Hospitals

Karin Smyth Excerpts

Wednesday 23rd April 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

It really is a pleasure to close this debate on behalf of the Government. I think there have been 33 contributions from hon. Members from across the House.

Nowhere is it more apparent that the NHS is broken than in our crumbling hospitals. Over 14 years, the NHS was starved of capital and the capital budget was repeatedly raided to plug the holes in day-to-day spending. Lord Darzi’s investigation into the NHS in England made it clear that we have crumbling buildings and IT, mental health patients sharing showers in Victorian-era cells infested with vermin, and parts of the NHS operating in decrepit portacabins. Some 20% of the primary care estate predates the founding of the health service in 1948.

I thank the Liberal Democrats for bringing forward this debate. We broadly agree on the disgrace that the backlog of repairs, the decades-long cannibalisation of capital budgets and the unfunded fantasy of the new hospital programme had become. Where we disagree is on the cause and the solution. As we have heard today, the Liberal Democrats are completely silent on the part they played as members of the coalition Government. They were active and enthusiastic partners in the decision to impose austerity, and our NHS was starved of funding on their watch. The practice of raiding capital budgets to keep things afloat started in 2014, on their watch. The disastrous top-down NHS reorganisation, which wasted billions of pounds and contributed to record-high waiting lists, happened on their watch.

As for the solution, the Liberal Democrats are silent on how they would pay for and accelerate the new hospital programme. They are playing the same cynical game that we saw from the Conservative party: they are dangling the prospect of a new hospital while being unable to explain where the funding would come from or how the construction industry could deliver it within the timeframe. It is indeed opportunism, as my hon. Friend the Member for Gateshead Central and Whickham (Mark Ferguson) said. We all remember the Rose Garden, as my hon. Friend the Member for Watford (Matt Turmaine) said. The Liberal Democrats opposed the autumn 2024 Budget, which delivered record investment in our NHS. In sharp contrast, this Government are prepared to take the decisions needed to back up our promises with the funding needed to deliver them, and we are determined to rebuild confidence and trust in politics by promising only what we can deliver.

I have met many hon. Members in person and heard them in the Chamber today, and I know others are not here who would have wanted to contribute. As the Minister, let me say plainly that I agree with everyone’s anger. I share that anger because, when I tour hospitals up and down the country—I did so recently in Doncaster and in Oxfordshire, where I visited the Warneford hospital—I often see equipment and infrastructure that was procured 20 years ago when I was working for the NHS in Bristol. Seeing these physical reminders of the past when I tour hospitals fills me with a mixture of pride and shame. I feel pride because I was part of a generation of leaders who delivered hospitals fit for patients in the biggest hospital programme in NHS history delivered under the last Labour Government, and I feel shame because our legacy was squandered and patients have paid the price. We understand the legacy, and Lord Darzi was very clear that the task for us is to take action. That is why the Chancellor took the necessary decisions in her Budget to meet this challenge, and why we have put the programme on a firm financial footing.

As my hon. Friend the Minister for Care said, we are not just writing the wrong; we are taking pressures off hospitals, shifting the focus of our NHS from hospital to community, recruiting over 1,500 more GPs to take the pressure off A&E and harnessing the power of AI to help people who depend on care to stay at home. That point was well made by my hon. Friends the Members for Stroud (Dr Opher), for Aylesbury (Laura Kyrke-Smith), for Milton Keynes Central (Emily Darlington) and for Calder Valley (Josh Fenton-Glynn). As he made me sponsor him, may I wish my hon. Friend the Member for Calder Valley good luck in the marathon this weekend? The challenge before us is immense, but every member of this Government is up for the fight.

Members made a number of points, and I will try to get through them in the time available. I could not agree more with those who made the point that we have to break out of the vicious cycle of false economy. This Government were elected on a manifesto to end short-termism, easy answers and sticking-plaster politics. When we came into government we were saddled with a bill of almost £14 billion in backlog maintenance. My right hon. Friend the Chancellor has given us the funding this year to back NHS systems with over £4 billion of operational capital. A lifesaving cash injection of £750 million for targeted estate safety funding is a vital first step towards fixing our crumbling estate. That is crucial not only for patients, but for staff morale, as my hon. Friend the Member for Carlisle (Ms Minns) said. There is also £440 million to tackle crumbling RAAC concrete, keeping patients and their families safe. We are opening new mental health facilities, with more in construction, and that state-of-the-art provision will give the best possible care outcomes.

Furthermore, I assure Members that, unlike the previous Government, we will never raid capital budgets to plug day-to-day spending, and the Treasury has updated its fiscal rules to make that impossible. My hon. Friend the Member for Crewe and Nantwich (Connor Naismith) said that big promises with no plans are what got us into this mess, and that was echoed by my hon. Friend the Member for Mid Cheshire (Andrew Cooper), who talked about the false hope and the waste of the past. My hon. Friend the Member for Banbury (Sean Woodcock) echoed that point and reiterated the point about trust, which was almost shared by the hon. Member for South Devon (Caroline Voaden).

Members have called on the Government to reverse course and commit to a timeline that is unfunded, unrealistic and undeliverable. That has been recognised by a National Audit Office report, which stated that

“some schemes publicly promised in 2020 now face substantial delays and will not be completed by 2030…with implications for patients and clinicians.”

The delivery of these hospitals existed only as a figment of Boris Johnson’s imagination and this Government are doing the hard yards of putting the new hospital programme back on track. The NHP previously received a red rating from the Infrastructure and Projects Authority, now known as the National Infrastructure and Service Transformation Authority. Its latest review, which it carried out in January, rated the NHP as amber. That reflects the measures that we took to put the programme on a firm footing, as my hon. Friend the Member for Harlow (Chris Vince) rightly said.

Some Members, including the Chair of the Select Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), have asked us to publish the individual scores of each scheme following the outcome of the review, but may I just take issue with the hon. Lady’s use of the word “shady”? The Secretary of State and the Department will continue to co-operate with her Committee, but to be clear, as part of our analysis, schemes were prioritised into upper, middle and lower thirds, which gave a delivery schedule for the programme to align with the funding envelope, and there was no final individual score for each scheme. There is no formal delineation among schemes in wave 2, and schemes remain scheduled to start construction as outlined in our plan for implementation.

I briefly say to my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh) that it was a pleasure to meet Councillors McCabe and Garrod from her constituency and to understand their passion about the loss of resources. That is echoed in many low-income areas, and we have to reverse that loss of resources as we go forward with our 10-year plan.

We are taking a systematic approach to building the next generation of hospitals, known as Hospital 2.0, allowing trusts to benefit from economies of scale, provide excellent patient care and facilities, and ensure that staff are supported with technology for decent working environments. It contributes to our growth mission, putting more money in people’s pockets and supporting our supply chains. In response to my hon. Friend the Member for Milton Keynes North (Chris Curtis), we do abide by the Hospital 2.0 scheme. It is a systematic and centralised approach that will save taxpayer money, while driving innovation and laying the foundations for a new relationship between Government and industry. I am disappointed if it is official Liberal Democrat policy to oppose that approach.

I know the clock is against me but I want to end by saying that I completely understand why colleagues are so concerned about the plans, when previous Governments have so badly let them and their constituents down. I also hear the point made by the hon. Member for South Antrim (Robin Swann) about Northern Ireland. Northern Ireland benefits from the Barnett consequentials for revenue and capital. It is devolved and it can look at alternative means. The Department will continue to work with all devolved Administrations across all issues, but they do have particular problems.

Staff and patients deserve better, so I want to offer them some reassurance about our record since July. We promised to sit down with resident doctors and end the damaging strike action—promise made, promise kept. In October, we said we would recruit more GPs by April and we recruited more than we said—promise made, promise kept. We promised 2 million extra appointments in our manifesto and we smashed that target seven months early—promise made, promise kept. Last month, over 80% of patients in England referred for cancer had it ruled out or diagnosed within 28 days, the first time that target has been met for years, and waiting lists are now consistently falling.

We have gripped this critical issue since July, from day one with the review. The Secretary of State and I met MPs and the NHP team before the completion of the review. I met all colleagues the day after the announcement in January and I have had individual meetings. I will keep my promises to visit, when the diary allows. I am really looking forward to North Devon. I am also visiting Hillingdon, where I grew up, with my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales), and possibly visiting some old haunts. I have committed to visiting Basingstoke, with my hon. Friend the Member for Basingstoke (Luke Murphy). We will progress at pace on RAAC and wave 1. I am committed to holding more meetings with wave 2 and wave 3 MPs in the coming weeks and months to keep colleagues abreast of updates and to provide them with the opportunity to ask questions directly of the team. That is how I will work with colleagues across the House to make sure the programme happens.

Finally, the hon. Member for Sleaford and North Hykeham (Dr Johnson) talked about her experience of the PFI scheme she worked under and the nonsense she had to deal with. Her Government could have changed that at any point. My experience of a PFI scheme in Bristol was waking up about a year ago after I had had my melanoma removed, in an almost brand new hospital with fantastic facilities in a single, individual ward with my husband beside me. Maybe it was the drugs that made me feel a little bit bleary-eyed, but what I thought then was how proud I was to have been part of the development team, as part of the primary care trust board, bringing forward a fantastic hospital for north Bristol that serves patients so well. That would never have happened under another Administration. We rebuilt the hospitals under the previous Labour Government. I am proud of that record. We did it before; we are going to do it again. That is what a Labour Government do.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.

--- Later in debate ---

That this House regrets the appalling state of repair of NHS hospitals across the country; notes that the NHS maintenance backlog rose to £13.8 billion in 2023-24; further notes the sustained pattern of cannibalising NHS capital budgets to keep day-to-day services running; condemns the previous Government’s record of starved repair budgets and exploding maintenance backlogs, which made sewage leaks, cracked walls, crumbling ceilings and sinking floors commonplace; further condemns the previous Government for launching the New Hospitals Programme with no realistic plan to fund or deliver it; also notes that the Chancellor has announced new fiscal rules to ensure capital budgets can no longer be cannibalised, with transfers from capital to resource budgets not permitted; recognises that the previous Government left a New Hospital Programme which was unfunded, unrealistic and undeliverable; welcomes that the Government has taken action to review that Programme and has published the New Hospital Programme Plan for Implementation, to put the Programme on a sustainable footing; supports the Government’s investment in the Plan, which will increase to up to £15 billion over each consecutive five-year wave, averaging around £3 billion a year from 2030; and further supports the work being done to bring forward construction of the reinforced autoclaved aerated concrete replacement schemes wherever possible, to ensure that patient and staff safety is prioritised.

[Karin Smyth]

On a point of order, Madam Deputy Speaker, could you advise me whether it is in order that the hon. Member for Sleaford and North Hykeham (Dr Johnson), who opened the debate for the Conservatives, was not in her place for the close of the debate? I think that is discourteous to the House, and I would like your advice on how we rectify this matter.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

The point of order is most definitely on the record. It is a point of courtesy to be here for the close of a debate if you are here for the opening. No doubt, Opposition Front Benchers will make that very clear to the Member.

NHS Pensions

Karin Smyth Excerpts

Tuesday 1st April 2025 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on NHS pensions in the light of the statutory deadline for both remediable service statements and remediable pension savings statements being missed.

[The Minister for Secondary Care (Karin Smyth)]

I thank the hon. Member for Hinckley and Bosworth (Dr Evans) for asking this question, which gives me the opportunity to provide further information following the written parliamentary statement that I issued yesterday to update the House on the delivery of remediable service statements to affected members.

I have extended the deadlines for the NHS Business Services Authority to issue statements to ensure that members have enough time to make informed decisions. Once members have received statements, they will be able to use a tool provided by His Majesty’s Revenue and Customs to retrospectively adjust their annual allowance between 2015-16 and 2022-23.

Separately, the original deadline to issue the 137,000 remediable pension savings statements was 6 October. The NHS Business Services Authority issued statements to 57,000 members by this deadline, of which 23,000 were found to contain incorrect information; these have since been recalculated and reissued. The NHS Business Services Authority is working to issue outstanding statements as quickly as possible.

A revised delivery timetable has been developed and shared with trade unions and employer representatives. By the end of March, 106,000 statements had been issued. Statements for 11,000 members will be produced once further information has been received from their employers. The remaining 20,000 statements require additional manual input from the NHS Business Services Authority before they can be produced, and will be issued in July. There have been delays on all sides, which we have been aware of since last July. In fact, the Department had escalated issues of design with the previous Government, as I am sure the hon. Gentleman understands.

We know that this matter is really important and that there are high numbers of high earners in the NHS, which is why we have taken the decision to be open and transparent about the timeline that we can now commit to, having worked tirelessly to reduce the delays. Although these delays will cause inconvenience to some members, I have been crystal clear that no one will face any financial detriment as a consequence. Compensation arrangements are in place for direct financial losses, certain HMRC interest charges, and the costs of financial and accountancy advice.

The Government do acknowledge the impact of the delays on affected members. We are working hard to issue outstanding statements and to protect members from any financial detriment the delays may cause.

[Dr Evans]

What is going on with NHS pensions administration under this Government? I declare an interest as someone with an NHS pension. Today, the Government have missed the statutory deadline for issuing remediable service statements to doctors, and they are now pushing the deadlines back to December 2026. In mid-March, the Government confirmed that just 21 statements had been issued out of 380,000; as of yesterday’s written statement, there are still more than 370,000 outstanding. This creates huge tax liability uncertainties.

We and the British Medical Association have been raising concerns for months. Why has it taken the Government so long to act? Ministers have announced a revised delivery plan, but how will it work in practice? Will there be more staff to help with the backlog? What changes are being put in place to ensure that the deadline is not missed again?

What was most concerning, however, was the complete absence of any mention of the remediable pension savings statements in the written statement. This issue really matters, as doctors who are taking on overtime or who work privately rely on these statements to be able to track their contributions and avoid excessive tax bills. According to Dr Sharma from the BMA,

“There’s no doubt that without up-to-date information, doctors will be pre-emptively reducing or turning down extra work to avoid additional pension…bills that they might not even be due.”

The statutory deadline for the 137,000 statements was, as we heard, 6 October 2024. In February, Ministers confirmed that 60,000 were outstanding and that the majority would be issued by the end of February; by March, however, the backlog had actually grown to 70,000. Can the Minister explain how two legal deadlines have been missed? Will the Government be following up with the regulator to ensure that this does not happen again? Do the Government have confidence in the NHS Business Services Authority? With the Secretary of State abolishing NHS England, what does this mean for the future of this vital organisation?

We all want to see waiting lists fall, but as one newspaper put it today,

“Labour’s pledge to slash NHS waiting lists is being sabotaged by a litany of administrative errors, pension delays and punitive tax rules.”

I urge the Government to take swift action.

[Karin Smyth]

As I outlined in my response and in the written ministerial statement, we have taken action. We were made aware of some of these problems when we came into office in July, and we have pushed the NHS Business Services Authority to move faster than it would have done under the hon. Gentleman’s Government, so that action is happening quicker than it would have done before. We do have faith in the NHS Business Services Authority to get on with this and ensure that there is no financial detriment, in line with the timetable outlined yesterday, and as I have further made clear today.

Madam Deputy Speaker, the hon. Gentleman could have asked me more about waiting lists, which have fallen for the last five months in a row. He could have asked me about the 2 million more appointments that have been provided to deliver for patients seven months early. He could have asked me about the hundreds more GPs who are now working in the health service, or the impact of cancelling the strikes on services for people, or the record funding. In fact, last week in the Chamber he spoke on behalf of the National Pharmacy Association; this week, he could have congratulated the Minister for Care, who is sitting next to me, on the agreement to produce more pharmacy services.

We are making improvements to the NHS every day. The Darzi report reported not only the breadth but the depth of the decline that we inherited. We are resolving that, and fixing the fundamentals of the NHS.

[Chris Vince (Harlow) (Lab/Co-op)]

I thank the Minister for coming to the House and giving her response. We all know the issues she is talking about when she mentions the state of the NHS that we inherited, and I echo that with the issues I hear about from patients and staff at Princess Alexandra hospital in Harlow. On pensions, can she outline what the Government have done to mitigate the delays in the process?

[Karin Smyth]

It is important that people have confidence in the pension system. That is why we took action in July on coming into office to understand the depth of the problems that occurred under the previous Government. This is a complicated issue, which is why we want to be clear with people that there will be no financial detriment to them. We will continue to work with employers and trade unions to ensure that the issue is resolved as quickly as possible, in line with the timelines I have outlined.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

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

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

[Karin Smyth]

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

[Jayne Kirkham (Truro and Falmouth) (Lab/Co-op)]

Does the Minister agree that it is important that the affected members receive those statements to allow informed decision making? The Government have worked to minimise financial detriment to those affected, but this issue is part of the mess we have been clearing up. We have had record investments into pharmacies and more GPs, and we have cut waiting lists and stopped the junior doctors’ strikes. We are on the road to recovery.

[Karin Smyth]

My hon. Friend is absolutely right that we are on the road to recovery—and that, of course, is what the Opposition cannot stand. This is a complicated issue, as they well know. As I said, we inherited this complication in July, when we were made well aware of it. The Conservatives could have done more about it while they were in government, but it is yet another issue on which they have let people down—this time, it is staff.

We will ensure that we remedy that. The timelines are available in the written ministerial statement that I issued yesterday. We will continue to work with trade unions and employers to ensure that people understand. As my hon. Friend said, it is important that people do understand their own personal positions.

[Madam Deputy Speaker (Caroline Nokes)]

I call the Chair of the Health and Social Care Committee.

[Layla Moran (Oxford West and Abingdon) (LD)]

I have to say that I am none the wiser about what exactly has happened. If we are to ensure that this will not happen again—that these deadlines will be met—we need to know how we got into this position. It may well be the fault of the previous Government. Will this Government commit to a full review of exactly how we got here, so that we can ensure that the published deadlines are met this time?

[Karin Smyth]

The Chair of the Health and Social Care Committee makes a good point, as she so often does, about what went on previously. This is an issue from the McCloud judgment that runs across many Departments. It was a problem under previous Governments, starting with the coalition Government. I know that the Public Accounts Committee, on which I served, and the Treasury Committee have looked at the matter over time. The Department will certainly co-operate with any inquiry and investigate what happened across Government. I am happy to get back to the hon. Lady on that point.

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

This issue appears to be yet another example of the hangover left by the previous Conservative Government. Does the Minister agree that part of getting the NHS back on its feet includes cleaning up this mess and cutting waiting lists, which have already dropped for five months in a row?

[Karin Smyth]

My hon. Friend makes absolutely the right point. As I have said, Lord Darzi has helpfully outlined the breadth of the mess that we inherited back in July, and it makes for stark reading. We have still not had an apology from the Conservative party, so I am happy to take an intervention now if anybody decides to provide one. In these issues, we are seeing the depth of the destruction that the Conservatives have caused widely across Government. We will continue to fix that on behalf of the British people.

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

I declare my interest as a practising doctor and a public sector pensioner who has been through the McCloud process. Does the Minister understand that we will not improve productivity in the NHS as far as doctors are concerned if they continue to retire routinely in their mid-50s—in their prime? They do so because their accountants tell them that they would be foolish not to, given the fiscal environment and the structure of the NHS pension scheme.

[Karin Smyth]

I understand that point. Obviously, it is a source of much discussion. The change came about during the pandemic to encourage people to return to work, and it is a complex issue. We want to continue to use the skills of doctors at all stages of their careers, and we shall continue to work with them, the British Medical Association and others to make sure that there is no detriment to their returning to service in the NHS.

[Lewis Atkinson (Sunderland Central) (Lab)]

I declare an interest as a member of the NHS pension scheme. Can the Minister confirm that this issue arose only because the previous Government carried out their NHS pension reforms in a way that was found to be age discriminatory? More widely, does she agree that giving NHS staff the terms and conditions and the reward and recognition that they deserve also requires prompt action each year on agreeing the NHS pay award, which the Conservative party routinely failed to do when in Government?

[Karin Smyth]

My hon. Friend makes an excellent point on our commitment to staff to be clear on their terms and conditions, and our commitment to honouring that reward. That is why we acted promptly when we came into office. We have issued statements and provided answers to parliamentary questions to make sure that people are clear about the system and that we are transparent.

[Bob Blackman (Harrow East) (Con)]

It takes rather a long time to train a doctor—up to six years—so it is a good job that the previous Government had the opportunity to train more doctors. Will the Minister look at one aspect of concern, which is that if doctors start reducing their overtime hours because of fiscal aspects, it will hamper the opportunity to get more patients treated and to shorten the length of waiting lists?

[Karin Smyth]

As I said in response to the right hon. Member for South West Wiltshire (Dr Murrison), we understand that, and we will continue to work with all staff in the NHS to make sure that we deliver on our commitment to reduce waiting lists, which were left at a shocking level by the previous Government.

[Daisy Cooper (St Albans) (LD)]

I have a constituent who is suffering both financial and emotional distress as a result of these circumstances. I wrote to the NHS Business Services Authority, and it took four months to get a response. In written questions to the Government, I have asked how I might make representations about my constituent being affected by financial distress. The response that I received from Ministers simply said that NHSBSA has all the evidence that it needs, and there is no need for anyone to provide extra evidence. There is a very real risk that some people who are affected by this are suffering financial distress but have not been identified by NHSBSA. For those people, can the Minister please outline what mechanism we as Members can use to make those people known to NHSBSA, so that they can access their pension choice earlier?

[Karin Smyth]

I am sorry to hear about the emotional and financial distress of the hon. Lady’s constituent. If there is a gap, I am happy to go back to the NHSBSA on her behalf and make sure that I update the House.

[Lincoln Jopp (Spelthorne) (Con)]

Does the Minister have full confidence in the chair of the NHS Business Services Authority?

[Karin Smyth]

As I said in my statement, we have confidence in the business authority to undertake the actions that I have outlined.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her answers to the questions. Waiting lists are clearly beyond the pale. If the Government were able to address the remedial pension savings statement, we might be in better position to entice our doctors to take on additional hours. Will the Minister confirm that this is a Government priority, and that there is an understanding that a functioning NHS requires straightforward paths to working overtime, and payment at every level?

[Karin Smyth]

One of our major priorities is ensuring that the entire NHS workforce are doing the work that they are trained and committed to do, so that they can get down those waiting lists and deliver an NHS that is fit for the future. The staff, as Lord Darzi has outlined, have felt very severely the detriment caused by the previous Government. They are working under really difficult conditions, and we want to make sure that, through the 10-year plan and the NHS Long Term Workforce Plan, we offer them hope, so that they are ready to deliver the services that they have been trained to deliver.

[Madam Deputy Speaker (Caroline Nokes)]

I thank the Minister for her responses this afternoon. I will allow a moment for the Front Benchers to swap over.

NHS Pension Scheme: Remediable Service Statements

Karin Smyth Excerpts

Monday 31st March 2025 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

In 2014 and 2015, the previous Government reformed public service pension schemes with the intent to better balance the interests of public service workers, employers and taxpayers. When the reforms were introduced, they provided “transitional protections” which allowed members who were closer to retirement age to remain in the previous “legacy” schemes rather than move to the “reformed” schemes. In December 2018, the Court of Appeal found that these protections in the judicial and firefighters pension schemes gave rise to unlawful discrimination—the McCloud and Sargeant case.

Governing legislation—the Public Service Pensions and Judicial Offices Act 2022— was enacted to remedy the discrimination identified by the courts. A core element of the remedy is providing affected members with a choice of pension benefits, legacy or reformed, for the period the discrimination had effect. Schemes must provide affected members with remediable service statements which set out how this choice will affect the value of their pension benefits. Members who have already retired must be provided with a remediable service statement to allow them to make their benefit choice retrospectively.

The governing legislation requires that a statement is provided to each affected member on or before 1 April 2025 or “by such later day as the scheme manager considers reasonable in all the circumstances in the case of a particular member or a particular class of member.” Today, I am updating the House on the delivery of remediable service statements for affected NHS pension scheme members.

The production of remediable service statements involves a complex and challenging programme of work. Technical complexities, some of which extend beyond the NHS pension scheme, have affected delivery timelines for statements.

The NHS Business Services Authority, as the scheme administrator of the NHS pension scheme, is prioritising the delivery of remediable service statements. However, in order to ensure that affected members receive robust statements that enable informed decision making I have agreed to a revised delivery plan for these statements with the authority, on which it is communicating with affected members. The revised delivery plan prioritises members based on their likelihood of facing financial detriment as a consequence of the discrimination. Government acknowledge that the revised timelines mean many members will receive their statement later than anticipated and that this will have an impact, especially on those retired members who will financially benefit from their choice.

As part of the revised delivery plan, Government will be holding the NHS Business Services Authority to account against extended deadlines for the delivery of remediable service statements. These extended deadlines are detailed in the table below:

NHS England Revised Financial Directions 2024-25 and 2025-26

Karin Smyth Excerpts

Monday 31st March 2025 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

I am revising the 2024-25 financial directions to NHS England made on 26 March 2024 and setting the 2025-26 financial directions to NHS England. The amendment to the total revenue resource use limit for 2024-25 has been agreed with NHS England as required under section 223D(4) of the National Health Service Act 2006.

The directions reflect recent funding settlements with HM Treasury and include a number of transfers of funding between NHS England and the Department of Health and Social Care. The 2024-25 revisions include additional funding received in-year for the NHS pay awards and other in-year pressures, including elective activity. The 2025-26 total is as set out by HM Treasury at the autumn Budget, but with some additional transfers between NHS England and DHSC. They will be published on www.gov.uk. The existing NHS mandate remains unchanged by these publications.

[HCWS569]

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 25th March 2025 Commons Chamber

[Paulette Hamilton (Birmingham Erdington) (Lab)]

3. What assessment he has made of the adequacy of the provision of health services for women.

[The Minister for Secondary Care (Karin Smyth)]

The Government are committed to improving women’s health outcomes. We have already taken urgent action to tackle the gynaecology list through the elective reform plan, and we recently announced an £11 million trial using AI tools to detect breast cancer cases earlier. The 10-year health plan will set out how we will tackle the factors that lead to poor health outcomes and the improvements we expect to see.

[Paulette Hamilton]

What assessment has the Minister made of the adequacy of research into and the provision of fibroid treatment for women, taking into consideration that fibroids are three times more likely to appear in black women than in white women?

[Karin Smyth]

The Government welcome the work my hon. Friend has undertaken and the work of the Caribbean and African Health Network in highlighting health inequalities for black women. She highlights shocking and unacceptable statistics. The National Institute for Health and Care Research has funded a significant amount of research into women’s health issues, including a £1.5 million trial comparing treatment options for fibroids. I am happy to make sure she is updated on that work and on the details of that work.

[Mr James Cleverly (Braintree) (Con)]

Early diagnosis and treatment of breast cancer can make a huge difference to the women involved, and, of course, to the prognosis and the cost to the state of health provision. I welcome the reference in the cancer plan to early diagnosis, but what specifically will the Government do to encourage greater awareness of the full range of breast cancer symptoms, and to encourage women to get early diagnosis and treatment for better outcomes?

[Karin Smyth]

I thank the right hon. Gentleman for that question and for the work he has supported on behalf of his wife to raise awareness. Screening access and uptake are shockingly low across the country right now, and looking at that is a key part of what we need to do to ensure that women come forward for the screening test. The AI work will support the faster response time so that we can get women treated more quickly, and will absolutely form part of what we need to do in the coming years.

[Nadia Whittome (Nottingham East) (Lab)]

I want to put on the record my thanks to the Health Secretary for coming to Nottingham last week and meeting some of the families who have been harmed by extremely serious failings in maternity services at Nottingham University Hospitals NHS trust, and for his sincere commitment to them. It was clear just how moved he was by their stories. One of their asks is that the Government implement the 22 recommendations from the Shrewsbury and Telford Ockenden review, so I ask the Minister today to commit to doing that.

[Karin Smyth]

I know that my hon. Friend and other Members representing that area have supported the trust and particularly the families who have been affected. As she highlights, my right hon. Friend the Health Secretary visited last week and was deeply moved by those stories, and has committed to visiting again. The Government are working through those recommendations and will update the House shortly.

[Jess Brown-Fuller (Chichester) (LD)]

Following on from the question asked by the hon. Member for Nottingham East (Nadia Whittome), I held a debate in Westminster Hall a few weeks ago on maternity services and spoke to families across the country who have experienced failures in the system that ultimately left them without their babies to take home. It was a devastating experience for all involved. The immediate and essential actions in the Ockenden review were supported by the previous Government, and the Secretary of State for Health has been vocal in his support for their implementation. However, those families want to know how quickly they will see real change in maternity services up and down the country so that families can confidently go to deliver their babies.

[Karin Smyth]

The hon. Lady is right to highlight the impact of the failures in maternity services on women and their families across the country. As she highlights, my right hon. Friend the Health Secretary takes this matter personally and is looking at it. We will continue to work closely with Donna Ockenden on those recommendations and will continue to update the House regularly. This is an important issue for Members across the House representing their constituents, whether in this Chamber or Westminster Hall, and we are very keen to ensure that we support staff, build that confidence for women and their families and give them a good experience of maternity services.

[Joani Reid (East Kilbride and Strathaven) (Lab)]

4. What assessment he has made of the potential implications for his policies of the independent review into data and statistics on sex and gender by Professor Alice Sullivan.

--- Later in debate ---

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

6. What steps his Department is taking to help tackle inequalities in nursing career progression.

[The Minister for Secondary Care (Karin Smyth)]

I know that this subject is very close to my hon. Friend’s heart, after many years of NHS service. Ensuring great careers for NHS staff, including nurses, has been a key theme of our engagement with staff to shape the 10-year plan. I will shortly set out further measures to improve progression for nurses and their colleagues in other key NHS professions.

[Kevin McKenna]

I thank the Minister for her answer. Nurses across the profession are increasingly taking on complex roles and responsibilities, yet many do not have access to higher pay bands that reflect these changes, and there is too much variation around the country. As well as looking at this, will the Minister ask the Department of Health and Social Care to implement a consistent model for supported, structured progression from band 5 to band 6 for early career nurses based on the completion of key competencies and the acquisition of necessary experience?

[Karin Smyth]

My hon. Friend is right that NHS staff, including nurses, should be paid appropriately for the work they are asked to do and will be asked to do in future. We are working with the NHS Staff Council to ensure that the national job evaluation scheme is implemented fairly and consistently across nursing and all professions.

[Alison Bennett (Mid Sussex) (LD)]

My constituent Ben has spent two decades working as a nurse. He tells me that his paramedic and midwife colleagues received automatic pay band increases post qualification while he and his nursing peers did not. Ben and his hard-working nursing colleagues have missed out on tens of thousands of pounds compared to colleagues in other disciplines. Does the Minister agree that something must be done urgently to make up for this inequity?

[Karin Smyth]

I am absolutely clear that we need to make sure that the job evaluation scheme looks at staff across the piece and that people are rewarded appropriately for the work they are asked to do. We will do that as part of our discussions with the NHS Staff Council, and we will be working consistently with staff as part of the 10-year plan to ensure that people are rewarded. We depend on these staff, and we want to encourage them to be part of the NHS workforce. That is the approach we intend to take.

[Sojan Joseph (Ashford) (Lab)]

7. What steps his Department is taking to reduce the number of people waiting for NHS treatment.

--- Later in debate ---

[Christine Jardine (Edinburgh West) (LD)]

For eight years, I have seen how a young constituent has been able to completely control his previously life-threatening seizures with medicinal cannabis, but at huge cost to his family—a cost that is prohibitive for other people. Will the Secretary of State meet me to discuss how we can make access to such treatments more affordable, accessible and safe, so that we can help more people?

[The Minister for Secondary Care (Karin Smyth)]

We recently had a helpful debate in Westminster Hall on this topic. We are doing more research on this issue to ensure that the evidence base is there. I am happy to discuss the matter further with the hon. Member.

[Mohammad Yasin (Bedford) (Lab)]

In the ongoing discussion on assisted dying, one point on which we all agree in this House is the urgent need to improve palliative care. I therefore welcome the Government’s recent £100 million commitment to supporting hospices, including those that help my constituents. Can the Minister confirm whether long-term funding for hospices will be a priority in the upcoming 10-year health service plan?

--- Later in debate ---

[Karin Smyth]

Those statistics are shocking. Campaigns here and elsewhere have helped to raise awareness of endometriosis. The update to National Institute for Health and Care Excellence guidelines will help, as will more appointments, and our commitment to the 18-week target. Training for GPs is now part of the core curriculum, and we expect that to yield good results. NHS England and the Office for National Statistics have look-across to the statistics on diagnostic metric standards. I am happy to update my hon. Friend outside the Chamber, and I know other Members are also interested in how we are delivering on these commitments.

[Mr Gagan Mohindra (South West Hertfordshire) (Con)]

My constituents in South West Hertfordshire remain concerned about the significant delay to the redevelopment of Watford general. With the Chancellor already bringing a second emergency Budget before the House tomorrow, and with care homes, hospices and charities facing unsustainable pressure from this Government’s national insurance increases, what reassurances can the Minister give my constituents that the Labour party truly care about healthcare, rather than scoring political points?

--- Later in debate ---

[Tulip Siddiq (Hampstead and Highgate) (Lab)]

Much to my alarm, the North Central London ICB has recommended the closure of the maternity unit at the Royal Free hospital in my constituency. The Secretary of State knows the Royal Free well. Will he meet me to see how I can save my local maternity unit, which looked after me so well when I had gestational diabetes?

[Karin Smyth]

These local services are so important for local women, as my hon. Friend has experienced. It is really important that reconfigurations are discussed with local Members of Parliament, representing their constituents. This is obviously a matter for the local ICB, but I am happy to discuss it further with her.

[Daisy Cooper (St Albans) (LD)]

Following my long-running campaign, I am grateful to the Government for finally updating the outdated Treasury rules that were preventing local health boards from spending more money on keeping city centre GP locations. Will the Government now issue guidance to local health boards and NHS trusts to accelerate the pooling of resources, so that we can get more services out of hospitals and on to our high streets, especially as our high streets need extra footfall right now?

Down’s Syndrome

Karin Smyth Excerpts

Wednesday 19th March 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

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

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

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

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

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

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

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

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

[Graham Stuart]

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

[Karin Smyth]

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

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

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

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

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

[Dr Luke Evans]

Will the Minister give way?

[Karin Smyth]

I am sorry, but I think I have only a minute to go.

This week has been a powerful reminder of how far we have come regarding awareness of Down syndrome. It has also made us reflect that much more remains to be done. When the guidance is launched for public consultation, we will welcome Members’ support to ensure that the communities they represent are aware of it and can share their views.

I will just highlight the issue of regression, which my hon. Friend the Member for Thurrock mentioned. The guidance will deal with specific health needs, and regression will be part of that.

I thank the right hon. Member for Beverley and Holderness again for securing the debate and other hon. Members for joining the discussion. In particular, I thank the co-chairs of the APPG, the right hon. Member for East Hampshire (Damian Hinds) and my hon. Friend the Member for Mid Cheshire (Andrew Cooper), for their work, and everyone who works tirelessly to improve our support systems and services. It is incumbent on us all, working with people with Down syndrome, their families and carers, to get this done.

I appreciate that a number of requests have been made for different individuals and groups to meet my hon. Friend the Minister for Care. He is keen to do that. I will not make specific commitments, although the right hon. Member for Beverley and Holderness tempts me to do so, but I will make the commitment that my hon. Friend will be in touch via his office with colleagues who made such requests, to ensure that we make best use of the time and bring people with us on the implementation of this guidance, which is so crucial—I remember my time on that Bill well. I am thankful for the opportunity to be part of the debate this afternoon.

Contingencies Fund Advance

Karin Smyth Excerpts

Thursday 6th March 2025 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

The Department of Health and Social Care�s new cash requirement for the year exceeds that provided by the main estimate 2024-25. The supplementary estimate has not yet received Royal Assent.

The Contingencies Fund advance is required to meet commitments until the supplementary estimate receives Royal Assent, at which point the Department of Health and Social Care will be able to draw down the cash from the Consolidated Fund in the usual way, to repay the Contingencies Fund advance.

Parliamentary approval for additional resource of �1,400,000,000 will be sought in a supplementary estimate for the Department of Health and Social Care. Pending that approval, urgent expenditure estimated at �1,400,000,000 will be met by repayable cash advances from the Contingencies Fund.

[HCWS503]

Maternity Services

Karin Smyth Excerpts

Tuesday 25th February 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I am grateful to the hon. Member for Chichester (Jess Brown-Fuller) for raising this extremely important issue. It touches so many of our constituents and so many families across our country, and I know how many of them she and other Members have spoken to. As the Secretary of State said, it is an issue that keeps him awake at night. The hon. Lady spoke very movingly about her friend Steph and Steph’s son, Bendy, whom I know she remembers very fondly. We have had too many decades of similar stories, but she did good service to her friend and Bendy today.

I will do my best to answer as many questions as possible—it has been a wide-ranging, respectful and thoughtful debate—but the Minister for Patient Safety, Baroness Merron, who leads on this issue for the Department, will be happy to write to colleagues where necessary.

The hon. Member for Chichester asked a number of questions at the end of her speech, and I hope that I will address most of them. I completely understand why she is pushing on behalf of the families that the Secretary of State met for the maternity services plan to be outlined. Families have waited long enough, but we want to make sure we get it right, so we are taking time within the Department to discuss the next steps with officials and ensure that any plans we put out are as strong and effective as possible; we have had too many plans that have not been. Those families will receive an update on the next steps very soon.

I will come on to some of the essential actions from previous reports, but I will re-emphasise that all Donna Ockenden’s recommendations were accepted and are being worked on. I will pick up on that later in my speech.

On workforce and training, we will publish in the summer the refreshed long-term workforce plan. That will set out how we will build a transformed health service over the next decade, and obviously it will include midwifery.

[Helen Maguire]

Will the Minister give way?

[Karin Smyth]

I will, but I will not be able to get through my speech if I keep giving way.

[Helen Maguire]

I will be very brief. La Retraite sixth form in London has a T-level qualification in health with midwifery, linked up with Guy’s and St Thomas’, and it is proving successful. Will the Minister consider working with the Secretary of State for Education to look at rolling that out throughout the country? It is proving really successful in getting new midwives into the system.

[Karin Smyth]

The hon. Lady raises something very close to my heart. I spoke frequently in opposition about apprenticeships and the need for the health service to work on that. I actually visited that centre with the chief nursing officer and met students there. It was a lovely visit; we had a fantastic morning with really enthusiastic young people who wanted to go into the profession. The hon. Lady makes an excellent point, and we will continue to work with Guy’s and St Thomas’ on that. Others could take note of what they are doing.

We understand the issues with the CQC. They are well documented and were further highlighted by the hon. Members for Cheltenham (Max Wilkinson) and for Chelmsford (Marie Goldman). We do not think now is the time to make changes to the statutory limitation power, because we want the CQC to prioritise improving its regulatory approach and focusing resources on the recovery plan in line with the Dash report. Once that is done and the CQC is working better, the Government have committed to reviewing that statute of limitation power.

With regard to phonelines, Sands and Tommy’s do fantastic work for bereaved parents across the country— I know that from my own Bristol South constituency. We are always open to new ideas and suggestions from the experience of people working on the ground. I will ask officials to consider recording triage phonelines as part of our longer-term work on maternity and neonatal services. Many hon. Members raised general points about communications. The hon. Member for Chichester was right to mention communication for parents—both mothers and fathers. That was a point well made, and I will pick it up later.

Donna Ockenden rightly commands huge respect across Government, parties and the NHS. She was right to say that previous Governments were “asleep at the wheel” on maternity care. We have heard already, but it is worth restating, that babies of black ethnicity are twice as likely to be stillborn as babies of white ethnicity. The maternity workforce is experiencing significant challenges and safety in maternity care is very far from where we want it to be.

Hon. Members highlighted their meetings with families. The Secretary of State and Baroness Merron have met a number of bereaved families over the past few months, as I know others have done. My hon. Friend the Member for East Worthing and Shoreham (Tom Rutland) talked about the families he has met. He highlighted that when he talked to me recently about issues in his constituency.

As with so many issues in healthcare, there is no quick fix to the challenges we face. There have been too many high-profile independent reviews into maternity services over the past few years. With remarkable consistency, they all point to the same thing: a culture that belittles women, downplays concerns and puts reputations above all else, even patient safety. We know that is wrong and we know what needs to happen. It is now time to crack on and deliver.

We are making steady progress on recommendations from all 15 areas of the Shrewsbury and Telford review, such as workforce accountability and bereavement care. Much of that progress has been made through NHS England’s three-year delivery plan. The plan seeks to make maternity and neonatal care safer, fairer and more tailored to every woman’s needs, by setting out expectations for informed choice and personalised care planning, to improve women’s experience in labour and birth.

Some of the initiatives have been highlighted today. The saving babies’ lives care bundle, helping to reduce stillbirths and pre-term births, has been rolled out to every trust in England. I am pleased that all 150 maternity and neonatal units in England have signed up to the perinatal culture and leadership programme, an initiative to promote and sustain a culture of safety. There are also initiatives to reduce inequality. As I know from my constituency, women living in deprived areas are more likely to suffer adverse outcomes. It is right that local systems are trying to bridge the gap through equity and equality action plans.

We have set clear expectations for escalation and accountability through the three-year plan. We are supporting staff to hold up their hands when things go wrong, through the freedom to speak up initiative. The public can monitor the progress of the three-year plan against the Ockenden recommendations, through their local maternity and neonatal systems and integrated care boards. Local women and families, should they choose, can see what progress has been made, who is accountable and how the system is changing. NHS England is also investing £10 million every year to target the 10 most deprived areas of England.

Safety must be the watchword at every step of the journey. NHS Resolution’s maternity incentive scheme is rewarding NHS trusts that prove they are taking concrete steps to improve the quality of care for women, families and newborns. As highlighted by the hon. Member for Hinckley and Bosworth (Dr Evans), since 2010 the neonatal mortality rate has shown steady signs of improvement, decreasing by a quarter for babies born after at least 24 weeks of pregnancy. The stillbirth rate in England has decreased by 22% and the overall rate of brain injuries occurring during or soon after birth has fallen by 3%.

We all know there is so much more to be done to improve outcomes for mothers and babies, and to ensure that they receive the safe care that they need. There are ongoing initiatives to ensure lessons are learned from every tragic event, to prevent similar events in future. Hospitals carry out internal perinatal mortality reviews, which aim to provide answers for bereaved parents about why their baby died, and give them some closure. The reviews also help hospitals to improve care and ensure we learn the lessons from every tragedy.

The maternity and newborn safety investigations programme conducts independent investigations of early neonatal deaths, intrapartum stillbirths and severe brain injury in babies after labour. All NHS trusts are required to report those incidents, carry out an independent investigation and make safety recommendations to improve services in future. For those parents who go through the heartbreak of losing a baby, we must do everything we can to support them in their grief. That is why the Government extended the baby loss certificates; as of last week, we have issued almost 100,000 to grieving parents. It is also why, through the three-year plan, we have made provision for seven-day bereavement care supported by investment, and why we will continue to support the work of Sands and Tommy’s, which do so much for bereaved mums and dads across the UK.

The hon. Member for Chichester rightly talked about the importance of workforce and meeting safe levels of staffing. Throughout the winter I have seen up close NHS staff doing their absolute best in appalling circumstances that were not of their own making. I know that however dedicated our NHS staff may be, they cannot provide the right care without the right support. That is why we are committed to tackling the retention and recruitment challenges in the NHS, and why work is under way to modernise NHS working cultures and make our hospitals more attractive for top talent. That includes a much stronger focus on health and wellbeing, more support for flexible working and a renewed commitment to tackling inequality and discrimination.

Bringing in the staff that we need will take time, but it is an absolute priority for this Government and for me personally. NHS England is leading a range of initiatives to boost retention of existing staff and ensure the NHS remains an attractive career choice for new recruits. I say to the hon. Member for Strangford (Jim Shannon) that we are keen to work with all devolved Governments to ensure that and to share learning.

There is a dedicated programme for the retention of midwives, an issue highlighted by the hon. Member for Chichester and my hon. Friend the Member for Calder Valley (Josh Fenton-Glynn). The initiative contains a range of measures, including a midwifery and nursing retention self-assessment tool, mentoring schemes, strengthened advice and support on pensions, and the embedding of flexible retirement options.

NHS England has also invested in retention leads for every maternity ward. Alongside investment in workforce capacity, that has shown promising signs of bringing down vacancy, leaver and turnover rates. The leaver rate declined from 10.3% in September 2023 to 9% in September last year. There has been progress, but we know that there is more to be done. As of November, there were a record number of midwives working in NHS trusts, with around 24,700 working full time, up by over 1,300 compared with the year before.

While all this work is going on, we are also doing the hard yards of fixing the foundations of our NHS and making it fit for the future. I am pleased that the National Institute for Health and Care Research has commissioned over 40 studies looking at how we can prevent pre-term births and improve care for babies and women. It has launched a £50 million funding call, challenging researchers and policymakers to come up with new ways of tackling maternity inequalities and poor pregnancy outcomes.

While that work is going on, we will continue to talk to staff about the 10-year plan. My right hon. Friend the Secretary of State is attending a staff event in Peterborough on Thursday, and I will be attending one next week. We want to know how we can better support our staff, ensure we unleash their potential and give patients the care they need. A central part of the 10-year plan will be our workforce—how we train them and provide the staff, technology and infrastructure the NHS needs to care for patients across our communities. The hon. Member for Epsom and Ewell (Helen Maguire) is right to highlight the estate, which is also a problem in this area. We need to consider all policies, including those that impact maternity and neonatal care.

Over 95,000 people have responded to the consultation so far, and we want to hear from more. We have heard in this debate about midwifery-led care from my hon. Friend the Member for Lichfield (Dave Robertson), and about mental health support from the hon. Members for Eastleigh (Liz Jarvis), for Winchester (Dr Chambers) and for Dewsbury and Batley (Iqbal Mohamed). I hope that they contribute to the consultation.

I am conscious that I need to give the hon. Member for Chichester a few moments to wind up. We know that we will not be able to fix these issues overnight. We are committed to investing in safety, workforce retention and tackling inequalities, and we are making steady progress. As was highlighted, most women have safe care with a healthy baby, and are made to feel special at a very special moment. That is a testament to the staff. We need to make sure that that happens for all women, everywhere. A lot of work has been done. There is a lot left to be done, but I am confident that we will build a maternity and neonatal system that delivers for every woman.

HIV Testing Week

Karin Smyth Excerpts

Thursday 13th February 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve for the first time under your chairship, Dr Allin-Khan. This is such a marvellous debate to be part of. The Secretary of State asked me to respond to it on behalf of my hon. Friend the Member for West Lancashire (Ashley Dalton), who has been attending events this week and unfortunately could not be here today. I have known her a long time and I know that she will be a fantastic champion in this area, coming to the Department every day to do battle on people’s behalf.

I am grateful to the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) for securing this important debate and for his continued work in this area. I join my hon. Friend the Member for Colne Valley (Paul Davies) in commending the work of the APPG. I know that many hon. Members are caught in the dilemma of the two debates today, and many other people would be here, but I know that they will be listening to the debate with great interest on the fourth day of National HIV Testing Week.

This debate gives me the opportunity to thank all the amazing charities and organisations that are playing such a huge part in making this week a success—the Terrence Higgins Trust, National AIDS Trust, and the Elton John AIDS Foundation, which we have heard about today, to name just a few. I also want to add my voice to the enthusiasm I have seen in my time—nine years now—across all parties on this issue. There has been a long period of cross-party collaboration. I hope that that continues and that we continue to base our work on evidence and care. It is what has got us here today. My hon. Friend the Member for West Ham and Beckton (James Asser) made that point very well and asked for more resources, so well done him. I will perhaps come on to some of that.

In national testing week, we are making great strides towards the goal of no new transmissions in England by 2030. We are, as many members have said, at a crucial point in that journey. HIV testing has been revolutionised. It is now fast, free and available in the privacy of our own homes—even when our home is No. 10 Downing Street, as the Prime Minister showed us on Friday. I know that that is a powerful message not just in this country but globally, as my hon. Friend the Member for Exeter (Steve Race) highlighted.

When we normalise testing, we normalise prevention, treatment and care—and we normalise saving lives. I thank every colleague who attended Tuesday’s drop-in. It is so important for all of us in this place and elsewhere to help smash the stigma however we can, transform perceptions, and drive us closer to no new transmissions.

[Florence Eshalomi]

I thank the Minister for making an impassioned speech; she is doing an excellent job. She has highlighted the importance of testing and the fantastic work all the different organisations do in pushing it. Does she agree that for us to reach the vital goal of no new transmissions by 2030, we should be following Wales’s example of having year-round access to online testing to help more people test and to eradicate HIV by 2030?

[Karin Smyth]

I thank my hon. Friend for her comments and her great leadership in her work through the APPG. Some of that work looks very successful, and I will comment on it shortly, because we do need to learn and share from each other.

When it comes to reducing stigma, we have all exposed how old we are in this debate today. I am as old as the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale and perhaps the hon. Member for Strangford (Jim Shannon) and some others. I worked in the health service through the late ’80s. It was a gay man who started raising awareness to me about stigma around HIV and AIDS, and we have come an awful long way. The hon. Member for Strangford and my hon. Friend the Member for Edinburgh South West (Dr Arthur) rightly talked about the role of the stigma, and that iconic moment with Princess Diana was so important. It was so long ago but to some of us it seems like yesterday.

I can give some updates to colleagues. So far this HIV testing week we have given out 13,308 testing kits. That is 13,308 people who now have the power to know their status, take control of their health and contribute to the fight to end new HIV transmissions in England. Last year, National HIV Testing Week delivered more than 25,000 testing kits, achieving great results among communities disproportionately affected by HIV. For example, the uptake of testing kits for black African communities has tripled since 2021. My hon. Friend the Member for Vauxhall and Camberwell Green (Florence Eshalomi) made excellent points about that.

The right hon. Member for Dumfriesshire, Clydesdale and Tweeddale and my hon. Friend the Member for Edinburgh South West tempt me to comment on the Scottish Government’s role in this area. Politics aside, they highlighted a serious point about sharing good practice. My hon. Friend the Member for Cardiff West (Mr Barros-Curtis) made that exact point about the role of the Terrence Higgins Trust. I do not think I knew that Terrence Higgins was Welsh, and I am married to a proud Welshman—something that we share, Dr Allin-Khan —so that looks bad on me. My hon. Friend the Member for Cardiff West made an excellent point about the role of Terrence Higgins’s leadership and the people that came after him to lead that organisation. We need to learn from and work with each other. On behalf of the Department, I commit to continue our work across the United Kingdom to share and learn from best practice. I think that my colleagues across the United Kingdom, whatever political party they belong to, would echo that.

As the Minister here in England, I know that the campaign would not be possible without HIV Prevention England, the national HIV prevention programme, which is funded by the Government and delivered by the Terrence Higgins Trust with local partners. The programme aims to promote HIV testing in communities that are disproportionately affected by HIV, bringing down the number of undiagnosed and late-diagnosed cases. Every year, it runs National HIV Testing Week, a summer campaign to raise awareness of HIV and STI prevention and testing, and much more. We are committed to building on those successes, which is why we have extended the programme for a further year until March 2026, backed by an additional £1.5 million.

Looking to the future, we are making progress to end new transmissions before 2030, but we know that much more work needs to be done to reach our goals. We have had some excellent contributions on that today. Our work is not over until every person, regardless of race, sex, sexuality, gender or circumstances, has access to testing without barriers. I hear the comments made by my hon. Friend the Member for Exeter and others about fear and the historic fear that people have felt. We will not stop until every test is met with care, every diagnosis with treatment and every individual with dignity and respect, regardless of who they are or their HIV status.

[Steve Race]

Does the Minister agree that although we have a cross-party consensus here today and I accept the words of the hon. Member for Sleaford and North Hykeham (Dr Johnson) at face value, the history of HIV action in this country over the last 10 to 15 years paints rather a different picture? We might be closer to eradicating HIV transmissions if the public health grant, which was set in 2014, had had any increases until this Government increased it by 5.5% this year; if the national HIV prevention programme, which started out with a budget of £4 million in 2010, had not had only a £1.1 million budget by last year; if the funding for the HIV helpline had not been abolished in 2012; and if the HIV innovation fund had not been abolished somewhere among the Johnson, Truss and Sunak psychodrama.

[Karin Smyth]

I thank my hon. Friend for that intervention. My hon. Friend the Member for West Ham and Beckton made similar points. The level of cuts to our public services and, by implication, to third sector organisations and their contribution to the fabric of our society—they do work that the public sector cannot get to with groups of people that it cannot get to—is shocking. It was shocking as we went through it. Lord Darzi has given us a good diagnosis of some of those problems. We want to take forward the good work that has been done, but we have inherited a landscape that I wish we had not.

We are very much committed to making progress because we want to build a future where testing is routine, treatment is available to all, PrEP and post-exposure prophylaxis are accessible and no one is left alone in their journey. My hon. Friends the Members for Dartford (Jim Dickson) and for Clapham and Brixton Hill (Bell Ribeiro-Addy) talked about the important role of local government and had some fantastic examples.

To support improved PrEP access and many other critical HIV prevention interventions, the Government have provided local authority-commissioned public health services, which include sexual and reproductive health services, a cash increase of £198 million compared with 2024-25—an average 5.4% cash increase and a 3% real-terms increase. That represents a significant turning point for local health services: the biggest real-terms increase after nearly a decade of reduced spending between 2016 and 2024, as my hon. Friend the Member for Exeter highlighted. I hope that starts to put us back on track.

We are pushing that commitment forward by engaging with a range of system partners and stakeholders to develop our new HIV action plan, which we will publish this year. A number of points have been made about what should be included in that plan, and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire, will hear that and will work with colleagues here and in the Department to ensure the plan is effective.

I extend my sincerest thanks to Professor Kevin Fenton, the Government’s chief adviser on HIV, who is hosting engagement sessions and roundtables in parallel with external stakeholders, including the voluntary and community sector, professional bodies, local partners and others. We are also working alongside the UK Health Security Agency, NHS England and a broad range of system partners to inform the development of the new action plan, and guarantee that it is robust, inclusive and evidence-based. This collaboration is essential, because we are fighting not just HIV, but the barriers that keep people from knowing their status. We are fighting stigma, misinformation, and inequality in access to treatment and care.

Achieving these goals requires action, because the future is not just something we wait for; it is something we create. That is why, in December last year, the Prime Minister committed to extending the highly successful emergency department HIV opt-out testing scheme, backed by an additional £27 million, as the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale noted. During the past 34 months, more than 2.5 million HIV tests have been conducted through the scheme, indicatively finding more than 1,000 people who were undiagnosed or not in care. These are not just numbers; they are people we might never have reached who are now empowered with access to critical sexual health services. Increasing testing across all communities is a cornerstone of our new action plan and essential to ending HIV transmissions. That is why we must harness the power of HIV testing week.

Before I wrap up, I join the hon. Member for Sleaford and North Hykeham (Dr Johnson) in paying tribute to my hon. Friend the Member for Sittingbourne and Sheppey (Kevin McKenna) for sharing his own experience, which, in motivating his career in nursing—and now his new career—he used to serve and help others. He did that excellently today.

Today, testing is not just about detection; it is about connection. It is about linking people to the care, support and community they need to thrive. It is about ensuring that no one is left behind—and that includes globally. We have committed to supporting the international effort to ending HIV and AIDS, with £37 million towards increasing access to vital sexual and reproductive health services, including HIV testing, prevention and management services for vulnerable and marginalised people across the globe.

Our commitment is unwavering, and our mission is clear. This National HIV Testing Week, let me be clear: a single test can save a life, so let us make testing the norm, the expectation and the action that drives us to a future with no new HIV transmissions.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 11th February 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

As I am sure the hon. Member knows, Hinchingbrooke hospital is in wave 1 of the new hospital programme, and his constituents can now look forward to a new hospital under this Labour Government. The hospital has received over £44 million to deliver RAAC mitigation safety works, and my right hon. Friend the Secretary of State has commissioned a site-by-site survey of RAAC hospitals, which will ensure that individual development plans address the highest-risk elements as soon as possible.

[Ben Obese-Jecty]

Last July, Deborah Lee, the senior responsible officer for the Hinchingbrooke hospital redevelopment programme, stated that the deadline for the new hospital was 2030. In a written answer to me last year, the Minister confirmed that, even after the mitigation measures of failsafe steelwork, the lifespan of the remaining RAAC buildings would run only until approximately 2030. Can the Secretary of State confirm that the rebuild, and all waves of the new hospital programme, will not be delayed by the review of building safety regulations guidance announced by the Deputy Prime Minister in December? Will he assure my constituents that the RAAC buildings at Hinchingbrooke will be safe to use beyond 2030, and if so, will he publish the risk assessment that he has conducted to confirm that?

[Karin Smyth]

The hon. Gentleman has outlined the shocking state of some hospitals. I confirm again that we want a site-by-site report of those hospitals for exactly that purpose: to ensure that they are safe and to understand any critical issues before the schemes go forward. We expect that report in the summer.

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

Given that the Tory predecessor of the hon. Member for Huntingdon (Ben Obese-Jecty) failed to mention RAAC once, and mentioned Hinchingbrooke hospital only five times in 23 years, does the Minister agree that people in Huntingdon and across the country need a Labour Government committed to rebuilding the NHS, not a Tory Government who pay lip service but fail to back it up?

[Karin Smyth]

I commend my hon. Friend on his research into the previous Government, and for the hard work that he is doing on behalf of his constituents. We are committed to the rebuild of Hinchingbrooke and have put the new hospital programme on a sustainable footing, which is something that his constituents can look forward to.

[Ellie Chowns (North Herefordshire) (Green)]

5. What progress his Department is making in reducing waiting times for elective care.

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[Connor Naismith (Crewe and Nantwich) (Lab)]

9. Whether he has had discussions with NHS England on including vasa praevia screening as part of antenatal care.

[The Minister for Secondary Care (Karin Smyth)]

I thank my hon. Friend for his ongoing work in raising awareness in maternity services. We are committed to improving maternity care for women and babies. Evidence does not currently support screening for vasa praevia in the UK, but we have asked the Royal College of Obstetricians and Gynaecologists to review the guidance around this issue.

[Connor Naismith]

My constituent Cate Maddison suffered with severe vasa praevia in childbirth. This condition causes severe bleeding and can often result in the death of infants in childbirth and complications for the mother. However, the risks are significantly reduced when identified during pregnancy. Thankfully, Cate’s child survived, but she is campaigning to reduce unnecessary complications and deaths arising from the condition. Will the Minister meet me and Cate to discuss how we can tackle this important issue?

[Karin Smyth]

I am incredibly sorry to hear about Cate’s experience. We want to ensure that women receive safe, personalised and compassionate maternity care and that women with the condition are supported. That is why we have asked the college to look at the guidance. I will of course be happy to meet my hon. Friend and his constituent.

[Jim Shannon (Strangford) (DUP)]

There is clearly a need to consider vasa praevia as part of antenatal care. The hon. Member for Crewe and Nantwich (Connor Naismith) set the scene very well and the Minister responded in a good fashion. This issue, which the hon. Member was right to highlight, is also an issue in Northern Ireland. Will the Minister share what is going forward here with representatives at the Northern Ireland Assembly?

[Karin Smyth]

I thank the hon. Member for that point. As he knows, I am always keen to ensure we share good practice across the United Kingdom so that his constituents, like mine, can benefit. We will work through the usual processes to ensure that happens.

[Lisa Smart (Hazel Grove) (LD)]

10. If he will provide funding for the repair of Stepping Hill hospital in Stockport.

[The Minister for Secondary Care (Karin Smyth)]

I thank the hon. Lady, along with my hon. Friend the Member for Stockport (Navendu Mishra), for her continued support for Stepping Hill hospital. I know that she is working hard on this issue. We are backing the NHS with over £4 billion of funding for integrated care boards for capital priorities, with a dedicated £750 million estate safety fund next year to address the poorest quality hospitals. I am pleased that the replacement of Stepping Hill’s outpatient facility is already under way, backed by £11.5 million this year. I look forward to visiting as soon as my diary allows.

[Lisa Smart]

I am grateful to the Minister for her response and our ongoing correspondence on this issue. I very much look forward to meeting her on site at Stepping Hill so that she can see for herself the reported £134 million repairs backlog at the site. The most recent board papers mentioned a £19.9 million significant risk backlog, which is having a detrimental effect on the hospital team’s ability to see and treat patients. What hope can the Minister give that there is a plan for the funding of buildings at Stepping Hill so that my constituents get the treatment that they deserve?

[Karin Smyth]

The hon. Lady outlines for her constituents what many across the House will recognise: the state that the last Government left the capital estate in. The autumn Budget committed over £13 billion into next year, with £4 billion for ICBs to start prioritising some of this work. We have allocated £1 billion for critical backlogs, maintenance and upgrades. A longer-term capital plan will follow the 10-year plan that we are currently developing to offer the hope for her constituents that she asks for.

[Charlotte Cane (Ely and East Cambridgeshire) (LD)]

11. What steps his Department is taking with Cabinet colleagues to increase access to assessments for special educational needs.

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[Sojan Joseph (Ashford) (Lab)]

13. What steps he is taking to help tackle career progression inequalities in nursing.

[The Minister for Secondary Care (Karin Smyth)]

I know that this issue is close to my hon. Friend’s heart, after his years of service as a nurse in the health service. We have to ensure that the NHS is an attractive place for nurses to work, and that they can progress. We hear directly from staff through our 10-year plan, and work closely with the Royal College of Nursing, Unison and other trade unions through our social partnership forum.

[Sojan Joseph]

I must disclose that I worked as a mental health nurse in the NHS for the past 22 years, and that in my career, I progressed from nurse to head of nursing.

Recruitment and retention of nursing staff across the health and social care sector is key to delivering an NHS that is fit for the future, but the most recent NHS staff workforce survey showed that just 56% of staff felt that the health service acted fairly when it came to career progression. What steps will this Government take to address this issue, and to ensure that our nursing workforce feel valued and feel a sense of purpose in their wider work?

[Karin Smyth]

My hon. Friend is absolutely right that the issue is key, and that the results are worrying. I know how proud my friends and family members were to become nurses, and what a great career nursing offered them. We have to deliver on the promise of a good career, and build on that pride in being a nurse. We absolutely recognise that we cannot rebuild the NHS without their skills and their high-quality critical and compassionate care.

[Rosie Duffield (Canterbury) (Ind)]

Does the Minister believe that the NHS should expect biologically female nursing staff to get changed in front of biologically male colleagues who identify as female?

[Karin Smyth]

No.

[Robin Swann (South Antrim) (UUP)]

14. What steps he is taking to help devolved Administrations reduce waiting lists.

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[Joe Morris (Hexham) (Lab)]

T2. For those in villages such as Slaggyford, Kirkhaugh and Mohope, the cottage hospital in Alston is closer than the hospital in Hexham. As my constituent Rowland outlined to me, despite that proximity, ambulance services find themselves restricted by county borders. Rural constituents’ access to healthcare and rapid response services are suffering as a result. Will the Minister meet me to discuss ambulance services in rural areas?

[The Minister for Secondary Care (Karin Smyth)]

I holidayed in my hon. Friend’s constituency this summer—it is a very beautiful part of the world—so I understand some of the rural challenges. It is a matter for local integrated care boards how they organise ambulance services. There are many problems that we want to resolve, and I would of course be very happy to meet him.

[Mr Speaker]

I call the Liberal Democrat spokesperson.

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[Lee Pitcher (Doncaster East and the Isle of Axholme) (Lab)]

T9. Women across the country, including my constituent Lisa from Haxey, are struggling to access vital hormone replacement therapy medications, such as Estradot patches. Owing to a 30-year-long medical condition, Lisa had her ovaries removed and now faces severe health consequences because of these ongoing medication shortages, and there is no resolution expected soon. Given the repeated supply issues with HRT in recent years, what actions is the Minister taking to ensure a consistent and reliable supply of those essential medicines?

[Karin Smyth]

I entirely appreciate the frustration and distress caused by medical supply shortages. We are working intensively with industry to resolve the HRT supply issues, and the problems with the supply of Estradot are expected to be resolved by the end of the month. Meanwhile, we have issued a serious shortage protocol to allow community pharmacists to supply alternative brands of the same medicine, and those remain available.

[Mr Gagan Mohindra (South West Hertfordshire) (Con)]

T4. My constituent James, from Abbots Langley, wrote to me on the subject of the Chancellor’s recent talk about pushing infrastructure projects, such as the Heathrow airport expansion. Why is the Health Secretary not pushing for this infrastructure funding to be spent on the new Watford General hospital, a project that has cross-party support, is shovel-ready and will save lives?

[Peter Lamb (Crawley) (Lab)]

Since April, Crawley’s urgent treatment centre has been temporarily closed overnight because of low staffing levels. What do the Government intend to do to ensure that normal services are resumed for communities such as mine?

[Karin Smyth]

We are absolutely committed to urgent treatment centres, which play a vital role in supporting patients, especially during periods of high demand. I understand that this is temporary, and that the centre is running a pilot. I know that my hon. Friend will work closely with his local integrated care board to ensure that it serves his constituency adequately.

[Jim Shannon (Strangford) (DUP)]

T5. There are 153,000 people in the United Kingdom living with Parkinson’s, and one in 137 will be diagnosed during their lifetimes. There are 18,000 new cases every year, 4,200 of them in Northern Ireland. Does the Secretary of State agree that it is time we had a Parkinson’s charity, not just for England but for Scotland, Wales and Northern Ireland as well? As I always say, let us do it better together.

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[Tonia Antoniazzi (Gower) (Lab)]

The Government know how hard I have worked as co-chair of the all-party parliamentary group for medical cannabis on or under prescription. I am pleased to hear that there is a trial, but I urge the Minister and her team to make sure that it actually goes ahead, as others have not because of Brexit, covid and elections. Can she please meet me to ensure that the APPG and I are kept up to date on the work of the NHS?

[Karin Smyth]

My hon. Friend has been a strong campaigner on this issue on behalf of her constituents, and I congratulate her on that work. We are confident that the randomised trial will go forward, and we have invested over £8.5 million in it. I am very happy to meet her, and I urge people to come forward and support the trial. That is the way forward on this issue.

[Lee Anderson (Ashfield) (Reform)]

The new Health Minister has stated that it is okay for a human being to present as a llama. If I have a family member who presents as a llama and suddenly becomes ill in the middle of the night, should I send for a doctor, a vet or a straitjacket?