Medical Training (Prioritisation) Bill

Helen Morgan Excerpts

Committee of the whole House
Tuesday 27th January 2026 Commons Chamber

[The First Deputy Chairman]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

The amendments in my name raise concerns about the Bill’s impact on fairness, transparency and the smooth functioning of the NHS, notwithstanding the Liberal Democrats’ overall support for the Bill.

Clause 7(1) would allow Ministers to change who is eligible for prioritisation through the negative procedure, meaning that such changes could be made unilaterally, without meaningful scrutiny. In practice, that hands the Secretary of State the power to redraw the boundaries of opportunity, and to decide who gets prioritised for medical training places, without Parliament ever having a say. That is unacceptable for a decision that affects people’s lives and careers, as well as the future capability of our health service. While I do not doubt the intentions of the Secretary of State and the Front Bench team, it opens the door to the risk of political whim or prejudice influencing who gets access to career-defining opportunities in the future. That is why the Liberal Democrats have tabled amendments 2 to 5 to reverse this, and to ensure that any changes must be subject to full parliamentary consent.

On the timing of the Bill’s implementation, the Government intend to apply the new prioritisation rules midway through the 2026 specialty recruitment cycle. Let us reflect on what that means in practice. Doctors already working in the NHS have entered this cycle under one set of rules. They have paid for exams, secured visas, arranged travel, uprooted their families and committed themselves to the NHS. To change the rules halfway through the process would not only be potentially destabilising for services, but very unfair to those individuals, many of whom are plugging urgent staffing gaps right now.

We already face real workforce pressures, so the last thing our NHS needs is a wave of dedicated doctors forced out by uncertainty, or pushed to leave the country because the Government moved the goalposts after applications had already begun. For this reason, we believe that the Bill should come into force from 2027. We must protect frontline services and protect the integrity of the applications process. To address the problem directly, we have tabled amendments 6 and 7 to safeguard those already in the 2026 application cycle, ensuring that they are not deprioritised, because that is a simple matter of fairness.

We have also tabled amendments to improve the transparency and long-term impact of the Bill. Across the NHS, we face severe shortages, not just in general practice but in radiology, oncology, mental health services and many other specialities.

[Helen Maguire (Epsom and Ewell) (LD)]

Last year, research by the Royal College of Radiologists found that 76% of English cancer centres had patient safety concerns due to workforce shortages. While we welcome the Government’s recent commitment to ending the postcode lottery of cancer care, does my hon. Friend agree that the Government need to publish an assessment of the Bill’s impact on doctor numbers, broken down by speciality, to ensure that cancer treatment is not delayed because of staff shortages?

[Helen Morgan]

I thank my hon. Friend for her point, which I agree with fully. That is why we have tabled new clause 1. It will require the Government to publish a report on the Bill’s impact on the number of applicants to foundation and speciality training programmes and, crucially, to break that down by speciality. If applications fall as a result of these changes, the Government would be required to assess the impact on the total number of fully qualified doctors entering the NHS. This report would be produced annually after three years, allowing time for a full training cycle to complete. It is a sensible safeguard, one that ensures that we do not inadvertently exacerbate the very workforce shortages that we are trying to address. To return to the core principle that is at stake, we are not opposed to the Bill’s objective. We support the principle of prioritising those who have trained in the UK, but that principle must be implemented fairly, transparently and with proper oversight.

Medical Training (Prioritisation) Bill

Helen Morgan Excerpts

2nd reading
Tuesday 27th January 2026 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

I am pleased to welcome this Bill, broadly. It seeks to prioritise graduates from UK and Irish medical schools for foundation and specialty training places. On this point, the Liberal Democrats support the Government, but we have some concerns about how that will be delivered, and about the real-world consequences for our NHS, patients and the doctors who keep our health service going.

Taxpayers invest around £4 billion every year in training young doctors, yet far too many are left competing for too few posts. In 2025, around 12,000 UK-trained doctors competed with 21,000 international doctors for just 9,500 specialty training positions. Many highly skilled young doctors, who were ready to serve in the NHS, were left without a pathway into specialist practice. That is clearly unfair and unsustainable. It is hardly surprising that so many doctors decide to leave the country altogether and seek opportunities elsewhere, where their training and wellbeing are valued. This is a tragedy for them and a tragedy for patients, so prioritisation is right, fair and long overdue.

However, reorganising a queue does not shorten it or make it move any faster. The reality is clear: the NHS has a deep workforce shortage, with crises in some specialties, and this Bill alone cannot solve it. A detailed long-term workforce plan, which ensures that training provides the skill mix that the NHS needs for the future, is required as soon as possible. I look forward to the Minister confirming when that will be delivered.

Shortly before Christmas, the Government committed to 4,000 additional specialty training places in their negotiations with the British Medical Association, including 1,000 that were brought forward, but following the collapse of those negotiations, it remains unclear whether those places will materialise. Patients cannot wait for certainty, and neither can exhausted staff. Will the Minister confirm those places, and go further by addressing other issues that have prevented doctors from working in the NHS, such as restrictive rotas, workplace violence and inflexible working? Dealing with such issues might prevent doctors who have secured specialty training places from moving abroad once their training is completed, ensuring that taxpayers’ money is not wasted, and that doctors with local, relevant experience remain in the NHS.

I turn to the details of the Bill. We have concerns about clause 7(1), which allows Ministers to change eligibility for prioritisation through the negative procedure. That will enable sweeping changes, without proper parliamentary scrutiny, to who can access training places. Given the scale and sensitivity of the NHS workforce pressures, such decisions must not be made behind closed doors, or at the whim of a future Health Secretary with less desirable motives than the current one. That is why the Liberal Democrats have tabled amendments that would require Parliament to approve any future changes through the positive procedure.

We are also troubled by the Government’s decision to apply the new rules part of the way through the 2026 specialty recruitment cycle. The Bill allows for prioritisation at the offer stage for medical specialty training places in 2026. I would like the Minister to clarify in her closing remarks whether this means that international doctors already working in our NHS—who have paid for exams, secured visas and maybe uprooted their life and their family—will suddenly be pushed to the back of the queue, mid-cycle. These doctors keep our hospitals running today. They entered the system in good faith, and it seems unfair to change the rules midway through the process.

I would also be grateful if, in the Minister’s closing remarks, she outlined the expected impact on NHS service provision if people who are deprioritised during the application process decide to leave en masse. Will she give my constituents in North Shropshire reassurance that patient safety and patient outcomes will not be impacted? The Liberal Democrats would prefer implementation to begin in 2027, at the interview stage; that would protect both fairness and patient safety.

Would the Minister elaborate on the impact of the Bill on universities that offer medical degrees elsewhere in the world? I think we have all been contacted by Queen Mary, University of London; the implications for the university may be serious if graduates, who have always been considered UK graduates, undertaking NHS training, and a UK medical qualification registered by the General Medical Council, suddenly have their expectations changed.

As I have mentioned, retention is just as critical as recruitment, but unfortunately it is outside the scope of this limited Bill. In the year to September 2023, 10.7% of NHS staff—about 154,000 people—left their role. Burnout is rife, morale is low and too many staff are working in buildings that are crumbling around them. We have been contacted by GP trainers who are worried that the doctors they are training plan to leave for Australia or Canada as soon as they qualify. The promised workforce plan must address this problem.

International comparisons lay bare the scale of the problem. England has just 3.2 doctors per 1,000 people, which is well below the OECD and EU average of 3.9. We would need 40,000 more doctors to meet that benchmark. Prioritising UK graduates is sensible, but it will not on its own deliver the workforce that patients urgently need. That is why the Liberal Democrats have tabled an amendment requiring a specialty by specialty workforce assessment. Shortages are acute in general practice, radiology, cancer care, mental health and more, and transparency is essential if training places are to be directed at where the need is greatest.

It is neither right nor remotely sustainable that, at a time when patients struggle to see a GP, qualified GPs are unemployed, yet that is happening now, with vacancy freezes and financial pressure creating an NHS in which shortages sit alongside unemployment. The Government’s decision to raise national insurance has only exacerbated the problem, forcing some practices into lay-offs or closure. In my North Shropshire constituency, several GP practices have told me that they cannot take on additional doctors because they are constrained by the outdated physical space in which they operate. The Liberal Democrats would fund 8,000 more GPs, ensuring that every patient could see a GP within seven days, or 24 hours if the need was urgent, because we cannot fix the NHS without fixing the front door.

NHS staff are the backbone of our health service, and they deserve better working conditions and a fair career path. We will continue fighting for an independent pay review body, for safe and modern buildings, for flexible working from day one, and for practical support, such as reduced parking charges, so that staff are not penalised for simply turning up to care for us. We will always stand up for our NHS and the people who make it work. While we support this Bill, we will push to ensure that its implementation strengthens our health service as much as possible.

Oral Answers to Questions

Helen Morgan Excerpts

Tuesday 13th January 2026 Commons Chamber

[Mr Speaker]

Order. The question is about waiting lists, and I am sorry but we have got to stick to it. [Interruption.] Order. Mr Logan, I was very good in bringing you in, especially with health being devolved, so please let us not change the question before us. Helen Morgan will be a good example.

[Helen Morgan (North Shropshire) (LD)]

I always am, Mr Speaker; thank you very much. Recently, I have heard from Candice, who was interrupted while changing her stoma bag behind a curtain on the emergency ward; Lynne, who waited 17 hours for an ambulance after breaking several ribs; and Sandra, who has bladder cancer and spent 31 hours on a plastic chair in the “fit to sit” area. They all want to share their stories so others do not have to suffer like they did, in pain for hours and hours. Will the Secretary of State commit to ending the waits and back the Liberal Democrat call, welcomed by the Royal College of Emergency Medicine this morning, for a guarantee that no patient will have to wait for more than 12 hours in A&E?

[Wes Streeting]

We are striving towards meeting those standards, which were met so successfully under the last Labour Government. This Labour Government are having to pull out every stop to repair the enormous damage done by our predecessors. The Liberal Democrat spokesperson is right: safety, of course, is paramount, but so is dignity. When she describes those patients’ stories in those terms, it underscores the fact that behind the two words “corridor care” are countless stories of indignity and treatment in conditions that neither we, nor they as patients, nor staff want to see those people treated in. We are determined to put an end to it.

--- Later in debate ---

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

The social care crisis is piling pressure on hospitals, with beds taken up by patients who are fit enough to be discharged. It is also piling pressure on local councils such as Shropshire, where 80% of the budget goes to social care, yet the Government are shifting funding from counties to cities and dragging their heels on the social care crisis. Will the Secretary of State take action by reinstating the cross-party talks on social care as a priority, because we need to fix social care if we are going to fix councils, care and the NHS?

[Wes Streeting]

Cross-party working on social care has never been un-instated. I know there is much more to do, but we have been in government for 18 months and we have put in £4 billion of investment, legislated for the first ever fair pay agreements with £500 million committed to that, made significant additional investment in the disabled facilities grant and, in building the workforce plan for the future, we have commissioned Baroness Casey to do her work. She will be reporting soon and we look forward to taking that work forward.

Puberty Suppressants Trial

Helen Morgan Excerpts

Wednesday 17th December 2025 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson; you have one minute.

[Helen Morgan (North Shropshire) (LD)]

I hope that everyone in this House can agree that medical treatment should always follow the evidence on safety and effectiveness. It is right that expert clinicians are building this evidence base and therefore right that the Government are seeking to run this trial, because it should be led by evidence and not by ideology.

Given that the numbers on the trial will be very small and the waiting list for talking therapies, which are so important for children and their parents, is very long, with hundreds of thousands waiting, can the Secretary of State explain how he will increase access to NHS talking therapies so people can get the help they need and deserve? In a field with so little research, will he confirm if the pathways trial will look at international best practice in order to take learnings from abroad?

Transgender People: Provision of Healthcare

Helen Morgan Excerpts

Tuesday 16th December 2025 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve under your chairmanship, Mr Turner. I thank the hon. Member for North Warwickshire and Bedworth (Rachel Taylor) for securing this important debate on healthcare for transgender people and the excellent opening speech she made.

As Liberal Democrats, we believe that everyone should have the freedom to live their lives as who they are, with their fundamental rights protected. Nobody’s health or life chances should be limited or determined because of their sexual orientation or gender identity.

Liberal Democrats strongly support better specialist healthcare services for people who are struggling with their gender identity. These individuals are often the most vulnerable and marginalised in our society, and it is key that they get the support they need from both the Government and healthcare services to ensure they are protected.

I will start with young people. The old system—a single clinic with a shockingly long waiting list, rated “inadequate” by the Care Quality Commission—was clearly failing vulnerable people at a very difficult point in their lives. Before the gender identity development scheme closed, more than 5,000 young people were stuck on that list. They were left waiting for a first appointment for almost three years on average.

For teenagers going through what are often incredibly difficult experiences, three years is an eternity. I have met parents in my constituency surgeries who are visibly distressed by the additional pressure and interminable wait for help for their children or teenagers. We must try to do better for these families. Liberal Democrats have consistently campaigned for action to tackle appallingly long wait times across the NHS, whether it is for cancer treatment or mental health, and it is right that we do so for gender identity services, too.

Trans people should not face a delay in receiving healthcare just because they are trans, and the current situation of waiting years is simply unacceptable. That is why change is needed, and why Liberal Democrats have long pressed the Government to establish new specialist services and recruit and retain more specialist clinicians—so that trans people can access the appropriate, individually-focused and high-quality healthcare that they need.

The NHS’s move to create multiple new regional services is therefore welcome, but only three are open now—in London, the north-west and the south-west—leaving those who have already been stuck on waiting lists for years to wait even longer. There is no indication yet of when the other centres will open.

I hope the Government will show far more urgency in getting these centres up and running properly, or more people will be denied the critical care they need as they languish on long waiting lists. I urge the Minister to take this opportunity to put forward a solid timeline on delivery for the future centres.

Moving on to adults, we are concerned that the current waiting list for adults trans people attempting to access gender identity clinics in the UK is on average five years, and there are some reports of much longer averages of 12 years in England or even longer, as the hon. Member for North Warwickshire and Bedworth highlighted. That is unacceptable for people in distress.

Trans adults have significantly higher rates of mental health conditions, such as autism, dementia and learning disabilities, so timely help is really important. Furthermore, many patients report discrimination, misgendering or the refusal of standard services. Surveys reveal that 40% of trans individuals experience negative healthcare interactions and 21% say their needs were ignored. We have heard about the devastating impact that can have on these real people.

I welcome the commissioning of the Levy review into healthcare for trans adults. Will the Minister clarify when we might expect it to conclude and report back? I hope it will cover both the quality of healthcare and its timeliness. We believe that trans people have the right to be seen by a specialist within 18 weeks, as set out in the NHS constitution, and that they deserve further support while on an NHS waiting list, such as mental-health support and gender-affirming care. Therefore, I welcome the fact that the NHS has doubled investment, opened new clinics and initiated wellbeing pilots offering digital mental health and community support while patients wait, but there is still much more to do.

It is critical in our modern and inclusive society that no one should wait longer or suffer inappropriate care just because of their sexual orientation or gender identity. I urge the Minister to ensure that all UK citizens are provided with adequate care, support and protection by increasing the availability and quality of specialist gender services across the country.

NHS: Winter Preparedness

Helen Morgan Excerpts

Monday 15th December 2025 Commons Chamber

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

It is obvious already that this year is going to be very difficult for the NHS, with many A&E departments already overwhelmed, hospital wards full and too many patients looking at spending their Christmas on a corridor. Indeed, corridor care has been common throughout this year and even trusts that have seen improvement in other areas, such as Shrewsbury and Telford in my constituency, are struggling to make real progress in urgent and emergency care. In July this year, one in five people who arrived at an A&E in Shropshire had to wait more than 12 hours, and that was before the double whammy of a record winter flu epidemic and an irresponsible doctors’ strike.

Will the Prime Minister chair regular Cobra meetings to address this emergency? Will the Minister agree to make flu vaccines available to far more people and roll out an emergency vaccination scheme in communities to reach people who have been missed? Finally, will the Government support Liberal Democrat calls for a dedicated winter crisis unit, providing the locum doctors and social care support needed to discharge patients and free up hospital beds?

[Wes Streeting]

We are doing much of what the Liberal Democrat spokesperson asks; the hon. Lady is absolutely right that we need to focus on delayed discharge and demand management, and the system is doing all of those things. It is challenging in the NHS. The House will know of our determination to end corridor care. We have certainly ended the nomenclature of “temporary escalation spaces”, which makes corridor care sound like it is both normal and acceptable in the NHS, neither of which is true. I will stop short of asking the Prime Minister to chair Cobra meetings. That would not be the right mechanism or response, but of course he and I meet regularly to discuss winter pressures, and I will keep him apprised of the situation.

Budget Resolutions

Helen Morgan Excerpts

Tuesday 2nd December 2025 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

The NHS continues to face a historic crisis after years of mismanagement by the last Conservative Government. Their dire legacy is still felt across the country, with hospitals crumbling and dental deserts across England—not least in my constituency—as well as a mental health crisis and many people struggling to access their GP, waiting hours for an ambulance or suffering in crammed hospital corridors. The British people deserve better.

The Liberal Democrats welcome efforts to bring down the sky-high waiting lists left by the previous Government, and there have been green shoots of recovery across the country. In the Shrewsbury and Telford hospital trust, which serves my constituents, performance against the 28-day faster diagnosis standard has reached 80.1%—the highest on record. I thank all the hard-working hospital staff there and across the country, who are working tirelessly at the moment to improve the situation.

There are some welcome announcements in the Budget. The prescription price freeze is clearly the right thing to do, and we strongly support protecting victims of the infected blood scandal and their families from inheritance tax. It is an unacceptable injustice for bereaved families to lose out just because their loved ones died waiting for compensation. We also support the lifting of the two-child benefit cap, because it is the type of investment that will reap savings in the future and correct a moral injury.

I am afraid, though, that overall this Budget does not meet the moment. The Government are treading water on their spending commitments, and hundreds of millions of pounds are set to be drained from services to fund a medicines price hike. From the Office for Budget Responsibility’s report, it is not clear whether frontline NHS services will be raided to pay higher prices for branded medicines at the behest of President Trump, on top of the billions already anticipated in the spending review. No. 10’s briefing suggests that the money will come from the NHS budget, yet we have just heard from the Secretary of State that it will not. A statement to this House to clarify the details would be most welcome.

Yesterday we learned that the Government have capitulated to the US Government and will increase spending on medicines by 0.3% of GDP—more than the value derived from some trade deals—or from about 9.5% of the NHS budget to 12%. We desperately need to understand how that will be paid for; I hope it will not be by cutting frontline services. The Secretary of State has previously said that he would not allow the NHS to be ripped off by drug companies, and I hope the Minister will confirm that position.

The life sciences sector is vital to the UK. Rather than defunding vital NHS services, the Liberal Democrats urge the Government to take real actions to strengthen it by implementing a new, bespoke customs union with the EU to slash red tape, along with a major boost to research and development funding so that new drugs can be brought online as quickly as possible. NHS spending should be targeted at where our health service really needs it: ending the crisis in GP services so that everyone has a right to see a GP in seven days, or in 24 hours if it is urgent; guaranteeing that 100% of patients are treated for cancer within 62 days of an urgent referral; and ending unacceptable and degrading corridor care. I urge the Government to adopt these proposals without delay in order to protect patients and prevent trust in our NHS from being irreparably broken.

One of the most visible symptoms of decline is our crumbling hospitals and the degrading scenes that became commonplace under the Conservatives. Those patients falsely promised a new hospital by the Conservatives will continue to be bitterly disappointed. We all know that the 40 new hospitals promised to patients did not number 40, that they were not necessarily new, that they were not all hospitals, and that there was no plan to fund them. However, this Government have chosen not to pledge new investment, which means that the maintenance backlog will continue to balloon at eye-watering levels, having climbed from £13.8 billion in 2023-24 to an astonishing £15.9 billion in 2024-25.

The Chancellor should have guaranteed that no patient, doctor or nurse faces the indignity of substandard, broken and, frankly, unsafe estates. We appreciate that there is pressure on the public finances, but holding back on these improvements is a false economy when a fortune is being spent papering over the cracks to keep substandard buildings that should be condemned limping on. The repair backlog at the sites of new hospitals is set to reach nearly £6 billion by the time construction is due to start. The Liberal Democrats will continue to champion investment in our crumbling NHS buildings in order to protect patients, hard-working NHS staff and the taxpayer.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

The hon. Lady is outlining an extensive programme of capital expenditure on the national health service. Between last year and this year, we have had the largest set of Budget increases in the history of this country, but are the Liberal Democrats proposing that we should tax the British public even further to pay for the kind of thing that she has just described?

[Helen Morgan]

If the right hon. Gentleman had listened to our leader’s response to the Budget, he would understand that the Liberal Democrats do not propose to tax the British taxpayer further. We would sign a customs union deal with the EU and create £25 billion in extra tax revenue every year without going back to the British taxpayer.

The crisis in our NHS is perhaps most acute in our community services. For all the welcome promises on shifting care from hospital to community and treatment to prevention, the truth is that local health services are on their knees, with record waits to see a GP. Liberal Democrats have championed new investment and we welcome the Government’s announcement on neighbourhood health centres, but unless we see health centres in every community, with investment to ensure that everyone can see a GP within a week as a legal right, and the restoration of public health funding, this risks being an expensive failure.

[Sarah Dyke (Glastonbury and Somerton) (LD)]

On neighbourhood health plans, St Dunstan’s House health and wellbeing centre and West Mendip primary care network are seeking to put together a preventive approach to crime, social and mental health issues in the Glastonbury area. Does my hon. Friend agree that this innovative, community-based project should be included in the second wave of neighbourhood health scheme applications?

[Helen Morgan]

We would all welcome that kind of innovative, community-led approach to improve local health services across the country.

The commitment to set up 250 neighbourhood health centres in communities by 2025 is clearly a welcome step, but there are 543 constituencies in England, so many communities will remain under-served. For example, my own constituency of North Shropshire is part of the pilot for neighbourhood health centres, for which we are grateful, but the numbers indicate that there may be only one neighbourhood health centre, although the constituency has five market towns, spread over a large distance and with different catchment areas. It is not one neighbourhood. Investment in our general practices is essential to ensure that people can continue to access primary care when they need it.

Neighbourhood health is not just about buildings—it is about how teams operate—but when so many local practices are constrained by the physical space in which they must work, buildings are an important part of the puzzle. There is a danger that rural and coastal communities continue to remain under-served and isolated, unable to access services that may be many miles away and only reachable by private car.

[Steff Aquarone (North Norfolk) (LD)]

My hon. Friend and I both represent rural constituencies that face similar challenges. Businesses in North Norfolk already face extra struggles to stay afloat, including training and retaining staff, finding affordable premises, and even things as simple as getting a strong and reliable phone and internet connection. Does she share my frustration that rather than tackling those problems, last week’s Budget has just lumbered rural businesses with more tax, more costs and more stress for the future?

[Helen Morgan]

I share my hon. Friend’s frustration.

Perhaps the most glaring and alarming omission of all in this Budget is that the words “adult social care” do not appear. The sector is already stretched to breaking point and is now suffering from the Government’s 2024 hike in employer national insurance contributions, which is unfunded for most businesses operating in that sector. The pressure is clearly reflected in the Association of Directors of Adult Social Services’ 2025 spring survey, which found that three quarters of directors have only

“partial or no confidence that their budgets are sufficient to meet their legal duties for prevention and wellbeing.”

That is not only terrible for disabled and vulnerable people; it is a disaster for the NHS. One in seven hospital beds are taken by someone who should be discharged but for whom there is no appropriate social care package. The situation could not be more pressing.

We need the cross-party talks to move far more quickly. As we have heard, there has been only one meeting, back in September, and there are no current plans for further engagement. I ask Ministers to ask the Prime Minister to lead those talks and to treat them with the seriousness and urgency that they deserve. We also need a solution to provide the social care beds needed to stop a devastating winter crisis; 2028 is too late for that.

In addition to spiralling NIC costs, there is increasing demand and huge staff shortages in the sector. With an immigration policy that is clearly designed to disincentivise overseas workers in this area, there is no clear plan to ensure how those vacancies will be filled. In formulating their 10-year workforce plan, the Liberal Democrats urge the Government to introduce a funded and higher minimum wage for carers, and a new royal college of care workers to improve training and career progression and to give carers the recognition that they deserve.

When social care is not available, family carers must step in to fill the need. A fairer deal for family carers, such as guaranteeing more respite care and introducing paid carer’s leave, would enable many to continue caring for longer at home. We want to see more support for young carers in school by introducing a young carers pupil premium. These are simple but potentially transformational steps in supporting the millions of carers without whom our health service would collapse.

Winter is quickly closing in, and there are signs that the annual winter crisis could be even worse this year, having already become a year-round permacrisis. The Budget should have funded an emergency package to prevent A&Es collapsing this winter. Liberal Democrats have called for 1,000 extra hospital beds, emergency social care places to free up places in hospitals, a recruitment and retention drive to increase the number of out-of-hours GPs, and a qualified clinician in every A&E waiting room to protect patients who are at risk but stuck on trollies. Without those measures, there is a significant risk of another winter of harrowing scenes of corridor care and ambulances queuing outside hospitals, which should have no place in our society.

Let us take a step back and ask what this Budget really means for the NHS. The topic of today’s debate is investment and renewal, but this Budget means cost pressures are left unaddressed and reforms that are confused and disorientating. Inflation is forecast to run higher than the budget set by the Department of Health and Social Care back in March 2025 for the spending review. As a result, average real-terms growth in departmental budgets has shrunk by 0.1% since then.

The OBR notes that spending on branded medicines alone is expected to rise by 25%—an extra £3.3 billion—between 2025-26 and 2028-29. For context, that is equivalent to the budget for maternity care in England. Yesterday’s recent agreement confirms that it will be at least that sum, and possibly as much as another £6 billion a year, which is an eye-watering amount. Industrial action could add a further £1.2 billion by 2028-29. It is hard to see what would be left to repair our GP services, expand social care or take any of the other measures needed to lift the NHS off the floor.

On top of that, we have no clarity on the impact of the reorganisation of NHS England and ICBs. The Chair of the Public Accounts Committee has warned that the Department has removed

“a key piece of machinery without articulating a clear plan for what comes next”

and compared the reforms with those of HS2.

The 10-year plan sets out a vision that Liberal Democrats share, but it is missing any clear explanation of how it will be funded within the spending review settlement. Nowhere, across 170 pages, is there a credible costing or delivery plan. Five months on, we still have no idea whether the Government can deliver the essential reforms that they have promised. Unless the Government adopt a genuine “spend to save” approach, investing now to prevent greater costs and worse outcomes later, we are at risk of seeing only managed decline, mounting pressure and the continued loss of faith in the health service.

Rather than Labour’s unfair tax rises, we have set out a number of fair ways to fund our public services properly. Most importantly, this Government are refusing properly to fix our broken relationship with Europe. We are calling for a new EU-UK customs union, which could raise more than £25 billion a year. The Government would have plenty of time to put the deal in place by 2030, raising billions in extra tax revenue in a fair way after 2030. We have also called for a targeted windfall tax on the big banks, which would raise £30 billion in total by 2030.

Let me take this opportunity to say to the Government that if we are to rescue the NHS, they must tackle the crisis at its front door and at its back door. That means investing in public health and early access to community services, including GPs, pharmacists and dentists, so that fewer people need to go to hospital in the first place. It also means fixing the crisis in social care to stop so many people being stuck in hospital beds. Only these measures can bring down waiting lists, improve the quality of care and help people live longer, healthier lives. The NHS needs transformational change; the Government must wake up from their complacency, or it will be patients who pay the price.

Oral Answers to Questions

Helen Morgan Excerpts

Tuesday 25th November 2025 Commons Chamber

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

The impact of health inequalities on women’s health are starkest when it comes to maternity care, with many NHS trusts requiring improvement. Black and Asian women, and those from the most deprived communities, are far more likely to suffer the worst outcomes or even lose their babies. The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have vocally opposed the removal of the ringfence from the service delivery fund, saying that funding provided to drive change following the Ockenden review has disappeared at the stroke of a pen. Will the Secretary of State commit himself to reinstating that ringfence, and to ensuring that all the immediate and essential actions arising from that review of the failings at Shrewsbury and Telford hospital NHS trust are taken as soon as possible?

[Wes Streeting]

I thank the Liberal Democrat spokesperson for her question. She is right to raise the inequalities at the heart of poor maternity care, as well as failures in services overall. We are taking a number of actions, but on the issue of funding specifically—I think this will become a recurrent theme across a range of issues during this Parliament—the approach that we are taking as a Government is to try to devolve more power, responsibility and resources to the frontline. As we do so, we are removing national ringfences.

I appreciate what the hon. Lady says about the risk. It is important that we, and no doubt Parliament, scrutinise the situation to make sure that outcomes across the board improve and that the focus that this House wants to bring to issues like maternity safety is delivered in practice, but I think we are right to drive at the issue of devolution. Decisions are better taken within communities, close to communities and at a local-system level, but she is right to be vigilant about this issue, and we on this side of the House are absolutely open to challenge. If systems are not acting in the way that we want and it is having an adverse impact, we will reconsider.

--- Later in debate ---

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

Every MP will be aware of the huge value that unpaid carers add to the NHS, taking the pressure off paid carers while often under intolerable pressure themselves. We were therefore really pleased to hear the news this morning that thousands of unpaid carers will have their cases reviewed, after they had been left with huge debts as a result of a failure of Government over a long period of time. However, it has been reported that debts will continue to accrue and overpayments will continue to be pursued for as long as a year from now. Given his responsibility to unpaid carers, will the Secretary of State raise the issue with colleagues, urging them to suspend repayments until the recommendations are enforced, and ensure that those people propping up the care system are treated fairly from today, not from in a year’s time?

[Wes Streeting]

I am grateful to the hon. Member for that question, as this is a terrible situation and one of the many messes that this Government are now working to clean up. I will certainly ensure that the issue she raises is taken up with my right hon. Friend the Work and Pensions Secretary.

World COPD Day

Helen Morgan Excerpts

Thursday 20th November 2025 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve under your chairmanship, Mr Efford. I start by congratulating the hon. Member for Strangford (Jim Shannon), who is a friend of all of us in this House, on securing this debate and raising awareness of World Chronic Obstructive Pulmonary Disease Day, which took place yesterday. I thank him for his tireless campaigning for this cause, and for his excellent opening speech, which outlined the issues faced by COPD sufferers.

As we have heard, COPD is the name given to a group of health conditions that affect the lungs and cause breathing difficulties, such as emphysema and chronic bronchitis. Patients with COPD may face symptoms such as shortness of breath, a chesty cough, frequent chest infections and wheezing, which get progressively worse over time and may be exacerbated during the winter months. As someone who has had asthma from childhood, I know at first hand the fear, frustration and disruption to daily life that gasping for breath can cause. It is critical that there is a plan in place to manage respiratory disease, given that we may be facing a devasting winter crisis in the NHS once more.

The most recent data published by the NHS shows that there were over 1.17 million patients recorded by GPs as having COPD in England in 2023-24. The National Institute for Care Excellence warns that the real number of sufferers may be much higher, noting that previous Government research put the number at around 3 million in the UK, 2 million of whom remain undiagnosed. Approximately one in 10 adults over the age of 40 has COPD in the UK, at a cost of £2 billion a year to the NHS.

As the main cause of COPD is smoking, it is a highly preventable condition. I welcome the Government’s introduction of legislation to enable a smoke-free generation, but we must also consider those who have already started smoking and who are finding it hard to quit, or those who can circumvent the provisions of the Tobacco and Vapes Bill.

Smoking is much more common in deprived areas, as we have already heard, so COPD is also a stark indicator of social and health inequalities in this country. The Liberal Democrats want the new Government to take urgent action to support people to live healthier lives, starting by reversing in full the Conservative cuts to funding for public health, of which smoking cessation services are a critical part. I am sure all Members agree that prevention is better than cure, and helping smokers to kick the habit will not only reduce their risk of debilitating illness but will save taxpayers money in the long run. The cost of COPD is £2 billion per annum, and everyone benefits if fewer people require treatment for smoking-related illness.

Along with smoking, long-term exposure to air pollution may be a cause of COPD. The Liberal Democrats have pledged to reduce air pollution; to protect people, especially children, from breathing in harmful pollutants by passing a clean air Act based on World Health Organisation guidelines and enforced by a new air quality agency; and to improve public transport and active travel to reduce the harm caused by air pollution at home, school and work. I would welcome the Minister’s thoughts on those proposals, which would drastically reduce avoidable respiratory diseases.

The theme for World COPD Day this year is “Short of Breath, Think COPD”, and it aims to raise awareness of underdiagnosis and misdiagnosis of COPD. As I mentioned, there could be 2 million people undiagnosed in the UK who are missing out on essential treatment and advice on how best to manage their debilitating condition. NICE recommends that COPD should be suspected in anyone aged over 35 with a risk factor for COPD and symptoms of breathlessness, chronic cough, regular phlegm production, frequent chest infections in the winter, or wheezing.

The Liberal Democrats have called for anyone with a long-term health condition, including COPD, to have a named GP, which would improve the continuity and therefore the quality of their care. People with COPD consistently report difficulties accessing services that are essential to managing their condition, including GP appointments, specialist care and pulmonary rehabilitation. They also experience poor communication between different healthcare providers and inadequate follow-up after hospital discharge.

As we have heard, COPD patients are often left in the dark with inadequate information about their condition when they are first diagnosed. Better continuity of care in the community would surely help to overcome at least some of those issues. To achieve that, we need the Government to be much more ambitious in their plans to increase GP numbers. We need them to adopt Lib Dem plans to retain and recruit 8,000 more GPs over this Parliament to deliver that improvement in care.

We are also campaigning to improve the speed of new treatments by expanding the capacity of the Medicines and Healthcare products Regulatory Agency. We are also pressing for better social care, including for people with COPD who are struggling to manage independently. We would provide more support for family carers through initiatives such as the right to respite breaks, paid carer’s leave and an end to the cliff edge in the way that carer’s allowance is paid, so that no one is forced to pay back thousands of pounds because they worked an extra hour a week.

We would also help people who struggle to get into work because of their illness, with a new right to flexible working and the right to work from home unless there is a really good business reason why that is not possible. We would make it easier for people with long-term conditions, such as COPD and those with disabilities, to access public life, including the world of work, through a range of measures that allow better physical access and proper adjustment to the workplace.

Many people with COPD are at risk of a stay in hospital, and they are often unable to get home after that because of the crisis in social care, which is putting even more strain on the NHS. The Government established the Casey commission to find a cross-party solution to the social care problem, and I welcome that, but I have to report that despite a promising opening roundtable in September, there have been no further talks. Will the Minister update us on the progress of that work?

The winter presents an immediate problem. There are warnings of a particularly bad flu season, which is causing concern for everyone who is more vulnerable to respiratory illness, including those with COPD. My local hospital, Robert Jones and Agnes Hunt Orthopaedic hospital, and the Shrewsbury and Telford hospital NHS trust have already introduced some mandatory mask wearing to reduce the risk of transmission of respiratory disease in the hospital. That means that an effective vaccination programme is especially important this year.

I was concerned by news that covid vaccination eligibility has been significantly reduced. This autumn and winter, vaccination is being offered only to people over 75 and those with a weakened immune system. People with chronic respiratory disease, including COPD and asthma, have been excluded despite the clear risk—I speak from too many personal 2 am nebuliser experiences—that even a mild respiratory infection poses for them. Also excluded are the main carer for an older or disabled person, those who are in receipt of carer’s allowance or who are living with someone who has a weakened immune system, and, perhaps most surprisingly, frontline health and social care workers.

All those people remain eligible for a flu vaccine, and that is good. Even though covid is now considered to be a mild disease, time off for NHS and care workers when services are at their most pressured, as well as the significant risk of transmission to vulnerable patients, is concerning. Will the Government consider a review of the decision to restrict access to covid vaccines this year? Can the Minister provide statistics on the uptake so far of flu vaccines within different groups and outline what steps she is taking to ensure high levels of uptake among NHS and care workers?

In conclusion, COPD is a debilitating condition and, as with many conditions in the UK, there is something of a postcode lottery in the quality of care patients receive. I welcome the Government’s roll-out of the NHS RightCare COPD pathway and the National Respiratory Audit programme, along with plans to improve access to pulmonary rehabilitation. I would be grateful if the Minister updated us in her closing remarks on progress with those programmes, as well as answering my questions about vaccine roll-out, support for carers and the Casey commission, access to a named GP, and full restoration of the public health grant, including for smoking cessation services.

Cross-border Healthcare

Helen Morgan Excerpts

Tuesday 4th November 2025 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I also thank my hon. Friend the Member for Brecon, Radnor and Cwm Tawe (David Chadwick) for securing a debate that is really important along both the Welsh and Scottish borders.

It is always a pleasure to respond for the Liberal Democrats. This is an issue that my own constituents deal with daily, because North Shropshire has a very long and winding border with Wales. My office, as a result, has dealt with many upsetting pieces of healthcare casework that stem directly from the broken and disjointed system that serves our border counties and, critically, the lack of information that flows between them, as we have heard.

Take for example many of my constituents whose GP will be in Wales because that will be their closest GP, and who usually attend Wrexham Maelor hospital for investigations and procedures, because if they live in north-west Shropshire that is almost as close as the hospitals in Shrewsbury and Telford. It is certainly closer than Telford. In an emergency, because their address is in England, the ambulance that they are sent comes from the West Midlands ambulance service and it is most likely that they will be taken to Shrewsbury or Telford hospitals as a result. When they get there, those hospitals are unable to access their medical records, including any recent blood reports or clinical history. I think the Minister will agree that that is inherently dangerous for those patients, whose only “fault” is to live close to the border.

The 2018 cross-border statement promised that no patient would face delay or disadvantage because of which side of the border they lived on, but in reality that promise has not been kept. Another constituent of mine who is registered with a GP in Wales was unfortunately diagnosed with breast cancer about 18 months ago. Her GP in Wales was very good; her initial care was excellent, and she was set to have a mastectomy and reconstructive surgery in Telford, but a couple of days before the surgery she was told that the Welsh health board would not be paying for the reconstructive element of the surgery. Obviously she was distressed and very scared about her future, and worried about having to wait longer to have that vital surgery because the funding issue needed to be sorted out. Although my office resolved the issue fairly quickly, it should not be necessary for an MP to get involved in a funding flow across the border. That is not acceptable, and not how we should be dealing with cross-border care.

As my hon. Friend the Member for Brecon, Radnor and Cwm Tawe and the hon. Member for Montgomeryshire and Glyndŵr (Steve Witherden) have described, Powys teaching health board has set waiting times for elective surgery that are arbitrarily long and without reference to clinical need. That means that Shrewsbury and Telford hospital NHS trust, which treats my constituents, and the Robert Jones and Agnes Hunt orthopaedic hospital, which is in my constituency and provides the veterans centre that the hon. Member for Caerfyrddin (Ann Davies) mentioned, are being asked to prioritise waiting lists based not on need, but on nationality.

I am an accountant, not a medical expert, but how can clinicians at those trusts be expected to manage their lists if they must take into account nationality before clinical need? The teams in both trusts are working incredibly hard to bring down their own long waiting lists. They have ambitious targets to meet, but they are being instructed to leave some patients longer, for no obvious reason. It is clearly an untenable situation for those hospital trusts. The patients, who may be living with chronic pain, are being told to wait longer than necessary because they live in Wales. That is not fairness; it is failure. I ask the Minister to ensure that the Labour-led Welsh Government are working hand in hand with our English integrated care boards and hospital trusts to ensure that residents on the border—on the Welsh side and the English side—are provided with the care that they need and deserve.

Behind the problem with funding flows lies another problem—the data-sharing chaos. After 25 years of devolution, NHS England and NHS Wales still cannot share patient records properly. Although England uses the NHS e-RS, or e-referral service, Wales uses the Welsh clinical portal, I am reliably informed. Clinicians often need multiple logins to access cross-border data, and GP-to-GP digital record transfers do not work between nations, with referrals, test results and discharge letters still moving by post or fax, which is an absurd situation in 2025. As we have heard from our Scottish colleagues in today’s debate, there is a similar situation on the Scottish border.

A fundamental difference in national strategies has left those on the border torn between two healthcare systems and two sets of priorities. The pilot project between Powys and the Wye Valley is a glimmer of hope, but progress on that is too slow. This is leading to a situation in which it is harder to recruit GPs, referrals take longer and patients fall through the cracks, because the two systems do not talk to each other. Treatment pathways can be confusing and fragmented, as we heard from my constituent’s example. Patients are facing delays and disputes not because of medical need, but because of bureaucracy.

The 2018 “Statement of values and principles” has no legal force; it is a voluntary agreement that leaves patients powerless when things go wrong. What we really need is proper accountability, shared data and transparent funding, so that the border does not become a barrier to care. It should not decide how long people wait, what care they get and whether their doctor can access their records.

One of the communities hit hardest by these challenges is St Martin’s—the largest village in Shropshire and, of course, in North Shropshire. Its GP surgery was a branch of the medical practice over the border in Chirk and it was overseen by Betsi Cadwaladr university health board. In 2022 it was closed, despite strong opposition from me and the village residents.

The Betsi Cadwaladr university health board has no official responsibility for my constituents over the border in North Shropshire, but it does get funding from the Welsh NHS for each individual registered in Chirk. Shropshire, Telford and Wrekin ICB presumably cannot afford a new surgery for the village, despite its being Shropshire’s largest village—it is also rapidly expanding—which means that residents must travel into Wales to see their nearest GP, with all the complications that entails. The best interests of English patients were disregarded by Betsi Cadwaladr health board because it was not responsible for those patients’ outcomes. It is essential for the health and wellbeing of residents on both sides of the border that we move to a system that focuses on a smooth flow of information between the nations and, crucially, that prioritises patient outcomes.

Improvements should be built on existing systems and border projects, rather than attempting some kind of long-winded, full national integration. As a party, the Liberal Democrats believe that the best way to do it is by, for example: extending England’s secure nhs.net to Welsh GP practices to allow safe patient data exchange; expanding English clinicians’ access to the Welsh clinical portal, which is currently available just in Wye Valley, to improve safety and efficiency; implementing any further sensible measures integrating English, Welsh and Scottish secure email systems; broadening the Welsh clinical portal, including expanding the Powys teaching health board and Wye Valley trust data-sharing model to other border trusts; and investigating interoperability of the NHS app between countries to support patient communications.

In 2025, we should be in a place where the flow of information is smooth and patients in the UK need not worry where they are located or what nationality they are if they need healthcare. I call on the Minister to work with her colleagues in the Welsh Government to ensure that their health system works in harmony with ours. Devolution should not mean having a dysfunctional border region. It should help deliver the localised care that residents need. I look forward to the Minister’s response.