Medicinal Cannabis

Karin Smyth Excerpts

Thursday 30th January 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship, Ms McVey. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this debate. As he said, there are many hon. Members from both sides of the House representing constituents affected by the issue across the United Kingdom who would have liked to be here today. Obviously, health is a devolved matter. The hon. Gentleman spoke movingly about his constituents, and other colleagues talked about theirs. I agree with him. My words have been repeated back to me, so I do not need to say them again. This is an important issue for everyone in the Chamber and those who are listening in, as we all want to support people who are in very difficult circumstances.

The hon. Gentleman raised some key issues, which I will address. He said that landlords and the police are unaware of the legality surrounding prescribed medicinal cannabis. I encourage him to take that up with the Deputy Prime Minister and the Home Secretary. I understand that the Home Office has notified all police forces about the change to the law, and guidance has been issued to summarise what that means.

The hon. Gentleman mentioned electronic prescribing, which has been in operation for schedule 2 and 3 controlled drugs in NHS primary care settings since 2019. I am afraid there are no current plans to extend that to private clinics at this time.

The hon. Gentleman also spoke about an observational study with a small patient cohort. I am afraid that it would not produce results as robust as a randomised control trial, which is the gold standard for clinical trials, nor would it add to the current evidence base. It would not provide results suitable to inform routine clinical or NHS commissioning decisions, because there would be no way to compare the findings with what would have happened in the absence of the intervention. I will come on to clinical trials in more detail, but let us be clear about the problem we face, the challenge faced by all of us involved in this debate and the challenge faced by children, many of whom have been mentioned today.

Of course, we listen to Members of this House, and to patients, parents and families, who say that these medicines are safe and should be available. We must ensure the safety and effectiveness of all medicines. The benefits should outweigh any potential harm and, as the hon. Gentleman outlined, clinicians must have that assurance and clarity, too.

There are currently only two cannabis-based medicines in the world with marketing authorisations or licence. They are—I hope I do not stumble over them too—Sativex, for the treatment of muscle spasms in multiple sclerosis, and Epidyolex, for treatment related to two rare forms of epilepsy and tuberous sclerosis complex. Those medicines show that it is possible to develop cannabis-based treatments that have been assessed for safety, quality and efficacy. The evidence generated on their clinical effectiveness and cost-effectiveness can enable the National Institute for Care and Health Excellence to recommend them for use in the NHS.

The medicines we are talking about today are unlicensed, which means that they have not been assessed by the Medicines and Healthcare products Regulatory Agency. Indeed, they have not been assessed or granted market authorisations by any medicines regulator anywhere in the world. However, as has been noted, in 2018 the then Home Secretary, Sajid Javid, enabled the prescription of unlicensed cannabis-based products for medicinal use. That provided a lawful route to these medicines for prescriptions for individual patients who were not benefiting from standard treatments and were not part of clinical trials, while limiting the ability to prescribe to specialist doctors. That came on the heels of the review by Professor Dame Sally Davies, then the chief medical officer, which found enough evidence of benefit to recommend that cannabis-based medicine should be moved out of schedule 1 to the Misuse of Drugs Regulations 2001.

For epilepsy, that evidence was mainly in relation to cannabidiol, also known as CBD, rather than products containing the psychoactive compound tetrahydrocannabinol, or THC. The review did not provide evidence to support routine prescribing or funding of those medicines on the NHS, which the previous Government should have made clear at the time. Before we see routine prescribing of these unlicensed medicines, the NHS must have greater assurance on their clinical effectiveness and cost-effectiveness at a population level. I am not a clinician—we are all here as politicians—and it is right that prescribing any medicine or treatment is a clinical decision, whether it is done on the NHS or privately. It is not for us to influence those decisions, so I cannot comment on individual cases.

We want to see more medicines approved by the MHRA and available on the NHS. We inherited a broken system, and it will take time to fix that failure, but the Chancellor has made an in-year investment in the NHS to fill the black hole that we inherited and prevent our having to cut back on services. That means that, more than ever, the NHS must account for every penny that it spends and make difficult decisions on what treatments are made available.

The NHS must get the best possible value for its investment in medicines and consider the cost-effectiveness of treatments to ensure that resources are used efficiently. For that to be fair, medicines or treatments initiated privately would not routinely be prescribed by the NHS unless the requested treatment was already approved under existing policies, which unlicensed medicinal cannabis is not, or when there are individual, exceptional circumstances. That remains the case even if privately funded treatment has been shown to have clinical benefit for an individual patient. This is the current NHS policy for all treatment initiated and prescribed privately, and it is not specific to medicinal cannabis.

[Jim Shannon]

I thank the Minister for her comprehensive response. A constituent of her colleague, the hon. Member for South Ribble (Mr Foster), is in the Gallery today. Her young boy, Ben, is receiving Bedrolite and Bedica, which are both proven to assist him in having a 98% reduction in fits. The same thing happens to my young constituent, wee Sophia, and to many others as well, including Charlie, the constituent of the hon. Member for Broadland and Fakenham (Jerome Mayhew). If there is a proven evidential base, which there quite clearly is, should it not be part of the evidential base for NICE to ensure that all these medications are taken on board?

[Karin Smyth]

I will come on to the research.

As we have heard, and as I recognise, fewer than five patients have accessed these medicines on the NHS, so access is truly exceptional. The testimony of the children and families accessing these treatments privately—often at great personal cost, as we have heard this afternoon—is truly heartbreaking. I am sure we can all agree that all Government spending on health must be evidence-based, and colleagues are seeking to ensure that that is the case.

If we are to see more cannabis-based medicines routinely available on the NHS, we need more research. The National Institute for Health and Care Research, also known as the NIHR, and the MHRA are there to support manufacturers and researchers to develop new medicines and design quality studies. I strongly encourage the manufacturers of those products to invest in research to prove that they are safe and effective and meet the rigorous standards that we rightly expect for all medicines. They should engage with the NIHR and the MHRA on clinical research and medicines licensing processes. That is key in providing doctors with the confidence to prescribe cannabis-based products in the same way that they use any other licensed medicines recommended for use on the NHS, but we are not waiting for industry to respond to patient voices.

The NIHR and NHS England have recently confirmed more than £8.5 million in funding for clinical trials to investigate whether cannabis-based medicines are effective in the treatment of drug-related epilepsies. As I said when we were in opposition, and as has been highlighted today, action in this space is vital. Epilepsy is a terrible disease, and it can be life-limiting in the most serious cases.

We also know that although epilepsy is a fairly common neurological condition, affecting 1% to 2% of the population, about 30% of cases will sadly have seizures that are resistant to current treatments, so it is absolutely right that the NIHR and NHS England are pioneering truly world-first trials that will investigate the safety and effectiveness of CBD and THC in adults and children with treatment-resistant epilepsy. The trials will be co-led by experts from University College London and Great Ormond Street hospital and will look to recruit around 480 patients from across the UK. The study details are published on the NIHR website, and I understand that it will publish further details soon.

Further funding has also been awarded to the University of Edinburgh to investigate the efficacy of CBD in patients with neuropathic pain due to chemotherapy. Those are two examples of the type of research that we desperately need in this area of medicine, and a further 28 studies looking at cannabis-based medicines have been approved by the MHRA since 2018. It is an emotive and complex debate, but the clinical trials give me encouragement that there is a way forward. If the evidence supports it, we will see more cannabis-based medicines approved by the regulators and recommended by NICE. That is the only way we will see the evidence base improved and give clinicians the confidence to prescribe.

To conclude, the hon. Member for Strangford has brought this debate forward with his customary good faith and compassion.

[Jim Shannon]

Will the hon. Lady give way?

[Karin Smyth]

I will take another intervention.

[Jim Shannon]

I am sorry. I am not intervening just for the heck of it; I just want a wee bit of clarification. I welcome the fact that the Minister is referring to the trials, and how long they are. I ask the Minister, very quickly: how long will it be before they are complete? Also, I asked the Minister beforehand if she would agree to a meeting with the hon. Member for South Ribble and his constituent just to clarify the matter and take forward the case for a wee bairn. Those are my two asks.

[Karin Smyth]

I cannot answer the question about trials and research directly because, obviously, trials are run by the specialists at NIHR, in the usual way, and I am sure that the request for meeting has been heard. It would probably not be with me, but I am sure the officials have heard it and that the hon. Gentleman will have a response.

I thank the Opposition spokesperson for reading out my contribution and highlighting how proactive we are being, only seven months since forming the new Government. I am proud that the trials that we are looking to do are world firsts. No other country in the world is taking the same action to prove that the medicines are safe and effective. I know it will not come as much consolation to those families who are at the end of their tether with talk of processes, debates and regulations. I also know it may not feel like it, based on some of the things I have said today, but I think there is a way forward. There may be some light at the end of the tunnel, and this Government will do what we can to support NHS England and the NIHR to get the trials done.

Doncaster Royal Infirmary

Karin Smyth Excerpts

Thursday 30th January 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I congratulate my hon. Friend the Member for Doncaster Central (Sally Jameson) on securing a debate on this really important issue for her constituents. Since her election, she has been a committed champion for Doncaster Royal Infirmary, and I thank her for her tireless efforts. She is absolutely right that the promises made by the previous Government were hollow and built on sand. Even for the hospitals that made it into the new hospital programme, the money simply was not there. They let down the people of Doncaster.

On Monday, I had the privilege of visiting Doncaster Royal Infirmary, along with my hon. Friend and our hon. Friend the Member for Doncaster East and the Isle of Axholme (Lee Pitcher), and witnessed the outstanding care that staff are providing despite significant infrastructure challenges. I entirely agree with my hon. Friend’s comments about the situation, and about the pressure that the staff find themselves under. Staff and patients deserve better than a hospital prone to floods, fires and equipment failures, some of which I saw for myself on Monday. Doncaster Royal Infirmary now has a backlog-of-maintenance bill of approximately £114 million, and the constant need for critical repairs leaves scarce resources for developing and enhancing facilities.

That is the reality facing Doncaster Royal Infirmary and hospitals nationwide after years of under-investment by the previous Government. Reversing the trend and repairing and rebuilding our hospital estate is a vital part of our ambition to create an NHS fit for the future. That is why the Chancellor announced that health capital spending is set to increase to £13.6 billion in 2025-26, representing record levels of capital investment in healthcare. I am pleased that works to address some of the most pressing issues at Doncaster Royal Infirmary are under way, with £19.8 million confirmed for the refurbishment and relocation of the critical care unit. That will deliver a safer and more accessible environment for the most vulnerable patients. Supporting projects are already in progress, including the relocation of the surgical same-day emergency care department. While I accept that this by no means addresses all the issues raised today, it is nevertheless a project that will deliver much-needed safety improvements.

NHS planning guidance published today sets out the NHS’s operational capital envelopes, national capital programmes and allocation processes for 2025-26. I recognise that the guidance will be of interest to Members who wish to understand the impacts on their constituencies, but as we are here to discuss Doncaster Royal Infirmary, I will focus on the funding opportunities available for that hospital.

The Government are backing the NHS with over £4 billion in operational capital in 2025-26 to empower local systems and ensure that funds are allocated according to local priorities. NHS England confirmed today that South Yorkshire integrated care board, which is responsible for Doncaster Royal Infirmary, has been allocated £107 million in operational capital to spend on its capital priorities next year. In addition to the annual operational capital allocations, the Government have allocated £750 million to an estates safety fund for 2025-26, which will focus on the worst safety risks across the NHS estate. South Yorkshire ICB has been allocated £19 million of that funding on the basis of need, critical infrastructure risk, estates incidents, and the recent maternity estates survey.

Systems have been asked to prioritise their estate safety allocations to deliver maximum safety benefits locally. Their plans will be reviewed by NHS England and the Department of Health and Social Care to ensure that national and regional priorities are addressed effectively and schemes represent value for money. In some cases, estates safety funding may also be used to initiate multi-year schemes when that represents the most effective approach. I strongly encourage the trust to discuss options with the ICB for allocating some of its operational capital and estates safety funding to repairs at Doncaster Royal Infirmary.

Let me also draw attention to the £1.35 billion of capital funding allocated for constitutional standards recovery in 2025-2026. Although it is not targeted directly at repairs, Doncaster Royal Infirmary may be able to benefit from some of the £24 million that has been allocated to South Yorkshire ICB to support its progress towards achieving constitutional standards for my hon. Friend’s constituents. I encourage the trust to explore possible options with the ICB that could address constitutional standards recovery as well as critical repairs, maximising value for money and, crucially, benefiting patients who deserve much better.

The Government recognise that, like Doncaster Royal Infirmary, many hospitals across the country need funding to overhaul their digital infrastructure. That is why we are investing more than £2 billion in NHS technology and digital in 2025-26 to run essential services, increase productivity, improve cyber-security, enhance patient access, and ensure that all trusts have electronic patient records. I thank Doncaster and Bassetlaw trust for its co-operation on the implementation of a system-wide electronic patient record, and I want to reassure the trust that this investment in digital and technology will be available for projects beyond electronic patient records.

The Government understand that long-term certainty about capital funding will be essential to addressing the critical infrastructure issues at hospitals such as Doncaster Royal Infirmary, and across the NHS estate. Capital budgets beyond 2025-26 will be determined through the current spending review, which concludes in June 2025.

In conclusion, I thank my hon. Friend the Member for Doncaster Central for raising this important issue, and for her continued support, and that of her colleagues, for Doncaster Royal Infirmary. I extend my thanks to the staff of Doncaster Royal Infirmary for hosting my insightful visit, and for their candour in explaining to me how they have got into this situation in recent years. I hope to return when the new critical care unit is open. The Government are committed to repairing and rebuilding our hospital estate. It will take time—we have inherited a shocking situation—and I look forward to working with colleagues on this vital issue across the country in the coming years.

Question put and agreed to.

Women’s Health Strategy

Karin Smyth Excerpts

Thursday 30th January 2025 Commons Chamber

[Mims Davies (East Grinstead and Uckfield) (Con)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the women’s health strategy.

[The Minister for Secondary Care (Karin Smyth)]

I thank the hon. Lady for giving me the opportunity to set out our commitment to the women’s health strategy and everything that this Government are doing to fix our broken NHS, clean up the mess that the Conservatives left after 14 years and get women treated on time again.

When we came into office we inherited record waiting lists. The gynaecology waiting list stood at just under 600,000 women. Let that sink in—600,000 women in pain, waiting to be cared for. Almost half the women on gynaecology waiting lists are waiting more than 18 weeks. That is why the Prime Minister kicked off 2025 with our elective reform plan, setting out how we will cut the longest waiting lists from 18 months to 18 weeks. Our new agreement with the independent sector will mean that, where there is spare capacity in the private sector, women will be treated faster for gynaecology care, paid for by the state.

The Government are also committed to rooting out the appalling inequalities in maternity care. We are supporting failing trusts to make rapid improvements, training thousands more midwives for the first time, and we will set an explicit target to close the black and Asian maternal mortality gap. We are piloting a training programme to help avoid brain injury for babies in childbirth and, if successful, we will crack on with rolling it out nationally this year. In October, we extended the baby loss certificate service to help mums and dads who have suffered the heartbreak of pregnancy loss.

Let me also address the issue of women’s health hubs. There was a target in last year’s planning guidance to roll out pilot women’s health hubs across the country by last December. Today, there are at least 80 hubs, and at least nine out of every10 integrated care systems have an open women’s health hub.

Let me correct some fake news. We are not closing these hubs; we are not cutting them. The target to roll them out was in last year’s planning guidance. It was achieved in 93% of integrated care systems, which is why the target is not repeated in this year’s guidance—it has been met in 39 out of 42 areas.

Today, we have slimmed down the number of targets for the NHS so that we can focus on fixing the fundamentals —the system that the previous Government broke. We are instructing the NHS to prioritise: cutting waiting times for operations, A&E and ambulances; making it easier for people to see a GP or a dentist; and improving the mental health of the nation. That will mean around 60,000 women with suspected cancer are diagnosed earlier and treated faster; more than 200,000 extra women will be treated within 18 weeks, as we drive down long waits; and fewer women will be forced to wait 12 hours in A&E. That is the difference that a Labour Government are making to women’s health.

[Mims Davies]

For too long, a woman’s experience of the health service has been one of being pushed from pillar to post. Crucially, women’s voices have been ignored and responses to their pain, suffering, poor sex lives and traumatic births have been too slow. Overall, women have a sense of being forgotten. Some 2.4 million more women were in work under our Conservative Government. Pain and suffering were affecting too many women and their ability to remain in the labour market, resulting in early retirement or not having their true career potential fulfilled.

We took direct action, crucially, by listening to women’s experiences. We had almost 100,000 responses to our call for evidence on the gender health gap. We appointed Dame Lesley Regan as the woman’s health ambassador, and Helen Tomlinson as the cross-government menopause ambassador to find out the experience of women employed in different sectors. We delivered and funded new women’s health hubs and created joined-up services in the community. The Royal College of Obstetricians and Gynaecologists estimates that removing the requirement of integrated care boards to have a woman’s health hub will impact 600,000 women on waiting lists in England, creating longer waits, disease progression that could be prevented, and resulting in more women attending A&E, unable to work, care or live a fulfilled life.

Labour’s manifesto said that it will prioritise women’s health. Women are now reported to be a lobby group, relegated to being unheard once again. Will the Minister confirm whether it is true that the targets to deal with women’s needs will be dropped? If so, what is her justification for that? Will she be delivering on the roundly welcomed women’s health strategy from 2022?

A total of 1,300 families gave evidence to the all-party group on birth trauma. What are the plans to drive up maternity safety standards across the country? Will there be a response to that? Will Dame Lesley Regan be sacked, will she remain the women’s health ambassador, or will she be replaced, as Helen Tomlinson was, by someone who seems more interested in selling books than in delivering on the ground for women? What steps are being be taken on sex-specific language in health communications and guidance—

[Madam Deputy Speaker (Caroline Nokes)]

Order. The shadow Minister will know that there is a time limit, which she has exceeded. I have been very generous. I call the Minister.

[Karin Smyth]

I addressed most of those points in my outline statement. I think the shadow Minister wrote her comments when the Opposition thought that we were cancelling things, only to find out that we are not cancelling things. I have made clear our commitment to the women’s health strategy and how we seek to instruct the system at a local level to serve the needs of women and particularly prioritise those waiting lists. As I have outlined, the targets have already been achieved. Unusually, I will give a bit of credit to the other side, because a lot of this was rolled out and it was good practice, and the system still thinks that it is good practice, so sometimes Opposition Members should take a win. We are committed to that, it is embedded in the system, and we look forward to outcomes being improved for women.

[Madam Deputy Speaker]

I call the Chair of the Women and Equalities Committee.

--- Later in debate ---

[Sarah Owen (Luton North) (Lab)]

The Committee report on women’s reproductive health, started under our fantastic predecessors, laid out how medical misogyny has left far too many women suffering. Women have been left undiagnosed for debilitating conditions such as endometriosis for an average of eight years—not for treatment, for diagnosis. Black women are four to five times more likely to die during childbirth, and the rate of maternal death in the UK has risen by 15% in the last 10 years. The leading cause of that is suicide, accounting for 39% of deaths in the first year postpartum. Does the Minister therefore agree that women, and women of colour especially, have borne the brunt too often of 14 years of disastrous health policies? How can the Government reverse this trend?

[Karin Smyth]

I thank the Committee Chair for her question. I think she was congratulating the previous Committee and Chair rather than those who are now in opposition. I was very pleased to witness some of that work when we were in opposition, and she is absolutely right about it. The work of many women Members when in opposition, and, to be fair, of many women in the previous Government, have made sure that issues around endometriosis have risen up the agenda; indeed, we had a good debate in the Chamber recently. We are committed to taking forward the strategy. We think the health hubs, for example, are doing a good job, but there is a lot of learning to be done on them, and we will continue to do that.

[Madam Deputy Speaker]

I call the Liberal Democrat spokesperson.

--- Later in debate ---

[Dr Chambers]

Apologies, Madam Deputy Speaker. Yes, in one sentence: the Government’s manifesto rightly said that

“Never again will women’s health be neglected”.

Can we have assurances that we will not remove the ICB requirement to have women’s health hubs?

[Karin Smyth]

The hon. Gentleman is right to highlight those long waits. That is why we particularly highlighted gynaecology for attention in the elective reform plan. It is shocking that the last Government left 600,000 women on these lists, and moving back to making sure people wait no longer than 18 weeks will predominantly be helping those women.

The hon. Gentleman is also right to highlight the appalling maternity situation. The Secretary of State and my noble Friend Baroness Merron, who leads in this area, have met many families to discuss their experiences, and we know those experiences are unacceptable. We know there are big issues around staffing, and it is a priority to work with NHS England to make sure that we grow workforce capacity as quickly as possible so that we can be sure that those situations are safe. There are many debates in this place about the issue and we will continue to update the House.

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

Under the last Government, five times more research went into erectile dysfunction, which affects 19% of men, than went into premenstrual syndrome, which affects 90% of women. Women are waiting more than eight years for endometriosis diagnoses. GPs are not required to undertake a gynaecological rotation within their training. Women’s health must be put at the head of our agenda. Will the Minister assure women in this country that things will change under this Government?

[Karin Smyth]

I absolutely will give my hon. Friend that assurance. The situation will change partly because there are more people like her and more women in this place. We have more women across all parties raising this issue and more women in senior positions in the National Institute for Health and Care Research. Crucially, we have women leading in science and research. Dealing with the misogyny around the system and in medical systems is also important for making sure that women lead this work. We want to make sure that the NIHR, which has a strategy to address this issue, rectifies the situation that she outlines.

[Mark Pritchard (The Wrekin) (Con)]

The Minister will be aware of the Ockenden report back in 2022, which highlighted the tragic cases of more than 200 mothers and babies who were killed over a period of years at the Shrewsbury and Telford Hospital NHS Trust. Donna Ockenden recently returned to the trust and said that she was surprised and disappointed to hear from those parents and families affected that the trust had not been communicating as well as it should have been and had not been updating the families in a timely manner. Does the Minister agree not only that communication is key, but also that reviews, such as those undertaken by Donna Ockenden, should have the remit to go back to check and monitor the progress of maternity services that are either improving or not?

[Karin Smyth]

I completely agree with the right hon. Member. Donna Ockenden’s work is hugely valuable, and a lot of faith and trust has been placed in it, particularly by families. I do not know specific dates, but the Secretary of State and my noble Friend Baroness Merron, who leads on this work, have been discussing the matter with Donna Ockenden. I am happy to get back to the right hon. Member with the details.

On the specific point about the remit, I do not know the answer to that question. It is entirely sensible to look at progress and learn from mistakes. I know it is a challenge system, and we have to learn from those areas. If there are specific things to report back to the right hon. Member, I will get back to him, but this issue is absolutely a priority. The Secretary of State is meeting families directly. We know and understand that we have to do much better on this for everybody.

[Ms Julie Minns (Carlisle) (Lab)]

Having listened to the shadow Minister, I am slightly tempted to suggest to the Minister that our women’s health strategy include provision for the treatment of collective memory loss. The shadow Minister completely ignored the fact that the Tories let our NHS fall into disrepute over the past 14 years.

I want to ask specifically about how our health strategy will deal with treatment and support for young people, particularly young women, suffering from depression and anxiety. That follows a tragic case in my constituency and a coroner’s report last week, which found that our local hospital was not able to support that patient.

[Karin Smyth]

My hon. Friend is right to highlight some tragic incidents, and I know she will be working hard on behalf of her constituents. We are absolutely committed to the women’s health strategy. Clearly, that will be taken forward as part of the 10-year plan, and it is an important part of that. I met my noble Friend Baroness Merron yesterday and the team supporting that plan to make sure that we understand how those key issues are taken forward.

This is an opportunity, if I may, Madam Deputy Speaker, to say that the consultation on that plan is still open for ideas. We are keen to hear in particular from young people to make sure that we get a true representation. These sorts of things are not often consulted on, so we encourage young people and people who are suffering from depression and mental health issues to contribute their thoughts about the system they face as part of our 10-year plan consultation.

[Christine Jardine (Edinburgh West) (LD)]

I am sure we all welcome the move to reduce waiting lists and recognise that the women’s health strategy is a 10-year plan. But given the enormous problems highlighted by the hon. Member for Luton North (Sarah Owen) and my hon. Friend the Member for Winchester (Dr Chambers), does the Minister appreciate that, to many women who are having trouble accessing often fragmented gynaecological services, it will seem like a vital facility is about to be lost and that the Government’s promises of “never again” will sound hollow? What will the Government do to reassure all the women who are concerned about this move?

[Karin Smyth]

I am not entirely clear what the hon. Member is referring to. I have been clear that we are committed to the women’s health strategy, and we will take it forward as part of the 10-year plan. Most of the—[Interruption.] If it was about the women’s health hubs, they are mainly there but in different forms and with different levels of services. We want to ensure that the systems reflect their local population needs. That is an entirely proper way to go about things.

As I said, unusually, we think that many of the hubs, which were rolled out as pilots under the previous Administration, are doing a good job in most areas—although not everywhere, so we want to learn from the pilots. Our commitment is absolutely to women. That is why gynaecology waiting lists are particularly targeted: we had 600,000 women on them. Women should feel really assured about the support that the Government are giving them and their health, to prioritise their health. We are keen to learn more about women’s health hubs. They will be different in different places because they have different populations, and that is entirely in keeping with the direction of travel of the Government.

[Kirsteen Sullivan (Bathgate and Linlithgow) (Lab/Co-op)]

I also thank my hon. Friend the Member for Luton North (Sarah Owen) for her work in raising the serious health inequalities that women across the UK face every single day. Does the Minister agree that we need more expertise in women’s health issues in primary care settings to ensure early diagnosis and that women get the treatment they need at the earliest point?

[Karin Smyth]

My hon. Friend makes an excellent point about both the work of the Chair of the Select Committee, my hon. Friend the Member for Luton North (Sarah Owen), and the importance of primary and community care recognising, listening to and supporting women through women’s health, as well as making sure that our knowledge and good practice is spread across the team. This is an area where different systems have women’s health hubs using different teams and different technology, and they have different links to secondary care colleagues and specialist colleagues. By listening to each other and working together, they are so good at spreading some of that good practice.

[Mr Richard Holden (Basildon and Billericay) (Con)]

I welcome the Minister coming to the House to answer the urgent question, because the argument she is putting forward seems slightly confused. First, women’s health hubs seem to be working on the whole, and there are lots of them, so why remove the target for everybody to have them if we are already 90% there? Secondly, many of the hubs seem to be doing good work, and best practice is clearly emerging, so why cancel the target for the programme rather than spread that good practice throughout the system? I think the broad question from the Opposition is: why remove the targets specifically relating to women from the Government’s agenda going forward? It feels to many women and to the Royal College of Obstetricians and Gynaecologists, which has been in contact with me, that that downgrades the status of women in the NHS.

[Karin Smyth]

I will try to be brief, but this is hard to explain—[Interruption.] No, this is to answer the right hon. Gentleman. Targets in the NHS have not been met since 2015, which was under his Government’s watch but, actually, this target has been met—there are only three places in the country that do not have a hub—so there is no target for them because that has already been met. The issue now is to look at the outcomes from those hubs to see how they are performing. We think, and the system thinks, that they do a good job. That is why they are staying, why we are committed to them, and why we want to learn from them.

[Mohammad Yasin (Bedford) (Lab)]

Bedford hospital once had a gold-standard home-birth service, but in recent months it has been run down within the wider trust due to unfilled vacancies. Many of my constituents are concerned at the prospect of losing that service, which puts women’s needs and health choices first. Will the women’s health strategy ensure that women can access a consistent midwifery service that provides genuine choice for safe home births?

[Karin Smyth]

My hon. Friend makes an excellent point about maternity services, which are inconsistent and not good enough around the country. It is a source of great alarm for many people. Maternity absolutely remains a high priority within the overall women’s health strategy.

[Lisa Smart (Hazel Grove) (LD)]

If you are black and having a baby, you are more than three times more likely to die than if you are white and having a baby. I am sure that the Minister and Members across the House will agree that that is a national disgrace. I was encouraged to hear the Minister mention a target for maternal mortality disparity in her opening remarks, but I would be grateful if she could confirm that the elimination of that disparity is the target and update the House on when the NHS plans to achieve that.

[Karin Smyth]

The hon. Lady makes the point about using targets. This is something that is a high priority, but it is not happening. That is absolutely why I mentioned it in my opening comments—to ensure that that happens.

[Barry Gardiner (Brent West) (Lab)]

Forty years ago this month, my wife almost died of an eclamptic seizure because a general practitioner had failed to recognise the symptoms of pre-eclampsia. According to the most recent report on pre-eclampsia, four times as many women are dying of pre-eclampsia today than were dying in 2012. That is an absolute disgrace. If men got pre-eclampsia, they would have solved the problem many, many years ago. [Hon. Members: “Hear, hear.”] Will the Minister assure me and everyone else that the women’s health strategy will focus on pre-eclampsia, and try to finally find a solution?

[Karin Smyth]

My hon. Friend makes a very powerful case and talks of an experience that he and his wife went through forty years ago, which highlights that it can sometimes take an unacceptably long time to get what is known as good practice through the system and to have that consistency for women and their families across the overall system. We absolutely need to ensure that maternity services understand best practice and that it is rolled out properly across the country.

[Greg Smith (Mid Buckinghamshire) (Con)]

In an earlier answer, the Minister rightly talked about the arrangement the Government have over spare capacity in the independent sector. My female constituents and women up and down the land want to know what that actually means in practice: what does that mean for the 260,000 women waiting more than 18 weeks for gynaecology treatment? How many treatments will the independent sector be delivering, and to what timescale? We need to get those women the treatment that they need.

[Karin Smyth]

The hon. Gentleman can tell his women constituents what I hope everyone across the House will be able to tell their constituents: this Government inherited 600,000 women on those waiting lists, and we are committed—as said in our elective reform plan, which highlighted gynaecology in particular—to getting those waiting lists down from 18 months to 18 weeks in the lifetime of this Parliament.

[Cameron Thomas (Tewkesbury) (LD)]

I represent almost 40,000 women, and they and the men who love them would invite the Minister to state explicitly that the Government will not draw down their access to women’s health hubs or remove their women’s health targets.

[Karin Smyth]

I have made that commitment several times from this Dispatch Box. We think the women’s health hubs are working across the country—I do not know exactly how the hon. Gentleman’s hub is working at the moment. Only three areas do not have a women’s health hub, and we expect them to get on with that and have one. We will ensure we have the learning from them across the country.

[Jerome Mayhew (Broadland and Fakenham) (Con)]

The Minister got her tone wrong in dealing with this urgent question. If a Minister turns up late for a UQ, the least they can do is take the questions from the Opposition Front Bench seriously.

Amanda Pritchard, the CEO of NHS England, has said that the health service does not

“always have the needs of women at its heart.”

What message do the Government think scrapping women’s health targets will send?

[Karin Smyth]

The chief executive is right that the previous Government did not have women’s health at the heart of their strategy, and that is why we do.

[David Mundell (Dumfriesshire, Clydesdale and Tweeddale) (Con)]

As chair of the all-party parliamentary group on HIV, AIDS and sexual health, may I ask the Minister about the very low take-up of pre-exposure prophylaxis among women in the UK? What steps are being taken to change that? Obviously, there are barriers such as stigma and low levels of information, but does she agree that PrEP should not just be made available in sexual health settings, particularly as we have had the roll-out of opt-out testing?

[Karin Smyth]

I thank the right hon. Gentleman for the work he does in this area. He does an excellent job and makes an excellent point. I do not know the detailed answer to that question—it is not directly my area—but I am very happy to make sure that we write to him.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister very much for her answers. The women’s health survey for Northern Ireland closes tomorrow. Through it, the Department of Health back home is hoping to have a greater understanding of how government fails women. The results of this Northern Ireland-wide project will ensure the Department will be able to find the areas that are lacking, in particular endometriosis support. Will the Minister make contact with the Northern Ireland Assembly to discuss the health strategy and to share the results and the data, so that the UK Government and the Northern Ireland Assembly back home can work better together to make women’s health better across this great United Kingdom of Great Britain and Northern Ireland?

[Karin Smyth]

As I hope the hon. Gentleman knows, I think the health needs of women in Northern Ireland and the waiting lists there are particularly problematic, so finding out anything our Department can to do support or share learning across the United Kingdom is a personal commitment of mine. I will absolutely make sure that we do that. I am happy to meet, talk or even visit, which I always like doing.

[Victoria Atkins (Louth and Horncastle) (Con)]

On a point of order, Madam Deputy Speaker. On this incredibly important issue of the women’s health strategy, and the fact that the word “woman” has been excluded from the updated planning guidance, could you help me understand this? As a common courtesy to both you and the House, when a Minister is unable to organise herself such that she can get to the Chamber on time, is it not courteous to apologise to those of us she has kept waiting before we were able to discuss this important subject?

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I thank the right hon. Lady for her point of order. She is, of course, correct that it is courteous to the House for an apology to be made. Five minutes of time was wasted this morning. I think the Minister would like to make a further point of order.

[The Minister for Secondary Care (Karin Smyth)]

Further to that point of order, Madam Deputy Speaker. I absolutely, unequivocally apologise.

[Madam Deputy Speaker]

I thank the Minister.

A&E Services: Solihull Borough

Karin Smyth Excerpts

Monday 27th January 2025 Commons Chamber

Motion made, and Question proposed, That this House do now adjourn.—(Martin McCluskey).

[The Minister for Secondary Care (Karin Smyth)]

I congratulate the hon. Member for Meriden and Solihull East (Saqib Bhatti) on securing the debate, and congratulate other Members who have taken part in it. Let me start by thanking the NHS staff at Solihull Hospital for their remarkable efforts, stamina and care in the most challenging circumstances. That point was well made by the hon. Gentleman, and I know he feels passionately that he owes his own life and the lives of many others to their care.

The hon. Gentleman said that he did not want to make political points and that politics was about choices, but we did inherit an NHS that was in the worst state in its history. I hope he agrees with Lord Darzi’s diagnosis; we have still not heard from his colleagues whether they agree with it. The condition of the capital estate, as well as NHS services, has shocked the country, notwithstanding the result of the election, but we are working at full scale to making that situation better. The hon. Gentleman is right that politics is about choices, and I think that the wrong choices were made in the past 14 years.

It is right to point to the increasing demand for emergency departments in Solihull and elsewhere over the past decade, part of which can be explained by the appalling neglect of GP and primary care services to manage demand, and the failure of all parties—to which the hon. Gentleman alluded—to build consensus on a long-term solution for social care and support the flow of people through those hospitals. As the hon. Gentleman knows, Solihull Borough is within the University Hospitals Birmingham NHS Foundation Trust. In December, 58.2% of people were seen within four hours.

Let me set out some of the wider context. We need to remember that we have had one of the busiest flu seasons for a number of years, and although the number of cases is coming down, the number of Norovirus cases is still 80% higher than it was in the same period last year. We want to end the treatment of people in corridors, which has become normal and which it is completely unacceptable. As my right hon. Friend the Secretary of State has made clear, this is not the level of care that staff want for their patients, and it is not the level of care that the Government will ever accept for patients. It will take time to return to the standards that patients deserve, but it can be done. We did it before in government, and we will do it again. To mitigate pressures in Solihull and elsewhere, we are reforming the NHS to shift the focus of healthcare out of hospitals and into the community, freeing up beds for emergency patients and preventing so many people from having to call an ambulance or go to A&E in the first place. In the last two months, we have announced steps to begin rebuilding general practice and immediate long-term action on social care.

I understand that in November 2024, NHS Birmingham Solihull integrated care board had an average of 6.3 full-time GPs per 10,000 patients, just above the average in England, which stands at six. A few weeks after the election, we announced an extra £82 million of funding to increase access to GPs, and it is improving. Birmingham Solihull ICB area had 30 more GPs in November than in July, and I hope that that improvement has been felt by the hon. Gentleman’s constituents. In December we announced an extra £888 million in funding for GPs, the biggest funding uplift in years, alongside a package of reforms to bust bureaucracy, slash unnecessary targets, and give them more time to spend with patients as a first step towards bringing back the family doctor.

As well as considering demand, we know that there is no solution for accident and emergency activity that does not include fixing our broken social care system. Today there are about 12,000 patients in hospital beds who have no criteria to reside but cannot be discharged. The main reason for the delays is to do with capacity. More than 300 patients in that category are in the Birmingham Solihull ICB. I hope that the hon. Gentleman and, indeed, all Members will work with us to resolve the situation, but that is why the Government are making up to £3.7 billion of extra funding available for local authorities to provide social care, why we are delivering extra 7,800 adaptations through the disabled facilities grant this year and next year, why we have delivered the biggest increase in carer's allowance since the 1970s—worth an extra £2,300 to family carers—why we are introducing fair pay agreements to tackle the 131,000 vacancies for care workers that we inherited, and why we are appointing Louise Casey to develop a national consensus on that long-term solution for social care.

It is also clear that we can get our ambulance and A&E services working better, so before the spring we will set out the lessons learned from this winter and the improvements that we will put in place ahead of next winter. We are content to visit and hear from hon. Members from across the House about the situation in their areas.

The hon. Gentleman talked about the 2022 Act. I was on the Bill Committee and tabled a number of suggestions for better accountability of ICBs to local Members of Parliament, most of which were not accepted by the Government of the time. I agree with him that those organisations need to be more accountable to him and to other Members of Parliament representing their constituents.

We expect integrated care boards to ensure that the areas they run are safe, putting necessary care in the community, investing in technology and doing what is best for the people they are responsible for. The Government are investing an extra £26 billion in our health and care services while undertaking fundamental reform to help the ICB deliver the services that all our constituents expect. If the ICB intends to make substantial changes to the way it delivers services, it must conduct a public consultation and must meet the test to ensure that all proposals are proven to be in the interests of patients and the wider public.

I know that the hon. Gentleman will be meeting the ICB in a few weeks, and I am sure that he will continue to make his points to it; I suspect that it is watching or listening to our proceedings. I am sure that he would agree that it is for the people locally in Solihull to determine how their interests are best served. Ministers cannot impose views above the heads of the local ICB. Those decisions are best made in Solihull by people who live in Solihull and not in Westminster. Therefore, what I can do—what the Government are doing—is give ICBs the means to deliver services while undertaking fundamental reform of how those services are delivered. The hon. Gentleman is therefore doing exactly what he should do as an experienced Member of Parliament and making his case to the local ICB. I am sure that it will have heard him this evening and that his voice will be important in representing his constituents.

The hon. Gentleman was entirely right to raise population growth and planning, which was also mentioned by the hon. Gentleman’s neighbour, the hon. Member for Solihull West and Shirley (Dr Shastri-Hurst). We are committed to house building, unlike his Government; it is important that that goes ahead. That does put pressure on services. Unfortunately, under the previous Government, developments were not going ahead because of the issue of infrastructure. That is something that we are addressing.

The disconnect between ICBs and local authorities must change—the situation with vital infrastructure such as schools and hospitals has gone on for far too long—which is why we are committed to working with colleagues at the Ministry of Housing, Communities and Local Government to ensure that planning includes basic infrastructure. The Secretary of State for Health and Social Care has regular meetings with the Deputy Prime Minister to ensure that we are all pulling in the same direction on that.

Communities across the country, including the hon. Gentlemen’s constituents in Solihull, are struggling with poor services and crumbling estates. We are putting record capital funding into the NHS while reforming services to ensure that every penny of that money is spent well. We will return to 95% of patients being seen within four hours at A&E, we will get waiting lists back down to where they were in 2010, and we will fix the front door to the NHS with the GP services that all our constituents deserve. It will take time, but we will deliver an NHS and national care service that provide people with the care they need when they need it, and we will continue to work with all hon. Members across the House to ensure that that happens.

Rare Retinal Disease

Karin Smyth Excerpts

Thursday 23rd January 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Dame Siobhan. I start by thanking the hon. Member for Strangford (Jim Shannon) for securing this debate on such an important issue and other Members for their contributions.

Both the shadow Secretary of State and I are covering for other colleagues this afternoon, so hon. Members can imagine my joy when actual experts walked into the Chamber. The hon. Members for Leicester South (Shockat Adam) and for Torbay (Steve Darling), as has been said, bring great personal and professional expertise to this debate, so it was joyful to see them come in. It was good to hear from my hon. Friend the Member for Doncaster East and the Isle of Axholme (Lee Pitcher); the experience he brings through his wife is really valuable. My hon. Friend the Member for Battersea (Marsha De Cordova) has been such a champion of this issue both in her personal experience and since she came to the House. I understand that it is her birthday today, so I hope she is having a good time. She has brought great expertise to this place.

I am going to do my best to answer the questions. I have been billed highly by the hon. Member for Strangford, and I am grateful for that. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Gorton and Denton (Andrew Gwynne), will write to hon. Members about anything that is outstanding.

I would like to take time to acknowledge the experiences of those living with rare inherited retinal diseases and their families, who I know will be paying attention to this debate. I pay tribute to all those who work tirelessly to raise awareness of rare conditions and bring about change. Although rare diseases are rare individually, their impacts are far-reaching. One in 17 people will be affected by a rare condition over their lifetime; that is around 3.5 million people in the United Kingdom. As the hon. Member for Strangford said, rare inherited retinal diseases affect around 25,000 people in the UK and collectively represent a leading cause of sight loss in working-age adults. We recognise the impact that these conditions have on patients, families and wider society and the need for innovative approaches to tackle these changes.

The Government are committed to improving the lives of people with rare conditions. The hon. Member for Torbay used that quote about providing opportunity, support and determination for people. The UK rare diseases framework outlines four priorities to achieve this aim: helping patients get a final diagnosis faster; increasing awareness of rare diseases among healthcare professionals; better co-ordination of care; and improving access to specialist care treatment and drugs. In England, our annual rare diseases action plan sets out the steps we are taking to meet those priorities. We continue to make progress and are working to finalise our next England action plan for publication this year.

It is vital that NHS patients with rare diseases are able to access innovative new treatments as they become available. That includes those with progressive retinal diseases, where early intervention is crucial to preserve sight. Under England’s action plans, NICE, the Medicines and Healthcare products Regulatory Agency and NHS England are working to understand and address the barriers to access for rare diseases treatment. The hon. Member for Strangford asked a number of questions about NICE’s approach that I hope I will cover. NICE does a difficult job well, in my view, and we think its approach is appropriate for the evaluation of treatments for rare diseases. NICE recommended 84% of medicines for rare diseases evaluated through its standard technology appraisal programme in 2023-24. That is comparable to its approval rate for medicines for more common conditions. Those treatments are now available for the treatment of NHS patients.

NICE also operates a separate, highly specialised technology programme for the evaluation of a handful of medicines for very rare diseases each year that recognises the challenges of bringing treatments for very rare diseases to market. NICE recommended the gene therapy Luxturna for a type of inherited retinal dystrophy through that route. One of the recipients of that groundbreaking therapy on the NHS has spoken of his gratitude for the positive effects of the treatment on not just his vision, but his confidence and independence.

NICE is also in the process of reviewing the criteria for routing topics to its highly specialised technologies programme, which the hon. Member for Strangford asked about. That review will ensure that future routing decisions are more transparent, consistent, efficient and predictable. As part of that process, NICE has launched a public consultation on its progress. I encourage the rare diseases community and hon. Members interested to continue to engage with that process.

Research offers a way to accelerate access to new and innovative treatments. Through the National Institute for Health and Care Research, the Government support rare diseases research. There are currently eight active research projects on rare retinal disease funded by the NIHR, with a combined value of over £6 million. The NIHR also invests in infrastructure to support and deliver research studies. The NIHR Moorfields Biomedical Research Centre, which is dedicated solely to vision research, has made significant strides in the field of rare retinal diseases. By harnessing genomic data, the BRC has developed effective treatments, including gene-replacement therapies for inherited retinal disorders. The NIHR is also working closely with commercial companies to bring new medicines and technology to patients.

To connect people living with rare diseases to innovative treatments and sources of support, we need to diagnose these conditions as early as possible. The UK is a world leader in genomic diagnosis. Patients in England have access to whole genome sequencing on the NHS. Advances in genomics mean that new causes of rare retinal diseases are being found every year. As part of Genomics England’s generation study, we are harnessing the power of genomic sequencing to screen for over 200 rare genetic conditions that can be treated in the NHS in early childhood to improve outcomes for babies and their families. That includes the rare retinal disease RPE65-associated Leber congenital amaurosis, which can be treated with Luxturna.

A central mission of this Government is to build a health and care system fit for the future. The 10-year health plan will ensure a better health service for everyone, regardless of condition or service area. The plan will focus on our three shifts for a modern NHS: moving from hospital to community, analogue to digital and sickness to prevention. All three offer opportunities to improve time to diagnosis and care for people living with rare retinal conditions. The shift from analogue to digital will enable innovative uses of data to improve diagnosis and measure treatment outcomes, while NHS ocular genetics services’ use of video consultations continues to widen patient access to specialist advice, in keeping with the shift from hospital to community. Although many rare diseases are not preventable, early diagnosis, as we have heard, can lead to timely interventions that improve health outcomes.

I will outline the treatment pathway for rare retinal diseases. I am thankful for the role played by high street optometrists, some of them here today, in helping to identify patients with sight-threatening conditions. There is good availability of NHS sight-testing services, with over 12 million free NHS sight tests provided to eligible groups annually, including children, individuals aged 60 and over, and those on income-related benefits. Optometrists are required to refer any patient showing signs of injury, disease or abnormality and integrated care boards have been asked to ensure that there are direct referral pathways in place between community optometry and secondary care. As the hon. Member for Leicester South said, the eyes are the gateway into other health conditions. Optometry has a very important role.

As one of the busiest outpatient specialties with one of the largest waiting lists, we know that ophthalmology is facing huge challenges and we are working hard on how we can help to build capacity. NHS England is looking at how digital connectivity could improve the triage of patients referred between primary and secondary care. That would allow for images to be shared, and specialist advice and guidance could help to keep patients in the community where possible.

We recognise the importance of access to emotional and practical support, especially where treatment may not be available. A diagnosis of sight loss will have a profound impact on any individual, who will be at increased risk of stress, anxiety and depression. NHS England’s patient support toolkit for eye care commissioners and providers aims to ensure that patients with ophthalmic conditions or sight loss are supported throughout their care journeys. The RNIB patient support pathway aims to strengthen that and ensure that support and guidance are available to patients from their first eye care appointment through to having a confirmed diagnosis, and then right the way through to living well with their condition. I know that the work of the all-party parliamentary group on eye health and visual impairment and of other hon. Members will help in giving those people a powerful voice.

As we work towards building a health care service fit for the future, it is vital that people living with rare diseases are not left behind. With the UK rare diseases framework coming to an end in 2026, we will look to build on the progress made over the past five years, which the shadow Secretary of State mentioned. We will work with colleagues in the devolved Administrations, as highlighted by the hon. Member for Strangford.

We have commissioned an evaluation of England’s rare diseases action plans through NIHR and will also be undertaking engagement this year to inform future policy decisions. The Government are deeply committed to working across the health and social care system and with the rare diseases community to improve the lives of those with rare conditions.

Once again, I thank the hon. Member for Strangford for raising this important matter. It is good to have high interest, expertise and experience in this place. We want to work with colleagues here and we thank the rare disease community for their valuable ongoing engagement with us to bring about meaningful change.

[Dame Siobhain McDonagh (in the Chair)]

Order. I will now put—[Interruption.]

New Hospital Programme

Karin Smyth Excerpts

Wednesday 22nd January 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship, Dr Huq. I congratulate the hon. Member for Bexhill and Battle (Dr Mullan) on securing a debate on this important matter. I commend his timing in getting this debate two days after an announcement that nobody else knew about. If he were a Labour MP, there would be howls of “Fix!”

There has been a lot of back and forth, but I want to confirm that we pledged to support this programme, and we are supporting it. That is what Monday was about—let us be in no doubt about that. I was part of the largest capital programme in the NHS when I served as a non-executive director under the last Labour Government; this will be the next largest capital programme, delivered under this Labour Government.

As Lord Darzi noted in his investigation, the hospitals that we rely on are deteriorating after the NHS suffered years of under-investment. This Government inherited a programme to deliver new hospitals that was unfunded beyond March 2025 and was repeatedly delayed, with no credible delivery plan.

[Chris Vince]

I thank the Minister for the Secretary of State’s statement on Monday, in which £1.5 billion of Government funding was dedicated to Princess Alexandra hospital. At my local hospital in Harlow, it is not just an issue of funding: in fact, the land was not purchased and the business plan was not completed. The idea that the hospital would be completed by 2030 was a pipe dream, was it not?

[Karin Smyth]

I thank my hon. Friend; I am happy to take interventions, but I need to finish by half-past 4, so I am conscious of time. He is absolutely right, and I will come on to his point.

We need to be very clear and honest with people about what was ready and about the different stages of these programmes, which we are very keen to do. Staff and patients deserve better. That is why the Secretary of State asked officials to review the programme and put it on a firm footing with sustainable funding so that all the projects can be delivered.

I thank the hon. Member for Bexhill and Battle for his service to the NHS and his experience. I agree that it is appalling for staff. We all understand that he and I disagree in our political analysis, but he made some really well-informed points about models of care and future models of care, all of which we need to take into account in the delivery of this programme and other parts of the capital programme—and we will.

As the Secretary of State announced to the House on Monday, we now have a realistic plan to deliver the programme. I am pleased that we can be honest with people as we start a new chapter setting out a new commitment to deliver these hospitals, which are so important to all our constituents, that is realistic and backed with funding. We have worked closely with the Treasury to secure five-year waves of investment, backed by £15 billion of investment over consecutive waves, averaging £3 billion a year. This will ensure a balanced portfolio of schemes at different development stages being delivered now and into the future.

The new delivery plan sets out the order and the waves of investment in which each new hospital will be constructed. Hospitals included in a wave will begin construction, while forthcoming schemes will be undertaking pre-construction work to prepare planning permission and secure business cases. With this approach, we can ensure that schemes are ready to be built as soon as possible. A list of the schemes in each wave has been published on gov.uk and in the plan for implementation.

For reference, I will briefly outline the timeline for delivery. [Interruption.] Actually, I think we have seen all the waves, and the hon. Gentleman wants us to move on to Bexhill and East Sussex.

[Mr Mohindra]

For Watford general hospital, we have a window between 2032 and 2034. Given the certainty that the Minister is trying to give to the programme and to the rest of the country, what assurances and assumptions has she made for that two-year window? How can she assure me and my constituents that there will be no further delays?

[Karin Smyth]

I will pick up that point. Wave 3, which is what the hon. Member for Bexhill and Battle has secured this debate on, includes schemes that were always part of a post-2030 plan. We now have the confirmed dates. The East Sussex new hospital scheme for East Sussex healthcare trust includes, as the hon. Gentleman says, new buildings and refurbishments at Eastbourne district general hospital, Conquest hospital and Bexhill community hospital. The scheme is in wave 3 of the delivery plan, and construction will commence between 2037 and 2039. We understand that this is disappointing news to some people who were expecting and were told that their hospital would be built earlier, but we can assure them that there is now a credible and funded plan for delivery—no more false promises. Our priority now is to get on and deliver these new hospitals for the benefit of the staff and patients who so vitally need them.

We understand the importance of these schemes to local communities and the need to invest in health infrastructure. We will continue to engage with trusts—including Watford, which the hon. Member for South West Hertfordshire (Mr Mohindra) mentioned—over the next few years to establish whether there are any other activities that can be progressed during the spending review. We will be in discussions with all those trusts to understand mitigations in the meantime. That was the source of many questions that came up in the many meetings that I held with hon. Members yesterday. I understand that all these hospitals are critical—they would not be on the list if there were not a major problem with them—so we need to talk to the trusts about how we manage the process in the meantime.

I acknowledge that this will be a difficult time for the core teams and all the people who have been working on these schemes, many of which will be stood down. Their expertise and knowledge is extraordinarily valuable. I know that the programme teams will make efforts to ensure that expertise is retained where possible and used to develop the wider programme.

The trust is currently developing its strategic outline case, as per the business case process set out in His Majesty’s Treasury’s Green Book. Following the review and approval of the SOC, the next step will be the development, review and agreement of the outline and full business case. I understand that many areas, including Bexhill, have plans for housing to accommodate a growing population. My Department will work closely with integrated care boards and the Ministry of Housing, Communities and Local Government to ensure that those communities have the health provision that they need.

Beyond establishing a credible programme, we are taking steps to restore people’s trust through honesty and transparency. We will be setting out further information for each scheme shortly, to ensure a more open way of working and collaborative programme delivery.

Yesterday, I held meetings with Members of Parliament from all waves of the process to give them the opportunity to ask more detailed questions about their individual schemes, and to give them the clarity that their constituents deserve. Letters have also been issued to the trusts. That was a very successful way of working; I certainly learned a lot about the individual schemes. Members of Parliament of all parties came to talk about their schemes. I gave a commitment that I would continue to talk to colleagues about them. I absolutely offer the same to the hon. Member for Bexhill and Battle. I will work with Members’ trusts to understand the detail on the ground.

[Ben Maguire (North Cornwall) (LD)]

I warmly welcome the news, on which I congratulate the Minister, that the women and children’s hospital at Treliske and the emergency care hospital at Derriford are in wave 1. However, some of my North Cornwall constituents rely on the crumbling North Devon district hospital, which is potentially 15 years from a rebuild. We are talking about mitigations, so please will the Minister meet me to discuss how we can expand care at the community hospitals in Bodmin, Launceston and Bude, which are all at least one hour from their closest district hospitals?

[Karin Smyth]

I thank the hon. Gentleman for his intervention. We had a good discussion yesterday about North Devon; I understand the rurality of that location, as it is fairly close to my Bristol constituency. Obviously, however we manage it, there are a lot of schemes represented by a lot of MPs. I am open to suggestions about how we go forward. I hope hon. Members feel that we have tried to give as much information as we can to them and the trusts in the announcement and the meetings yesterday. That is the spirit in which we will continue.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I welcome the spirit of openness and transparency that the new leadership of the programme has demonstrated. Previously, and frustratingly, residents in Hillingdon were—to be frank—led up the garden path. We were left with all but an IOU note for £750 million for a new hospital. The revenue funding for the new hospital ran out this year. We were pleased to see it renewed, and to be in wave 1; a significant capital investment of more than £1 billion has been committed to.

This is complicated: it is hard to deliver projects at this scale. With the best will in the world, if another £20 billion were to appear, despite the Conservative party opposing any methods that would raise money, the construction sector would struggle to build all these hospitals at once. Is it not the case that it is challenging to deliver this project at scale? Will the spirit of openness and transparency continue?

[Karin Smyth]

I thank my hon. Friend for his continued campaigning on behalf of the residents of Hillingdon; I used to be one of them. Talking to people is really important, and we have learned a lot from it. In case I have not outlined this enough, let me be clear that all our constituents who are on the programme are in severe need. The programme has looked at clinical need and deliverability. We understand how difficult these choices are, so I thank my hon. Friend for that intervention.

[Helena Dollimore]

I welcome the Labour Government’s confirmation of funding, which will help the Conquest hospital in Hastings, part of the East Sussex Healthcare trust, and other hospitals that my constituents use. It comes alongside the Chancellor’s announcement of a big package of support in the Budget, with record investment in our NHS to provide more appointments to clear the backlog left by the Conservatives.

[Karin Smyth]

I thank my hon. Friend for her intervention, which highlights the point that the hon. Member for Bexhill and Battle raised about other capital plans and programmes to help his constituents and others over the coming years.

In conclusion, I thank the hon. Gentleman for raising this issue.

[Clive Jones]

rose—

[Dr Mullan]

rose—

[Karin Smyth]

If the hon. Member for Bexhill and Battle, whose timing is superb, wants to make an extra point, I will give him the courtesy of a chance to come back in.

[Dr Mullan]

In the last hour, I have had a communication from the trust explaining that, with the delay, the extra cost may be in the hundreds of millions. I would be grateful to take up the Minister’s offer of some time, as well as to talk to MPs who use those services, to see how we can help the trust to access that funding.

[Karin Smyth]

I thank the hon. Gentleman for that intervention. We learned a lot yesterday from the expert team from the new hospital programme; I thank them for their incredible work in getting to this point. Those colleagues who could make the meetings yesterday found that the team’s knowledge about every single programme was phenomenal. I have yet to ask the team a question about any scheme to which they do not know the answer—I give hon. Members that confident assurance. The team includes colleagues from both NHS England and the Department.

When I went to an assurance meeting a few weeks ago, I learned that the relationship between the central control of the programme and the trusts, how we get the schemes delivered for everyone’s constituents, and the value of parliamentarians talking to me—everyone has stopped me in the corridors to raise these issues—are all very valuable. That is a good function of parliamentarians. That is the spirit in which we want to continue.

Our commitment is to deliver these hospitals, including the Eastbourne district general, Conquest hospital and Bexhill community hospital schemes, and I am pleased to say that we have an affordable, deliverable plan to do so. It will be difficult, but I look forward to working with the hon. Member for Bexhill and Battle and other colleagues.

[Mr Mohindra]

It is very gracious of the Minister to allow me to intervene again. In the interests of full transparency, can she assure us that if the development of the new hospitals gets delayed, all MPs will be informed, not just those in the relevant constituency? Work on Watford general is meant to begin between 2032 and 2034. Will the Government communicate any further delays as quickly as possible? That will certainly be critical to our constituents.

[Karin Smyth]

We absolutely will. This is one of the advantages of the waves: we recognise, and everybody knows, that there are sometimes unavoidable delays to schemes, perhaps to do with the sites, but the advantage of the pre-construction work and our knowledge of the sites is that most of that should be built into the programme and the timing. But life happens.

One of the central issues for the programme is capacity in the construction arena, as well as across the country, in terms of developing primary estate to get these things done. The advantage of the waves is that they give us flexibility if things move, as they inevitably will—that is life. We very much want to keep up relationships with local trusts and inform them. That will be difficult, as my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) says, but that is the spirit in which we want to continue. I give him and other colleagues that absolute commitment.

Question put and agreed to.

Welfare of Doctors

Karin Smyth Excerpts

Tuesday 21st January 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

I will of course adhere to your instruction, Sir John.

I am grateful to my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for bringing this important topic to the House. I know it is close to his heart, as a working doctor. I thank him for his continued dedication to the NHS, as a surgeon and an MP, and I thank his family, too, for their dedication to it. We welcome the knowledge and expertise that he has already brought us, and he has done so again powerfully today. What a lovely memento he has of his own father’s service.

I thank my hon. Friend for highlighting the incredible role that resident doctors play in our NHS. We absolutely recognise the challenges that they face as they progress through postgraduate training. We are committed to giving them the support that they need to develop and thrive in the NHS. My hon. Friend spoke passionately about the welfare of doctors. Let me acknowledge, as I know he would, the tireless professionalism and dedication that all health professionals show across the NHS daily.

The NHS is broken, but we have a plan to fix it. In his investigation into the state of the NHS last year, Lord Darzi identified that this Government have inherited an NHS that is in serious trouble, with record waiting lists, people struggling to see their GP, and quality of care often lagging behind other countries. He found that too many staff are disengaged, that levels of sickness absence are worryingly high, and that many people working in the system are still exhausted from the pandemic and its aftermath, which has resulted in

“a marked reduction in discretionary effort across all staff groups.”

The Government completely agree with that assessment. We are on a mission to fix our broken NHS by driving fundamental reform to bring our analogue health service to the digital age. Through our 10-year health plan, we will cut waiting lists, reduce waiting times and get the health service delivering for patients and staff once again. Those ambitions will be possible only thanks to the hard-working staff, so it is essential that doctors and others are properly valued, supported and looked after at work.

Employers across the NHS play a pivotal role in looking after doctors. Strong and effective leadership is fundamental to building a healthy organisational culture and too many NHS organisations are falling short in that regard. I have been shocked to hear stories, some of which we have heard again today, about the lack of support received by resident doctors, whether on shift patterns and rota changes, access to rest breaks while on duty, or really basic things that we should expect from any employer, such as hydration and the provision of decent food. We have heard about people sleeping in cars and not being able to go to a close relative’s wedding or to be the best person at their best friend’s wedding. It is unbelievable, really, and it cannot continue. It has to improve. We expect better from trusts and employers and we will make sure that that happens.

We brought an end to the industrial action by resident doctors that was impacting the NHS’s ability to deliver a good-quality service and having such a corrosive effect on the morale of the workforce. As part of that deal, resident doctors and dentists in training received an average uplift of just over 4% into the 2023-24 pay scales, on top of the average 8.8% uplift they received for 2023-24. The Government have committed to improve the current exception reporting process, and to work in partnership with the BMA and other health organisations to review the current system of training, as my hon. Friend the Member for Bury St Edmunds and Stowmarket highlighted, and rotational placements. That is in addition to the work being undertaken by NHS England to improve working lives.

We want to work with the unions on the key issues that doctors face on the frontline, and improve their working lives. That applies to all NHS staff. For example, we are working at the moment with the BMA resident doctors committee to improve the exception reporting process. We know that is important to residents, and we agreed to address it as part of their pay deal.

It is vital that we look after the health and wellbeing of the whole NHS workforce. High-quality care and support for patients cannot be effectively provided without a compassionate and inclusive working environment. My hon. Friend listed a number of actions, some of which are more easily addressed than others. We would expect many of them to be included as part of a supportive culture in trusts. I accept that some are more challenging and involve discussions with NHS England, the Government and trusts, but I do not think that many are beyond local trusts and systems, working with the profession, to resolve.

The mental health of doctors and all NHS staff is incredibly important. We saw the strain and trauma placed on staff during the pandemic. They do so much for patients, and we owe it to them to ensure that they are properly supported in return. The NHS offers occupational health and wellbeing services for staff when they need them, but provision can be patchy. There is a drive to improve the quality of those services across the NHS. Not only can that reduce sickness absence and improve retention, but proactive and preventive occupational health can lead to improvements in productivity and, in the long run, save taxpayers money.

Access to specialist mental health support is important. I know that services such as the practitioner health programme, which we have heard about this afternoon, are highly valued by many doctors. NHS England is currently reviewing the mental health and wellbeing support available across the NHS, and looking at how it can be made more equitable and sustainable. There is no doubt that we need to continue to improve the mental health support available to NHS staff, and I look forward to seeing the outcome of that review. NHS England is also moving forward with a joint initiative with NHS charities to invest £10 million in health and wellbeing initiatives for staff. That will provide grants for better facilities and invest in improved wellbeing support.

I want to make a point about violence, which I do not think my hon. Friend particularly highlighted in his speech. Sadly, the threat of violence in the workplace is another thing that NHS staff are dealing with, as we saw in last week’s horrific assault in Oldham—I extend my wishes to the nurse and her family for a speedy recovery, as I know we all do. I reiterate that the Government take a zero-tolerance approach to that type of behaviour. Doctors, nurses and all healthcare workers are the backbone of our NHS and should be able to care for patients without any fear of violence or abuse.

At a national level, NHS England is focused on improving workplace experience, with the NHS people promise and the NHS retention programme addressing the issues that matter to staff, whether that be improving opportunities for flexible working, tackling racism and discrimination, preventing and reducing violence in the workplace, or improving facilities so that staff have the basic opportunity to rest and recover. Resident doctors face many challenges as they progress through postgraduate medical training, as my hon. Friend outlined. Expanding access to less than full-time training, rationalising and reforming statutory and mandatory training, and increasing choice and flexibility in rota management are just some of the things we are looking to do to improve their working lives.

We are also working with NHS England to support the GP workforce, including with measures to boost recruitment, to address the reasons why doctors are leaving the profession and to encourage them to return to practise. The NHS is working to address training bottlenecks, so that there are enough GPs for the future and patients can get the care they need. We have provided £82 million of additional funding for 2024-25 to address GP unemployment and support the recruitment of more than 1,000 new GPs.

In conclusion, through the 10-year plan, we are engaging widely with staff, patients and the public and listening to their views on how we need to reform and modernise the NHS. That applies equally to the NHS as an employer. Our ambition is for the NHS to become a modern, innovative and supportive employer. That is a necessity if we are to continue to attract and retain skilled and experienced professionals, give them the support they deserve as they care for the nation, and build a robust and resilient NHS. I look forward to working with NHS England. My hon. Friend the Member for Bury St Edmunds and Stowmarket will bring great expertise to this work in the House, as will Members more broadly, to make it a reality.

Question put and agreed to.

Medicines and Healthcare Products Regulatory Agency

Karin Smyth Excerpts

Thursday 16th January 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I congratulate the right hon. Member for Tatton (Esther McVey) on securing this debate and thank her and all those who have spoken for their contributions. We have heard some powerful stories of failure as well as some useful experiences. I have to thank my hon. Friend the Member for Stroud (Dr Opher), the hon. Member for Dewsbury and Batley (Iqbal Mohamed) and the shadow Minister for sharing their expertise. I have heard many of these stories before in my 10 years in this place. Sadly, I have also had a constituent who shared her experiences with me, for which I am grateful. Frankly, those experiences shocked me and my staff.

I congratulate my hon. Friends the Members for Camborne and Redruth (Perran Moon), for Washington and Gateshead South (Mrs Hodgson), for Poole (Neil Duncan-Jordan), for Bolton South and Walkden (Yasmin Qureshi) and many others who have brought their experiences to this place, shining a light on the issues. It is right for us to debate this matter. Six months into the job and I am still learning, Madam Deputy Speaker, so I am grateful for being able to take part in this debate.

I can assure my hon. Friend the Member for Blackley and Middleton South (Graham Stringer) that I cannot answer everything, and I am glad that he recognised that. The right hon. Member for Tatton has focused my mind, for which I am very grateful. If I do not do justice to the points that have been raised, I will write to Members about specific things. I am meeting representatives from the MHRA and will be very clear about our expectations. It is absolutely the role of Parliament to be the ultimate monitor of its work.

The MHRA plays a vital role in fulfilling the Government’s health mission: balancing its responsibilities to maintain product safety and championing innovation. I will, if I may, be clear about the role of an enabler. It is about enabling innovative products to reach patients without compromising patient safety and without unnecessary delay.

It is thanks to vaccines and medicines such as antibiotics and modern surgical procedures that we are living longer, healthier, and more active lives. No medical product is completely free of risk; the main objective of the safety monitoring process is to identify any new risks that may emerge. When that happens, the MHRA must take its responsibility seriously, rigorously and transparently when balancing population risks and benefits of each medical product, taking prompt and decisive action whenever that is needed.

On supporting safety, the MHRA recognises the need constantly to seek to improve its safety monitoring systems to deliver better results for people. Recent improvements include implementing the new Safety Connect IT system, following recommendations from the Cumberlege Review. This IT system will improve the efficiency of reporting and processing of yellow card reports, much of which we have heard about today, supporting the prompt identification and assessment of new safety concerns.

In addition, the MHRA makes use of real-world data via the clinical practice research datalink, which collects anonymised patient data from a network of GP practices, across the UK, encompassing data from 60 million patients, including 18 million currently registered patients.

The MHRA has recently launched a pilot, in partnership with Genomics England, to create a rich source of genetic information to investigate the role of genetic pre-disposition in the development of serious adverse drug reactions. The aim is to establish a yellow card biobank to reduce the number of harmful side effects caused by medicines—a step towards personalised prescribing.

The Cumberlege review also highlighted the need to improve the regulation of implantable medical devices. In November last year, the Government introduced new regulations to strengthen the requirements for manufacturers to proactively monitor and report on medical devices once they are on the market, which was noted by my hon. Friend the Member for Washington and Gateshead South.

We plan to lay further reforms before Parliament this year, including unique device identifiers and implant cards to improve the traceability of implanted devices, as well as increasing the classification of devices to ensure that they receive the highest scrutiny throughout their lifetime. Finally, the MHRA has made some progress in response to the wider set of recommendations set out in Baroness Cumberlege’s report. It listened carefully to the people who gave evidence and to the review’s findings, and is committed to bring about those changes. It is our job to ensure that that happens.

The yellow card scheme provides the backbone of our safety monitoring system. The scheme relies on voluntarily reporting from patients, parents, caregivers and healthcare professionals. The MHRA also collects reports of suspected safety concerns involving defective, falsified or fake healthcare products. Last year, it assessed more than 118,000 reports, and identified 134 safety signals, but I take onboard the comments made today. When safety signals lead to confirmed risks, the MHRA can introduce specific risk minimisation measures, such as introducing particular warnings about the risk of side effects in the product information, restricting the use of the medicine or medical device, or suspending or removing the medicine or device from the market. The MHRA will continue to proactively encourage the reporting of adverse effects through improvements such as those within the new Safety Connect system, and will ensure that there are better connections between clinical systems, working with the wider healthcare system.

The MHRA recognises that there have been delays in some of the regulatory services that it provides, including licence applications for innovative and generic medicines, variations to licences, and inspections of manufacturing and laboratory premises. Since September 2024, all new applications for marketing authorisations of established medicines are being assessed within expected timescales. That element is therefore improving, but we will keep a close eye on it.

I reiterate my thanks to the right hon. Member for Tatton. This has been an informative and, bizarrely, a wide-ranging but focused debate. Trust is really important. Patients have to be at the heart of our work, and that of the MHRA. Patient safety is the foremost priority. The MHRA is continuing to work on improving engagement and involving patients in decision making throughout the life cycle of the products that it regulates. It will continue to work to facilitate patient access to new medicines and medical devices, in collaboration with health system partners across the UK. The regulator maintains its focus on continuous improvement, and has implemented new ways of working to maximise productivity in ways that put patients and public health outcomes first. I take the point made by the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), that communication around that is key.

The MHRA has turned around performance on clinical trials and is on track to deliver all regulatory services within statutory timelines by the end of March 2025. Later this year, as part of its programme of reform, we will introduce new point of care manufacturing legislation that will make the MHRA the first regulator in the world to introduce a tailored framework for innovative manufacturing methods, taking the manufacture and supply of medicines to patients. It is truly an exciting development, and I pay tribute to those involved.

The process for recruiting the new chief executive is well under way. We welcome Professor Anthony Harnden. His strategic focus is on helping the organisation to protect patient safety through robust surveillance systems, embracing risk-proportionate regulation and fostering an inclusive workplace where people flourish. Without putting him on the spot, we should think about organising a parliamentary event of some sort to bring people together to discuss matters with the MHRA and build that trust. I am pleased to support its work. It is internationally recognised as a regulator. We want to do better. The Government will ensure that the MHRA is better.

Endometriosis: Women in the Workplace

Karin Smyth Excerpts

Wednesday 15th January 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

I congratulate my hon. Friend the Member for Sheffield Brightside and Hillsborough (Gill Furniss) on securing this important debate on the impact of endometriosis on women in the workplace. In opposition I supported the work of the APPG. I echo the praise for the campaigning work of Endometriosis UK and the support that you, Madam Deputy Speaker, and others in the Chamber have given to the APPG. I also remember the work of our friend David Amess. I echo the recognition of the recent report by the Women and Equalities Committee on reproductive health conditions. My Department is working across Government on our response, which will be published in due course.

I welcome the progress made on raising awareness—we are moving very fast on this—and on providing better support for women’s health conditions, including endometriosis. Nevertheless, this Government recognise that women with endometriosis have been failed for far too long, and we acknowledge the impact that it has on women’s lives, relationships and participation in education and the workforce. There is still much more work to be done. We are committed to improving support for any women and girls whose periods or women’s conditions disrupt their normal life, work or education.

In addition to receiving support in the workplace, all women should have access to healthcare support to help diagnose and manage this condition. We are making progress to ensure that those with endometriosis receive a timely diagnosis and effective treatment.

[Sir Alec Shelbrooke]

There has been a lot of cross-party work on this issue. I led a debate—the last one before the general election was called, I think—on endometriosis education. It is not prescribed that schools should educate about what a bad period is—I still meet women born in this century who do not know. If someone does not know what a disease is, how do they know that they have it? I urge the Minister to ensure that those messages are pushed in the Department for Education, as we need to ensure that people know what diseases they could have.

[Karin Smyth]

I thank the right hon. Gentleman for that point, which I will talk about later.

On the Employment Rights Bill, our plan to make work pay sets out a significant and ambitious agenda to ensure that workplace rights are fit for a modern economy, empowering working people and contributing to economic growth. On 10 October, the Government fulfilled their manifesto commitment to introduce legislation within 100 days of entering office, by introducing the Employment Rights Bill. As part of the Bill, we are taking the first steps towards requiring employers to publish action plans alongside their gender pay gap figures. The relevant clause sets out that regulations may require employers to develop and publish action plans relating to gender equality, which include measures to address the gender pay gap and support employees going through the menopause. It deliberately does not provide an exhaustive list of matters related to gender equality, giving us the scope to be led by the actions themselves. This reflects the fact that many of the actions employers take will be beneficial for people in a lot of different circumstances; for example, improved provision of flexible working can be valuable for an employee balancing childcare as well as someone managing a health condition such as endometriosis.

In the same way, ensuring that employers support staff going through the menopause will necessitate them taking steps that are positive for supporting women’s health in the workplace more broadly. For example, menopause best practice includes greater discussion around women’s health and awareness of potential workplace adjustments—things that have a much wider potential benefit. As my hon. Friend said, we need to start to reduce the stigma and taboos and remove them from the debate.

Through the Employment Rights Bill, the Government are also making statutory sick pay payable from the first day of sickness absence. This will particularly benefit those who suffer from conditions such as endometriosis, who may need to take time off to manage a flare up. We are also removing the lower earnings limit and extending statutory sick pay to up to 1.3 million additional low-paid employees, particularly benefiting women, young people and those in part-time work.

The Minister for Equalities, my hon. Friend the Member for Llanelli (Dame Nia Griffith), leads for the Government on the Bill from the equalities team, and I can assure my hon. Friend the Member for Sheffield Brightside and Hillsborough that we are working with her and talking about this issue throughout the Government. For example, I regularly join Women and Equalities questions here in the Chamber to make sure we work closely together, and I will continue to work closely with colleagues on these issues.

The new measures we are seeking to introduce build on existing Government support for employers, which recognises their key role in increasing employment opportunities and supporting disabled people and those with health conditions to thrive as part of the workforce. The Government’s current offer to employers includes a digital information service that provides tailored guidance to businesses to support employees to remain in work. That includes guidance on health disclosures and having conversations about health, as well as guidance on legal obligations including statutory sick pay and reasonable adjustments. The service is available across Britain and can currently be accessed from a range of trusted locations, including both the Health and Safety Executive and ACAS websites. We are also taking steps to better understand the challenges faced by women with endometriosis in the workplace and to improve workplace support for those with the condition.

The Government health and wellbeing fund has awarded almost £2 million to 16 voluntary, community and social enterprise organisations leading projects focused on supporting women who experience reproductive health issues to remain in or return to the workplace, including a project on endometriosis delivered by Endometriosis UK.

An Office for National Statistics study is investigating the impact of endometriosis on women’s labour market outcomes. This important study will be a vital step to improving our understanding and will inform future actions policy work. The first publication in this research project, on the characteristics of women diagnosed with endometriosis in England between 2011 and 2021, was published in December.

In addition to providing workplace support for endometriosis, the Government are committed to improving healthcare support and ensuring that women with endometriosis can receive timely diagnosis and treatment. We recognise that patients have been let down for too long while they wait for the care they need. Nearly 600,000 women are on gynaecology waiting lists. It is unacceptable that patients are waiting too long to get the care they need. I thank my hon. Friend the Member for Sheffield Brightside and Hillsborough for her sympathy with the task of reducing those lists, but that is our priority. Cutting waiting lists, including for gynaecology, is a key part of our health mission and a top priority for this Government. We have committed to achieving the NHS constitutional standard that 92% of patients should wait no longer than 18 weeks from referral to treatment by the end of this Parliament, and that absolutely includes those waiting for gynaecology treatment.

My noble Friend Baroness Merron, the Minister responsible for patient safety, women’s health and mental health, and I recently met with the Government’s women’s health ambassador, Professor Dame Lesley Regan, and NHS England to discuss progress on women’s health and current issues including gynaecology waiting lists. Following that meeting I am pleased that our recently published plan for reforming elective care sets out commitments to support the delivery of innovative models in gynaecology offering patients care closer to home and piloting gynaecology pathways in community diagnostic centres for patients with post-menopausal bleeding.

Enabling access to adequate healthcare support begins with providing high-quality education and information on menstrual health, as the right hon. Member for Wetherby and Easingwold (Sir Alec Shelbrooke) highlighted, so that women and girls know when and how to seek help for symptoms such as heavy or painful periods. The compulsory aspects of the curriculum on relationships, sex and health education means all pupils are taught about several areas of women’s health, including menstruation, contraception, fertility, pregnancy and menopause.

My right hon. Friend the Secretary of State for Education has committed to providing teachers with clear guidance that focuses on the wellbeing of children. Her Department will look carefully at all relevant evidence and engage with stakeholders, including young people and parents, ahead of publishing a consultation response and the revised guidance later this year. I am pleased that Dame Lesley Regan, in her role as women’s health ambassador, has been feeding women’s health perspectives into this work.

My Department has worked with NHS England to improve and create new content on endometriosis symptoms, diagnosis and treatment options on the NHS website and YouTube channel. NHS England has also published a decision support tool for managing heavy periods to support women’s understanding of their symptoms and appropriate treatment options to discuss with clinicians. Education and clinical guidelines support healthcare professionals to provide care for women with endometriosis.

The General Medical Council has introduced the medical licensing assessment for most incoming doctors, including all medical students graduating in the academic year 2024-25 and onwards. The content for the assessment includes several topics relating to women’s health, including menstrual problems and endometriosis, and will encourage a better understanding of common women’s health problems in all doctors as they start their careers in the UK, which we all want to see. Endometriosis is also already in the core curriculum for trainee GPs, obstetricians and gynaecologists.

Last year, the National Institute for Health and Care Excellence published updated guidelines on the diagnosis and treatment of endometriosis, and the new and updated recommendations on referral and investigation should help women receive a diagnosis more quickly. Through the National Institute for Health and Care Research, the Department has also commissioned a number of studies focused on endometriosis diagnosis and treatment and patient experience.

In closing, I thank my hon. Friend the Member for Sheffield Brightside and Hillsborough for tabling this debate and for her continued long-standing advocacy for women’s health. Let me affirm the Government’s commitment to supporting the many women who live with endometriosis in the workplace and beyond. This Government are committed to prioritising women’s health as we build an NHS fit for the future. My noble friend Baroness Merron is carefully considering how we take forward the women’s health strategy by aligning it to the Government’s missions and forthcoming 10-year health plan, and women’s equality will be at the heart of our missions. It is vital that we work with women to better understand their experiences and address their concerns, which have been ignored for far too long.

Question put and agreed to.

7.27 pm

House adjourned.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 7th January 2025 Commons Chamber

[Graeme Downie (Dunfermline and Dollar) (Lab)]

1. What steps he is taking to improve mental health services for children.

[The Minister for Secondary Care (Karin Smyth)]

The delivery of mental health services for children in Scotland is the responsibility of the Scottish Government. I hope that they will make the best use of the boost from the recent Budget to invest in mental health services. In England, we will support children and young people earlier by providing access to a specialist mental health professional in every school and rolling out Young Futures hubs in every community. We will also cut waiting times by recruiting 8,500 more workers across children and adult mental health services.

[Graeme Downie]

The long-term impact of the covid-19 pandemic on young people is often forgotten, with isolation leading to missed opportunities, lost life experiences and still unknown impacts on mental health. Child and adolescent mental health services referrals in Fife and across Scotland have skyrocketed, and despite a record Budget settlement from the UK Government, the SNP Scottish Government have told NHS Fife not even to bother asking for more funding to tackle this massive problem. I and colleagues will write to the Scottish Government about that. Will the Minister join me in urging the Scottish Government to reverse course and ensure that young people have the support that they deserve and need?

[Karin Smyth]

My hon. Friend makes an excellent point on behalf of young people. It is disappointing that the Scottish Government do not seem to be allocating the funding as they could. He raises a powerful case, and I know that he will work hard with the Government in Edinburgh to make the situation better for his constituents.

[Damian Hinds (East Hampshire) (Con)]

Is the mental health support in schools that the Minister just mentioned the same as or different from the plan for mental health support teams in schools that was already being rolled out by the previous Government?

[Karin Smyth]

Our plan is to have universal coverage in every school. That was not achieved by the previous Government, and we hope to ensure that it happens.

[Charlie Dewhirst (Bridlington and The Wolds) (Con)]

2. What assessment he has made of the potential impact of the increase to employer national insurance contributions on social care.

--- Later in debate ---

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

7. Whether he has made an assessment of the effectiveness of improvements made to the Care Quality Commission.

[The Minister for Secondary Care (Karin Smyth)]

In response to the report by Dr Penny Dash, we have made it clear that the CQC is not fit for purpose and requires significant reform. We have increased our oversight of the CQC to ensure implementation of the recommendations in Dr Dash’s review, and we will continue to monitor the CQC’s progress through this period of improvement. We are also supporting the swift and efficient recruitment of CQC leadership roles, including the new chief executive Julian Hartley, who started in December.

[Josh Fenton-Glynn]

It is inarguable that the CQC needs improvement. Many who run care services in local authorities have little confidence in its performance. Does my hon. Friend agree that we could go some way to improving how it is viewed by looking at the use of single-word assessments, which create undue stress for social services leads? They were raised by the Dash review as insufficient to support local authorities to improve, promoting box-ticking over real improvement and giving little information to members of the public on the quality of social services provision.

[Karin Smyth]

My hon. Friend is right that confidence is the key word in the huge agenda that the CQC has to deliver. Dr Dash and Professor Mike Richards highlighted serious failings that need to be re-addressed. As one of our predecessors said, priorities are our language. Currently, a review of one or two-word ratings is not a priority, but it will be kept under review.

[Mr Gregory Campbell (East Londonderry) (DUP)]

Is the Minister indicating today that there will be a new start in the Care Quality Commission, and that things will change for both staff and the recipients of care?

[Karin Smyth]

The hon. Gentleman makes an excellent point, particularly with regard to staff, who need support to continue their important work. A new start with new leadership is what they need, as well as implementation of the recommendations.

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

8. What steps his Department is taking to improve access to mental health services.

--- Later in debate ---

[Emily Thornberry (Islington South and Finsbury) (Lab)]

13. How many and what proportion of NHS employees have received enhanced maternity leave entitlements under Agenda for Change contracts.

[The Minister for Secondary Care (Karin Smyth)]

I thank my new Dame Friend for her question. The Department does not collect data on the number of people who have specifically received enhanced maternity leave entitlements. Access to an enhanced maternity leave benefit forms part of the total reward package for Agenda for Change staff, which we believe is critical for retaining our much-valued and needed NHS workforce.

[Emily Thornberry]

Thank you very much, Mr Speaker. Doctors throughout the NHS, no matter who employs them, have blanket maternity agreements, but nurses do not. When I visited the River Place health centre, I found that nurses employed by Whittington Health were working alongside nurses employed by the GP practice who got completely different maternity leave and pay. As we turn out our hospitals into the community and do much more work in that way, such anomalies will get worse. It is not fair and I wonder what my hon. Friend is going to do about it.

[Karin Smyth]

My right hon. Friend highlights a problem throughout the system, not just in her area. Self-employed contractors to NHS GP surgeries are not bound by national terms and conditions; they can develop their terms and conditions as they see fit. They have the flexibility to set terms and conditions to aid recruitment and retention. We anticipate that good employers will set wage rates and terms and conditions that reflect the skills and experience of their staff. That is better for staff and for patients, and I know that she will continue to highlight that with her local employer. It is certainly something that we need to keep an eye on as we develop services further.

[Pippa Heylings (South Cambridgeshire) (LD)]

14. What steps he is taking to extend Start for Life services to South Cambridgeshire constituency.

--- Later in debate ---

[Mohammad Yasin (Bedford) (Lab)]

T8. The East of England ambulance service NHS trust remains at the highest escalation level—level 4—as call handlers in Bedford remain under immense pressure after responding to 39,000 calls between Christmas and new year. Despite the unprecedented demand, the trust is considering closing the Bedford emergency operation centre, putting nearly 200 jobs at risk. Given that resources are already stretched to the limit in Bedford, does the Secretary of State agree that we must keep experienced staff who have helped to save countless lives in the region?

[The Minister for Secondary Care (Karin Smyth)]

My hon. Friend is right to highlight the particular problems in his constituency. Decisions on the configuration of call centres are a matter for local trusts in consultation with staff and representatives, and I encourage him to continue to engage with the trust in the interests of his constituents.

[Greg Smith (Mid Buckinghamshire) (Con)]

Will the additional money announced for hospices before Christmas cover the full cost of the increase in employer’s national insurance contributions or not?