Wheelchair Provision: Independent Review Body

Luke Evans Excerpts

Tuesday 21st April 2026 Westminster Hall

[Jim Shannon]

I thank my hon. Friend for her intervention; she underlines the point. I was going to give the example of a young fella from Newtownards. He lives in Dundonald, but he is more seen in Newtownards. He has severe, complex mobility needs, but he is the brightest wee boy you ever met in all your life, and he always encourages and lifts me when I meet him. He is a Chelsea supporter, so he needs some help at the minute, because they are not doing too good. I am a Leicester City supporter, and we are not doing too good either, so we have something in common.

There was just no way in the world that the NHS could give him the wheelchair that he needed for his special needs—similarly to the example that my hon. Friend mentioned in respect of those who have served in the forces. The only way that wee boy could obtain the wheelchair that he needed was through fundraising. Dessie Coffey in Newtownards has been fantastic. He raises money for all charities, but he did so especially for this wee boy. Over a period of time, we raised about £6,000 to help him with his wheelchair, and today that wee boy has some independence.

I wrote to one of the Manchester United stars—my mind just went blank and I cannot remember who it was, but he no longer plays for them—and he sent me a signed autograph, so I gave it to the wee boy and he sold it for £100. Again, if it was not for individual fundraisers, he just would not have had the money. I very much believe that we need an independent national review body to oversee wheelchair provision, and I support the hon. Member for Bexleyheath and Crayford in his call for one.

Some might ask why we need another body in an already complex system. The answer is quite simple: because the current system is failing the very people it was built to serve. Northern Ireland has the longest health waiting lists in the United Kingdom. People are waiting years for orthopaedic surgery, and while they wait, their mobility needs change, often without the system keeping pace. Just last year, we saw the collapse of NRS Healthcare, which was the main provider of repairs for our regional service. The Business Services Organisation stepped in to steady the ship, but that moment of crisis exposed the fundamental truth that out wheelchair services are fragile.

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

The NRS case is so important. I am keen to understand how the Government are ensuring the ongoing provision and servicing of wheelchairs, given that NRS has gone bust. I have been contacted by constituents who worked at high levels in NRS, and who are concerned that those contracts will not be followed up. Is the hon. Member concerned about that, too?

[Jim Shannon]

I certainly am. The shadow Minister always speaks with great knowledge on such matters, and I look forward to his speech. Hopefully, the Minister will respond positively to his point. Although waiting lists do not fall under the Minister’s responsibility, the fact is that they are of such length all over the country that mobility is declining, and support is needed more than ever.

One of the greatest merits of having an independent review body would be the death of the data desert. Currently, we do not have a full, transparent picture of the true demand for wheelchairs in the United Kingdom. An independent body would mandate high-quality, comparable data, forcing the Department of Health to confront the true scale of the backlog. The issue of data comes up during almost every debate we have on health. How can we know how to respond if we do not have the data and information? Perhaps the Minister could tell us how we can quantify the demand through data, which clearly needs to be collected.

We also need accountability that has teeth. Currently, when things go wrong, users are often left to navigate a complaints maze with their trust. An independent body would act as an impartial watchdog, ensuring that the wheelchair equality framework is not just a document on a shelf in Belfast or elsewhere, but a standard to which every service user can hold their trust. I gave the example of the wee boy—his name is Reuben Walls—and how fundraising got him what he wanted, but we need a system to help those who cannot fundraise and do not have the finances.

Every day that a child waits for a wheelchair or an adult sits in an ill-fitting seat that causes pressure sores, the cost to the health and social care system grows. Research shows that the right wheelchair can deliver a societal return worth triple its cost. Having an independent body would ensure that we treat wheelchair provision not as an optional extra, but as a vital investment in our economy and health. We need a national body that listens to the Wheelchair Collective, champions the user voice and ensures that the promise of

“the right chair, at the right time, right now”

is kept for every citizen in this United Kingdom of Great Britain and Northern Ireland. I look to the Minister and the Government to ensure and provide that, and I think all of us here today wish to see the same thing.

--- Later in debate ---

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

I thank the hon. Member for Bexleyheath and Crayford (Daniel Francis). He is becoming a regular in these Westminster Hall debates, rivalled only by the hon. Member for Strangford (Jim Shannon). It seems that there is a competition to be the one who makes the most representations.

On a serious note, last month in the debate on disability equipment provision the hon. Member for Bexleyheath and Crayford spoke passionately and movingly about his personal experiences. We should treasure so much, in this House, people bringing their experience to try to make things better for their constituents, their family and the nation. The hon. Member deserves a lot of credit and I thank him for securing this debate. I also thank the all-party parliamentary group for wheelchair users for its work to ensure that wheelchair users are heard, and I thank the Wheelchair Alliance and others who continue to hold this House, Ministers and the Opposition to account on these issues.

There is little disagreement in the debate about the nature of the problem. The Government themselves acknowledged last month, in the debate on disability equipment provision, that too many wheelchair users wait too long for the equipment they need, with knock-on consequences for their independence, health and ability to participate fully in daily life. That admission is welcome, but recognition alone is not enough. The question before us is how responsibility, accountability and improvement are to be delivered in practice. On that point, the picture is far less clear. Ministers have been explicit that they do not intend to publish a national strategy for wheelchair services. At the same time, the Government are embarking on a major restructure of the NHS in England. Understandably, that combination raises concerns about where national oversight will sit in the future, how consistency will be ensured and who will ultimately be accountable when services fall short.

During last month’s debate on disability equipment, the Minister acknowledged the uncertainty created by the changes, noting that seemingly small gaps in practice or responsibility can have disproportionate impacts on the quality of life of disabled people. That is precisely why clarity matters. As the NHS is reshaped, wheelchair users and their families need to know who is responsible for setting expectations nationally, who is responsible for commissioning locally and who steps in when the system is not working. Without that clarity, there is real risk that the responsibility becomes fragmented and that unacceptable variation goes unchecked. Ministers often rightly point to the role of integrated care boards in commissioning wheelchair services for their local populations, but ICBs are being asked to do a great deal at once—to meet 18-week standards for community services, adopt the best practices set out in the wheelchair quality framework, and now to do so while operating with up to 50% reductions in headcounts and constrained budgets. So it is fair to ask whether those competing pressures risk pushing wheelchair provision further down the list of priorities rather than elevating it to where it should be. Going forward, who will be responsible for overseeing the wheelchair quality framework itself, and how are the Government assessing whether that is genuinely improving outcomes on the ground rather than simply setting aspirations?

There are also practical questions that remain unanswered. The Under-Secretary of State for Health and Social Care, the hon. Member for Glasgow South West (Dr Ahmed), previously undertook to look at the reuse and return of disability equipment, which could have real benefits for patients and for public value. Many will be keen to hear what progress has been made on that work and whether it will form part of a more coherent approach in provision.

Finally, I raise the issue of innovation. In my constituency of Hinckley and Bosworth, local businesses have shown how responsive, user-focused solutions can make a real, tangible difference. I mentioned Mounts and More as a primary example last time. As the national structure evolves, innovation like that must be supported rather than stifled.

As the Minister responds this morning, wheelchair users and their families are listening carefully. They will want assurances that, amid the structural change, accountability will not be diluted, responsibility will not pass around the system, and there will be clear leadership to ensure faster, fairer access to the equipment that is so fundamental to independent living. I have three questions to the Minister on that basis.

First, as NHS England is abolished through an NHS service modernisation Bill, can the Minister set out clearly which body will hold national responsibility for wheelchair service standards and oversight, and how Ministers will be held accountable when or should services for wheelchair users fail across different parts of the country? Secondly, who will be responsible going forward for overseeing and enforcing the wheelchair quality framework? What assessment have the Government made to date as to whether that is making a difference, and how we can have improvements?

Thirdly—I touched on this in my intervention—many wheelchair users will have had provision from NRS Healthcare. Given the size and scale of the impact of NRS collapsing, there is real concern about servicing their contracts and making sure their wheelchairs are maintained. What have the Government done and what do they have to say on that topic?

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)]

It is a pleasure to serve under your chairmanship, Dr Murrison. I congratulate my hon. Friend the Member for Bexleyheath and Crayford (Daniel Francis) on securing this important debate and also on challenging us, born of his lived experience, to make the lives of disabled people better and better lived across our country. We are grateful for his presence in this House and this place, every single day. I am also grateful to my hon. Friend for the work he has done to champion this interest more generally in his capacity as co-chair of the all-party parliamentary group for wheelchair users.

In recent months wheelchair services have received considerable attention, both within Parliament and more widely. As has been highlighted, last month I participated in a debate on the provision of disability equipment, brought forward by the hon. Member for Aberdeenshire North and Moray East (Seamus Logan). I have been struck by the compelling testimonies shared during those discussions and the ones today, highlighting the profound impact that timely access to appropriate disability equipment can have on people’s lives.

This is a matter clearly deserving of much more attention. Since the previous debate on this topic, I have written to the national quality board to request that disabled people and the equipment they use are considered as part of the board’s ongoing work to improve quality and reduce inequality across health and care services. I am pleased to update that the board has confirmed it will take this forward.

This Government remain steadfast in their commitment to ensuring that disabled people can access the services and support they need. Through our reforms to health and social care, we are dedicated to delivering meaningful change that will make that vision a reality. Integrated care boards, as has been highlighted, are responsible for commissioning local wheelchair services. Responsibility for providing disability equipment lies with local authorities or the NHS, depending on the person’s needs.

For adults and children with long-term complex needs, services are typically provided by NHS wheelchair services. There is a range of NHS wheelchair providers across England, as we have heard. I acknowledge the concerns that the hon. Member for Hinckley and Bosworth (Dr Evans) raises about NRS. My hon. Friend the Minister for Care and I will be having discussions about that, and it would be appropriate to write the hon. Member an urgent letter to update him, as I know that he is genuinely concerned about the topic. ICBs are expected to monitor service provision and effectively manage contracts with their commissioned providers.

Although the latest data from NHS England shows a reduction in wheelchair waiting times for adults, I recognise that far too many people of all ages, as we have heard today, experience unacceptable delays for appropriate equipment. The covid pandemic had a significant impact on wheelchair services, from which we are still suffering in terms of supply chain disruption. That has meant that waiting times for both adults and children have fluctuated unnecessarily—well, unacceptably—as services have worked to recover. Those with more complex needs can also experience delays due to the lead-in time for supply of more bespoke equipment.

I understand that there have been complaints about the quality of services commissioned by some ICBs. Some of these are being dealt with on an individual basis by the Parliamentary and Health Service Ombudsman, following escalation by individual patients. As part of its oversight of ICBs, NHS England is also gathering intelligence through regional teams to understand fully the issues being raised.

It is important that local commissioners have the discretion to decide how best to meet the needs of their local population, and we are giving systems control and flexibility over how that is done. None the less, the Government are taking action to support local systems in delivering effective wheelchair services. Although there are no plans at the moment to establish a national review body to oversee wheelchair provision, the medium-term planning framework, published in October, requires that from this year all ICBs and community health services should actively manage and reduce waits over 18 weeks and develop a plan to eliminate all 52-week waits. The framework also states that in 2026-27, ICBs are required to

“increase community health service capacity”—

including wheelchair services—

“to meet growth in demand, expected to be approximately 3% nationally per year”.

[Dr Evans]

Can the Minister just clarify who he sees as responsible for the framework?

[Dr Ahmed]

Ultimately, ICBs are responsible for delivering the framework. The Government are held accountable in the manner being seen today, and I have no doubt that in the new structures that we propose there will be further accountability, because in many ways the middleman will be removed and we will have more direct oversight as to what is going on with wheelchair services and other services up and down the country.

I take the hon. Member’s point on data as well. I am the Minister responsible for data, health innovation and innovation in general, and I think this moment of restructuring, whether in relation to wheelchair services or other parts of the system, is a moment for us to really get into the 21st century with our capabilities for monitoring data for operational and capacity planning. I am very happy to share with him some of my thoughts about that over a cup of tea later, if he is interested.

The community health services situation report will be used to monitor ICB performance against waiting time targets in 2026-27. Those targets will guide systems to reduce the longest waits. In addition, the 10-year plan makes a commitment to reviewing the complaints regulations, and NHSE and the Department of Health and Social Care are developing plans to achieve that.

NHS England has developed policy, guidance and legislation to support ICBs to reduce delays and unacceptable regional variation in the quality and provision of wheelchair services. In April 2025 NHS England published the wheelchair quality framework, in collaboration with the wheelchair advisory group, which I understand includes the Wheelchair Alliance and Whizz Kidz, both of which were recognised by hon. Members in the debate today.

That framework is designed to assist ICBs and NHS wheelchair service providers in delivering high-quality provision that offers improved access, outcomes and experiences. The framework sets out quality standards relevant to all suppliers and aligns with the Care Quality Commission assessment framework that applies to providers, local authorities and integrated care systems. Those quality standards should be used to develop local service specifications and to benchmark current commissioning and provision.

Other measures taken by NHS England include the establishment of a national dataset on wheelchair waiting times to increase transparency and to enable targeted action if improvement is required, and the introduction of the legal right to a personal wheelchair budget in 2019. Personal wheelchair budgets provide a clear framework for ICBs to commission personalised wheelchair services that are outcomes-focused and integrated with other aspects of care.

Oral Answers to Questions

Luke Evans Excerpts

Tuesday 14th April 2026 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

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

Under the Labour Government’s new GP contract, Bracknell GPs and all GPs will have to refer through a single point of access. Can the Minister confirm that every referral deemed clinically necessary by a GP will be reviewed explicitly by a specialist consultant before being rejected or redirected?

[Stephen Kinnock]

I am astonished that the Conservatives seem to be teaming up with the British Medical Association in opposition to our reforms. They ought to listen to their voters and their members, who are crying out for change. We are getting the NHS to do things differently because that is the only way we are going to turn it around. Advice and Guidance is seeing more investment in GPs and getting patients cared for in the right place at the right time.

[Dr Evans]

The House will have heard that there was not an answer—that was a no. It is plain for all to see that this means patients will be blocked from seeing a specialist. They could potentially be assessed by a non-doctor, under Government pressure, with a target of one in four referrals being bounced. The Government’s own answers show that patients never appear on a waiting list. This is not about improving healthcare; it is about massaging the waiting lists, isn’t it, Minister?

[Stephen Kinnock]

I have honestly never heard so much nonsense in my entire life. We invested £80 million in Advice and Guidance. Some 1.1 million Advice and Guidance requests were diverted from the waiting list, so that care is being delivered in the right place. We have embedded A&G into the core contract, recognising it as routine practice, removing annual sign-ups and providing more predictable funding. The shadow Minister seems to be saying that patients who do not need to be treated in hospital should be treated in hospital. That runs completely counter to the entire strategy, which is about moving care from hospital into the community. The Conservative party needs to get with the programme.

Endometriosis Services

Luke Evans Excerpts

Tuesday 24th March 2026 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Dowd. Hon. Members have share powerful and distressing stories and experiences from their constituents. They are typified by Monica and I pay tribute to her for coming here to explain her story.

We must recognise the reality faced by many women and girls living with endometriosis. For too many, it means years of pain and possibly being dismissed, and it definitely means lives put on hold. From a GP’s perspective, the diagnosis is frequently delayed because symptoms overlap with other conditions such as fibroids, adenomyosis, irritable bowel syndrome, PCOS or pelvic inflammatory disease.

However, this debate is really about access, and there is a risk that current changes will make access worse, not better. The hon. Member for Ipswich (Jack Abbott) is a stalwart for raising that point as a central issue. The last Government drastically increased testing. They rolled out 161 community diagnostic centres across the country, which carried out ultrasounds, MRI and CT scans, and blood tests. That has helped with diagnosis by ruling in endometriosis and, equally importantly, ruling it out. That is not to mention the elective surgical hubs, 48 of which were delivering gynaecological procedures by March 2024. Those were important steps, but capacity remains constrained.

The first women’s health strategy, which committed to reducing diagnostic times for endometriosis, was also published in 2022. That strategy is now due to be renewed. In March 2026, the Women and Equalities Committee published a report from its inquiry into the menstrual health of girls and young women, which states that women’s health has not been “sufficiently prioritised” in recent proposed reforms to the healthcare system. The Government’s plan to renew the women’s health strategy is an opportunity to do so. Will the Minster confirm that those recommendations will be considered, and confirm when the renewed women’s health strategy will be published?

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

The points my hon. Friend makes, as a clinician and an MP, are very important. Eleanor, my constituent from East Grinstead, has faced dismissal and delay. She has multiple issues, including pelvic congestion, which she says have ripped her life apart. Will my hon. Friend talk about the impact on A&E if that health strategy does not work? Far too many women see their symptoms as normal and extreme pain is dismissed too easily, which can lead to A&E trips.

[Dr Evans]

I am grateful to my hon. Friend for raising her constituent’s case; Eleanor must be suffering, and the aim is to try to get more people into primary care so they can get the support that they need. That view is shared by both sides of this House and that leftward shift into primary prevention would be helpful. Access will be crucial, which is why some of the Government’s changes to that access—which I will touch on later—are concerning.

Women’s health hubs were intended to improve access to care for menstrual problems. They were rolled out by the last Government with £25 million of investment and 39 out of 42 were in place. However, after Labour came in, it removed the national targets in January 2025, leading to an article from the Health Service Journal in April 2025 that stated:

“Most integrated care systems lack a women’s health hub offering full services—contrary to government claims—according to research seen by HSJ.”

It is not clear whether those numbers have improved and what the situation now looks like. I ask the Minister to provide any updates she has on those women’s health hubs, how they are functioning and whether they are fully operational; if she does not have that information—I know she is a new Minister—I would be happy to receive a letter on that.

That leads on to Endometriosis UK pointing out that there have been shortages in trained clinicians and diagnostic specialists. We know that as we expand community diagnostic centres, that will be really important. Under the last Government, there was a workforce plan. We have heard talk of a workforce plan, but it has been delayed multiple times by the Government. I wonder whether there is a date for when that will be finalised, because it is really important.

Finally, the heart of this debate is access to primary care. In a debate on endometriosis at the start of this month, the Minister for Secondary Care said:

“We have introduced Jess’s rule, which requires GPs to rethink diagnoses for their patients.”—[Official Report, 5 March 2026; Vol. 781, c. 1068WH.]

That rightly encourages GPs to rethink the diagnosis and refer when needed, but at the same time, every referral will now have to be routed through advice and guidance. In effect, it is moving to a single point of access, with a system explicitly aimed at diverting a significant proportion of referrals back to GPs. The new advice and guidance are aiming for about 25% of GP referrals to be diverted back to GPs for “10 high volume specialities”—of which gynaecology will be one—meaning one in four referrals will be bounced back under the neighbourhood health framework released 17 March.

On the one hand, GPs are told to refer; on the other hand, the system is designed to send those patients back, which risks patients being kept on waiting lists and away from secondary and specialist care. That really matters for endometriosis. It is a perfect test case, and the new NICE guideline is crystal clear. Recommendation 1.1.3 states:

“Gynaecology services for women with suspected or confirmed endometriosis should have access to: a gynaecologist with expertise in diagnosing and managing endometriosis, including training and skills in laparoscopic surgery; a gynaecology specialist nurse with expertise in endometriosis; a multidisciplinary pain management service; a healthcare professional with an interest in gynaecological imaging and fertility services.”

All those services are gatekept as secondary care. Someone might have a normal scan in primary care, primary care treatments might fail and a GP might know that they will need to be referred to a specialist—yet they will not be able to get access. Women’s waits could become longer, not shorter. I have tabled multiple parliamentary questions on advice and guidance and have received only holding answers, despite the changes coming in on 1 April.

I ask the Minister three questions. First, does she accept that mandating advice and guidance risks delaying referral? Secondly, how will this system avoid conflicting with Jess’s rule? Thirdly, will GPs retain the ability to refer directly into secondary care when clinically necessary?

Endometriosis is already hard enough to diagnose and treat; for patients, it is harder still. If access is to improve, the Government must set out clearly how this new system will work. If they cannot do that, they risk making access worse, rather than better—and that is something none of us wants to see.

[The Parliamentary Under-Secretary of State for Health and Social Care (Mrs Sharon Hodgson)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate my hon. Friend the Member for Ipswich (Jack Abbott) on securing this very important debate. I am honoured to respond to it on behalf of my hon. Friend the Minister for Secondary Care, who unfortunately cannot be here today—this area of policy would normally fall under her portfolio.

I want to start by thanking Monica for sharing her story with us today through her MP and—as we heard—friend, and for being with us today in the Public Gallery, along with a large number of women who are suffering from this most painful and debilitating condition. Monica’s distressing experience highlights that we still have more work to do to ensure that all women with endometriosis can access the care they need.

As we have heard, for too many years women with endometriosis have felt unheard or dismissed and have been left to cope alone. We recognise the wide impact the condition has on education, work, family life and wellbeing, as well as on mental health, as the hon. Member for Eastleigh (Liz Jarvis) said, and we acknowledge that that is unacceptable.

This year’s Endometriosis Awareness Month theme is “endometriosis doesn’t wait”. That highlights the urgent need to reduce diagnosis times, improve care and address the impact of this debilitating condition. The Government are not waiting: we have already taken action to ensure that women with endometriosis have access to the services that they need. Many women spend years seeking answers, as we have heard today, being misdiagnosed, having symptoms minimised or being passed from service to service. The experience highlighted by all hon. Members who have spoken in the debate and by Endometriosis UK’s recent report underlines why earlier diagnosis and consistent, compassionate care must be central to our approach.

That is why we have introduced Jess’s rule, requiring GPs to reconsider diagnosis where symptoms persist, as the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans) mentioned. We are also rolling out Martha’s rule, giving in-patients in acute hospitals in England the ability to initiate a rapid review of their case by someone outside their immediate care team. Those measures will help ensure that women’s concerns are not dismissed.

[Dr Evans]

Those were the words that the Minister’s colleague read out in the previous debate, but I have no gripes about the Department saying the same thing. My question is about Jess’s rule and its interaction when there is a single point of referral. There will be a rub between GPs who say that someone needs to be seen because they might have a diagnosis of endometriosis and the system saying that those patients will be bounced back. I would be grateful if the Minister could clarify what that rule will look like in practice, because endometriosis is a good example to demonstrate it.

[Mrs Hodgson]

I was going to come on to what the hon. Gentleman said about that, as well as his request for an update on women’s health hubs. I will take the opportunity to write to him about that update and his specific question on how referrals will work. I am aware that colleagues have raised issues with referrals and, as the hon. Gentleman says, endometriosis will be a good example of whether that system is working as it should. I do not have the answer to hand, but I commit to writing to him on that.

We are also expanding access to diagnostic services. Community diagnostic centres are being rolled out countrywide for women on gynaecological pathways. Last month, 106 centres offered out-of-hours appointments so that women could get vital tests around work and caring responsibilities.

We are modernising how specialist care is delivered. In September, we announced the new online hospital NHS Online, which will be unconstrained by geographical boundaries. It will better align clinical capacity with patient demand so that patients will be seen and triaged faster. Earlier this year, we confirmed that menstrual problems, often a sign of conditions such as endometriosis, will be among the first nine conditions available for referral from 2027. Details are being worked through ahead of next year’s launch. Additionally, we are supporting integrated care boards to expand women’s health services at neighbourhood level, building on the successful pilot of women’s health hubs, so that good practice is spread and services are improved everywhere.

NHS England is currently updating the service specification for severe endometriosis, which will improve the standards of care for women with severe endometriosis by ensuring specialist endometriosis services have access to the most up-to-date evidence and advice. That will be published in due course.

Tobacco and Vapes Bill

Luke Evans Excerpts

Consideration of Lords amendments
Monday 23rd March 2026 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister.

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

I welcome the new Minister to her place; she is stepping in and taking the Bill through this stage, like a technical finishing substitute. I, too, have been substituted for my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), who spent a huge amount of time going through the Bill in Committee. I place my thanks to her on the record. Because of what she did, I have not had to do it, which has been a relief.

Eradicating smoking among young people is a public health priority. There may be differences in how we would achieve that, but the objective is shared by Members across the House, and we will not divide the House on the Bill tonight. There has been important common ground. As my colleague Lord Kamall said in the other place, smoking is harmful, vaping is less harmful than smoking, and not vaping is better than vaping. I think we can all agree that those principles should guide this legislation.

Those principles underpinned the Bill introduced by the previous Government. Since then, it has expanded, and at times it risks losing focus on its central aim of reducing smoking, particularly among young people. The Opposition have been concerned, for example, about measures that have placed additional burdens on hospitality and retail, and about restrictions on vaping that could undermine its role as a quitting tool for adult smokers. I therefore welcome the changes made in the House of Lords and the Government’s acceptance of them.

Further, the exemption of the adult mental health in-patient setting from the ban on vapes vending machines is a sensible and compassionate decision. Ministers were right to respond to concerns raised by peers, including my colleague Lord Moylan, and mental health charities, and we welcome the changes to clause 12. It is also right that local authorities will be able to retain proceeds from fixed penalty notices to support enforcement under the amendments to clause 39.

However, the Bill marks not the end of the process, but simply the end of the beginning. Key questions remain, including about the regulation of flavours and descriptors, advertising, and the designation of vape-free places. Those decisions will pretty much determine whether the Bill works in practice. It is therefore essential that the Government proceed in a way that is proportionate, enforceable and sustainable. We have already seen the importance of that balance. I welcome the decision to drop proposals to extend restrictions in pub gardens, which would have placed further strain on the hospitality sector. However, Ministers should take note. Restrictions should be targeted at areas where there is a clear and significant risk to public health. Possible considerations include restrictions outside schools and playgrounds, and I gently ask the Minister to reflect that approach as further regulations are developed.

The Lords also strengthened the Secretary of State’s powers in relation to cigarette filters, enabling more effective regulation of components that contribute to environmental harm. In addition, a series of technical amendments were agreed to, aimed at clarifying definitions, improving compliance mechanisms and ensuring that secondary legislation is subject to the appropriate level of parliamentary scrutiny. For example, Lords amendment 1, relating to age verification regulations under clause 1, requires the affirmative procedure to be used, increasing oversight of a core part of the Bill. Those are sensible improvements that reflect the spirit of constructive scrutiny.

A key and central issue raised throughout the passage of the Bill has been the risk of unintended consequences, and particularly the growth of the illicit market. Whether we are for the Bill or against it, one concern unites us all: the black market. If regulation is too restrictive or poorly enforced, it will drive consumers away from the legal market and into illegal supply, which would undermine both public health and enforcement. The Opposition proposed an annual report on illicit tobacco and vaping activity, which the Government rejected. Given the concerns raised throughout the passage of the Bill, I would be grateful if the Minister could set out clearly how the Government will monitor and respond to changes in the illicit market.

We support the broad objectives of the Bill, but we will be watching closely. Its success depends not on its intentions, but on its delivery. When it was first introduced, I spoke about my experience as a junior doctor on a respiratory ward—my first hospital job. I saw patients struggling for breath, families in distress, and moments when, despite everything, there was little more that could be done. The true test of the Bill is simple: in years ahead, fewer families should have to experience the same pain, suffering and despair. Let us hope this works.

[Mary Kelly Foy (City of Durham) (Lab)]

I declare an interest: I am proud to be the co-chair of the all-party parliamentary group on smoking and health. I am pleased that the Bill has returned from the Lords with minimal amendments. All the amendments before us are either Government amendments or have Government support, so I hope that the Bill can achieve Royal Assent as soon as possible. I understand that the amendments put forward today by the Secretary of State are simply to correct drafting errors, so I assume that they will need only brief consideration by the Lords.

I am proud that the Bill will become law under a Labour Government. I hope that this Government will be remembered as the one that began the end of smoking in this country. In a few decades’ time, I hope that people, particularly young people, will look back on smoking with disbelief, and will say, “Can you believe that selling tobacco, a lethal product, with the aim of getting us hooked, was ever allowed?”

Before coming to this place, I was a councillor in Gateshead council, where I held the public health portfolio from 2009 to 2019, and I chaired the Gateshead Tobacco Alliance. Tackling smoking was a central part of my work during that time, and it continues to be so today, because it remains the single biggest driver of health inequality in communities like mine and across the north-east.

In areas of high deprivation, smoking is not just a public health issue, but a deeply entrenched inequality. It is far more common in disadvantaged communities, where people are more likely to start smoking younger, find it harder to quit, and suffer the worst health outcomes as a result. That means higher rates of cancer, heart disease and respiratory illness, and lives cut tragically short. I have seen that reality at first hand over many years, and it is why action like that set out in the Bill is so important.

We should remember that tobacco is the single most harmful commercial product on sale in the world. It is sold for profit, while killing around two thirds of its long-term users and generating enormous returns for the companies that manufacture it. It is highly addictive, and many who start smoking wish they never had. Over 80,000 people die in this country every year because of it, and if it was introduced today, it is unthinkable that it would ever be permitted.

This Government are right to legislate for a smokefree generation, because there is a fundamental imbalance at the heart of this issue. Companies are making vast profits from a product that drives disease, kills two in three of their customers, deepens inequality and places huge costs on our NHS and wider society. We know how important it is to work towards a truly smokefree future, and to drive smoking rates down to as close to zero as possible.

In the north-east, we have a clear declaration for a smokefree future, endorsed by all directors of public health, our integrated care boards, Fresh, all 12 local councils and all 10 local hospital trusts. That kind of whole-system commitment is vital, not just for improving health but for tackling poverty, supporting a more productive region and preventing the premature loss of loved ones to smoking-related disease. That work is already delivering results. In County Durham, smoking rates have nearly halved over the last decade, reflecting a sustained effort across prevention and support to help people quit. However, rates remain higher in some communities, so we cannot afford to lose focus now.

I am equally pleased about the strong cross-party support for the Bill. We saw that clearly in debates in the other place. The APPG on smoking and health is a great cross-party effort, which I am proud to co-chair with the hon. Member for Harrow East (Bob Blackman).

There is much to welcome in the amendments. In particular, amendment 80, which requires the Government to review the Act, is an important addition that strengthens the Bill. To be clear, it is not a sunset clause, nor is it a test of whether the smokefree generation policy has succeeded in its health aims—the impact assessment makes it clear that we are playing the long game—but rather it will assess how smoothly implementation has progressed and what burdens, if any, have fallen on retailers. I am confident that it will report positively, and that it will encourage other countries to follow our lead. I note that a similar private Member’s Bill is before the French Parliament, which I hope reassures colleagues about the policy’s compatibility with EU law.

--- Later in debate ---

[Dr Evans]

I am glad the Minister has addressed many of the questions that I posed. One was about the designation of vape-free places, and I think there is consideration of what that will look like. How will the Government approach that? I would welcome it if she could at least set out the framework of what she might think about in her new role.

[Mrs Hodgson]

That is being looked at, and I can write to the shadow Minister with the details as we progress. I will commit to doing that.

GP Contract

Luke Evans Excerpts

Monday 16th March 2026 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the changes to the GP contract in 2026-27.

[The Minister for Care (Stephen Kinnock)]

When we came into office, we found GP services in an appalling state—underfunded, understaffed and in crisis. Since July 2024, this Government have been fixing the front door to the NHS, investing more than £100 million to fix up GP surgeries this year, making online booking available to patients across the country and recruiting 2,000 more GPs who are now serving patients on the frontline. Following investment in advice and guidance, we have seen 1.3 million diverted referrals since April 2025. Those are people who would have otherwise been added to the electives waiting list. A lot has been done, but there is a lot more still to do. We are determined to make the system fairer for coastal communities and deprived areas, so we have launched a review into the Carr-Hill formula to close the gap on health disparities and ensure that funding is targeted on the basis of need. We will shortly update the House in the usual way on our Carr-Hill review.

Last year’s GP contract saw the biggest cash increase in more than a decade, and this year we are investing an additional £485 million, taking the total investment made through the contract to more than £13.8 billion this financial year. Investment must always be combined with reform, so the new contract will improve access for patients by requiring that all clinically urgent requests are dealt with on the same day. It will provide a mechanism to hire even more GPs via a new practice-level reimbursement scheme, and it will support the shift from treatment to prevention, as set out in our 10-year plan, through incentives to boost childhood vaccination rates, better care for patients living with obesity and requiring GPs to share data with the lung cancer screening programme.

These ideas were not cooked up by someone sat behind a desk in Whitehall. What is happening is that we are taking the best of the NHS to the rest of the NHS, working with pioneering practices that have been doing these things for a long time. Today we can see that our policies are working, and after years of decline in general practice, we are getting the front door back on its hinges. Patient satisfaction with general practice is finally moving in the right direction. According to the Office for National Statistics, almost 77% of people described contacting their GP as easy in January this year, up from just 60%, where it was languishing in July 2024. I know that when he gets up, the hon. Member for Hinckley and Bosworth (Dr Evans) will hugely welcome, as will his hon. Friends, the progress that we are making.

[Madam Deputy Speaker (Judith Cummins)]

I call the shadow Minister.

[Dr Evans]

The Health Secretary and his team have perfected the sales pitch for NHS reform. The problem is that the detail never seems to arrive. We have seen a 10-year health plan with no delivery chapter, and a plan for the abolition of NHS England with no price tag; the Health Secretary has announced 10 new “straight to test” referral pathways, but could not name a single one; and now we are seeing a new GP contract with more questions than answers.

Calling something modernisation does not make it reform. If the rules and the delivery are unclear, it is simply confusion with branding. “Advice and guidance”, for example, appears in practice to create a single point of access for referrals. GPs will no longer be able to refer patients directly to a consultant, even when they believe that it is clinically appropriate. Will the Government publish the clinical evidence supporting that approach? Who will carry the legal responsibility if, in a GP’s professional judgment, a patient needs to see a consultant but must first go through “advice and guidance”? If advice and guidance becomes mandatory as an extra layer before referral, are the Government not, in essence, managing the waiting list by keeping patients in primary care rather than treating them in secondary care? Waiting lists will look shorter on paper, but patients are simply waiting elsewhere in the system. Can the Minister clarify exactly where those patients will appear in the official waiting list figures? The contract also requires patients whose cases are deemed “clinically urgent” to be dealt with on the same day, but it does not define “urgent” or explain what “dealt with” means, and that really matters.

Let me therefore ask the Minister three clear questions. First, when will the Government publish the clinical definition of “urgent”—a patient’s sick note is urgent for the patient, but not clinically urgent—and what counts as a patient’s being “dealt with” on the same day? Secondly, the Minister has talked about access, but how can practices guarantee same-day responses when demand is uncapped and definitions are not published? Finally, with advice and guidance being required as a mandate beforehand, how will we ensure that patients are protected, and where will they appear on the waiting lists?

[Stephen Kinnock]

I thank the hon. Gentleman for the GP-related questions, for which I was grateful when he finally got to them.

On clinical evidence for advice and guidance, I think that the evidence speaks for itself. We introduced advice and guidance in the last contract with an £80 million investment, and it has been a stunning success. Take-up across the country has been huge, and—this is the statistic that matters most of all—1.3 million referrals that would otherwise have gone to electives have been dealt with by GPs. [Interruption.] The hon. Gentleman, who is chuntering from a sedentary position, seems not to care about what actually matters for patients, but through advice and guidance they are able to get a response from their GPs within about 48 hours. I can assure him that it takes a great deal longer to secure an out-patient appointment. If he is looking for statistics on advice and guidance, let me give him that one again: 1.3 million referrals have been taken off electives and dealt with by GPs. That is part of the hospital-to-community shift.

The hon. Gentleman asked for a definition of “urgent”. We trust our clinicians. We know that general practitioners are experts in their field. They know when they see an urgent issue, but they also know that that the symptoms might be a more acute manifestation of chronic obstructive pulmonary disease, or that a child’s rash suddenly looks more dangerous than it did the day before. We trust our GPs to make those decisions, and it is a real pity that Opposition Members do not seem to do the same.

The hon. Gentleman also wanted a statistic in relation to access. In July 2024, patient satisfaction with access to a GP was languishing at a miserable 60% after 14 years of Tory neglect and chaos. Today it stands at 76%, which is a 16 percentage point improvement. The hon. Gentleman asked for statistics; perhaps he should take that statistic and deal with it.

Disability Equipment Provision

Luke Evans Excerpts

Wednesday 11th March 2026 Westminster Hall

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

It is lovely to see such a thoughtful, thought-provoking debate, with cross-party unity on the question of how we can better support our constituents who are suffering. It could be with a stairlift, a shower, a home aid or an adaption. When I was a GP, I saw what difference that can make to people. More recently, I visited Mounts & More in Stoke Golding, a company of specialists who support wheelchair users. Margaret and her family started Mounts & More in Market Bosworth in 1996; it fits mounting systems, such as for augmentative and alternative communication, to wheelchairs. The company’s best example is of Professor Stephen Hawking—it fitted the specialist holding position for such equipment. It also drives innovation and the small business side of things that we so long for in the UK.

I am keen to dive straight into some of the questions asked, as time is short, but before I do so, I pay tribute to the hon. Member for Aberdeenshire North and Moray East (Seamus Logan) for being so succinct in his well thought out speech. He is a rare parliamentarian in that he had only a single question for the Minister. I congratulate him on that. He raised a significant point about strategy. The Government say they do not have a plan to bring forward an equipment strategy, and they tend to point towards the ICBs as the commissioners on this.

There is going to be some difficulty, though, if the ICBs are cutting their staff by 50%. I do agree with the Liberal Democrat spokesman, the hon. Member for Epsom and Ewell (Helen Maguire), who asked whether there is an opportunity to look at what can be done in the forthcoming health Bill. I would be grateful if the Minister would set out whether this is a consideration when it comes to dealing with support for people with disabilities.

I have another question for the Minister on the disabled facilities grant. The Government have done a review, which is welcome, and recently published their look at the issue. As more and more people become infirm—the good news is that they are living longer, the bad news that they have more disabilities—the need will go up. It is not clear from the information that has been published just how that will be monitored. How will we ensure that the funding is going to the right place and working? There is a calculator on the website that says how it will be redistributed, but I point out that clarity on accountability will be hugely important. I would welcome input from the Minister on what that will look like.

[Sir John Hayes]

On that specific point, the Government have said that that additional money for the grant will provide about 5,000 additional home adaptations. It would be really useful if the Minister, when he responds, could describe how local authorities will access that funding, how those 5,000 adaptations will be distributed across the kingdom and what kind of adaptations we are talking about. Are we talking about adaptations to new build houses or long-standing traditional houses in the private or public sectors? A bit more detail on that would be very welcome.

[Dr Evans]

My right hon. Friend has hit the nail on the head. This is part of the problem in how we get different parts of the system to work together to get a full understanding of the situation; that is most important for those who are affected, but also for the commissioners who are trying to make the decisions on where the equipment goes. I hope the Minister has heard that and will be able to work it into his response.

I was very pleased to hear the hon. Member for Bexleyheath and Crayford (Daniel Francis), the chair of the APPG, raise the very important issue of the insolvency of NRS Healthcare. For those who do not know, NRS Healthcare accounts for about 40% of coverage, covering 15 million people and 21 local authorities across the country. Its insolvency showed a weakness in the way we deliver our supply.

I wrote to the Government back in the summer to try to find out what was being done and what lessons had been learnt. I received a generic response early on in August, saying that things are being kept under review. It stated:

“The Department continues to monitor the situation closely and will support LAs to learn lessons and consider the implications for future resilience in this market.”

I followed up very quickly and wrote back in September to ask more questions, but unfortunately I have not as yet received a response. I have with me a copy of the letter that was sent asking questions, particularly about what lessons have been learnt in this case and, more importantly, what is being done to implement more resilience in the supply chain. I would be grateful if the Minister could take a look.

If such a thing were to happen again, given the stark economic situation we are facing, which I appreciate is outside the scope of this debate, it would have knock-on effects for some of the most vulnerable in our society. I would be grateful if the Government would set out exactly what they are doing to make sure the supply chain is secure.

Finally, I want to raise concerns about the better care fund. The Government have been clear in the 10-year health plan about their promise to reform the fund, which has been very useful in bringing pooling together. However, we have already noticed that NHS England has already reduced the amount of additional voluntary funding it was putting in by £388 million. The example given by my right hon. Friend the Member for South Holland and The Deepings (Sir John Hayes) goes to the heart of the question: looking from the top down, how do we make sure these things are all integrated? How do we understand what ICBs, councils, the NHS and charities are doing through their provision?

I would be grateful if the Government could set out where they see that better care funding fitting in and when we will actually see the outcome of the changes they propose. It appears that there have been delays in the national neighbourhood health service guidance and delays in the better care fund. Without that structure and without joining it all together, it is very difficult for those scrutinising the system and, more importantly, those working in and using the system to understand exactly what to expect and when. I would be grateful if the Minister would be kind enough to set that out.

I thank Members for their thoughtful contributions today, because, at the end of the day it is really important to shine a spotlight on those constituents who suffer the most and get on with it the most. They are the most pragmatic, fantastic people, and their support is paramount.

--- Later in debate ---

[Dr Ahmed]

I am grateful to the right hon. Gentleman, and to those who raised this matter earlier in the debate. It does trouble me deeply that we have a situation in which equipment is going unused when there is that need in another part of the system. I actually feel that quite acutely. Hon. Members may know that I am a vascular surgeon; at times, unfortunately, some of my job involves having to amputate people’s limbs for end-stage vascular disease. I see for myself that transition from someone being able-bodied to needing assistance, and, where that assistance is not available, the impact that has, especially when people know there is this lack of productive exchange of equipment in the system highlighted by hon. Members today. I am therefore very happy to take the issue forward with my officials to see what can be done further to marry the demand and the supply together in the country.

Regarding wheelchair provision, NHS England has developed policy guidance and legislation to support ICBs to commission effective, efficient and personalised wheelchair services. I again nod to the remarks from the hon. Member for Aberdeenshire North and Moray East on making sure we get better, more efficient and personalised service provision.

In April 2025, NHS England published the wheelchair quality framework, developed in collaboration with the NHS England national wheelchair advisory group. The framework is designed to assist ICBs and NHS wheelchair service providers in delivering high-quality provision that offers improved access, outcomes and experience. NHS England introduced personal wheelchair budgets, including legal rights, in 2019, providing a clear framework for ICBs to commission personalised wheelchair services that are outcomes-focused and integrated. Those budgets give people greater choice over the wheelchairs that they are provided with. Additionally, the model service specification for wheelchairs sets out that wheelchair assessments should take place in the most suitable environment based on the needs of that individual.

NHS England is aware, as am I, that several complaints have been made about the quality of services commissioned by some ICBs. NHS England is working through the appropriate regional teams to gain intelligence from those ICBs on quality concerns and contracting arrangements, to fully understand the issues being raised.

[Dr Luke Evans]

Will the Minister give way?

[Dr Ahmed]

In the interest of time, I will not, but I think I know where the hon. Gentleman wants to go with this, with the NRS. I will be happy to write more fully—

[Dr Evans]

It was a different point.

[Dr Ahmed]

Well, I have not got time. I will write more fully regarding his correspondence. I am genuinely disappointed, if it is true, that he has not been responded to since September.

In addition, the 10-year plan makes a commitment to reviewing the complaints regulations. NHS England and the Department are developing those together to achieve better accountability. The Government are also taking wider action to support disabled people through the 10-year health plan. On neighbourhood health, the neighbourhood health service will support disabled people to have choice and control over their care. That includes increasing the uptake of personal health budgets, which provide individuals with that greater choice and control over how their health is assessed and their wellbeing needs are met.

One aim is to have a neighbourhood health centre in each community, bringing the NHS, local authority and voluntary sectors together to create a holistic offer that meets people’s needs in the place that they are. We expect these services to be designed in a way that reflects the specific needs of disabled people, with a focus on personalised, co-ordinated care. I particularly think that this is an opportunity, as we move care from hospital to the community, to address some of the concerns raised in the debate today.

On social care, the Government are also driving forward improvements for disabled people. We are enabling people to have more choice and control over their care—through greater use of direct payments, for example. We are also expanding care options to boost independent living at home and have recently confirmed £723 million for the disabled facilities grant in 2026-27. The total DFG budget across 2025-26 and 2026-27 is £150 million more than the total budget across the previous two years. That represents an 11% increase and will support more disabled people to get the vital home adaptations that they might need.

The Better Care Fund, which took effect in April 2025, is a framework for ICBs and local authorities to make joint plans and pool budgets to deliver better joined-up care. That can include the provision of assistive technology and equipment, such as wheelchairs. This financial year, ICBs and local authorities plan to spend £440 million on assistive technology and equipment, and we have introduced care technology standards to help them to choose the right support. In addition, as we move from hospital to community, commissioners can, if they wish, think about better co-commissioning, transcending traditional boundaries between local authorities, social care and the NHS.

I am grateful to the hon. Member for Aberdeenshire North and Moray East for securing this important debate and I want to respond to a question he asked. Whether we call it a strategy or a framework, there is a real opportunity at this time of change in the NHS—including the development of a national quality board at NHS England, which will come into the Department of Health and Social Care once NHS England is abolished —to genuinely think about how we define “quality” for disabled people and about the equipment and the spaces that they use. Again, I will be very happy to discuss that with my colleagues in charge of the quality board. I will write to the hon. Gentleman with specifics that we can perhaps tease out after this debate today.

We recognise the life-changing impact that having timely access to suitable disability equipment can have on the lives of disabled people across the United Kingdom, in every nation. The Government are dedicated to ensuring that all disabled people have access to the services and support that they need to live a fulfilling life; the presence of disability Ministers in each Department is certainly progress in that regard. Our work to reform health and social care, alongside the new plan for disability, will also help us to achieve that.

NHS Capital Spending

Luke Evans Excerpts

Wednesday 4th March 2026 Westminster Hall

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

I, too, associate myself with the comments about the hon. Member for West Lancashire (Ashley Dalton) on her stepping down as a Minister. She was a formidable opponent and will be sorely missed. I am sad to see her step back, but she has made the right decision for her, as in this place we should all do.

I thank the hon. Member for Carshalton and Wallington (Bobby Dean) for securing this debate. He was absolutely spot on when he said we do not scrutinise the process of NHS capital spending nearly enough. I was taken by what he said on that point, but less surprised that not many solutions came forward, although that is key to having this debate, because it is hugely technical.

I will use an example from my constituency for both the pros and the cons, the good and bad stories about capital investment. I was elected in 2019 and Hinckley is my biggest town. Healthcare is an important priority for my constituents and talk of improved hospital services there has been ongoing for 30 years now. On the good side, we were lucky enough to be picked to have a community diagnostic centre, a £24 million investment, and I was lucky enough to open it last year. That shows what good can come of capital investment. Under the previous Government, at August 2024, there were 165 similar good news stories of community diagnostic centres being opened across the country, not to mention the 108 surgical hubs that have not been talked about, but that are increasing patients’ ability to be seen and treated quickly, helping to deal with the waiting lists.

I also come with a negative story related to the same hospital. We were looking for a second project, a £10 million day case investment, but unfortunately, despite funding having been secured, delays in the system and difficulties with changing need have meant that that has been cancelled. The NHS papers specifically on that case state:

“The STP Capital business case for the Hinckley Day Case Unit received national approval in March 2024”—

but then struggled. The papers go on to say:

“However, since business case approval there have been further key changes… Changing financial context nationally and local financial challenges… Increased capital costs of the scheme circa £2m compared to that approved by the board… Programme delays resulting in a significantly reduced capital resource”.

They go on to explain that further delays to the programme occurred due to

“Cost pressures that exceeded the STP capital allocation…Since the approval of the STP Capital Business case in 2024, delays can be attributed to…The planning application phasing (considering the contention surrounding the demolition of the Hinckley District Hospital…The delay in submitting the planning application to allow the development of a robust design to address the Local Planning Authority’s concerns”.

We can already see the difficulties in how need is being allocated across Leicestershire and how planning and inflation interfere. That is the process issue at the heart of making these capital decisions.

That leads us to the bigger picture that confronts the Government today. As has been mentioned, funding is important, so what is the best document we can look at to see what the Government are trying to do? The 10-year plan is clear:

“We will continue to use private providers to improve access and reduce waiting times, to return the NHS to its constitutional standards. As we outlined in our Plan for Change, we will not let spare capacity go to waste on ideological grounds. We will continue to make use of private sector capacity to treat NHS patients where it is available, and we will enter discussions with private providers to expand NHS provision in the most disadvantaged areas.”

The Opposition agree with that, but I am not sure that all Government Members will, so I am interested to know whether all the Minister’s hon. Friends are aligned with it. I agree with the concern that the previous Government’s private finance initiatives, which brought in £13 billion of investment for new hospitals, cost the taxpayer more than £80 billion in repayments. We are still paying for that now.

Turning back to the NHS 10-year plan, a section called “Harnessing new investment” states that

“we will learn from previous experience with the Private Finance Initiative…In other cases, however, PFI was a costly mistake which represented poor value for money. Contracts were too complex and lacked proper transparency.

As the government considers new sources and models of private investment, we do so with this experience in mind.”

How do we know that? Where is it set out that the Government have learned this time? In the same section, the Government tell us they will “evolve” their

“infrastructure finance models and…consider the use of Public Private Partnerships…where there is a revenue stream, appropriate risk-transfer can be achieved, and value for money for taxpayers can be secured.”

Those are not small tests; they are the fundamental ones that we must ensure are in place, so my simple question is this: what is different this time? How will we assure value for money, and who will make that decision? How will we see genuine risk transfer being assessed, rather than simply pricing it into decades of payments? How will that work?

The 10-year plan also states:

“We will codevelop this with the National Infrastructure and Service Transformation Authority (NISTA), building on the successful NHS Local Improvement Finance Trust programme, and will look to drive competition in the market to incentivise others, including third party developers, to improve their offer to deliver better services at lower cost to the taxpayer.”

That is great—but LIFT is used only for small practices, so what model will come forward for everything else? The plan states:

“We will engage with the market on this programme and support NISTA in its wider market testing of a new PPP model.”

What is that model? Can we see it? What does it look like?

I note from the Minister’s answers to written questions that 120 neighbourhood health centres will be operated by 2030; 70 will be new buildings, 50 will come from refurbishment and, of those, 80% will be funded through PPPs. However, there are no plans to publish the business case. That raises legitimate questions. Why are the Government hiding this? We have been here before, and the country is nervous about this, so why can we not see what is being brought forward? If a new model is genuinely different, transparency should not be a threat; it should be a strength. Why will Parliament and the public not see it?

[Luke Taylor]

It would be remiss of me not to ask at this point, while the hon. Gentleman is speaking about transparency and funding for hospital projects, about the previous Government’s imagined 40 new hospitals. I invite him to give some transparency as to where the money to fund that hospital programme was supposed to come from and where it ultimately disappeared to. My residents are still suffering from the impact of his Government’s not providing that money. Can he expand on what happened to that money, which never arrived?

[Dr Evans]

I am grateful for the chance to put this on the record. The health infrastructure plan 2019 had the £3.7 billion, which was the seed funding to look into the projects to bring things forward. That also dealt with the first wave—the three hospitals that were brought forward to allow the second and third waves to come on. The hon. Gentleman will also know that, as the Government and the Opposition have stated, all big national infrastructure is done through a series of spending reviews. The money—£20 billion—was committed through those stages on the basis of that plan. The Government throw the same argument back at us when it is convenient for them to say, “We are not increasing defence spending because it needs to come in a spending review.” Both sides are playing politics, but there was money allocated in that plan. I appreciate that the hon. Gentleman was not in Parliament at that time, but he can ask the House of Commons Library to look at it so that he understands it, and he can then pass that on to his constituents to answer that question.

If we have a new model, we in this House need to be able to scrutinise it. GPs’ rents and rates are reimbursed, but there is concern that if we have further PPPs, similar to the previous PFIs, GPs may be on the hook for ongoing premises costs. We must have crystal clear guarantees, so they understand what they are and are not accountable for.

The 10-year plan states:

“We will also work with NISTA to consider the opportunities for health that could be achieved through private financing of revenue-raising assets (such as key worker accommodation and car parks)”.

That will set alarm bells ringing, as it looks like the Government will use key workers, or staff and patients coming into car parks, to generate funds. I would be grateful for clarity about what the Government actually mean by that statement, because this is a contentious issue. People know that we need to have funding coming into the health services, but where will those streams come from and what will they look like? If the 10-year plan is looking at revenue-raising assets, I am keen to understand exactly what that looks like.

Overall, there is a desire in the 10-year plan, which is shared across the House, to improve healthcare. Nobody disagrees with that, but the criticism of the 10-year plan is that there is no delivery chapter. I am grateful to the hon. Member for Carshalton and Wallington for securing this debate so that the Opposition can ask questions about what delivery will actually look like when it comes to improving the health of the nation.

--- Later in debate ---

[Karin Smyth]

The Chancellor has made her key decision to put us back on track, announcing in the Budget that capital health spending would increase by £15.2 billion by the end of the spending review period in 2029-30. That funding will be used as intended; in previous years, as we heard, capital funding was diverted to cover day-to-day costs. We have tightened the Treasury rules; we have changed them, because that is what Government can do—who knew! As a result, capital funding will now be fully focused on repairing, upgrading and expanding NHS buildings and facilities to support long-term productivity. This settlement represents record levels of capital investment into healthcare, and it will support the three shifts set out in the 10-year health plan: moving care out of hospitals into the community, replacing outdated systems with modern digital services and focusing on preventing illness rather than just treating it.

Of course, rebuilding NHS infrastructure cannot happen overnight. I assure hon. Members that the Government do understand that long-term certainty over capital funding is needed for the NHS to move from these short-term fixes to more strategic investment. That is another key decision made by the Chancellor. That is why, through the 2025 spending review, we have delivered a four-year capital health settlement, extending to 2029-30. That is backed by a further five years of certainty for estates maintenance funding. I am genuinely grateful to hon. Members for recognising that that is a massive change that we have engineered into the system, and I think we are all seeing the benefit.

That change means there is a £30 billion commitment in capital funding over five years to support the day-to-day maintenance and repair of the estate, with a further five years of funding certainty, as set out in the 10-year plan. For the first time, NHS trusts have also been given multi-year operational capital allocations, with clear funding set out until 2029-30, and indicative funding for a further five years. This is an unprecedented opportunity for local health systems to plan with confidence over a nine-year period, and I continue to encourage all Members to engage with their integrated care boards, which will be prioritising schemes over that period.

Within the £30 billion, the estates safety fund will continue, providing £6.75 billion of investment over the next nine years to target the most critical building repairs, alongside £2 billion to continue supporting NHS England’s RAAC programme across the spending review. Additionally, £21 billion in operational capital over the five-year spending review will empower NHS organisations to invest in local priorities, including hospital infrastructure. It will take time to build up capacity and capability, but this marks the beginning of our rebuilding of an NHS that is fit for the future.

I also assure Members that this Government recognise the pressures faced across the system and are committed to bringing performance standards back to what patients expect. That is why we are investing to expand hospital and emergency care capacity, helping to reduce waiting times and improve care for patients. Over the next four years, there is £1.9 billion for urgent emergency care to support A&E departments, as well as to support ambulance services in reducing handover times.

There is also £1.5 billion for diagnostics, including funding to expand the hours of community diagnostic centres, shifting care from hospital to the community. The hon. Member for Hinckley and Bosworth noted that those centres were started under the previous Government, but we have ensured they have expanded hours and that there are more of them. Crucially, they are not built as add-ons, but are fundamental to the pathways experienced by patients in the system and ensure we have good value for taxpayers’ money.

There is £473 million for mental health services, including for people with learning disabilities and autism. I think we would all agree that the mental health estate needs recognition. There is more than £280 million for community care, supporting services closer to home, and more than £139 million for electives across the next two years. To move away from paper-based systems towards modern digital services, the autumn Budget confirmed £300 million in capital investment in technology, building on the combined revenue and capital investment announced at the spending review of up to £10 billion by 2028-29.

We are transforming healthcare by shifting care out of hospitals and into the community. Over the next four years, we are investing more than £400 million to upgrade primary care buildings and deliver neighbourhood health centres, as part of our commitment to those 250 neighbourhood health centres through the rebuild programme.

[Dr Evans]

Will the Minister give way?

[Karin Smyth]

I will finish these points and answer some of the issues that have been raised.

The first 120 neighbourhood health centres will be operational by 2030 and will, as we have heard, be delivered through a mixture of public and private partnerships. I thank the hon. Member for Carshalton and Wallington for being one of the few to acknowledge that that is difficult—there is some controversy around it—but I am a strong supporter of the previous local improvement finance trust schemes and of the scheme at Southmead hospital in my local area, which was one of the better PFI schemes, and delivered unprecedented levels of care to the people of Bristol, including myself. It is important that we learn the lessons of the past, and we absolutely have, including those in the NAO report. Working with NISTA, as has been outlined, we will continue to pursue this issue and bring forward cases.

I do not want to rehearse the lack of funding for the new hospital programme.

[Dr Evans]

Will the Minister give way?

[Karin Smyth]

No, I will not, because I want to get through my final comments.

We put the new hospital programme on a sustainable footing. I understand that local people across the country were led up the garden path and told something was going to happen. I think we all recognise that the money was not there and that the programme was not on a sustainable footing. We have backed it with the appropriate investment, which is rising to £15 billion over each consecutive five-year wave from 2030, averaging £3 billion a year. The exact profiles of funding will be confirmed at future spending reviews, and that is weighted to ensure that the schemes profiled most are caught in that.

We are progressing wave 1, and I will continue to liaise with hon. Members on progress. My message every week to any NHS trust, to any Member of Parliament, to NHS England and to the team running the new hospital programme is that we need to deliver these hospitals. There is a large queue behind them, and we have heard about some of them today. I also understand that a number of colleagues do not have a hospital being progressed in the scheme. The Government are keen to get on with building these hospitals. As hon. Members have said, a lot of this is about trust and commitment. I want hon. Members and anyone paying attention to know that I am clear about the importance of getting on with this programme, delivering on the ground and ensuring that the programme is robust.

Finally, alongside increased capital funding, we are improving how that funding is managed. As we have heard, the old processes did not work: a local scheme went to the ICB, to the region, to NHS England, to the Department, to the Treasury and back again, with huge amounts of sign-off but no control or accountability, and with no one locally understanding what was happening. We are transforming that, bringing together a team and streamlining the process, ensuring it is well governed. That will ensure that things happen more quickly, and we are already seeing that. With underspends this year, we have got the money out and into schemes already in the system. We are getting more DEXA scanners. That is how we ensure this happens on the ground.

It is up to ICBs to prioritise proposals, and we are working more closely with them to support them to bring things forward. I urge all hon. Members who have spoken today, including my hon. Friend the Member for Harrow West (Gareth Thomas), the hon. Member for Torbay (Steve Darling), my hon. Friend the Member for Rushcliffe (James Naish), the hon. Members for Taunton and Wellington (Gideon Amos), for Sutton and Cheam (Luke Taylor), for Eastbourne (Josh Babarinde) and for North Devon (Ian Roome), to keep working with their local systems on particular schemes. I am happy to keep talking to people.

To the hon. Member for Taunton and Wellington, let me say that I have met NHS England about looking at maternity in the area, which I know is a huge concern, and I am happy to meet him. I will get back to the hon. Member for North Devon about some of the numbers he outlined, which are not familiar to me. On another point that was made, we are ensuring that we are building in contingency for the future, because we live in volatile times.

Motion lapsed (Standing Order No. 10(6)).

Pharmacy First: Withholding Payments

Luke Evans Excerpts

Thursday 12th February 2026 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the withholding of Pharmacy First payments to pharmacies.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)]

It is a pleasure to take the traditional Department of Health and Social Care urgent question before recess—I would not miss it for the world.

Since coming into office, we have reversed the decade of cuts to community pharmacy with the biggest uplift for the sector in years and frozen prescription charges to help our constituents with the cost of living, and women can now get the morning-after pill free of charge across the country. Earlier this week, I spoke to the National Pharmacy Association’s winter reception to pay tribute to its members for their work and to assure them that I have their back, as does the Minister for Care.

The hon. Member for Hinckley and Bosworth (Dr Evans) raises the important issue of payments made via Pharmacy First. As he knows, pharmacy contractors receive a monthly fixed payment if they meet certain requirements. We agreed to reduce the claim window, in conjunction with Community Pharmacy England, as part of our deal for 2025-26 to introduce a new Pharmacy First fixed first payment of £500. That has supported a broader range of pharmacies and has meant that more pharmacies have become eligible for payments. We are in discussions with Community Pharmacy England to consider where improvements to the claiming process can be made, address concerns raised by contractors and aim for a more consistent approach to remuneration. We will also consult with Community Pharmacy England shortly on the contractual framework for next year.

There are issues relating to contractors being suspended from providing Pharmacy First that are for separate consideration. When concerns are raised, NHS England can suspend individual contractors from providing the service pending a full investigation. There are a number of reasons why that might be necessary, but the measures are there, first and foremost, as the House will appreciate, to protect patient safety. I am a clinician, as is the hon. Member for Hinckley and Bosworth, and I am sure that he will agree that patient safety should be at the forefront of everything we do.

Finally, funding for the core community pharmacy contractual framework has been increased to over £3 billion—the largest uplift of any part of the NHS in the last two years. As part of this year’s contractual framework, we have agreed to keep the current cost control mechanism linked to Pharmacy First that we inherited from the previous Government to ensure that the money is spent within that envelope. I thank the hon. Gentleman for his question.

[Dr Evans]

It is a regret that I have had to summon the Minister here to answer questions, and surprise, surprise—

[Mr Speaker]

Order. May I just say that you did not summon the Minister? I granted an urgent question. Think about the language you choose, Dr Evans, and think that we have given you something.

--- Later in debate ---

[Dr Evans]

I of course withdraw that remark, Mr Speaker, and I thank you for summoning the Minister on my behalf. It seems to have had the desired effect, because the outstanding parliamentary questions have, strangely enough, been answered this morning. I hope to get some clarity as this is really important.

The issue has been explained simply by the chair of the National Pharmacy Association:

“The work was done. Patients were treated. The NHS benefited. Yet payments are being withheld on a technicality.”

What makes that worse is that many pharmacies do not even realise that some of the money is missing. He goes on:

“Statements appear ‘successful’, yet Pharmacy First payments are absent. Contractors are only discovering the issue long after the window has closed, when it’s already too late.”

Will the Minister tell the House how many pharmacies the Government think are impacted? What is the total value of the outstanding payments? What steps are the Government taking to rectify this, and would they consider a late payment mechanism to help solve the issue?

There is a wider concern. Payments are administered by the NHS Business Services Authority. The chair of the NPA labelled the behaviour of NHSBSA “outrageous”. That already follows repeat concerns about NHSBSA’s performance, including multiple serious delays in NHS pension processing and several urgent questions on the Floor of the House. Does the Minister still retain confidence in NHSBSA? Given the ongoing concerns from multiple fields, will he commission a review of the operational performance of the entire NHSBSA?

Community pharmacies are already under intense pressure from this Government, with tax rises on employment and business rates and with increases in costs, and now they appear not to be being paid for work already done. I hope the Minister will act quickly to put this right.

[Dr Ahmed]

As the hon. Gentleman will know—or should know—the current remuneration method was agreed in conjunction with the sector. The adjustment was agreed with the sector’s representative body, Community Pharmacy England. Advance notice of the change was provided to those contractors by letter and in an article published by the NHS Business Services Authority in May 2025. In addition, Community Pharmacy England knows that, should this be a priority issue for it to negotiate in the next contract, we will take that on board and use it as an option.

There are of course always extenuating circumstances, such as IT not working. Officials have reassured me that, following discussions with Community Pharmacy England, we have introduced specific provisions in the drug tariff that will allow pharmacy contractors to receive payment for claims that were delayed due to IT issues outside of its control.

I can appreciate why the hon. Gentleman wants to expand the remit of the urgent question across primary care—well, let me tell him. I know he had neck surgery recently; I did not realise they put a brass neck in him as well when they did it. He knows what kind of NHS decline and decay over which he and his Government presided over the past 15 years: primary care where people are left wandering around asking for GPs, and the Conservatives left GPs on the scrapheap, unemployed. This Government ensured, when they came into office, that—

ADHD Diagnosis

Luke Evans Excerpts

Tuesday 20th January 2026 Westminster Hall

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

It is a pleasure to respond on behalf of His Majesty’s official Opposition. I thank the hon. Member for Sefton Central (Bill Esterson) for getting so many MPs here to talk about such an important topic. His tribute to Matty Lock was truly epic. The only thing I am sad about is that we could easily have filled a 90-minute debate. Perhaps he can take note of that for the next time that he applies for such a debate.

Time is short, so I will skip to the most important questions. This debate is about ADHD diagnosis, and there is no disagreement among Members on both sides of the House about the challenges that we face. We have seen the numbers go up, so the question is: what are the Government prepared to do about it, and how can the House work to facilitate them in that?

Before the general election, the previous Government worked with NHS England to establish the independent ADHD taskforce, with the aim of developing a data improvement plan. As we have heard, there have been two iterations of that. The Minister confirmed in a written ministerial answer to the hon. Member for Broxtowe (Juliet Campbell) on 17 November that the Government are considering those recommendations. Will the Government respond to the taskforce’s recommendations today? If not, when will they do so? If so, will they take on all the recommendations, or will they challenge some?

I commend the Government on commissioning their own independent review into autism and ADHD. They are often linked and there can be co-morbidities, which are important to consider. As we have heard, there is no distinct timeline for that—summer is a long period of time—so I would be grateful if the Minister can set out exactly how the Government define “summer”. How will that intertwine with the work that the taskforce has already done? Will that work get superseded, or will the two pieces of work dovetail together?

Finally, I want to talk about accountability and delivery. I understand that NHS England has identified reducing long waits for ADHD assessments as a priority in the medium-term planning framework. With NHS England set to be abolished, it is unclear how those priorities will be maintained and enforced. Will the Minister confirm that reducing the long waits for ADHD assessment will remain an explicit national priority for the NHS? How will the Government enforce that, given that NHS England is being taken away, and ensure consistency across integrated care boards?

I welcome the acknowledgement in a recent written answer that data on ADHD waiting times at ICB level is currently not held centrally, but that there is an intention to publish it in 2026 or 2027. That transparency matters, so will the Minister confirm that the plans to publish ICB-level ADHD waiting time data will continue regardless of the structures of the NHS after the change? Will he provide an indicative timeline for the delivery? Is it 2026 or 2027?

Will the Government publish more data about Right to Choose that shows what is and is not successful, and what is good practice and what can be improved? That is one of the ways to deal with the postcode lottery. At the heart of this debate is the fact that behind the numbers is a person, a child or a family seeking answers, support and stability. It is our duty in this House to hold the Government to account for delivering that for all across the nation.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)]

It is a pleasure to serve under your chairship, Ms Vaz. I thank my hon. Friend the Member for Sefton Central (Bill Esterson) for securing what is, by all acknowledgement, an important debate on ADHD. I thank other hon. Members for their valuable contributions today, particularly my hon. Friends the Members for Hertford and Stortford (Josh Dean), for Sheffield Hallam (Olivia Blake) and for Warrington South (Sarah Hall), and the hon. Member for Yeovil (Adam Dance) for sharing personal experience that has been invaluable to this House. In this debate, we have heard moving testimonies and I want to thank all hon. Members who have shared personal and family experiences. I personally express my welcome and my deepest sympathies to Christine and Richard, the parents of Matthew Lock. I thank them for being in the Public Gallery for this debate, and thank them for all the invaluable work that they have done with the Department and with NHS England to raise awareness of the issues surrounding ADHD and suicide through the charity that they set up in Matthew’s memory.

We have learned, through this debate, the intersection between ADHD, other mental health conditions and suicide risk. Every suicide is a profound tragedy that leaves families, friends and communities devastated. That is why, in addition to our approach to ADHD, mental health and autism, we are committed to delivering the suicide prevention strategy for England, which aims to address the risk factors contributing to suicide to ensure that fewer lives are lost. We will work across Government to improve support to those who are suffering, and those who have been bereaved by suicide.

We know that people with ADHD have co-occurring neurodevelopmental conditions. We must not only intervene early but assess people with suspected neurodevelopmental conditions—about which I will say more later—and ensure that, following diagnosis, people have the right support to meet their needs, including their mental health needs. The Government have already taken significant steps to stabilise and improve NHS mental health services but, of course, there is so much more to do. Transforming the system always takes time but we are committed to delivering a new approach to mental health.

The 10-year health plan sets out the ambitious reform that we wish to undertake to make the system fit for the future. In line with that, we will go further to ensure that NHS mental health services deliver the care that people deserve and rightly expect. The publication of the “Staying safe from suicide” guidance in 2025 means that all mental health practitioners must now follow the latest advice in understanding and managing suicide. Associated training is now available to all NHS and non-NHS mental health staff.

Following the tragic loss of their son Matthew, Richard and Christine have been keen to ensure that other families are made aware of the increased risks of addiction and suicide that are associated with ADHD. NHS England has worked closely with Richard and Christine to revise content on the nhs.uk website, and has included separate, tailored content on ADHD for adults, children and young people. The website also specifically highlights the increased risks of suicide and addiction in those with ADHD, it signposts anyone who might be struggling to find urgent help and support, and has updated wording to reflect lived and clinical experience. I extend my thanks again to Richard and Christine for all their input to that work. I invite them into the Department to meet me alongside my colleague, the mental health Minister, to see how we can go further faster.

We know that too many patients are facing long waits to access services including ADHD assessments and support. I know that such issues are affecting our constituents up and down the country, as has been reflected in this debate, and I understand the devastating impact that that has on individuals and families. Lord Darzi’s report laid bare the growth in demand for ADHD assessments nationally. That has been so significant in recent years that it risks completely overwhelming the resource available. I thank everyone who has taken part in sharing evidence for Lord Darzi’s report, and with the subsequent ADHD taskforce established by NHS England. We know, from the taskforce’s report, that there are quality concerns with assessments. There has been rapid growth in remote assessments and in use of the independent sector. We are urgently looking into those concerns. That is why work is currently underway to improve ADHD services in both the short and long term to meet the needs of those waiting for an assessment, or those needing treatment for a diagnosis.

[Dr Evans]

On that point, the Minister mentioned the taskforce. It did produce its report, with its recommendations, and the Government have not yet responded to those recommendations. Will the Minister give a timescale for when he is looking to do so?

[Dr Ahmed]

I have met the chair of the taskforce: we discussed the outcomes, and the need—as the hon. Member mentioned in his remarks—for work on those outcomes to dovetail with the prevalence review. I think that would be the most appropriate way to provide a holistic response. We, of course, respect the findings of the report, which is an excellent scientific piece of work looking at the data underpinning the diagnoses.

[Dr Evans]

To clarify, if it is going to dovetail, is he suggesting that the recommendations will come out in the report in the summer, all in one lump, or will we see the recommendations of the taskforce come out before we see the full report of the newly commissioned work?

[Dr Ahmed]

At present, the hon. Gentleman will have to ask my colleague the mental health Minister about the specifics, but my understanding is that the prevalence review will be a wider piece of work that will be partly informed by the ADHD taskforce report. It would be better to respond to them as a combination rather than as individual reports.

The House will know that on 4 December 2025 the Secretary of State announced the launch of the independent review into prevalence and support for mental health conditions, ADHD and autism. It will bring together the most respected researchers, clinicians and voluntary organisations in the country, alongside, crucially, people with lived experience, who will be directly engaged to scrutinise the evidence and support the development of recommendations. Part of that will be about how we address and label reporting, and I would expect that we come up with a better definition and a better way of reporting than we have at the moment.

The Government’s 10-year plan sets out the core principle of early intervention and support, and will make the NHS fit for the future. Through the NHS medium-term planning framework, published in October 2025, NHS England has set an expectation that local ICBs and trusts improve access, experience and outcomes for ADHD services over the next three years.

I heard the call from hon. Members for much more integration between community mental health services, GPs and other healthcare bodies. It is our expectation that through the NHS reform Bill and the disbanding of NHS England, as well the production of independent health authorities and strategic commissioning, the health service will be better able to serve the needs of children requiring assessment for mental health conditions and ADHD. We will end up having a helicopter view, which is currently not possible.

Oral Answers to Questions

Luke Evans Excerpts

Tuesday 13th January 2026 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

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

Community pharmacies are a vital part of the primary care infrastructure, including in Epping Forest. Using NHS Organisation Data Service data, can the Minister tell the House how many pharmacy contracts ceased in England last year?

[Stephen Kinnock]

I thank the hon. Gentleman for his question and congratulate him on the addition of the facial hair. I am glad to see that he is joining that particular club—I think it is the only club we may both be a member of!

The Government are aware of the pressure on pharmacy; it is a major challenge that we are facing. We gave pharmacy a 19% uplift in the last spending review. Of all the sectors in my portfolio, that was the one that received the largest uplift. We are also looking to secure better progress with the use of technology, and we are looking at the medicines margin and the dispensing fee, recognising the significant financial pressures that pharmacies are under. Through reform and investment, we believe that we can turn the corner and rebuild pharmacy in our country.

[Dr Evans]

I appreciate the Minister’s answer. However, the answer to my question is: 650 contracts across England and Wales. He only had to look at the newspaper headlines from yesterday to see that—this is his Department and his portfolio.

The chair of the Independent Pharmacies Association, Leyla Hannbeck, has specifically warned that higher business rates and increases in national insurance contributions, which are both set by the Government, are to blame and are driving up costs, while pharmacy income—which, again, is set by the Government—remains fixed. Does the Minister accept that those tax decisions taken by his Government directly increase the costs and contribute to the loss of pharmacy contracts, and will he therefore raise this matter with the Chancellor immediately?

[Stephen Kinnock]

I think there is some dispute over the number that was on the front page of the Express. We are looking into that number and will certainly come back to the hon. Gentleman on it. On his broader point about the decisions that the Chancellor took at the last Budget, I suppose I have a question back to him: would he be cutting the £26 billion that this Labour Government are investing in the NHS, and if not, how would he be paying for it?