Duchenne Muscular Dystrophy

Karin Smyth Excerpts

Thursday 12th June 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

It is a real pleasure to respond to this moving debate. I know that many people with Duchenne muscular dystrophy and their families will have wanted to tune in to hear what was said this afternoon. I thank Members who have contributed in different ways to the debate. In particular, I thank my hon. Friend the Member for Stockton North (Chris McDonald), who secured this debate and advocated so powerfully for these families. He really brought to life the experiences of Benjamin, Jack and Eli, and I commend him for doing so.

I first acknowledge the profound impact that this debilitating disease has on those living with it, and their families, and the urgent need for new and effective treatments. As has been said, my right hon. Friend the Secretary of State for Health and Social Care heard at first hand from people affected by this condition earlier this year, when he attended an event hosted by Duchenne UK. He met many young patients and listened to what they said about the challenges that they face. As we all know, meeting families and individuals from our constituencies leaves a long-lasting effect on us, and it is important that we continue to meet them.

Timely and equitable access to innovative medicines for the treatment of DMD and other rare diseases mentioned today is of the utmost importance. The National Institute for Health and Care Excellence is the independent body responsible for assessing whether new licensed medicines can be recommended for routine use in the NHS, based on a thorough assessment of their clinical effectiveness and cost-effectiveness. Through this process, many thousands of patients, including those with rare diseases, have been able to benefit from effective new treatments at prices that represent value to the NHS. NICE has been able to recommend two medicines for the treatment of DMD: ataluren, recommended in 2023, and vamorolone, which was recommended in January this year and is now available on the NHS to around 1,700 eligible patients, in line with NICE’s recommendations.

As my hon. Friend has said, NICE is appraising givinostat, and the first NICE committee meeting is scheduled for July this year. If the medicine is recommended, the NHS in England will be legally required to fund it. I am aware that a small number of patients in the UK have been receiving treatment with this drug through a company-led early access programme, established by the pharmaceutical company Italfarmaco, as we have heard. It is important to note that participation in these programmes is decided at NHS trust level, and although the drug is free to patients taking part in it and to the NHS, NHS trusts must still cover administration costs and provide clinical resources to deliver the EAP.

NHS England has published guidance on free-of-charge medicine schemes, such as the givinostat EAP, providing advice on financial, administrative and clinical risks. NHS England cannot, however, centrally direct NHS trusts to participate in company sponsored EAPs like this one, or in any other private activity. To issue any form of national direction around participation in EAPs would both pre-empt and undermine the role of NICE, whose purpose is to advise the NHS on whether particular treatments should be made routinely available on the NHS.

Even when there is an agreement that a company will continue to provide a drug free of charge in the event of a negative decision by NICE, participating trusts remain liable to cover the significant costs of delivering that service, including the cost of the clinical resources and staff time needed. That would be outside their funding allocation and in addition to paying for any subsequent NICE-recommended treatments that they would be mandated to fund.

[Chris McDonald]

I thank the Minister for her response, to which I am listening very carefully. I appreciate her point that it would be inappropriate for the Department of Health and Social Care to direct what trusts should do, but what we have heard from the trusts is that they would like to issue this drug, but have certain issues and problems. Perhaps it might simply be a matter of the Department giving help and support, and facilitating information-sharing between trusts that have made this work and those that have not. Perhaps it could be more encouragement than direction.

[Karin Smyth]

I thank my hon. Friend for that constructive suggestion. We need to wait to see how the NICE recommendation goes in July. With this disease and so many others, it is important to share learning and information, and trusts should be encouraged and supported in doing so. We will work with him on that constructive recommendation.

I understand my hon. Friend’s concerns about the fact that non-ambulant patients are not yet able to access givinostat, but it is important to note that the eligibility criteria for participation in the early access programmes have been determined by the pharmaceutical company. NHS trusts that decide to participate in the EAP must only provide treatment in line with the criteria, which state that patients must be ambulant. A clinical trial is being carried out by the pharmaceutical company to evaluate the safety and tolerability of the drug in non-ambulant patients, and to further explore the efficacy of the drug in this population. I know that for the patients and families affected, it will be disappointing to hear that there is no access to the drug for ambulant patients before a NICE decision, or for non-ambulant patients prior to clinical trials being concluded. I want to assure my hon. Friend that we have arrangements in place to support rapid access to new medicines.

[Freddie van Mierlo]

Will the Minister give way?

[Karin Smyth]

I will not; I want to finish in the time available, and I think Members want to hear the full response.

Outside of company-led EAPs, there are established routes for patients to get access to new, innovative medicines prior to them being licensed. The early access to medicines scheme, or EAMS, helps give people in the UK with life-threatening or seriously debilitating conditions early access to new medicines that are not yet licensed where there is a clear unmet medical need. EAMS is supported by key partners, including the MHRA, NICE and NHS England, and is a key part of this Government’s commitment to accelerating patient access to innovative, life-changing treatments, in support of the UK’s position as a global leader in life sciences. In fact, since the scheme launched in 2014, over 50 medicines, including for this disease, have benefited from being accessed early through EAMS.

The innovative medicines fund has also made available £340 million of ringfenced funding for the NHS to fund early access to medicines that NICE has recommended with managed access. Through this process, licensed treatments that demonstrate substantial clinical promise but still have significant uncertainty around their clinical and cost-effectiveness can be funded. Further evidence is then collected on the drug for a defined period of time. That is considered by NICE in determining whether the drug can be recommended for routine NHS funding.

The Secretary of State has been clear that if givinostat is recommended by NICE in draft guidance, NHS England should aim to work with the pharmaceutical company to provide early funding through the innovative medicines fund. This could potentially speed up access by up to five months, and the treatment could be funded as soon as this summer, if recommended.

This scope of this debate is wider than just access to new medicines. It is important to note that while rare diseases are individually rare, they are collectively common. One in 17 people will be affected by a rare condition over their lifetime. The UK rare diseases framework outlines four priorities, based on engagement with the rare disease community. They are: helping patients to get a final diagnosis faster, increasing awareness of rare diseases among healthcare professionals, better co-ordination of care, and improving access to specialist care, treatments and drugs. In England, we publish a rare diseases action plan annually. These detail the specific steps we are taking to meet the shared priorities of the framework. I am pleased to highlight the 2025 England action plan, which was published in February this year on Rare Disease Day. One such action is reviewing the effectiveness of early access schemes, such as the early access to medicines scheme, the innovative licensing and access pathway, and the innovative medicines fund. They are all designed to help make innovative treatments available earlier to patients who need them. We are specifically considering how well they support access to treatment for people living with rare diseases like Duchenne.

NHS England, NICE and MHRA will meet annually to continue to discuss progress on these schemes. These meetings will include representatives from patient advocacy groups and from industry, and clinical researchers, and the next one will happen in the summer.

Managing a complex rare condition can be challenging, and it often means interacting with many different specialists and providers of health and social care. It can mean travelling across the country to access highly specialist care from experts. All of that can add up to a significant emotional and physical burden, and it can deepen inequalities. Co-ordination of care can minimise this burden on patients and their carers, and it can ensure that healthcare professionals work together to provide the best possible care, as we have discussed this evening.

In the 2025 action plan, we have introduced a new action to incentivise providers to run clinics for multi-system disorders, in order to reduce the number of appointments and improve co-ordination of care for families. The NHS is also working to include the definition of “co-ordination of care” that is set out in the CONCORD—co-ordinated care of rare diseases—study in all new and revised NHS service specifications for patients with rare diseases.

I recognise how hard it is when patients want access to these new treatments. I also recognise the distress and worry it causes, not only to patients, but their families and friends. Hon. Members have articulated that well on behalf of their constituents this evening. The Government are committed to providing access to the most innovative medicines, but it has to be at a price that provides value for the NHS, and it has to be clinically safe and effective. That is why we are working hard with industry, NICE and MHRA to make that happen. I know that my hon. Friend the Member for Stockton North will continue to work with the Government and providers to make that happen. I am grateful for the opportunity to respond to this debate on such an important issue.

Question put and agreed to.

Covid: Fifth Anniversary

Karin Smyth Excerpts

Thursday 12th June 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I am short of time, but the Under-Secretary of State for Culture, Media and Sport, my hon. Friend the Member for Barnsley South (Stephanie Peacock), who leads on this issue, has hotfooted it from Committee and will take up any issues that I do not address. I thank my hon. Friend the Member for West Ham and Beckton (James Asser) for securing what has been a moving and popular debate. As he says, we have to remember the people and communities behind the numbers. My thoughts, and those of everyone, are with the families and communities who lost loved ones because of the pandemic. We have heard the magnitude of that grief expressed today, as well as the pain of families who were unable to be with their loved ones in the normal rituals of grief and bereavement.

My hon. Friend the Member for Middlesbrough South and East Cleveland (Luke Myer) spoke about the loss of his grandfather. The hon. Member for Honiton and Sidmouth (Richard Foord) talked about the loss of Adam, and we understand the battle to get compensation payments. My hon. Friend the Member for Ribble Valley (Maya Ellis) talked about women’s experiences of pregnancy and birth. I pay tribute to my hon. Friend the Member for Paisley and Renfrewshire South (Johanna Baxter) for the work that she is doing on the APPG, and I will make sure that she gets a response to her letter.

It has been heartening to hear of the many ways that communities have commemorated the losses and sacrifices experienced during the pandemic. The Government will bring forward a programme of covid-19 commemorative activity, and we will set out full details in response to the recommendations of the UK Commission on Covid Commemoration. I thank Baroness Morgan of Cotes and all the commission members for their consideration in recommending how to mark this period, and for their ongoing engagement with the Department for Culture, Media and Sport, which will lead on the commemorative activity.

DCMS is working with a range of partners, including my Department, and regularly engages with the covid-19 bereaved family groups. I thank those groups for their ongoing support and commend them for their strength and resilience, and for the support that they provide to other grieving families. As part of the commemoration of the pandemic, the Government supported the Covid-19 Day of Reflection in March, when more than 200 events took place. I can confirm that the Covid-19 Day of Reflection 2026 will take place on Sunday 8 March, and I hope that Members will support activities in their constituencies.

As we have heard, across the river from this House stands the covid-19 memorial wall. I certainly remember the first time we stopped at that memorial after we lost my father-in-law, Brian Davies. It is a really moving and powerful tribute to the lives lost, with almost 250,000 hearts lovingly painted on the wall. For families, it is a really important space where they can remember. I agree with the hon. Member for North East Fife (Wendy Chamberlain) that it is a poignant reminder when we pass it every day, and I know that my colleagues in DCMS are working with the Friends of the Wall on that long-standing commemoration and will update the House in due course.

Together we remember the courageous sacrifices made by frontline workers across the country, and we have heard about many of them today. There are too many people to mention, but they include NHS staff, train and bus drivers, refuse collectors, and supermarket and delivery staff. I agree with my hon. Friend the Member for Loughborough (Dr Sandher) that many on the frontline were the poorest and lowest paid, and they were disproportionately affected. We must continue to make sure that that does not happen again.

The pandemic demonstrated the remarkable work of civil society. An estimated 12.4 million people volunteered in some way, including as vaccine volunteers, befrienders and carers, as was mentioned by my hon. Friend the Member for Coatbridge and Bellshill (Frank McNally).

I will briefly turn to the steps that we are taking to ensure that the United Kingdom is better prepared for a future pandemic, which remains a top priority for this Government. My hon. Friend the Member for Glasgow North (Martin Rhodes) made a crucial point about learning lessons on PPE, as did my hon. Friend the Member for Bolton West (Phil Brickell). Later this year, we will conduct a national exercise to test our ability to respond to a pandemic, and this will involve all regions and nations of the United Kingdom, with thousands of participants. The outcome of the exercise will inform how we approach a pandemic in future.

We have heard about long covid, and I would talk more about it if I had more time. The right hon. Member for Hayes and Harlington (John McDonnell) spoke about that, as did many others. Since 2020, NHS England has invested significantly in supporting people with long covid, including through specialist post-covid services for adults, children and young people, and it has invested over £57 million in long covid research, which will remain hugely important.

I am grateful to my hon. Friend the Member for West Ham and Beckton for securing this important debate. As we mark the fifth anniversary of the pandemic, together we will ensure that lessons are learned, that our losses are honoured, and that as a nation we do not forget.

Spending Review: Health and Social Care

Karin Smyth Excerpts

Thursday 12th June 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

With permission, I would like to make a statement on the outcome of the spending review for the Department of Health and Social Care.

This Government were elected on a manifesto to fix our broken NHS and make it fit for the future. Our job is twofold: first, to get the NHS back on its feet and treating patients on time again; and secondly, to reform the service for the long-term so that it is fit for the future. That is why, in her autumn Budget, my right hon. Friend the Chancellor took the necessary decisions to give health and social care a record uplift in day-to-day spending at the conclusion of the first phase of the spending review. The Department for Health and Social Care received a cash injection of £26 billion covering day-to-day spending and capital investment in 2025-26, compared with the 2023-24 out-turn.

All Opposition parties have rejected that investment and those changes to repair the damage done to our NHS and move it forward. They have rejected two above-inflation pay increases for our NHS staff, the recruitment of 1,700 more GPs and the agreement of a GP contract for the first time since the pandemic, the biggest investment for hospices in a generation, the biggest expansion of carer’s allowance since the 1970s, a boost for older and disabled people through the disabled facilities grant, and the biggest real-terms increase to the public health grant in nearly a decade.

We have also given pharmacies the biggest funding uplift in years, ensured that women across the country can access the morning after pill free of charge, frozen prescription charges for the first time in three years, enabled an extra 3.5 million appointments for operations, consultations, diagnostic tests and treatments—reaching and surpassing our manifesto pledge seven months early. I can update the House on waiting lists, which, as of this morning, have fallen by over 30,000 compared with last month, amid a reduction of 232,000 since this Government took office.

I could go on, but I have only 10 minutes, Madam Deputy Speaker, and I would not like to try your patience, so I will make this point briefly. To govern is to choose, and anyone who opposed the decisions that the Chancellor took in her Budget must tell us what they would have subtracted from that list. We cannot spend money if we do not raise it.

As the Minister of State for Secondary Care, I regularly hear appalling anecdotes from colleagues across the House whose local hospitals, GP surgeries and community services are crumbling, with rusty equipment, leaky pipes and buckets catching rainwater. Phase 1 of the spending review has allowed us to arrest 14 years of shocking neglect and undercapitalisation in the NHS, with a record capital investment of £13.6 billion in 2025-26. [Interruption.] The Conservatives do not like it, but I will go on. That money has gone towards repairing our crumbling hospitals, supporting over 1,000 GP surgeries to modernise their buildings, and installing state-of-the-art scanners across the NHS estate, including the latest linear accelerator machines. However, as my right hon. Friend the Secretary of State has made clear, investment must come with reform. This year we have unveiled our plan for change, our elective reform plan, our urgent and emergency care plan and a crackdown on agency spend in order to reinvest £1 billion into the frontline.

Yesterday, my right hon. Friend the Chancellor set out the conclusion of phase 2 of the spending review, setting budgets that will enable us to make firm plans to deliver on the people’s priorities in the coming years, while going further and faster on reform. Our settlement increases day-to-day spending on health, bringing the budget for my Department and our NHS up to £232 billion by 2028-2029. That means £29 billion more day-to-day funding for the NHS in England, in real terms, than in 2023-24. We have also secured the largest-ever health capital budget, with a £2.3 billion real-terms increase in capital spending by 2029-30, compared with 2023-24, representing a more than 20% real-terms increase by the end of the spending review period.

Let me hammer this point home: investment must be matched by reform. This will be a critical year for the NHS as we achieve better value for taxpayers, who must see their money being spent well and delivering results. We would rather take those difficult decisions now, to save our NHS so that it is there for future generations. NHS England is a top-down organisation—the biggest quango in the world—with a less efficient system than the previous Government inherited in 2010 and twice the headcount at the centre. That is why my right hon. and learned Friend the Prime Minister announced in March that we will bring together NHS England and the Department of Health and Social Care to form a new joint centre. That will put an end to duplication and enable substantial efficiency savings, while bringing the management of our NHS back under democratic control. We will also unlock £17 billion of savings over the spending review period through 2% annual productivity growth in the NHS—money that will be either reinvested in the frontline or used to support radical transformation to make the health system more agile and efficient.

Our elective reform plan set out how we will ensure that by the end of this Parliament 92% of patients will not have to wait more than 18 weeks for elective care. This settlement will drive us further towards that goal, with over £6 billion of additional capital investment over five years across new diagnostic, elective and emergency and urgent care capacity, which could deliver more than 4 million additional tests and procedures.

We will build on the record capital investment from phase 1 to repair the NHS estate. That means continuing the delivery of 25 new hospitals; investing £30 billion in maintenance and repairs, with £5 billion of it to address the most critical building repairs; and reducing by half the number of hospitals containing RAAC—reinforced autoclaved aerated concrete—over this Parliament.

This spending review provides for an increase of over £4 billion for adult social care in 2028-29 compared with 2025-26, including an increase in the NHS contribution via the better care fund. Local authorities with responsibility for adult social care will also benefit from wider reforms to better align funding with need, multi-year settlements and simplification of the funding landscape that enables them to plan more effectively. Last but not least, we have taken steps to simplify targets and better monitor delivery, and we will continue to work with local systems to improve financial and operational performance, to get the most from every penny.

A key part of our 10-year plan is driving progress on the three shifts: from analogue to digital, hospital to community and treatment to prevention. On digital, we will invest up to £10 billion in technology and transformation, to start making the NHS app a digital front door and deliver a single patient record. We will work in partnership with the Wellcome Trust to launch the world’s first health data research service, backed by £600 million, to accelerate the discovery of lifesaving drugs.

On primary and community care, we will invest in training thousands more GPs, helping to bring back the family doctor through millions of extra appointments a year; in 700,000 additional dentist appointments annually; in at least 8,500 extra mental health staff by the end of this Parliament; and in mental health support teams for every school within five years. Finally, on prevention, our world-leading immunisation programmes will be supported by £2 billion, and we will invest £80 million in tobacco cessation programmes and our Tobacco and Vapes Bill.

I want to end by thanking the Chancellor for her unwavering commitment to getting our NHS back on its feet. Fixing broken Britain will not be easy, but nothing that is worth doing ever is. Today I have set out how every penny from the public purse will be matched by reform, to make our NHS fit for the future. We remember we were elected on a manifesto to end sticking-plaster politics and do the hard yards of fixing our country, and we will never betray that promise to the British people. The public have a right to know how public money will be spent, and this is something we take extremely seriously. They can put their trust in this Government, because we have fixed the NHS before, and with the help of this Chancellor, we will fix it again. I commend this statement to the House.

[Madam Deputy Speaker (Caroline Nokes)]

I call the shadow Secretary of State.

[Edward Argar (Melton and Syston) (Con)]

Yesterday, yet again, we saw the Chancellor do what the Labour party always does: default to high spending, more borrowing and higher taxes, leaving the public finances vulnerable. The Minister has spoken of additional funding for the NHS. To use the same comparison as the NHS England chief executive, the NHS budget will now be roughly the equivalent of the entire GDP of Portugal, yet we are still none the wiser as to how the Government actually intend to use most of the money—there is no real detail and no real plan. Just last September, the Prime Minister pledged that there would be no more money without reform. Despite the Minister’s words, that is exactly what the Government have done. There is still no plan for reform, and the Secretary of State is unwilling to set out the bold reforms that are needed.

Despite 14 years in opposition and nearly one year in government, the Labour party has failed to come up with a plan for the NHS, with the exception of the abolition of NHS England, which will not happen for years and appears to be delayed and in chaos. Ministers respond to every written parliamentary question about it by saying they cannot set out the savings, how the people will change or how the structure will change at this stage—yet again, there is still no plan. We have been very clear that where the Government are wrong, we will oppose it, but where they get something right, we will work constructively with them. That includes reform, but there is still no reform for us even to consider supporting.

Can the Minister tell us where the £29 billion she set out will be spent? The chief executive of the NHS Confederation said yesterday that increases in NHS staff pay will

“account for a large proportion”

of the funding increase. The former NHS chief financial officer echoed that view at the Health and Social Care Committee in January, saying that pretty much all the last tranche of additional spending was absorbed by pay rises, national insurance and inflation. Can the Minister confirm how much the pay offers from the independent pay review bodies, alongside increased national insurance, will cost, how much of this funding will have to go to cover that and how much will actually make it to the frontline to improve patient services?

The Minister touched on the aim of meeting the NHS 18-week target for hospital waiting times within this Parliament. Of course, we wish the Government well in achieving that and hope they succeed, but just yesterday The Times reported that internal departmental modelling showed they are not on track and could only come close to meeting the target with “implausible” and “over-optimistic” assumptions. The independent Institute for Fiscal Studies agreed. Can the Minister set out how the Government will meet that target? Again, where is the plan? We need a plan, not empty rhetoric.

It is clear that the NHS needs reforms, not just more funding, so when will the 10-year plan finally be published? Will it be before the one-year anniversary of the Labour party being in government? Will it be like their elective reform plan: simply a reheat of the plan that Sajid Javid brought forward in 2022, with nothing new? The Secretary of State needs to be more ambitious—words that I suspect will never be echoed by the Prime Minister or his team in No. 10.

The capital budget remains broadly flat in real terms from this year onwards. The Minister has said she wishes to continue with the new hospitals programme and invest in technology to boost productivity, but it is unclear how that can be achieved with this settlement. These are not my warnings but those of respected independent think-tanks, including the Nuffield Trust and the King’s Fund. The Chancellor’s plan is clear—indeed, not one Treasury Minister has ruled it out: more tax rises are coming.

Finally, and importantly, we have seen social care largely neglected again by this Government. There were just two sentences about it in a four-page statement. Social care deserves better. The Minister knows very well that we cannot improve the NHS without social care working well. Earlier today I met with social care providers. They want to see reform, yet the Government have apparently abandoned cross-party talks on social care reform for an independent commission led by the very able Baroness Casey, who is still doing her Home Office work on grooming gangs and is yet to be full time on this commission, which has a deeply unambitious finishing time of 2028. When will Baroness Casey be full time on the commission? These providers were clear that they want a seat at the table when better care funds are distributed by the NHS—they want to have their voices heard in decision making on that funding. Will the Minister agree to that?

Finally, the Chief Secretary to the Treasury said he has modelled his assumptions on continued trends in local government finance and local government precepts —in other words, a 5% uplift in the precept. However, a large number of counties are now controlled by Reform—whose Members are, as ever, notably absent from the Chamber when we talk about health and social care—who have pledged no tax rises whatsoever in their councils. If they do that, what is the Minister’s plan to make sure social care is funded? As ever, the Government have gone for the headline announcement, but sadly without a plan, without delivery and with no real reform to benefit patients.

[Karin Smyth]

I am entirely unclear, after that run-through of a number of different issues, whether the Conservatives welcome the extra investment in the NHS or oppose it. We know they oppose the means of funding it, but after that, I have no idea. At some point, they have to make up their mind whether they support that extra investment or not. As I said in my statement, if they do not, what out of the list of the improvements that we have already made would they not do?

As Lord Darzi made clear, under the Conservatives’ watch for 14 years the NHS was broken. Staff were left with out-of-date equipment and unable to do the job they needed to do. We agreed with Lord Darzi’s diagnosis, but Conservative Members have still not said whether they agree with it, or apologised for the state they left the system in. I do not know whether the right hon. Member for Melton and Syston (Edward Argar) has not been able to read the elective reform plan or the urgent emergency care plan that we published recently. It is up to him to read those plans properly and try to understand what is happening.

The right hon. Gentleman has started to do my job for me again, because he cites various think-tanks and people who have said that this cannot be done. Well, I can tell him that we were told, for example, that waiting lists would not drop in April because of seasonality, but we have shown—by keeping a relentless focus on the system, working closely with leaders on the frontline and being clear with officials in the Department—that it can be done. That is what we heard this morning.

We are taking a relentless approach to spending, line by line, throughout the NHS and the Department of Health and Social Care. We have rolled up our sleeves and we will not accept putting more and more taxpayers’ money into a leaky system, which is what happened under the right hon. Gentleman’s Government. If he had read the patient satisfaction survey, he would know that taxpayers across the country, in all our constituencies, love the NHS. They understand that the Tory party broke it and that it will take long time to fix. They also know that they are paying more taxes for it and getting a worse service, and they expect us to do much better. That is what we have already shown we are doing, and what we will continue to do.

I have outlined the capital that is going into the new hospital programme, which we are committed to, and we have already seen increases in diagnostic capability and surgical hubs throughout our constituencies. We will continue to do more of that. I agree with the right hon. Gentleman that it is critical to ensure that social care is supported alongside the NHS. That is why £4 billion is going into social care through our colleagues in the Ministry of Housing, Communities and Local Government, and as he knows, Louise Casey will publish her interim report next year.

We are clear that fiscal responsibility does not stop at the Treasury or down in Victoria Street with the Department of Health and Social Care. It is important that everybody in the NHS is aware that we are determined to fix the NHS and put it back on a sustained footing. There is record investment; that is our commitment to people, and I know from the people I worked with in the health service over many years that they are determined to make it better. Morale sank to an all-time low under the Conservative party, but we are raising that morale, and we will continue to work with the system to make sure that it is fit for the future.

[Alex McIntyre (Gloucester) (Lab)]

I welcome my hon. Friend’s statement about the record funding going into our NHS. We are already seeing the benefit in my constituency, with millions of pounds going into investment in our hospital; that is so desperately needed to get waiting lists down. People were left behind by the Conservative party, and I note that there is still no apology to any of my residents who were left in pain and agony for years and years under their watch—not one word of an apology.

One of the big challenges facing my constituents is accessing an NHS dentist—my hon. Friend knows about that from the time she came to visit me during my campaign. I am campaigning to get new dentists for my constituents in Gloucester, so will she help me to get a meeting with the relevant Minister to ensure that some of this record funding comes to Gloucester to get an NHS dentist for all my constituents?

[Karin Smyth]

As my hon. Friend said, this is a health area that I know well, and he has been the most amazing campaigner for Gloucester and the health service there since he became the Member of Parliament. He is absolutely right: dentistry is a key worry. It is one of the key areas that the Conservative party neglected for 14 years. That is why it was a manifesto commitment, and why I was able to outline today that meeting the target of 700,000 is front and centre, and part of the plan as we go forward. I know that the Minister for Care, who is responsible for dentistry, is keen to meet many hon. Members, and I will make sure he has heard that request.

[Madam Deputy Speaker (Caroline Nokes)]

I call the Liberal Democrat spokesperson.

[Dr Danny Chambers (Winchester) (LD)]

To reiterate: after years of Conservative mismanagement, the NHS is in crisis, with patients left waiting hours for ambulances, women giving birth in unsafe maternity units, and children turning up at A&E with rotting teeth because an NHS dentist cannot be found. That is the Conservative legacy, and they must never be trusted with our health service ever again. So yes, we welcome this funding boost—we really do—and we agree that funding must come with reform, because unless this funding is targeted properly, it will not bring the change that patients urgently need.

When it comes to reform we need to talk about fixing social care, because putting more money into the NHS today will be like pouring money into a leaky bucket. Last year, the Secretary of State for Health and Social Care stated that £1.7 billion a year is wasted because patients who are medically fit for discharge cannot leave hospital, simply because no care is available to support them at home. The hospital in Winchester that supports both your constituency, Madam Deputy Speaker, and mine has up to 160 people waiting to be discharged at any given time, and they would be better cared for with social care packages.

We need urgent action and a higher minimum wage for care workers. We need proper respite and financial support for family carers, and a clear commitment to conclude the social care review, hold cross-party talks, and deliver the real reform that the Minister has been talking about. We also need to tackle the crisis in primary care, because that is where prevention happens and where pressure on hospitals is eased. Will the Minister confirm that the funding boost will deliver the extra 8,000 GPs that are needed to guarantee everyone an appointment within seven days, or within 24 hours for urgent cases? Can she also confirm that the funding will bring dentists back into the NHS, and bring an end to dental deserts? That will not happen without urgent reform of the NHS dental contract, which is outdated, unworkable and driving dentists out of the system.

Finally, we cannot ignore the shocking state of NHS buildings, including our hospital in Winchester. It is an outrage that overcrowded hospitals must close operating theatres due to unsafe ceilings and other health and safety issues. I urge the Minister to spend the money where it matters: on primary care, on social care, and on ensuring that our existing NHS buildings are fit for purpose.

[Karin Smyth]

I thank the hon. Gentleman for welcoming, on behalf of his party, the commitment that the Chancellor has made and the extra funding that she has identified, but I think his party still opposes the way in which we have raised the funding to do just that. It is good to have your cake and eat it, but we are clear that the funding does come with reform. As I said in my statement, we are committed to improving the front door—primary care—as well as social care and discharge. That is why the NHS contribution, as part of the settlement to the better care fund, increases. He will be aware that we previously revised the better care fund to make it better and more targeted on discharge, which is important.

The urgent and emergency care plan that we published a couple of weeks ago also confirms our recognition that flow through the hospital system is important for patients and staff; we must ensure that we do not face that continued crisis of corridor care over many years. We are committed to the fair pay agreement, and our colleagues in the Ministry of Housing, Communities and Local Government will make more statements in the coming weeks about how that will work.

[Yasmin Qureshi (Bolton South and Walkden) (Lab)]

I draw the attention of the House to my entry in the Register of Members’ Financial Interests, as chair of the all-party parliamentary group for dentistry and oral health. Access to NHS dentistry is in crisis, including in my constituency. New analysis by the British Dental Association shows that the share of NHS funding spent on dentistry has more than halved since 2010, from over 3% to just 1.5%. I know how committed the Government are to reforming the dental contract, but the Public Accounts Committee made it clear that reform will work only if it is backed by proper, sustainable funding. Will the Minister ensure that NHS dentistry gets a fair share of the £29 billion announced in the spending review, so that we can end forever the crisis that is affecting millions across the country?

[Karin Smyth]

I thank my hon. Friend for her question and for the work she does to support NHS dentistry as part of the all-party group. As I have said, this issue is of huge importance to our constituents, and the shocking state in which the Conservatives left dentistry is there for all to see—particularly the shocking state of children’s oral health. That is why we acted rapidly to introduce the toothbrushing campaign—which, if I remember rightly, was ridiculed by Conservative Members when we discussed it in opposition—and the arrangement with Colgate to ensure that we improve children’s oral health. We are absolutely committed to reform of the contract; the Minister for Care is working hard on that and he will continue to update the House regularly. It is our confirmed commitment, as I have reiterated today, to increase access to dental services.

[Madam Deputy Speaker (Caroline Nokes)]

I call the Father of the House.

[Sir Edward Leigh (Gainsborough) (Con)]

Our spending on the NHS is now as much as the entire GDP of Portugal. We used to be a country with an NHS attached to it, but we are almost becoming an NHS with a country attached to it. Of course we would welcome this spending if we got the same outcomes that people get in civilised countries, like the Netherlands or Australia, but every time I mention fundamental reform, I am dismissed as wanting to bring in privatisation, so it is hardly worth raising that issue. Australia has an extremely successful pharmaceutical benefits scheme; I know that the Secretary of State for Health and Social Care went out there, and I have talked to Australian doctors about it. Will the Minister at least look at the successful outcomes, including some of the highest life expectancies in the world, that are being delivered in countries like Australia and the Netherlands, to see how we can deliver better outcomes? There is no point spending more money if people’s only right is to join the back of a queue.

[Karin Smyth]

I was expecting the right hon. Gentleman to talk about the funding model, and I am disappointed that he did not; it is something that he has talked about for many years. I do not know the details of the Australian model, but will ensure that he gets a proper answer. I am always happy, as is my right hon. Friend the Secretary the State, to look at models from across the world. We want to learn from the best, and we want to deliver the best in the NHS.

The Conservatives seem to have an obsession with input into the health service. It is true that the last Government put more money in, but it went into a leaky bucket and they got nothing out. This Government have taken a different approach. We are not just taking money from the Treasury, handing it out and then coming back for more. We are being very clear with providers and the system more generally. My right hon. Friend the Secretary of State is talking at the NHS Confederation conference this afternoon; we are working with them to ensure that we look not just at the inputs, but at what goes on in the system. We want to ensure value for taxpayers’ money in all our constituencies. There are outstanding examples of both financial and operational good practice across the country. We want to take the best to the rest, and make the best of every taxpayer pound.

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

The Minister has demonstrated the difference that a Labour Government make to our NHS, and to the people of our country. As she mentioned, reform is needed. May I draw her attention to the report by the independent Commission on Palliative and End of Life Care? Around 100,000 people cannot access hospice care, and too few people are able to access specialist palliative care. The report demonstrates a new system of end of life and palliative care that will transform people’s end of life experience. To go alongside the reform agenda, will she ensure that we invest in that precious time in people’s lives, and deliver a comprehensive palliative care service?

[Karin Smyth]

My hon. Friend is right to highlight end of life care. We know it has been neglected. I worked on it during my time in the health service, over 15 years ago, and I feel very passionately about it. It is important that we support people. We must have a system that allows people to have those conversations, and that ensures there are options for people throughout the pathway of their life. The Minister for Care is working hard to ensure that happens as part of our overall development of the health service over the next 10 years.

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

Will the Minister confirm that the funding envelope that she set out in a letter to the Queen Elizabeth hospital in King’s Lynn in April stands unchanged after this spending review?

[Karin Smyth]

Yes.

[Terry Jermy (South West Norfolk) (Lab)]

I warmly welcome the news that waiting lists are continuing to fall, not by chance, but because of the choices made by this Government. As the Minister will know, both the hospitals that serve my constituency have reinforced autoclaved aerated concrete, and both have received funding, but as I visit GP surgeries and dentists, it is clear that there is a link between crumbling buildings and the availability of appointments. Will the Minister reassure me that primary care in particular will continue to be supported by upgrades to buildings?

[Karin Smyth]

I thank my hon. Friend for the great work that he is doing to support progress on work at the RAAC hospitals in his constituency. He makes the excellent point that such issues exist not only in hospitals. As our settlement makes clear, we understand the strain in primary care, as well as in mental health services and community services, which often do not get discussed. When we publish the 10-year plan later in the summer, he will see that the move towards community and neighbourhood health services will be front and centre of what we want to achieve over the next 10 years.

[Caroline Voaden (South Devon) (LD)]

Like my hon. Friend the Member for Winchester (Dr Chambers), I welcome the increased investment, and the attention that the new Government are giving to the NHS. I would like to turn our attention to dentistry. My constituency of South Devon is a dental desert. I welcome the announcement of 700,000 extra dental appointments, but we have lost three dental surgeries since the election last year, and more are on the brink. The Government have been in office for a year now, and have talked about reforming the dental contract with the NHS. If that contract is not reformed, we will lose so many dentists that we will never be able to catch up. How long will it take the Government to announce a newly reformed contract with NHS dentistry, so that we can start increasing the number of appointments, and saving the dentist surgeries that we have left?

[Karin Smyth]

The hon. Lady is right to highlight the shocking state that dentistry was left in by the last Government. They could have reformed that contract at any time over the past 14 years. We were ready to do that in 2010, but things worked out differently; we left office, and the Liberal Democrats and the Conservatives between them did not reform the contract. The Minister for Care is working at pace to ensure that happens, and we will update the House as soon as possible.

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

I very much welcome yesterday’s statement, the funding, and the fact that the funding will go on for several years. Does the Minister agree that we depend on the people in our NHS? Will she join me in congratulating Dr Cameron and all the teams at the West Suffolk hospital, who, by adopting a whole-hospital approach, have abolished corridor care and improved the hospital’s throughput, using a model that could be widely adopted?

[Karin Smyth]

I am very happy to thank Dr Cameron and the whole team. As ever, with his vast experience of the health service, my hon. Friend makes an excellent point. We are reliant on clinical and managerial staff to make the system better. I know, and he knows, how low morale has been; Lord Darzi made that point very clear, and we cannot over-estimate how difficult that is for staff. That is why we have reached two record inflation-beating pay settlements for staff, and importantly, we have supported the independent process, because we want to work with staff to make things better at all levels. My hon. Friend gives an excellent example of how, by working with excellent clinical leadership and excellent managers, we can bring the best of the NHS to the rest of the NHS.

[Andrew Rosindell (Romford) (Con)]

The Minister will know that I too want to abolish corridor care at the Queen’s hospital in Romford. I thank her deeply for meeting me on Monday, with the chief executive of the NHS trust for Barking, Havering and Redbridge, Matthew Trainer, who is appealing for a new A&E facility at the Queen’s hospital. The situation has led to patients being cared for on trolleys in corridors. I find that unacceptable, and it is costing my local trust, which services 800,000 people in the area, an extra £100,000 a month because of additional staffing needs. Will the Minister ensure that what was said at our meeting is carried forward, and that we get a better facility for boroughs in the east London and Essex area, which the Queen’s hospital serves?

[Karin Smyth]

The hon. Gentleman is absolutely right that this is unacceptable. I was pleased to meet him and his local NHS leaders this week. They made, as hon. Members always do, an excellent case. Clearly, the situation was left badly under his Government. I hope that he will welcome the extra measures in this settlement. I know that my right hon. Friend the Leader of the House told him earlier that she looks forward to him joining us in the Division Lobby to support the extra funding. I hope that hon. Members know that, whatever party they come from, when I meet them, particularly in surgeries, I will follow up on the questions that are asked. They are often matters for the local integrated care board, but we will continue to work with all local systems to deliver the best care possible for all our constituents.

[Sonia Kumar (Dudley) (Lab)]

As an NHS physiotherapist, I welcome the statement. The Government will soon launch their 10-year plan for our NHS, in which a focus will be a move from sickness to prevention. Will the Minister set out how the spending review will support Dudley integrated care board and other ICBs in bringing healthcare on to our high streets, so that patient care is at the heart of our communities?

[Karin Smyth]

I thank my hon. Friend for the excellent role she plays as a clinician. Her expertise is really welcome; we want to hear from a wide variety of experts in this House—that is very valuable. She understands from her professional background, as well as from her constituency, how important it is to look at the entire pathway of care for patients, and to ensure that they have the best possible care as close to home as possible. We think that is better not just for patients, but for clinical outcomes, and it is more efficient and better use of taxpayers’ money. The move from hospitals to communities is front and centre of our 10-year plan, as is delivering neighbourhood health services.

[Sir Julian Lewis (New Forest East) (Con)]

The Minister will be well aware of Sir Andrew Dilnot’s ambitious plan to put a cap of £86,000 on the cost of the social care that any family would ever have to pay. It was never going to be easy to implement that. Previous Governments postponed the plan, and the Chancellor effectively scrapped it completely. May I appeal to the Minister to work across party lines, and to focus on the crippling debt that hits hard-working families when they come to the end of their working lives and need the support of the state?

[Karin Smyth]

I agree that this issue absolutely needs to be resolved. There was agreement previously, under the coalition, and it is so disappointing that it was so unceremoniously dumped when I came to this place in 2015; that was one of the first things that the subsequent Tory Government did. It was a great disappointment to many people across the country, particularly those who were responsible for supporting an older person or a disabled person. We have ensured that we will address this issue, and have appointed Louise Casey to lead the interim report. I know that she will continue to work with everybody, and that all hon. Members will take an active interest in that work.

[Liz Twist (Blaydon and Consett) (Lab)]

I welcome the additional £29 billion of day-to-day funding and additional capital announced yesterday. Our investments are already paying interest, in the reduction of waiting lists. May I remind hon. Members of the announcements made earlier this year? I was particularly pleased that the Shotley Bridge hospital replacement in Consett was announced in wave 1, and I thank the Minister for her personal interest in ensuring that wave 1 happens. The 10-year plan will soon be announced. How will the comprehensive spending review announcements help us to shift from a sickness model to a prevention model?

[Karin Smyth]

I thank my hon. Friend for welcoming the Government’s investment in the health service. She has been such a strong campaigner for Shotley Bridge, and it has been a pleasure to work with her; I know she has continued to advocate strongly on behalf of her local population. The hospital is needed, but as she knows, in her community—and all our communities—patients should not always be expected to travel to hospital for care that can be delivered closer to home. We see massive improvements in virtual care and technology, which is why we have announced a £10 billion increase for technology over the spending review period. We are improving the NHS app and ensuring that people are enabled to do more digitally, but I recognise that does not suit everybody, so we will ensure that parallel processes are available for everybody. Our constituents deserve and need care closer to home, and want more of it.

[Ellie Chowns (North Herefordshire) (Green)]

More money for the NHS is of course welcome, although if we in the Green party had our way, it would be raised by taxing extreme wealth fairly, rather than by taxing work. The small amounts of money for social care announced in the spending review are nowhere close to the funding needed to tackle the social care crisis, and the burden is put on local authorities. In the Minister’s Department, there is a reduction in the revenue budget for social care and public health. When will her Government stop going slow on social care? When will they hold the long-promised and much-delayed cross-party talks? When will they recognise, as Lord Darzi has said, that we cannot fix the NHS without fixing social care? A truly joined-up approach to health and social care is long overdue.

[Karin Smyth]

The economics of the Green party are even more fantastical than the economics of the Conservatives and Reform; we all dread to think what things might be like under that party. We see that in the local council in my city of Bristol, and it is an absolute disaster. If the council could just get on with building council houses and social homes, it would help more people to live a better life, and would aid prevention. We are getting on with tackling social care. That was announced in the spending review, and that is what the Casey review will do.

[Peter Swallow (Bracknell) (Lab)]

I warmly welcome the largest-ever capital investment in our NHS in the spending review yesterday, building on the Chancellor’s announcement in last year’s Budget of the money to rebuild RAAC-infested hospitals such as Frimley Park hospital, which will benefit my constituents. That was committed to by the previous Conservative Government, but, shockingly, it was never paid for. With the Government standing four-square behind rebuilding Frimley Park hospital, does the Minister agree it is time for Frimley Health NHS trust to get on and announce the site for the new hospital?

[Karin Smyth]

I thank my hon. Friend for his support for the Chancellor’s statement and our commitment to the NHS. I know he has been working so hard on this issue on behalf of RAAC hospitals and Frimley Park hospital since he became a Member of Parliament last year, and we are four-square behind that work getting on. It is at the beginning of a very long queue in the new hospital programme. It is one of the things we inherited—we wish it was a better inheritance, but we are working with what we have. We have put the new hospital programme on a firm financial footing, and Frimley Park is at the beginning of that queue. We are very keen that people get on with it very quickly, because there are very many other people waiting behind them.

[Graham Stuart (Beverley and Holderness) (Con)]

The hon. Member for North Herefordshire (Ellie Chowns) is absolutely right about social care. We have a system in which healthcare is dependent on social care—Lord Darzi says so, and I think even Ministers have said so—yet all funding is going into the NHS, not into social care. We are fundamentally pouring the money into a bucket with a hole in the bottom. The Minister pretends the exact opposite of the truth. Will she share a more honest assessment with the House? What went on? Labour had 14 years to think about it, and here we are with the funding going into the NHS. As the Father of the House, my right hon. Friend the Member for Gainsborough (Sir Edward Leigh), said, the Minister is following on from the last Conservative Government and pouring more and more money into an unreformed NHS with a social care system underneath it that is broken, and she is not doing anything about it.

[Karin Smyth]

I have already given a history lesson about some of those 14 years. When the Conservatives and the Liberal Democrats were in the coalition together, we had a commitment, a promise and a cross-party agreement; the Conservatives then got into government by themselves and broke it, so we are where we are. We want to invest in social care, which is why we have announced the £4 billion. We are seeing a very interesting alliance going on between our Green and Conservative colleagues; they agree on something, as we saw in the Lobby last week.

[Warinder Juss (Wolverhampton West) (Lab)]

I thank the Minister for her statement and the excellent work that this Government are doing in bringing additional investment in the NHS and bringing waiting lists down. We have had to make really difficult decisions to clear up the mess left by the previous Government, and I am sure we all agree that we need to protect our charitable adult social care providers. Will the Minister facilitate a meeting with myself and Woodlands Quaker Home in my constituency, which provides non-profit residential social care for older people so that they are able to carry on in the best way possible?

--- Later in debate ---

[Karin Smyth]

My hon. Friend makes an excellent point about bringing down waiting lists for his constituents, and we are so pleased to see that that is continuing, as we were able to announce this morning. He also makes an excellent point about social care providers, which do an amazing job for many of us who have close family members supported by them, and it is important that they are supported and work. I am not sure whether an answer to his question about a meeting needs to be from my Department or from my colleagues in the Ministry of Housing, Communities and Local Government, but I will ensure that he has an answer.

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

I welcome the funding announced to repair hospitals with RAAC, which will hopefully include Harrogate district hospital in my constituency. It has already received some money to remove RAAC in one building, which has since been demolished, but it still has a £15 million business case waiting with the Department of Health and Social Care for the next round of RAAC repairs. Will the Minister set out a timetable for repairs to hospitals such as Harrogate’s and for when we should expect to know if we will receive some of that funding?

[Karin Smyth]

We are committed to ensuring that those RAAC hospitals are sorted and fit for purpose, and I was able to visit Airedale myself recently. We are asking people on the ground to do a really difficult job, keeping hospitals going and serving patients while remedying the problem of RAAC. I do not have in front of me the exact timescale for the hon. Gentleman’s hospital, but I encourage it to work very closely with the team at the Department of Health, which I think is working really well. As long as a clear timetable has been put forward, I will ensure that the hon. Gentleman gets a response to his question.

[Amanda Hack (North West Leicestershire) (Lab)]

I thank the Minister for her statement. The NHS is the No. 1 issue for my constituents, and I know that they will welcome the investment in the spending review. My constituency is a rural area, and one thing people often raise with me is ambulance waiting times, which I am pleased to report have improved in every category over the past year. Can the Minister explain how the spending review will ensure continued improvements in ambulance waiting times, supporting my constituents to get emergency care when they need it?

[Karin Smyth]

My hon. Friend is right to raise the issue of ambulances. We ensured that they were a key part of our urgent and emergency care plan, which was issued the week before last, I think—I cannot remember the exact date. We recognise how crucial that issue is, and how much more can be done by ambulances by the roadside. I was privileged to go out with the South Western ambulance service recently; it is so impressive to spend time on the frontline with people who are dealing with whatever comes at them. We know that they can do more, including remotely. We are very keen to ensure that ambulances do not spend time outside hospitals; that is why we have introduced a 45-minute turnaround time through the release to rescue scheme, which has worked very successfully in many parts of the country. We are keen to see that scheme rolled out across the country, so that we do not have ambulances queuing outside of hospitals with people, but put them back on the road where they need to be.

[Greg Smith (Mid Buckinghamshire) (Con)]

We have been here before with Governments of all different political persuasions. Ministers come to the Dispatch Box and trumpet what seem like very attractive amounts of money for the NHS, but the reality on the ground is that that money just about covers pay rises and inflationary pressures. On care, Buckinghamshire council and no doubt all councils are worried that the money being offered up may only just cover things such as the fair pay agreement. Can the Minister confirm from the Dispatch Box that with increasing amounts of councils’ budgets rightly being spent on care, they will get funded for things such as the fair pay agreement separately from core social care spend?

[Karin Smyth]

The hon. Gentleman says that we have been here before, and we really have. I was on a primary care trust board under the last Labour Government, so I saw at first hand what good government, working with local systems, can deliver: the best patient satisfaction in the NHS’s history, the lowest waiting lists, and the best access to GP and primary care. We have been here before, and that is what we will do again. From the hon. Gentleman’s questions, I do not understand whether he wants more spending or less. That is what the Conservative party is still not saying; its Members stand up and ask for more, like Liberal Democrat Members, but they will not identify the means of raising that money—in fact, they oppose them.

To respond to the specific question that the hon. Gentleman asked, over the coming weeks, my colleagues from the Ministry of Housing, Communities and Local Government will obviously be outlining in more detail how the spending review will fall out.

[Alice Macdonald (Norwich North) (Lab/Co-op)]

I welcome this brilliant investment in our NHS, which will also be welcomed by my constituents. I know that this Labour Government will ensure that everyone in every part of the country benefits, including women. Last year, I highlighted that women in Norfolk face the longest waits in the country for gynaecological care, with hundreds waiting more than a year for treatment for conditions such as endometriosis. Can the Minister assure me that as we advance these plans for the NHS, we will ensure that we tackle those waiting lists? Far too many women are paying the price for years of inaction under the Conservatives.

[Karin Smyth]

My hon. Friend has been such a strong and powerful campaigner for women’s health since becoming an MP last year, and she is absolutely right to do that. I am pleased that we have been able to make some progress on conditions such as endometriosis. Many campaigns have been fought by many women in this House—including you, Madam Deputy Speaker, if I may say so—to highlight the importance of this issue. We see women’s health as front and centre. We want to learn from the women’s health hubs in their different guises and ensure that they are an integral part of neighbourhood health services.

[Clive Jones (Wokingham) (LD)]

I was really saddened that there was no mention of cancer in the Minister’s statement, so I will give her the opportunity to correct that omission. Will this new money for our NHS ensure that all cancer waiting time targets are met by the end of this Parliament, and can the Minister confirm that those targets will be included in the 10-year health plan? Finally, have Ministers had a chance to read my 11-page letter and accompanying submission on what should be in the national cancer plan?

[Karin Smyth]

I have a slight “get out of jail free” card, because I think that letter might be with one of my colleagues, not with me. Obviously, though, I look forward to the summary.

The hon. Gentleman makes a really important point about cancer. I would have to check, but I do not think I mentioned lots of disease-specific areas, including key manifesto commitments such as dentistry. Obviously, cancer is a huge part of waiting lists overall. We will get those waiting lists down—we are determined to meet that target—and we will issue a cancer plan later in the year.

[Dr Scott Arthur (Edinburgh South West) (Lab)]

I thank the Minister for supporting the launch of Sarcoma UK’s report yesterday. The recommendations in that report are really important for tackling that awful rare cancer.

I welcome the ambition in what has been presented, but the comparison with what my Edinburgh South West constituents face in Scotland could not be more stark. I have just come from a meeting in which, yet again, I have been trying to defend the mental health provision at Scottish Action for Mental Health’s Redhall walled garden; in contrast, I hear from the Dispatch Box real ambition to support people with mental health problems. People in Scotland are also jealous of the falling waiting lists they see in England, and hope that one day, they will arrive in Scotland. May I ask the Minister to keep on being ambitious, in the hope—because hope is all I have—that some of it will rub off on the Scottish Government?

As Madam Deputy Speaker is feeling a little generous, may I also say that Saturday will mark the 200th Oriam parkrun in my constituency? If we are serious about preventative healthcare activities, parkrun is a great example of how we can improve both our mental health and our physical health. The Minister is welcome to attend, of course.

[Karin Smyth]

I always shudder a little when I am invited to do any running, jogging, boxing or whatever else people get up to—we all have our own things we like doing. Although my hon. Friend’s fabulous city is a great place to be, I will not be able to join in this weekend, but I wish good luck to everybody taking part.

We all live in hope that the SNP might learn some lessons from what we are doing to fix our NHS. We remain willing to work with the SNP, and with anybody who wants to serve patients and get a better service for their taxes. If the SNP wants to get in touch, it can do so, but the best thing to do is to elect a Labour Government in Scotland, which will hopefully happen soon.

My hon. Friend makes an important point about mental health. We are committed, as we said in our manifesto, to 8,500 more people working in mental health, and to ensure that our schools and young people have the support they deserve.

[Ian Roome (North Devon) (LD)]

I thank the Minister for agreeing to visit North Devon district hospital very shortly, and I look forward to welcoming her to my constituency. Despite some welcome extra repairs under the estates safety fund, that hospital now faces many years of make do and mend. What provision have the Government put aside for those years of increasing maintenance costs?

[Karin Smyth]

I thank the hon. Gentleman for his question. His invitation has been a long-running one, and sometimes his diary has been busier than mine, but I think we finally have a date to go to North Devon, which I am looking forward to. It is a challenged system—we had a good debate yesterday in Westminster Hall about many of the problems in Devon, and I know he will review that debate carefully. Devon is one of the systems that we are looking closely at. It has had deficit funding this year, but we want to eradicate deficit funding from the system, so we are looking very closely at how every single system uses all of its money. I know that the hon. Gentleman will continue to support the Government in ensuring that his local taxpayers get the best service for their money.

[Matt Turmaine (Watford) (Lab)]

I welcome the comprehensive spending review and its focus on NHS funding. It will deliver on Labour’s election promise to get the NHS back on its feet, which will be of so much benefit to my constituents. Does the Minister agree that nearly one year on, this Labour Government are really tackling the disastrous Conservative-Liberal Democrat reforms introduced under the Lansley legislation?

[Karin Smyth]

My hon. Friend has been such a strong advocate for Watford since he came into this Chamber, and in particular for ensuring that that hospital is in the new hospital programme. I look forward to visiting his constituency soon, because I know we lost some time.

My hon. Friend is absolutely right. I do not know if he knows this, but others will have heard me say before that one of the terrible consequences of the Lansley reforms was that they made me so angry as a manager in the system that I decided to become a Member of Parliament, and here we are today. We have learned from the lack of focus on the frontline and on patient care. That is why we are so clear—whether in the reforms we have put forward on elective care and urgent emergency care, or in the planned reforms on dentistry and primary care, in the 10-year plan and on social care—that we have to keep a relentless focus not just on taxpayers’ money, but on patients. The people’s priorities are clear. They want the NHS to do better, but they are clear in their demands that we make it work better for them and make sure that every single pound of taxpayers’ money is working to the best effect.

[Mr Adnan Hussain (Blackburn) (Ind)]

I welcome the Minister’s statement and this Government’s commitment to investing in the NHS, but she did not address how that funding will be allocated across the country. My constituency of Blackburn has one of the worst GP to patient ratios, with more than 3,200 patients per GP. That is placing immense strain on primary care and pushing patients to an already overstretched hospital that is frequently on red alert. Will the Minister ensure that areas with such disparities, like Blackburn, receive targeted support? Will she meet me to address these long-standing imbalances in healthcare provision?

[Karin Smyth]

The hon. Gentleman makes an excellent point on primary care, which sees 90% of contacts with the NHS and is where most people experience the NHS. That is why it is very much in our sights to support that work. As part of our 10-year plan, we will bring forward the neighbourhood health service to make sure that people can be seen more locally. That will be built around using primary and community care to best effect. He makes a point about funding formulas. We had a long debate about that yesterday in Westminster Hall, and it is an area of huge controversy. He will see over the coming weeks how the funding is allocated. NHS England did issue—if he has not seen it, I will make sure that he has access to it—guidance on the funding formula and where the different systems are in relation to that. We want to move everybody towards that target, and I am happy to discuss that with him once he has had a look.

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

This Government have made phenomenal progress on the elective care waiting lists left by the last Government, but the progress on mental health waiting lists has been stubbornly slow, with 1.2 million people still waiting for treatment. That includes 62,000 people covered by the West Yorkshire ICB that serves my Calder Valley constituency, which I think is the second-highest figure in the country. Can my hon. Friend please assure me that we will use this settlement to redouble the work we have done on elective waiting lists, while also putting a real focus on mental health waiting lists?

[Karin Smyth]

My hon. Friend makes an excellent point on mental health, which is of great concern to all Members. He is right that elective care and mental health are measured in different ways, but we are committed to supporting mental health services with 8,500 extra staff. We are making sure in particular that young people in schools are supported. We know that the situation has been terrible for young people in our country, and we will continue to provide that relentless focus.

[Jim Shannon (Strangford) (DUP)]

The Labour Government have committed more money to the NHS, and that has to be welcomed. For that reason, I thank the Minister for her statement today. The Chancellor yesterday announced some £50 million—this does tie in to health—for Casement Park. However, the Government were clear that that was dependent on funding from the Northern Ireland Executive. Does the Minister expect the Northern Ireland Executive to take extra moneys granted to the Northern Ireland Assembly through Barnett consequentials and divert them to a sports stadium? Are the moneys for the NHS ringfenced and protected? If not, how do I look parents in the eye in my constituency of Strangford, when their child cannot receive cutting-edge medical technology because money has to be found for a sports stadium?

[Karin Smyth]

The hon. Gentleman is an experienced parliamentarian, and he understands how the funding settlement for the Department of Health and Social Care is allocated through the Barnett formula to Northern Ireland.

[Josh Newbury (Cannock Chase) (Lab)]

This investment is so welcome, because my constituents in Cannock Chase have been struggling to access urgent care between their GP and accident and emergency since our hospital’s minor injuries unit was temporarily closed in March 2020. Despite the welcome investment in Rawnsley surgery, Chadsmoor medical practice and Red Lion surgery in my constituency, our ICB plans to kibosh any hope of our MIU reopening. Does the Minister agree that this Government’s huge investment in our NHS needs to be felt in the parts of the country, such as my towns and villages, that were so badly let down by the Conservatives? Will she meet me to discuss the worrying urgent care reform proposals for Staffordshire?

[Karin Smyth]

I thank my hon. Friend for welcoming the extra support for GP and primary care. I am sure he understands from our urgent and emergency care plan that we have a number of arrangements for making sure that people are seen urgently in local community settings. It is for local ICBs to decide on the best way, within that urgent emergency care plan, for people to be seen locally and treated within the available resources. I am happy to meet him, perhaps at an upcoming surgery, to discuss that further.

[Chris Webb (Blackpool South) (Lab)]

My constituents in Blackpool South will never forgive or forget that the previous Government left us with the worst health outcomes in the country. We have an ICB having to make £350 million of cuts. The hospital that my son and I were born in has been left inadequate and one of the worst in the country. We have dental deserts. People cannot get access to mental health counsellors or GPs. I welcome the millions of pounds allocated to Victoria hospital and to health outcomes in my constituency by this Government, and we are seeing waiting lists finally coming down. Does the Minister agree that we need to continue on this path and give deprived areas, such as Blackpool, more support to get our waiting lists down to an acceptable level?

[Karin Smyth]

My hon. Friend is absolutely right that his constituents and constituents across this country will not forgive the Conservatives for the state in which they left the NHS. That is clear from Lord Darzi’s diagnosis. We have still had no comment from the Conservatives on whether they acknowledge that. We are determined to be about the future, and that is what this settlement and the Chancellor’s announcement yesterday are about. It is about putting that extra funding that we raised last year into services and into a reformed system that reaches all parts of this country. We will tackle health inequalities, making sure that people who have not had that access and people who suffer worse health than others are raised up. We must take the best of the NHS to the rest of the NHS.

[Madam Deputy Speaker (Caroline Nokes)]

After more than an hour of diligent bobbing, I call Chris Vince.

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

Apologies for my premature bobbing earlier, Madam Deputy Speaker.

I thank the Minister for her statement today and for her ongoing commitment to the NHS. I welcome the growth in day-to-day spending on the NHS and this Government’s commitment to bringing down NHS waiting times. However, may I gently advocate for Harlow in respect of the future of the UK Health Security Agency? It has a business case, details, designs and a site ready to go, and the estimated timeframe has consistently been assessed as the best value for money and the quickest to deliver.

[Karin Smyth]

I like how my hon. Friend says “gently”, because honestly no day goes past without him talking about this issue or, indeed, his new hospital. He is right, and he is a fantastic campaigner for the people of Harlow. He has made his point again, and I cannot make any further comment today, but he will be hearing from the Secretary of State soon on that issue.

[Madam Deputy Speaker]

I thank the Minister for her answers this afternoon. I ask anyone who is leaving before the Select Committee statement to do so quickly and quietly.

NHS Funding: South-west

Karin Smyth Excerpts

Wednesday 11th June 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Dr Huq. I thank the hon. Member for Torbay (Steve Darling) for securing the debate. We could have had more time, as this is an important issue for us all across the whole south-west. I thank colleagues for taking part.

The hon. Gentleman is right that the system has real challenges receiving deficit funding in our part of the NHS recovery support programme. He will rightly be following that closely. In the autumn Budget, which I think virtually everyone in this room disagreed with, the Chancellor took the necessary decisions to put our NHS on the road to recovery, with a more than £22.5 billion increase in day-to-day health spending and over £3 billion more in the capital budget over this year and the last. Today, the Chancellor has announced the conclusion of the spending review, with £29 billion more day-to-day funding in real terms than in 2023-24. There is a £2.3 billion real-terms increase in capital spending over the spending review period—something I hope everyone welcomes.

The SR puts the NHS on a sustainable footing by cutting waiting lists so that by the end of this Parliament 92% of patients will start consultant-led treatment for non-urgent health conditions at 18 weeks, delivering on the Prime Minister’s plan for change commitment and prioritising people’s health. To respond to the hon. Member for Bath (Wera Hobhouse), we do encourage use of the independent sector for capacity, and that is a decision for ICBs to make sure they achieve those standards. The settlement also supports the shift from analogue to digital, with a total investment of up to £10 billion in NHS technology and transformation between ’26-27 and ’28-29, and an almost 50% increase from ’25-26. I agree with the right hon. Member for Salisbury (John Glen) that technology offers huge opportunities in geographies like ours.

Thanks to the Chancellor, we are taking the necessary steps towards fixing the foundations of our NHS and making it fit for the future. Since coming into office, the Government have published our urgent and emergency care plan, which will support the NHS across England to improve the timeliness and delivery of care to patients requiring urgent and emergency care over the next year, including for next winter. We are delivering on our plan for change through the accelerated roll-out of the NHS app. We will create an NHS fit for the future and continue to invest in the latest technology, shifting healthcare from analogue to digital.

Our investment and reform in general practice, to fix the front door to the NHS and bring back the family doctor, includes an additional investment of £889 million. We have published our elective reform plan, which will cut waiting times from 18 months to 18 weeks. We have exceeded our pledge to deliver an additional 2 million appointments, tests and operations—we have delivered over 3 million more. Waiting lists have fallen for the sixth month in a row and have now been cut by over 219,000 since we came to office. The Government have committed to a10-year health plan that will lead the NHS to meet the challenges set out in the plan for change to build the NHS for the future, and it will be coming very soon.

I know that hon. Members across the House share the concerns of the hon. Member for Torbay about the crumbling NHS estate after years of neglect. I wish to assure Members that my right hon. Friend the Chancellor has given us the funding to begin reversing the trend of decline in the south-west and nationwide, with health capital spending rising to £13.6 billion this year.

In the south-west region, allocations have been made totalling £448 million in operational capital, empowering systems to allocate funding to local priorities; over £238 million from our constitutional standards recovery fund to support NHS performance across secondary and emergency care; and £83 million from the £750 million estates safety fund to deliver vital safety improvements, enhance patient and staff environments and support NHS productivity. This includes £7.3 million for Torbay hospital in the constituency of the hon. Member for Torbay; £10 million from our primary care utilisation fund for improvements in the primary care estate; and almost £5 million to help to reduce inappropriate out-of-area placements for mental health patients in the south-west.

ICB allocations have been talked about a lot today. For the south-west, they have been confirmed as totalling £11.5 billion out of a total of £116.7 billion allocated for England. The regional allocation per capita for the south-west is above the national average. We heard from my hon. Friends the Members for South Dorset (Lloyd Hatton) and for Bournemouth East (Tom Hayes) that the signs are being seen in their constituencies.

[Richard Foord]

Will the Minister give way?

[Karin Smyth]

I am going to just complete these points, so that I can try to address as many points as possible.

In the constituency of the hon. Member for Torbay, the local ICB, NHS Devon, receives £2.5 billion of the £11.5 billion for the south-west. The allocation per capita for Devon is higher still, and above the south-west regional average. Likewise, NHS Cornwall and the Isles of Scilly ICB received just over £1.2 billion of that £11.5 billion total. The allocation per capita for Cornwall and the Isles of Scilly is above the south-west regional average and national average.

To respond to the hon. Member for St Ives (Andrew George), I understand from NHS England that the ICB has had the debt written off, so that might be something he wants to follow up. My hon. Friend the Member for Truro and Falmouth (Jayne Kirkham) and others talked about funding allocations—we could talk about this for a very long time. They are difficult things to get right, and are controversial, but the funding formulation does account for older people and for rural populations.

The latest financial performance position publicly available is for quarter three of last year. It showed an overall deficit position of £51.7 million against the year-to-date plans, of which Dorset ICS had the largest variance of £27.7 million. Final end-of-year positions are still being finalised and will be made publicly available in due course. For ’25-26, NHS systems overall have received £2.2 billion of deficit support funding in their allocations. All systems in the south-west have now agreed a balanced plan for ’25-26. The position on deficit support for ’26-27 will follow the spending review settlement for individual organisations agreed as part of the planning guidance process.

NHS England will continue to support all organisations to deliver financially sustainable healthcare through a range of improvement measures, some of which we have heard about today. Devon integrated care board, and three trusts within the ICB, are currently part of the recovery support programme, which provides intensive support to challenged organisations. Where organisations are struggling significantly, the Department of Health and Social Care provides cash support to support the continuity of patient services—obviously, that is critically important. So that colleagues are aware, I am personally meeting with finance colleagues from NHS England and the Department of Health every week to support that work. We are clear as a Government that we need to be certain that every pound of taxpayers’ money is used to best effect, and that best practice is followed in this region and across the entire NHS.

The hon. Member for Torbay asked about coronary services, and that is a local decision. NHS Devon and Torbay Foundation Trust have proposed undertaking a test-and-learn process for out-of-hours primary percutaneous coronary intervention. That service will be provided in Torbay and Exeter, which would involve a temporary change to provide out-of-hours services at Exeter only. Members will be aware that the ICB was due to make a decision on the pilot at its board meeting in May. However, following significant local feedback, the ICB has decided to reflect on those issues raised, and I am sure the hon. Member for Torbay will be following up on that. The ICB will be providing an update at its board meeting in July.

In conclusion, the Government are taking the necessary steps to fix the NHS, and the Chancellor’s spending review settlement puts the NHS further on the road to recovery. I assure Members that we will write back to them on any other individual points raised.

Attention Deficit Hyperactivity Disorder

Karin Smyth Excerpts

Tuesday 10th June 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Ms Jardine.

I thank the hon. Member for Henley and Thame (Freddie van Mierlo) for securing this important debate on support for people with ADHD, and for sharing the experiences of his constituents in Oxfordshire. I know that the hon. Gentleman and others wrote to the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock) about many of the issues he raised today; I hope he found the Department’s response to that letter useful. I thank other colleagues for their interventions. These issues also affect my own constituents, and I see them in my inbox, so I understand their impact on families and communities.

First, we must be honest about the challenges. The Government inherited a broken NHS with too many patients facing long waits to access services, including ADHD assessments and support. Lord Darzi’s report laid bare that the growth in demand for ADHD assessments nationally has been so significant in recent years that it risks completely overwhelming the scarce resources available. The report also shows that, at current rates, it would take on average eight years to clear the backlog of adult ADHD assessments and that for many trusts the backlog would not be cleared for decades. We absolutely recognise the need to better understand the factors behind the rise in demand for services to ensure that we offer the right support.

The hon. Member for Henley and Thame asked why his trust has closed its waiting list. In preparing for the debate, I asked officials to give me a clearer understanding of what is happening in the Buckinghamshire, Oxfordshire and Berkshire West ICB, which saw a near 50% increase in referrals year on year between 2019 and 2024. I am pleased that the hon. Gentleman has had contact with the chief executive. The trust felt that it could not cope with that level of demand because it viewed it as an unmanageable risk to patient safety and staff wellbeing. That is why it made the difficult decision to close the waiting list for new adult ADHD assessments in February last year. That was the trust’s decision.

As someone who worked in the system over the peak years of austerity—some people may remember them—I completely understand how trusts are often confronted with such decisions. The recent growth in demand seems quite exceptional. Integrated care boards are responsible for commissioning services in line with the health and care needs of the people they serve. It is up to local decision makers to make tough choices, because they know the situation on the ground better than Ministers in Whitehall.

I understand that the ICB has established an ADHD programme steering group to stabilise its services, and it is working with local partners, including people with lived experience, to develop a new service model aimed at addressing health inequalities, providing a single-service model across the ICB, with a single provider, and providing support for people who do not benefit from medication. I understand that the trust is working to open a service for 18 to 25-year-olds as an interim measure to help those who transition from children and young people’s services to adult services, which we know is a difficult time in their lives. I am sure that the hon. Gentleman will maintain a close watch on those commitments.

[Carla Lockhart (Upper Bann) (DUP)]

Following on from the intervention by the hon. Member for North Down (Alex Easton), I know that this is a devolved matter, but the issues are exactly the same in Northern Ireland as in GB, with long waiting lists and a lack of access to services. Does the Minister agree that people with ADHD are being discriminated against right across the United Kingdom because of the lack of access to services? Does she also agree that, in the interim, those who go for a private diagnosis should be able to enter into a shared care arrangement so that they can access the medication that assists them to function day to day, live normal lives and be part of our society?

[Karin Smyth]

I will come on to shared care agreements. As the hon. Member says, this is a devolved matter, and I am focusing on support for issues facing ADHD services in England and what we are doing to support trusts to get back on top of waiting lists and improve access to services.

First, NHS England has commissioned an independent ADHD taskforce, which is working to bring together those with lived experience and experts from the NHS, education, charity and justice sectors. The taskforce is developing a better understanding of the challenges affecting those with ADHD, including timely and equal access to services and support. I can confirm today—I know that this will be of interest to many hon. Members—that the taskforce will publish its interim findings shortly, with a final report expected after the summer recess. The interim report will helpfully focus on recommendations that support a needs-based approach, beyond just the health system, in which people can access support based on their needs, not their diagnosis. The report will also set out recommendations for support to be provided beyond medication, and by healthcare professionals other than specialists.

Secondly, NHS England recently published an ADHD data improvement plan to inform future service planning, and on 29 May it published management data on ADHD waiting lists. Thirdly, it has been capturing examples from ICBs that are trialling innovative ways of delivering ADHD services and using that information to support systems to tackle waiting lists and provide support.

Fourthly, as part of the Government’s five long-term missions, we have launched the 10-year plan to deliver the three big shifts that our NHS needs to be fit for the future: from hospital to community, from analogue to digital, and from sickness to prevention. All those shifts are relevant to supporting people in all parts of the country with a range of conditions such as ADHD.

Fifthly, we are supporting innovation. Earlier this year, at a parliamentary event, many of us will have met innovators who are supported by NHS partners. I heard about the QbTest technology that complements the knowledge and skills of clinicians as part of the ADHD assessment process. I understand that 70% of NHS children’s ADHD services already use that technology, and the evidence suggests that it has a positive impact in making the assessment process swifter and simpler.

[Freddie van Mierlo]

Will the Minister comment on the fact that in Oxfordshire there is no commissioned service for the specialist reviews that NICE requires annually as a condition of being on the powerful medication? How can it be that someone can be started on medication but have no route to continue on it because they cannot get their annual review?

[Karin Smyth]

I am not aware of the detail of the pathway in the hon. Member’s ICB. I suggest that that is a matter for him to discuss with the ICB, which will have heard his question about how it is delivering those services on the ground.

Members raised issues around shared care agreements and the difficulties that people with ADHD are experiencing in accessing medication through such agreements, particularly when they have received a diagnosis through a private provider. It is the responsibility of secondary care specialists such as consultants, rather than GPs, to initiate treatment of ADHD. However, sometimes a shared care agreement, in which the GP takes over monthly prescriptions and routine monitoring once the patient is happy with their medication and dosage, can be put in place. The General Medical Council, which regulates and sets standards for doctors in the UK, has issued guidance to help GPs decide whether to accept shared care responsibilities for any condition. NHS clinicians need to be content that any prescriptions or referrals for treatment for any condition are clinically appropriate. All shared care arrangements are voluntary, so even where arrangements are in place, practices can decline shared care requests on clinical or capacity grounds.

If I may, Ms Jardine, I will take the opportunity to update the House on the supply of medicines, which has also been raised by colleagues; I understand that it was raised at business questions recently, too. The Government recognise the difficulties that some people have experienced with accessing ADHD medication due to medicine supplies. We know how worrying and frustrating those shortages are for patients and families. I am pleased to say that we have resolved many of the outstanding issues affecting the supply of lisdexamfetamine, atomoxetine capsules, atomoxetine oral solution and guanfacine prolonged release tablets. However, some specific manufacturers continue to have issues with methylphenidate.

We continue to work with manufacturers to resolve remaining issues. In fact, I met the medicine supply team this morning, as I do very regularly, to make sure we are on top of these issues as much as we can be. The team is working hard to make sure that the situation improves. Where issues remain, we are directing suppliers to secure additional stocks, expedite deliveries where possible, and review plans to support continued growth in demand for the short and long term. We have worked with specialist clinicians during this time to provide comprehensive guidance to healthcare professionals where there is a disruption to supply. We keep the Specialist Pharmacy Service website up to date with the latest availability of ADHD medicines. I commend it to people listening to the debate and to hon. Members. It also provides comprehensive guidance on switching to alternative treatments, supporting clinicians to make informed choices with their patients.

I can assure colleagues that, as the Minister responsible for medicine supply, I will instruct officials to keep a close eye on this issue, so we do not see any of the progress we have made undone. I plan to hold an event, hopefully in Parliament and possibly in the autumn, to keep updating hon. Members on this issue, because I know it is one that concerns us all.

In closing, I want to address the young people who may be watching or tuning into the debate at home. I know it is tough for many neurodivergent kids today. You might be stuck on a waiting list, suffering at school or struggling to find your medicine. We really do care about this. We are trying to get to grips with some of the problems we found when we came into office, and I hope you will start to feel that progress within the next few years.

[Rachel Gilmour]

May I bring the Minister back to the subject of my earlier intervention? Will she, as a matter of urgency, take it up with the Home Secretary and get a decision? We should not discriminate against people with ADHD by preventing them from joining the services, whether it be the police, the Army, the Royal Navy or the RAF. I am so shocked about this I am like a dog with a bone—I cannot let it go.

[Karin Smyth]

I will ensure that the hon. Lady gets a reply on that issue.

I thank the hon. Member for Henley and Thame for securing this important debate and for giving me the chance to put on the record some of the issues the Government are addressing. The Government know there is much more to be done to get better access to timely diagnosis and support for all our constituents, but I hope the actions I have set out today provide some reassure to the hon. Gentleman and other colleagues.

Question put and agreed to.

NHS Urgent and Emergency Care Plan 2025-2026

Karin Smyth Excerpts

Monday 9th June 2025 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

Today I am updating the House on the publication of our NHS urgent and emergency care plan for 2025-26. This plan sets out the key actions and milestones across 2025 and 2026 that will support the NHS across England to improve the timeliness and delivery of care to patients requiring urgent and emergency care.

The most recent winter clearly showed that, despite the hard work and compassion shown by NHS staff up and down the country, patients did not receive the standard of care we all expect.

Every day, more than 140,000 people access urgent and emergency care services across England. Since 2010-11, demand has almost doubled, with ambulance service usage rising by 61%.

A&E waiting time standards have not been met for over a decade, while the 18-minute target for category 2 ambulance calls has never been hit outside the pandemic. We know that something has to change.

This Government have committed to a 10-year health plan, which will lead the NHS to meet the challenge set out in the plan for change, here www.gov.uk/government/publications/plan-for-change to build an NHS that is fit for the future.

But we know that we cannot stand still. That is why we asked the Department of Health and Social Care and NHS England to work together to develop an urgent and emergency care plan for 2025-26.

This delivery plan focuses on improvement activity in line with the current round of NHS operational planning guidance. It is vital that we have clear, shared objectives, which is why we have instructed the NHS to focus as a whole system on those improvements that will have the biggest impact. We will make sure that this winter is significantly better than recent winters by setting ambitious but achievable targets and increasing transparency about progress.

In hospitals, the plan will ensure at least 78% of patients who attend an A&E department are seen within four hours—more than 800,000 people receiving more timely care than last year. To support care settings, the plan confirms that we will allocate almost £450 million of capital investment, including for same day emergency care and mental health crisis assessment centres, ensuring that patients who would otherwise be unnecessarily admitted to hospital can be assessed, diagnosed and treated on the same day and then discharged without an overnight stay.

We know that at least one in five people who attend A&E do not need urgent or emergency care, while an even larger number could be better cared for in the community. We will renew our focus on improving vaccine uptake, making it easier than ever to access vaccination appointments closer to home. We will also improve vaccination rates among health staff to prevent them from getting flu—reducing the number of sick days and ensuring that staff are well and able to care for patients across the busy winter period.

We will continue to invest in data and digital tools to speed up and improve patient care, ensuring that paramedics across the country can access patient records on the move, enabling them to provide better care and avoid unnecessary admissions.

These measures mark a fundamental shift in our approach to urgent and emergency care—moving from fragmented efforts to genuine collaboration across the whole system—and mean better co-ordination between NHS trusts and primary care to identify patients who are most vulnerable during winter.

[HCWS686]

Breast Cancer Screening: Bassetlaw

Karin Smyth Excerpts

Monday 9th June 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I thank my hon. Friend the Member for Bassetlaw (Jo White) for bringing forward this debate on a really important topic that is close to my heart and, I know, the hearts of so many other hon. Members. It is really important to ensure that as many women as possible take up the offer of screening. They should not feel embarrassed to seek help if they feel something untoward when checking their breasts.

My hon. Friend has spoken really eloquently, and has been supported by other colleagues. As she has done on other occasions, she has highlighted her family’s experience of losing a loved one due to the fear of seeking medical advice, and she is right to raise the issue of the downturn in women choosing to be screened in her constituency and, sadly, across the country.

Survival rates for breast cancer can be good. If breast cancer is found early, at stage one, the five-year survival rate can be as high as 98.2%, but the five-year survival rate plummets to 26.6% when breast cancer is not found until stage four. The earlier breast cancer is caught, the earlier it can be treated, and the more likely it is that the patient will recover.

Everyone is encouraged to check their breasts for lumps. There have been some excellent public health campaigns over the years from various charities explaining what to look for, be it a lump, a discharge or a dimpling of the skin on the breast. If a change is found, it is essential that no time is wasted before contacting a GP. That is why screening is an essential tool in our arsenal when trying to prevent this disease.

A mammogram can identify breast cancer before it is large enough to be felt. The NHS national breast cancer screening programme invites all women aged 50 to 71 to attend a screening appointment once every three years. Mammograms can be uncomfortable, as those of us who have had them know, and many women have anxiety about having to get undressed in front of strangers, but that short discomfort could save a life. It is important that we encourage all women not to put off their scans.

The NHS breast screening programme was badly affected by the pandemic, as we have heard this evening. Screening for breast cancer was paused, and when it restarted, the number of women taking up the offer did not recover to pre-pandemic levels. Even after the backlog of missed appointments had been cleared, the take-up of invitations was low, and data indicates that lots of women are still not coming forward to start their screening journey. The NHS is doing more to help to drive up engagement, and we can all do more to help, as my hon. Friend is doing.

The most recent NHS data shows that breast cancer screening uptake in the area including my hon. Friend’s constituency is reported at 74.1%, with an achievable standard of 80%. That is higher than the national average of 70%, but it is short of that achievable high standard. Also, the percentage of women screened within 36 months of their previous screen is reported at 97.5%, versus the acceptable standard of 90% and the achievable standard of 99%.

While more can clearly be done to increase uptake, I hope that those figures for the entire patch that includes my hon. Friend’s constituency provide some reassurance that women are coming forward to be screened. However, I absolutely take the point made by her and her colleagues that the data needs to be understood at a more granular, local level—particularly data on the women coming forward in areas of high deprivation. I will ensure that my hon. Friend has access to that information following this debate.

I am pleased that the Doncaster and Bassetlaw teaching hospitals breast screening service has made significant improvements over the past year to improve attendance at appointments. I really commend my hon. Friend’s “Love your boobs” campaign, and the work that she has highlighted with local women like as Liz, Maria, Barbara, Claire and Lynn, and with men such as Danny, which makes the point that is important that men also check. The service has recently expanded availability by offering more appointments outside traditional hours. It has extended its clinic hours, and has regular Saturday appointments. The invitation method has also been changed from open appointments to timed and dated appointments, which has been shown to help increase engagement, and the service has met with the Cancer Alliance and commissioners to review ways of increasing uptake. I understand that Doncaster and Bassetlaw teaching hospitals’ breast screening service is planning to invite my hon. Friend to visit a clinic in her constituency. I hope that visit will furnish her with further information about local efforts to increase uptake, and I know she will make sure that visit happens.

In February this year, the NHS launched a national breast screening awareness campaign to encourage more women to take up the offer of screening, and debates such as the one we are having tonight help raise awareness of its importance. We are not complacent: as well as increasing the uptake of routine screening, we need to make sure that the women who are most at risk are screened more frequently. The breast screening after radiotherapy dataset, or BARD, programme is working to identify and invite women who received radiotherapy involving breast tissue when aged between 10 and 35. As we have heard this evening, genetic tracing programmes are also looking at identifying carriers of genes, including BRCA, that predispose individuals to a higher risk of breast cancer. Those women are entitled to more frequent screening, and we need to ensure that they are identified and informed.

The UK national screening committee is considering other changes to the breast screening programme. It is looking at whether women with denser breasts need to be screened differently, and an ongoing trial called BRAID—breast radiography to aid identification of cancers in dense breasts—is looking at breast density. The UK NSC is discussing the first findings of that trial, which I am sure hon. Members will maintain a close interest in. It will continue to review BRAID and other findings as they become available to ensure that early decisions can be made to keep the screening programme updated and dynamic.

We are also investigating the age thresholds for screening. Currently, only higher-risk women are invited for screening below the age of 50. The programme stops at the 71st birthday, although women aged over 70 can choose to opt back into regular screens. A trial called AgeX is reviewing whether an additional screen three years before and three years after the existing age thresholds would increase the effectiveness of this programme and ultimately save more lives, and the EDITH research study is looking at whether artificial intelligence can be used to support the reading of mammograms. If it can, that could relieve pressure on the workforce and allow more screens to take place, as there would be increased capacity to translate the results. The Government have already invested £11 million in that trial, and we keenly await the results.

More widely, the Government are committed to tackling breast cancer and ensuring that women get diagnosed and treated faster and more efficiently. That is why we will publish a national cancer plan later this year. That plan will have patients at its heart and will cover the entirety of the pathway, from referral and diagnosis to treatment and ongoing care, as well as prevention, screening, research and innovation. It will seek to improve every aspect of cancer care to improve the experience of, and outcomes for, people with cancer. Our goal is to reduce the number of lives lost to cancer over the next 10 years.

I again thank my hon. Friend the Member for Bassetlaw and other hon. Members for being in the Chamber this evening, giving this House an important opportunity to shine a light on the lifesaving importance of breast screening. My hon. Friend is doing a great service in publicising her work with the NHS, and I wish her good luck with Race for Life. We all have the same goal, and together, we can improve outcomes and increase the number of women surviving breast cancer.

Question put and agreed to.

NHS Supply Chains: Eradicating Modern Slavery

Karin Smyth Excerpts

Thursday 5th June 2025 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

Modern slavery includes forced labour, human trafficking and exploitative labour conditions and it remains a significant global rights violation, with an estimated 50 million individuals affected worldwide. The UK Government are committed to eradicating the presence of this heinous crime in its supply chains, including those within the health sector.

The NHS is one of the UK’s largest procurers of goods and services, and as such has a significant role to play in combating modern slavery. The Government, supported by NHS England and the Department of Health and Social Care, will send a clear signal that there is no place for goods and services linked to modern slavery in our healthcare system. I am pleased to announce that we are taking decisive action to eliminate modern slavery in NHS supply chains in England by proceeding to introduce robust regulations.

In my statement published on 21 November 2024, I confirmed DHSC’s pledge to create regulations to eradicate from the NHS goods and services tainted by slavery and human trafficking, as required by the National Health Service Act 2006. The Department has worked hard to ensure that regulations are fit for purpose and interact with the current legislation and updated policies.

The review of modern slavery risk in NHS supply chains published on 14 December 2023 found that 21% of suppliers are at high risk of slavery and human trafficking. The review recognised the need to improve and standardise the approach to modern slavery risk management. It recommended that DHSC proceed to introduce regulations to enforce and enable a consistent approach to risk management across the NHS.

Modern slavery is a complex issue that cannot be tackled through a singular legislative measure. There are existing measures in place to tackle modern slavery both in terms of criminalising it and addressing it through commercial levers. The Modern Slavery Act 2015 provides a legal framework for punishing those committing modern slavery offences. These provisions do not regulate public bodies or provide a framework for public bodies to address modern slavery in their supply chains. The Procurement Act 2023 provides a single framework for the rules and procedures that public procurement bodies must follow. It includes grounds for the mandatory or discretionary exclusion of suppliers from a tender process where modern slavery offences have been committed. Procurement of healthcare services for the NHS in England—approximately £60 billion—are not in scope of the Procurement Act 2023. They are covered by the Health Care Services (Provider Selection Regime) Regulations 2023, which give NHS decision-makers flexibility to arrange services in the best interests of patients, the taxpayer and the population. We aim to introduce a single, enforceable approach to modern slavery that sets a standardised risk management approach across the NHS, covering all the supply chains for goods and services provided to the NHS.

These regulations will require all public bodies to assess modern slavery risks in their supply chains when procuring goods and services for our health service in England. We are then asking public bodies to take reasonable steps to address and, where possible, eliminate the modern slavery risks when designing procurement procedures, when awarding and managing contracts, and when setting up frameworks or dynamic markets.

Reasonable steps may include: ensuring robust conditions of participation and assessment criteria are built into procurement processes; using specific contract terms to monitor and require mitigation where instances of modern slavery are discovered; and monitoring suppliers’ compliance and reassessing risk throughout the life of the contract.

We invited views and contributions from a wide range of stakeholders through extensive engagement and public consultation. We sought and considered input from public bodies, suppliers, trade associations, interest groups and the public. This has been a valuable step in the development of our regulations, which we intend to lay before Parliament soon.

The public consultation ran from 21 November 2024 to 13 February 2025. We are pleased to announce that the Government’s response to feedback received has now been published.

This is a step towards strengthening the Department’s leadership role in championing ethical procurement, setting a benchmark for other sectors beyond health. Modern slavery is an abhorrent crime that exists everywhere, not just the UK or within supply chains of the health sector. It demands a collective international response. DHSC has a duty to eradicate the use of goods and services tainted by modern slavery in NHS supply chains. We have a continued commitment to work across Government and sectors to ensure our efforts align with these priorities and uphold the responsibilities of public bodies within our jurisdiction.

[HCWS683]

Yeovil Hospital: Maternity Unit

Karin Smyth Excerpts

Tuesday 3rd June 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I thank the hon. Member for Yeovil (Adam Dance) for securing this important debate about the temporary closure of maternity services at Yeovil district hospital. I know, having given birth to three myself, that choosing where to give birth and the planning of that journey, as has been outlined, is incredibly important for women. We are determined that all women are given choice over their care and are listened to and supported with compassion. The hon. Member is an advocate for the Yeovil community, and I welcome his representations, ensuring that his constituents’ voices are heard. That is an important role for Members of Parliament.

I will start by acknowledging the concerns that hon. Members have raised on their constituents’ behalf, both in their letter and in this debate, and I hope I can update them on the relevant issues as they stand. In preparing for this debate, I have met the trust and Somerset ICB, and I am grateful for their time and briefing on these issues.

As hon. Members know, the trust cannot safely staff the paediatric service as well as the special care baby unit. This means that it has taken the difficult decision to close the special care baby unit, which also means that it cannot safely provide maternity services—I think that point was acknowledged by the hon. Member for Yeovil.

The hon. Member is concerned about the process followed by Somerset NHS foundation trust in coming to this decision, particularly about it not having consulted the local council, MPs or other stakeholders. He also identified concerns about the information going to staff. In some situations, such as this one, NHS providers may need to make a temporary service change due to a risk to the safety or welfare of patients or staff. Legislation allows them to do so without consulting the scrutiny committee beforehand, provided that that service change is needed for safety or welfare reasons. I understand that the trust briefed Somerset county council’s health overview and scrutiny committee on 15 May, and has committed to further updating the committee in October. The trust has had one-to-one conversations with affected women and families to help them with alternative plans, which have been supported by Somerset Maternity and Neonatal Voices Partnership.

[Adam Dance]

Does the Minister agree that the timescale given to our NHS staff, and telling them on Teams or not telling them at all—with them finding out on social media—is not the right way to treat them? Imagine how that makes those staff feel.

[Karin Smyth]

I am not aware of the operational details of how the decision was communicated, but I am happy to come back to that. As I have said, when decisions are made for reasons of safety—which is of primary importance—sometimes staff will not be able to be consulted in the usual way. Of course, some staff will not be working at a given time, or may be on holiday, and organisations have to take particular measures to inform staff. I appreciate that that is very disruptive and personally distressing for staff who have been working in a unit and need to know where to go, but emergency situations sometimes necessitate things not being done as robustly as might be desired.

Local leaders have assured me that this closure is not intended to be permanent—that is very important for hon. Members and their constituents to understand. The trust is committed to reviewing the position in three and six months, and following the three-month review, Somerset ICB will provide an update in September. Finally, once a decision is made, any permanent change would need to be based on clear evidence of better outcomes for patients.

On the wider issue that has been raised this evening, as hon. Members will be aware, the Government’s position is that changes to NHS services should always be locally led and clinically evidenced. Any decision about the next steps for the neonatal and maternity services at Yeovil hospital should be taken by the local NHS, with support from the Care Quality Commission. I understand that work is currently under way to mitigate the impact of the closure and move towards safe operation of services. The NHS England South West regional team is working with the trust and the ICB to mitigate the risk of the closure and ensure that the wider systems work together to provide safe services. The trust is working closely with neighbouring hospitals in Bath, Salisbury, Poole, Dorchester and Exeter to ensure sufficient capacity, which should provide assurance to local people.

Regional team clinical leaders have attended a rapid quality review meeting with ICB and trust clinical leaders, and work continues on mitigating the risks that have been identified. I have been assured that Somerset ICB will monitor progress against improvement plans, formally noting any new or emerging risks and actions required. It will also be monitoring the impact on Musgrove Park maternity unit. I understand that Somerset NHS foundation trust and Somerset ICB have also written to the hon. Member for Yeovil since the closure and that there is due to be a call with local MPs tomorrow. I think that is good progress; as I said to representatives of the trust when I met them, I commend that way of operating with local Members of Parliament. I hope it is helpful in having detailed conversations locally to reassure hon. Members and—more importantly, if I may say so —their constituents at what I appreciate is a really difficult time for women who are either due to give birth, or are thinking about starting a family.

We are committed to tackling staffing challenges that the NHS faces, such as this one. For the maternity workforce, NHS England is undertaking a programme of targeted retention work for midwives. This includes a midwife retention self-assessment tool, a mentoring scheme, strengthened advice and support on pensions, and flexible retirement options.

NHS England has also invested in unit-based retention leaders, who focus on retention and give pastoral support to midwives. This initiative, alongside investment in workforce capacity, has seen a reduction in the number of vacancies and in leaver and turnover rates. Maternity care remains a top priority for providers, as is demonstrated in the planning guidance, in which the NHS was instructed to improve safety in maternity and neonatal services as a priority.

I know that there is concern in Somerset more widely about how this change will affect services in the local area. Let me reassure Members that NHS Somerset is committed to investing in local services for both hospitals there. That includes a commitment to a fully functioning district general hospital in Yeovil. The Yeovil diagnostic centre, which is due to open later this year, will be a modern, three-storey, state-of-the-art centre based at Yeovil district hospital. It will have the capacity to deliver an additional 70,000 diagnostic tests and out-patient appointments each year and to be open seven days a week, providing radiology, endoscopy and cardiology services, audiology tests and out-patient appointments.

I thank the hon. Member for Yeovil again for raising this important issue. I know that he and his colleagues will keep a close eye on progress. I hope that I have responded to his immediate concerns tonight, and I will of course write to him and other Members shortly in response to their letter of 19 May.

[Sarah Dyke]

May I raise the issue of maternity services at Musgrove Park hospital, which will be taking on a number of patients? An upgrade that was due has now been pushed back to the mid-2030s. At present, maternity services are provided in a 1940s dormitory-style building. Does that really show mothers-to-be that their needs are being prioritised?

[Karin Smyth]

I am of course aware of that, because I lead on the new hospital programme. The Government are committed to a clear timetable for the programme, which includes Musgrove Park. In our Budget last autumn, we announced decisions—which the hon. Lady and her colleagues did not support—involving capital plans and ensuring that that programme is now on a financial footing that it was not on previously.

I am confident that the local NHS is aware of the impact of this change and continues to work hard to improve the situation. Any change in NHS services must be made with the utmost sensitivity to local views, while also prioritising safety. I know that Members will continue to monitor this issue, and I will ensure that they receive a response to the letter of 19 May.

Question put and agreed to.

Access to NHS Dentistry

Karin Smyth Excerpts

Thursday 22nd May 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I thank the hon. Member for Sleaford and North Hykeham (Dr Johnson); I could not have asked for a better set-up. I pay great tribute to my hon. Friend the Member for Great Grimsby and Cleethorpes (Melanie Onn). This is an issue she has pursued for some time, and I am grateful for her securing this important debate. I know many more Members would have liked to speak. I will not take any interventions in the short time I have to respond because I want to address some of the questions raised.

This issue continues to be a matter of great concern to Members and all our constituents. Poor oral health can have a devastating effect on individuals, as we have heard, impacting their mental and physical health alike and, indeed, their opportunities for work, as my hon. Friend the Member for Leigh and Atherton (Jo Platt) made clear. Yet it is a largely preventable issue through good oral health hygiene and regular visits to a dentist. We inherited a broken NHS dental system, and our ambition is to rescue and restore NHS dentistry so that we deliver more NHS dental care to those who need it. Fourteen years of neglect, cuts and incompetence by the previous Government have left NHS dentistry in a state of decay. That is simply unacceptable and needs to change, which it will.

As of March 2024, more than 36,000 dentists are registered with the General Dental Council in England, and yet less than 11,000 full-time equivalent dentists were working within the NHS. Lord Darzi said in his report:

“There are enough dentists in England, just not enough dentists willing to do enough NHS work”.

That is why this Government are prepared to take strong action. Since coming into office, we have made good progress on our plan for change. We have already taken action to address the immediate needs of patients in pain and requiring urgent dental care through our manifesto commitment to deliver an additional 700,000 urgent dental appointments per year. Integrated care boards started to deliver those appointments from April, and each area has been given expectations for delivery based on their local needs.

That point was noted by my hon. Friends the Members for Filton and Bradley Stoke (Claire Hazelgrove) and for Amber Valley (Linsey Farnsworth), who campaigned studiously in opposition and continue to bring this to the House. ICBs have returned detailed plans for delivering against the expectations, and the Minister for Care is holding regular meetings with officials in the Department and with NHS England to monitor and drive progress against those plans. I commend my hon. Friend the Member for Gloucester (Alex McIntyre) for pursuing the matter with his ICB—that is exactly the right thing to do.

To have a truly effective dental system, we cannot focus just on those already in pain. We must have a system that prioritises prevention, particularly for children—a point well made by my hon. Friends the Members for North Ayrshire and Arran (Irene Campbell), for Blackpool South (Chris Webb) and for Morecambe and Lunesdale (Lizzi Collinge). That is why we have invested over £11 million to roll out a national supervised toothbrushing programme for three to five year olds. That will reach up to 600,000 children a year in the most deprived areas of England. Alongside that, we have launched an innovative partnership with Colgate-Palmolive, which is donating more than 23 million toothbrushes and toothpastes over the next five years. That is incredible value for the taxpayer and a fantastic example of how businesses and Government can work together for public good.

We have also taken the decision to expand community water fluoridation across the north-east of England. That is the first expansion for decades and will bring benefits to an additional 1.6 million people in the region.

Our workforce is crucial, as we have heard this afternoon. A strong dentistry system needs a strong workforce, and we recognise the incredible work that dentists and dental professionals do. I pay tribute to Mr Dobranski mentioned by my hon. Friend the Member for Leigh and Atherton—what amazing service. I also mention my own dentist Aidan Moran, who has been seeing me for the best part of three decades.

A central part of our 10-year health plan will be our workforce and how to make sure that we train and provide the staff, technology and infrastructure the NHS needs to care for patients across our communities—a point well made by my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley). We will publish a refreshed workforce plan to make sure the NHS has the right people in the right places with the right skills to deliver the care that people need.

As my hon. Friend the Member for South Norfolk (Ben Goldsborough) highlighted, we are all sadly familiar with the term “dental deserts” to describe parts of the country where access is especially difficult. We are continuing to support integrated care boards through the golden hello scheme, but of course dentists are only part of the team; dental therapists, hygienists, nurses and technicians all play a vital role, and we need to make the NHS a better place to work for all of them.

We are committed to fundamental reform of the dental contract. It could have been done sooner; it could have been done at any point over the last 14 years by the coalition or the Tories, but they left it for us to do. It will take time, but I assure everyone here that development of these proposals is under way. We continue to work with the British Dental Association and other representatives to deliver our shared ambitions for dentistry. My hon. Friend the Minister for Care met the BDA recently and they have a productive relationship.

In the spirit of honesty, let me be clear: there are no perfect payment models, and any changes to the complex dental system must be carefully considered, so that we deliver genuine improvements for patients and the profession. It is an immense challenge. There are no quick fixes and no easy answers, but people across the country deserve better access, and we are determined to make that happen.

We know we must deal with the immediate crisis. That is why we will deliver 700,000 extra appointments each year, get more dentists into the communities that need them the most, and make sure that everyone who needs an NHS dentist can get one. NHS dentistry will not be rescued overnight. It will take time, investment and reform, but improving access to NHS dentistry is key to our mission to get the NHS back on its feet and fit for the future.