Puberty Blockers

John Hayes Excerpts

Tuesday 23rd June 2026 Commons Chamber

[James Murray]

If a child is looked after under a care order, the local authority has parental responsibility, so it would need to be part of the consent process as the corporate parent.

I turn to the points raised by the right hon. Member for Salisbury (John Glen) about young people becoming involved in the trial and the checks that are in place to enable that to happen. As I set out earlier, as the trial involves children, it comes with a responsibility to interrogate and understand its design. As Health Secretary, I have sought the most detailed assurances possible from my clinical advisers as to how children taking part in the trial will be protected.

There are a number of important safeguards. As I have said, children can participate only with the consent of a parent or guardian, and the child themselves must consent or assent. They can participate only if they have had a diagnosis of gender incongruence for at least two years, have received psychosocial support through the NHS and are of stable physical and mental health. They can participate only if they are not subject to any safeguarding concerns and if they and their parents demonstrate sufficient understanding of the nature of the treatment, including its possible advantages and disadvantages. They can participate only if the treatment has been deemed clinically appropriate by both the NHS care team and the national multidisciplinary team and if they are already accessing NHS gender services. On eligibility, the bar is extremely high.

The number of young people who would expect to qualify for the trial will be low and the safeguards to ensure their safety and wellbeing will be rigorous. I have sought and had an assurance that, once they are involved in the trial, participants may be withdrawn at any point. We are not proceeding with the previous, now decommissioned, model of care overseen by the Conservatives when they were in government. We are proceeding cautiously, with rigorous safeguards in pursuit of the evidence, as Dr Cass recommended.

Last Thursday, the independent MHRA approved an updated protocol that significantly strengthened the objective criteria for withdrawing children from the trial, which is a change that I welcome. Signs of greater risk to participants will now trigger increased monitoring, clinical review or their automatic withdrawal from the trial. All participants will be monitored before, at the start of, every three months during, and after the trial. Before and during the trial, information will be collected about mental health, quality of life, self-harm and suicidality, body image, cognition, puberty stage, physical health and side effects.

I have been determined to ensure that the oversight of this trial is as rigorous and robust as it possibly can be, so I have requested monthly updates on its progress. That will include my being notified of any emerging risks.

This trial is rightly one of the most scrutinised UK clinical trials of recent times. We should expect nothing less when we are talking about the health and wellbeing of some of the most vulnerable children in our country. Yet, as Dr Cass has made clear, we have to build the evidence base to show whether the treatments are safe and whether they produce the positive outcomes that young people and clinicians want from them.

The Opposition’s motion would prevent us from following expert clinical advice, when proceeding with the trial is the most appropriate way forward. I say that not because I am suggesting that we should feel instinctively comfortable in doing so but because I have arrived at that conclusion after considering the clinical evidence and receiving robust assurances on the safeguards that are in place.

[Sir John Hayes (South Holland and The Deepings) (Con)]

I know that the Secretary of State has agonised over this matter—he made that clear in his statement to the House last night and again today—but what is not in doubt is the harm that these drugs do. It is an established medical fact. He is determined to be driven by the evidence. That is evidential. We know that the drugs have harmful effects, so in essence what he is saying is that we are prepared to wear those harmful effects on the off-chance that the drugs may have a beneficial set of effects, when there is no evidence to suggest up until now that they do.

[James Murray]

The MHRA has introduced additional safeguards. As a result of its dialogue with the trial sponsors, the amended protocol published last week increases the level of safeguards. That means that if the regular monitoring, which will happen at least every three months—it can be more regular during the trial—shows any sign of increased risk of harm, that will lead to increased monitoring, clinical review and, when considered against objective criteria, automatic withdrawal from the trial.

It is a question of monitoring this trial, possibly more closely than any trial before—the level of scrutiny is very great indeed—to ensure that at the first sign of any increased risk of harm, action will be taken. That is the assurance that I have sought in interrogating this matter carefully in recent days, and that is the basis on which I am talking to the right hon. Gentleman and others in the House today.

We must come to a fair and settled conclusion on this matter to move forward as a country, and I believe that we should follow clinical advice and establish the clinical evidence gathered in a highly scrutinised trial with all the safeguards in place that I have described. Only that approach will give us the confidence about where we settle on this matter in the future. On that basis, the Government oppose this motion.

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[Sir John Hayes (South Holland and The Deepings) (Con)]

The journey from childhood to adulthood is challenging for many, difficult for some, and tortuous for a few. Through that journey, the support of older people, who are often parents, loved ones, people who care, is critically important. For those who suffer from gender dysphoria, that journey is all the more challenging. Many people—perhaps all of us in this Chamber—will have struggled with the emerging sexuality that is part of the journey to adulthood, but most people who suffer from dysphoria cope with it as they go through puberty. Indeed, the evidence—and there has been much talk of evidence in this debate—shows that medical intervention in those cases would not only be unnecessary but profoundly damaging.

Yet at the Tavistock clinic, the horrors of which I first highlighted in 2019, thousands of children were prescribed life-altering drugs. Indeed, it is more shocking still: more than 70 children aged three and four were sent to that clinic, and 382 children aged six and under were referred. The Government are fond, now, of speaking about the Cass review commissioned by. the previous Government, but the review was not welcomed by the Minister and the trans lobby. When it was commissioned, it was regarded with horror by those who presumably now support this trial.

The Cass review found that doctors must be extremely cautious about giving trans drugs to under-18s—not 11, 12 or 13-year-olds, but people under 18. It found that doctors must be able to

“refer to the longer-term benefits and risks”

of treatment options; that young children should have therapy before they are allowed to socially transition; that many parents expressed concern about their child being socially transitioned and affirmed in their expressed gender without parental involvement; that too many decisions about changing gender have been rushed, with too little consideration given to whether children might regret their actions later in life; and that childhood trauma, neglect and abuse feature heavily in the cohort of patients seeking gender change.

As many as two thirds of those referred had suffered neglect or abuse, with high levels of parental mental illness, substance abuse and exposure to domestic violence. Those are the vulnerable children who went to the Tavistock clinic, which was closed after pressure from those who understood the horrors that took place there. When it was opened, of course—

[Dr Arthur]

Will the right hon. Gentleman give way?

[Sir John Hayes]

I will in a moment, when I have made an attack on the liberal bourgeoisie, which the hon. Gentleman might want to hear. When the Tavistock clinic was opened, it was seen as an emblem of progress by the liberal bourgeoisie. Now, of course, we know that it was the embodiment of wickedness. On that note, I give way to him.

[Dr Arthur]

I am part of the liberal working class. This debate is not about the Tavistock clinic. The right hon. Gentleman has just quoted Baroness Cass, but one thing he has not said is that she recommended that the clinical trial go ahead. She said recently that she supports the trial because she thinks there will be real benefits to it. Rather than talking about Tavistock, will he address what Baroness Cass, who he quotes extensively, thinks about this trial that we are debating?

[Sir John Hayes]

Baroness Cass certainly wanted to gather more evidence. The evidence we have shows the damage that puberty blockers can do. We know that the substantial science suggests that they affect bone maturation, cerebral capacity and, of course, fertility. It is certain that there is no compelling evidence that puberty blockers have a beneficial effect. That is why she sought more evidence, as she concluded that there was no compelling evidence that they have a beneficial effect.

[Christine Jardine]

As another member of the liberal working class, I wonder whether the right hon. Member has the experience that many of us in this place have of talking to constituents, friends and family who have children who have struggled with their gender identity and have benefited from puberty blockers. While he says that there is no evidence, many of us have direct experience of seeing the benefits in action.

[Sir John Hayes]

That experience clearly contradicts the Cass review’s findings, but it is for the hon. Lady to have that debate, no doubt, with Dr Cass.

What is certain is that we have no indication from the Government about what success in the trial will look like. When challenged on that subject, answer came there none. How will we gauge whether the trial is a success or a failure? Are these children really guinea pigs to be used to provide the evidence that the hon. Lady says is already freely available in her anecdotal experience of communicating with her constituents and others?

We know that there is certainly evidence from other countries. Have the Government looked to draw on that, rather than engaging in this dangerous trial? We know that there is evidence too from the 2,000 or more children who went through Tavistock. Some have suggested that we should look at the data already available rather than putting any more children at risk. Yet despite the Secretary of State’s agonised decision—I do not intend that to be sarcastic or pejorative; I appreciate that the Secretary of State was completely straightforward about how difficult it was to make the decision—the trial goes ahead. I accept that there are additional safeguards—this is not Tavistock; it is something different—but none the less it brings immense risk alongside the determination to try to gain facts. Instead, let us look at Finland and Denmark and at other countries that have already gathered evidence. Let us look at what we know of those who have already been through this process.

G. K. Chesterton said:

“children are innocent and love justice”.

I fear that this trial will steal their innocence and deny them justice. I hope that even at this late stage the Government, recognising that, will abandon this awful trial and save innocent children from that fate.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

We come to the wind-ups; I invite the shadow Secretary of State.

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[Stephen Kinnock]

This is a debate about hormones for suppressing puberty, and is related to the matter that the hon. Lady raises, but it is important that we get the sequencing right. Let us look at the trial and the evidence. That is part of the process of understanding the milestones and the forks in the road faced by children who are experiencing gender incongruence. Let us do this one step at a time.

We are proceeding carefully, cautiously and under the mantra that the safety and wellbeing of children are non-negotiable, and with clarity that a robustly scrutinised trial with rigorous safeguards is the only way of establishing a robust evidence base for puberty-suppressing hormones.

Many hon. Members have asked about safeguards, so let me remind the House what they are. A child can participate only with the consent of a parent or guardian and the child’s own consent or assent, and only if they have had a diagnosis of gender incongruence for at least two years; if they are of stable physical and mental health; if they are not subject to any safeguarding concerns; if they and their parents demonstrate sufficient understanding of the nature of the treatment, including its potential advantages and disadvantages; if they have been deemed clinically appropriate by both their NHS care team and the national multidisciplinary team; and if they are already accessing NHS gender services, including participation in a tailored package of psychosocial care.

[Sir John Hayes]

Will the Minister at least commit to looking again at the experience of Finland and Denmark, whose evidence has led them to now emphasise counselling rather than medical intervention?

[Stephen Kinnock]

A little later, I will go through all the different work that is going on. This is absolutely not happening in isolation; we are taking into account a range of other studies.

Some colleagues have raised the work of the MHRA in strengthening the safeguards for young people involved in the trial. The MHRA has been engaged in a scientific dialogue with the trial sponsors, and it was the outcome of that process that led the MHRA, as an independent body, to publish the updated protocol last week. We welcome the changes, because they show that the MHRA is taking its job seriously and that the system is working as intended. We cannot cut corners when it comes to the safety and wellbeing of children, and the safeguards are now in place to guarantee greater monitoring and clinical reassessment, including objective criteria for withdrawing children and young people from the trial entirely. I remind colleagues that the bar to qualify for the trial is extremely high, with only a small number of young people expected to meet the strict criteria.

Some other colleagues—I turn now to the point made by the right hon. Member for South Holland and The Deepings (Sir John Hayes)—have queried the need to have a clinical trial when a number of children have already taken puberty blockers and information is already available. However, Dr Cass concluded that there is not enough evidence about the risks and benefits of those medications. That is why she was so clear in recommending a trial to find that clinical evidence, because that is the basis on which we can take those decisions.

The information in the data linkage study is much more limited than the detailed information that the research team will be able to collect about the relative benefits and risks of puberty-suppressing hormones. NHS England is, however, committed to delivering the data linkage study and has taken time to ensure that the data is shared by relevant organisations.

Pathways Study: Puberty Suppression

John Hayes Excerpts

Monday 22nd June 2026 Commons Chamber

[James Murray]

My hon. Friend asks about the data linkage study, and I apologise to my hon. Friend the Member for North Northumberland (David Smith), who a few seconds ago also asked about that—I did not respond then but can now address both questions together.

It is important to understand that the information in the linkage study is much more limited than the detailed information that the research team will be able to collect about the relative benefits and risks of puberty blockers. NHS England is, however, committed to delivering the data linkage study. NHS England, since assuming responsibility for that study, has taken time to ensure that the data is shared by relevant organisations. Let me be absolutely clear, for the avoidance of all doubt, that the Government’s clear expectation is that all relevant organisations will provide the data required to complete the study.

[Sir John Hayes (South Holland and The Deepings) (Con)]

I first raised the horrors of the Tavistock clinic in this House in 2019, having been provoked to do so by staff who said that they were often under pressure to refer for life-altering treatment children and young people who had experienced mental health difficulties, abuse and family trauma. Indeed, the Secretary of State will know that the Cass review found that childhood trauma, neglect and abuse featured heavily in the cohort of patients seeking gender changes. As many as two thirds of those referred had suffered neglect or abuse, with high levels of parental mental illness, substance abuse and exposure to domestic violence. So will the Secretary of State, even at this late juncture, abandon this trial? I have no reason to believe that he is anything other than a good man who wants to do the right thing. He has made it clear that he knows that this matter often sorts itself out through puberty and adulthood. I implore him to do so, for I fear that because he is a good man, he will regret this cruel experiment on harmless children.

[James Murray]

I thank the right hon. Gentleman for his comments, and although he and I come to a different conclusion on this, I do not doubt for a second the sincerity of his motivation in wanting to protect children and young people. I actually agree with him, as I said in my earlier comments, that most young children who are questioning their gender will resolve it on their own—let them be to resolve it. But there is a small subset of children who will need extra support, and within that there is a question about whether for a very small subset of them there might be a benefit to having treatment, and that is what this trial seeks to conclude.

I would add that the right hon. Gentleman refers to what happened in the Tavistock clinic and the stories that led to Dr Hilary Cass being commissioned. I think the right hon. Gentleman and I agree on how unacceptable that situation was, and I put on record my thanks to Sir Sajid Javid for commissioning the work by Dr Cass, because it has been such an important piece of work not only to expose what was happening before, but to provide a way forward.

Sudden Unexpected Death in Childhood

John Hayes Excerpts

Tuesday 24th March 2026 Westminster Hall

[Dr Roz Savage (South Cotswolds) (LD)]

I thank the hon. Gentleman for bringing forward this important debate and for his very moving speech. I recently had the honour of meeting Eleanor Wroath, who is here in the Gallery today with her son Sam. Eleanor lost her daughter Miranda, aged 18 months, in 2008. Since then, she has been a tireless campaigner for raising awareness of sudden unexplained death in childhood. She and Sam will be running the Great North Run in support of the charity. Does the hon. Gentleman agree that, as highlighted by campaigners such as Eleanor and Sam, there is an urgent need for more specialist research to understand the causes of and the risk factors underlying SUDC?

[Sir John Hayes (in the Chair)]

Order. Given the seriousness of the subject and of the hon. Lady’s intervention, I let that go, but interventions should generally be slightly more pithy.

[Andy MacNae]

Yes, of course I agree, and I am coming on to the research. We simply owe families answers and our best efforts to find those answers.

As I was saying, we know that research and awareness raising, backed up by national leadership, can make a profound difference, as it has in other areas. When priorities are clear, progress does follow. For example, research and safer sleep campaigns have significantly reduced unexplained infant deaths—known as sudden infant death syndrome, formerly cot death. About 200 babies die from SIDS each year compared with 40 older children from SUDC, yet there has been 100 times more research into SIDS than SUDC, which receives only a fraction of the attention.

Peter Fleming CBE, the clinical lead for the SIDS Back to Sleep campaign and a scientific adviser to SUDC UK, has said:

“Research into unexpected deaths in infancy has led to an 80% reduction in such deaths over the past 30 years in the UK. Unexpected deaths in older children are less common, much less well understood, and to date little research has been conducted in the UK to try to understand or prevent such deaths… I am convinced that with the right research we will soon be able to prevent many deaths”

of older children. The families here today are not asking for guarantees—they understand that science takes time—but simply asking for this issue to be treated with the urgency it deserves.

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[Several hon. Members rose—]

[Sir John Hayes (in the Chair)]

I remind Members to bob—and I can see that they are doing so. A number have indicated that they desire to speak. Given the seriousness and sensitivity of the subject, I want to be able to get them all in. Please bear that in mind when you contribute.

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[Lincoln Jopp]

As ever, the hon. Member is making an incredibly powerful speech. I know he feels these things incredibly strongly. I am sure we are all looking forward to his closing remarks.

[Sir John Hayes (in the Chair)]

Jim, why don’t you bring your remarks to a conclusion?

[Jim Shannon]

I will do that. Let us work together to make sure every child has the chance to grow up, and every family has the answers they deserve. While we do not mourn as those do who have no hope, I always treasure the fact that Jesus wept with Mary in her grief, even though he had a plan. God has a plan; sometimes we do not understand what it is, but we have to trust. So we weep together and we hold on to the hope we have. Today, we express our determination to do more for those grieving in our families, in our towns and in our great nation of the United Kingdom of Great Britain and Northern Ireland.

[Sir John Hayes (in the Chair)]

I call Michelle Welsh. Michelle, I want to start the winding-up speeches at around 10.30 am.

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

It is a pleasure to serve under your chairmanship this morning, Sir John. I declare an interest as an NHS consultant paediatrician and as a member of the Royal College of Paediatrics and Child Health. I congratulate the hon. Member for Rossendale and Darwen (Andy MacNae) on securing today’s important debate.

The death of a child is every parent’s worst nightmare. It is perhaps even more horrific when such a death happens suddenly, without warning and when no explanation can be found. I would like to convey my condolences to the family of Frankie Grogan, to Cheryl, Darren and Louis, to Nathan and Fiona, to the Rogers, Pitts and Williamson families, and to all other families grieving such a profound loss.

Childhood death is thankfully rare. However, more than 3,400 children aged nought to 17 die in England each year, and in around 40 cases the death cannot be explained. Parents are left with more questions than answers. Why has this happened? Why now? Since many cases are unwitnessed, did the child suffer? What was the cause? Could it have been prevented? Will it happen again to a sibling or a future child?

I want to focus on two questions today: how do we identify the cause of death in more cases? And how can we use that information to prevent future deaths? We can do that because we have done it before. In the 1980s, 2.35 children per 1,000 live births died within between a week and two years. That has been reduced by over 90%. The key factors were research, the Back to Sleep campaign, general safe sleeping advice and the avoidance of cigarette smoke. There is more to be done, but with the right plan, we have shown that lives can be saved.

I would first like to acknowledge some progress, including through the work of Baroness Kennedy, whose 2004 report and subsequent work with the Royal College of Pathologists and the Royal College of Paediatrics and Child Health led to the introduction in 2008 of a standard set of clinical samples, called Kennedy samples, that must be taken in the event of a sudden child or infant death. In most of the trusts I have worked in, there is now a box in each emergency department with all the samples and a list of what needs to be taken so that nothing is missed in any cases.

Child death overview panels, which were also established in 2008, are multidisciplinary panels to review the deaths of all children aged nought to 17. That process was further updated in 2018. When a child dies, all registrars must inform the child death overview panel, of which there are currently 58 in England. An expected death goes to a review meeting to look at the detail of the causes and whether it can be prevented in the future. In an unexpected death, there is an urgent joint agency response meeting including police and education, and a review meeting takes place later. All that information then feeds into the national child mortality database, set up in 2019, which is there to spot patterns and aims to prevent future deaths. It produces several reports each year with detailed guidance for Government on how deaths can be prevented.

It might be helpful to discuss an example. In December 2024, the NCMD published a report on child deaths due to asthma or anaphylaxis. I commend those who produced that report, including my medical colleague Dr Emilia Wawrzkowicz. They found that certain factors increased the risks of asthma or anaphylactic death in children, and that milk was most likely to trigger a fatal reaction. They found problems with auto-injectors that were forgotten, out of date or not with the child, or that the training had not been adequate, particularly in schools. They found issues with indoor air pollution, a failure to recognise life-threatening asthma and that children did not have asthma action plans.

Work has been done in many of those areas, which will have saved children’s lives since. My hon. Friend the Member for Rutland and Stamford (Alicia Kearns) has been promoting Benedict’s law, which hon. Members voted for just last week, to ensure that children at school are protected from anaphylaxis. Can the Minister update the House on progress in delivering the recommendations of the national child mortality database’s report? At the moment, the Government are not obliged to produce a response to the recommendations of the national child mortality database’s reports, unlike many other reports, and I think they should be. A more recent report was on the effect of consanguineous marriage on the rate of child deaths. It would be helpful to have Government responses to show that those reports are being read and acknowledged, and that the work that has been done is leading to change.

I worry about the effect of the imminent abolition of NHS England on the national child mortality database’s work. Child death overview panels do very good work in investigating each child death individually, but ICB funding cuts mean that not only bereavement staff, but investigatory staff, are being cut. The mergers of ICBs mean that local knowledge may be lost as the areas become very large. That is not in line with the statutory guidance in the Children Acts. Can the Minister update us on the Government’s plans in that area?

Whole genome sequencing offers an increased likelihood of finding children’s causes of death, but there is a long wait for results; it can take six months. Families are in great distress while they wait for those results, as we have heard. The Government suggest that they want to expand genome sequencing work, but it has already taken a very long time and the workforce plan has not yet been published. What are the Government doing to make sure we have the right staff and the right capacity to deliver that ambition?

Skin biopsies can be very helpful, particularly in diagnosing inborn errors of metabolism, which in children can cause illness and death, but they are not yet available everywhere. Can the Minister update the House on what is being done to roll out these tests so that, where possible, all causes can be found?

The Liberal Democrat spokesperson, the hon. Member for Mid Sussex (Alison Bennett), mentioned the fact that there are not enough pathologists. That is very important because it causes distress and delays, including to post-mortems, and it means that families have to wait much longer for results. Also, some children tragically die overseas, as happened to one of my patients relatively recently. In such cases, SUDC panels rely on being told about it and find it more difficult to investigate. Does the Minister have any comments on that?

Hon. Members talked about research. The Lullaby Trust has been doing gene sequencing on tissue samples from children who died of sudden unexplained death. In four of 20 cases, the tests were able to find evidence of infection, so there is hope that people who have been bereaved by a sudden unexplained death in the past can, with more modern techniques and retained tissue samples, discover the cause in the future. However, that will only happen if the research takes place. This research is charitably funded. We heard about the charity-funded research being done in Bristol, but the Government also need to fund research so that we get as much information as possible to prevent these deaths.

Lastly, I will talk about bereavement support. We have heard about the vital role that it plays in helping families, including siblings, in their time of grief, but I have heard about cuts to that as a result of mergers and funding changes to ICBs. In one case, a phone line has been taken away, meaning that families who want to approach bereavement support have to email and wait for a response—I can see hon. Members frowning. This is clearly not good enough, so I urge the Minister to look carefully at it and take the time to find out what is going on in each ICB regarding the commissioning of these services, so that we are not leaving families without the support they need during the most awful time they could ever experience.

What we have heard today is a call for action. We have heard a call to explain the unexplained, support families better, improve on research and, ultimately, to prevent the deaths of children.

[Sir John Hayes (in the Chair)]

In calling my long-standing friend, Mrs Hodgson, I let hon. Members know that she has agreed to leave a couple of minutes at the end for Mr MacNae to wind-up. In turn, he is about to agree to leave a couple of moments at the end for me to move the motion.

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[Mrs Hodgson]

I think I may have mentioned some Government-funded research, but I will commit to write to the hon. Gentleman on that point, rather than try to guess what I may have said.

In closing, I again thank my hon. Friend the Member for Rossendale and Darwen for bringing forward this debate, and all hon. Members for their heartbreaking speeches. Those of us here today who have had the privilege of taking part in this debate will never forget them and the names of the children either: Frankie, Miranda, Jack, Louis and Harry—as well as all the other precious children who we have lost to SUDC. The names, families and circumstances mentioned today are all in Hansard now forever. I want to thank all the families in the Public Gallery for being with us today and for their campaigning for change, research and better support.

A number of Members here today recognise that drive because it is what drove us here ourselves. I take on board the plea from the hon. Member for Spelthorne (Lincoln Jopp) to ensure that we see progress and do not all find ourselves back here in a few years’ time having the same debate. We will continue to work with clinicians, researchers, charities and—above all else—families to deepen our understanding, strengthen the support available, and ensure that every child’s death is fully examined and that their life is never forgotten.

[Sir John Hayes (in the Chair)]

Thank you, Minister. Before I call on Andy to wind up, I echo the thanks to all Members for contributing to this important debate. I also particularly thank all those who have taken time to attend in the Public Gallery. Thank you so much.

Disability Equipment Provision

John Hayes Excerpts

Wednesday 11th March 2026 Westminster Hall

[Sir John Hayes (South Holland and The Deepings) (Con)]

I want to speak about three things in this debate, which was helpfully secured by the hon. Member for Aberdeenshire North and Moray East (Seamus Logan).

The first has already been dealt with but requires some amplification: the system is not working as well as it should. The figures that we heard quoted about access to wheelchairs, for example, are stark and surprising. In researching for the debate, I was surprised that, according to figures from NHS England—and we heard it again from the hon. Member—70% of wheelchair users wait more than three months for their chair, 30% wait more than six months, and 15% more than 12 months. Those are pretty astounding figures.

I say to the Minister: do not let the perfect be the enemy of the good. If those people could be provided with some help—perhaps not the chair ideally suited to their needs but something that assisted them—through a recycling scheme, I am sure that they would feel that the authorities were at least making an effort. If someone is sitting at home, hearing nothing and getting nothing, they must get increasingly frustrated. Let us be more creative in how we improve those numbers. Recycling equipment has to be at the heart of that. It is not a perfect solution, because equipment often has to be tailored to the specific requirements of the individual concerned, but it might help.

The second point I want to raise is about housing. There are real problems with adapted housing, with the obligation on developers to build enough adapted houses, and with local authorities facing up to their responsibilities. I know that you are a great expert in this field, Mr Betts—a greater expert than me—but I would like to go back to the days when adapted housing was built for the elderly, the infirm and the disabled, perhaps with a resident warden who would take personal care in their interests and be available night and day for their needs. I am talking not about a distant individual obtained by means of a telephone or—heaven forbid—online, but about someone with hands-on knowledge of local residents. That existed in our lifetimes, and it does not exist now in any significant shape or form. Let us think again about best practice from past times in respect of housing, and create some obligations on local authorities and private developers to build a sufficient number of adapted homes.

It is not just me; various reports have indicated the need. Analysis published in January 2026 by the Office for Equality and Opportunity, “Disabled people’s lived experience of housing in the UK: an evidence review”, stated that there are specific requirements or financial provision to provide suitable housing, but that the physical design of adaptations needs more understanding of individual needs, and that too often adaptations were not focused on the quality of life, wellbeing or independence of the person living there. Let us do more, and better, in respect of housing.

My final point—I said I was only going to make three—is perhaps something that others will not raise, or certainly have not so far: the way that the provision of all kinds of other services can support disabled people. For example, various organisations that represent the blind and partially sighted have reported that flat bank cards have been a huge disadvantage to partially sighted people. Access to cash is actually quite important, because coins, which can be felt and are tactile, are important for small transactions. These small things make a huge difference to people’s lives. We need to think more laterally, and give considerably more thought to such small ways in which we as a Parliament, and the Minister as part of a Government, can make a huge difference to disabled people in all our constituencies.

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[Dr Luke Evans (Hinckley and Bosworth) (Con)]

It is lovely to see such a thoughtful, thought-provoking debate, with cross-party unity on the question of how we can better support our constituents who are suffering. It could be with a stairlift, a shower, a home aid or an adaption. When I was a GP, I saw what difference that can make to people. More recently, I visited Mounts & More in Stoke Golding, a company of specialists who support wheelchair users. Margaret and her family started Mounts & More in Market Bosworth in 1996; it fits mounting systems, such as for augmentative and alternative communication, to wheelchairs. The company’s best example is of Professor Stephen Hawking—it fitted the specialist holding position for such equipment. It also drives innovation and the small business side of things that we so long for in the UK.

I am keen to dive straight into some of the questions asked, as time is short, but before I do so, I pay tribute to the hon. Member for Aberdeenshire North and Moray East (Seamus Logan) for being so succinct in his well thought out speech. He is a rare parliamentarian in that he had only a single question for the Minister. I congratulate him on that. He raised a significant point about strategy. The Government say they do not have a plan to bring forward an equipment strategy, and they tend to point towards the ICBs as the commissioners on this.

There is going to be some difficulty, though, if the ICBs are cutting their staff by 50%. I do agree with the Liberal Democrat spokesman, the hon. Member for Epsom and Ewell (Helen Maguire), who asked whether there is an opportunity to look at what can be done in the forthcoming health Bill. I would be grateful if the Minister would set out whether this is a consideration when it comes to dealing with support for people with disabilities.

I have another question for the Minister on the disabled facilities grant. The Government have done a review, which is welcome, and recently published their look at the issue. As more and more people become infirm—the good news is that they are living longer, the bad news that they have more disabilities—the need will go up. It is not clear from the information that has been published just how that will be monitored. How will we ensure that the funding is going to the right place and working? There is a calculator on the website that says how it will be redistributed, but I point out that clarity on accountability will be hugely important. I would welcome input from the Minister on what that will look like.

[Sir John Hayes]

On that specific point, the Government have said that that additional money for the grant will provide about 5,000 additional home adaptations. It would be really useful if the Minister, when he responds, could describe how local authorities will access that funding, how those 5,000 adaptations will be distributed across the kingdom and what kind of adaptations we are talking about. Are we talking about adaptations to new build houses or long-standing traditional houses in the private or public sectors? A bit more detail on that would be very welcome.

[Dr Evans]

My right hon. Friend has hit the nail on the head. This is part of the problem in how we get different parts of the system to work together to get a full understanding of the situation; that is most important for those who are affected, but also for the commissioners who are trying to make the decisions on where the equipment goes. I hope the Minister has heard that and will be able to work it into his response.

I was very pleased to hear the hon. Member for Bexleyheath and Crayford (Daniel Francis), the chair of the APPG, raise the very important issue of the insolvency of NRS Healthcare. For those who do not know, NRS Healthcare accounts for about 40% of coverage, covering 15 million people and 21 local authorities across the country. Its insolvency showed a weakness in the way we deliver our supply.

I wrote to the Government back in the summer to try to find out what was being done and what lessons had been learnt. I received a generic response early on in August, saying that things are being kept under review. It stated:

“The Department continues to monitor the situation closely and will support LAs to learn lessons and consider the implications for future resilience in this market.”

I followed up very quickly and wrote back in September to ask more questions, but unfortunately I have not as yet received a response. I have with me a copy of the letter that was sent asking questions, particularly about what lessons have been learnt in this case and, more importantly, what is being done to implement more resilience in the supply chain. I would be grateful if the Minister could take a look.

If such a thing were to happen again, given the stark economic situation we are facing, which I appreciate is outside the scope of this debate, it would have knock-on effects for some of the most vulnerable in our society. I would be grateful if the Government would set out exactly what they are doing to make sure the supply chain is secure.

Finally, I want to raise concerns about the better care fund. The Government have been clear in the 10-year health plan about their promise to reform the fund, which has been very useful in bringing pooling together. However, we have already noticed that NHS England has already reduced the amount of additional voluntary funding it was putting in by £388 million. The example given by my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) goes to the heart of the question: looking from the top down, how do we make sure these things are all integrated? How do we understand what ICBs, councils, the NHS and charities are doing through their provision?

I would be grateful if the Government could set out where they see that better care funding fitting in and when we will actually see the outcome of the changes they propose. It appears that there have been delays in the national neighbourhood health service guidance and delays in the better care fund. Without that structure and without joining it all together, it is very difficult for those scrutinising the system and, more importantly, those working in and using the system to understand exactly what to expect and when. I would be grateful if the Minister would be kind enough to set that out.

I thank Members for their thoughtful contributions today, because, at the end of the day it is really important to shine a spotlight on those constituents who suffer the most and get on with it the most. They are the most pragmatic, fantastic people, and their support is paramount.

--- Later in debate ---

[Dr Ahmed]

I am very grateful to my hon. Friend. He always channels personal experience in such a productive way and he is a credit to this House in the way he conducts himself. I remember his maiden speech with great fondness in that regard. I do agree, and I will come later in my speech to how we can maintain quality more persistently across the whole system.

Access to temporary wheelchair provision to support hospital discharge is also determined locally by ICBs. We recognise that elements of the NHS—despite it being on the road to recovery—are functioning below par and that many people are waiting too long to access equipment such as wheelchairs. During the pandemic, some wheelchair services experienced lower referral rates, which led to a surge in referrals post pandemic. Because of that, providers not only reduced their services but now, of course, face a backlog of referrals. That has meant unacceptable waiting times for both adults and—sadly—children, and those have fluctuated as services work to recover.

However, action is being taken to address waiting times in England. In October 2025, we published the NHS medium-term planning framework, requiring all ICBs and community health services to actively manage and reduce waits above 18 weeks and to develop a plan to eliminate all 52-week waits. The community health services situation report will be used to monitor ICB performance against waiting-time targets in 2026-27, and it currently monitors waiting times for children, young people and adults under

“Wheelchair, orthotics, prosthetics and equipment”.

These targets will guide the system to reduce the longest waits first.

[Sir John Hayes]

Have the Government made any assessment of the return and reuse of equipment? That is not always possible, as I said earlier, but it would be an incredibly powerful message to send to many of those people who have waited so long, and, I think, a very straightforward thing to do. If that assessment has not been made, will the Minister commit today to making such an assessment? That would be a positive outcome from this debate.

[Dr Ahmed]

I am grateful to the right hon. Gentleman, and to those who raised this matter earlier in the debate. It does trouble me deeply that we have a situation in which equipment is going unused when there is that need in another part of the system. I actually feel that quite acutely. Hon. Members may know that I am a vascular surgeon; at times, unfortunately, some of my job involves having to amputate people’s limbs for end-stage vascular disease. I see for myself that transition from someone being able-bodied to needing assistance, and, where that assistance is not available, the impact that has, especially when people know there is this lack of productive exchange of equipment in the system highlighted by hon. Members today. I am therefore very happy to take the issue forward with my officials to see what can be done further to marry the demand and the supply together in the country.

Regarding wheelchair provision, NHS England has developed policy guidance and legislation to support ICBs to commission effective, efficient and personalised wheelchair services. I again nod to the remarks from the hon. Member for Aberdeenshire North and Moray East on making sure we get better, more efficient and personalised service provision.

In April 2025, NHS England published the wheelchair quality framework, developed in collaboration with the NHS England national wheelchair advisory group. The framework is designed to assist ICBs and NHS wheelchair service providers in delivering high-quality provision that offers improved access, outcomes and experience. NHS England introduced personal wheelchair budgets, including legal rights, in 2019, providing a clear framework for ICBs to commission personalised wheelchair services that are outcomes-focused and integrated. Those budgets give people greater choice over the wheelchairs that they are provided with. Additionally, the model service specification for wheelchairs sets out that wheelchair assessments should take place in the most suitable environment based on the needs of that individual.

NHS England is aware, as am I, that several complaints have been made about the quality of services commissioned by some ICBs. NHS England is working through the appropriate regional teams to gain intelligence from those ICBs on quality concerns and contracting arrangements, to fully understand the issues being raised.

Brain Tumour Survival Rates

John Hayes Excerpts

Monday 9th February 2026 Commons Chamber

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

I thank the hon. Members for Mitcham and Morden (Dame Siobhain McDonagh) and for Witney (Charlie Maynard) for bringing forward this debate on a very important subject. The hon. Member for Mitcham and Morden talked about the people she had met who had experienced brain cancer and brain tumours. For me, this debate is about my grandfather, who sadly died of a brain tumour some years ago.

Some 12,000 people have a brain tumour diagnosed each year, and this debate is supposed to focus on how we improve the survival rates for this condition, which are very poor. It is the leading cause of cancer deaths among children and adults under 40. The five-year survival rate is poor and—unlike the rate for many other cancers over the last few years—has not really moved at all. How can we improve the survival rates for people with brain tumours? There are essentially three areas that we can look at: prevention, early diagnosis and better treatment.

On prevention, if we look on the NHS website to see how we can prevent a brain cancer or brain tumour, it talks about having a good diet and preventing obesity. These things are important, but not specific to brain cancer. It also talks about trying to avoid head injury, for example by wearing helmets. What about early diagnosis? Some people have genetic conditions, such as neurofibromatosis, Li–Fraumeni syndrome, tuberous sclerosis and Von Hippel-Lindau syndrome, that make them genetically predisposed to having tumours in their central nervous system. Those individuals can receive regular screening, which can help identify these tumours at a much earlier stage, but what about people who do not have such conditions?

[Sir John Hayes (South Holland and The Deepings) (Con)]

I apologise, Madam Deputy Speaker, for intervening despite not being here for the beginning of the debate. My hon. Friend will know that I chair the all-party parliamentary group for acquired brain injury, and I am also president of the Lincolnshire Brain Tumour Support Group—she is right about the connection between the two. Does she think it would be advisable for those who have suffered a brain injury to be screened routinely, given the correlation between an earlier brain injury and the later advent of cancer?

[Dr Johnson]

My right hon. Friend invites me to speak outside my area of expertise; I am afraid I do not know the answer to that.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)]

I start by thanking my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh), and the hon. Members for Witney (Charlie Maynard) and for Kingswinford and South Staffordshire (Mike Wood) for supporting this important debate. I would like to take a few moments to acknowledge the contributions of all hon. Members across this House—from personal experience, I know how hard it is to talk about these issues when people close to your family are lost to brain tumours. They include my aunt, who was instrumental in my pursuing a career in medicine. She passed away in 1997, only four months after a diagnosis of glioblastoma.

The hon. Member for Witney asked about consent in relation to tumour tissue research, which is a really important and pertinent topic. I am very happy to go away and consult with the Human Tissue Authority regarding the facility we have at the moment, which is quite sizeable, for securing consent to research on tissue from living persons and deceased persons. As a transplant surgeon, I am relatively au fait with some of the consent issues that can arise in using tissue from deceased persons, and I am always very happy to encourage consideration of those issues wherever possible. The hon. Member rightly challenged us to improve our architecture for digital consent. We continue to do so through our “analogue to digital” platform, on which the 10-year health plan is based, not only for care but for research.

I thank my hon. Friend the Member for Colne Valley (Paul Davies) and the hon. Member for Mid Dunbartonshire (Susan Murray) for their thought-provoking contributions to this debate, as well as my hon. Friend the Member for Edinburgh South West (Dr Arthur), who talked so passionately about these issues. I thank him once again for bringing forward his private Member’s Bill, which will do so much to move the dial on research, not only on brain tumours but on rare cancers more generally. He had a specific ask about visa costs for talent coming from elsewhere in the world, and I assure him that we are looking seriously into these issues. Only today, I was chairing a session of the Life Sciences Council, where we talked about the global talent fund. That is pertinent to the discussions that my hon. Friend is having, and I am happy to put the council in touch with him to further those discussions regarding how we attract the brightest and the best to our country to advance the cause of life sciences generally, as well as the cause of researching rare cancers.

The hon. Member for Wokingham (Clive Jones) talked more specifically about referral targets. I can reassure him that we are totally committed as a Government to hitting those national standards on 62-day waits. He challenged us to go to 100%. I caution him that although 85% is possible, 100% is not, usually for clinical reasons. There may be genuine clinical reasons why patients cannot access treatment within 62 days in terms of planning and specialist access.

My right hon. Friend the Member for Hayes and Harlington (John McDonnell) talked about diagnostics. That issue is close to my heart, and I reassure him that through the continued opening of community diagnostic centres up and down the country and £2 billion of funding, I am determined to ensure that diagnostics is improved and available closer to home wherever possible.

The hon. Member for North East Hampshire (Alex Brewer) talked about her friend being diagnosed with a brain tumour in A&E. As someone who was a young casualty officer many years ago, that resonated strongly with me. The A&E department is the last place where any tumour should be diagnosed, but I remember it happening far too frequently as a young casualty officer. One litmus test of the success of our cancer plan will be that much fewer of those diagnoses will be undertaken in an unplanned fashion in A&Es up and down our country.

I am always grateful for the learned remarks of my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley). I always feel like I learn so much from him. In fact, I learned so much tonight that I might add his contribution to my portfolio of continuing professional development when I submit myself back to the General Medical Council to extend my licence.

The hon. Member for Strangford (Jim Shannon) always raises thought-provoking issues about four-nation working. I assure him that I continually and frequently discuss many matters pertaining to the health of our four nations with the Minister of Health in Northern Ireland. I can also reassure him of our UK-wide commitment to the life sciences sector plan and life sciences project. On that note, it was my great pleasure to meet academics from Queen’s University Belfast in this place only a few months ago, where I reaffirmed my commitment as life sciences Minister to the life sciences sector plan being a true four-nation project. That of course includes Northern Ireland, and I know from my own academic interests that much expertise resides in Northern Ireland.

The hon. Member for Epsom and Ewell (Helen Maguire) talked about benign tumours not being forgotten, and she is absolutely right. Those of us from a medical background know that it is a spectrum between benign and malignant tumours. Many benign tumours can evolve into malignant tumours, and they must be captured by plans such as the national cancer plan. She challenged me about publishing regular outcomes from the national cancer plan, and I can certainly commit to that. Those can be scrutinised in the normal way by the Health and Social Care Committee.

The shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson) talked about screening. She will know, as I do, that screening is important when it is evidence-based and where the benefits outweigh the harms. Screening is never harm-free, so it is important to ensure we are calculating these things based on expert evidence. Neither she nor I are experts in screening, so we always defer to the UK National Screening Committee and its deliberations and opinions on these matters.

The shadow Minister asked me about the workforce plan. I can assure her that that is in play and will be published shortly, in the spring or very early summer. She asked how that might interact with diagnostic capacity, and I can assure her that we are working at great speed to ramp up diagnostic capacity through the funding envelope that I mentioned. She will know that it is important, when we plan both for workforce and diagnostic capacity, to take account of AI moving at a rapid pace. We have already been able to eliminate one radiologist from breast cancer diagnoses, and it is entirely possible that we will be able to have a similar impact with technology on the rates of other cancers and, for example, lung cancer diagnostics. It is important that, as we work through the workforce plan, we take account of what the future will look like in that context.

When we came to the topic of the potential association between traumatic brain injury and brain tumours and my hon. Friend the Member for Bury St Edmunds and Stowmarket intervened on the hon. Member for Sleaford and North Hykeham, the medical man in me could not help himself. I looked at PubMed quickly to check whether there was indeed an association, and I picked out a paper that may be of interest to the medical people in this place. Following 24 years’ worth of data from Mass General Brigham hospital, with 75,000 patients on each arm looked at retrospectively, there would seem to be a mild association between severe traumatic brain injury and the diagnosis of malignant brain tumours.

[Sir John Hayes]

As the Minister is now referring to my specialist subject, I thought that I had better intervene. Although I defer, of course, to the immense experience of the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) in these matters, I think that this is associated with lesions and scarring, and that is why, as the Minister said, there is a mild association. As the hon. Member said, there is a much more profound association with other neurological conditions, particularly dementia.

While I am on my feet, may I ask the Minister to address the issue of research? The hon. Member for Bury St Edmunds and Stowmarket is right: diagnostics are terribly difficult, but 1% of the expenditure on cancer research currently goes towards brain tumour research. Can we increase that?

[Dr Ahmed]

I am grateful to the right hon. Member for his remarks. At the risk of turning this into some sort of medical journal club—I will move on quite swiftly, Madam Deputy Speaker—let me point out that the association is based on retrospective data, and we all know that we have to be a little bit cautious with retrospective data. As for the question of research, I can assure the right hon. Member that we are committed to spending more of the £2 billion NIHR budget on rare cancer research, some of which is ringfenced.

The hon. Member for Sleaford and North Hykeham asked about rural areas. In the workforce plan, we are committed to ensuring—

Domestic Abuse-related Deaths: NHS Prevention

John Hayes Excerpts

Tuesday 20th January 2026 Westminster Hall

[Several hon. Members rose—]

[Sir John Hayes (in the Chair)]

I remind Members that they need to bob to catch my eye— although I can see they already know that.

--- Later in debate ---

[Alex Sobel (Leeds Central and Headingley) (Lab/Co-op)]

I start by thanking my hon. Friend the Member for Stroud (Dr Opher), not only for securing this debate but for all the work that he does in the NHS as a GP on the issue of domestic violence and abuse.

The NHS has opportunities to safeguard against domestic violence and, in the most serious cases, domestic homicide. Domestic homicide can be a consequence of honour-based abuse, which is particularly grounded in lived experience in my constituency in Leeds. Honour-based abuse is widely misunderstood, meaning that hundreds of victims are not being helped and perpetrators are escaping justice; I thank my hon. Friend the Member for Stourbridge (Cat Eccles) for highlighting it in her speech and in the work she did when she was in the NHS.

Honour-based abuse, a form of domestic abuse, is motivated by the abuser’s perception that other persons have brought, or may bring, dishonour or shame on themselves, their family or the community. It can take many forms and be complex to identify, but perpetrators of honour-based abuse often use methods of coercive control to force their victims to behave in certain ways, or to subscribe to certain beliefs. For some people, the concept of honour is prized above the safety and wellbeing of individuals, and to compromise a family’s honour is to bring dishonour and shame. That can be used to justify many types of abuse and even disownment or physical harm.

Honour-based abuse is frequently missed or misidentified within health settings. It is often framed as family conflict, particularly when it involves multiple perpetrators, rather than being recognised as domestic abuse and a form of violence against women and girls. This is particularly concerning because victims of honour-based abuse often have repeated contact with the NHS, including GPs, A&E departments and other hospital services, sometimes over many years. Those touchpoints present critical opportunities for early identification and intervention.

The point is tragically illustrated by the story of Fawziyah Javed, a constituent of mine who was a victim of domestic homicide. She had regular, ongoing contact with GPs and hospital services prior to her death. Fawziyah’s case highlights how risk can be present and escalating without being fully recognised or responded to within health settings, particularly where honour-based dynamics are not understood.

Fawziyah had such a beautiful and vibrant character that she could fill a room with joy just by her presence. She was full of life and soul. Helping others was so central to her being that she was well-known in the charity sector within Yorkshire. In December 2020, she married Kashif Anwar, but the marriage quickly became a prison of abuse. Despite reporting her husband’s abuse to police on two separate occasions prior to her murder, Fawziyah was failed on multiple levels.

The abuse of Fawziyah escalated. Ultimately, her abuser pushed her off the cliff at Arthur’s Seat while they were on a trip to Edinburgh. She died at the scene in the presence of female allies, who would later confirm that her dying words pointed to Kashif being her murderer. When Fawziyah died, she was 17 weeks pregnant with her baby boy.

Fawziyah had contact with the NHS during her pregnancy. Her family feel that there were missed opportunities to protect her during that time. A risk assessment was begun by one member of staff but completed by another, meaning that vital information might have been missed. Handing that assessment over when it was only partly complete undermined the seriousness of both the process and Fawziyah’s case. Her mother told me:

“This was a clear example of how systematic failures, lack of accountability and poor safeguarding practices can leave vulnerable women at risk. It is exactly why mandatory, trauma-informed Domestic Abuse screening and better training for NHS staff are so urgently needed.”

It is vital that healthcare professionals support and encourage the early identification of signs of domestic abuse. Routine sensitive questioning could help to protect people and potentially save lives.

When Fawziyah was pushed off Arthur’s Seat, at no point did her abuser dial 999. Instead, his first reaction was to call his father, showing how the family’s complicity helped enable the abuse. The failure to recognise the dynamics of honour-based abuse, and the involvement of multiple perpetrators, played a significant part in the tragic loss of a life. If her case had been recognised as the multilayered abuse it was, along with the honour dynamics involved, Fawziyah might have had a chance to escape the violence.

Domestic homicide reviews consistently identify health as a key agency, with recurring recommendations around improved identification of abuse, better information-sharing, professional curiosity and escalation pathways, especially in cases involving honour-based abuse and coercive control. I thank those at Karma Nirvana, based in my constituency, for their essential work on the issue, tackling misconceptions. I also thank Fawziyah’s family for sharing her story with me over many years, ensuring that we will strive for it not to be repeated and never to be forgotten.

Fawziyah’s story is a tragic reminder of why we must do more to recognise and address honour-based abuse and the impact it has on victims. Recognition, training and support in the NHS for victims of honour-based abuse are vital. I look forward to hearing the steps that the Minister intends to take to improve the situation.

[Sir John Hayes (in the Chair)]

For the benefit of the large number of visitors in the Public Gallery, I say that we now move to the wind-up speeches. I call the Liberal Democrat spokesperson.

--- Later in debate ---

[Dr Opher]

I thank the Minister and all those who spoke and brought their fantastic experience of this really difficult problem. Let me say two very simple things. We need to imprint on healthcare workers the idea “Think domestic abuse”, so that we do not miss it. If someone presents, we must have in the back of our minds the question, “Is this domestic abuse?” That will help to identify victims much earlier. After that, we need to enable them to be referred in a simple and effective process that brings them support immediately.

I thank everyone here, and you, Sir John, for chairing the debate.

[Sir John Hayes (in the Chair)]

Thank you for winding up. This has been a really important debate and I am so pleased that everyone was able to contribute. I hope that, had I spoken in the debate and not chaired it, I would have spoken with the same passion and insight that everyone has shown.

Question put and agreed to.

Resolved,

That this House has considered the role of the NHS in preventing domestic homicides and domestic abuse-related deaths.

Acquired Brain Injury Action Plan

John Hayes Excerpts

Thursday 4th December 2025 Westminster Hall

[Sir John Hayes (South Holland and The Deepings) (Con) [R]]

I beg to move,

That this House has considered the potential merits of a comprehensive acquired brain injury action plan.

Dickens wrote,

“Reflect upon your present blessings—of which every man has many—not on your past misfortunes, of which all men have some.”

There are few greater misfortunes than an acquired disability. Among those, a brain injury can challenge every aspect of life, whether people can walk, talk or think—or at least think straight. The effects are various: they can be mild or severe, and recovery will often take not just weeks or months, although the initial trauma can be treated in that timeframe, but many years. However, an improvement can be made over the long term.

Most of us think, “This will never happen to me.” I guess that is true of most misfortunes, including ones of this severity. Brain injury is the leading cause of disability and death among people under 40 in the UK. It can happen at any time, in any place. The causes, again, are various. One thinks of sporting injuries, or perhaps an attack—a violent incident. Of course, the principal causes are things like road traffic accidents, motorcycle and car accidents. Acquired brain injury, for the reasons I have given, has long warranted more attention than it has received, both publicly and among policymakers.

While the Department of Health and Social Care plays a central role in dealing with the immediate trauma caused by the sorts of accidents I have described, many other Government Departments have a relationship with the effects of brain injury. That is well illustrated by the work done by the all-party parliamentary group for acquired brain injury, which I am now proud to chair, and published in a report to which I will refer later in my speech.

We made the case that a cross-departmental approach to brain injury is required, for exactly the reasons I have set out. Of course, it affects the Department of Health, but it also affects the Department for Culture, Media and Sport—I spoke about sporting injuries a moment or two ago. It affects the Ministry of Justice, because such a high proportion of the incarcerated have brain injuries. It affects almost all aspects of Government, on which I know other contributors to this debate will focus, so a lateral approach to the way that public policymakers consider brain injury and its effects is critical.

As you will know, Dame Siobhain, as an extremely experienced and very wise Member of this House, might I say—

[Dame Siobhain McDonagh (in the Chair)]

Flattery will get you nowhere.

--- Later in debate ---

[Sir John Hayes]

I was hoping it might. Lateral policymaking is not easy in Government, because of the way Government works and ministerial responsibilities are exercised. It is a challenge, therefore, to get that sort of approach adopted by a Government of any colour or persuasion.

[Mr James Frith (Bury North) (Lab)]

The right hon. Gentleman is making a typically thoughtful contribution, and I congratulate him on securing this debate. I also thank Clare Harrison, a constituent of mine, from the Brain Injury Group for bringing this important matter to my attention.

The right hon. Gentleman makes a point about the Government’s role, and as he mentioned, sporting injuries populate such issues. Among those affected are former professional footballers, who are four times more likely to develop a neurodegenerative disease, support for which is patchy. For female former professional footballers, that support is non-existent. Will he join me in encouraging the Minister to consider the creation of an independent, football-funded body, alongside any wider action plan that his APPG is advocating for?

[Sir John Hayes]

I am grateful for the hon. Gentleman’s contribution. He makes a valuable point and an interesting suggestion that I will reflect on. He is certainly right that more can be done to affect brain injury in the first place. I have spoken a bit about its effects, but he is right to speak at greater length than I did about its causes. In the area of sport, of course, he is right that we now know that heading a football does all kinds of damage that no one imagined a generation or two ago. His suggestion is well made and worthy of further consideration.

Around 350,000 people a year are admitted to hospital with acquired brain injury—that is one every 90 seconds. About 125,000 of those are admitted following a traumatic brain injury, around 43,000 with brain tumours and others following strokes. I pay tribute to Lincolnshire brain tumour support group, of which I am president, and to Headway, which I will say more about in due course. The end result of those admissions is that about 1.3 million people are living with the consequences of acquired brain injury every day. They and their families, loved ones and friends, and the communities of which they are part, are dealing with the effects.

According to our all-party group’s latest report, the cost to the UK economy through healthcare, social care, lost productivity and wider public services is £43 billion annually, which equates to 1.3% of GDP. Of that, £20 billion is accounted for within the NHS and social care budget for acute long-term care, £21.5 billion is attributed to lost productivity, £1.5 billion is spent in the criminal justice system and the Department for Education—yet another Government Department that needs to be involved in the consideration of this issue in the lateral way I mentioned—and about £1.9 billion is spent on benefits. Leaving aside the human cost and the visceral effects brain injury can have on affected individuals and those who care for them, this has a considerable effect on Government, the Exchequer and the public purse.

Those ramifications only scratch the surface of the wider social cost. The real cost is in lives disrupted, plans abandoned and ambitions jettisoned as a result of brain injury; in parents seeing a child’s personality change overnight and carers stretched to their limits, with little or no respite, because symptoms are dismissed as being mild or imperceptible or attributed to some other cause entirely. Although less obvious, those effects are just as devastating. When those costs are added to the ones I have described, the all-party group estimates that the real cost of acquired brain injury is £91.5 billion. That is about half of what the NHS spends every year. It is extraordinary that this issue is not given greater consideration. I am delighted that this debate gives us a chance to do so, at least for this short time. I thank all colleagues across the House who have been part of these efforts.

We have argued for what we call a right to rehab. Putting aside the substantial financial cost, the physical and emotional costs are still higher. The estimates do not include many of the costs associated with homelessness, addiction, mental health services and psychiatric stays. The cost to the NHS and welfare of lengthy treatment and recovery is huge and rises quickly during spells in hospital before one even receives community support and longer-term social care provision. Much of this could be prevented, and many of the costs could be reduced, if we had the right to rehab.

Much work has been done on this subject, including by Headway, which I mentioned earlier, and the United Kingdom Acquired Brain Injury Forum. A report from earlier this year, commissioned by the APPG, urged the Government to invest in specialist neuro-rehabilitation to save long-term societal costs. The report called for brain injury to be treated on a par with cancer and dementia. A statutory right to rehab in every region means that specialist neuro-rehabilitation services after an acquired brain injury would be put in place.

None of the failures that we see today in response to brain injuries is inevitable. The Ministry of Defence already guarantees the right to rehabilitation for military personnel, so we have a precedent. We want to build on that precedent, across Government, for those affected by brain injury.

We know from the MOD the results of having that right for rehabilitation—shorter recovery times, better outcomes, restored lives and improved prospects. The same approach is being piloted by the National Rehabilitation Centre, where every £43,000 invested in rehab yields savings of up to £680,000. That is a remarkable 16:1 return on investment.

Now is the time to extend the entitlement adopted by the MOD much more widely. We must establish a national neuro-rehabilitation framework that guarantees that access to specialist care is not a lottery, but a certain path to recovery. In doing so, money would certainly be saved, but life chances would be improved immeasurably, too. High-quality rehabilitation reduces the risk of homelessness, addiction and a drift into lawlessness. It allows people to contribute, return to work and rebuild lives and relationships—to begin to stand tall again.

Now is the time for the Government to act. I have every confidence that the Minister will rise to her feet at the summation of this debate and tell us that she has not only thoroughly studied the all-party group’s report—daily, perhaps—but that she is ready to respond in the way that we invite.

I pay tribute to the hon. Member for Rhondda and Ogmore (Chris Bryant), who chaired the APPG before I did—I was his vice-chairman for many years. He drove the original version of the report, which was republished more recently. It is an outstanding piece of work. We all know that APPGs vary, but this one is focused on the subject for which it is responsible and is determined to make its voice heard, because of the all-party support it attracts and because of the salience and significance of this subject.

Given the number of people affected by brain injury, the comparatively low cost of effective interventions, such as rehabilitation and community support, and the ongoing lack of support services, there continues to be a strong need for a proper strategy to be put in place.

I spoke earlier about a lateral approach. We are calling for a national strategy on brain injury. Around 60% of prisoners report having an acquired brain injury. We discussed that at a recent APPG meeting, where we heard from experts in the field. I have served as a Minister in multiple Departments—I will not list them all—and I know that cross-departmental working is tough, and the Minister will know that too, but it can be done. It requires structures to be created that facilitate Ministers to come together. The Cabinet Office might be able to play a part. I served in the Cabinet Office and its purpose, in a sense, is to deal with those issues that could otherwise fall between the cracks and departmental silos. However it is done, we need a national strategy.

As far back as 2001, the Health Committee published a report on head injury, issuing 28 recommendations that included, as a matter of urgency, finding ways of improving methods of data collection on incidence, prevalence and severity. In 2005, the national service framework for long-term neurological conditions was launched; it contained many good ideas, but had no mandate and no funding. In 2010, the National Audit Office published a report, “Major Trauma Care in England”, which highlighted the need for improvement in major trauma care. That led to the establishment—you may remember it, Dame Siobhain—of trauma networks, with a centralised and specialised approach to trauma care and service across the country.

The excellent work of the APPG for acquired brain injury, which was reformed in 2017, showed that there was a strong case for a cross-party commitment to action. I have already spoken about the 2018 report, which called for a national reconsideration of rehabilitation and the collation of reliable statistics, given the problems with data collection and analysis that prevail.

To be fair to the previous Government, our report was well received by Ministers. Indeed, they responded to what we had called for by committing to publish a strategy on acquired head injury in 2021. The following year, there was a call for evidence to inform the development of such a strategy. The previous Government said that they were going to do it, committed to the principle and welcomed the work that we were doing. However, we then, of course, had the inconvenience of an election—one of the aspects of democracy that sometimes gets in the way of these sorts of things. Therefore, the work was not brought to a conclusion.

Earlier this year, the current Government announced their intention to develop an “action-oriented, and accountable” ABI action plan

“with input from NHS England and other Government departments”.

It was due to be published “this year”—well, the year is running out, Minister. However, there are still a couple of sitting weeks left: a statement could be brought to the House and perhaps a document could be published that responds to the calls that we have made. We have the work that the previous Government and this Government have done. There has been no party politics; over time, Ministers have recognised the challenge—the scale of the problem—and the reasons for addressing it, which I have set out.

We can hope that this Minister, who I know is dutiful and diligent, will rise to exactly that challenge. I do not know whether I am flattering her, Dame Siobhain—I am doing my best.

[Dame Siobhain McDonagh (in the Chair)]

I think that may be your modus operandi.

[Sir John Hayes]

Following representations from myself and others, the Minister, who has responsibility for public health and prevention, kindly responded to say that the Government will publish an action plan in 2026. I hope that it will be published as early as possible—if not before Christmas, perhaps as an early new year’s resolution.

After years of campaigning by charities and MPs, the excellent news is that there now seems to be momentum on this issue, which is what sufferers and their families deserve; it is what they warrant and certainly what they need. The plan needs to include a focus on better community rehabilitation and on how that will help to achieve real change for people with ABI. It could also include national training for local authority and integrated care board commissioners, and for social workers, on the complexities of ABI. I have talked about the subtlety of the effects that ABI can have, including the changed personality that many people experience as a result of a brain injury. Addressing such subtle changes requires a level of understanding and expertise, so national training could be really important and of immense value.

I hope that the plan will also include funding for community-based specialist brain injury services. Staggeringly, the vital research by Dr Alyson Norman found that a third of serious case reviews in social services involved someone with a brain injury. Dr Norman lost her own brother to suicide after he suffered a lifetime of untreated brain injuries sustained in childhood.

Given that brain injury is no less than a hidden epidemic, it is imperative that the Government take further action to collect statistics about it, so that we can accurately ascertain the numbers impacted. We need a UK-wide consensus on which conditions are classified and coded as brain injury, and to make that data freely available. Access to hospital admission data on brain injuries must be free; currently, charities face significant costs.

The charity Headway, which has done so much in this field, is not an immensely wealthy organisation and so those costs are significant to it. I hope that we get some reassurance on that point. Research by Headway has shown that over three quarters of brain injury survivors encounter daily challenges due to the hidden nature of their injury, and that nine out of 10 people affected by a brain injury cite societal misunderstanding as a major obstacle in navigating life with a hidden disability. Collecting those facts and figures is important because of the nature of acquired brain injury.

I will not say too much more about the costs to the sector, except that over the past three years several local Headway charities have permanently closed, including one in the last month. Three local volunteer branches have also shut down. That is because of rising costs of all kinds, which I do not need to list here. Closures really do risk brain injury survivors feeling lost. This is an area of work and a need that can go unrecognised and unseen. The feeling of isolation and loneliness—this is, as I described, a hidden epidemic—can place immense strain on families as survivors are no longer able to access, for example, the specialist daycare centres that they might otherwise enjoy.

We need to find a way of granting exemptions for charities from things such as the employer national insurance charges. I hope that the Minister will look at that, or even speak about it in this debate. Some 57% of Headway charities say that they have experienced delays in receiving payments from local authorities and integrated care boards. Some charities have even had to employ additional staff members purely to chase the debts that they were owed. These are small organisations with limited budgets; they just need help.

I know that other hon. Members want to contribute to the debate and can see their eagerness to do so, so I will draw my remarks to a close. For survivors, a head injury is just the beginning; the real challenge after survival lies in the days, months and years that follow. Individuals and their families struggle to navigate, with minimal support, a fragmented and underfunded system of rehabilitation. I know that because more than 40 years ago, like so many other young people, I suffered a serious head injury. But the key for me is that it did not stop me from doing what I wanted or being what I became. That is fundamental for anyone with an acquired disability.

It is a matter of record that I decided to become a Conservative MP when I was seven—I was probably six, actually. That did not alter as a result of my head injury, but it might have done. I have seen those much more seriously affected by the traumatic injury they endured. As I looked at them I thought, “There but for the grace of God go I”, so I was determined thereafter to do all I could to fight for people with serious head injuries who struggle with their effects. I have been determined to champion their cause and to turn my hopes on their behalf, and their hopes too, into reality.

I started with Dickens, one of our greatest writers, and I will end with Tolstoy, the great Russian writer. He wrote:

“As long as there is life, there is happiness. There is a great deal, a great deal before us.”

For everyone, regardless of what they suffer, to be able to glean that happiness, through the care and support that they receive, should be the ambition of every Government Minister and every Member of this House.

[Several hon. Members rose—]

--- Later in debate ---

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

It is a pleasure to serve under your chairship, Dame Siobhain. I congratulate the right hon. Member for South Holland and The Deepings (Sir John Hayes) on securing this important debate on an issue that touches many thousands of lives across the country. I acknowledge and thank all hon. Members for the stories of their constituents that they have shared today.

I begin by paying tribute to the right hon. Gentleman and the all-party parliamentary group for acquired brain injury for shining a light on what has too often been an invisible issue. Through its recent report, “Right to Rehab: The Cost of Acquired Brain Injury to the UK Economy”, the all-party group, ably supported by the UK Acquired Brain Injury Forum, has demonstrated both the human and the economic imperative for action. That report reveals the staggering £43 billion annual cost of ABI to our economy. It makes a compelling case for improved rehabilitation, cross-Government co-ordination and investment in specialist services. That work has helped to drive vital conversations across health, justice, education and beyond to ensure that people living with ABI are no longer overlooked.

Recently, I was delighted to be able to attend and speak at the UKABIF annual ABI summit last month, where I met key stakeholders, including people with lived experience, for a panel discussion on the stage and at a separate meeting afterwards. I have taken away some important calls for action from those discussions. The Government have also listened to the calls of the all-party group and others for a dedicated plan. I reassure the right hon. Member for South Holland and The Deepings and others that we remain committed to delivering on that promise.

In the coming months, in the first half of next year, I confirm that we will publish the acquired brain injury action plan, a landmark step in delivering the joined-up approach that people with ABI deserve. I also confirm that when we publish it, that plan will draw on a wide range of evidence, including the evidence that was submitted in the 2022 call for evidence. The plan will set out clear priorities across health, social care, education, justice and beyond in a bid to move towards rehabilitation and long-term support being better embedded throughout public services. It will reflect continuing engagement with clinicians, charities and people with lived experience. It will provide the blueprint for improving outcomes, reducing inequalities and supporting independence.

[Sir John Hayes]

All the Minister has said so far is incredibly welcome. On ministerial engagement, given what she said about the cross-departmental working, which I called for earlier, is she engaged with the Ministers in those Departments in drawing up the plan and, if so, how?

[Ashley Dalton]

I am just coming to that, so the right hon. Member’s intervention was very timely. As has been highlighted, the plan matters, because ABI is not just a health issue; it touches education, employment, justice, work, benefits, housing, homelessness and many other areas of life. Without co-ordinated action, too many people will continue to fall through the gaps.

In the first instance, therefore, I have started conversations with ministerial colleagues who have responsibility for education at the DFE, for the criminal justice system at the MOJ, for housing and homelessness at the Ministry of Housing, Communities and Local Government, and for work and benefits at the Department for Work and Pensions. The Department also reached out to those working on transport, sport and defence, among others, asking them to commit to tangible actions in the ABI plan. I note the suggestion of my hon. Friend the Member for Bury North (Mr Frith)—he is no longer in his place—and we will give that consideration.

The plan will build on already excellent work that is going on across Whitehall, helping to tackle the impacts of ABI directly or indirectly. That includes the Ministry of Justice’s update to its new neurodiversity action plan; working with the Department for Transport on its road safety strategy; the Department for Education’s planned consultation on an updated version of supporting pupils with medical conditions at school; and the Home Office-led work to tackle domestic abuse.

I also confirm, as was raised by the hon. Member for Bath (Wera Hobhouse), that the Government are committed to advancing research into ABI in sport. We recognise the significant impact of sports-related head injuries on long-term health outcomes. Through the National Institute for Health and Care Research, we are co-funding a major initiative, the UK traumatic brain injury platform. In addition, the Department for Culture, Media and Sport established the concussion in sport research forum, in which we are working alongside them.

We recognise that developing the plan is taking slightly longer than we had originally wished, but I reassure right hon. and hon. Members that that is not because of a lack of commitment; it is because we want to get it right. We want to take ABI stakeholders with us and to set the plan against the new health and social care landscape described in this summer’s 10-year health plan. In Manchester last month, I had the opportunity, as I said, to hear directly about potential solutions and opportunities from those at the coalface.

ABI affects every facet of life, and creating a plan that truly delivers requires co-ordination across multiple Departments and extensive stakeholder engagement, as well as alignment with wider reforms and developments such as the 10-year health plan, neighbourhood health services, new NICE guidance on rehabilitation and NHS England’s recently refreshed service specification for adult neurology services. That will mean that, although the report may be slightly delayed, it will have a comprehensive cross-Government approach to drive real change by improving rehabilitation, reducing inequalities and supporting people with ABI to live independent and fulfilling lives.

I know that the all-party group, the right hon. Member for South Holland and The Deepings, my hon. Friend the Member for Hartlepool (Mr Brash), and the Lib Dem spokesperson, the hon. Member for Mid Sussex (Alison Bennett), all recognise that rehabilitation is the cornerstone of recovery and independence. Reports from the APPG and UKABIF have made it clear that timely, specialist rehabilitation can transform lives. Rehabilitation is what turns survival into quality of life, enabling people to return to work, education and their communities. The APPG has consistently championed a statutory right to rehabilitation because it knows that too many people face fragmented services and missed opportunities, and as a result their health deteriorates once they are back in the community.

What the final action plan will say on community rehabilitation will be worked through carefully with stakeholders and with NHS England to ensure that we get it right. We must ensure that our proposals are feasible and viable. However, at the absolute minimum, it will highlight the new NICE guidelines on rehabilitation, setting the expectation that the NHS should take these into account, as well as showcasing the best practice that already exists.

Many hon. and right hon. Members raised data sharing. I am keen to pursue better data sharing on ABI across Departments and the NHS to ensure that our response is joined up and that it improves patient identification, care and support. Rehabilitation is a central focus of our 10-year health plan, which recognises that timely, high-quality rehabilitation reduces long-term disability, improves quality of life and saves significant costs for both health and social care. By embedding rehabilitation into integrated care pathways, expanding community-based services and investing in specialist multidisciplinary teams, the 10-year health plan will ensure that support is available when and where it is needed, including for people who have experienced ABI. That commitment reflects a shift towards person-centred care, helping people to regain skills, to return to work or education, and to live fulfilling lives after serious illness or injury.

Through the 10-year health plan, we are introducing neighbourhood health centres and deploying multi- disciplinary teams to provide holistic support to people with conditions like ABI. We know that every ABI journey is different, and recovery depends on care that reflects individual needs, goals and circumstances. That is why the plan promises to expand personalised care approaches, giving people a say in their care. We commit, therefore, to providing 95% of people with complex needs with a personalised care plan by 2027. That means that people with ABI will benefit from structured and co-ordinated support that is tailored to their needs. The expansion of personal health budgets outlined in the health plan will give people greater flexibility, choice and control over their care.

Our digital transformation commitments will make a real difference too. By improving data sharing between health, social care and rehabilitation services, we can ensure continuity of care and avoid delays. Digital care plans will allow patients and professionals to track progress and adjust goals in real time. Those innovations mean more personalised and co-ordinated care. I am really keen to explore better data collection and sharing between the NHS, patient groups, researchers and those with lived experience across my long-term conditions portfolio, which includes ABI. There are ongoing discussions within the Department on how we might be able to improve the quality of, and access to, health data. I know that there is some great data out there, but too often access to it is too restricted.

The Government will publish the 10-year workforce plan in spring 2026. This will set out action to create a workforce that is ready to deliver the transformed service set out in the 10-year health plan.

My hon. Friend the Member for Blaydon and Consett (Liz Twist) mentioned mental health. NHS talking therapies have a specific pathway for people with long-term physical health conditions, including ABI, and all ICBs are expected to expand services locally by commissioning NHS talking therapies services integrated into physical healthcare pathways, including those for ABI.

Together with the ABI action plan, the 10-year health plan and the 10-year workforce plan will represent a step change in how we support people with ABI. The action plan will deliver a joined-up approach across health, social care, education, justice and beyond, ensuring that rehabilitation and long-term support are no longer fragmented. The 10-year health plan complements this by embedding personalised care planning, expanding community rehabilitation and harnessing digital innovation. These commitments will mean better access to timely, tailored services, improved continuity of care, and a focus on independence and quality of life. By working collaboratively across Government, the NHS and stakeholders will turn these plans into action and deliver the outcomes that people with ABI deserve.

I have covered as many issues as possible. There are some that I do not have immediate information about, but I will write after the debate to the shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson), about her question on mechanical thrombectomy. By working together right across Government and making sure we have joined-up data and joined-up thinking, we will bring forward the action plan on ABI in the first half of 2026 to deliver the outcomes that people with ABI deserve and need.

[Sir John Hayes]

This has been an extremely good debate. Contributions from across the Chamber have illustrated how strongly Members feel about the need for exactly the kind of strategy that the Minister has confirmed the Government will introduce. It is welcome that the Minister has recommitted to that plan. I offer thanks and a warning. The thanks are because she clearly understands and takes this seriously. The warning is that if we do not see the plan, we will be back, and next time we will be altogether more fierce.

While we have been debating these matters, tens of people, scores of people, have been admitted to hospital with an acquired brain injury—extraordinary. I can tell from all the contributions, including from my great friend on the Front Bench of my party, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), and from Members across the House that the plight of those with ABI is our cause and their needs are our mission. Let us do all we can to ease their plight and meet their needs.

Question put and agreed to.

Resolved,

That this House has considered the potential merits of a comprehensive acquired brain injury action plan.

Resident Doctors: Industrial Action

John Hayes Excerpts

Thursday 10th July 2025 Commons Chamber

[Wes Streeting]

In all honesty, I am afraid I cannot give my hon. Friend that assurance. NHS finances are precariously balanced. We have been relative winners across the Budget and the spending review set out by my right hon. Friend the Chancellor of the Exchequer, but we are asking a lot of the system. As well as the progress and improvements we want in the NHS, we inherited a lot of mess to clean up, and that will take time and resource. Every penny spent on the price of failure through strike action is a penny that could have been spent on driving improvements in the service—improvements for patients and for staff—and on creating the jobs and opportunities that mean doctors do not graduate into unemployment and that mean resident doctors can progress into specialty training posts. That is why I say clearly and unequivocally to the BMA that if this strike action goes ahead, with all the costs, pain and misery that will follow, it will not just be patients—or, indeed, this Government—who suffer, but the BMA.

[Sir John Hayes (South Holland and The Deepings) (Con)]

I have known the Secretary of State a long time. I knew him before he was an important man—although he was always important to me, of course. He will know that as a Minister, I worked with the trade unions in every sector for which I was responsible, as the RMT and the University and College Union will confirm, and I was also a member of the Association of Teachers and Lecturers. I entirely endorse and amplify what he says. Responsible trade unionism requires people to be reasonable, and reasonable people in this House know that this strike against this background is entirely unacceptable, as he has described.

I ask the Secretary of State this: will he ensure that this unhappy, unwholesome and unhealthy action does not jeopardise the health of my constituents, and will he write to the local authorities—the integrated care boards—in my area and others to set out how they can minimise the impact of this action? The last thing that you want, Madam Deputy Speaker, or that I or any Member across this House wants, is for those at risk to be put at greater risk as a result of this irresponsible action by these militant people.

[Wes Streeting]

I thank the right hon. Gentleman for his question. He is that rare beast: a Tory trade unionist. He raises the serious point of the consequences of strike action. I will, of course, keep the House updated, but I want to reassure the House that we are taking every step possible to mitigate the disruption that these strikes will cause. That will come at a financial cost and a cost to patients because of the disruption that will follow. It will also come at a cost to other staff, many of whom are paid less than resident doctors, who will be left at work with more pressure and in harder conditions, picking up the pieces because of the actions of their colleagues who were given a higher pay rise, but who will be stood outside protesting the 28.9% pay rise that they received.

I assure the House that we will do everything we can to mitigate the impact of the strikes on patients and the disruption that will follow. What I cannot say to the House, however, is that we can offset or cancel the impact or detriment felt by patients. We will look carefully at the data on the experience and impact of the strikes that occurred during the previous round of negotiations. I will ensure that that information is published so that the House can see the impact of the previous strikes, so that we can brace ourselves for what may lie ahead.

Terminally Ill Adults (End of Life) Bill

John Hayes Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Sarah Olney (Richmond Park) (LD)]

It is a privilege to be called at this stage in the debate. My principal reason for voting against the Bill on Second Reading was my concern that vulnerable people would be put at risk. I agreed to serve on the Bill Committee to do what I could to allay my concerns about that issue and address some of the issues raised by others. I do not think that the revised version of the Bill properly or completely reflects the concerns expressed on a multitude of different occasions. Consequently, it does not fully mitigate the risks to vulnerable groups.

We all recognise that decision making of any kind does not take place in a vacuum and that, in all parts of life, we live in a particular context. The Equality Act 2010 recognises that many people face discrimination or unfair treatment as a result of particular characteristics and that reasonable steps should be taken to eliminate that. It was very clear from the oral evidence sessions that particular care has to be taken to assess the context within which people are making the decision to seek an assisted death: if they suffer from a mental illness or eating disorder, if they are from a low-income or ethnic minority background, if they suffer from a disability or if they are in an abusive relationship. Those factors are likely to lead to an increased risk that someone will seek an assisted death that they would not have sought if those factors were not present.

In Committee, I and others made the point that it would have been desirable to have received an equality impact assessment before the detailed work of Committee scrutiny had begun, so that Committee members had a sense of how the proposed legislation would impact groups that we know can suffer disproportionate levels of disadvantage.

[Sir John Hayes (South Holland and The Deepings) (Con)]

Will the hon. Lady give way?

[Sarah Olney]

I will not, if that is okay.

We were told that it was not practical to produce such an assessment until after Committee stage, as it would be necessary to assess the impact of amendments made in Committee.

The equality impact assessment was finally published five weeks ago. I have to say that I was pretty astounded. It does not recognise that certain groups in this country may have their lives prematurely shortened as a result of this legislation; instead, it concerns itself with the barriers that vulnerable people may face when trying to access assisted dying. I find that astonishing. Did the people who drafted the assessment not hear the speech of the hon. Member for Vauxhall and Camberwell Green (Florence Eshalomi) on Second Reading? She spoke with passion about how the underlying inequalities in access to healthcare experienced by those from black and minority ethnic backgrounds would be exacerbated if the Bill passed unamended. Did they not listen to the oral evidence that Dr Jamilla Hussain gave to the Bill Committee? She talked about her experience of working with racialised communities in Bradford and their fears of being pushed disproportionately towards an assisted dying pathway. Did they not listen to the testimony of Dr Miro Griffiths on the experience and concerns of disabled people—testimony that has been echoed by Baroness Tanni Grey-Thompson and the actress Liz Carr?

I find it inexplicable that the framing of the impact on vulnerable people should be the removal of barriers to accessing assisted dying and not, as it should be, the increased risk to their health and wellbeing that the Bill presents. I am concerned that we are thinking about the impact on vulnerable people solely with reference to those who are suffering a terminal illness with less than six months to live. We are not thinking about the impact on wider society of introducing a concept of lives not being worth living and how that might disproportionately affect our more vulnerable communities.

My new clause 19 and consequential new schedule 2 and amendment 88 seek to ensure that a comprehensive range of statistics are collected about those who seek and receive an assisted death, so that proper and complete monitoring of requests can be carried out. It is imperative that we get the most detailed possible picture of who is requesting an assisted death so that any patterns of disproportionality can be properly detected and addressed.

--- Later in debate ---

[Paul Waugh]

I completely agree with my hon. Friend. The dangers of what is happening in America provide a real lesson for us here.

As the hon. Member for Reigate (Rebecca Paul) put it, conversations about assisted dying should happen in person—between the relevant doctor and the patient. They should not be prompted by a TV ad, or something seen on a bus. My hon. Friend the Member for Bexleyheath and Crayford (Daniel Francis) spoke very movingly about the way that IVF services have been commercialised, leaving people who are, as he says, “already on their knees” vulnerable to exploitation, so that someone else can profit.

I am certain that nobody in this House believes that passing this Bill into law should mean the rise of a similarly aggressive market for assisted death, but it is our role—indeed our responsibility—to deal not only in intended consequences, but in unintended ones, too. The real risk in the drafting of new clause 14 is that it allows exceptions that are not specified in the Bill. A future Secretary of State will be empowered not only to make the necessary regulations, but to amend them at any time; and a future Secretary of State, who does not share the concerns of this House, would have the ability to draw the exceptions so widely as to make the ban worthless. There are a number of similar advertising bans already in place on tobacco products, surrogacy and the latest cancer drugs being marketed to the public. In every case, the legislation sets out the exceptions, leaving no room for doubt as to how Parliament intended to protect the public.

Why should the services that this Bill would legalise not be subject to that same legal clarity? Do people who have less time to live not deserve all the protection we have the power to give them from a death they do not truly want? I cannot believe that this Parliament would be content to have that power taken out of its hands, and the rights of our most vulnerable constituents left for someone else to decide on some other day.

My amendment therefore sets out that exceptions to the advertising ban should be limited to cases where a person has requested information and where the materials are intended for health professionals and not for their patients. New clause 14 would allow a future Secretary of State to make provisions that would usually have to go through the House in legislation. It is not at all clear to me why that power is needed to introduce a ban on advertising.

[Sir John Hayes]

I am very grateful to the hon. Gentleman and I entirely support his argument and his amendment. This is the difference between, in his estimation, accepting a request and promoting a service. Advertising is about the promotion of a service to doubtful, fearful and vulnerable people, and that is precisely what his amendment addresses.

[Paul Waugh]

I agree with the right hon. Gentleman, and there is a wider point here about the Henry VIII powers in the Bill. This would be the third such power added to the Bill since Second Reading. At that stage, it had none. The Attorney General, Lord Hermer, has said that “excessive reliance” on Henry VIII powers

“upsets the proper balance between Parliament and the executive”,

and he is right.

Away from matters of constitutional principle, I am especially concerned about the practical impact of such a power, which would allow a future Secretary of State to change the law as set out in the Suicide Act 1961. This is the Act that contains the offence of encouraging or assisting a suicide. Ministers have confirmed that the Bill leaves the offence in place in all cases except where a medical practitioner assists a person to die under its provisions. We must surely therefore not hand the power to a future Secretary of State to weaken or even abolish that offence without the need for primary legislation. My amendment specifies that the Suicide Act cannot be amended in that way.

I hope that my hon. Friend the Member for Spen Valley recognises that my amendment does not seek to undo or undermine her new clause, but rather to build on it and to ensure that the ban she intends to deliver does not collapse around the loophole at its heart.

--- Later in debate ---

[Gregory Stafford]

I thank the hon. Gentleman for his intervention. I do not disagree that drugs are used for different things; that is not the thrust of the argument that I am making. What I am saying—relatively clearly, I hope—is that when the drugs we would potentially use in these situations have been used, there have been unintended consequences and side effects. We must ensure that the drugs we use, if the Bill passes, are absolutely effective in what they are intended to carry out: namely, the end of the life of the individual.

[Sir John Hayes]

Will my hon. Friend give way?

[Gregory Stafford]

This is the last intervention that I will take, as I must make progress.

[Sir John Hayes]

The reason why what my hon. Friend has said is so important is that it is yet another important safeguard, particularly given that, as we learn from analysis in the impact assessment, much of this is outsourced to private organisations. Those organisations need to be regulated in precisely the way he has described.

[Gregory Stafford]

My right hon. Friend is entirely correct.

The Royal College of Physicians has said:

“Medicines prescribed and administered in assisted dying must be regulated for safety and efficacy for this use.”

If that is a requirement of the Royal College of Physicians, we in the House should take it seriously and put it into the Bill.

I will now draw my remarks to a close, but I should say that I also support amendment 99, which would require a report on the drug’s effects before Parliament approves the regulation, as well as a number of the other amendments, which hopefully would remove the wide-ranging Henry VIII powers currently in the Bill. In the light of all that I have said, I remain deeply sceptical as to whether the Bill, in its current state, provides the robust, protective and operationally sound framework that such a profound societal change deserves.

--- Later in debate ---

[Adam Jogee]

My hon. Friend makes a very good point.

[Sir John Hayes]

Will the hon. Gentleman give way?

[Adam Jogee]

I will take one intervention from the other side of the House, and then I will continue.

[Sir John Hayes]

The hon. Gentleman is fast becoming one of my favourites on the Government Benches, among many competitors. The point that he makes is fundamental. If we are going to do this right, we have to do it thoroughly and with independent analysis. Had the hon. Member for Spen Valley (Kim Leadbeater) engaged in pre-legislative scrutiny and thorough analysis before introducing the Bill, we may have ironed these matters out in the first place.

[Adam Jogee]

I thank the right hon. Gentleman for his intervention—it teaches me not to take them. I also thank him for helping my street cred this morning. He raises an important point.

Members of this House have been told that this Bill—it is this Bill we are voting on, not the principle—was rigorously tested and refined in Committee. However, we are now seeing efforts to undermine the decisions of that same Committee. Amendments 94 and 95 serve the singular purpose of undoing amendments introduced in Committee to improve the Bill and make it a safer and more conventional piece of legislation, but their implications go beyond just that: they challenge the basic tenets of our democracy.

One of the key roles at the heart of our democratic system is the role of the or a Minister of the Crown. It is our Ministers who prepare the groundwork for legislation to be enacted successfully, and amendments 94 and 95 would completely do away with that core ministerial function. They would see the responsibility for ensuring the roll-out of assisted dying in Wales—the power that we the people entrust to our Ministers and democracy—taken away from them. [Interruption.]

Conscious of your cough, Madam Deputy Speaker, I shall quickly move towards the end of my remarks—I have taken half of them out already. In my view, Ministers should be able to lead the roll-out of assisted dying in Wales, just as they should in England. It is Ministers, not the supporters of the Bill, who will be responsible for delivering these seismic changes to our health and legal systems, so it is only right that they decide when the provisions become law. Amendment 42 would put England back on an even footing with Wales.

Getting this right is literally a matter of life and death. It makes sense to avoid any possible pressure on decision making and decision makers and, at the very least, allow Ministers to enact legislation with the usual constitutional powers. One death because of a rushed decision would be one too many and should give us all food for thought. I do not want it on my conscience that our collective sticking to an arbitrary deadline led to a death or deaths that may otherwise have not taken place. We must recognise that we can prevent any such situation, and we can prevent that with our vote today. To do so, we must remove the deadline for automatic commencement in England and uphold it in Wales. I urge Members to support my amendment 42 and to vote against amendments 94 and 95.

--- Later in debate ---

[John Grady]

I think everyone in the House debates this issue in good faith, and in the courts there is a general view that one should be reluctant to attack otherwise. I am sure that question was meant on that basis. However, one must not lose sight of the fundamental point that the protections in the Bill will not address the profound societal pressures that people will face. One must not lose sight of the fact that, whatever protections are included in the Bill, it will not protect people against coercion.

[Sir John Hayes]

Edmund Burke said:

“Bad laws are the worst sort of tyranny.”

Over time, I have seen many imperfect measures put before the House—under Governments of all persuasions, by the way—and usually, through scrutiny, they are improved. That is because the parliamentary process works when there is time available, and in particular when there is pre-legislative scrutiny, independent analysis and thorough thinking about the consequences of what we debate here. That could have happened on this important matter, but it has not because it has been shoehorned into a process ill-fitted for its purpose.

The amendments we are debating are a late attempt to improve the Bill. I particularly recommend the amendments tabled by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), who made an excellent contribution to our debate, my right hon. Friend the Member for Salisbury (John Glen) and the hon. Member for Rochdale (Paul Waugh). I support those amendments because it is critical that the safeguards in the Bill are not only maintained but improved and enhanced, for all the reasons advanced by hon. Members across the House about coercion and vulnerable people.

The hon. Member for North Herefordshire (Ellie Chowns) said she has never encountered coercion. North Herefordshire must be a wonderful place where people carry harps and drink ambrosia, but in the rest of the kingdom and, I assert, the rest of the world, there are many wicked people doing many bad things. We must never allow those wicked people to have reign and power over those who inevitably, because of their circumstances, will be at risk if the Bill is not improved.

[Several hon. Members rose—]

[Sir John Hayes]

I give way to the hon. Member for North Herefordshire as I cited her.

[Ellie Chowns]

I am afraid that the right hon. Gentleman has misrepresented what I said. I was contributing an observation from somebody who has been deeply involved in palliative care practice, who reports that it is far more frequent that the dying person wishes to die, while it is their family who are pressuring them and encouraging them to stay alive as long as possible. The fears about coercion appear to be worry about something that is not actually the case in these cases of dying people.

[Sir John Hayes]

I am afraid that I disagree. There are numerous cases where people will be encouraged, and perhaps even forced, to take a decision, when they are coping with illness and at their most vulnerable—when they are frightened, doubtful and distressed, and may be unbalanced. Of course we have to protect against that eventuality if the Bill is to be passed.

[Tim Farron]

On that point, evidence from exit interviews shows that 35% of people choosing an assisted death in Canada and 47% in Oregon listed as their reason for doing so that they felt they were a burden to their family.

[Sir John Hayes]

The hon. Gentleman anticipated what I was about to say; I have cited exactly that evidence many times during the debate. We need to look at the experience elsewhere to inform what we do here. We always do that when we pass the right laws in this place.

There is worse news than that, because rather than being improved during its passage, the Bill has in many ways got worse, in particular by giving additional powers to Ministers—so-called Henry VIII powers. When the two words “delegated legislation” are mentioned in this place, we should always be fearful; when the words “ministerial discretion” are used, be doubly fearful. I said that looking directly at Government Front-Bench Members, but I could have been looking at the Conservative Front Bench. The Bill gives permissive powers to Government to make all kinds of changes. I want to take some of those to illustrate my point.

The Bill empowers Ministers to amend the Suicide Act, including the offence of encouraging suicide. They can rewrite the principles of the NHS, in section 1 of the National Health Service Act, to read, “secure improvement in the mental health of the people of England and Wales and end the lives of the terminally ill”. They can amend the NHS Act to specify that this service is not free of charge. The Bill points only to the section of the National Health Service Act that says,

“services to be provided free of charge except where charging expressly provided for”.

They can amend the definition of a registered medical practitioner, so it is not a doctor carrying out the assessment. And so on and so forth.

That is why the amendment in the name of the hon. Member for Mitcham and Morden (Dame Siobhain McDonagh) is so vital. The speech she gave was among the best speeches I have heard in this House. The passion she feels for vulnerable people and the difference the NHS makes to them is not only felt on the Labour Benches, as she well knows, regardless of the theatre. We all come to this place to ensure that the least fortunate have a voice; that those with less power are given a little more by our advocacy.

In conclusion, I say to the hon. Member for Spen Valley (Kim Leadbeater) that there has never been any doubt about the depth of her piety. Let us now be sure about the breadth of her mind. If she really wants the Bill to be passed in a way that is palatable, then she must surely accept the amendments I have supported and highlighted in this brief—all too brief—contribution.

[Madam Deputy Speaker (Judith Cummins)]

Members need to be aware that I will start the Front-Bench speeches at 1.30 pm. I call the final Back-Bench speaker, Rachael Maskell.

Gender Incongruence: Puberty Suppressing Hormones

John Hayes Excerpts

Wednesday 30th April 2025 Westminster Hall

[Sir John Hayes (South Holland and The Deepings) (Con)]

It is a pleasure to serve under your chairmanship, Ms Lewell, and I am grateful to my hon. Friend the Member for Reigate (Rebecca Paul) for securing this debate. Everyone, regardless of their particularities, deserves dignity, but that open-mindedness has in recent years been supplanted by an ideology-driven series of harrowing episodes involving, in this case, both medical policy and clinical practice. That led me, in 2019, to raise the issue of the Tavistock clinic when a number of the professionals there drew attention to the fact that they were

“often under pressure to refer young people for life-altering treatment even though they did not believe that it was in the individual’s best…interests…experimental treatment is being done on children who have experienced mental health difficulties, abuse and family trauma.”—[Official Report, 11 April 2019; Vol. 658, c. 479.]

Those kinds of concerns led to the review by Hilary Cass, and Cass was clear, when she published her report, that there was a lack of evidence on the long-term effects of using puberty blockers to treat gender incongruence to know whether they were safe or beneficial. Later, I had an exchange with the current Health Secretary—the previous Government having taken action latterly—in which he assured me that he would be implementing the Cass report in full. It is right that he should, because of the tragic history of the prescription of drugs that even those involved in that process regarded with such concern that they gave up their professional lives.

We have altered young people; we have warped them, and that is a result of a policy that was adopted without proper consideration and of clinical practice that did not have its basis in scientific fact. Given that the Health Secretary has seen most of that and acted upon it, it is important to consider what happens next. We know that the Tavistock clinic has been closed and we now know that there is a new series of measures to deal with these matters. There will be six new regional gender identity clinics for children and young people by 2026.

However, alongside the decision to ban the prescription of puberty blockers for under-18s, the National Institute for Health and Care Research is sponsoring a clinical trial, and I have a number of questions for this Minister about that trial. The trial will be run by a team at King’s College London, led by Professor Emily Simonoff. According to The Times, the study will involve monitoring

“the well-being of children who attend a network of new NHS gender clinics for children, including those not on”

puberty blockers, and

“whether puberty blockers affect young people’s thinking and brain development, using various activities and brain scans.”

All that is disturbing, it seems to me, and that view has been argued by David Bell, who has suggested that other kinds of research could be adopted, other measures put in place. He refers to long-term follow-up studies of those who have undergone such treatment, qualitative research into the experiences of the growing numbers of detransitioners, and further animal studies to understand the biological impact of these drugs on adolescent brain development.

That view has been reinforced by the Clinical Advisory Network on Sex and Gender, which is calling for the Government and NHS to pursue alternative research options to the proposed clinical trial, including evaluating the effects of puberty blockers on children treated by the Tavistock clinic.

It seems to me that, after our having made the mistake that led to Tavistock and then having commissioned the Cass review, which led to its closure, the risk is that we now make another mistake, not out of ill will but out of a concern expressed by some of the people I have mentioned going unheeded. I hope the Minister will heed those concerns. They are not only mine, as I have made clear.

There was an ideological aspect to this situation that we must not understate. There was a belief, on some people’s part, that rather than accepting that young people as they grew might be homosexual, their sex should be altered. That is a chilling perspective, but it did hold sway in a number of cases, with medical intervention to support it. I hope this Government do not perpetuate that distorted view of humankind, and I am immensely grateful to my hon. Friend the Member for Reigate for giving us the chance to explore just that.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Ms Lewell. I start by making a declaration of interest as an NHS consultant paediatrician and a member of the Royal College of Paediatrics and Child Health. My work in the NHS at times involves looking after children who may have gender dysphoria, although it is not specifically for that purpose. I congratulate my hon. Friend the Member for Reigate (Rebecca Paul) on securing this important debate, and on her excellent speech.

Hippocrates’ dictum, “first do no harm”—although it does not actually appear in the Hippocratic oath—captures a core medical ethic, and is an important guiding principle in policymaking. When it comes to children and young people expressing gender dysphoria, we must take a compassionate but firmly evidence-based approach. The causes of gender incongruence are not fully understood, but they are likely to be multifactorial and influenced by both biological and social factors. It is of huge concern that diagnoses of gender dysphoria have risen over fiftyfold, and that vulnerable and same-sex attracted children are over-represented.

There are legitimate licensed uses for puberty blockers, such as in cases of children who enter puberty very young, and in the treatment of certain malignancies. However, using puberty blockers for young people with gender dysphoria represents a significantly different context, both medically and ethically. With most children with gender dysphoria, symptoms resolve without treatment, with many finding that the natural process of puberty leads to a resolution to their distress.

The Gender Identity Development Service began trialling puberty blockers for adolescents with gender dysphoria back in 2011. Preliminary findings in 2015-16 showed no psychological benefit from the treatment and, alarmingly, a deterioration of wellbeing in some children, particularly some girls. The Cass review, published last year, showed that there is insufficient evidence on the long-term effects of using puberty blockers to treat gender incongruence. I ask the Minister: why does the planned trial not look at long-term outcomes?

The Cass review made the risks of these drugs explicit. Puberty blockers can seriously compromise bone density and can lead to adverse long-term neurodevelopmental effects. As for the purported benefits, the review added that,

“no changes in gender dysphoria or body satisfaction were demonstrated.”

The often repeated justification that blockers are for “time to think” was not supported by the evidence, with concern that they may instead alter the developmental trajectory of psychosexual and gender identity.

In May 2024, the last Government passed emergency legislation to temporarily ban puberty blockers for new treatments of gender dysphoria. The current Government have renewed that order twice, continuing restrictions until the end of this year. However, that does not affect cross-sex hormones. Does the Minister plan to commission research on the outcome of masculinising and feminising hormones on young people? Do the Government plan to extend the ban to cross-sex hormones in the fullness of time?

We heard in February that the NHS has announced plans to start offering puberty blockers as part of a clinical trial. There are questions about this trial. Given that most children’s symptoms will resolve anyway, and that the Cass review clearly states there is no method of proving in advance which children will have improved symptomatology and which will not, the trial will be essentially treating a whole cohort of healthy children with drugs to see the effect on the around 15% whose symptoms may not resolve in adulthood. Former Tavistock clinicians, including David Bell, have said that they would not refer patients to the clinical trial.

The Government are taking direct control of NHS England, so it is now the Secretary of State’s responsibility to ensure that any such trial is properly conducted. The gold standard for a medical trial is the double-blind randomised controlled trial. Will the Minister confirm that if the trial goes ahead there will be a control sample? The trial still requires ethical approval from the Health Research Authority. Will the Minister provide an update on when that decision is expected, clarify how the Government are ensuring the impartiality and safety of the decision-makers, and clarify whether provisions are in place to pause or suspend the trial if safety concerns arise?

[Sir John Hayes]

Might my hon. Friend add to her list of questions and ask about the experience of other countries that have looked at these matters? For those countries that have used alternatives to having children in trials, how effective have such alternatives been?

[Dr Johnson]

My right hon. Friend raises important questions that I hope the Minister will answer. It is important to look at the data that we already have. That was the next part of my speech—my right hon. Friend is, as usual, reading my mind.

Given that these drugs have been used on hundreds of patients at GIDS alone, why not look at that data, rather than conduct new experiments on further children? Despite the last Government legislating to ensure that data could be made available for research, several NHS trusts refused to participate fully in the Cass review. What are the Government doing to retrieve that data and to ensure that NHS trusts, which are now more directly controlled by the Government, comply with data-sharing requirements in the future? If the trial does go ahead, how will the Secretary of State ensure the genuine impartiality of those conducting the trial so that we can rely on the results?

In conclusion, this debate is about the wellbeing of young people. Gender-questioning children are not solely defined by their gender incongruence and gender-related distress; they are whole individuals. They deserve holistic care and the same rigorous evidence-based care as any other young patient.

--- Later in debate ---

[Karin Smyth]

I thank my hon. Friend for that intervention; I hope to get on to that subject in my speech. It is important that people are aware of that progress.

I know that many people are concerned about the ethics of this research, as the hon. Member for Reigate and the right hon. Member for South Holland and The Deepings (Sir John Hayes) both noted. I assure hon. Members that the UK has, as we know, extremely rigorous and robust ethical approval pathways, and that no clinical trial can proceed without the necessary independent scientific approvals.

We already regularly use those processes to consider clinical trials in children so that we can evaluate new treatments for a whole range of conditions, including cancer, depression, respiratory infections, or any illness. Many aspects of the methodology of this trial are still being looked at, such as how long it will follow children, how many children will be on the trial and how the demographics of the trial will be constructed. That is all still to be confirmed and approved; many hon. Members asked about those points today. All participants in the trial will also be part of the ongoing observational study.

Following the decision by the Secretary of State for Health and Social Care about puberty blockers, which was based on the evidence, we needed to make sure that we got on with helping scientists, researchers and clinicians to do their jobs. Some people have called for the Government to stop those experts from pursuing this line of inquiry, and we have heard such calls again in this debate. They have argued that the decision to halt the sale and supply of puberty blockers should be the end of the matter, and that young people should not have access to this medication, come what may. That would be to ignore the distress and real experiences of young people, and the Government have no doubt that it would drive people towards possible illegal and underground routes, shutting off young people’s access to conversations with professionals and the opportunity to pause and consider other options.

Instead, as Dr Cass suggests, we can set out a proper path to treatment that involves young people, their parents, clinicians and mental health professionals. Knowing that they are on a path will reassure young people that they are being taken seriously. The cautious process that they will have to work through before joining a trial means that young people will have access to support and counselling, which may result in them deciding against joining the trial and pursuing a medical route. That is an approach entirely missing over recent years.

We all agree that treatment should be offered based on the best available evidence, and clinical trials in the UK are considered to be the gold standard for evaluating healthcare interventions. The Cass review found:

“The evidence base underpinning medical and non-medical interventions in this clinical area must be improved.”

That is why we have commissioned the PATHWAYS programme of research, one aspect of which includes the world’s first clinical trial designed to help us to better understand the relative benefits and potential wider effects of the use of puberty blockers in affected children.

We must look at the most appropriate medical and non-medical approaches to support physical, emotional and psychosocial health. That is why the trial forms just one component of a wider study and a growing portfolio of research, jointly hosted by NHS England. That includes looking at the experiences of the 9,000 adults who, as children, were cared for under a previous model of NHS care, which I know the hon. Member for Reigate has described as a “medical scandal”. Dr Cass was clear in her review that both a clinical trial on puberty blockers and a data linkage study, which many hon. Members have raised today, are important to improving the evidence base on gender incongruence in children and young people.

Regardless of individuals’ views on the practices of the Tavistock, I hope we can all agree that learning from the experiences of those thousands of people who have accessed puberty blockers is important; it will provide different and separately valuable information from the clinical trial. That data alone, however, will not provide the answer as to whether we should—or should not—consider routinely prescribing these drugs in the future, or continue the ban indefinitely.

The adult gender services have now committed to sharing their data, a point also raised by hon. Members. I acknowledge that we need to move quickly, and I expect to be making progress on this soon. We will consider all data that is relevant to puberty blockers, including from the adult gender clinics.

As with all clinical research, the team leading the trial must ensure that approval is obtained from the regulatory authorities, including one of the Health Research Authority’s independent ethics committees and the Medicines and Healthcare products Regulatory Agency. Those are all standard steps where the research receives full scrutiny. Once approvals are granted, the study protocol will be finalised and published, and only then can the trial commence. I am not able to comment on the finer details of that today, but we will issue further updates when they are available, and I commit to keeping Members updated.

I assure hon. Members that entry into the trial will be guided by strict eligibility criteria. It will involve only young people under the care of the NHS children’s gender services who have received a full assessment, where other appropriate forms of support have been offered and where their clinician supports a referral to the trial. Under the law, if a child is under 16, a parent will have to consent to their participation, and the child also needs to agree.

I am repeating myself slightly, but that level of caution was entirely missing over recent years. This is a more considered and evidence-based approach. In the past, puberty blockers were presented as the magic pill that young people needed to access; this trial will give children and young people the support they need to make these major decisions.

As we have heard today, we are currently in a situation where some people think it is unethical not to provide these treatments, and some think it is unethical to provide them. The reality is that we do not have definitive evidence. When that happens, we routinely ask for the study to be checked by an independent ethics committee. We spell out the uncertainty to young people and their parents, so that they can balance any such risk against their desire to join the trial before deciding whether they wish to participate.

[Sir John Hayes]

Will the Minister give way?

[Karin Smyth]

I am sorry, but I am tight on time.

Uncertainty is common to many new treatments, but through that process, we ensure that those treatments are no longer used in the absence of such evidence. During the trial, an independent committee checks whether new results have emerged from other countries around the world—a question that was raised several times—and, if those results provide evidence that the benefits or risks are clear, such that we could issue clinical guidelines based on them, the trial would be stopped.

We need better-quality evidence to support the NHS in providing reliable and transparent information and advice to children and young people, and their parents and carers, in making important treatment decisions. That is exactly what NHS England and the National Institute for Health and Care Research programme will provide.

I was asked to provide an update on implementing the Cass review, which, beyond that research, we are absolutely committed to doing. From what we heard this afternoon, I am not entirely sure what the Liberal Democrat position is, but we are very clear that we will continue to work on that in lockstep with NHS England. We have opened the three services, and a fourth is planned in the east of England from this spring.

Those services operate under a fundamentally different clinical model, where children and young people get the tailored and holistic care they need from a multidisciplinary team of experts in paediatrics, neurodiversity and mental health. At first, those services saw patients transferred from the now-closed gender identity development service at the Tavistock, but I am pleased that all the services now take patients from the national waiting list. NHS England aims for there to be a service in every region of England by 2026. That will help to reduce the waiting list and bring the services closer to the homes of the children and the young people who need them.