Independent National Maternity and Neonatal Investigation

Karin Smyth Excerpts

Monday 15th September 2025 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

I am announcing today the 14 hospital trusts that will be looked at as part of a rapid, independent, national investigation into maternity and neonatal services. In June, the Secretary of State for Health and Social Care, my right hon. Friend the Member for Ilford North (Wes Streeting), announced this urgent investigation because of concerning patterns in baby deaths and maternal mortality, and because of the extremely harrowing and traumatic stories that bereaved families brought directly to the Secretary of State and the Department.

The Secretary of State asked Baroness Valerie Amos to chair this review—a former diplomat with vast leadership experience and a passion for driving change. Baroness Amos has selected the 14 trusts for local investigations, based on a range of factors. These include data and metrics, such as data from the Care Quality Commission maternity patient survey and MBRRACE-UK perinatal mortality rates, as well as criteria to ensure: a diverse mix of trusts; variation in case mix, trust type, and geographic coverage; and provision of care to individuals from diverse backgrounds, including consideration of social, economic and racial inequalities, family feedback, and where previous investigations have taken place.

From smaller hospital trusts to those operating in our bigger cities, the 14 trusts will help Baroness Amos and her expert advisers to assess maternity and neonatal units of all shapes and sizes. Rest assured that the voices of women and families remain at the heart of this process, as evidence is gathered directly from those with lived experience. I know that for families who are carrying a traumatic burden from what they have gone through, helping us shape this is yet another extremely difficult process to bear. The Secretary of State and I are incredibly grateful to all the families who have taken part and fed into this investigation.

To be clear, this is not about naming and shaming trusts. Expecting parents should not be discouraged from visiting their local hospital, wherever it is, because of this investigation. Hard-working maternity staff should know that this is a sincere and focused effort to support trusts across the country by giving them the tools to provide the best possible care. The Secretary of State has now agreed the final terms of reference with Baroness Amos, and these will be published today.

The 14 hospital trusts are:



Barking, Havering and Redbridge University Hospitals NHS Trust

Blackpool Teaching Hospitals NHS Foundation Trust

Bradford Teaching Hospitals NHS Trust

East Kent Hospitals NHS Trust

Gloucestershire Hospitals NHS Trust

Leeds Teaching Hospitals NHS Trust

Oxford University Hospital

Sandwell and West Birmingham Hospitals NHS Trust

Shrewsbury and Telford Hospital NHS Trust

The Queen Elizabeth Hospital, King’s Lynn

University Hospitals of Leicester NHS Trust

University Hospitals of Morecambe Bay NHS Foundation Trust

University Hospitals Sussex NHS Foundation Trust

Yeovil District Hospital NHS Foundation Trust / Somerset NHS Foundation Trust

The investigation will start detailed work with the 14 trusts straight away, looking closely at the care for women, babies and families. There have already been a raft of reviews and reports, and Baroness Amos and her team will draw on these to create one clear, national set of actions to improve care across the country.

Importantly, the investigation will gather evidence directly from women and families, including fathers and non-birthing partners. This evidence will inform recommendations and result in an initial set of findings and recommendations by December 2025.

Baroness Amos will develop one clear set of recommendations for achieving consistently high-quality, safe maternity and neonatal care. The chair will be supported by a small team of expert advisers and will engage regularly with affected families throughout the investigation process.

This investigation is separate from the National Maternity and Neonatal Taskforce, which the Secretary of State will chair, and will take forward the recommendations of the investigation, forming them into a national action plan to drive improvements across maternity and neonatal care. These recommendations will supersede the multiple existing actions and recommendations already in place.

[HCWS923]

Non-surgical Aesthetic and Cosmetic Treatments

Karin Smyth Excerpts

Thursday 11th September 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship this afternoon, Sir Desmond. I thank the hon. Member for Bromsgrove (Bradley Thomas) for securing today’s debate on this important issue, and other Members for their contributions. This is an area of significant interest to colleagues, and indeed the public.

I think this may the first time the hon. Member for Bognor Regis and Littlehampton (Alison Griffiths) has spoken formally for the Opposition, so I congratulate her on that, and I wish her colleague, the hon. Member for Sleaford and North Hykeham (Dr Johnson), well. She made the point that we had been slow. Let me make the point gently back to her that this is an issue I inherited and that, as people will know if they have read Lord Darzi’s report—if they have not, I really commend it to them—both the breadth and the depth of the inheritance for me and my colleague, the Secretary of State for Health and Social Care, is sometimes beyond description.

I was therefore determined to make progress on this issue, and was absolutely delighted to be able to announce in August that we will, as a Government, step in to regulate in this space. As colleagues will know, doing a press round on an August morning is often not the highlight of everyone’s day, but I was humbled by the responses from families, journalists and campaigners—those women who have shared their stories over many years. I pay tribute to many of them, particularly lots of young women journalists who have taken those stories and told them so powerfully.

The response to that announcement, and the interaction with journalists, was humbling. Indeed, it was a pleasure to make those announcements in my home city of Bristol, where some surgeons have been campaigning on this issue for 20 years, and for them to see what has happened and that the Government are prepared to move in. We are really aware of this issue, and I thank hon. Members for the cross-party support for us moving in this area. We have all seen those troubling headlines about the devastating consequences of unsafe cosmetic practices, and all our inboxes have been inundated by constituents who rightly expect us to make things safer. I am grateful to those who have shared their stories about what can go wrong and who have pushed for action.

I have particular concern for parents who are worried by what their children see on social media, as we have heard this afternoon: young women and girls who are made to feel unhappy in their own bodies by what they see online and feel the need to go through risky and unregulated procedures to ease their concerns. Also as we have heard this afternoon, people think the industry is regulated and are shocked to find out that it is not

The Government of course back small businesses. We recognise the benefits that the industry brings to people and communities. I am also mindful that the sector is full of female entrepreneurship. It is an industry led by women, largely for women, and is a success story to be celebrated, especially in the face of fierce competition from medical tourism. Getting a cosmetic procedure can be a very positive experience—a point made by my hon. Friend the Member for Calder Valley (Josh Fenton-Glynn) and others. The sector is growing to meet a demand, as more and more people seek to take advantage of the increasing availability and affordability of cosmetic treatments. That is a good thing, but for too long the sector has been left with little in the way of safeguards. We need to balance the priority of public safety without stifling creativity and innovation.

My hon. Friend the Member for North West Leicestershire (Amanda Hack) made some excellent points. She visits salons to talk to women—there might also be an occasional man running one of those salons, and we want to work with them, too. She talks to them so that she is informed. I encourage her and others to keep sharing views from the frontline, because people want to do a good job and we are keen to hear from them.

So what are we doing? First, we will prioritise developing legal restrictions on high-risk cosmetic procedures, as we outlined in last month’s response to the consultation. I urge anyone listening to this debate to look at “The licensing of non-surgical cosmetic procedures in England”. High-risk procedures include the so-called liquid Brazilian butt lift, which tragically led to the death of Alice Webb in September last year. Her Member of Parliament, my hon. Friend the Member for Stroud (Dr Opher), has been talking to me about these issues since he became a Member.

Bringing the restricted high-risk procedures into the Care Quality Commission’s scope of registration will mean procedures being performed only by suitably qualified, regulated healthcare professionals working for providers who are registered with the CQC. We will come down like a ton of bricks on providers who flout the rules, with tough enforcement from the CQC.

Secondly, the hon. Member for Bromsgrove raised a really important point about qualifications. He is right that it is currently far too easy for someone with minimal or no training to set themselves up as a practitioner. We will introduce a local authority licensing scheme in England for lower-risk cosmetic procedures such as botox and lip fillers. This was widely supported by many people who responded to the 2023 consultation started by the last Government on the scope of licensing. That consultation received over 11,800 responses. Licensing will ensure consistency of standards and allow action to be taken against practitioners who fail to comply with the requirements. All practitioners will be required to meet rigorous safety training and insurance standards.

Local authorities will run and enforce the scheme, under which it will be an offence for anyone to carry out specific non-surgical procedures without a licence. I understand the excellent points made by many Members about local authorities. It will be an offence for anyone to carry out procedures without a licence. If the rules are breached, businesses risk fines or financial penalties. Detailed proposals will be set out in the consultation in the new year, which will seek views from local authorities on suitable enforcement powers and costs. Many hon. Members here who are experienced in local authorities know that we need to do that carefully with them. We also understand that that will add to local government’s workload, so we will work with them closely to understand what support, training and resources are required as we try to strike the right balance and ensure that councils have enough time to prepare and implement proposals safely across England and to swiftly protect public safety. That will be an ongoing discussion as we go through the next stage of the process.

Licensing will allow people to be confident that the practitioner they choose to perform their procedure has the skills to do so safely. For those in the sector who do the right thing, as so many do, this will protect their businesses and position them as trusted providers in a regulated market.

The hon. Member for Bromsgrove also warns about so-called lower-risk procedures falling through the gap. I can assure him and other hon. Members present that we will work closely with all our partners on where we should set the bar to make ensure that the measures we introduce to protect the public encompass all necessary procedures, and that all legislative safeguards are proportionate and informed by a careful evaluation of risk. As I said, we will prioritise action against the highest-risk procedures first. We look forward to setting out the changes in a detailed public consultation early next year.

In terms of the impact of regulation, I want to make it clear that this is not about stopping people from getting treatments altogether; it is about preventing the cowboys, the crooks and the chancers from exploiting people. We want to support legitimate and safe businesses to continue to provide treatments while, as the hon. Gentleman mentioned, saving taxpayers from footing the bill when things go wrong.

I began my remarks by talking about societal pressures and the influence of social media. Children and young people can be particularly vulnerable to concerns around body image. The Advertising Standards Authority places a particular emphasis on protecting young and vulnerable people. In 2022, new rules came into effect across all media, including social media, banning ads for cosmetic procedures being directed at under-18s.

To meet the challenges of regulating online, the ASA has rebalanced its regulation away from reactive complaints casework and towards proactive tech-assisted gathering, monitoring and enforcement, using artificial intelligence to proactively search for problematic adds and ensure that children are not being influenced by inappropriate and irresponsible marketing.

Choosing to go through a cosmetic procedure is a serious decision, which requires a level of maturity to undertake an informed consideration of the risks and benefits. That is why many procedures should never be performed on children who are still developing physically and emotionally. In England, it is already illegal to give botox or fillers for cosmetic reasons to under-18s unless it is done by a qualified healthcare professional and approved by a GMC-registered doctor. We want to extend this level of protection, and will be introducing further age restrictions on a range of cosmetic procedures.

This is a UK-wide issue, and it is good to see the hon. Member for Strangford (Jim Shannon) in his place. I thank him for his kind words. I can assure him and others that we are working closely with the devolved Governments to understand and share information on approaches being taken across the country. We are pleased that Scotland is also considering similar information, and I have been really encouraged, in my conversations with officials, to learn about the relationship between our officials and the shared learning that is going on with colleagues in Scotland. This is a really complex area and it is changing all the time, with new things coming on board.

The changes we make will affect livelihoods, and it is essential that we get the balance right, given that we know that people are at risk and the sector is expanding. Government action must be proportionate to protect public safety without restricting the legitimate activities of those businesses. We want to collect data, gather more evidence and give businesses their say through the public consultation. That will take time, but we will leave no stone unturned and work tirelessly with expert partners and people across the sector. The proposals will be taken forward through secondary legislation, and therefore subject to parliamentary process in the usual way before legal restrictions or licensing regulations can be introduced.

My hon. Friend the Member for Putney (Fleur Anderson) raised an issue around implants. She has been a fantastic campaigner for her constituent, Jan Spivey. I know that she has been in touch with my hon. Friend about that, and has played a key role in ensuring that this issue, along with others, received due parliamentary attention in previous Parliaments when women raised the issue. I myself am due to appear before the Women and Equalities Committee, which has an interest in this issue and PIP. We will certainly want to work with them and await the outcome of their review, to see whether any further work is needed in that area.

I thank the hon. Member for Bromsgrove for raising such a vital issue and all hon. Members for their contribution. Due to different things happening in London, many parliamentarians who would have liked to be here this afternoon cannot. The hon. Gentleman did excellently by getting in early after the announcement.

It is our duty in this place to protect people like Alice Webb from unqualified practitioners who cut corners, while backing British businesses that do the right thing. This is something we take seriously. Colleagues will want to hold us to account as we deliver, and I give hon. Members my commitment that we want to work with colleagues as we develop these regulations. We want to get them right, and that will take time. This is complex, as people understand. I look forward to working with colleagues to make this a success.

Urgent Care Centres: Hillingdon

Karin Smyth Excerpts

Wednesday 10th September 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I am grateful to the hon. Member for Ruislip, Northwood and Pinner (David Simmonds) for securing this debate. He mentioned that his wife works in the system, so I pay tribute to her for her service in the local trust.

As the hon. Gentleman alluded to, I am a Hillingdon girl; it is where I was brought up. My brother was born in Hillingdon hospital, some 59 years ago. It was a great pleasure to be there recently with my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales). Some years ago, I predicted that we might have a Labour MP there, so after being around the area for a long time, I am personally very pleased to see that.

The hon. Member for Ruislip, Northwood and Pinner tempted me to move into the wider areas of what are rightly a to-ing and fro-ing on some of the bigger pressures in that part of north-west London and into Hertfordshire. I will not go into that, but it is absolutely right that hon. Members use this platform to share their campaigning on behalf of their constituents.

Service changes such as these are always hard and they are rarely popular. I have been the Member of Parliament for Bristol South for more than a decade, and before that I was an NHS manager, so I have seen many service changes and reconfigurations over the years. Like the hon. Gentleman, I was also a non-executive director in a past life. All the changes that I have seen were done through good consultation, with strong clinical leadership and a good clinical case, and involved patients and the public.

I strongly believe that patients, public and staff are often ahead of the wider system and sometimes of politicians in knowing the balance of the money, the funding, the good value for taxpayers’ money, clinical outcomes and safety. If they are managed well, those conversations and the sorts of debates we are having tonight can often yield better results than maintaining the status quo or decisions made behind closed doors. I am familiar with such debates, as like many of us I often found myself standing where the hon. Member for Ruislip, Northwood and Pinner is, advocating for my constituents against changes that I thought were not in their best interest or not clearly communicated. He was right to secure this debate.

[David Simmonds]

I agree with every word that the Minister has said about how we get good decisions in the interests of local people, but does she share my concern that there has been no public consultation about this decision at all? There has been very limited engagement even with local residents’ associations about the process and, for the staff involved, there has been some—shall we say—degree of ambiguity about what decisions have been made at each stage of the process. Does she agree that it would be wise at this stage, as a very minimum, to pause, to think again and to undertake that public consultation, so that the NHS managers tasked with making the decisions fully understand the impact on the local community?

[Karin Smyth]

I will comment on that later. I understand that there is a meeting on Friday, to which I will allude.

In preparing for the debate, I met representatives of the trust, and I am grateful to those in the local NHS for their time in giving some further background. The trust is clear that it would be more efficient for urgent care services to be consolidated at the site in Hillingdon, bringing forward the urgent care nurse practitioner service at Mount Vernon into the urgent treatment centre at Hillingdon hospital. The rationale for having urgent treatment centres alongside A&E is well established clinically.

The hon. Gentleman referenced the 10-year plan—I am pleased he is such a fan—and the direction of travel. I am pleased to say that the trust also believes that people are better served by primary care hubs, so that more responsive care can be delivered closer to where people live. Three such hubs are being developed in Hillingdon, one of which will be in Ruislip. I am sure that he welcomed the announcement this week of the roll-out of the first of the 43 hubs, including the one in Hillingdon, which will deliver the neighbourhood health services model.

[Danny Beales]

Despite some of the heat in the debate, the misquoting of things that have been said and the unfortunate politicisation of this important local issue, about which there is general agreement among Members of all parties and in the community, the consensus that I hear is that people want more accessible services, more locally. There is a need for three hubs—the system wants that—and I am pleased that the Government have announced funding and prioritised Hillingdon. I have also heard that there is a potentially greater role for community pharmacies in providing urgent services and care. Does the Minister agree that more can be done by primary care providers across the board in Hillingdon and elsewhere?

[Karin Smyth]

I agree with my hon. Friend that that is the direction of travel that we want to see in all of our constituencies across the country.

The long-promised rebuild of Hillingdon hospital will be delivered by this Government as part of wave 1 of the new hospital programme. The money is guaranteed and construction will start between 2027 and 2028. We are already helping the trust to prepare for when we get spades in the ground, and it was a pleasure to visit the trust recently with my hon. Friend the Member for Uxbridge and South Ruislip.

The hon. Member for Ruislip, Northwood and Pinner raised the issue of consultation. I understand that there is a meeting with the trust, the integrated care board and the local authority on Friday, and I am sure that he and other hon. Members will be part of that. It is entirely proper for a Member of Parliament to raise issues about changes in their area—that is part of our democracy and democratic accountability. Now that this Government have put the new hospital programme in order, it is also proper for the House to hold us to account on its progress.

[John McDonnell (Hayes and Harlington) (Ind)]

I will try to attend the meeting on Friday, but the Minister must appreciate that there is an element of scepticism about the future, in particular about what is happening with this unit. It confirms in my mind that if you stand still long enough, things will come around time and again. In our constituencies in Hillingdon, we have gone from cottage hospitals that provided immediate care for minor injuries, as well as having beds, which were closed, to being promised Darzi units, which we never saw, to looking forward to the hubs themselves. On Friday, I want to be able to convince people that there is a comprehensive plan that will be held to and properly invested in, because people will be very sceptical about the closure of a unit without the confidence that the architecture will be in place to meet the needs of our constituents. The petition has garnered such a large number of signatures because of that concern.

[Karin Smyth]

I understand what the right hon. Gentleman says. I have seen some of those promises made and not delivered over many years. It is important that Members of Parliament are involved and that there is a wide conversation with the ICB and the trust around those changes and the development that they make towards delivering the 10-year plan.

My right hon. Friend the Prime Minister announced that we would bring together NHS England and the Department for Health and Social Care precisely because we think that democratic accountability for £200 billion of taxpayers’ money is important. However, that accountability does not mean micromanaging, or intervening in every difficult decision that the ICB makes. We expect local NHS organisations to make changes and to reconfigure their services as best needed by the people they serve. That is in line with the direction outlined in the 10-year plan.

My right hon. Friend the Secretary of State for Health and Social Care has received several requests to intervene on a number of issues. Having looked at them thoroughly and assured himself that patient safety and access were guarded, he has decided not to intervene in nine reconfigurations. Getting our NHS back on its feet is a team effort, and we have to trust local NHS leaders to deliver. Decisions that affect the people of Hillingdon should be made in Hillingdon—it is not for someone sat behind a desk in Whitehall to make those decisions for them.

Having said that, I want to assure colleagues that that does not mean we will give local leaders a blank cheque to do whatever they like. Yesterday, we published a data tool and league tables that make NHS performance open and accessible, to inspire improvement and deliver a better NHS for all. Those NHS organisations that are doing well will be rewarded with greater freedoms, such as in how to spend their capital, and those that demonstrate the best financial management will get a greater share of capital allocation. We want to move towards a system in which freedom is the norm and central grip is the exception, in order to challenge poor performance.

Improving services for patients should be rewarded; the quid pro quo is that there will be no more rewards for failure. Undertaking the reforms we have set out to make as a Government will require a good deal of trust between central Government and local leaders, and we will build that trust only by showing those local leaders that we trust them to get on with the job and make difficult decisions where necessary.

[David Simmonds]

Will the Minister give way?

[Karin Smyth]

I am going to pursue this point, if I may. Debates about service changes and reconfigurations have gone on since the birth of our NHS. I understand that they are really important for local people, and I understand the level of discussion about this issue and—as the hon. Gentleman has outlined—the wider impact on areas such as Watford. It would be easy for this Government to make ourselves popular by sacking some managers and promising people that services are never going to change, or that they will never close in any part of the country, but we were not elected on a populist platform, and it would not be in patients’ long-term interests not to reform and modernise the system.

We are building an NHS that is fit for the future. That is what the 10-year long-term plan is based on—moving services from hospital into the community, from analogue to digital, and from sickness to prevention. We expect local NHS leaders to make that happen. They must do so with local clinical leadership in the best interests of the populations they serve, and they must do it with the public—we expect open and transparent communications going forward. Local politicians have an important role in that, which Members present in the Chamber have demonstrated ably, and will continue to do so. I would be very happy to maintain contact with the hon. Member for Ruislip, Northwood and Pinner. The wider implications of the issues he has raised need to be outlined to him, and I commit to writing back to him about the consideration that is being given to those wider implications. I note his concerns, and I am happy to continue working with him.

Question put and agreed to.

NHS Performance Data Tool and NHS Trust League Tables

Karin Smyth Excerpts

Tuesday 9th September 2025 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

I am updating the House about the publication of a data tool and league tables that make NHS performance under the NHS oversight framework open and accessible. This delivers a commitment in the “10 year health plan for England: fit for the future” to publish new league tables and as part of our plan for change, ensuring our investment in the NHS delivers meaningful outcomes, greater efficiency, and real value for patients.

At last year’s NHS providers conference, the Secretary of State for Health and Social Care announced league tables as part of our plan to stop rewarding failure and to create a better and more transparent health service. We know that this is more important than ever, and the public expect better care and value following the record investment in the NHS made by this Government. This is why today NHS England has published these league tables, along with a data tool that gives a high-level view of the performance of NHS trusts. With this, the public will be able to see how their local NHS organisations are performing, including data on key areas such as urgent and emergency care, ambulances and electives—data that MPs and peers can also draw upon. Everyone can now see for themselves how their local services are doing and better hold their local NHS organisations to account.

The top trusts will be rewarded for their performance with greater autonomy, including the ability to reinvest surplus budgets into frontline improvements, such as diagnostic equipment and hospital repairs. We are also introducing a new wave of foundation trusts, which will give the best-performing trusts more freedom to shape services around local needs.

Meanwhile, trusts facing the greatest challenges will receive enhanced support to drive improvement, with senior leaders held accountable through performance-linked pay. The best NHS leaders will be offered high pay to take on the toughest jobs, sending them into challenged services and turning them around.

This is not a “name and shame” exercise; we know that there is amazing work carried out every day in every NHS organisation, and the information we are releasing will shine a light on the achievements of the frontline and back-office staff who push hard every day to improve the lives of everyone in this country. We are publishing these tables to drive high-level performance changes and, where needed, to inform difficult conversations about organisational performance, to inspire improvement and deliver a better NHS for all. We are also improving the fundamentals of oversight through the NHS oversight framework, which NHS England published on 26 June. It sets out a revised transparent approach to the oversight of integrated care boards and trusts following feedback from these organisations and wider system partners. The streamlined set of metrics within the new framework will enable systems and providers to focus on the recovery that we know the NHS needs, while maintaining quality, safety and patient experience. Trusts will be placed into one of four segments based on their performance against these metrics. The framework explains how NHS England will use the segmentation of providers to inform incentives and consequences for performance, and support improvement.

This is a transitional year for ICBs, as they transform in line with NHS England’s model ICB blueprint to focus on strategic commissioning and implement plans to meet the running cost reductions the Government require. We have decided, therefore, that they will not be scored, segmented or ranked this year. NHS England will still conduct annual assessments of ICBs to review how well each is performing its statutory duties, and will introduce ranking in the next performance year, 2026-27.

The league tables, data tool and underpinning framework are an important first step in both the recovery and the transformation of our health service in line with the 10-year plan. We will continue to refine our approach to both the league tables and the data tool in the light of feedback from the NHS, experts, and the public. They will make what the NHS is good at—and what it needs to improve—more visible to the public, so that they can hold us to account for its successes and failures.

[HCWS916]

Integrated Care Boards: Running Costs and Boundary Alignment with Strategic Authorities

Karin Smyth Excerpts

Tuesday 9th September 2025 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

Today I am updating the House on progress towards reducing the running costs of integrated care boards and the Government’s ambition to align the boundaries of integrated care boards and strategic authorities where feasible.

We have committed to reducing the running costs of ICBs and to redirect this funding to frontline services. To deliver this, our “10 Year Health Plan” sets out that ICBs must focus on their role as strategic commissioners, ensuring the best possible value in securing local services that improve population health and reduce inequalities.

In directing ICBs to focus on strategic commissioning, we are reducing duplication of functions that are undertaken by other NHS organisations such as performance management and assurance, freeing up vital resources.

To deliver a reduction in running costs in this financial year, a number of ICBs will cluster together to share leadership and functions; clustering ICBs remain legally separate organisations with their own financial allocations. It will mean that during this financial year the number of ICB senior leadership teams will go from 42 to 26.

In the longer term, there will be fewer, larger ICBs enabling them to harness a shared budget of sufficient size to improve efficiency and reduce running costs. Our ambition is for these ICBs to be coterminous with one or more strategic authorities wherever feasible, a commitment made in the “English Devolution White Paper” and reaffirmed in our “10 Year Health Plan”.

Aligning public service boundaries facilitates service integration, harnesses the opportunities of strategic planning between the NHS and strategic authorities, and supports delivery of a “health in all policies” approach.

I am today announcing the first of these new ICB footprints. These will come into effect on 1 April 2026 and are:

Norfolk and Suffolk ICB

Essex ICB

Hampshire and the Isle of Wight ICB

Surrey and Sussex ICB

North West and North Central London ICB

Thames Valley ICB

Central East ICB (Hertfordshire, Bedfordshire, Luton, Milton Keynes, Cambridgeshire and Peterborough).

In the case of Thames Valley ICB and Central East ICB, we are progressing with these new ICB footprints on the understanding that these may be reviewed in future to allow for alignment with any future strategic authorities, and newly established unitary authorities resulting from local government reorganisation.

Next summer, as local government reform progresses, we plan to decide further ICB mergers and boundary changes to come into effect on 1 April 2027.

The Department of Health and Social Care, alongside NHS England and the Ministry of Housing, Communities and Local Government, will continue to work closely together, and with ICBs and their local partners, to ensure future changes to ICB footprints achieve the best outcomes for patients and citizens. ICB leaders will continue to engage with all local partners, including Members of this House, on the further development of plans, as we stride towards delivering the ambitions set out in our “10 Year Health Plan”.

[HCWS915]

Covid-19 Vaccination Harm

Karin Smyth Excerpts

Wednesday 3rd September 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is an absolute pleasure to serve under your chairship today, Ms Lewell. I am speaking today on behalf of the Minister for public health and prevention, my hon. Friend the Member for West Lancashire (Ashley Dalton), who cannot be here for other parliamentary reasons. I know that she agrees with me that debates such as this are important to uphold the British people’s trust in public health measures, so I thank the hon. Member for Christchurch (Sir Christopher Chope) for securing it.

I want to start by giving some assurance, particularly to people watching at home. We know that over 53 million people, following the example of Her late Majesty the Queen, took the jab during a once-in-a-generation health emergency, and that covid vaccines helped to keep millions of people out of hospital and, in many cases, saved lives. It is important to remember that the vast majority of people who took the jab did not suffer adverse effects. The hon. Member for Christchurch has made some of those points publicly, and I am grateful for that. However, that does not mean that we should turn a blind eye to the rare and tragic instances where things have gone wrong, as he eloquently highlighted.

I want to take the opportunity to pay tribute to some of the campaigners, Kate Scott, Sheila Ward and Kelly Hatfield, for their tireless campaigning on this issue, and to Gareth Eve and the family of John Cross, all of whom have raised the issue of vaccine injury with my ministerial colleagues. Their loved ones took the vaccine because they wanted to protect their families and the NHS.

Today, those brave campaigners are still fighting for all people who suffered adverse reactions. They are not statistics—as hon. Members have said today, they are people. They are our constituents. Their voices must be heard. I am glad that they continue to have the opportunity to raise their concerns with the Secretary of State for Health and Social Care and with my colleague, the Minister for public health and prevention. The conversations are difficult, but they are essential to making Whitehall understand where the system falls short and where we can make a meaningful difference. It is not just a question of making sure that systems are in place to support people when things go wrong. As the hon. Member for Christchurch outlined this morning, it is about maintaining public confidence in our health service and vaccination programmes. That is what is at stake in this debate, and that is why it is helpful that he secured it.

That said, I do not think I will be able to assure the hon. Gentleman on the exact timelines that he asked for. However, I assure him that we are neither being complacent nor playing hard to get, as he said of even his own Government. Indeed, I echo the Secretary of State’s comments to the right hon. and learned Member for Kenilworth and Southam (Sir Jeremy Wright) back in June.

We are taking tangible steps to improve the administration of the vaccine damage payment scheme. As hon. Members know, the VDPS is a statutory route through which those who have suffered serious harm as a result of vaccination can apply for financial support. The scheme has been in existence for many years, but since the covid-19 vaccination campaign began, there has been a rise in the number of applications. That is to be expected, given the record number of vaccinations given in such a short timeframe, but it has put pressure on the processing time. That is why the Department has been working with the NHS Business Services Authority, the administrators of the scheme, to modernise operations, improve the experience of those who apply for an award and process claims at a faster rate. To get that done, additional medical assessors have been appointed and the application process has been digitised.

The NHS Business Services Authority has also been working to improve the return rate of medical records from the healthcare providers required to assess claims through engagement with NHS institutions and using subject access requests as needed.

With regard to the ongoing work, we recognise that concerns about the scheme go wider than the application process. We have heard those calls from the hon. Member for Christchurch, other Members present and campaigners, and, as he references, during the covid inquiry hearings, when the Government were asked to look at issues such as the eligibility criteria for the scheme and the current award amount. Last September, the Secretary of State met campaigners to discuss that issue, and ministerial colleagues have had further meetings since. In those meetings, my colleagues set out that although any changes to the scheme would be a cross-Government decision, our door remains open to campaigners and we will do everything we can to keep progressing this at pace.

I recognise that individuals and their families who have suffered harm following vaccination are waiting on a more detailed update, but I reassure them that the Secretary of State and Ministers are continuing to look at the issues and a range of options. I reiterate the comments that the Secretary of State made at Health questions. We want to be clear in our response. I will not be able to offer the hon. Member for Christchurch the timeline that he wants today.

[Sir Christopher Chope]

The Minister says she cannot give us an exact timeline. Could she give us an approximate time? Is this going to be finished before the end of this year, for example? That is not an exact timeline, but it would be an indicative timeline. And when she talks about various options, can she not explain which of those options are being considered or which ones are not being considered? For example, is increasing the £120,000 payout being considered? Is reducing the disability threshold from 60% being considered? Is disapplying the three-year limitation period for the bringing of civil claims being considered? Please can we have a yes or no to those things? We are not asking for the decisions on those, but we are asking whether they are being considered or not.

[Karin Smyth]

The hon. Gentleman tempts me to give more details, which I cannot do today. But I will take back to the Department that broader request for timelines and what things are being considered. I will make sure we get back to him on that as a result of this debate.

On the Medicines and Healthcare products Regulatory Agency, the hon. Member for Christchurch and the right hon. Member for Tatton (Esther McVey) asked about the effectiveness of the MHRA in monitoring harms. The MHRA is globally recognised for requiring high standards of safety. Vaccines used in the UK are authorised only once they have met robust standards of effectiveness, safety and quality.

Once approved, the comprehensive post-market surveillance of a vaccine begins, where the benefits and risks of the vaccine are very closely monitored. The MHRA collects data through the reporting of adverse reactions by the public and healthcare professionals to the yellow card scheme, as well as from other information sources domestically and internationally.

As hon. Members know, a dedicated team of scientists constantly reviews the information to look for safety issues or rare adverse effects. All reports of adverse events, alongside other information, are analysed and reviewed continuously to identify trends and patterns that may require action, with any information indicating a possible new safety concern thoroughly evaluated. Updated advice for healthcare professionals and patients is issued where appropriate.

The covid-19 vaccines have been scrutinised continuously since roll-out, with the MHRA having implemented a proactive surveillance strategy for monitoring the safety of all UK-approved covid-19 vaccines.

I just want to end by saying that the vaccine programme—

[Sir Christopher Chope]

Obviously, the Minister has a brief that has been given to her by officials on behalf of the Minister with responsibility for public health, the hon. Member for West Lancashire (Ashley Dalton), who is not able to be here. Can this Minister give me some assurance that I, together with my colleagues who have participated in this debate, will be able to meet the relevant Minister, so that we can go over some of this stuff? I realise that this Minister does not have the discretion to be able to respond to this debate, but the public health Minister would have that discretion, so can she guarantee that we can fix up a meeting, please?

[Karin Smyth]

The hon. Gentleman is of course a very experienced campaigner, and he asks his question absolutely appropriately. I know that my hon. Friend the public health Minister is very happy to meet people and discuss this, but I can also assure the hon. Gentleman that the Secretary of State is very much looking at this personally as well. I will take that request for a meeting with the public health Minister back to the Department, and I am sure that she will be happy to do that.

The vaccine programme was an immense contribution to public health during a once-in-a-lifetime health emergency, and many of us remember the sense of relief that we and family members felt when we got that text with the invitation to come forward. But for a small number of people and their families, it brought pain, loss and hardship. We must never forget them, and our responsibility as a Government is clear. We are absolutely committed, as I have said, to further work to improve the scheme, as well as to continue to engage with those who are affected and have suffered vaccine harm, to consider how the system could better reflect their needs. That does include the issues raised by the hon. Gentleman, and other colleagues here today, on behalf of all our constituents.

Question put and agreed to.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 22nd July 2025 Commons Chamber

[Laura Kyrke-Smith (Aylesbury) (Lab)]

3. What assessment he has made of the potential impact of the 10-year health plan for England on perinatal mental health.

[The Minister for Secondary Care (Karin Smyth)]

The 10-year health plan sets out ambitious plans to boost mental health support across the country, including for women during the perinatal period. During the year to April 2025, a record 64,805 women accessed maternal mental health services or specialist community perinatal mental health services, such as those at the Whiteleaf centre in Aylesbury. The Department for Education is also investing £500 million to roll out Best Start family hubs to all local authorities in England, which will also support new mums.

[Laura Kyrke-Smith]

I am really grateful to the Minister for her answer and for her focus on this. I would like to ask about midwives, who do incredible work supporting parents and babies, including identifying and supporting women who are facing mental health challenges. We desperately need more of them, yet the Royal College of Midwives has found that eight out of 10 student midwives who are due to qualify this year are not confident that they will find jobs. What steps is the Minister taking to ensure that newly qualified midwives are able to find work?

[Karin Smyth]

I recognise my hon. Friend’s great work in this place to support women on this issue. We recognise that newly qualified midwives are experiencing challenges in gaining that first role. That is partly due to the record number of midwives in post and to better retention rates. NHS England is working with employers, universities and regional midwifery leads to help midwives find those roles after qualification and to transition into workforce, and we will keep a close eye on that with them.

[Alex Easton (North Down) (Ind)]

In assessing the impact of the 10-year plan on perinatal health for England, can the Minister assure us that the lessons learned will be shared across the rest of the United Kingdom, to enhance care quality and reduce regional disparities, especially in Northern Ireland?

[Karin Smyth]

The hon. Gentleman makes an excellent point about the important need to share the learning across the United Kingdom, and I will make sure that we do indeed make efforts to do that.

[Mr Speaker]

I call the Liberal Democrat spokesperson.

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

Over the weekend, The Guardian reported that the number of women dying in the perinatal period had risen sharply since 2015. Families that have been failed, and health professionals feel that whether it is perinatal depression or unsafe births, lessons are not being learned and the same errors are repeated in review after review. Alongside the inquiry that the Secretary of State has launched, will the Government immediately implement every action from the Ockenden review and put an end to this national scandal in maternity service?

[Karin Smyth]

The hon. Lady has raised a really important issue. She highlights the work that the Secretary of State is putting in place to address these issues and finally bring all that together to produce a plan that will assure people, and we are working at pace to ensure that those recommendations are implemented.

[Greg Smith (Mid Buckinghamshire) (Con)]

4. If he will make an assessment of the potential merits of siting a neighbourhood health centre in Long Crendon, Buckinghamshire, as part of the 10-year health plan for England.

--- Later in debate ---

[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

7. What steps his Department is taking to improve electronic patient record systems in the NHS.

[The Minister for Secondary Care (Karin Smyth)]

My hon. Friend will know that trusts have responsibility for securing—using the approved procurement framework—an appropriate electronic patient record system that delivers all the core capabilities set out in the digital capabilities framework. Since 2022, £1.9 billion has been invested in digital transformation, including in the roll-out of EPRs to NHS trusts that do not have one and in support to optimise existing ones.

[Gareth Snell]

The Minister will be aware that my hon. Friend the Member for Stafford (Leigh Ingham) and I have been working on a replacement system for the University Hospitals of North Midlands NHS Trust in north Staffordshire, which would improve public and patient experience, and productivity, at those hospitals. Will the Minister meet us so that we can consider how further to unlock that funding to improve productivity and patient experience in good time?

[Karin Smyth]

I commend my hon. Friend, and our hon. Friend the Member for Stafford (Leigh Ingham), for their diligent work with their trust and local system. Progress is being made on that EPR, which will have huge benefits. I will ensure that he has a clear outline of progress to the final planned operating of the go-live date for that issue. I am happy to meet him.

[Mike Martin (Tunbridge Wells) (LD)]

Blocked beds cost Pembury hospital £18,000 every night, yet discharge teams have to manually phone care homes to place people there. My constituent Debbie has created a dashboard—it is basically like Skyscanner—to accelerate discharges by matching discharged patients to care beds. It has already received seed funding of £200,000 from Kent county council, and could save up to £7 million a year in Pembury alone. Will the Minister meet me and Debbie to discuss that idea?

[Karin Smyth]

The hon. Gentleman highlights the serious problem of staff operating in an analogue age in the NHS, which we keenly highlighted in the 10-year plan. We want to move the system into a more digital age. We would be very happy to hear more about the scheme that he outlines and the great work that staff are doing to get over some of the problems that they are working with.

[Ms Julie Minns (Carlisle) (Lab)]

My constituent Lee Armstrong contacted 111 when he was suffering from an Addisonian crisis. Lee and his partner provided full details about his condition to 111, and when his condition worsened, they called 999, but what neither Lee nor his partner knew was that the electronic record details given to 111 would not be available to 999, and neither would his patient records. As a result, the ambulance was not dispatched with the urgency required and Lee died. Will the Minister set out how the improvements in the digitisation of electronic records will cover the integration of the 111 and 999 services so that lives like Lee’s can be saved?

[Karin Smyth]

My hon. Friend outlines a horrific case in her constituency, where she has been a fantastic campaigner since last year. Information sharing between 111 and 999 already exists in many places. We want standards in place to ensure that that happens safely across the country. That is a key part of what we are trying to do in our 10-year plan by bringing together single patient records and records within systems. I am very happy to follow up with her in more detail on the case she mentions, if that would be helpful.

[Edward Morello (West Dorset) (LD)]

Many GPs say that their buildings are not fit for purpose and lack digital infrastructure. Without fully integrated electronic patient records and better systems, including the electronic prescription service across all hospitals and community trusts, we risk wasting time and money while increasing pressure on frontline staff. Will the Minister outline the steps being taken to full integrate the electronic prescription service across all settings in Dorset?

[Karin Smyth]

The hon. Member highlights the importance of getting this right not only from hospital to discharge but, crucially, in primary care, where 90% of patient contacts happen across the system. That is why a central plank of our 10-year plan has been moving the entire system from the analogue to the digital age. We have allocated £10 billion, particularly in this spending review, to address this issue and make sure we get this right for the system and for patients.

[Kate Osamor (Edmonton and Winchmore Hill) (Lab/Co-op)]

8. What assessment he has made of the potential impact of the 10-year health plan for England on the prevention of ill health.

--- Later in debate ---

[Josh Babarinde (Eastbourne) (LD)]

10. What steps his Department is taking to improve car parking provision at NHS hospitals.

[The Minister for Secondary Care (Karin Smyth)]

The Department has published guidance that trusts are expected to follow to manage the provision of car-parking spaces for patients, hospital users and staff. Responsibility for hospital car parks lies with each individual trust, and provision must be managed alongside the existing policy, providing free parking for those in the greatest need.

[Josh Babarinde]

Parking at Eastbourne district general hospital, where I was born, is woefully inadequate. The car park is often full, so patients have to park way away up the Rodmill hill, and car park services are crumbling. More than that, lower-banded NHS staff now face a near doubling of car parking charges to cover the cost. Given that the Government have delayed investment in our new hospital and, therefore, in a new car park until the 2040s, what support will they provide in the meantime to upgrade our DGH car parking facilities without our NHS heroes being expected to foot the bill?

[Karin Smyth]

As the hon. Gentleman knows, the discussions about any advanced works arising from the new hospital programme are ongoing. I am very happy for the Department to continue to discuss with the trust how future investment can best meet the needs of the future.

[Rachel Taylor (North Warwickshire and Bedworth) (Lab)]

University hospital Coventry and Warwickshire suffers from really poor car parking facilities. I have had to take both my parents there over recent years to use its specialist cardiology services. The poor quality of those car parking facilities causes additional stress for patients visiting those services, which they can ill afford when they have suffered strokes or heart attacks. It is becoming extremely vital that something is done, so will the Minister meet me and other local MPs to discuss the crisis in car parking at the hospital?

[Karin Smyth]

The provision of car parking remains an issue for trusts. I recognise the stress caused by trying to get patients to hospital, particularly if they have mobility problems. I commend the many hospitals across the country that have really good active travel plans and are working with their local communities to resolve some of these issues. We need to hear more from the trust about what provision it is putting in place to serve my hon. Friend’s constituents.

[Perran Moon (Camborne and Redruth) (Lab)]

11. What steps his Department is taking to tackle health inequalities across the country.

--- Later in debate ---

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

Eight years ago, Weybridge community hospital burned down. After a long journey, the replacement finally received planning consent last week; all it needs now is for the Secretary of State to sign the cheque on the dotted line. Will he do so as soon as possible?

[The Minister for Secondary Care (Karin Smyth)]

The business case for the rebuild of the health centre has been submitted to NHS England for review, and NHS Property Services will in parallel be asked to approve the capital funding. Subject to those approvals, a new health centre will be fully completed in 2027.

[Will Stone (Swindon North) (Lab)]

Phlebotomists across the country play a vital role in our NHS. Will the Minister consider making the job role band 3 across the nation to ensure that everybody is paid fairly?

[Karin Smyth]

Phlebotomists are paid on an “Agenda for Change” pay scale, which is underpinned by the job evaluation scheme. It is something the Secretary of State and I discussed with the trade union Unison last week; I should declare that I am a member of Unison. It is working closely with the trust in question, but I am happy to discuss the matter with my hon. Friend further.

[Dr Danny Chambers (Winchester) (LD)]

Many carers have told me how much they rely on respite care to protect their own physical and mental health so that they can continue to care for their loved ones day in, day out. The wonderful Chesil Lodge day centre in Winchester has recently been threatened with closure, and I have been fighting alongside constituents to keep it open. How will the Department ensure that respite services such as those at Chesil Lodge are consistently available and are not subject to a postcode lottery? Can I also—

Regulation of NHS Managers: Consultation Response

Karin Smyth Excerpts

Monday 21st July 2025 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

Ensuring strong and accountable NHS leadership will be critical to delivering our plan for change and building an NHS fit for the future.

We know the important role that high-quality leadership plays in fostering a compassionate and transparent culture within the NHS and we want a healthcare system where staff feel confident to speak up, with a positive and open workplace culture.

The vast majority of NHS managers do an excellent job. They are also responsible for hugely significant decisions that affect patient care, and the Government believe that they should be held to the same high standards of accountability as the healthcare professionals who work in the NHS.

Too often, tragic cases and high-profile reviews have shown repeated instances where leaders have failed to act appropriately and have not been held to account for their actions. The Government are committed to ensuring NHS leadership is transparent and accountable. Today, the Department of Health and Social Care has published its response to the 12-week consultation on options for the regulation of NHS managers. This important development forms part of a programme of work to meet the Government manifesto commitment to introduce professional standards for, and regulation of, NHS managers.

Regulating managers will strengthen their professional accountability by providing a consistent and fair means of addressing concerns about conduct or performance, protecting the public by removing those from the profession whose conduct is unacceptable.

The consultation had a high level of engagement, with 4,924 responses, over 100 of which were from organisations. I would like to put on record my sincere gratitude to everyone who took the time to share their views on this pivotal piece of work.

Having considered these views, the Government will be bringing forward legislation to provide the health and care professions council with the powers to run a statutory barring system for NHS board level leaders and their direct reports so that those who commit serious misconduct or silence whistleblowers will not be able to practise in senior roles in the NHS. We will explore what further steps can be taken so that those barred from working in the NHS are not employed in equivalent roles in social care.

It is equally essential that managers and leaders are supported with the skills they need to deliver transformation in the NHS and that they can access development opportunities that enable them to meet the high standards that will be expected of them. This is why today’s consultation response builds on our wider programme of leadership and management development that will ensure patient, public and professional confidence in NHS leadership and equip the NHS with the leaders needed to deliver our 10-year health plan. This programme of leadership reform, designed to strengthen the capability, confidence and accountability of NHS managers includes the establishment of the college of executive and clinical leadership. As part of our work to develop the college, we will work with stakeholders to consider whether there are forms of accreditation that could be implemented to recognise the professionalism of NHS managers and leaders. This will be complemented by wider work to strengthen NHS leadership, including NHS England’s leadership and management framework, the NHS very senior manager pay framework, and the implementation of General Sir Gordon Messenger’s recommendations to establish a national and regional strategic approach to talent management in the NHS.

The consultation also asked about the introduction of a professional duty of candour for NHS leaders, if leaders should be under a duty to ensure that the existing statutory (organisational) duty is correctly followed in their organisation and about the responsibility of leaders to respond to patient safety concerns.

These issues have been highlighted in previous reviews and inquiries including the 2019 Kark review, the 2024 infected blood inquiry and the Thirlwall inquiry into events at the Countess of Chester hospital. This consultation response reinforces the responsibility of leaders and managers in relation to candour and patient safety. As we implement regulation of managers, take forward recommendations from the IBI and consider the implications of the Cabinet Office’s proposed Hillsborough law, we will consider what further sanctions may be required in relation to failing to uphold the principle of candour.

Next steps

Department officials will prepare draft legislation to provide the HCPC with the powers to implement a statutory disbarring regime for NHS managers. When parliamentary time allows, we intend to bring forward this legislation, which will be subject to a further public consultation. We will continue to engage with stakeholders throughout and we will work closely with NHS England to ensure alignment with the wider work under way to develop and professionalise NHS managers and leaders.

[HCWS873]

NHS Pensions: Frontline Patient Care

Karin Smyth Excerpts

Thursday 17th July 2025 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on NHS pensions and the impact of administrative delays on frontline patient care.

[The Minister for Secondary Care (Karin Smyth)]

As the House knows, the NHS pension scheme is administered by the NHS Business Services Authority, which is facing challenges, as are all public sector pension schemes, as a result of the coalition Government’s public sector pension reforms in 2015, which in 2018 were found to have been discriminatory—known as the McCloud remedy. The work to remedy that is complex, and much of that I have already detailed in a written ministerial statement on 31 March and a subsequent urgent question. It is complex, technical work, and as the NHSBSA began to produce individual statements, it became clear that its initial estimate of the time needed for each one was too low. My written statement of 1 July updated the House that the NHSBSA did not meet its deadline to deliver statements to certain classes of member by that date and set out the actions that I was taking.

Let me be clear that this Government remain absolutely committed to providing affected members with their statements at the earliest opportunity, and that is what we are doing. The authority is developing a revised plan, and I will hold it to account against the new deadlines. I met the chief executive of the authority and was very clear about my disappointment in the progress, my expectation for the authority to remedy the situation for members, and the need to have a more robust assessment of the delivery plan. I also ensured that the independent chair of the NHS pension board is ready to set up an independent review of the delivery plans. I met her yesterday and was clear that I expect a thorough review of the process and a realistic assessment of delivery, and to hear her initial assessment. She will give her full report after the summer recess.

I will set new deadlines, including for members who are expecting statements this month. I will update the House as soon as possible, of course, both on the progress with the assessment and on the revised deadlines. Let me be clear that members will not face further financial detriment as a consequence of remediable service statement delays, interest on related pension arrears will be paid at 8%, and my Department and the authority have already put in place compensation arrangements for direct financial losses that members may have incurred.

People who have served in our NHS deserve their dues, and we will prioritise members based on need. Let me end by reassuring the House that there will be no direct impact on frontline care. I will continue to update the House.

[Dr Evans]

I declare an interest, for myself and on behalf of the shadow Front-Bench team, as we all have NHS pensions.

In April, Mr Speaker granted us an urgent question because the Government have no real plan for NHS pension statements. Today we return because the Government have now admitted in writing that a new plan is failing— deadlines were missed, then pushed back, and now we have no idea what they are. Just 1,359 statements have been issued out of a required total of 381,920—just 0.35%. Further still, there is no comment on the remediable pension savings statements. Has the Government’s own delayed deadline of July been met or discussed?

This matters. Hundreds of thousands of frontline doctors are not getting their pension statements. The British Medical Association is clear that senior doctors are stepping back from extra work for fear of unexpected tax liabilities. In short, taking on extra work risks an extra tax bill of thousands of pounds. When I raised this in April, the Minister retorted that I could have asked about the impact on services of cancelling the strikes. Well, I will do so now, as the strikes are back on. It will be the senior doctors who have to pick up the slack—the very doctors who are avoiding extra shifts for fear of the tax. If they will not take on the extra work for fear of the heavy tax burden, we have a huge problem.

This should be a priority for the Government, especially as we plan for winter pressures. What will the Minister do to remedy the situation with RSS? What will she do regarding RPSS? Ministers cannot just announce new deadlines and then miss them, so would she be kind enough to publish a delivery plan? Finally, she said that the Government have faith in the NHS Business Services Authority. Is that still the case? Will she demand that the Pensions Regulator steps up and expedites its investigation, given that the referral was made in December 2024? In the end, doctors are counting on her, and so are their patients.

[Karin Smyth]

As I outlined in my initial response and further to the written ministerial statement, we have asked for an independent review of the process and will report back as soon as possible with a realistic deadline for that. With regard to the strikes, we will continue to be open to discussing the avoidance of those strikes, and I hope that the Opposition will support us in that.

[John Slinger (Rugby) (Lab)]

Given that the summer recess is imminent, will the Minister use this opportunity to update the House on the number of additional appointments and, more importantly, the number by which the NHS waiting lists have fallen under this Government? Does she agree that it would be very nice if the Conservative party addressed the crisis in which they left our NHS? It is a mess that this Labour Government are proud to be clearing up.

[Karin Smyth]

I thank my hon. Friend, who is a superb advocate for his constituents. I met him again yesterday as he advocated for services in his constituency—that is the focus of Labour Members. He is absolutely right; as I said in my statement, this is part of the overall mess that we inherited from the Conservatives. As I said in my previous response on this issue, the problems outlined by Lord Darzi are wide and deep. It is still shocking, after a year in government, to be faced with the level of disaster that was left to us after a complete abdication of responsibility for sorting out the problems. We will continue to focus on getting more of the appointments that people so need and on reducing waiting lists, which is what our constituents expect.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson.

--- Later in debate ---

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

I thank the Minister for coming to the House to answer this urgent question. These administrative delays are deeply worrying. They make financial planning for those affected very difficult and, more importantly, stop doctors taking on additional work for the NHS as they could face large and unknown tax penalties. That was highlighted at the start of the year, when 4,000 NHS staff missed out on pension tax compensation after administrative failings.

This is having a direct impact on patient care, so how will the Minister reassure NHS staff regarding their pension entitlements, and when can they expect to see the compensation the Minister mentioned to encourage them back into the workforce? Can she assure the House that the Government are taking steps to prevent doctors with missing pension records from being unfairly penalised? Can she tell us how the Government will address the 156,000 years of missing pension data for GPs? Finally, will the major reorganisation of the NHS—especially the 50% cut to the organisations that oversee local health services—potentially compound this problem?

[Karin Smyth]

I thank the hon. Lady for those questions. She highlights a number of important issues regarding the complexity for the NHS Business Services Authority of dealing with this. There is a large number of high earners in this scheme. With regard to tax liabilities, that makes the system complex, as does the movement of doctors throughout the system in their career.

One issue I discussed with the independent reviewer yesterday is the need to ensure there is a technical look at solutions to issues such as missing years. The hon. Lady is right to highlight that changes make a difference to following people’s careers through the system. There are wider lessons, which I have already started to discuss with the reviewer, about how we make the best use of technology so that we can track people through their careers and give confidence to the current workforce that we are addressing this not just for the cohort who have immediate issues but for the future. That is the sort of action this Government are taking. We do not do sticking plasters. We are looking at this very seriously.

[Dame Harriett Baldwin (West Worcestershire) (Con)]

I declare an interest, as a trustee of the parliamentary contributory pension fund.. Many people in the public sector receive a significant pension contribution, but they are not aware of its value. The Pension Schemes Bill currently going through Parliament presents an opportunity to place on someone’s pay cheque and pay offer the annual value of that incredibly important contribution to a public sector pension fund. That is something that very few people in the private sector are now able to enjoy, and it feels like it is undervalued by those who benefit from it. Will she consider taking that opportunity?

[Karin Smyth]

I thank the hon. Lady for that really constructive suggestion. In my discussions with the NHSBSA, the reviewer and officials at the Department, I have raised similar issues. I am a member of the NHS pension scheme and the parliamentary pension scheme. I tell my young people that this is a really valuable asset, and I encourage my constituents who are looking for jobs in the NHS to consider the pension scheme, because people sometimes do not look at it immediately. We should look at ways to encourage people to take part in the pension scheme—particularly for lower earners, it is a really valuable and stable contribution—and the value of it from the public purse should be well known.

I am not across the detail of the hon. Lady’s point on the Pension Schemes Bill, but I will talk with my colleagues across Government about how we can look to do that and come back to her, because I agree that it is a really valuable thing—it rewards the contribution of public service, and we should make the most of it.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

I would like to take this opportunity to put my thanks on the record to the Minister. I have spoken to her outside this place about the money we have secured for removing reinforced autoclaved aerated concrete at Harrogate district hospital, which I have been campaigning on for years.

It is great having state-of-the-art hospital facilities, but if we do not have the staff there, it is all a bit moot. I want to press the Minister on the concerns raised by colleagues that people might not come back or take on additional hours in the NHS as a result of this issue. Will she commit to updating Members throughout the recess on progress on this matter?

[Karin Smyth]

I congratulate the hon. Gentleman on, yet again, shoehorning in a reference to his local hospital, for which he does a great job.

People are determined to work in and support the national health service. We take remedying confidence in pensions seriously. I will not give further deadlines before we hear from the assessor. I have asked her to come back and make a very clear statement as soon as possible after the summer recess. I will then be happy to update the House.

Coming forward to work in the NHS is a matter of choice for individuals, and we particularly want to work with consultants to ensure that their career progression is the best it can be. We very much value their work in the service.

[James Wild (North West Norfolk) (Con)]

With the British Medical Association set to strike, and with the Health Secretary reduced to pleading with it not to, thousands of patients are set to have their appointments cancelled. Can the Minister assure the House that she will grip this issue so that senior doctors do not also reduce their hours? And will she rule out bonuses for NHS Business Services Authority executives?

[Karin Smyth]

We are working very closely to ensure that resident doctors do not go on strike. We are very clear that we cannot negotiate on pay this year, but we will work with everybody to improve conditions. Some of those conditions are shocking, and we want to work constructively with them to avoid disruptive strike action.

[Robbie Moore (Keighley and Ilkley) (Con)]

The Daily Telegraph reported in April that a quarter of doctors have reduced their overtime to avoid potential five-figure tax bills, and NHS capacity has been reduced by about 10% as a result. This has been raised many times when I have been out and about door-knocking across Keighley and Ilkley. What steps will the Government take to rectify this absurd situation, which is preventing doctors from working more to reduce waiting lists?

--- Later in debate ---

[Karin Smyth]

The hon. Gentleman highlights yet another mess that we inherited due to his party’s lack of proper engagement with the workforce over the last decade to resolve the disincentives to making the system work more effectively.

Making the system work more efficiently and more effectively is a key part of our 10-year plan announced, I think, only last week—the days keep rolling by. We not only involved the public in those conversations but had valuable conversations and received insights from all staff groups. There is a real spirit of optimism that everyone wants to pull together to ensure that the incentives are right for staff at all levels—over 1.5 million of them—to make the NHS fit for the future, and that is what we are focused on.

[Blake Stephenson (Mid Bedfordshire) (Con)]

The Minister knows that I have a keen interest in NHS reorganisation and the impact on frontline services, particularly in Mid Bedfordshire. Given the failures of NHSBSA, has consideration been given to reorganising that authority? I also repeat the question asked by my hon. Friend the Member for North West Norfolk (James Wild): given the failures, will the Minister rule out bonuses for the NHSBSA’s leadership?

[Karin Smyth]

I am totally focused on remedying this situation and learning from the mistakes. If further action is required, I will happily update the House at that point. My absolute focus at the moment is on getting everybody in that organisation and the independent review focused on sorting out the pension situation for those who have already lost out.

[Jim Shannon (Strangford) (DUP)]

As always, I thank the Minister very much for her answers. I recently read an article that referred to the mechanism of the NHS pension scheme as a “Ponzi scheme”, which gives me great concern about the scheme’s ability to cope in 20 years’ time. How do the Government and the Minister intend to convert the transitional arrangement in place since 2019—of topping up pensions from another source—into permanent and transparent arrangements so that we can stop robbing Peter to pay Paul and ensure that those who are working 70 hours a week in 2025 have a real pension and retirement fund in 2065?

[Karin Smyth]

The hon. Gentleman tempts me to stray further from the urgent question, but he raises an important point, further to the one raised by the hon. Member for West Worcestershire (Dame Harriett Baldwin), who is a trustee of the parliamentary contributory pension fund.

The NHS pension scheme is an extremely important part of the reward package that NHS staff at all levels absolutely deserve. We want to ensure that it, like the rest of the NHS, is fit for the future. If hon. Members have suggestions for how to make it work better, as part of ongoing discussions, I am happy to hear them.

Women and Girls with Autism: Mental Health Support

Karin Smyth Excerpts

Tuesday 15th July 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Sir Edward. I am grateful to my hon. Friend the Member for Bournemouth West (Jessica Toale) for securing this debate and raising this extremely important topic. We know that, sadly, autistic people are at the wrong end of statistics on a range of mental health conditions: 70% to 80% of autistic people will experience mental health problems during their lives, and tragically many are more likely to die by suicide.

We have heard the devastating impact that can have on individuals and families. I pass my heartfelt condolences to my hon. Friend’s constituent, Ms Bridges, on the loss of her daughter. My hon. Friend spoke of the campaign for Lolly’s law, and I commend her for her tireless work to ensure that autistic people get the mental health support and treatment they deserve. As my hon. Friend said, that is exhausting, and too many parents are forced into campaigning roles. As she rightly said, Lauren should still be here.

It is clear that the number of autistic people and those with a learning disability who are in mental health hospitals is unacceptable. There are still too many people being detained who could be supported to live well in their communities. We want to ensure that people get the support they need in the community, improving care and keeping people out of hospital. The Mental Health Bill, currently before Parliament, would limit the scope to detain autistic people and those with a learning disability, so that they can be detained under part 2 section 3 only if they have a co-occurring mental disorder that requires hospital treatment.

The Bill would also introduce a package of measures to improve community support for autistic people and those with a learning disability. It is also critical, however, that when autistic people do need to be admitted to mental health in-patient settings, due to a co-occurring mental health condition, they receive the right care and support.

[Alison Bennett (Mid Sussex) (LD)]

My constituent, Annabel, who is a teenager, has parallel experiences to Lolly, as set out by the hon. Member for Bournemouth West (Jessica Toale). She also had a terrible experience being detained in a secure unit, which her parents did not think was safe. Does the Minister agree that when teenagers—children—are detained in secure units, more needs to be done to ensure that they are safe and fit for purpose to protect those children’s welfare?

[Karin Smyth]

The hon. Lady raises another terrible case concerning a teenager on behalf of her constituent. We must of course be mindful of that provision for children and young people. My hon. Friend the Member for Bournemouth West spoke of her constituent’s campaign to retrain mental health staff, to improve understanding and acceptance of autistic women and girls. As we have heard, we know there can be differences in how autism presents in males and females, which can make autism harder to identify in girls.

[Rachael Maskell (York Central) (Lab/Co-op)]

I am grateful to my hon. Friend the Member for Bournemouth West (Jessica Toale) for securing the debate. Will the Minister ensure that mental health trusts and integrated care boards do not put people waiting for an autism assessment through a process of filling in a pro forma, only to be left languishing on a list, perhaps never having an assessment? We know the predominance of young women on those lists, yet the right support in the right way never comes. Will the Minister ensure that that process is brought to a conclusion?

[Karin Smyth]

I will come on to talk about what we expect local providers to do, but obviously no one should languish on a list as she describes.

[Dr Lauren Sullivan (Gravesham) (Lab)]

In the new training regimen, can we please ensure that parents are believed? Young women and young girls often mask very well in schools where all the professionals are, but then at home they can explode and have meltdowns. Some parents are not believed at that stage. Will that also be included in the new training guidelines?

[Karin Smyth]

My hon. Friend makes an excellent point about carers. We should address that. She made an excellent point about support for parents wanting to support their own children. With regards to training, we are taking action to increase awareness and understanding of autism in health and adult social care services. Under the Health and Care Act 2022, providers registered with the Care Quality Commission are required to ensure that their staff receive specific training on learning disability and autism appropriate to their role.

To support that, we have been rolling out the Oliver McGowan mandatory training on learning disability and autism to the health and adult social care workforce. The first part of the training has now been completed by more than 3 million people. NHS England has also rolled out additional training across mental health services, and 5,000 trainers have been trained as part of the national autism trainer programme. That training covers autism representation in women and girls, as well as exploring misdiagnoses, including of personality disorders, for example. These trainers will cascade their training to teams across mental health services. NHS England also commissioned the Royal College of Psychiatrists to deliver the national autism training programme for psychiatrists, with over 300 psychiatrists having been trained in the past three years.

My hon. Friend the Member for Bournemouth West spoke about her constituent’s campaign on suicide prevention. We have committed as a Government to tackling suicide through the suicide prevention strategy for England. It identifies autistic people as one of a number of groups for tailored or targeted action at a national level. To support that, the Department, through the National Institute for Health and Care Research, has commissioned a review to understand what is known about the effectiveness, cost-effectiveness and experience of interventions to reduce suicide among autistic people.

More broadly, we also know that autistic people can face challenges in accessing mental health services. While it is the responsibility of local NHS bodies to ensure services meet the needs of their local populations, we are taking actions to support them to address the challenges that autistic people face. In addition to the training I have outlined, NHS England has published guidance on how to improve the quality, accessibility and acceptability of care and support for autistic adults to meet their mental health needs, as well as taking guidance on adaptation of NHS talking therapies for autistic people.

NHS England has also developed a reasonable adjustment digital flag, which enables the recording of key information about a patient and their reasonable adjustment needs to ensure that health support can be tailored appropriately. We are taking action to support early intervention and improve access to mental health services more broadly. Through the 10-year health plan, we will continue to roll out mental health support teams in schools and colleges to reach full national coverage by ’29-30. We will also ensure that support for the mental health of children and young people is embedded in the new young futures hubs, alongside a wellbeing offer to ensure that there is no wrong front door for young people seeking help.

[Afzal Khan]

Clearly, there are issues on the school side. Without tailored support, accessible information and properly funded SEND pathways, too many girls are being left behind, often resulting in mental health difficulties and poor educational outcomes. Does the Minister agree that urgent investment in SEND support in schools is needed, alongside reforms that recognise the different ways that autism presents in girls?

[Karin Smyth]

I understand that the previous debate was on SEND; I am sure my hon. Friend will pick up that point with the relevant Minister. As I have said, we are rolling out more support into schools, so that should join up to support those young people.

We are also transforming mental health services through the 24/7 neighbourhood mental health centres, to support our ambition to shift care from hospitals to communities. People will also get better direct access to mental health support and advice 24 hours a day, seven days a week through the NHS app, without needing a GP appointment. Our ambition is that, through improving access to mental health support in the community, we will prevent the escalation of mental health needs for all people, including autistic people.

My hon. Friend the Member for Bournemouth West asked a number of questions that I hope I have largely addressed. Regarding anti-ligature doors and specialist suicide prevention for in-patient units, I know that she has received a letter from the Department. I will make sure that officials provide a more thorough answer on the issues outlined in that request. She also raised the issue of the transformation programme, and support for and work with families. We have committed to developing a new national autism strategy to help support the direction of local systems to include families. I will ask officials to consider the specific issues that my hon. Friend raised, and make sure that she gets an answer.

I also assure my hon. Friend that, on out-of-area placements, ICBs have published plans to localise in-patient care under the national in-patient commissioning framework. To support that, we have allocated £75 million in this financial year to help stop mental health patients being sent far away for treatment. I know from my own constituency work that that is an issue of great concern. We will make sure that we are focused on it.

I am happy to request that the Minister responsible for this policy area, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), meet my hon. Friend the Member for Bournemouth West and her constituent. I know that he wanted to attend this debate, but could not do so for family reasons. We will get that meeting in train.

I again thank my hon. Friend for raising such an important issue, and recognise the tireless efforts of her and her constituent to raise awareness of mental health needs, and the need for support for autistic women and girls. I also thank all hon. Members in this debate who raised issues on behalf of their constituents. This is a really important issue for many of us, and I hope that my comments have gone some way to assure people that we take it very seriously, and are committed to working with them to make life better for people.

Question put and agreed to.