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.

Auditory Verbal Therapy

Helen Morgan Excerpts

Tuesday 21st January 2025 Westminster Hall

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve with you in the Chair, Mr Western. I thank the hon. Member for Washington and Gateshead South (Mrs Hodgson) for introducing the debate, as well as Sam, his family and Auditory Verbal UK for campaigning on this important issue. I confess that I am quite new to auditory verbal therapy, and it has been fascinating to research the issue more for the debate and to listen to hon. Members’ contributions.

The hon. Member for Washington and Gateshead South made a hugely compelling argument for improving access to auditory verbal therapy, setting out not only the benefits for the children who would be able to improve their ability to listen and speak, but the economic benefit that would derive from what I think we can all agree is a small investment—as an accountant, I can confirm that £2 million is probably a rounding error in most instances. I also thank other Members for their useful speeches today, not least the hon. Member for Bury North (Mr Frith), who highlighted the importance of early intervention, and the hon. Member for Derby South (Baggy Shanker), who highlighted the educational impact that early access to appropriate therapy can have.

There are more than 50,000 deaf children in the UK. Around 7,200 of them are under the age of five. Some 90% of deaf children are born to hearing parents, who do not have the experience of dealing with hearing impairment. Although deafness is not a learning disability, deaf children face a significant attainment gap during their time at school, and their educational outcomes are poorer. There is also a higher risk of poor mental health. In addition, deaf people are less likely to have decent employment, and suffer generally from inequality as a result of being hearing impaired.

It is important to say up front that all deaf and hearing-impaired people have the right to participate fully and independently in society. Too often at the moment, those rights are not being fully realised. Liberal Democrats believe, as I am sure hon. Members from all parties do, that every deaf child deserves the best possible start in life, the opportunity to flourish and for their families to be supported, so that they can express themselves and communicate with ease, in the way that is most comfortable for them.

The hon. Member for Bolton North East (Kirith Entwistle) highlighted that offering a range of therapies is the best way to support families who have a child who is deaf, and that they should be able to exercise choice when deciding which therapy is most suitable for them. Under section 17 of the Children Act 1989, local authorities in England have a duty

“to safeguard and promote the welfare of children within their area who are in need”

by providing

“a range and level of services appropriate to those children’s needs.”

A child is defined as being in need if they are disabled, and the Act says that a child is considered disabled if they are deaf. We are therefore in a position where it seems that local authorities must be compelled to provide appropriate support for deaf children and their families. The National Deaf Children’s Society notes that

“in some cases, local authorities do provide funding to help”

a child “access AVT”.

The problem is that the Government have confirmed that audiology services are commissioned locally and that

“the responsibility for meeting the needs of non-hearing children lies with…National Health Service commissioners.”

That leaves us with the dreaded postcode lottery. It would be helpful if the Government provided guidance to local authorities on the level of support they should be providing, particularly, in the context of this debate, for AVT.

Locally in Shropshire, headteachers report an inability to access basic speech and language therapy for hearing children. The strain on local government finances will clearly have a significant impact on what is available to children in each area. Will the Minister confirm whether provision of AVT will be a responsibility of the Department of Health and Social Care or local government? Therapies such as this might sometimes fall into the gap between the two, and it would be useful to understand how it can best be delivered.

As I mentioned, I am slightly new to this topic but Liberal Democrats have long campaigned for better support for people who are deaf, and particularly for those who communicate through British Sign Language. We would like BSL to have official, equal status to the UK’s other languages, and would like free access to sign language lessons for parents and guardians of deaf children. We welcome all the developments in improving outcomes for deaf children, including technology such as cued speech visual systems, for which there is a major centre in the constituency of my hon. Friend the Member for South Devon (Caroline Voaden).

I echo the call of the hon. Member for Washington and Gateshead South for a pilot scheme—that seems a sensible way forward. The existing research on AVT is promising but the evidence base is still narrow and a pilot scheme seems the best way to broaden that evidence base and convince those who have not yet been convinced by meeting children who have benefited profoundly from the therapy. More broadly, the Government should strengthen the availability of basic speech and language therapy training for people working with children to ensure that children who are struggling with hearing impairment can be identified, that their progress is monitored and supported, and that an equal outcome is found for them.

In conclusion, will the Minister confirm whether the provision of AVT is the responsibility of the Department of Health and Social Care or a local government issue, bearing in mind that the provision of such assistance comes through local government? Will he also confirm that the 10-year plan will address services such as AVT for deaf children and adults? Finally, will he consider a pilot scheme to broaden our understanding of the benefits of AVT?

--- Later in debate ---

[Stephen Kinnock]

The hon. Gentleman will know that NICE has a prioritisation board, and ultimately that is the decision-making process for prioritising guidelines and the entire operating framework for what falls under NICE’s remit. This is something that absolutely should be on the radar, and of course we are constantly in conversation with NICE about its prioritisation, but it is important that it takes an objective clinical stance on the question.

We have committed to develop a 10-year plan to deliver a national health service that is fit for the future. The engagement process has been launched. As we work to develop and finalise the plan, I encourage those concerned about the availability of services to support children with hearing loss, including auditory verbal therapy, to engage with that process to allow us to fully understand what is not working, as well as what should be working better and the potential solutions. I encourage all hon. Members present to go to change.nhs.uk to make their voice heard.

This summer, we will publish a refreshed long-term workforce plan to deliver the transformed health service we will need to build over the next decade to treat patients on time and deliver far better patient outcomes. We are also in the process of commissioning research to understand the gaps between the supply and demand of different therapy types for children and young people with special educational needs and disabilities. That will help us to understand the demand for speech and language therapists and inform effective workforce planning.

[Helen Morgan]

I am pleased to hear that the Government have increased the number of speech and language therapists, which is so important for young people who are struggling to achieve their potential in an educational setting, but will the Minister address the specific point on commissioning by local authorities? Often, they are so strapped for cash that they are effectively trying to limit demand.

[Stephen Kinnock]

Commissioning is led by ICBs. It is important that ICBs have open channels of communication with local government. We in the Department of Health and Social Care have close contact and engagement with colleagues in the Ministry of Housing, Communities and Local Government, and it is important that that relationship and interaction feeds down through the entire system, but the leading organisations on commissioning are the ICBs.

A number of colleagues raised the question of a pilot scheme to identify how our existing workforce can work differently. The early language and support for every child programme is an excellent example of different professions coming together to support children and young people—local authorities, schools, and the health and care system working together in the community to support our children and young people. The ELSEC workforce model focuses on recruiting pre-qualification speech and language therapy support workers into the workforce to improve the capacity and knowledge of staff who support children with emerging or mild to moderate speech, language and communication needs in early years and school settings.

Nine regional pathfinder partnerships are trialling new ways of working to better identify and support children in early years settings and primary schools. We have asked pathfinders to consider how to make the model sustainable after the project period. The therapy assistant roles have the potential to attract individuals to train to become speech and language therapists through the apprenticeship route. I understand that Auditory Verbal UK is progressing a National Institute for Health and Care Research grant application to support a pilot, and I would welcome an update from AVUK about how that is going when we get the chance to meet.

We welcome the work that AVUK is doing to upskill health professionals to deliver auditory verbal therapy. On the point made by the shadow Minister, the hon. Member for Hinckley and Bosworth, there are as yet no NICE guidelines on hearing loss in children, and NICE has not made any recommendations on AVT specifically. Decisions on the need for guidelines on new topics and updates to existing guidance are made by NICE’s prioritisation board, in line with NICE’s published common prioritisation framework. I understand that NHS England met with AVUK and discussed the need for more high-level research evidence for the intervention and the need to develop evaluations of impact. I am pleased that AVUK has been invited to join the chief scientific officer’s audiology stakeholder group, where it will contribute to decision making.

We recognise the impact on the lives of children of timely access to high-quality services, including different therapies to help children to develop the right skills to engage with education. The Government’s ambition is that all children and young people with SEND or in alternative provision receive the right support to succeed in their education and as they move into adult life. We will strengthen accountability on mainstream settings to be inclusive, including through the work of Ofsted, by supporting the mainstream workforce to increase their SEND expertise and by encouraging schools to set up resourced provision or SEN units to increase capacity in mainstream schools. That work forms part of the Government’s opportunity mission, which will break the unfair link between background and opportunity, starting with giving every child, including those with SEND, the best possible start in life. We will work with the sector, as essential and valued partners, to deliver our shared mission and restore parents’ trust.

I again thank my hon. Friend the Member for Washington and Gateshead South for securing this debate and sharing her insight on the vital issue of early interventions for non-hearing children. We recognise the importance of such services and the life-changing impact they can have on the lives of children. We are committed to ensuring that all children receive the support they need to live healthy, fulfilling lives. I will continue to work closely with NHS England and the Department for Education as we strain every sinew to deliver on those commitments.

Obesity: Food and Diet

Helen Morgan Excerpts

Monday 20th January 2025 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to close the debate for the Liberal Democrats. I congratulate the hon. Member for Stroud (Dr Opher) on securing the debate. All the contributions, including his opening speech, have been excellent and well informed.

I was particularly interested to hear about the existence of good food deserts in Blackpool South and Liverpool West Derby. Even in Shropshire, where we grow some of the most wonderful and nutritious food that can be imagined, we have a higher-than-average obesity rate: 67% of adults are overweight and 32% are medically obese. That is an interesting reflection on the availability of good food and on people’s ability to choose healthy options because of the cost of food at the supermarket. In rural areas, housing is more expensive but average wages are lower. If people cannot access public transport, as the hon. Member for Bathgate and Linlithgow (Kirsteen Sullivan) pointed out, they are often forced to shop at expensive local shops and are thereby forced into buying packets of less nutritious food.

We need to deal with obesity. Two thirds of the adult population are overweight. The NHS is spending almost a tenth of its annual budget on diabetes. Obesity has a significant impact on the health and wellbeing of people who deserve better: they are three times more likely to develop colon cancer, two and half times more likely to have high blood pressure, and five times more likely to have type 2 diabetes. The history of tackling those problems is a litany of failure for all three major parties in 30 years of government because, as other hon. Members have mentioned, we have had 700 different policies on the issue over the years, with no impact. It is time for a coherent strategy to tackle the obesity crisis.

It is good to tentatively welcome the Government’s new national food strategy and their steps on junk food advertising, which are a positive move. The Liberal Democrats would like to see the Government go further, particularly on the use outdoor advertising in areas where people are particularly vulnerable to seeing it. For example, we want local authorities to be allowed to restrict outdoor advertising near schools.

I am interested in some of the suggestions that have been made about planning and fast food outlets, especially as 35.2% of children aged 10 to 11 are now overweight—a staggering 20% rise since 2015. That coincides with a 16% fall in spending on obesity-related measures in the public health grant during the same period. We welcome the Government’s proposed preventive measures. We hope that some of the large sum earmarked for health and the NHS in the recent Budget can be put into public health and prevention measures, because we want to stop people getting unhealthy in the first place rather than dealing with the problem after it occurs.

In Shropshire, one in five children aged four to five are overweight and more than one in 10 are obese. Ironically, almost half are not eating enough fruit and veg, despite the fact that they are grown all around us. The same number are not active enough. To encourage activity, we could introduce a different classification for leisure centres. Hon. Members have mentioned the importance of swimming pools and places to become fit and healthy. I know that the hon. Member for Stroud says that the food element is more important than the activity element; none the less, we should be encouraging getting fit as part of a healthy lifestyle. Will the Minister consider making leisure centres part of our critical health infrastructure so people can rely on their leisure centre staying open and can have somewhere to go if they cannot exercise in their home or their local area?

Healthy eating helps with other preventable problems, such as tooth decay. My hon. Friend the Member for Honiton and Sidmouth (Richard Foord) mentioned poor oral health, another avoidable issue that we can deal with. The importance of good oral health in care homes has recently been impressed on me by various members of the dentistry profession, because poor oral health can lead to aspirated pneumonia. That is a partially separate issue from obesity, but unhealthy and sugary snacks are being offered to people in care homes, so I wonder whether we can encourage healthier eating in those settings as well as in our schools and hospitals.

There is no getting away from the fact that obesity is intrinsically linked to inequality and deprivation. Since 2019, the cost of a weekly food shop has risen by almost a third. As I mentioned, rural areas are not excluded. In Shropshire, 14% of households are struggling with food poverty, or as I prefer to call it, poverty. There is a high risk of cost of living vulnerability for children who are in poverty.

Lots of Members spoke about the great work of their local food bank. In Shropshire, an organisation called OsNosh takes food that is due to be thrown away by the supermarkets at the end of the day but is still perfectly good to eat. The next day, it produces fantastic chef-cooked lunches that people can enjoy. If people are able to pay for those lunches, they can do so; if they are not, they do not have to. It is a wonderful way of bringing the community together to eat good food without the stigma of not being able to afford it. However, I think we all agree that reliance on the third sector to solve this problem is not really acceptable in the modern age, so lifting families out of poverty must be a priority for the Government. Our policy is for free school meals for all children in poverty, and a roll-out of free school meals to all primary schools is our ambition when funds allow. I hope that the Government also have the ambition, when funds allow, of lifting the two-child benefit cap, which would lift a quarter of a million children out of poverty.

Holiday activities and food programmes happen across the country, not just locally. In the summer, I visited a HAF programme in Oswestry at which children were offered a healthy meal, a day out of the home—often in a much safer environment than their home—and a good day of activities. The organisation that delivers that in Oswestry, the New Saints Foundation, offers it not just to children whose families cannot afford a nutritious meal at home but to all children, to remove the stigma, and give all the kids a fun day at the HAF programme. Future funding for HAF programmes is not certain, so will the Minister clarify what will happen to them? They are a really good way to ensure that children eat healthily through the holidays, as well as when they are at school and in receipt of free school meals.

The hon. Member for Stroud also mentioned labelling. I am conscious of time, so I will be fairly brief with this little anecdote. Labelling can be really misleading, even to parents who are comfortably off—I would not describe myself as the most well off—and well meaning. It was a long time ago, so I will not mention the brand, but I resorted to buying an organic brand of food for my child when we were at the puree stage of weaning. He became so addicted to it that it became really difficult to wean him off on to something much more nutritious, filling and healthy, such that I had a sleepless night every night because he was still hungry. One evening, I had a very embarrassing moment in the supermarket, almost having a breakdown because I had bumped into an old friend and the supermarket had sold out of these food pouches, and that was a complete disaster.

I found out later that although the puree was organic and had no added sugar, it was actually really high in sugar. It was essentially just pears, water and some spelt, so it was really sweet and sugary. I had inadvertently given my child something that I had expected to be healthy but was not. Good labelling would have solved that problem; I am sure that it would help many parents whose child has a single brand addiction. It was 15 years ago, and the brand may well have reformulated since then, which is why I will not mention the name, but it is something that we need to be aware of.

The right hon. Member for Wetherby and Easingwold (Sir Alec Shelbrooke) spoke powerfully about his own struggle with his weight, and he mentioned the use of various different types of jab to tackle obesity. I do not think that we should dismiss jabs out of hand. Clearly, they are very helpful for some people, but I really think that the Government’s emphasis needs to be on prevention, and on a public health strategy to stop people getting to the point of needing to use those drugs in the first place.

The UK should be one of the healthiest countries in the world. We have a great history of grassroots sports, the highest-quality food production imaginable, and world-leading medical research, but we are becoming sicker, and falling behind similar countries. It is time to act. We welcome the junk food advertising ban and restrictions on high-caffeine energy drinks as a really good first step. We also welcome the commitment to a national food strategy. I put in a plea for our farmers, who work to very low margins. I ask for the strategy to consider the role of the Groceries Code Adjudicator, and ensure that our farmers are kept in business to continue to deliver our food. Finally, please consider our calls for prevention, to give children a healthy start in life.

Health and Social Care: Winter Update

Helen Morgan Excerpts

Wednesday 15th January 2025 Commons Chamber

[Madam Deputy Speaker (Judith Cummins)]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I associate myself with the comments of the Secretary of State and the shadow Secretary of State regarding the abhorrent attack in Oldham.

The pressure on our hospitals this winter brutally demonstrates the scale of action needed after years of Conservative neglect of the NHS. Across England last month, 71% of A&E patients were seen within four hours, but that statistic varies wildly depending on where one happens to live. At Shrewsbury and Telford emergency departments last month, ambulances had to wait an average of over two hours to hand over their patients. Just 50% of patients were seen within four hours, and nearly 1,500 patients were left stuck on a trolley for more than 12 hours.

Statistics like these often fail to have much impact now, because we have heard them so regularly—particularly since winter crises have become normalised—but it is very important that we consider who is behind them. It is patients such as my constituent Emma, who having been diagnosed with sepsis spent 48 hours in a fit-to-sit area and then 12 hours on a trolley in an X-ray corridor before finally being admitted, alongside a horrifying delay in the medication required to deal with her life-threatening condition. Yet we often have to wait weeks for data that fully explains what is happening in our hospitals, and no official data is collected about the number of critical incidents. This leaves patients potentially ill-informed, and it makes scrutiny and support in this place, in particular, difficult to provide.

Will the Secretary of State commit to introducing faster and more detailed reporting about the live state of play in our emergency departments, including the number of critical incidents and the temporary escalation spaces, and give a timeline for reporting that information? Will he publish information that shows the impact that delays are having—for example, by looking at the number of deaths in emergency departments—and will he act on the long-term Liberal Democrat request to publish localised data on ambulance delays so that support is provided in areas, such as Shropshire, where it is most needed?

[Wes Streeting]

I thank the Liberal Democrat spokesperson for her usual constructive contribution to proceedings. She is absolutely right to raise the issue of variation in performance across different parts of the country. It is not acceptable, and one thing we will be doing as a Government is to ensure that, as well as creating a rising tide that lifts all ships, we raise the floor in performance so that we see far less unwarranted and unwanted regional variation. She talked about the Shrewsbury and Telford trust, which has had a number of challenges over many years. We have seen some signs of improvement as recently as this week, and we continue to support local leaders as they strive to improve the performance of their system overall.

The hon. Member raises some good and interesting questions about the frequency with which we publish data. It is right that we ensure that data is properly validated so that accurate data is put into the public domain, even as NHS England’s control room monitors live reporting into the centre. I will take into account what she said about her requests both for more live data—collected and published data—about critical incidents and for more localised data in individual trusts, including ambulance services, to monitor variations in response times within a region. Although the points she has raised are interesting, I add the caveat that we would not want to burden the system with more reporting requirements if that causes a distraction from improvement. I tend to lean towards more transparency in data and reporting, however, and I will take into account the representations she has made as we put together our urgent and emergency care plan.

Oral Answers to Questions

Helen Morgan Excerpts

Tuesday 7th January 2025 Commons Chamber

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

Coverage Care, a not-for-profit adult social care provider in North Shropshire that operates 11 care homes and employs around 1,000 local staff, has been in touch to say that it expects the impact of the increase in national insurance contributions to be £840,000 in the first full year of implementation. Given that there are huge numbers of vacancies across adult social care in North Shropshire, will the Secretary of State consider exempting social care providers from the national insurance increase? Otherwise we are putting money into social care with one hand and taking it away with the other.

[Stephen Kinnock]

I refer the hon. Lady to my previous answer on the very substantial funding that we are providing to local authorities, which of course are key to the adult social care system. However, funding must always be married with reform. We have brought forward a packed programme of reform—from data sharing and empowering care workers to take on basic healthcare to promoting better use of care technologies—and in the spirit of cross-party collaboration that we believe is absolutely vital and urgent in this area, I gently encourage her to see those reforms as the first step towards rebuilding our care service and making it fit for the future.

--- Later in debate ---

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

Dentistry is a key part of primary care, yet an estimated 5 million people in England have been left without an NHS dentist. That is why today a petition is being handed in at Downing Street signed by more than a quarter of a million people. We have moved on from the election, but we do not yet have a timetable for when the negotiations for a new NHS dental contract will begin and when another 700,000 extra urgent appointments will be rolled out. Can the Secretary of State confirm the timetable for those improvements? What specifically are the Government’s plans for the new patient premium, and will he offer assurances to dentists that any changes to the current model will be outlined in detail to them as soon as possible?

[Wes Streeting]

We are looking at two things, the first of which is making sure we deliver what we said in our manifesto, including the 700,000 urgent appointments. We are determined to deliver those as fast as we can and my hon. Friend the Minister for Care is having discussions with the British Dental Association to that effect. He is also looking closely, as am I, at the money that is already going into NHS dentistry—how that money could be better spent and how it is that year after year, despite people’s teeth rotting to the extent that they are having to pull them out themselves or children having to attend A&E to have their teeth pulled out, we saw consistent underspends in the dentistry budget under our predecessors. We are determined to give dentists the tools to do the job so that patients can see a dentist when they need one.

NHS Backlog

Helen Morgan Excerpts

Monday 6th January 2025 Commons Chamber

[Helen Morgan (North Shropshire) (LD)]

I beg to move,

That this House has considered backlogs in the NHS.

Happy new year to you, Madam Deputy Speaker. I thank the Backbench Business Committee for granting the debate. I applied for it because many Members were interested in having the chance to discuss the problems and consult constructively on the potential solutions for the NHS across the country. It has ended up being a particularly timely debate given the Secretary of State’s statement this afternoon, which we broadly welcomed.

The Conservatives have pushed the NHS to breaking point, leaving a legacy that includes the biggest waiting list in history and a healthcare system on the brink of collapse. We have reached a crisis point of backlogs in the NHS system. They affect not only those who are in dire need of medical care, but the wonderful staff who work tirelessly in hospitals, GP surgeries, dental surgeries, pharmacies, social care providers, hospices and so on. The situation in Shropshire right now demonstrates the scale of the crisis.

The pressure is extreme on every aspect of healthcare and reflects the fact that in many cases rural areas are bearing the brunt of a national problem. Shropshire’s NHS has declared a critical incident—one of many across the country, I know—as staff battle to cope with the huge winter spike of viruses. That means that people cannot visit their loved ones on a regular basis, and are required to wear a mask when they go into the hospital. That is just one example of how the system is failing to cope with the pressure.

Understandably, talk about NHS backlogs centres on the 7.5 million cases waiting for treatment. But backlogs also apply to the overflowing A&E waiting rooms and to the long lines of ambulances queuing outside. They apply to the elderly people who have fallen and waited many hours for an ambulance. They apply to possible heart attack and stroke patients being told to make their own way to hospital by West Midlands ambulance service at certain times this year. Outside Shrewsbury and Telford hospitals last Sunday—the latest day we have data for—ambulances waited an average of three hours and 48 minutes to hand over a patient. Across England on the same day, 2,620 patients had to spend more than an hour stuck in an ambulance waiting for space to become available at A&E.

[Steve Darling (Torbay) (LD)]

In my constituency, our hospital faces almost 700 sewage leaks, which has an impact on its ability to provide services. That is another pressure. Does my hon. Friend agree that the sooner the Government advise on what investment they will make to enhance services for our hospitals across the UK, the better?

[Helen Morgan]

I had not put the crumbling estate into my speech, but my hon. Friend makes a very valid point, because people cannot work efficiently when they are dealing with terrible hygiene and safety issues around them every single day.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Lady on bringing forward this debate, and on being so consistent and assiduous on this issue. I understand that she will come on to the Lib Dem manifesto, which a lot of us in this Chamber, whether Lib Dem or not, can agree with. In Northern Ireland we have the health and social care board, which has been working on various strategies to reduce the backlog, but the scale is truly significant. Does the hon. Lady agree that, collectively, England, Scotland, Wales and Northern Ireland should look at all the recommendations and bring them together so that this great United Kingdom of Great Britain and Northern Ireland can benefit collectively?

[Helen Morgan]

The hon. Gentleman always makes an excellent contribution to our debates. He is right that we should look at best practice in Northern Ireland and the devolved nations, as well as in England, to get the right solutions for the problems that we face. I hope colleagues will forgive me as will not take any more interventions because we are tight on time and a lot of people want to speak.

We have reached a point where patients suffering heart attacks are being advised to find their own way to hospital. How can that be acceptable? Once patients get into A&E, they are confronted with the brutal reality of the backlogs. The reality means that only half of patients arriving at A&E in Shropshire were seen within four hours in November. The statistics are shocking, but individual people with serious problems suffer as a result—people such as my constituent with a pericardial effusion, who was deemed fit to sit and left in a chair for more than 24 hours before finally being taken on blue lights to receive the care she needed.

Staff in this situation are so overworked that the standard of care that they give is below what they would like to provide. The patient’s dignity is compromised, and staff are being driven from the service because they are unable to provide the care that they desperately want to. Until the Government put a plan in place to solve the workforce crisis, there is a risk that these scenes will continue to happen. In my local hospital trust alone, a total of 854,839 hours of nursing shifts went unfilled in the 12 months to October.

Liberal Democrats are calling for a qualified clinician in every A&E waiting room to ensure that anyone whose condition is deteriorating is treated more urgently. We are also calling on the Government to publish accessible localised reports of ambulance response times so that the delays that blight places such as North Shropshire and other rural areas can finally be addressed.

A key reason for the emergency backlog is that every day, around 12,000 hospital beds are filled with patients who could leave if they had a care package in place. That is the equivalent of around 26 hospitals being out of action every day. That is why Liberal Democrats have been banging the drum for social care. Without capacity in the care system, beds will remain blocked, A&Es will stay clogged and ambulances will continue queuing outside hospitals.

I am pleased that the Government have finally listened to our call for cross-party talks to fix a broken care system, and I look forward to constructively engaging with them throughout that process, but we cannot afford to wait three more years for this plan to be enacted. I hope that the Government will reconsider their timescale and get the review done as soon as possible, so that the care sector can see the long-term cross-party commitment to reform that it so drastically needs.

Part of solving this issue is supporting preventive measures, which stop people needing secondary care in the first place. I recently visited the North Shropshire charity Energize and saw the work of its Elevate programme, which works to improve fitness, balance and co-ordination in elderly and frail patients. It has had some amazing achievements: I met a gentleman suffering from Parkinson’s who had been falling five times a week before he started his programme, and who is now falling only once a week. Of course, it would be great if he did not fall at all, but I am sure everybody would agree that that is a huge improvement. It is estimated that for every £1 invested in that programme, £26 is saved, so it is an area where we can really make a difference to the crisis in the NHS.

Few backlogs have as much impact as those in cancer diagnosis and care. Nationally, the target of 85% of patients receiving treatment within 62 days has been missed every month since December 2015. At my local hospital trust, fewer than two thirds of patients began treatment within the 62-day target. Improving this situation is integral to increasing survival rates. It is also key to restoring patient faith in the NHS, stopping cases like that of my constituent, whose family felt completely failed by the NHS after he waited almost a year for treatment after first presenting with bowel cancer symptoms. Could the Minister clarify whether the Government remain committed to meeting the cancer waiting time targets this Parliament, as promised in their manifesto, and whether those targets will be included in their new national cancer strategy?

To achieve that improvement, we need to address key workforce issues, notably in radiology, where there is a 31% shortfall of consultants across the country. Again, in rural places such as Shropshire, it is recruitment and retention issues that have caused the sharpest problems. Throughout 2024, it became normal in Shropshire to wait months for cancer test and scan results, with patients in my constituency only receiving their results after their next scan was due to have happened. I am pleased to report that under new management, this backlog is now in the process of being cleared. However, that is happening due to overseas outsourcing, which is not a sustainable long-term solution for this country. We need to retain, recruit, and retrain more radiologists and ensure that enough modern equipment is in place across the country so that no one has to wait too long or travel too far to get the scans that they need. Will the Minister address whether that will also be part of the national cancer strategy?

We cannot talk about backlogs without talking about mental health. According to the Darzi review, 1 million people were waiting for mental health services by last April, over 340,000 of whom were children—children whom we as a nation need to protect, because they are our future. Waiting times for child and adolescent mental health services are shocking in every constituency in the country; from ADHD diagnoses to anxiety, depression and eating disorders, far too many people are not getting the urgent support that they need. A headteacher of a school in north Shropshire told me that in recent years, nine students at his school have lost a parent to suicide, yet there are no community mental health services in the town.

Along with the Government, Liberal Democrats would introduce a mental health professional in every school. However, we are also calling on the Government to improve early access to mental health services, and to cut mental health waits by establishing mental health hubs for young people in every community and introducing regular mental health check-ups at key points in people’s lives when they are accessing the NHS, so that we can pick up those problems and intervene early.

Meanwhile, GP surgeries are also struggling to handle the growing pressure being exerted on them. More than a million patients who tried to contact a GP last year could not get through. If patients cannot access primary care, they seek help elsewhere, or they do not seek help at all; in both cases, this creates further problems down the line. In Shropshire, we have lost 14.3% of fully qualified GPs in the past eight years. A young constituent of mine had to wait seven weeks just for a telephone consultation—a wait that would have been even longer if they had wanted an in-person meeting. Liberal Democrats would give everyone the right to see a GP within seven days, or within 24 hours if it was urgent, using 8,000 more GPs. If we can improve primary care, we can reduce backlogs across the health and care system.

Yet the Government have pledged to increase national insurance charges that could cost GP surgeries the equivalent of 2 million appointments a year. This hike will also hammer pharmacies, with more than a third of pharmacy owners now worried that their business may not survive the winter. If pharmacies close, backlogs will simply increase elsewhere. If we can keep them open and improve services such as Pharmacy First, we can reduce pressure across the system. We would like the Government to commit to removing the increase in employer national insurance contributions to support these crucial community services, so that fewer people end up in hospital and more people are treated in the community, where they will get better and quicker treatment.

Meanwhile, in dentistry, where practices will also be hit by the national insurance rise, there is not so much a backlog of care as an absence of care. Some 6 million adults in the UK are not registered with an NHS dentist and, in places like Shropshire, it is becoming almost impossible to find one, with increasing numbers of practices handing back contracts that have become unsustainable. One of my constituents has been trying to register with an NHS dentist for five years, while another pulled out his own tooth with a pair of pliers.

The Labour Government must show that they understand the problem better than the Conservative Government, whose solution was to introduce golden hello payments. They have been in place in Shropshire for years and they have not achieved the desired outcome. With that in mind, will the Minister outline the Government’s plans in relation to the new patient premium and offer assurances to dentists that any changes will be communicated, so that practices can plan and prepare to best serve their patients? NHS contracts need to be reformed so that we can end the use of the term “dental desert”, end DIY dentistry and guarantee access to people who are in pain.

In conclusion, the Liberal Democrats believe that people should be able to take control of their own lives and their own health. That means everyone should be able to access the care they need, where and when they need it. We welcome much of today’s announcement on elective care, and we welcome today’s announcement on social care, but we are concerned that the decision to hike employer NICs could worsen the crisis in the NHS. Hitting GPs, hospices, dentists and social care providers with higher taxes makes no sense. The Treasury is giving to the NHS with one hand, but taking away with the other. We also want much faster action on social care. As I said, I look forward to engaging constructively with the Minister to come up with the consensus we need, but we cannot afford to wait until 2028 for improvements to be made.

The Conservatives’ legacy on the NHS is that it is on its knees. The Liberal Democrats understand that there is no magic quick fix to change that, but to give people the care they need and deserve we must look at the measures needed for the whole service, giving equal priority to both heart attacks and hip replacements.

--- Later in debate ---

[Helen Morgan]

Looking at the time, I shall be extremely brief. I thank all colleagues who have come along today to make such thoughtful and, in some cases, harrowing contributions to the debate. I would like to thank the Minister, the shadow Minister and the hon. Member for Chichester (Jess Brown-Fuller) for their contributions and for so effectively summing up the arguments that have been made today.

Everybody knows that the NHS is in crisis. The Government have acknowledged that, which is welcome. We all want to see things improved for our own constituents, who are suffering the consequences of a system that is on its knees. I welcome the Government’s announcements over the past few weeks. I hope they will listen to the constructive comments made by Liberal Democrats, because they are intended to deliver the NHS that our constituents deserve, and that I know the staff who work in the NHS want to be able to deliver.

Question put and agreed to.

Resolved,

That this House has considered backlogs in the NHS.

Health and Adult Social Care Reform

Helen Morgan Excerpts

Monday 6th January 2025 Commons Chamber

[Mr Speaker]

I call the Liberal Democrats spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I add my thanks to those of the Secretary of State and the shadow Secretary of State to all those who worked in our health and care services over Christmas and the new year.

Our health and social care system is in crisis, so the Liberal Democrats are broadly supportive of the measures that the Government have announced today. However, we do have some concerns, not least that action on social care may arrive too late and that the focus on elective care may come at the expense of emergency care. The Liberal Democrats have long called for cross-party talks on social care, so we are glad that the Government have listened and we look forward to working constructively with the Secretary of State and other UK-wide parties as the review develops. However, carers, care providers and councils are on the brink of bankruptcy and they need solutions right now, not in three years’ time. There have been many such reviews, and what is needed now is action on the recommendations they have made.

It is absolutely crucial that waiting times for elective care are cut radically, so the action announced today to speed up scans and treatment is very positive. A waiting list of more than 6 million people is one of the worst legacies left by the Conservatives, but those legacies include overcrowded A&Es and unacceptable ambulance delays, which can mean the difference between life and death, as people in North Shropshire know only too well. Emergency care is under immense pressure at the moment—one visit to Shrewsbury hospital demonstrates that—and we need bold action if we are to ensure that this is the last ever winter crisis.

As the MP for a rural area, I hear every week from constituents suffering because of the crisis, so they will be following today’s developments closely. Many of my constituents are elderly—far more than average—and they are the people most likely to need the NHS and the most likely to be digitally excluded. According to Age UK, around 29% of people aged 75 and over do not use the internet, and around a third do not have a smartphone. They deserve as much choice and control as everybody else, so can the Secretary of State outline how those without access to the NHS app will be able to benefit from the same options and information as those who do have access?

Will the Secretary of State consider fast-tracking the social care review so that the sector can get the urgent attention it needs? Will he commit to rescuing our emergency services by supporting Liberal Democrat calls to make the NHS winter-proof with a new winter taskforce that builds resilience in hospital wards, A&E departments and patient discharging? Finally, will he define what a working-class area is, because the health and care crisis is acute in rural Britain and we cannot afford to be left behind?

[Wes Streeting]

I thank the Liberal Democrats for their support for the commission and for the way in which their party has put the issue of social care much higher up the political agenda, particularly during the general election campaign. That has been very helpful to me in the last six months and to the Government, and we look forward to working with the Liberal Democrats to build as broad a consensus as we can on the solutions to the social care crisis.

As I have mentioned, we have hit the ground running in a number of respects, including the biggest expansion of carer’s allowance since the 1970s. On investment in health and social care, I just point out that the £26 billion the Chancellor allocated to the Department of Health and Social Care alone at the Budget dwarfed what the Liberal Democrats promised in their manifesto. I know that not all the funding decisions the Chancellor and the Government have made in the last six months for the desperately needed investment in our public services have been popular, but I respectfully say to people who disagree with the decisions the Chancellor has made that they need to spell out which services they would cut or which other taxes they would increase, because those are the choices. We have made our choices; we stand by them. What people cannot do is welcome the investment but not say how they would fund it if they oppose what we have done. The Prime Minister, the Chancellor and the entire Government have been willing to make unpopular choices in the last six months because we believe they are the right choices to get Britain out of the hole it was left in by our predecessors. People will not thank us for resorting to the short-termist, sticking-plaster, government-by-gimmick politics that plagued this House during the last Parliament.

I turn to some of the other issues that the hon. Lady mentioned. We will make further proposals on urgent and emergency care reform. I want to take the best of the NHS to the rest of the NHS, whether it is “hear and treat” over-the-phone triage—a more appropriate community response that is often faster than ambulance response times—or getting ambulances and ambulance handover speeded up at all our hospitals with the “release to respond” approach. We have seen that working successfully in some parts of the country, but it needs to be consistently rolled out.

The hon. Lady talked about patient choice for those who are digitally disconnected or do not want to organise their lives around their smartphones. That is why I believe very strongly in choice—different courses for different horses. Those of us who do not book appointments over the phone free up the line so that those who prefer doing their business and booking appointments by phone can get through.

The hon. Lady asked us to fast-track the social care work. The first phase of Louise Casey’s commission will report next year, but we are of course willing to talk to parties across the House about how we move forward.

The hon. Lady urges us to set up an urgent and emergency care taskforce. Let me reassure her that the Minister of State for Health my hon. Friend the Member for Bristol South (Karin Smyth) and I have every week—and often more frequently—convened health and care leaders virtually and in the Department to keep a grip on what is going on, to provide as much central support as possible, and to respond to crises as they emerge. If only that was just about setting up a taskforce. We already have one; what we need is sustained improvement from one year to the next and that is what we are determined to deliver.

Hospice Funding

Helen Morgan Excerpts

Thursday 19th December 2024 Commons Chamber

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

I wish you and the whole team a very merry Christmas, Mr Speaker.

Last week, I visited Hope House in my constituency, where I met beautiful young Esmay, one of hundreds of children cared for by the hospice every single year. She is nearly three and has a life-threatening heart condition. Esmay’s family do not know what the future holds for her, but they know that Hope House will be there to support them, as it has since before she was born.

There are 300,000 people like Esmay treated in hospices every year, and just one third of their funding comes from the NHS. That leaves institutions such as Hope House and nearby Severn hospice reliant on generosity and unable to plan as they wait for confirmation of the funding they will receive from the NHS. That situation has been made more difficult this year because of the increase to national insurance contributions, which Hope House estimates will cost £177,000.

Funding is welcome, and I welcome the Minister’s commitment today. Will she explain whether the increase that she has announced today will cover the NIC hike for hospices and the increase in the living wage that was announced at the Budget? Will she also commit to providing future settlements in a timely manner so that hospice managers can budget effectively for the coming year?

[Karin Smyth]

I thank the hon. Lady for her questions and for welcoming the announcement. She will know that, in the past 14 years, the sector has been neglected, like the rest of the NHS and social care system. As we have repeatedly said, to govern is to choose. We have improved the settlement for the sector this year. Today’s welcome announcement can be used by the sector to manage some of those pressures and deliver the sorts of services it wants for the future.