Women’s Health Strategy
Karin Smyth Excerpts(2 days, 19 hours ago)
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The Minister for Secondary Care (Karin Smyth)
With permission, I will make a statement on the Government’s renewed women’s health strategy.
The NHS was founded on the principle of equality and the right care for everyone, whenever they need it, but there is no getting away from the fact that it has failed to live up to that founding promise. For too long, women have been left to navigate a confusing system, fighting to get the basic care they deserve, and under-represented in health research. Above all, women’s voices and choices have been dismissed, and it is truly shocking how often women have been ignored when telling medical professionals about their pain. From pelvic mesh to endometriosis, we are expected to put up with pain as our lot in life, as if it were normal. But it is not normal, and since coming into office this Government have taken a number of measures to improve women’s health.
We have taken action to bring down gynaecology waiting lists, introduced menopause questions into routine health checks, made the morning-after pill available for free at high street pharmacies, stood up a rapid and independent investigation into maternity services, and introduced Jess’s rule, so that GP teams have to “reflect, review and rethink” if a patient presents three times with the same or escalating symptoms.
The blunt reality is that the NHS is failing women and girls on even the most basic measures of healthcare. Indeed, we do not treat all women equally either. The wealthiest 10% of women live almost 10 years longer than the poorest 10%, while the most deprived spend over a third of their lives in bad health—something I see starkly in my constituency of Bristol South. Disabled women experience poorer outcomes, and we should recognise the additional disadvantage faced by black and Asian women, who face the double discrimination of racism and misogyny all at once.
Our renewed women’s health strategy will address those and other glaring injustices. It will give women and girls faster care from a health system that actually listens. It will make it simpler and faster for them to access the care they need the first time they ask for it, and it will make sure that the latest innovations work for women, ranging from reproductive and maternal health to menopause and chronic conditions. Of course, every day women are receiving outstanding, compassionate care from our dedicated NHS staff, but being ignored, gaslit, humiliated and disrespected are all-too-common experiences for far too many. More than eight women in 10 say there have been times when healthcare professionals did not listen to them. Our mission is to dismantle the culture and ingrained behaviours that allow that medical misogyny to fester and grow, and that starts by listening to women.
Women’s voices and choices are the golden thread that runs through this renewed strategy. Their voices will be heard, as we work to reduce variation in how GPs listen to and respond to women, using patient survey data in a quality improvement programme. Their voices will be heard as we capture whether women have been treated with respect, kept informed, and involved in decisions about their own care. Their voices will be heard, as we co-develop new standards of care for procedures such as hysteroscopy, so that every woman has informed consent and a real choice over her pain relief.
Yesterday, my right hon. Friend the Secretary of State announced that we will do the first trial of a scheme known as patient power payments, which will cover gynaecology services. Women will get a say on whether the NHS provider should get full payment for the services women receive, based on the quality of their experience. It means that if a woman is not happy with her experience, a portion of the tariff paid to that provider would be redirected to fund improvements in the same services instead. In other words, women will have the power to kick medical misogyny where it hurts: in the budget.
All this is building on the evidence and expertise that informed the original strategy. I wish to acknowledge the intended ambition of that work, not least because it was based on the contributions of thousands of women. However, the changes that were promised have not translated into consistent improvements in access, quality of care or outcomes. Take gynaecology services. The waiting list for gynae care was north of 600,000 when we took office. Today that figure is finally moving in the right direction, but we cannot make as much progress as we would like because the system simply was not designed with women in mind.
I pay tribute to Baroness Merron, who has led this work on behalf of the Government. As she made clear in her foreword, this system was not designed in such a way—to be fair to Nye Bevan, in 1948 he was largely thinking about working men who were dying early in their sixties from the awful consequences of poor work, with some support for maternity services. We need to change that. We will support integrated care boards to introduce a single point of access for all non-urgent referrals to gynaecology and women’s health services, to speed up access. We will redesign the most common clinical pathways for heavy periods, menopause and urogynaecology, to remove unnecessary delays. Women with fibroids and endometriosis will be listened to at first presentation. They will be seen faster, and offered clear information through our new virtual hospital, NHS Online.
Women’s health pathways are being prioritised in NHS Online, and menopause and menstrual health services will be among the first to go live when it becomes operational this year. There will be a relentless focus on reducing women’s pain, improving standards, and reducing variation in both procedural and chronic pain management, including for chronic pelvic pain. We will launch a new programme to help young girls grow up understanding their menstrual health and know when to seek help.
From gynaecology to pain relief, our renewed strategy takes forward the work of the previous Government, and goes further and faster to fill the holes they left. It has only been made possible by the record £26 billion in funding for the NHS that was secured by my right hon. Friend the Chancellor, the first woman to hold that office. All that will be underpinned by an NHS that finally listens with respect, dignity and compassion to the voices and choices of every woman and every girl, every time. That is not least with the creation of the women’s voices partnership, which is a new space for organisations representing women, giving them a direct line to Whitehall to inform national decision-making. The partnership will have a particular focus on those women who are most excluded from traditional services, and through it we will ensure that women’s voices help to shape the long-term direction of NHS reform.
Unlike the original strategy that was based on an outdated model of care, this renewed strategy maps across the three shifts in our 10-year plan for health. The shift from sickness to prevention will mean that women can better understand and act on their risk of conditions such as breast cancer and diabetes. The shift from hospital to community will mean services designed around women’s lives, with much faster access to diagnosis and treatment. The shift from analogue to digital will mean that women will avoid long waiting lists for painful conditions through NHS Online. Within two years we will launch a new challenge fund, backing the most promising women’s health technology start-ups, with a focus on tackling health inequalities in community settings. We are embedding new sex and gender policies into studies through the National Institute for Health and Care Research, so that findings are genuinely representative and no woman is left behind by science.
As every woman hearing this statement knows, to fully exercise power over our lives we need to be at the top of our game, both mentally and physically. We also know that women’s health has been neglected for too long. It therefore falls to this Government to restore the founding promise of our national health service, and to deliver the right care for everyone when they need it. From the classroom to the clinic, our renewed women’s health strategy promises a fairer, healthier future for women and girls everywhere, acting on women’s voices and choices, transforming NHS performance in services that matter most to women, supporting all women to live healthier lives, and creating an approach to research and development that works for and empowers women. We are designing the system to fit around women’s lives. This will not be a strategy that sits around gathering dust on a shelf, because women are counting on us, and we will not let them down.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
I am glad to see that the much-delayed women’s health strategy is finally here, and I thank the Minister for her work on that and for advance sight of her statement. I am particularly pleased that Ministers have pledged to prioritise medical health conditions such as endometriosis and to continue the roll-out of the HPV testing that we piloted.
Today it is one year since the For Women Scotland judgment in the Supreme Court confirmed that sex is biological sex. At the time the Secretary of State told the public:
“We will be issuing guidance in the coming weeks before the summer”.
To be fair to him, he did not say which summer. This week, a Minister told the House that the guidance on single-sex spaces could not be published under purdah rules until after the local elections. Will the Minister explain why it is okay to announce policy on other aspects of women’s health but not on single-sex provision in the NHS?
I find it remarkable that the Minister has the audacity to talk about women harmed by pelvic mesh when, after almost two years in office, the Government have still not responded to the Hughes report. When do they intend to do so?
I was disappointed not to find a commitment in the strategy to the lobular breast cancer moon shot project. Will the Minister give us a timeline for what I understand is a commitment to that project by the Government?
The Minister talked about waiting lists. While it is welcome that gynaecology waiting lists have fallen in the past year by 1.9%, for those requiring some sort of procedure or admission, waiting lists are 4.5% higher than they were a year ago. One way to make waiting lists shorter is to not start counting until someone has been waiting for a few days already—more targets can certainly be hit that way—so will the Minister clear something up for me? The Government have decided to prevent GPs from directly referring patients to consultants, insisting that they request advice from consultant-led teams instead. If the consultant then decides to offer an appointment, the clock starts, but that will be a few days after the original request is received, making the waiting time a few days shorter. This is where it gets really confusing: the Minister for Care said that the rules are going to change so that the clock will start when the advice request is received, so that patient waiting times are accurately reflected, but the Minister for Secondary Care has said that that will only happen from October.
Who is right? Do the Government intend to try and fiddle the figures by making people’s waits look shorter between now and the autumn? Given that we have heard different answers from two different Ministers, do they not know what is going on? Or can they confirm that with their new process and with immediate effect waiting times will be calculated from the moment that the advice and guidance request is received, in the same way as happens with referrals now?
The first chapter of the strategy is about acting on women’s voices and listening to women, which of course is welcome, but the Government plan to abolish Healthwatch in favour of listening to organisations. Why are the views of organisations that may or may not accurately represent the voices of women more generally being prioritised, and the voices of women themselves being somewhat deprioritised?
In the strategy, the Government commit to increasing capacity for surgical—in other words, later—abortions. They commit to making the morning after pill available free from pharmacies; they have made the oral contraceptive pill available from pharmacies too, and they have said that they will improve workforce capacity to provide long-acting reversible contraception. At a time when sexually transmitted infections are on the rise, with potential significant short-term and long-term consequences for women, there is no mention of condoms in the strategy. Given that some men can be reluctant to use condoms and there is discussion of eliminating misogyny throughout the document, will the Minister explain the choice not to include those too?
Another issue I want to raise is that of fracture liaison services. On entering Government, the Secretary of State said that one of his first jobs would be to establish universal fracture liaison services by 2030, yet that is moving at such a slow pace that he will not meet his target. Will the Minister set out how many of the dual-energy X-ray absorptiometry—DEXA—scanners are new, how many are replacements and how many will be used to set up new fracture liaison services?
There are many more questions that I can ask, but I understand that I have run out of time. In summary, while there are a few good points, it has taken a long time to produce a strategy that is rather disappointing. Women deserve much better.
Karin Smyth
It is hard to know where to start. I heard the word “welcome” somewhere in the hon. Lady’s remarks, so thanks for that.
In launching what we call a “renewed strategy” we have given credit to the previous strategy, which we welcomed when we were in opposition. However, on issues where there could be cross-party agreement, from going to war to the women’s health strategy, the Conservatives’ modus operandi is now to give nothing for us to work on together on behalf of the people who we represent. It is disappointing that they choose to start on a negative and really they could have done better.
In opposition, we welcomed the initiative to have a women’s health strategy and we supported that work going forward, which has led to the publication of this renewed strategy, because the diagnosis of many of the issues was right. However, as I have made clear, we are upending the system because for decades the health service was built around the work and health needs of men and the predominance of men working in the system, despite the fact that 77% of our nursing staff are women. We are upending that to put women’s voices and choices front and centre, including control of the budget and through NHS Online. Those are the game changers.
The Conservatives do not recognise the total game-changing nature of NHS Online in facilitating services for women wherever they live across the country, whether they live near highly specialised centres, such as those that I am privileged to have in my city of Bristol, in the coastal and rural communities represented by Members from across the House, or near tertiary centres. Any woman, from any part of our country, can access NHS Online and have that specialist service. We are trialling that with gynaecology. They will then get support from our rapidly expanding community diagnostic centres, about whose expansion we made an announcement this week, in order to get quicker diagnosis and the support that they need, closer to home in their neighbourhood health services.
I am happy to respond to the other issues that the hon. Lady raises, including the For Women Scotland judgment, and to set out the work that we have had to do to clear up the mess that the Conservatives left. Everything that happened to women under that system happened on the watch of the Conservative Government, from self ID to the issues at the Tavistock and everything else. There was a lack of rules, a lack of governance and a lack of clarity, and they did not take control. That is the mess that we inherited from the Conservative Government.
The Minister for Women and Equalities, my right hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson), is doing an excellent job: she is made of steel and good experience, and she has had to navigate a difficult landscape. The Conservatives understand the rules of purdah like the rest of us, so let us not pretend that they do not. My right hon. Friend will be laying that guidance as soon as she can after the election.
I will go on to talk about the DEXA scanners that we are investing in and fracture liaison services bringing people together, which were promises in our manifesto. This strategy is about specialists coming together and working together in fracture liaison services and women’s health hubs. Those have led the way among clinicians about how we can work better for women. That is why we are building on and expanding them, and it is disappointing that the Conservatives do not want to work with us on that.
Sonia Kumar (Dudley) (Lab)
I warmly welcome the women’s health strategy. I recently visited the Navigating Our Womanhood Together bus in Dudley, which supports women’s health from menstruation to menopause, and I look forward to more such initiatives being delivered as part of the strategy in my constituency. Will the Minister set out how the strategy will harness allied health professionals, including specialist physiotherapists, to support pelvic health, such as incontinence, prolapse and post-natal care?
Karin Smyth
My hon. Friend is a fantastic champion in this area. We are so pleased to have her clinical experience and no day goes past without her representing her own speciality of physiotherapy and AHPs more generally. She is absolutely right that those professionals have led the way in looking at women’s care and it is important that women feel confident with that physiotherapy advice. I think that she will be pleased to see the developments that will come from the women’s health strategy and those that will come when we bring forward our workforce plan, which will have AHPs front and centre working in women’s neighbourhood healthcare.
Madam Deputy Speaker (Caroline Nokes)
I call the Liberal Democrat spokesperson.
Dr Danny Chambers (Winchester) (LD)
The Liberal Democrats welcome the strategy, and its specific recognition of the socioeconomic and racial disparities in women’s healthcare, which it is important to put front and centre. We also appreciate the specific recognition of endometriosis and similar conditions. My partner, Emma, suffers from endometriosis, and on many occasions I have seen her unable to stand up or barely get off the sofa, having been told for years that her symptoms are completely normal and that there is nothing wrong with her. Given that at least one in 10 women suffer from endometriosis and there are over 500,000 people on gynaecology waiting lists, clearly her experience is not unique.
The picture around maternity safety is deeply troubling. Maternal mortality has increased by over 20% in the past 15 years, and there have recently been some high-profile media discussions about women and babies being let down, sometimes with devastating consequences. That is why the Liberal Democrats have been calling for one-to-one midwifery care and specialist doctors on every unit.
I welcome the Government’s specific commitment on treatments for morning sickness. My hon. Friend the Member for Lewes (James MacCleary) has campaigned on that issue for a long time, and it is right that we end the postcode lottery for these medicines. The condition can be debilitating for some people, and it is not fair that women have different experiences simply because of where they live.
Given that this is not the first women’s health strategy to be brought to this place—the previous Government brought one through in 2022—and the fact that many women we speak to do not feel that there has been any meaningful change, a lot of people are saying that we cannot just keep announcing strategies while women are waiting for basic care. Given the failure of the last Government to deliver meaningful change, can we have reassurances that this will not simply be another strategy announcement and that women will feel a difference in the care that they receive?
Karin Smyth
I thank the Liberal Democrat representative for his comments—frankly, that is the way it is done.
Let me turn to some of the issues that the hon. Gentleman raised. May I take the opportunity to mention endometriosis in particular? There have long been campaigns on that issue in this place from many women and men such as him talking not on behalf of their partners, but for them about the suffering. That is all very welcome.
I commend the work of Sir David Amess, a former Member of the House whose plaque is behind us, and of my right hon. Friend the Member for Redcar (Anna Turley) in chairing the all-party parliamentary group on endometriosis. When in opposition in 2017 or 2018, I had a member of staff—I hope she does not mind my saying so—who opened my eyes to this issue. Persistence works. We have got to where we are by supporting women’s voices across the country, and that is front and centre in this strategy.
On the hon. Gentleman’s wider point, I am sure that when he gets all the way through the strategy, he will see that there is a list of 102 actions—if I remember rightly—with dates aligned to them. I am sure that all hon. Members will look at that. I notice that my friend Baroness Merron is in the Gallery; she will be keeping everybody’s feet to the fire, including the Secretary of State’s, to deliver on this work. That list is in the strategy, and we wanted to set it out very clearly. We are waiting for the roll-out of NHS Online during the summer, and seeing how that works will be a litmus test for us, so I very much welcome the hon. Gentleman’s challenging us on that.
Jen Craft (Thurrock) (Lab)
I strongly welcome the women’s health strategy, and I congratulate both Baroness Merron and my hon. Friend the Minister on their work on it. Since its publication yesterday, my inbox has received a number of emails from women in my constituency who suffer from endometriosis.
I wanted to highlight that, because it is very rare that constituents contact us on the publication of a Government report to comment on its contents so quickly. That shows what an absolute hotbed this issue is and how profoundly it affects people. They speak of sometimes having decades of debilitating pain, going into debt while looking for treatment, losing housing, and suffering from relationships being impacted, their jobs being undermined and experiencing a loss of income, but overall they talk about how the condition is just not recognised and how their pain goes unheard.
One of my constituents said that women need better understanding, better support and better options, and seeing that set out in black and white in a Government report has really meant so much to women. Will the Minister join me in thanking these women for their bravery in continuing to raise their voices despite their continued experience?
Karin Smyth
My hon. Friend is absolutely right. It is unusual to receive emails saying good things. There will be challenges in this work, but it speaks to a wider issue. Many of us as women experience much of this ourselves, and we have women in Parliament who are able to articulate that. There are some fantastic women clinicians whom we have been pleased to work with and who have really pushed forward those voices as they have become more senior in the medical and clinical professions to help us with those clinical pathways. We have been able to build on all that in bringing this strategy forward.
May I commend my right hon. Friend the Secretary of State? He was on various media yesterday and he has been working with people such as influencers to give voice to those women. I think that this is an important part of our democracy. It is worth emailing MPs—I am sorry if that elicits more emails to other Members and to my staff—because we listen and we are engaged. It matters when people raise these issues in our surgeries and come forward with them. Sometimes policy development and getting action is a struggle for all of us; it is tough and takes a long time. The process of politics sometimes takes too long, but those women have made this happen, and I thank them for it.
Mr Andrew Snowden (Fylde) (Con)
I want to ask the Minister about a particular area of women’s health and how this strategy might impact on it. This is a very personal issue for me and my wife, regarding the pathways and support for women who have colostomies or ileostomies and have lifelong stoma care. I place on record my thanks to Mr Arnab Bhowmick, who is my wife’s very long-term consultant and has performed two major surgeries on Caroline—he is known as “the fantastic Mr B” in our house and to many of his patients. We know that on those pathways and in the decisions leading up to making the decision to have a stoma, putting it off can put people’s lives at risk. How people cope with a stoma afterwards has very unique elements for women—that can be around periods, fertility and pregnancy, or around the menopause later in life. How does the Minister think the strategy will help women like my wife, the friends she has met in hospital and others on those pathways?
Karin Smyth
I really thank the hon. Gentleman for raising the sometimes taboo subject of stoma and stoma care and for highlighting the complexity of that for women. I send my best wishes to his wife. I did not get the name of her clinician, but I thank the hon. Gentleman for getting their name on the record; that matters when people are dealing with such an intimate sort of care.
Again, bringing voices forward is a key part of this work. The thing to bear in mind in the development of this strategy is that it is predicated on the 10-year plan and on bringing care closer to home. For example, people who have stoma and stoma care sometimes have quick questions and do not need to make an appointment to go and see somebody else, with lots of rapid appointments to and from a hospital, and all the parking, travelling and so on.
There are ways in which we can use online services and particularly neighbourhood services, where people are closer to home, to facilitate the management of care of things like stoma after people have come through or are in ongoing care. That is the sort of place where we have voices and experience informing local care, which will look different in different geographies depending on the other facilities available. I ask the hon. Gentleman to keep working with us on how that experience works out.
Josh Fenton-Glynn (Calder Valley) (Lab)
I welcome this strategy, having worked on maternity and medical misogyny on the Health and Social Care Committee. I will bring up the thorny issue of sexual health. In a recent sitting of the Committee, we heard that a third of sexual health doctors are set to retire in the next three years and that there are only 14 training places. The key to ensuring that we are looking after women’s sexual health is to have a pathway for new doctors. Will the Minister look at that issue and at what we can do to resolve the training blockages?
Karin Smyth
Yes, of course. The retirement age is a constant issue that we need to look at across a number of professions, and I am happy to come back to my hon. Friend on that. As part of our workforce plan, we are looking in particular at retaining the expertise that we have, as well as at recruiting people into new roles.
Luke Taylor (Sutton and Cheam) (LD)
On behalf of the newly established APPG on urinary tract infections, which I am proud to co-chair alongside the hon. Member for Stoke-on-Trent South (Dr Gardner), I warmly welcome the Minister’s statement and this strategy. The APPG welcomes the acknowledgement that women’s health has been neglected for far too long, and we cautiously welcome the commitments to redesign urogynaecology pathways and fund a specialist centre in each region.
On behalf of the many women and, heartbreakingly, children who suffer from chronic urinary tract infections, can the Minister confirm whether those commitments cover the treatment of acute, recurrent and chronic UTIs? Will she consider our requests for support to establish agreed clinical definitions for the different types of UTIs so that we can inform long-overdue updates to National Institute for Health and Care Excellence guidelines and finally end the scandal of sufferers being ignored and gaslit by medical professionals, which has happened for far too long?
Karin Smyth
I thank the hon. Gentleman and my hon. Friend the Member for Stoke-on-Trent South (Dr Gardner), who I know cannot be here today. She has used her expertise to drive forward recognition of UTIs and incontinence—another taboo subject. We have previously had a very good debate in this Chamber on that issue, and that has all informed what we are saying.
The hon. Gentleman tempts me to move into some clinical definitions and clinical pathways. I am not going to do that, but I am very keen to hear about the work that the APPG is doing and its expertise. We will continue to hear from it and about the work that he and my hon. Friend the Member for Stoke-on-Trent South are leading to ensure that we make this work in reality. That is absolutely central to the strategy.
Marsha De Cordova (Battersea) (Lab)
I welcome the Government’s renewed women’s health strategy and their efforts to tackle the ethnic disparities that still exist in the healthcare system. Placing women’s voices at the heart of the strategy is absolutely the right approach, but does my hon. Friend the Minister recognise that there are still persistent gaps that will require robust, targeted interventions if we are to truly address some of the racial barriers that black women still face within the healthcare system, and can she say a little bit about how the strategy will seek to address those gaps?
Karin Smyth
I thank my hon. Friend for the work she has done, both on maternity and on sight loss, and for people generally. She is a great advocate for making sure that those voices are heard, both from her own experience and through her advocacy. We are bringing together a voices group—apologies, I cannot remember exactly what we called it in the end—so that there is direct representation in Whitehall at a national level. That is one of the things we wanted to make sure was included in the strategy, and my hon. Friend Baroness Merron has worked assiduously with stakeholder groups and their representatives to ensure that we make that work, as well as on the development of online services and the work to bring things into neighbourhoods. I am very committed to working with her to make sure that that happens.
Josh Babarinde (Eastbourne) (LD)
I commend the Minister on this women’s health strategy, and particularly on action 59, which is to invest in the women’s maternity and neonatal estate. I am also grateful to the Minister for agreeing to meet me next week about power cuts at Eastbourne district general hospital, which have knocked out the maternity unit at various times. I am really disappointed, though, that although the invitation was originally extended to me and two guests—who included our chief executive—that has been withdrawn. Can the Minister confirm that those guests can attend, so that we can discuss how to put this strategy into action in Eastbourne?
Karin Smyth
The hon. Member is referring to a meeting as part of my ministerial surgery, which is for Members. I will be happy to see him next week.
Melanie Onn (Great Grimsby and Cleethorpes) (Lab)
I congratulate my hon. Friend the Minister and the noble Lady Merron on bringing forward this renewed strategy. My constituent Jodie Goodwin has recently been refused a hysterectomy for reasons of funding, despite the medical and surgical advice that that is what she requires to deal with her health issues. Can the Minister advise me on whether the strategy will deal with matters like this and with Jodie’s issue in particular, and would she perhaps make some time available to discuss this case in detail?
Karin Smyth
I thank my hon. Friend for highlighting the case of her constituent Jodie and many others—such cases will be familiar to many people, and they are of course unacceptable. I am very happy to meet my hon. Friend to discuss that case further.
Leigh Ingham (Stafford) (Lab)
I welcome the Minister’s statement and the strategy. I want to speak specifically about one constituent who has contacted me, who has waited over 200 days without receiving the results of a gynaecological test—200 days of anxiety, uncertainty and delays to her treatment. Please forgive me while I read her actual words:
“this complaint is not simply about one patient having an unfortunate experience. It concerns what I believe to be a broader and deeply concerning failure in the way menstrual and gynaecological pain is recognised, assessed, investigated, and acted upon”.
I completely agree with her. Does my hon. Friend the Minister agree that yesterday’s renewed women’s health strategy allows us to commit to streamlining and improving gynaecological care, and can she tell me more about how she believes this will make a real difference for my constituents?
Karin Smyth
Again, my hon. Friend raises a shocking case on behalf of her constituents, and I agree with her and her constituent. Access to diagnostics is a key part of our 10-year health plan, which is why, as we were able to announce this week, we are rolling out more community diagnostic centres to improve diagnostic capacity more generally. I am also working with the Minister for patient safety, my hon. Friend the Member for Glasgow South West (Dr Ahmed), to look at how clinical pathways can be streamlined. That work is informing how we are developing NHS Online and making sure that we shorten those pathways, as my hon. Friend has rightly called for. All those cases—including, unfortunately, her constituent’s experience—have informed that work. We are linking our work on the 10-year-plan with that work and putting women, gynaecology and menstrual health front and centre as trailblazers, because unfortunately, those are the areas in which this work is needed. That is what this strategy does.
Rachael Maskell (York Central) (Lab/Co-op)
As the Minister knows, I have long campaigned around mental health. The strategy highlights that women disproportionately have poor mental health, and I welcome that recognition. However, action 49 says:
“we will improve mental health support for women and girls”,
but it does not say what the Government will do. Will they produce a strategy for delivering on this, and how will progress against this document be measured, so that we can hold the Government to account?
Karin Smyth
I thank my hon. Friend for her question. The document contains a long list of actions, with clear dates alongside them, so that she and others—including her constituents—can see what we are saying, and can measure progress.
Jessica Toale (Bournemouth West) (Lab)
Ignored, humiliated and misdiagnosed—these are the experiences of far too many women, and far too often, those experiences have tragic consequences. There is no more depressing example of this than the women who were prescribed the banned anti-miscarriage drug diethylstilbestrol, or DES, and the struggle that they, their children and their grandchildren have had in accessing the care and support that they need and deserve. I welcome the steps this Government have taken to improve women’s health outcomes. Will the Minister consider meeting DES campaigners to ensure that their voices and experiences are part of this strategy?
Karin Smyth
As we know, and as is documented in the strategy, there is sadly a long list of issues that particularly affect women that have been ignored, and it has taken far too long for women to draw attention to those issues. I understand that my hon. Friend the Minister for patient safety has met DES campaigners, and we will continue to listen to and learn from their experiences as we develop the strategy.
Kirsteen Sullivan (Bathgate and Linlithgow) (Lab/Co-op)
As chair of the all-party parliamentary group on endometriosis, I thank the ministerial team and my honourable Friend in the other place, Baroness Merron, for the focus that they have placed on that condition in the strategy, and for putting women’s voices front and centre; too often, they have been ignored. I also commend the sterling efforts and work of the late Sir David Amess and my right hon. Friend the Member for Redcar (Anna Turley) to establish the APPG in 2019 and put endometriosis firmly on the parliamentary agenda. I am delighted that a new programme to improve menstrual health education for girls is included in the strategy, but does the Minister agree that there must also be menstrual health education for all clinicians, so that symptoms can be recognised at the earliest opportunity, and women and girls can get the care they need, when they need it?
Karin Smyth
Again, I put on record my respect and thanks to Sir David Amess and my right hon. Friend the Member for Redcar for the work that they started. I could not remember the exact year—I thought it was 2017, but my hon. Friend says that it was 2019. They raised awareness of what was a taboo only a few years ago. Many of us, including me, accepted it as normal to feel pain, whatever we did. Now, we are saying—that includes clinicians—that it is not normal. We look forward to joining in the great work that my hon. Friend and others are doing to make sure that this strategy becomes a reality, and that women see that happen very quickly.
Oliver Ryan (Burnley) (Lab/Co-op)
I so welcome this strategy. I am quite ashamed to say that before being elected to this place, I did not know enough about women’s health issues, and in particular the issues with pelvic and vaginal mesh—the wait for treatment and the struggle to be heard—and endometriosis; people with that condition face a wait for diagnosis and a struggle for recognition. Since I was elected, I have been contacted by tens of women across Burnley, Padiham and Brierfield, who are fighting the fight for recognition of these topics on behalf of women across the country. It is because of that that I am educated enough to stand here today. Those women feel ignored and abandoned by a health service that does not care enough about women’s health issues. Will the Minister give a commitment to campaigners such as the women in Burnley, Padiham and Brierfield who have approached me that because of this strategy, they will now be heard?
Karin Smyth
I thank my hon. Friend for his question. He should not apologise for not knowing before; my generation of women, and many before us, were told not to talk about this. We were told not to tell anybody, and to put up with it. We were told that every month, whatever happened to us was normal, and we should crack on. A generation of men, and all of us mothers, need to talk about this, too. We welcome all allies and spokespeople. Learning is a key part of being in this place, and my hon. Friend and others are bringing the experiences of women to this campaign. The proof is in the pudding, and we will make sure that what my hon. Friend has asked for happens.
Ms Polly Billington (East Thanet) (Lab)
I thank my hon. Friend for her announcement of this strategy. In particular, I welcome the fact that the strategy says that it will be made simpler and faster for women to access the care that they need the first time they ask for it. More than eight in 10 women say that there have been times when healthcare professionals did not listen to them. One such woman was my constituent Daizy Bing, who, at the age of 17, came to me to raise her concerns. She had been told by her GP that she was too young to have an endometriosis diagnosis. Thanks to my intervention, she got a gynaecological appointment, but we all know that an MP’s surgery should not be the gateway to decent healthcare. Daizy has turned her experience into academic research. Will my hon. Friend meet her, so that her insights can inform the delivery of this ambitious and game-changing strategy?
Karin Smyth
My hon. Friend again raises younger women’s voices; we want to continue to hear from them. Part of this strategy is about working with the Department for Education to ensure that girls—and indeed boys—are made more aware of some of these issues. The women’s voices partnership—my apologies for not quite being able to remember its name earlier—will bring women together, including younger women and girls. If her constituent is keen to be one of those advocates, we would welcome that. We are talking about having new patient-reported experience measures and patient-reported outcome measures; we will develop those pathways over the years. Through that, women will have clear ways to navigate the system, and to put their voices forward.
Samantha Niblett (South Derbyshire) (Lab)
I thank the Ministers for this renewed women’s health strategy for England. Two of my constituents in particular—Evie Solomon, who founded HER Circle, and Shelly Lynn—will welcome the focus on medical misogyny, and they will be watching to make sure that we deliver. It was great to hear that there were influencers at the launch of the strategy yesterday. I met one of them, Milly Evans, who is a sex educator. Is there space in the women’s health strategy and the men’s health strategy for the provision of lifelong sex education, so that we have consistent, relevant and appropriate sex education for everyone who needs it? Frankly, women who have health issues still want a fulfilling and happy sex life.
Karin Smyth
As I said, part of this strategy is about educating girls and boys on health and bringing together all parts of education. We are keen to work in new ways with new media, and with influencers who are positive about women and women’s health, and we will continue to do so.
Chris Vince (Harlow) (Lab/Co-op)
I thank the Minister for her statement, and for her ongoing commitment to ensuring that women’s health is at the heart of this Government’s agenda, which is hugely important. A bit like my hon. Friend the Member for Burnley (Oliver Ryan), I was shocked by the number of women from my constituency of Harlow who came forward to tell me about their terrible experiences of being gaslit, ignored and disrespected, particularly when it came to endometriosis and the pelvic mesh scandal. My constituent Belinda, when she was 36 years old, went to the GP complaining of head pains. She was told that it was nothing and was sent home. She had actually had a stroke. She was told by the GP that she could not possibly have had a stroke at the age of 36, which was obviously incorrect. What would the Minister say to women in my constituency who have long felt ignored, disrespected and gaslit because they are women?
Karin Smyth
Belinda’s story is shocking, and I hope that she is doing better. This strategy is, as I said, a total game changer. In particular, the renewal of this strategy, based on the previous strategy, sends a signal to the system that we will look at the experience of women and take it into account. We will look at the budgets and the return of money to the service to improve things. As my right hon. Friend the Secretary of State said yesterday, there is nothing quite like seeing chief executives and chief finance officers suddenly notice—perhaps they had not noticed it before; they are busy sometimes—women’s clear dissatisfaction with gynaecology. The strategy sends a positive signal to improve the service, and that puts power in the hands of women.
The other real game changer is the online service. As I said, women, wherever they live, be it in Harlow, Bristol, rural Lincolnshire or coastal areas like Thanet—I have heard from Members from so many places this afternoon—will have access to online specialist treatment. There will be a further roll-out of diagnostic services, to get that diagnostic record back into neighbourhood healthcare, so that people can be treated closer to home. Building an NHS around women, women’s needs, women’s experiences—that is the game changer promised by this Labour Government.
Adam Thompson (Erewash) (Lab)
As a trained science teacher, I welcome the Minister’s news that through the strategy, the Government are launching a new programme to improve education for girls about their menstrual health, with additional funding from this year to support targeted work in schools and community settings. Does the Minister agree that this programme will support girls’ knowledge of menstrual health, and when to seek healthcare?
Karin Smyth
I thank my hon. Friend for his expertise, and I agree that the programme will do that. When I was first told about menstrual cycles as a young girl, I was told to hide what happened, even from my father and my brother in the household, let alone my peers in school and so on. We have come a long way, and it is good to have so many good advocates to help us. Education in school is central to that.
Oral Answers to Questions
Karin Smyth Excerpts(4 days, 19 hours ago)
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David Davis (Goole and Pocklington) (Con)
The Minister for Secondary Care (Karin Smyth)
Good managers are crucial to fixing our NHS, which is why the Government are backing managers and leaders with targeted investment. We will introduce professional standards for managers, establish a leadership college and implement mechanisms to prevent unsuitable individuals from holding senior NHS posts. Our workforce plan will set out how we will professionalise managers and leaders, equipping them with the skills, tools and operating frameworks to deliver lasting improvements across the NHS.
David Davis
Following on directly from the Secretary of State’s comments to my right hon. Friend the Member for Herne Bay and Sandwich (Sir Roger Gale), last month two national health service trusts in my constituency were found to be among the worst in England, one of them actually the worst. NHS England will now be brought in to turn those trusts around. However, the former chief executive of those trusts, who was responsible for overseeing their decline and was terminated in that job, has been promoted as the NHS turnaround manager for Yorkshire. Supposedly, he will be the man to correct the problem he created. That is by no means the first time that people have been found failing upwards in the national health service. What steps are the Secretary of State and the Minister taking to prevent NHS leaders who have failed in one role from being moved to a different post within the NHS?
Karin Smyth
I thank the right hon. Member for his question. I know he has raised it previously with the Leader of the House, and a similar issue has been raised with me by many hon. Members in his local geography. He knows that it would not be appropriate for me to comment on individual cases, but further to my comments about the importance of supporting good managers, we do not want people failing upwards as we have had in the past. I confirm that the planned disbarring system will prevent unsuitable NHS leaders who cover up poor performance or silence whistleblowers from taking up other leadership roles in the NHS and moving around the system.
Dr Beccy Cooper (Worthing West) (Lab)
Effective NHS management lives or dies on the ability of our integrated care boards to address population health needs. As the devolution Bill moves forward and at pace in areas such as mine in Sussex, it brings with it more opportunity for working strategically across sectors such as health and local government. What steps is the Minister taking to strengthen population health management in our integrated care boards?
Karin Smyth
I welcome my hon. Friend’s question. She is absolutely right, and it is an area I worked on myself as a local NHS manager. It is crucial to have that link between health and local government. That will dictate most of the social determinants of health, as she well knows from her own expertise serving the population. That is why our 10-year plan commits to strengthening joint working, so that we will have better alignment across ICBs and strategic boundaries where possible, including in her area of Sussex, as well as that work with local governments to improve local population health as part of our neighbourhood health plans.
Calum Miller (Bicester and Woodstock) (LD)
Kirith Entwistle (Bolton North East) (Lab)
The Minister for Secondary Care (Karin Smyth)
Ophthalmology waiting lists have fallen since we have taken office. Average waiting times have reduced, and 18-week performance has improved. ICBs have the flexibility to commission services across specialties within a fixed financial envelope, and may use contract levers to manage that activity. That is good management of public money to achieve the outcomes we want to see.
Clive Jones (Wokingham) (LD)
Patrick Hurley (Southport) (Lab)
Karin Smyth
These organisations play an important role. We are making sure that they are treated fairly, and are supported to play a bigger role. They will be supported by the forthcoming plan for voluntary, community and social enterprise spending targets to 2028, and a combined action plan for small and medium-sized enterprises and VCSEs. That will include measures to ensure clearer visibility of opportunities, earlier market engagement, proportional financial and evaluation requirements, and a strong performance on prompt payment across the health system.
Adrian Ramsay (Waveney Valley) (Green)
Gareth Davies (Grantham and Bourne) (Con)
In 2022, Grantham saw the opening of one of the country’s first community diagnostic centres; since then, more than 100,000 tests have been completed for the local population. Now, I want the same for the town of Bourne. Will the Minister meet me, so that I can make the case for a new community diagnostic centre in Bourne?
Karin Smyth
I was happy to announce the further expansion of CDCs this morning. We will continue to work to roll out these centres across the country. I am happy to discuss with the hon. Gentleman the proposals from his local ICB, if he wants to provide a bit more detail on that, as these centres are critical to getting down our waiting lists.
Ben Coleman (Chelsea and Fulham) (Lab)
Will the Secretary of State join me in welcoming the success of sickle cell bypass units in north-west London and across the country in reducing pressure on emergency departments, while improving care for sickle cell patients, who have historically been overlooked? Does my right hon. Friend recognise that the future of these units is threatened, and will he meet me to discuss the need for ongoing central funding, so that these vital and efficient services are not lost?
NHS England: Financial Directions
Karin Smyth Excerpts(3 weeks, 3 days ago)
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The Minister for Secondary Care (Karin Smyth)
I am revising the 2025-26 financial directions to NHS England made on 31 March 2025, and setting the 2026-27 financial directions to NHS England.
The amendment to the total revenue resource use limit for 2025-26 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 His Majesty’s Treasury and include a number of funding transfers from and between the Department of Health and Social Care and NHS England.
The 2025-26 total is as set out by HM Treasury at the autumn statement, with some additional transfers in-year, including for pay, industrial action and redundancy costs. The 2026-27 total is as set out by HM Treasury, with some additions from budgets held in the wider DHSC group.
Both directions will be laid before Parliament and published on gov.uk.
[HCWS1457]
General Medical Council Legislative Framework: Reform
Karin Smyth Excerpts(3 weeks, 4 days ago)
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The Minister for Secondary Care (Karin Smyth)
Today, we are launching a consultation for the General Medical Council that aims to bring healthcare professional regulation into the 21st century.
The consultation will provide a basis on which to tackle inefficiencies, slow processes, and bureaucratic barriers to change, thereby enabling faster, fairer and more forward-looking regulation. This is necessary for more effective protection of patients and the public.
For years there have been frequent calls from regulators, professions, and the public to make healthcare professional regulation more modern and efficient. These were reflected in recommendations by the Law Commission in 2014 and further substantiated by responses to the regulating healthcare professionals, protecting the public, policy consultation in 2021.
The principal objectives of the draft General Medical Council Order 2026 are:
To introduce a modern and agile regulatory framework for medical practitioners, physician associates and anaesthesia associates in the United Kingdom.
The GMC will be able to consult and amend its rules more efficiently as these will no longer require Privy Council approval. This will allow GMC to respond to external events in a timely manner which should lead to swifter and stronger public protection.
To provide the GMC with enhanced flexibility to set standards for education and training in different forms, for example formal teaching or digital learning and settings for example, clinical settings or community based settings, which will ensure high quality for all educators and learners.
To provide a duty on the GMC to hold a single register, rather than multiple registers as it does currently. The register will be clearly divided into parts for each profession the GMC regulates. This will make it easier for the public and patients to find and understand registration information about the GMC’s registrants.
To reform registration powers so the GMC can amend requirements flexibly, ensuring swifter adaptations to workforce needs and regulatory developments.
To overhaul the fitness to practise process to make it swifter, fairer and less adversarial, thereby strengthening public protection and improving the experience for all parties involved. This will further support the work GMC has already done to eliminate bias in its fitness to practice processes.
To establish a framework which may be used for future reforms to the other healthcare professional regulators, enabling faster and more consistent cross-regulator outcomes.
The proposed legislation also delivers several review recommendations which pertain to healthcare professional regulation.
The noble Lord Mann’s review into antisemitism and other forms of racism in the NHS recommends implementing a number of measures to strengthen the safeguards relating to healthcare professional regulation.
These include the GMC retaining its existing right to appeal fitness to practise panel decisions to the courts, strengthening the powers of the Professional Standards Authority for Health and Social Care by permitting them to require information from regulators, strengthening the PSA’s appeal rights, and allowing the PSA to request that specific fitness-to-practise decisions made by case examiners are revised. These measures will strengthen the oversight of the regulatory system and demonstrate the Government commitment to stamping out racism and discrimination at all levels of the healthcare system. Work is under way to finalise a range of further recommendations from the Mann review, which will be shared in due course.
The consultation also seeks views on recommendations 1 and 9 of the Leng review which recommended that the roles of “Physician Associate” and “Anaesthesia Associate” be re-named “Physician Assistant” and “Physician Assistant in Anaesthesia”, respectively, to ensure clarity for patients.
The proposed UK-wide changes laid out in the consultation are crucial in ensuring the GMC is fit for purpose and can ensure protection of the public to the best of its ability.
[HCWS1443]
Puberty Blockers Clinical Trial
Karin Smyth Excerpts(3 weeks, 5 days ago)
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Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
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The Minister for Secondary Care (Karin Smyth)
It is a pleasure to serve under your chairship, Mr Mundell. I thank the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) of the Petitions Committee for the way in which he introduced the debate. In his usual style, he made sure that he had talked to a range of people and experts to inform this debate.
I want to start by recognising that the thousands of signatures on the petition show the real strength of feeling on this issue. I thank everyone for taking part. I am acutely conscious of the young people, their families and people in the Public Gallery today and outside who are paying close attention to this debate and what is being said. I hope to address all the issues that have been raised—I have kept notes and listened carefully—as I know people want to get this on the record. I will say now that I will not take any interventions; I will just set out where I think we are. If I do not answer particular questions, I will get back to people.
I want to assure colleagues and the signatories to the petition, particularly young people and their families, and those who are waiting for, have had or have been concerned about gender services, that this Government will always be led by science and not ideology. We are proceeding carefully in line with clinical advice and we will always put the interests of vulnerable children first, because their health and wellbeing are not negotiable. That is our position.
Let me start, briefly, with some of the context. In 2020, NHS England commissioned Dr Hilary Cass to undertake a review of NHS children and young people’s gender services. Like others, I am sure, I have taken time over the weekend to re-read her interim report and her full report; I commend both to people with an interest in the subject.
Dr Cass is one of the most pre-eminent clinicians in her field, and her review is the most definitive assessment of its kind. It laid bare the inadequacy of the now decommissioned Tavistock Gender Identity Development Service. The interim review and final report made it clear that we needed better data and a stronger evidence base to design the right services for children and young people presenting with questions around gender dysphoria or gender incongruence, given the poor evidence base for services and treatment against rapidly increasing and, as we have heard, changing demand.
Dr Cass recommended a new model of care based on holistic assessment and psychosocial support, with further research into puberty blockers, specifically where they are not provided in isolation. The Labour party in opposition welcomed her report and accepted her findings, and we continue to do so in government. Many of the recommendations in her report are being implemented, including opening new NHS children and young people’s gender services while building the evidence base in parallel through a national research programme.
As the hon. Member for Caithness, Sutherland and Easter Ross outlined, the rationale for the clinical trial is part of the recommendations to gather robust, contemporary and comparative evidence on the relative benefits and harms of puberty-suppressing treatments in children. That is how we can decide whether puberty suppression can be an option in NHS gender care in future.
The PATHWAYS trial has undergone thorough scientific, clinical, ethical and regulatory safeguards. Following academic peer review, it was supported by the independent National Institute for Health and Care Research funding committee. It was endorsed by a multidisciplinary and multi-agency national research oversight board, and was then subject to formal regulatory approvals via the Medicines and Healthcare products Regulatory Agency; the Health Research Authority, including a review by an independent research ethics committee; and finally, the Commission on Human Medicines, which made considered recommendations to the study team that were adopted in full.
As with all complex clinical trials, the top priority of each of those organisations is the safety of the trial participants. The MHRA in particular is maintaining a high level of scrutiny and taking a cautious and measured approach. Where appropriate, after initial approvals have been granted, there can be ongoing dialogue between the sponsors of clinical trials and the MHRA. That is part of the process—I want to stress that point.
The MHRA has raised concerns relating to some elements of the trial design, and those questions obviously need answering. Rigorous and constructive discussions are accordingly under way between the MHRA and the trial sponsor.
Karin Smyth
I am not going to give way; I am going to get through these points.
The safety and wellbeing of children and young people have always been the driving consideration in every decision we have made regarding this trial, and always will be. That is why the trial sponsor has paused recruiting until these issues can be resolved. There have been calls today to cancel the pause, to continue with the pause and to cancel the trial, but the position is that the trial is paused until the issues are resolved, because we will not compromise an inch on safety. The trial will proceed only if the regulatory approval is reconfirmed. We will provide an update on the outcome of those discussions as soon as we can.
David Mundell (in the Chair)
Order. I think the Minister has made it clear that she is not taking interventions.
Karin Smyth
Thank you, Mr Mundell.
Dr Cass also recommended that we take forward the data linkage study as part of the wider national research programme. The linkage study is not a clinical trial, and as such it will not in and of itself provide the type of evidence that can demonstrate cause and effect for any particular treatment. It is observational in nature, linking and analysing existing routinely collected data for adults who were referred as children to the Tavistock before it was decommissioned. The study requires no active patient participation; instead, it relies on an analysis of digital information held within health records and other databases.
Data linkage studies have faced difficulties that are a matter of public record, but since then there have been great efforts to improve the collaboration of the adult clinics and other organisations. Important final steps are currently being taken to enable the study to begin. We expect the study analysis to then take around one year to complete. On 26 February, we laid an order before the House to make it lawful for people and organisations to share or process data that could be subject to protections under the Gender Recognition Act 2004 where it is for the purpose of the study. That order came into force last week.
The PATHWAYS clinical trial is a key step that we are taking to build an evidence base to prove whether puberty blockers are safe and effective in treating gender incongruence and gender dysphoria. As we speak, the new clinical model is collecting a consistent and comprehensive core clinical dataset while we develop a supporting national registry.
In the meantime, hormone medications are not being prescribed. NHS England now prevents the routine use of puberty-suppressing hormones in the NHS children and young people’s gender services, and the Government have indefinitely extended restrictions that prevent them being supplied privately. Last year, NHS England issued guidance to GPs that strongly advised against supporting prescribing agreements with unregulated providers, who do not always have children’s best interests at heart. That includes online overseas providers who are known to have supplied puberty suppressants and cross-sex hormones to children in the past without any proper safeguarding. NHS England issued that warning because of the serious safety risks that unregulated providers continue to pose to children in this country. In some cases, we are talking about puberty blockers being prescribed following a questionnaire or a brief Zoom call.
I will come on to other issues around future services, although I think I have answered most questions. All clinical trials have appropriate insurance to cope with the issues outlined by the right hon. Member for Tonbridge (Tom Tugendhat). The trial sponsor is King’s College, so my understanding is that the issue raised by the hon. Member for South West Devon (Rebecca Smith) with regard to the state having conflicts does not arise. The hon. Member for Bristol Central (Carla Denyer) cited regulations that were mainly from overseas, but the UK has its own regulatory independent network: the MHRA, which we work with. The Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson), who I respect in her role as a paediatrician, asked a number of questions about timing and process. She will be aware that there is a judicial review, but I will make sure that she gets an answer on some of those issues.
I want to update the House that since April 2024, NHS England has opened three new services in the north-west, London and the south-west. I can confirm that a fourth service will become operational at Cambridge University hospitals NHS foundation trust very shortly. Those are important services for young people and their families who are awaiting treatment and who want to understand when and how they will receive care.
Karin Smyth
I am not going to give way.
Those services operate under a fundamentally different clinical model from the Tavistock clinic. Children and young people will get comprehensive, tailored assessment and support from multidisciplinary teams made up of experts in paediatrics, neurodiversity and mental health.
Under this Government, mental health spending has gone up in real terms, and we are putting specialist mental health teams in every school to support those young people. However, I know there are still families who are desperately worried by some of the debate and are concerned about the future, often to the detriment of their own mental health. They want clarity on the options open to them. I want to end by assuring hon. Members that we will update the House on all these issues as soon as possible. I urge all hon. Members to continue to engage with the evidence that best supports our young people. That is what we, as a Government, continue to be focused on.
Health and Social Care
Karin Smyth Excerpts(1 month ago)
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Helen Maguire
The Minister is making an important point about the vital need for capital funding in the NHS. I and a number of colleagues are here in the Chamber because St Helier hospital is falling apart, and unfortunately patients are being affected, but the hospital build programme has been delayed another three years. There has been lots of goodwill in the debate, but we are looking for additional investment in the A&E. I hope the Minister will take that away, and that there might be something about it in a statement soon.
Karin Smyth
The Chancellor has made her key decision to put us back on track, announcing in the Budget that capital health spending would increase by £15.2 billion by the end of the spending review period in 2029-30.
[Official Report, 4 March 2026; Vol. 781, c. 387WH.]
Written correction submitted by the Minister for Secondary Care, the hon. Member for Bristol South (Karin Smyth):
Karin Smyth
The Chancellor has made her key decision to put us back on track, announcing in the Budget that capital health spending would increase to £15.2 billion by the end of the spending review period in 2029-30.
Palliative Care
Karin Smyth Excerpts(1 month, 1 week ago)
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The Minister for Secondary Care (Karin Smyth)
I thank my hon. Friend the Member for York Central (Rachael Maskell) for securing this important debate. We entered Parliament at the same time; we were immediately on opposite sides of the assisted dying debate, and we remain so. Although the Government are neutral, we have always articulated our concern around palliative and end-of-life care in many debates in this House. My hon. Friend has done a marvellous job of that today by bringing forward this debate.
I also thank all my hon. Friend’s colleagues on the commission on palliative and end-of-life care for the vital work they do as they continue to develop their third report. We are really grateful to all those who work or volunteer in the palliative care and end-of-life sector for the care and support that they provide to patients, families and loved ones at a time when they need it the most. As my hon. Friend the Member for Cannock Chase (Josh Newbury) said, everyone deserves a good death.
I commend the shadow Secretary of State for his contribution regarding his excellent experience in the sector; he made some really valuable comments. I have talked about this before, but I too come to this debate with experience. In 2008, I worked with clinicians around end of life and how to live and die with chronic obstructive pulmonary disease—a really unpleasant disease, if there is such a thing as a pleasant disease. I was made aware that people were talking about how to live with it, but no one was really responsible for working with patients and families on how to die with COPD.
I learned a lot about how we talk about death and dying in the health service and the care service, as well as the great work that our trainers and people do to support our clinicians about how best to die. That was really valuable for me when my own father died at home in 2010, supported by Macmillan and a fantastic community care team, which happened partly due to the training that I had and how I was able to articulate on behalf of my family. Things should not have to be like they are. That was 16 years ago, and it is really concerning that across the country people are still experiencing such poor care.
I see lots of that good care in my own local hospital, St Peter’s, which is doing some of the innovation that the shadow Secretary of State mentioned.
I want to reassure colleagues that the Government and my hon. Friend the Minister for Care, who leads on this work, are absolutely committed to creating a society in which everyone receives high-quality, compassionate care from diagnosis through to the end of life.
We have heard a lot about the role of hospices today, from my hon. Friends the Members for York Central, for St Helens South and Whiston (Ms Rimmer), for Birmingham Erdington (Paulette Hamilton), for Beckenham and Penge (Liam Conlon), for Cannock Chase, for West Dunbartonshire (Douglas McAllister) and for Bury St Edmunds and Stowmarket (Peter Prinsley), and from shadow Health Secretary, the right hon. Member for Daventry (Stuart Andrew). Although we recognise that the majority of palliative and end-of-life care is provided by NHS staff and services, we absolutely recognise that many hospitals do fantastic work in this area, and they face a challenging financial situation due to a range of pressures.
That is why last year we announced that we would support the sector with a record £125 million capital funding boost for those hospitals in England, to help them to provide the best physical environment for the people they care for. That money can be spent on fixing a roof, paying for double glazing or buying a new boiler. Although I take the shadow Secretary of State’s point that sometimes people are more willing to contribute to those sorts of things, I know too that finding the money to fund such repairs is what keeps those running the system awake at night, and this work also saves money in the long run, particularly on energy bills. The full £125 million has now been allocated to 158 eligible hospices by Hospice UK. My hon. Friend the Minister for Care has been touring the country to visit many of those hospices to see at first hand some of the good that the money is doing.
On top of that, we are providing around £80 million in revenue funding for children and young people’s hospitals over the next three years, as been said, giving them the stability they need to plan ahead—that was welcomed by the right hon. Member for New Forest East (Sir Julian Lewis). To reassure him, we absolutely recognise the different needs of children and their families in this work. A long-term commitment was a key demand from the sector, which faces a cliff edge in funding cycles every year. Children and young people’s hospices and integrated care boards have been informed of their allocations for the next financial year, and we intend to let hospices know about funding for future years once the process is complete.
We absolutely recognise that this money will not be a silver bullet, and many hospices still face pressing challenges. The need for palliative care and end-of-life care is also projected to rise in coming years with our ageing population, as we have heard. However, although around 75% to 90% of those at end of life would benefit from palliative care and end-of-life care support, only about 55% are identified as such in primary care. That is why NHS England recently wrote to all ICBs requesting an immediate update on the financial stability of hospices in their footprint and the steps needed to mitigate those risks. That will give us a clear national picture of any hospitals at risk of closure or significant service reductions and the potential impact on patients’ families and the wider urgent care system.
With regard to the wider system, neighbourhood health services and their development sit at the heart of our 10-year plan. We are building a service that will deliver more personalised care closer to where people live, empower people to lead healthier, independent lives where they can, and give them a genuine choice about how to access support. I want to reassure hon. Members that the NHS medium-term planning guidance identifies those at the end of life as a high-priority cohort in the implementation of neighbourhood health. I also say to my hon. Friend the Member for Newcastle upon Tyne East and Wallsend (Mary Glindon) that the workforce plan, when it comes forward, will reflect the move into neighbourhood services.
We have to move away from disjointed pathways, as my hon. Friend the Member for Worcester (Tom Collins) articulated so well in speaking about his terrible experience with his mother, and ensure a paradigm shift that looks at people holistically throughout the pathway, as my hon. Friend the Member for Bury St Edmunds and Stowmarket said.
I am the Minister responsible for reforms to the system architecture, and we are asking ICBs to do more. NHS England’s strategic commissioning framework makes it clear that we expect them to commission services in line with the current and future needs of the people they serve. We are moving away from ringfenced incentive budgets, and streamlining the incentives to focus more on the outcomes that we should all expect from our systems. Via the model ICB blueprint, we have made it clear that it is the mission of ICBs to reduce inequalities through a careful assessment of the quality, performance and productivity of existing provision. As we heard in today’s debate, we have to ensure that there are high standards and focused objectives. Next month, ICBs and NHS providers will create a new plan to more effectively manage the needs of high-priority people. NHS England is supporting commissioners to understand those needs, with a dashboard that brings together all relevant local data in one place.
There is currently a contracting mix in the sector, as we have heard today. When we support ICBs to commission more strategically, we have to start moving away from the grant and block contract models. That is why the Government are developing a landmark palliative care and end-of-life modern service framework, or MSF, for England. Palliative and end-of-life care has been variable across the country for far too long, but the modern service framework will put a floor under the kind of care that patients can expect, as we heard from my hon. Friend the Member for City of Durham (Mary Kelly Foy). Although it would not be right to pre-empt exactly what will be in the final MSF at this time, we are working closely with all stakeholders to ensure that everyone has access to the care they need in the right place and at the right time. As part of the MSF, we have invited colleagues from a number of organisations to engage with us.
Ben Coleman
Can the Minister confirm that the MSF will include targeted support for children who require palliative care?
Karin Smyth
My hon. Friend pre-empts my next paragraph; I thank him for his contribution.
As part of the development of the MSF, we will be looking at some of the important aspects of care that my hon. Friend the Member for York Central mentioned, such as early identification of need, care delivered closer to home by integrated generalist and specialist teams, and strengthened out-of-hours community health support, including a dedicated phone line. I assure the right hon. Member for New Forest East that children, parents and carers will be included in that endeavour. As my hon. Friend the Member for Chelsea and Fulham (Ben Coleman) said, the experiences of people like Amy inform such work. Let me say to my hon. Friend the Member for Alloa and Grangemouth (Brian Leishman) that the experience of Calum and the Turner family must not be repeated.
Hospices do an amazing job for people at the end of life, those with life-limiting conditions, and the whole community of family and friends who support their loved ones on that journey, including through bereavement support, as we have talked about today. The quality of care, the compassion and the love that hospices provide are second to none. We absolutely recognise that the sector faces challenges, and we are determined to work with all our partners to understand those challenges. We are not talking about spending more; we are talking about focusing on the money we have at the moment and spending it better. We are developing a values-based, outcome-focused financial model to reflect people’s experience of care throughout their lifetime. While there are no easy answers, we are supporting them with record funding and reform.
Rachael Maskell
I am grateful to the Minister for her speech, but we have heard throughout the debate that 100,000 people are not getting the care they need. One in three people needs additional support. By maintaining the financial cap, how are we going to build enough capacity to ensure that everybody has access to excellent care at the end of life?
Karin Smyth
I thank my hon. Friend for her contribution. This issue warrants a longer debate, so that we can understand how to move the resources that exist. As we have heard this afternoon, when people are unnecessarily admitted to hospital, which is terribly distressing for them and their families, the resources follow them. It is about moving those resources towards neighbourhood health services, in which this cohort of people will be absolutely central, as I have said. That is what we need to be doing, and we will continue to discuss this with people as we move the service towards being community-based.
Colleagues are right to champion their cause in the House today, and we will continue to work on this issue to make sure that people have good-quality care across the country. Given the measures I have outlined this afternoon, I hope Members will agree that we are listening. We look forward to working with colleagues to make sure that we develop these services for the future.
Women’s Health Strategy: Endometriosis and Fibroids
Karin Smyth Excerpts(1 month, 1 week ago)
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The Minister for Secondary Care (Karin Smyth)
I congratulate my hon. Friend the Member for Erith and Thamesmead (Ms Oppong-Asare) on securing this important debate. Baroness Merron, who leads on this work for the Department, and I are grateful to my hon. Friend for the conversations that she has been leading; for putting the spotlight on endometriosis, as well as on the renewed women’s health strategy; and for giving me the opportunity to set out what the Government are doing this Endometriosis Action Month.
As my hon. Friend has said, for far too long, women with gynaecological conditions including endometriosis and fibroids have been failed. We acknowledge the impact that that has on all aspects of their lives. This Government’s message to women is clear: you do not have to put up with that any more.
I am pleased to hear that my hon. Friend will be hosting a screening of the short film “This Is Endometriosis”, which is about the harrowing experience of a woman seeking care for her endometriosis symptoms. I hope to be able to get along to that screening when it happens, and I encourage others to do so, too.
This Government inherited a broken NHS system that still does not understand the needs of many women and was not designed with women in mind. We are committed to changing that, and to ensuring that women are listened to and get the healthcare that they need, when they need it. Improving awareness of endometriosis, fibroids and other women’s health conditions is a vital first step in meeting our commitment to end this neglect of women’s health and reduce the stigma attached to it. My hon. Friend is doing her part through this debate.
The General Medical Council has begun work to improve women’s health representation in the curricula used to train healthcare professionals. Since last year, students graduating from UK medical schools have been required to pass the medical licensing assessment, which encourages a better understanding of common women’s health problems among all doctors as they start their career in the UK. This assessment includes topics to do with women’s health, including endometriosis and fibroids. Women’s health is included in the Royal College of General Practitioners’ curriculum for trainee GPs and its women’s health library, which brings together educational resources and guidelines on women’s health. In November 2024, the National Institute for Health and Care Excellence updated its guidelines on endometriosis to make recommendations for healthcare professionals on referral and investigations for women for whom that is suspected to be the diagnosis.
Taken together, these actions will improve the standard of care that women receive. It is encouraging to see not just the NHS but all our partners and arm’s length bodies taking action to raise awareness and improve training. This work has to be ongoing across Government. It is shocking, perhaps, that this started only fairly recently, but like my hon. Friend, I pay tribute to many hon. Members across the House who have led an awful lot of work to raise awareness of this issue in the last few Parliaments, and I think that work is starting to bear fruit. Last July, the Department for Education published revised statutory guidance that sets out in black and white that secondary schools should cover menstrual and gynaecological health, covering things like heavy bleeding and when to seek help from professionals.
Women often spend years being dismissed, misdiagnosed or simply not listened to. This was reflected in Endometriosis UK’s recent report, which my hon. Friend has made reference to. We are clear that this is unacceptable, and that women should not have to put up with it any more. We have introduced Jess’s rule, which requires GPs to rethink diagnoses for their patients. We are also rolling out Martha’s rule, which will give in-patients in acute hospitals in England the ability to initiate a rapid review of their case by someone outside their immediate care team. These rules will help to ensure that women are listened to by their doctors, and that their concerns are not dismissed.
Early diagnosis is key, and that is why we continue to roll out community diagnostic centres across the country for women on gynaecological pathways. As of last month, 106 community diagnostic centres across the country offer an out-of-hours service 12 hours a day, seven days a week, meaning that patients can access vital diagnostic tests around busy working lives.
In September, we announced NHS Online, a new online hospital, to give women on certain pathways the choice of getting the specialist care that they need from their home. This will mean that wherever women live in this country, they can access the very best gynaecological care. Earlier this year, we announced that menstrual problems, which may be a sign of endometriosis and fibroids, will be among the first nine conditions available for referral from 2027. The detail is being worked through ahead of the launch next year.
Our revolutionary online hospital will help reduce patient waiting times, and deliver the equivalent of up to 8.5 million appointments and assessments in its first three years. That is four times more than an average trust, and it will give women choice and control over their care. Finally, this Government are committed to encouraging integrated care boards to further expand women’s healthcare at neighbourhood level, and to support ICBs in learning from women’s health hub pilots, so that they can improve services for women, as well as for the rest of the population.
Women can be impacted by a range of health conditions at the same time, including those that only affect women; those that affect women differently from, or more severely than, men; and those that affect different groups differently, such as fibroids. As my hon. Friend said, black women are disproportionately affected, and often face barriers to timely and compassionate care. This is also the case for ethnically diverse women with endometriosis, as highlighted in the Endometriosis UK report.
We are not complacent about these inequalities. We are committed to building a fairer Britain to ensure that people can live well for longer and spend less time in ill health. Our 10-year health plan will focus on shifting care from hospital to communities, and on how neighbourhood delivery will help address gaps in provision and long waiting times, specifically for those from deprived areas in constituencies like mine, and women from ethnic minority backgrounds.
Let me turn to the point about research made by the hon. Member for Didcot and Wantage (Olly Glover). The Department, through the National Institute for Health and Care Research, has commissioned several studies focused on endometriosis diagnosis, treatment and patient experience. The NIHR is funding seven active research awards, with investment totalling £7.8 million. That includes a new £2.3 million award for research starting in March 2026 on the effectiveness of pain management for endometriosis.
As my hon. Friend the Member for Erith and Thamesmead has said, we know that services are not serving women as they need to right now, but there are some helpful signs that that is starting to change. Training and awareness are a key part of that. We need to keep highlighting the differences as women present for care. We will listen to women, and I look forward to working with my hon. Friend and others on developing and implementing a renewed women’s health strategy over the coming months.
Question put and agreed to.
NHS Capital Spending
Karin Smyth Excerpts(1 month, 2 weeks ago)
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The Minister for Secondary Care (Karin Smyth)
It is a pleasure to serve under your chairmanship, Mr Western. I thank colleagues for their kind remarks about my hon. Friend the Member for West Lancashire (Ashley Dalton). We will miss her. She has set a great example, not only by continuing while undergoing cancer treatment but, as hon. Members have said, by recognising that sometimes we need to look after ourselves and prioritise our constituents. No doubt she will be doing that very well, and I look forward to her contributions from the Back Benches.
I congratulate the hon. Member for Carshalton and Wallington (Bobby Dean) on securing this important and timely debate. I hope that my name came up occasionally when he was perusing previous debates on this issue, because I am one of the few Members of Parliament over the past 10 years who has banged on quite a lot about capital. I am delighted to be the Minister, because the sound management of that capital is absolutely crucial to the provision of healthcare for all our constituents. I agree that it does not get enough airtime, and the hon. Gentleman made an excellent speech outlining most of the issues. We have heard a lot of contributions today, and I will try to do justice to this very wide-ranging debate.
Let me remind hon. Members of the problem. I have with me Lord Darzi’s report, which said:
“The NHS has been starved of capital and the capital budget was repeatedly raided to plug holes in day-to-day spending…Some £4.3 billion was raided from capital budgets between 2014-2015 and 2018-2019”.
It said:
“The result has been crumbling buildings”
and
“services were disrupted at 13 hospitals a day in 2022-2023. The backlog maintenance bill now stands at more than £11.6 billion”.
The report also said that the NHS was “in the foothills” of the digital transformation that the rest of the country—indeed, the rest of the world—was undergoing. There was also a shortfall in capital investment.
I kind of admire the hon. Member for Hinckley and Bosworth (Dr Evans) for defending that situation—it is a tough gig—but we all see what happened in our constituencies. I am very proud of the capital investment under the last Labour Government, and I will come back to PFI in a moment.
Reversing that trend and repairing and rebuilding our healthcare estate is a vital part of our ambition to create an NHS fit for the future. That is why we are prioritising the estate to support that task. First, we are prioritising core and safety technology equipment and—this is an important measure introduced by the Chancellor—changing the rules on capital to stop capital-revenue transfer. We are also incentivising the system and streamlining the processes; the hon. Member for Hinckley and Bosworth tells us how terrible the processes were, but his party was in government. We have taken control and used Government to good effect to start streamlining those processes. Part of that is about moving towards making one team of NHS England and the Department of Health—I hope hon. Members will support us in that. We are also building the capacity and capability of the staff in order to develop and do the work we need them to do. That capacity has been completely depleted over the last 14 years.
We have put a lot of information into the system to move things quickly, and I think we are all seeing the benefits of that in our constituencies. We will bring forward a capital plan in the spring to make all of that clearer for the system and for hon. Members.
Helen Maguire (Epsom and Ewell) (LD)
The Minister is making an important point about the vital need for capital funding in the NHS. I and a number of colleagues are here in the Chamber because St Helier hospital is falling apart, and unfortunately patients are being affected, but the hospital build programme has been delayed another three years. There has been lots of goodwill in the debate, but we are looking for additional investment in the A&E. I hope the Minister will take that away, and that there might be something about it in a statement soon.
Karin Smyth
The Chancellor has made her key decision to put us back on track, announcing in the Budget that capital health spending would increase by £15.2 billion by the end of the spending review period in 2029-30. That funding will be used as intended; in previous years, as we heard, capital funding was diverted to cover day-to-day costs. We have tightened the Treasury rules; we have changed them, because that is what Government can do—who knew! As a result, capital funding will now be fully focused on repairing, upgrading and expanding NHS buildings and facilities to support long-term productivity. This settlement represents record levels of capital investment into healthcare, and it will support the three shifts set out in the 10-year health plan: moving care out of hospitals into the community, replacing outdated systems with modern digital services and focusing on preventing illness rather than just treating it.
Of course, rebuilding NHS infrastructure cannot happen overnight. I assure hon. Members that the Government do understand that long-term certainty over capital funding is needed for the NHS to move from these short-term fixes to more strategic investment. That is another key decision made by the Chancellor. That is why, through the 2025 spending review, we have delivered a four-year capital health settlement, extending to 2029-30. That is backed by a further five years of certainty for estates maintenance funding. I am genuinely grateful to hon. Members for recognising that that is a massive change that we have engineered into the system, and I think we are all seeing the benefit.
That change means there is a £30 billion commitment in capital funding over five years to support the day-to-day maintenance and repair of the estate, with a further five years of funding certainty, as set out in the 10-year plan. For the first time, NHS trusts have also been given multi-year operational capital allocations, with clear funding set out until 2029-30, and indicative funding for a further five years. This is an unprecedented opportunity for local health systems to plan with confidence over a nine-year period, and I continue to encourage all Members to engage with their integrated care boards, which will be prioritising schemes over that period.
Within the £30 billion, the estates safety fund will continue, providing £6.75 billion of investment over the next nine years to target the most critical building repairs, alongside £2 billion to continue supporting NHS England’s RAAC programme across the spending review. Additionally, £21 billion in operational capital over the five-year spending review will empower NHS organisations to invest in local priorities, including hospital infrastructure. It will take time to build up capacity and capability, but this marks the beginning of our rebuilding of an NHS that is fit for the future.
I also assure Members that this Government recognise the pressures faced across the system and are committed to bringing performance standards back to what patients expect. That is why we are investing to expand hospital and emergency care capacity, helping to reduce waiting times and improve care for patients. Over the next four years, there is £1.9 billion for urgent emergency care to support A&E departments, as well as to support ambulance services in reducing handover times.
There is also £1.5 billion for diagnostics, including funding to expand the hours of community diagnostic centres, shifting care from hospital to the community. The hon. Member for Hinckley and Bosworth noted that those centres were started under the previous Government, but we have ensured they have expanded hours and that there are more of them. Crucially, they are not built as add-ons, but are fundamental to the pathways experienced by patients in the system and ensure we have good value for taxpayers’ money.
There is £473 million for mental health services, including for people with learning disabilities and autism. I think we would all agree that the mental health estate needs recognition. There is more than £280 million for community care, supporting services closer to home, and more than £139 million for electives across the next two years. To move away from paper-based systems towards modern digital services, the autumn Budget confirmed £300 million in capital investment in technology, building on the combined revenue and capital investment announced at the spending review of up to £10 billion by 2028-29.
We are transforming healthcare by shifting care out of hospitals and into the community. Over the next four years, we are investing more than £400 million to upgrade primary care buildings and deliver neighbourhood health centres, as part of our commitment to those 250 neighbourhood health centres through the rebuild programme.
Karin Smyth
I will finish these points and answer some of the issues that have been raised.
The first 120 neighbourhood health centres will be operational by 2030 and will, as we have heard, be delivered through a mixture of public and private partnerships. I thank the hon. Member for Carshalton and Wallington for being one of the few to acknowledge that that is difficult—there is some controversy around it—but I am a strong supporter of the previous local improvement finance trust schemes and of the scheme at Southmead hospital in my local area, which was one of the better PFI schemes, and delivered unprecedented levels of care to the people of Bristol, including myself. It is important that we learn the lessons of the past, and we absolutely have, including those in the NAO report. Working with NISTA, as has been outlined, we will continue to pursue this issue and bring forward cases.
I do not want to rehearse the lack of funding for the new hospital programme.
Karin Smyth
No, I will not, because I want to get through my final comments.
We put the new hospital programme on a sustainable footing. I understand that local people across the country were led up the garden path and told something was going to happen. I think we all recognise that the money was not there and that the programme was not on a sustainable footing. We have backed it with the appropriate investment, which is rising to £15 billion over each consecutive five-year wave from 2030, averaging £3 billion a year. The exact profiles of funding will be confirmed at future spending reviews, and that is weighted to ensure that the schemes profiled most are caught in that.
We are progressing wave 1, and I will continue to liaise with hon. Members on progress. My message every week to any NHS trust, to any Member of Parliament, to NHS England and to the team running the new hospital programme is that we need to deliver these hospitals. There is a large queue behind them, and we have heard about some of them today. I also understand that a number of colleagues do not have a hospital being progressed in the scheme. The Government are keen to get on with building these hospitals. As hon. Members have said, a lot of this is about trust and commitment. I want hon. Members and anyone paying attention to know that I am clear about the importance of getting on with this programme, delivering on the ground and ensuring that the programme is robust.
Finally, alongside increased capital funding, we are improving how that funding is managed. As we have heard, the old processes did not work: a local scheme went to the ICB, to the region, to NHS England, to the Department, to the Treasury and back again, with huge amounts of sign-off but no control or accountability, and with no one locally understanding what was happening. We are transforming that, bringing together a team and streamlining the process, ensuring it is well governed. That will ensure that things happen more quickly, and we are already seeing that. With underspends this year, we have got the money out and into schemes already in the system. We are getting more DEXA scanners. That is how we ensure this happens on the ground.
It is up to ICBs to prioritise proposals, and we are working more closely with them to support them to bring things forward. I urge all hon. Members who have spoken today, including my hon. Friend the Member for Harrow West (Gareth Thomas), the hon. Member for Torbay (Steve Darling), my hon. Friend the Member for Rushcliffe (James Naish), the hon. Members for Taunton and Wellington (Gideon Amos), for Sutton and Cheam (Luke Taylor), for Eastbourne (Josh Babarinde) and for North Devon (Ian Roome), to keep working with their local systems on particular schemes. I am happy to keep talking to people.
To the hon. Member for Taunton and Wellington, let me say that I have met NHS England about looking at maternity in the area, which I know is a huge concern, and I am happy to meet him. I will get back to the hon. Member for North Devon about some of the numbers he outlined, which are not familiar to me. On another point that was made, we are ensuring that we are building in contingency for the future, because we live in volatile times.
Motion lapsed (Standing Order No. 10(6)).
North Middlesex Hospital Accident and Emergency Services: Cancer Patients
Karin Smyth Excerpts(1 month, 2 weeks ago)
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The Minister for Secondary Care (Karin Smyth)
It is a pleasure to serve under your chairmanship, Dr Murrison.
I thank my hon. Friend the Member for Edmonton and Winchmore Hill (Kate Osamor) for securing the debate. I echo her comments about Mrs Thorn in the light of her husband Jack’s experience. My hon. Friend has worked diligently on behalf of her constituent. We know that constituents should not have to take on such advocacy when they are suffering such trauma, but their experience is always valuable. Constituency MPs are always grateful to people who share their experiences, and my hon. Friend has done an excellent job on behalf of her constituent this morning.
We are clear that every patient should be treated with dignity and respect. For far too long, NHS performance and practices have not met the high standards that patients should expect, which is why we are taking action to improve cancer pathways and urgent emergency care, to build an NHS that is fit for the future. On the treatment of cancer patients in A&E in particular, far too many cancer patients and their families have been failed by the NHS, with care lacking empathy and dignity. It is not right that patients, and particularly those with a cancer diagnosis, face distressing situations waiting for care in A&E.
Through our recently published national cancer plan, which my hon. Friend alluded to, we commit to addressing poor experiences, driving earlier diagnosis and supporting general practitioners to spot cancer earlier through, for example, Jess’s rule and reducing inappropriate diagnosis in A&E. Jess’s rule is a patient-safety principle that requires GPs to reflect, review and rethink a patient’s diagnosis after three unresolved presentations, to reduce missed and delayed cancer diagnosis.
My hon. Friend and I entered Parliament at the same time; she had experience in primary care and I had experience as a commissioner. She will be as shocked as I am, because in 2026 cancer patients should not be going through A&E when they are known to have a condition. We have been working on that for a very long time. Our plan will reduce the need for people who are undergoing cancer treatment to attend A&E—for example, through rapid access to a booked appointment in same-day emergency care. As my hon. Friend alluded to, we already see that in other trusts, such as the Whittington in her area. That should be standard, and is in many places.
We recognise that some cancer patients will have more extensive needs. For those patients, we need to deliver an enhanced level of care during and after treatment, known as supportive oncology. This will include support for severe and sometimes sudden symptoms, when people need rapid access to the right care in their home or community. That will be key to getting those patients the support they need, and thereby reducing the need for them ever to attend A&E.
It is vital to deliver compassionate care in the best setting for each patient. Our national cancer plan will redesign cancer services around people’s lives, not just around hospitals, recognising that more people are living longer with and beyond cancer and need ongoing co-ordinated support. That support will increasingly be delivered through neighbourhood services and be accessible digitally through the NHS app. We will ensure that patients have a named neighbourhood lead to help to co-ordinate their care locally, working alongside hospital specialists to provide continuity, reduce fragmentation and make it easier for people to navigate services, in my hon. Friend’s constituency and across the country.
We will deliver greater use of virtual monitoring and growing opportunities for treatment and follow-up in community settings, where that is safe and appropriate. This will help to ensure that patients get high-quality support early, thereby reducing the crisis situations that my hon. Friend alluded to that currently drive unacceptable and unnecessary A&E visits.
Where patients do need to attend A&E, we are committed to improving standards and returning to the waiting times set out in the NHS constitution. We have expert improvement teams providing tailored support to challenge trusts like the North Middlesex, and they have shown progress, as my hon. Friend has highlighted. I pay tribute to the work of leaders locally in improving the situation—they have made progress since last year.
In addition, the NHS team in London recently agreed to a pilot for the oncology assessment unit, to proactively support cancer patients away from the emergency department, as my hon. Friend discussed. If she needs more detail on the final confirmation of that pilot, I will make sure she gets it in writing after the debate, because we do think that is an appropriate way to proceed.
Nationally, we recently published guidance on the model emergency department, setting out the core principles and pathways for high-performing emergency departments. Our urgent and emergency care plan for 2025-26 sets out a clear path to strengthen urgent care outside hospital. We are using data from shared patient care records and digital tools to support better triage, join up services and anticipate pressures before they arise. That is backed by £2 billion of investment in NHS digital infrastructure.
We are also investing £250 million to strengthen same-day emergency care and urgent treatment centre provision, helping systems to avoid unnecessary admissions for patients and supporting the same-day diagnosis, treatment and discharge of patients. The plan is working: A&E performance is improving and people are receiving their cancer diagnosis within a month. We do not underestimate how much more there is to do and how difficult it is for many patients at the North Middlesex hospital, as my hon. Friend has spoken about, and other places. We want to take the best to the rest. We know there is more to do, but the investment and modernisation along clear pathways are starting to make a difference, and the NHS is showing clear signs of recovery.
The NHS is under pressure. The Government are taking decisive action through our urgent care emergency plan, the national cancer plan and our longer-term reforms. We are putting the service back on its feet and ensuring that patients receive the high-quality, timely care they deserve. I welcome my hon. Friend raising this issue on behalf of her constituents, and many other Members discussing the issues with me. I am happy to continue working with my hon. Friend and local NHS leaders on how we can further strengthen urgent emergency care services and the delivery of the cancer plan, to reduce the disparities and support patients to receive the right care in the right place.
Question put and agreed to.