris Bloore), for Ilford South (Jas Athwal) and for Wolverhampton West (Warinder Juss), and the hon. Members for West Suffolk (Nick Timothy) and for South Devon (Caroline Voaden), as well as the Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), and the shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson). I will endeavour to deal with as many issues and questions as I can. If I do miss any, will hon. Members please get in touch with me afterwards, and I will make sure they are picked up?

The hon. Member for West Suffolk mentioned the commitment made by the Secretary of State to meet him and visit his constituency, and I will ensure that that issue is raised. The parliamentary private secretary, my hon. Friend the Member for Ealing Southall (Deirdre Costigan), is here, and I am sure she will be happy to pursue a response. We will also do what we can to get a response from the Treasury for the shadow Minister.

The hon. Member for Glastonbury and Somerton and other hon. Members rightly raised constituents� experiences of long waits for an ambulance response. I put on record my deepest sympathies for the hon. Lady�s constituent Jim on the loss of his wife. As the Secretary of State has made clear, this is not the level of care that staff want for their patients, and it is not the level of care that this Government will ever accept for patients.

Lord Darzi investigated the issues facing the NHS, and his report was honest about the challenges facing the health service. Urgent and emergency care performance remains a long way from a resilient position and there is continued high demand for A&E and ambulance services, with ongoing seasonal winter pressures. For example, in December the London Ambulance Service recorded more than 121,000 incidents, the highest on record for the service. Improvement needs to happen across the urgent and emergency care pathway and through the expansion of neighbourhood health services.

Nationally, congested emergency departments reduce the productivity of ambulance services, a matter that I think almost all hon. Members raised. A huge amount of time is lost to ambulance handover delays because there is no space for patients. Having crews tied up waiting outside hospitals exacerbates poor ambulance response times. We have also seen the continued normalisation of corridor care. We will never accept patients being treated in corridors; it is unsafe and undignified. We are investing an extra �26 billion to begin turning around the NHS, and we will do all we can, as fast as we can, to consign corridor care to the history books.

Lord Darzi�s investigation into NHS performance highlighted wide variation across different parts of the country. The situation is unfair to patients and goes against the principle of a universal service. I acknowledge that there can be challenges in rural areas, where longer distances often mean that patients wait much longer for ambulances than in urban areas. I often find myself in this place with the hon. Member for Glastonbury and Somerton, and we both talk about the experience in our rural constituencies. I assure her that that is on my agenda. As she says, ambulance response times for the south-west and some other areas highlight the rurality differential.

In January, the South Western Ambulance Service�s average response for category 2 emergency incidents, which include strokes and heart attacks, was 51 minutes and 45 seconds, which is 26 minutes longer than the best-performing ambulance trust in England. The NHS constitutional standard for category 2 average response times is 18 minutes, and no ambulance trust in England has met that target since the pandemic. This cannot go on. Prioritising patient safety will always be the Government�s and the NHS�s main focus. We are committed to getting A&E waiting times and ambulance response times back to NHS constitutional standards.

The independent review of ambulance trust culture was published in February 2024. Its recommendations included addressing workforce pressures. NHS England is working closely with ambulance trusts to implement those recommendations. We have made some significant investments in the ambulance workforce, and the number of NHS ambulance staff has grown by 9% compared with last year, but we recognise that there is much more to do on retention and wellbeing for ambulance staff. That is something that we will continue to work on.

We cannot keep plugging the gaps. There is a need for more fundamental reform. We have been clear that there are no quick fixes and that to turn things around will take investment and reform. We have provided the highest real-terms capital budget for the NHS since before 2010. We announced an extra �22.6 billion in day-to-day health spending and an additional �3.1 billion further capital investment over two years. That extra investment will be accompanied by fundamental reform, of which ambulance services.

In January, the Government published �Road to recovery: the government�s 2025 mandate to NHS England�, which clearly sets out delivery instructions for the NHS through the prioritisation of the five key objectives aimed at driving reform in the NHS. Improving A&E and ambulance service performance was also one of a small number of prioritised objectives in the Government�s mandate to NHS England to specifically start to address the current challenges facing urgent and emergency care.

In turn, NHS England�s planning guidance for this year includes the target to improve average category 2 ambulance response times to no more than 30 minutes across 2025-26. The guidance also sets out a range of key actions for the NHS to deliver in the same timeframe, focused on reducing avoidable ambulance dispatches and conveyances and reducing hospital handover delays.

[Helen Morgan]

Will the Minister pick up on the point about social care? Inability to admit to hospital is a key point in the handover delay problem, and the social care talks are a key measure in solving it.

[Ashley Dalton]

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

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

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

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

Department of Health and Social Care

Helen Morgan Excerpts

Wednesday 5th March 2025 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

I thank the Chair of the Public Accounts Committee, the hon. Member for North Cotswolds (Sir Geoffrey Clifton-Brown), for securing this debate and for his excellent opening speech.

We all know that we have reached a crisis point across the NHS and care sectors, with more patients than ever waiting for treatment. That is affecting not just those in need of care and treatment, but those who work tirelessly across the NHS and care sectors, who are feeling the full brunt of the crisis. The Conservatives have a legacy of hours-long waits for ambulances, treatment in crowded hospital corridors—captured in horrifying detail by the “Dispatches” documentary, which looked into the hospital that serves my constituents in North Shropshire—and communities grinding to a halt under the weight of all sorts of waiting lists and backlogs. We urgently need to move forward.

The Secretary of State has repeatedly outlined the need to shift from treatment to prevention and from hospital to community, and the Liberal Democrats absolutely support him in that endeavour—indeed, we called for many measures that would achieve that shift in our own manifesto. Stronger primary care and community services were the strong recommendations of Lord Darzi’s report, which was commissioned by the Secretary of State and has been broadly welcomed.

There has been a great deal of consensus across the House today that we need to take those measures, but I fear that these estimates paint a picture of an NHS that continues to pour money into the previous, failing model in which capital budgets are drained to pay for day-to-day services and a huge proportion of increased spending goes on NHS staffing, while community care and primary care providers wrestle with the huge increase in employer national insurance contributions.

When that is combined with the decision to scrap targets on mental health and community services for the sake of prioritising targets on elective care, we must ask: when will the stated objectives of the Secretary of State really be matched by actions? The latest estimates are an indictment of the broken state of the NHS after years of Conservative neglect, but we urge the Government to go further and faster to address the failure.

[Ben Coleman]

Having heard the hon. Lady’s comments and the comments of those on the Conservative Benches, may I share with her my confusion? She seems surprised that she has not heard the full solution of what this Government are going to do with the NHS, when it is quite clear that there will be the three shifts, a 10-year plan and a huge amount of reform coming down the line. As that seems to have escaped the Opposition’s attention, has it also escaped hers?

[Helen Morgan]

There is clearly a point in the debate at which we need to urge the Government to go further and faster. As a constructive Opposition, that is exactly what we will do.

Primary care providers are on their knees, and I am afraid to say that that has been made worse by the national insurance hike announced in the Budget. They cannot meet demand for local appointments as things stand, and in many cases the constraining factor is the estate in which they operate. Prescott surgery in Baschurch in North Shropshire wants to provide additional services to the community and keep people away from hospital, but the surgery is physically not big enough. A local developer has provided land for a new surgery, and the local council has community infrastructure levy funding for that building, but it cannot be done because the ICB will not pay the notional rent, which everybody has agreed to forfeit. It is crazy. I hope that the Minister can commit to finding some kind of easy solution to that kind of nonsensical situation that we find ourselves in.

[Nesil Caliskan]

On the point about the inability of ICBs sometimes to get things going, in my constituency it has taken the ICB nine months to procure something very similar. Does the hon. Lady agree that it is about not just their ability to pay, but their procurement processes?

[Helen Morgan]

I fundamentally agree. There are many such instances, and I chose that one because I spoke to the providers there recently.

I will come on to community pharmacy, because I am particularly concerned about pharmacies, which are a key pillar of care in the community, dispensing prescriptions and providing over-the-counter medicines and advice. Critically, they also provide Pharmacy First, but they are closing at an alarming rate. Analysis by the National Pharmacy Association predicts that another 1,000 pharmacies will close—900 of them by the end of 2027—if the current rate of closures continues. That is because of a 40% real-terms cut in their funding since 2015.

In fact, community pharmacies are essentially subsidising the NHS by making a loss on many of the prescription drugs that they dispense. In a few weeks’ time, in April, they will be clobbered by not only the NICs hike, but the increase in business rates, which will affect high street retailers. Shamefully, they have not even had their funding rates for the current financial year confirmed—the one that ends in three weeks’ time.

Pharmacy First, the flagship plan to move care into the community, has not had its funding confirmed beyond the first week of April this year, which is in just a few weeks’ time, according to the National Pharmacy Association. In her remarks, will the Minister confirm the future of Pharmacy First? Is there a funded plan to deliver that service? What steps are being taken to keep our community pharmacies in business? If we want to see care in the community, it is essential that we support them.

I want to mention dentistry. In Shropshire, Telford and Wrekin, the number of NHS dentists fell by 12.3% from 2019-20 to 2023-24. Many of my constituents cannot access a dentist, and the Government have committed to improving the situation, so can the Minister confirm when the negotiations on the new dental contract will begin?

The crisis that the social care system faces is daunting, not least because of the additional national insurance hike that will take place in a couple of weeks’ time. Last week, caring organisations launched an unprecedented day of action, with thousands of people marching on Westminster to highlight the precarious state of the organisations that provide care. The Darzi review found that people waiting to access social care account for 13% of NHS hospital beds. We all understand the urgency of tackling social care, but the cross-party talks collapsed last week—they have not started. There is no date for a new meeting, and there are no published terms of reference. We think that 2028 is far too late to resolve this problem, so can the Government urgently reinstate those talks and act now to deal with the social care crisis?

Before I conclude, I will talk about mental health. As Lord Darzi has said,

“There is a fundamental problem in the distribution of resources between mental health and physical health. Mental health accounts for more than 20 per cent of the disease burden but less than 10 per cent of NHS expenditure. This is not new. But the combination of chronic underspending with low productivity results in a treatment gap that affects nearly every family and all communities across the country.”

He is dead right. By April 2024, about 1 million people were on a waiting list for NHS mental health services, of whom 340,000 were children. My casework is full of children who wait months and months for the diagnosis and treatment that they need. The Government have removed the targets for mental health waiting lists; I urge them to reinstate those targets, so that we have parity between mental and physical health in our health service.

I am very conscious of time, so in conclusion, I will just reiterate our asks. Those are to ensure that social care talks start immediately; to deal with the problems with pharmacies; and to make sure that mental health and social care receive parity.

[Madam Deputy Speaker (Judith Cummins)]

I call the shadow Minister.

Maternity Services

Helen Morgan Excerpts

Tuesday 25th February 2025 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve with you in the Chair, Sir Christopher. I thank my hon. Friend the Member for Chichester (Jess Brown-Fuller) for securing this important debate and making such an excellent opening speech, in which she covered most of the ground that we need to cover.

It is important to acknowledge that the vast majority of babies arrive safely, despite the increasing number of complex pregnancies. My own experience of having a baby was 16 years ago, but I am sure that the thousands of women having babies now are having the same experience that I did. The staff of hospital maternity units make you feel simultaneously that you are the most important person ever to have given birth, and that you are the umpteenth person to have done so this week, they know exactly what they are doing and you can relax. I felt like that even when everything went wrong, which is a great testament to the professionalism of the staff at Wycombe general hospital all those years ago.

This is one of many debates on maternity services that I have attended in the last three years. The first followed the issuing of Donna Ockenden’s report on maternity services in Shrewsbury and Telford hospital trust, which serves my constituents, including Kayleigh and Colin Griffiths, who fought alongside Rhiannon Davies and Richard Stanton and others to give a voice to the many families who suffered as a result of the failings at the trust. But that was not the first scandal in NHS maternity services—Morecambe Bay had already been investigated and reported on by Dr Bill Kirkup—and, tragically, it was not the last either. Dr Kirkup has reviewed significant failings at East Kent, and Donna Ockenden is currently investigating a huge number of incidents at Nottingham. We have also heard the concerns of the hon. Members for East Worthing and Shoreham (Tom Rutland) and for Leeds North West (Katie White) about the state of services in Sussex and Leeds. I am sure that Members across the House are concerned that the tragedy at Shrewsbury and Telford will not be the last.

It makes me quite angry to say that that is not a surprise. We have heard that 65% of trusts were rated inadequate or requiring improvement when it comes to safety in maternity services in the latest CQC survey. That is despite the previous Government’s commitments from the Dispatch Box, which I believe were made in good faith, to deal with unsafe staffing levels and bring about cultural change across the country. The lack of action is unacceptable. Donna Ockenden described the Conservative Government as being “asleep at the wheel” when it came to making progress on the 15 immediate and essential actions she recommended for the whole of England in March 2022, despite their having accepted all those actions.

Each of the reviews into these heartbreaking tragedies has found the same recurring themes: poor management of incidents when things go wrong and, critically, a failure to learn from them, which is indicative of defensive management culture and sometimes toxic working arrangements, including a feeling among staff that they do not have the freedom to speak out and, when they do, inadequate protection for whistleblowers; failure to ensure safe and timely assessment at triage; reluctance to acknowledge the need for medicalisation for a C-section when one is in the best interests of the mother; unsuitable estates and a lack of access to equipment, as we heard from my hon. Friend the Member for Epsom and Ewell (Helen Maguire); and, underpinning all these issues, unsafe staffing levels.

That last point is really important, because staff are experiencing burnout. They are leaving the service in high numbers, and are unable to deliver the care that they really want to deliver to mothers at their most vulnerable moment. There are no excuses now—the issues have been identified time and again—but there is evidence that we are going backwards on maternity care. The 2015 national maternity safety ambition to halve rates of stillbirths and neonatal and maternal deaths by 2025 has stalled and is unlikely to be met this year.

There is a shocking disparity of outcomes between different ethnic groups. Black women are more than twice as likely to die than white ones, and other ethnic groups also carry an unacceptably high risk. No one really understands why; there has been no research into it. There are clear links to deprivation, because people in deprived areas also carry a much higher risk, but translation difficulties, certain health conditions and, shamefully, even racism may all play a part in this shocking disparity. The women’s health strategy for England proposed to address these disparities, but it is impossible to point to any measurable progress. Poor maternity care can have a devastating impact on families, and it makes no sense for the taxpayer either. As we have heard, 60% of the value of clinical negligence claims is related to maternity services, and that costs more than £1 billion a year. It makes no sense not to address these issues.

It is important to acknowledge the work of charities such as Sands and Tommy’s and the work of a number of APPGs in this place over the last few years, including the baby loss, maternity, and birth trauma APPGs, all of which I was involved in. They have campaigned tirelessly for safe staffing levels and to improve care across England, and indeed the UK. This debate relates to England because health is a devolved matter, but the whole of the UK must strive to become the safest place in the world to have a baby.

Addressing disparities in obstetric care is essential for a fair society. The immediate and essential actions of the Ockenden report must be implemented at once, because if they are not, more families will face the trauma of a birth injury or worse. The actions included a commitment to safe staffing, and in 2022 the Government made a significant investment in staffing; it is essential that that is continued. The commitments made in the workforce plan must be backed by adequate funding, and include expansion of the wider maternity and neonatal workforce. The UK Government must renew the national maternity ambitions beyond 2025 to include all four nations, and include a clear baseline to measure progress. They must also address this critical issue of health disparities. In her 2022 report into Shrewsbury and Telford hospital trust, Donna Ockenden said:

“The impact of death or serious health complications suffered as a result of maternity care cannot be underestimated. The impact on the lives of families and loved ones is profound and permanent.”

In my first debate on this subject, in March 2022—the day that report was issued—everyone in the Chamber contributing said that the scandal at Shrewsbury and Telford should be the last. It was not. I hope the Minister will today commit to a strategy to ensure that maternity care scandals are ended on the watch of this Government.

Oral Answers to Questions

Helen Morgan Excerpts

Tuesday 11th February 2025 Commons Chamber

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

Last week, the Secretary of State issued a new mandate for the NHS in which a number of mental health targets were dropped. I accept that targets that drive perverse behaviours should be dropped and that some sharpened focus is necessary, but mental health waiting lists are at a record high, huge numbers of people are not at work because of poor mental health, and our young people are being let down badly by CAMHS, not least in my constituency of North Shropshire. Does the Secretary of State accept that mental health targets should be reinstated and that mental health should be treated with equal priority to physical health?

[Stephen Kinnock]

What we know about targets is that if we try to overload a system with too many targets, it causes confusion and ends up with, as the hon. Lady rightly says, perverse outcomes. We are clear that we do not want to have a system based on just making policy by press release, as was the case under the previous Government, putting out press announcements about loads more targets. It all makes for nice front-page headlines, but it does not lead to any serious delivery of the strategy that we need to deliver. I am with her on the point about focus. We are absolutely committed to mental health, as is set out in the planning guidance. It is also one of the priorities in the planning guidance, and we will continue to deliver on that priority.

--- Later in debate ---

[Helen Morgan (North Shropshire) (LD)]

I, too, welcome the new Minister to her place. This morning’s oral health survey revealed that more than one in five five-year-olds in England have experienced dental decay, affecting their ability to smile and socialise, as well as causing pain and distress. Will the Secretary of State guarantee the Government’s commitment to tackling the problem, and back Liberal Democrat calls for an emergency scheme that guarantees dental check-ups for children?

[Wes Streeting]

This is an issue that the Government are prioritising. The hon. Member will be aware of the commitment we made to provide 700,000 urgent dentistry appointments. We are ramping up to deliver on that commitment, as well as to deliver supervised toothbrushing in our schools. Further wider-ranging reform is needed; I am working closely with the Minister for Care to rebuild NHS dentistry, after the rot left in it by the Conservatives.

Accessibility of Radiotherapy

Helen Morgan Excerpts

Tuesday 4th February 2025 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

Thank you very much, Sir John. It is a pleasure to see you in the Chair. I promise that I will not go on at great length, partly because—

[Tim Farron]

Because I did!

[Helen Morgan]

Well, my hon. Friend did go on at great length. He has secured a really important debate for World Cancer Day; it is an honour to speak in it for the Liberal Democrats. He outlined the issues comprehensively; I am not sure that I could improve on what he said. I welcome the Government’s announcement earlier today on the national cancer strategy and I highlight the excellent work of my hon. Friend the Member for Wokingham (Clive Jones), who campaigned for it.

Cancer services in general have declined to an unacceptable level, as I think everyone would agree. I hope that the Government stick to their word on addressing that issue and ensuring that everybody can access the care they need, when they need it and—as my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron) pointed out so eloquently—where they need it.

In the UK, over 100,000 cancer patients receive radiotherapy treatment each year from a specialist workforce of 6,400 professionals. Cancer is one of the most difficult diseases—it is difficult for individuals and it is difficult for their families—and yet the number of patients who have waited over four months to receive cancer treatment has more than doubled since 2020.

Like so many areas of NHS care, the time people have to wait and the quality of care that they receive depends hugely on where they happen to live. That has to change; I hope that the Government will make that one of their urgent missions. People’s chances of surviving should not depend on their postcode.

NHS data shows that the west midlands had over 150,000 radiotherapy attendances in 2022, which is the most recent available data. That is the highest of all regions, yet hospitals such as Shrewsbury and Telford hospital in my constituency have had some of the worst waiting times. In September 2024, at the Shropshire, Telford and Wrekin trust, only just over half of patients requiring radiotherapy met the 62-day treatment standard. The target for treatment is 85%.

It is important to acknowledge that the situation at Shrewsbury and Telford hospital trust is improving—I welcome that—and that it was impacted by the staff shortages that many hon. Members have outlined today. But it is not just about numbers and statistics; it is about the impact on people’s lives. I think my hon. Friend the Member for Wokingham has pointed out the importance of scans, and some of my constituents who are undergoing cancer treatment have waited a long time for scans and say that sometimes they have not had the result of a scan until their next treatment was due. That is due to staffing shortages.

Waiting times are important, but so too are distances, particularly when somebody is poorly and finding it difficult to travel a long way. People in Shropshire are served in Shrewsbury, so I am glad to say that the distance issue is perhaps not as acute as it might be in other rural areas in the country, but the public transport issue remains so. Many people rely on friends and family to drive them to appointments, as there is no other reliable way of getting there and a taxi is simply too expensive for them to consider. For that reason, some will not be accessing the care that they need. Across the country, 3.4 million people live further away than the target of 45 minutes from a radiotherapy centre, so it is important that we address those radiotherapy deserts and ensure that people can access the care that they need.

In addition to the outdated, sparse machines and low morale, we found that 65% of staff felt that they did not have enough machine capacity and 93% felt that workforce numbers were too low. Therefore, in addition to the long distances involved, we must put an end to the problem of people being unable to be treated not just because they live a long way from the equipment, but because the equipment, when it is available, is outdated or because there is nobody to staff it properly and interpret what needs to be done.

My hon. Friend the Member for Westmorland and Lonsdale has said all this before, so I will draw my remarks to a conclusion. The Liberal Democrats would boost cancer survival rates by introducing a guarantee that 100% of patients would start treatment within 62 days of their urgent referral. We need to replace the ageing radiotherapy machines and increase the number of machines, so that no one has to travel too far for treatment. We need to recruit nurses, cancer nurses and the specialist staff required to staff the radiotherapy machines. We would also like to see a cancer survival Bill, requiring the Government to co-ordinate and ensure funding for research into those cancers with the lowest survival rates. I hope the Minister will be making cancer a top priority for the new Government and push to reinstate the UK as a global leader in cancer research and, most importantly, in cancer outcomes.

I welcome the commitment already made to invest £70 million in replacing ancient machines and delivering new ones, but I hope the Minister will consider where that investment is distributed so that we can address the urgent problem of treatment deserts. I hope that he will also consider that this is a spend-to-save issue—radiotherapy treatment is both effective and cost-effective, and a worthwhile investment for the NHS to consider from a financial perspective.

I also want the Minister to commit to introducing a 10-year workforce plan for radiotherapy as part of the national cancer strategy to which the Government are already committed, to ensure that people get the care they need, when they need it, with the appropriately qualified professionals necessary to deliver it.

Finally, we must address the problem of building space. Many of our hospitals, as we all know, are crumbling. Care must be delivered in an appropriate setting, as my hon. Friend the Member for Wokingham has outlined on a number of occasions. In conclusion, we welcome the Government’s steps so far, but I would like to push them to go further.

[Sir John Hayes (in the Chair)]

Thank you, Helen; as you predicted, your speech was pointed and not too long. I now call the shadow Minister.