Myalgic Encephalomyelitis

Luke Evans Excerpts

Wednesday 19th November 2025 Westminster Hall

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

I try to take a positive outlook. The one thing the pandemic did was shine a spotlight on the likes of long covid and ME, and I know from my medical career how difficult that can be. I would like to thank Sajid Javid, who in 2022 announced the plan for ME, and I congratulate the Minister because she brought it to fruition on 22 July 2025. There are some similarities between the NHS 10-year plan and the ME plan: the ME delivery plan is fantastic, and a lot of people agree with it, but, importantly, there has been a lack of delivery. Action for ME has said:

“The Plan also lacks clear accountability structures with no mechanisms to measure impact or deadlines to hit. We are concerned that despite this well-meaning Plan being published, it will have no material impact on the historically stigmatised and ignored ME community. Action for ME wants to work with MPs, Ministers and Officials to improve its implementation.”

It went on to say that the delivery plan on ME/CFS fails to include a “strategic approach” to ME research. However, that was not the only group to say so; the ME Association said:

“There is no clear ambition or strategy to drive consistent implementation of the NICE guideline recommendations”

across ICBs. It went on to say:

“Severe and very severe ME receives minimal attention, despite known risks during hospital admissions”.

It also said:

“Several of the Plan’s own deadlines have already passed, and it is unclear what progress has been made.”

In the short time that I have, I want to focus my questions on two areas: action and accountability. The first concerns the questions that those living with ME will have, particularly when it comes to the changes around the Department for Work and Pensions and what that will look like in the light of the imminent Timms review. I would be grateful to understand what plans the Government have for both Departments to discuss what this will look like, given the scale of the problems facing the 400,000-plus people with ME/CFS in this country.

Secondly, turning to the actual plan, we need to look at what actions will be delivered. I am keen to look at the section called “After publication of the FDP”, because it goes on to say that

“we will monitor the actions included in it. The DHSC secretariat will continue to engage with the Task and Finish Group in an appropriate form as required”.

Given the debate today, is that required, and what form will it take?

The document also goes on to say that a

“sub-group will be created to focus on improving care for those with ME/CFS.”

Has that group been created, and how many times has it met? It further states:

“We recognise the needs of those with ME/CFS and we remain dedicated to developing our approach as new research emerges and as we seek further engagement.”

Could I press the Minister on what that engagement is? Who is it with, and what does it look like? At the end of the day, there is a plan here and we do agree with it, but it is the actions and accountability within it that are truly going to make a difference.

ME may challenge the body, but it never diminishes a person’s worth or their hope that they carry. That is critical. When we have such a great plan, it is the action that is going to take it forward.

--- Later in debate ---

[Ashley Dalton]

I recognise my hon. Friend’s points, and I will cover some of them in my remarks. She will be aware that the women’s health strategy is currently being refreshed, so we hope to dovetail wherever possible.

I want to set out the steps that this Government are taking to change the misunderstanding, stigma and inconsistent care that patients have experienced. Through our ME/CFS final delivery plan, we will deliver better care, boost research and ensure that every person living with ME/CFS is treated with dignity and compassion.

First, let us acknowledge the reality. ME/CFS is a complex multi-system condition. Its fluctuating nature makes diagnosis and management challenging. Historically, services have been extremely varied, and in some cases patients have felt dismissed or rejected by the healthcare system. That is unacceptable. We have heard those concerns loud and clear through our extensive consultation on the interim delivery plan and through ongoing engagement with patients, carers, clinicians, researchers and charities. Last year’s prevention of future deaths report following the tragic death of Maeve Boothby O’Neill further highlighted the urgent need for reform, pointing to a lack of specialist beds and inadequate training for clinicians. We cannot and will not allow such failings to continue.

In July, we published the ME/CFS final delivery plan, marking a significant milestone in our commitment to improving lives. The plan is built around three core themes: boosting research, improving attitudes and education, and enhancing care and support. With a clear commitment to ensure that people with ME/CFS can live as independently as possible and see their overall quality of life enhanced, that plan will help us to take an important step towards achieving that, but we acknowledge that there is more to do. We will continue to build on the foundation of those actions well beyond the publication of the plan. It is the springboard—the beginning, not the end.

Although the final delivery plan does not include every suggestion received through the consultation responses or through the task and finish group, it does not mean that those proposals will not be considered in the future, subject to resource and funding. We look forward to continuing those conversations.

[Dr Luke Evans]

The Minister attended the task and finish group, as did I. Will it meet again to consider that?

[Ashley Dalton]

I will come to the task and finish group in my remarks.

Research is the key to unlocking better treatments and improving quality of life. As has been mentioned, we have seen progress through projects such as DecodeME, the world’s largest genetic study of ME/CFS, which is funded by the National Institute for Health and Care Research and the Medical Research Council. Preliminary findings from the study indicate genetic differences in eight areas linked to the immune and nervous systems in people with ME/CFS. That discovery of specific genetic signals may help us to understand the biological pathways involved in ME/CFS in the future.

However, we need to go further. That is why the plan includes a funding offer and a commitment to continue working with researchers, industry and patient groups. New awards announced this year include funding for repurposed treatments and £845,000 for a large infrastructure project called PRIME, or, to give it its full name, Building Infrastructure for Patients, Researchers and Industry for ME/CFS.

Together with the MRC, we are actively exploring next steps in ME/CFS research. For example, earlier this month we co-hosted the research showcase event for post-acute infection conditions, including ME/CFS. It brought together people with lived experience, researchers, clinicians and funders to help to stimulate further research in this field. We are now considering the discussions that took place at the showcase to explore the next steps to stimulate further research. The output of that event will be circulated as soon as possible.

The final delivery plan also sets out actions to improve access to specialist services—to provide better support for children and young people, and their families, and to address employment challenges. It aligns with our 10-year health plan, which includes the roll-out of neighbourhood health services, bringing care closer to home and ensuring that multidisciplinary teams can support people with complex conditions such as ME/CFS.

Provision varies across the country and we are determined to reduce those inequalities. The final delivery plan includes actions to improve service mapping and workforce training so that every patient, regardless of postcode, can access the care they need. NHS England is working closely with the Department to support ICBs in commissioning equitable evidence-based services. Two of the most important actions in the plan are focused on NHS services. NHS England has already started its work on co-designing resources for systems to improve services for mild and moderate ME/CFS.

[Dr Evans]

Given that NHS England is due to be abolished, who will take that on?

[Ashley Dalton]

While NHSE is in the process of being dismantled, all its functions continue, and the new Department of Health and Social Care will continue all its work. None of that is being got rid of; it is simply being brought together into a more efficient, new Department of Health and Social Care. The Department will continue to meet a group of key stakeholders to move the work forward on mild and moderate ME/CFS in the coming weeks. Additionally, I confirm that the DHSC has already started conversations with NHS England to explore a specialised service prescribed by the Secretary of State for Health and Social Care for severe ME/CFS. That work will continue.

Changing attitudes is as important as changing services to many people with ME/CFS who have faced disbelief or stigma. As outlined in the plan, we will address that by launching a public awareness initiative to improve understanding of the condition and the support available. We will work with schools, employers and social care providers to ensure that children and adults with ME/CFS receive the information and support that they need.

Suicide: Reducing the Stigma

Luke Evans Excerpts

Wednesday 19th November 2025 Westminster Hall

[Michelle Welsh (Sherwood Forest) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Mundell.

Today’s debate on reducing the stigma associated with suicide is of grave importance to my constituents, particularly those in Ollerton, which has one of the highest suicide rates in the country. We know that the suicide rate is three times higher for men than for women, and although there are many contributing factors to that, one of the most significant is the stigma associated with asking for help and speaking up about mental health. There are so many societal pressures saying what men should be and how they should act. Often that involves appearing strong and as if they can face any problem head-on and by themselves. This starts very early. As a mother to a boy, I know that the attitude towards boys is often that they have to be strong, be tough and face things head on, and that crying is a weakness. It is ingrained by society in boys at a very young age. As a mother, I am consistently having to battle with those things.

The stigma of suicide affects not only the person struggling, but the people around them. Often loved ones do not know that someone is struggling and are left feeling confused and heartbroken. There is a ricochet effect to suicide, especially on the family and friends left behind. I know that because our family lost someone to suicide. The act of suicide leaves you grieving for a life gone too soon. It leaves questions, anguish and guilt and a space that will never be filled again. Mark was a son, a brother and a friend. I therefore welcome the Government’s landmark new health strategy, which will help to tackle men’s mental health challenges.

I want to take this opportunity to highlight the incredible work of a Nottingham organisation: In Sam’s Name. After the death of Sam Fisher, Sam’s friend Richard McHugh wanted to create a safe place for males to break the stigma of talking about their mental health and help them realise that they are not alone. Their peer support group helps members find strength from men who have previous experience, or are also suffering with mental health issues themselves. Through the power of conversation, friendship and support, men in Nottinghamshire are saving lives. I will never fail to be astonished at the ability of people who have experienced unimaginable pain to use that in pursuit of making the world a better place for others. The organisation runs several groups in Nottinghamshire communities, including in Ambleside community centre in Ollerton, and has a partnership with our fantastic local football team, Ollerton Town football club. It is vital that we take this conversation directly to men where they spend their time, and that—especially in my constituency—is at the football.

We must also ensure that our communities are equipped with the necessary infrastructure to give help and support when it is needed. Access to healthcare in Ollerton is poor. Given its rural nature and high levels of deprivation, it is no stranger to the struggle to access basic services. Deprivation is a huge factor in suicide: rates in areas of high deprivation are almost double those in areas of low deprivation. If we are to reduce the stigma around mental health and suicide, people, no matter where they are born in the country, need access to healthcare and support. For Ollerton, that must include a super health centre where people can walk in off the street and access the healthcare they need. Working in collaboration with Ollerton Town football club, we want to transform lives, and that could work in combination with a healthcare centre.

I hope that the Minister will join me in recognising the importance of access to health services and support in showing men that there are places to help and people willing to listen. Nowhere is that more important than in Ollerton, where there is such a high rate of male suicide. Perhaps he would like to get on a train to sunny Ollerton, visit the football club and meet In Sam’s Name—

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

indicated assent.

[Michelle Welsh]

The shadow Minister has obviously been to Ollerton before.

The Minister should go to see the fantastic work In Sam’s Name does, because it could be replicated across the country and have a huge impact. It would also allow him to see an area with fantastic people who support one another, but which is suffering because it does not have the services or infrastructure to combat suicide, and that is what we need to save young lives.

--- Later in debate ---

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

I want to start by finishing where I left off in the main Chamber in the debate during Suicide Prevention Month. I talked about a TikTok meme that was going around about where men go, and who they turn to, when they are at their lowest. The answers in that video are all “no one”: “No one cares”; “There’s no one”; “It’ll be used against me.” I want to speak to the people in that video, because after I mentioned it, I received literally hundreds of messages, first to thank me for raising it, secondly to thank me for raging, because people are not listening, and thirdly to say, “Well, people don’t care.” Actually, the hon. Member for Richmond Park (Sarah Olney) and the Members from across the parties in the Chamber today do care.

This is an ongoing conversation that we are having, and action has been taken by previous Governments and is being taken by this Government. We must get out the message that things are happening and that people are talking about it and are interested in it. This is being looked at and discussed at the highest possible level to bring in changes to make the world a little bit better. It is thanks to the pressure that we apply in this place that such changes are made, and I think it is important to get that on the record.

When it comes to men’s health, I am very keen to point out that this is not an “or” issue—it is not about women or men, but about women and men. That is particularly the case for mental health and mental wellbeing because woman partners often spot the issue first. Women are the advocates we all need when we are having this discussion, and it is important to make sure that is on the record too. The last Government brought forward the women’s health strategy, and we now have an allied men’s health strategy. They are not in competition, but work in conjunction, which I think is important.

I followed up September’s debate on suicide prevention with a letter to the Ministers to raise a few points, and I think it would be prudent for me to use my time to press them home a bit further. The first point was about the £10 million suicide prevention grant fund, which was brought in to deliver specific support for 79 organisations between August 2023 and March 2025. The fund has now run out, and after that was raised, the Minister for Care responded in answer to a written question:

“There are currently no plans to run another grant fund.”

However, in April he followed up by saying:

“We will be evaluating the impact of the fund, and the services that have been provided by the grant-funded organisations. Learning from this evaluation will help to inform the delivery of the Government’s mission to reduce the lives lost to suicide.”

In my letter, I asked whether we could have

“some details on the basis behind this decision”

as well as

“what alternate provision…is being provided”

and when we would hear about the evaluation. I was lucky enough to get a response on 13 November from the Minister in the other place who has responsibility for mental health. She addressed that point, but she simply said:

“As previously stated, the Department is evaluating the impact of the Suicide Prevention Grant Fund from 2023 to 2025, and the services that have been provided by the grant-funded organisations. The evaluation will be completed in due course and learnings from that evaluation will help to inform the delivery of the Government’s mission to reduce the lives lost to suicide.”

That is welcome news, but we have now gone from April to November, and I would like to understand when the evaluation will come, because it will be imperative in deciding how we take forward these services.

In that light, I welcome the men’s health strategy, particularly its emphasis on suicide. However, as my Liberal Democrat colleague, the hon. Member for Winchester (Dr Chambers), pointed out, the £10 million over two years seems to dwarf the £3.6 million across three years. That is a concern for the Opposition, especially when we look at how it is likely to be delivered, which is through the charity sector, as the national insurance changes have already taken a massive toll. For example, Mind has said that that tax increase will cost it £250,000, so its £1 million across a year suddenly starts to be whittled away. I am keen to understand how the Government will square that circle.

That leads me to my last point, which we have raised in the House before—I have certainly raised it both with the last Government and now with this one—on the issue of representation for men and boys. Before the election, the last Government were looking at having a men’s health ambassador. In my letter, I asked whether any consideration was being given to bringing in such an ambassador or about having a Minister for men and boys. I am open to suggestions about how that could work or would not work, but it strikes me that in the current climate, we have a Minister for Women, but not one for men and boys.

That leads me full circle back to where I started, which is that this is not an “or” issue, but an “and” issue. If we believe that women consult differently on their health, by definition men must do so too, so we need different pathways. The strategy is a good stepping stone from the Government, and I welcome it, but I just hope they use it as a springboard, rather than simply as a plank across a river.

We have talked a lot about the stigma, which is probably the most important thing, and heard a lot about how it is important to talk, but if we think about what the people in that TikTok video are really saying when they talk about how they feel there is no one, we as a society and this House have to not only listen, but show that we care, we have to make people believe that we care, and we have to follow that up with actions to allow people, in particular men, to get the help they need to help themselves. That is really important.

--- Later in debate ---

[Stephen Kinnock]

My hon. Friend is right. I do not know whether there is a connection, but it is possible that some of the perhaps more macho attitudes in some sporting environments are connected to the difficulties that some men—particularly men in those environments—have in reaching out, talking and being honest and open about their feelings. There may well be a connection. However, I hope that other sporting federations—the Rugby Football Union, the Welsh Rugby Union or whichever sporting association it might be—will look at what the Premier League is doing, and that we will perhaps see a blossoming of these initiatives across other sports and sporting disciplines.

The Premier League’s reach is unmatched. The partnership will engage men who are less likely to seek help and more likely to suffer in silence, meeting them in spaces that they trust, rather than waiting for them to access traditional health services.

[Dr Luke Evans]

It is great to hear about the Together Against Suicide partnership with the Premier League, but will the Minister explain how it works? Having looked at the details, it appears to be run in conjunction with the Samaritans. Is extra funding coming from the Premier League or from the Government to run the scheme? If the Samaritans provide the signposting, how are they being supported? In essence, it looks like an area to people together. Is that correct?

[Stephen Kinnock]

There are 11 premier league clubs that have signed up so far. The most visual way in which the partnership will manifest itself is through the advertising hoardings, which will be given over for periods of the game to advertise our Every Mind Matters campaign. That will offer talking therapies and an online mental health tool that we have developed. Anybody in the stadium—often there are 50,000, 60,000 or 70,000 spectators—can see that information flashing up. In some stadiums, there will also be mental health experts—wearing visible materials to show who they are and what they do—who people can come and talk to. The scheme is quite devolved, so each club will do things in a slightly different way. The Premier League is covering all the costs, so this is an entirely Premier League-funded partnership, with us providing the content, the steering and the opportunity to engage with the programmes, and the clubs are looking after the rest.

Ageing and End-of-life Care

Luke Evans Excerpts

Thursday 30th October 2025 Commons Chamber

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

I yet again thank the hon. Member for Strangford (Jim Shannon). He should be proud of Mona Shannon, and she will be proud of him not just for raising this topic today, but for all the work he does across this House talking about health, because he is assiduous and dedicated to timely health interventions, and that should be applauded across the House and this nation. I am indebted to him for securing this debate.

In the hon. Member’s speech, he mentioned who he had spoken to. I, too, have met the organisations Sue Ryder and Marie Curie, including at party conference, and I have met many other organisations, including LOROS and Rainbows, that cover my area. When I saw the title “Ageing Community” for this debate, I must admit that I thought the hon. Member should have applied for a five-day debate, considering what we could cover. I also notice the expertise in this debate. We have a secondary care surgeon, someone with public health experience at the back and me as a GP. It is turning into a multidisciplinary team, and there is a lot to unpack, whether it is prevention, mitigation, healthy lifestyles or looking at the best examples across the world. I recently travelled to Japan and Korea and saw how they look after their elderly and their approach to the lifestyle of the elderly. There is a lot to be learned out there, as across the world we all grapple with an ageing population.

There are other topics that we could talk about, and some were touched on. On social care, it is a shame that there has been a change from cross-party talks to an independent commission. I note that Baroness Casey is being taken back to the Home Office, which means she is spread thinly. There is a wider debate to be had on social care, which is: what do the British public actually want? Often we look at the Scandinavian model, but say that we do not want to pay the taxes for it. We want the household or family approach, like the Bangladeshi or Pakistani model, but we certainly do not actually want grandma or grandpa coming to stay with us and we want to stay working. Therein lies the problem in British culture. We are not 100% sure what we want when we cross over from the NHS into social care, and we are not sure how to provide it.

Some hard evidence of policies on an ageing community has been talked about, and unfortunately I have to raise the issue of winter fuel. In the Government’s analysis when they took away winter fuel payments—despite all the warnings—they knew that it would put 50,000 people into absolute poverty and 100,000 people into relative poverty. We can contrast that with the Opposition and our recent announcement on stamp duty. Jackson-Stops estimates that in the first year alone, up to 500,000 people above the age of 55 would consider downsizing because of that policy. I do not call that downsizing, as we heard in the debate on stamp duty—it is right-sizing, because it gives a real chance not only for more families to go upwards, but for people to move into more appropriate accommodation as they age.

There is a lot to be said in the debate about an ageing population, as the hon. Member for Shipley (Anna Dixon) pointed out, but I will focus my comments on the three questions that I think I caught from the hon. Member for Strangford: the assessment of the need for a national strategy for palliative care; what the Government are doing to ensure that palliative care is included in neighbourhood health centres; and the progress being made on 24-hour support.

I will start with the national strategy and funding, and let us give credit to the Government where it is due. When it comes to children’s hospice funding, they have continued the payment and extended it, which is welcome, although it does not offer enough mitigation for national insurance contributions. The Government will say that when it comes to adult funding, they have given £100 million. That is capital funding, though, and as one hospice worker put it to me, there is no point in having new curtains and a lick of paint if there are no staff.

As the Liberal Democrats pointed out, the National Audit Office report on the hospice sector that came out only yesterday states:

“DHSC and NHS England do not know what proportion of the total amount of palliative and end-of-life care provided in England is delivered by the independent adult hospice sector, and therefore how reliant they are on the sector”,

or what the real impact of Government funding is. It continues:

“In 2024-25, 11 independent adult hospices in England reported service reductions or staff redundancies, and other hospices announced plans to reduce services, in response to reduced income or increased costs. Cuts appear to be across all types of services offered by hospices. Most hospices reported the increase in the costs of service delivery within the palliative and end-of-life care sector as being the primary reason for service reductions…Six hospices have been designated by ICBs as ‘commissioner requested services’, a mechanism to forewarn ICBs of potential difficulties with services that, should they discontinue, would have significant impact on the local population”.

Hospice UK responded to that, saying:

“unfortunately the whole hospice sector is…struggling, just as demand for their services is rising. Surging costs mean 2 in 5 English hospices are planning cuts this year, and 20% ended last year with a deficit of over £1m.”

What does that actually look like in real life? In my area, LOROS is facing a deficit of £2 million. It has already had to reduce its in-patient capacity from 31 to 20 beds, and it is reducing its day therapy and cutting its physiotherapy, occupational therapy, social work, chaplaincy and complementary therapies, and closing the volunteer home-visiting service.

It is not just my region that is affected: a cursory look at Hansard will show that the Kirkwood hospice in Kirklees has made 19 redundancies; the Ashgate hospice in Derbyshire has 52 jobs at risk, with beds cut from 21 to 15; St Catherine’s hospice in West Sussex is looking at 40 job cuts, with half of its new rooms being mothballed; Weston Hospicecare—highlighted both here today by the hon. Member for Weston-super-Mare (Dan Aldridge), and by others, including my hon. Friend the Member for Bridgwater (Sir Ashley Fox) at other times—faces an increased national insurance bill of £139,000; the Arthur Rank hospice in Cambridgeshire is losing £829,000, which is forcing the closure of nine beds, 40% of its capacity; and Marie Curie has pointed out that its national insurance contribution costs have risen by £2.9 million.

Through all this, we have still never heard whether the Health team knew that this was going to happen and chose to push it through, or whether it was simply an oversight when it came to challenging the Treasury. Ever since the Budget, we have never heard an answer to that. At the time of the Budget, the CEO of Marie Curie, Matthew Reed, said:

“The Health Secretary himself has acknowledged that palliative and end of life care is not good enough, so we are shocked by the lack of measures in the budget to fix it. Palliative care needs are projected to rise by 25% over the next 25 years, around 147,000 more people each year, yet this government lacks a strategy to tackle the magnitude of this challenge.”

Have the Government made an assessment of how much the NICs increase has impacted the hospice sector? As has been mentioned, Together for Short Lives estimates that the average hospice is facing a bill of about £133,000.

I raised a lot of these questions in a debate in January, and the Minister for Care kindly wrote to me in response. It is not just about the financial side; we are looking at the structural aspect too. He wrote:

“As you are aware, integrated care boards…are responsible for the commissioning of palliative and end-of-life care services to meet the needs of their local populations. To support ICBs in this duty, NHS England has published statutory guidance and service specifications. In addition, the National Institute for Health and Care Excellence…has published quality standards and guidelines to support commissioners to carry out this duty. While the NICE guidelines are not legally binding, they act as a regulatory benchmark for best practice in palliative and end-of-life care…Whilst the majority of palliative and end-of-life care is provided by NHS staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at the end of life and their loved ones.”

So there is a grey area about where hospices are covered, and that fits in with the NAO report.

[Anna Dixon]

As the hon. Member rightly says, ICBs are under a legal duty to commission palliative care services. Does he not recognise that the problems we are having, not just with hospice care but with the lack of availability of palliative and end-of-life care, often come down to poor commissioning—ICBs failing to commission in line with that statutory guidance—and the confusion that arises between charitable donations and that which should be commissioned by the NHS?

[Dr Evans]

The hon. Lady is spot on; that is exactly the point that I was getting at. While there is a legal duty in terms of palliation, what that palliation looks like is important. Her question was also raised by the hon. Member for Strangford, who asked whether it is now time to have a strategy dedicated to palliative care, given the rise in demand.

The letter goes on to say:

“Charitable hospices are autonomous organisations that provide a range of services that go beyond that which statutory services are legally required to provide. Consequently, the funding arrangements reflect this.”

We are in a grey area, and a palliative care strategy could well be a way to unlock this problem. I will be interested to hear what the Government have to say on this issue.

However, it is not just about finances and commissioning; it is also about the workforce. That is partly addressed in the letter:

“As set out above, we have committed to develop a ten-year plan to deliver an NHS fit for the future. This summer, we will publish a refreshed NHS long-term workforce plan to deliver the transformed health service we will build over the next decade so that patients can be treated on time again.”

By my calculations, we are coming up to Halloween and even bonfire night, and we still have not seen a workforce plan. My question to the Government is: when are we likely to see that?

That leads me on to my next point: how do the Government intend to ensure that palliative care specialists are included in neighbourhood health centres? The 10-year plan is laudable, and I think there is agreement across the political spectrum on its contents, but the one thing it is missing is a delivery chapter. How are we going to do it? The shift is correct, but we do not know how we are going to get there, so I would be grateful if the Minister could address that. The 10-year plan explicitly talks about public-private partnerships, and there is concern on both sides of the House that we could see PFI mark 2. If Members need to have their memory jogged, private finance initiatives brought in £13 billion to build hospitals and services, but at a cost of £80 billion to taxpayers.

Why does this all matter? In my last few moments, I will turn to the final question that was posed by the hon. Member for Strangford, which was about access to 24-hour support. I will quickly read out a couple of comments from one of my constituents, whose husband Mat sadly passed away from a brain tumour. She highlights this issue:

“During the day, the support was outstanding because I could call the community nurses and the palliative nurses, and they would always call me straight back. They would visit Mat daily to administer the medications needed in his syringe drivers. They were kind, caring and so supportive to us and our family.

The night times were different and frightening. Often during the night when I was trying to get support, he could see how scared and stressed I was, which made him more scared, often telling me he was okay just to try and not make me worry. Every night I used to be thinking what might happen tonight—will Mat have another seizure? Will he be in so much pain again? Will they call me back if I need support? How long will it take to get help to arrive?”

Marie Curie points out that only seven of the 42 ICBs in England have a single point of access. I raised this issue with the Minister in a letter in August, and he kindly responded in September. He pointed out that integrated care boards must commission on this basis. There is NICE guidance on “End of life care for adults”, under quality standard 13, and on “End of life care for adults: service delivery”, under NICE guideline 142, which talks about the fact that there should be some form of 24-hour care, but at no point did the letter address the issue of the phoneline. When I asked the Department about data, I was told in a letter:

“Regarding data about palliative care helplines, such as average waiting/response times, the Department does not collect or hold this information.”

Will the Minister look at that and consider whether the Department should hold such information?

The letter went on to say:

“We recognise that more could be done to support the palliative and end-of-life care sector. I have tasked officials within the Department and at NHS England to look at how improving the access, quality and sustainability of all-age palliative and end-of-life care to ensure that their proposals are in line with the ten-year plan.”

I would be grateful if the Minister could ask the Minister responsible whether there is indeed an update and what that looks like. At the end of the day, we are concerned not necessarily about inputs, but much more about outputs.

We know that death is certain for us all; only our willingness to face it seems optional. This is very much a British mentality, and I believe we need to change that when it comes to talking about death and our mortality. We need to speak more openly and candidly about what an ageing population looks like, for that is what we are. That is why the hon. Member for Strangford brought forward this debate, and he reminds us that we chase the days ahead while never quite noticing how swiftly they turn into years behind us. That leads me to reflect on the fact that, as politicians and as a society, we build a world to live longer, yet we all too easily forget to ask: how do we want to grow old?

--- Later in debate ---

[Dr Ahmed]

I am very concerned to hear what my hon. Friend has reported to the House. Clearly, coercion is unacceptable in all forms. Safeguarding is taken very seriously by the national health service and by the Department of Health and Social Care, and as the Minister with responsibility for patient safety, I am very happy to look into that further and to take it up with him after the debate.

As set out in the 10-year health plan, we are going to shift more care out of hospitals and into communities, and make care more personalised. If there is anywhere where that is most important it is palliative care and end-of-life care. Palliative care and end-of-life care, including hospices, have a big role to play in that shift, and they were highlighted in the 10-year plan as an integral component of neighbourhood health teams.

In England, integrated care boards are responsible for the commissioning of palliative care and end-of-life care to meet the needs of the local population. To support ICBs in this duty, NHS England has produced statutory guidance. That includes the need for 24/7 access to palliative care and advice, and a palliative care and end-of-life care dashboard that brings together all relevant data in one place. The dashboard helps commissioners understand the palliative care needs of the local population. Of course, the majority of palliative care and end-of-life care is provided by NHS staff and NHS services, and that has benefited from the record funding in the NHS that the Chancellor delivered in the last Budget.

I will not be able to address all the points made by the hon. Member for Hinckley and Bosworth (Dr Evans), as he was in a typically verbose mood, but if he wills the ends, he must will the means, and if he does not agree with the means, he must present his thesis as to the alternative model of funding that he wishes to see. Otherwise, it is a case of cutting services.

However, we recognise the vital part that voluntary sector organisations, including hospices, play in providing support to people at the end of their lives and to their loved ones. In recognition of that, £100 million of capital funding has been made available to hospices in England to ensure that they have the best physical environment for caring. That includes helping hospices to provide the best end-of-life care to patients and their families in a supportive and dignified environment. It includes funding to deliver IT systems and provide refurbishments and facilities for patients and visitors, so that they can see their family members at the end of their lives in a dignified environment—much more than just a lick of paint.

[Dr Evans]

Given the recent National Audit Office report and the fact that the tax increase to national insurance contributions has had the biggest impact on the voluntary sector, has an impact assessment been carried out into how much the cost has gone up for hospices in England to provide their services? If not, will the Minister consider it?

[Dr Ahmed]

The hon. Gentleman knows that the NAO report covers a period both when his party was in government and beyond. I go back to the point about NICs. If he wills the end, he must understand the means. I am very happy to have that conversation with him at length after the debate, respecting the confines of the time that I have—I do not want to test your patience, Madam Deputy Speaker.

I am delighted that the first £25 million of the £100 million fund has been passed to Hospice UK and has been spent on capital projects already. The Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), visited Katharine House hospice earlier this year, Wigan and Leigh hospice in July, and Noah’s Ark children’s hospice earlier this month to see directly for himself how that record investment is making a meaningful impact on the ground. We can confirm that the Department of Health and Social Care has now transferred the rest of the £75 million to Hospice UK for onward spending in 2025-26. We are also providing £26 million of revenue funding to support children and young people’s hospices. This is a continuation of the funding that, up until recently, was known as the children’s hospice grant. That funding will see circa £26 million allocated to children and young people’s hospices in England each year via local integrated care boards on behalf of NHS England. This amounts in total to £80 million of hospice funding over the next three years.

For many of us who are in good health, managing complexity and ageing seems a distant idea. The Government recognise that the number of people with palliative care and ageing needs is projected to rise significantly over the next quarter of a century. That is why we are shifting more healthcare out of hospital and into communities through our plan for change. That is why we are investing, through the National Institute for Health and Care Research, over £3 million in a policy research unit in palliative and end-of-life care. The unit launched in January 2024 and is building the evidence base on palliative care and end-of-life care.

Earlier this year the Minister of State for Care and, more recently, the Secretary of State met key palliative care and end-of-life care and hospice stakeholders at dedicated roundtables, and focused that discussion on long-term sector sustainability within the context of the 10-year plan. Following the recent publication of the plan, the Minister of State for Care tasked officials to work at speed to generate proposals to improve the access, quality and sustainability of all-age palliative care and end-of-life care as we start to implement the plan.

In closing, I hope that those measures assure the hon. Member for Strangford of the Government’s seriousness to build a sustainable palliative care and end-of-life care sector for the long term.

[Dr Evans]

Will the Minister give way?

[Dr Ahmed]

I will not, in the interests of time.

I reiterate my thanks to the hon. Member for Strangford for bringing forward this vital issue, and I thank all hon. Members who have spoken today. He can be assured that he has raised the voice of those who deserve dignity at the end of their lives, and that his call has been well and truly heard by the Government.

Oral Answers to Questions

Luke Evans Excerpts

Tuesday 21st October 2025 Commons Chamber

[Mr Speaker]

Can I just suggest to Members that their supplementary question should relate to the tabled question? That would be helpful. I call the shadow Minister.

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

With reports of over £1 billion in costs for integrated care board redundancies and the chief executive officer of NHS England warning that services could have to move to plan B, could the Secretary of State set out what plan B is?

[Wes Streeting]

We are absolutely committed to delivering the transformation that we have outlined, and we are working with ICB leaders and NHS leaders to do that in a timely way. Those savings will deliver better value for money and enable us to redeploy resources to the frontline where they belong.

[Dr Evans]

I thank the Secretary of State for his answer, but waiting lists have risen for three successive months now, doctors are on strike, GPs are in formal dispute with the Government, and the ICBs are cutting 50% of their staff and do not have £1 billion to pay for it, all while the NHS 10-year plan has been published but with no delivery chapter. When will the Secretary of State come to the House with the delivery plan for the NHS 10-year plan?

[Wes Streeting]

Not only have the Conservatives failed to get in the news, but they have clearly not been reading it either. There have been no doctors strikes in the NHS since before the summer, and we have sat down with resident doctors and their new leadership to try to avert future strike action. The hon. Gentleman is right to point out that the action taken by the previous committee—unnecessary and irresponsible as it was—has impacted on waiting lists in the last few months, as have higher levels of demand than anticipated. I say that by way of explanation, by the way, not by way of excuse. I am determined to make sure that we hit our target, as outlined in the Government’s plan for change, and I think he will find that in the coming months we will be back on track and well on course to achieving something that the Conservatives failed to do when they had the chance.

Healthcare: Bolton

Luke Evans Excerpts

Wednesday 15th October 2025 Westminster Hall

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

I too congratulate the hon. Member for Bolton North East (Kirith Entwistle). She covered a huge amount within her allotted time. The only sadness is that we have only an hour, and I have only a couple of minutes to try to address many of her points.

The biggest message that we take home today is that Bolton must not be left behind. The hon. Member has been exemplary in stepping forward and making that case. I would slightly and gently push back and say that I do not think that Bolton was left behind by the previous Government. The trajectory she is working towards is already there, if we look at examples of the investment that was made by the previous Government, most notably the £20 million, which made up part of the £40 million in levelling-up funding, for the medical college at the Royal Bolton Hospital, and listen to Professor Holmes, who said:

“It is incredibly rewarding for us at the University to witness our flagship facility reach this important milestone of practical completion.

It is a privilege to be home to one of the nation’s leading clinical skills facilities here in Greater Manchester and this is a key step in our aim to become a national centre of excellence for health.”

On top of that, there was a £20 million investment in the elective care centre, which has opened with four theatres dealing with about 5,000 patients. The hon. Member for Bolton North East was right to pick up on the maternity and women’s health unit, which is really important. In 2023, we saw a £38 million investment to help the unit, and it will hopefully be done by 2027. I have no doubt that she will be there to wag the stick to make sure that it is. I hope that she and the Government will be successful in that.

I want to tease out a couple of questions for the Government. The hon. Member stressed maternity, which is really important. At the general election, the Labour party made firm commitments on maternity services, so I ask the Minister: when will the national maternity safety ambitions be published, and will targets be set around the maternity mortality gap? What will be done to address it?

The hon. Members for Bolton North East and for Bolton South and Walkden (Yasmin Qureshi) both rightly raised the integration of system and service, which is also a concern on the Opposition side. We have seen top-down reorganisation, especially around integrated care boards, and I am sure the Greater Manchester integrated care partnership will have been asked to make reductions in its headcount.

The problem is that the Government have not set out how they will pay for those redundancies, or what that shape will look like, so they are trying to make transformative change and looking internally. There is real concern about that among the Opposition, so I hope the Minister will be able to set out how much that will cost and whether the redundancy package will be coming forward, because we hear it could be up to £1 billion. As the chief executive of NHS England has said, if we do not hear something in the next few weeks, the NHS will have to turn to plan B—if there is a plan B. I would be grateful if the Minister could set that out.

Finally, on GPs, we also know that the Government have stated in the 10-year plan that GP leaders will be pivotal in shaping and delivering these new services and will be supported to do so with two new contracts from 2026. Of course, we have learned in the past couple of weeks that GPs have entered a formal dispute with the Government because of the contractual changes, so I would be grateful to understand what the Minister is doing—although it is not in her brief—and what her team are doing to try to pull it back from the brink and hopefully resolve some of the contractual issues, particularly when it comes to access.

To close on a personal note, I congratulate the hon. Member for Bolton North East on her work as a manbassador. As someone who, since stepping into this House, has campaigned on mental and physical health for men and boys, I know it often gets left behind. I made that point on the Floor of the House only a couple of weeks ago, so it is fantastic that she is championing men and boys. We need advocates for both sexes, both ways round, when it comes to men’s and women’s health. It is not a competition; it is not one or the other—it is “and”, and she typifies that. No man or boy should be left behind, but nor should Bolton.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship this afternoon, Ms Lewell.

It was a valiant effort from the hon. Member for Hinckley and Bosworth (Dr Evans) to raise things such as top-down reorganisation and the state in which the Conservatives left the health service after their 14 years in government. It is as a result of that record that I am delighted to have my hon. Friend the Member for Bolton North East (Kirith Entwistle) here, alongside such strong representation from Labour, following the electorate’s verdict on the last 14 years only 14 months ago. She has been an excellent campaigner since joining Parliament, and securing this important debate is part of that. I am grateful to other hon. Members for taking part.

As a result of the action taken by my hon. Friend the Member for Bolton North East in securing this debate, I met the chief executive, Fiona Noden, and the local ICB to understand, in a more granular fashion, some of the issues I expected my hon. Friend to raise. She was right to thank the staff—both at a leadership level and across the board in Bolton—for their great work. I commend that leadership for meeting regularly, and my hon. Friends the Members for Bolton North East and for Bolton South and Walkden (Yasmin Qureshi) for meeting regularly with those leaders. That happens in my own patch, but it does not happen everywhere. As I often say, it is a really valuable local relationship, because it makes hon. Members more informed and NHS managers better leaders as well.

As we have heard so eloquently, the NHS faces pressures all over the country, including in Bolton and north-west England. Our 10-year health plan is designed to fix that. I thank my hon. Friend the Member for Bolton North East for holding one of those important consultation events. They were very powerful. As a result of the work that she and others have done to bring the patient voice directly to Government and make it a fundamental part of the plan, I think our plan has widespread support. I hope her constituents can hear their voices reflected in the plan that we have developed: it is about access to healthcare for everyone, no matter where they live or how much they earn. We must make sure that our health service is based on that need.

The three shifts—hospital to community, treatment to prevention, and analogue to digital—will ensure that community and neighbourhood health services get the investment they need and that patient communication is more joined up. We are also working with the NHS to make the tough choices that are needed to get it back on its feet.

We will create an NHS where patients have more control, staff have more time to care, bureaucracy is reduced, power is devolved and the health inequalities that we have so sadly heard about again this afternoon are narrowed. That includes creating a new operating model with fewer, larger ICBs, enabling them to harness a shared budget of sufficient size to improve efficiency and reduce running costs. It is a 10-year plan, but of course we are already seeing some improvements and we have set key targets and milestones along that trajectory. As my hon. Friend the Member for Bolton South and Walkden said, we cannot all wait 10 years. We have to see that improvement along the way.

Child health is crucial. We have heard about the inequalities and poverty that many children in Bolton experience. That is why the Government have committed to raising the healthiest generation of children ever, and will soon publish an ambitious strategy to reduce child poverty, tackle the root causes, and give every child the best start in life.

A huge part of realising our ambitions for the NHS is about improving access to dentistry services. The Government understand that, which is why extra urgent dental appointments are being made available across the country, including in Greater Manchester. That is expected to deliver an extra 17,897 urgent dental appointments across 2025-26. Additional dentists have also been recruited in areas that need them most, and we are committed to delivering fundamental contract reform before the end of this Parliament.

All of that will deliver better dental care for everyone in England, including those in Bolton. We also recognise that we need to go further to improve the oral health of children, which is why we are providing funding to local authorities to roll out the targeted, supervised toothbrushing programme for three to five-year-olds. As a result of the programme, Bolton has received over 32,000 donated products to implement supervised toothbrushing alongside an additional £127,000 this financial year.

Hon. Members rightly raised the issue of RAAC at Royal Bolton hospital, which is obviously deeply concerning for staff and patients. Let us be very clear: the safety of patients and staff has to come first. Each trust with RAAC issues has invested significant levels of NHS capital to mitigate safety risks. Locally, the Bolton NHS foundation trust has received over £9.5 million to mitigate the RAAC risk and for eradication works at Royal Bolton hospital. The trust will continue to have access to further necessary funding for RAAC removal, enabling the hospital to complete development and modernisation upgrades.

Hon. Members also raised the important subject of women’s health. As part of our work in this area, we are tackling waiting lists, of which gynaecology is a substantial part. We will see those waiting lists come down and we will soon make emergency hormonal contraception free in pharmacies, but we know that there is much more to do for women. That is why we will look at where we can go further and reflect that in an updated women’s health strategy to better meet the needs of women in Bolton and across the country.

This year the Secretary of State announced a rapid national independent investigation into NHS maternity and neonatal services. He will also chair a maternity and neonatal taskforce to develop the action plan based on the investigation’s recommendations. I am happy to report encouraging local initiatives such as Bolton’s new maternity and women’s health unit, which is set to open in early 2027, as well as a focus on paternal support and investment in strong community-based care and specialist parental mental health support, which we know is so important.

Issues around mental health were raised this afternoon. Mental health support in maternity is made possible only by strong mental health services across the board. That is why we are transforming mental health services. We have heard about Opposition Members serving on the Public Bill Committee and we thank them for their work. We need to build new dedicated mental health emergency departments, improve outreach, and increase overall funding to benefit Bolton and the rest of the country. That includes transforming mental health services in 24/7 neighbourhood mental health centres, building on the existing pilots, and investing up to £120 million to bring the number of mental health emergency departments up to 85.

We also heard about urgent and emergency care this afternoon. We will be publishing an urgent and emergency care plan. The plan will reduce A&E wait times, provide almost £450 million of capital investment for same-day emergency care and mental health crisis assessment centres, and get more ambulances back on the road. The local picture is promising. In Bolton, 12-hour wait times are down compared with a similar time last year, and meaningful infrastructure improvements are being delivered. We are not complacent, however, and we know the situation is not acceptable for people.

A large part of the contributions was about improving general practice and recognising the need for people to feel they have access to it, because that is where most people have contact with the health service. That improvement is a crucial part of our agenda. It is heartbreaking to hear about patients not getting the testing or treatment they need, and of course Leah and her son should not have had to endure that shocking ordeal. I hope that they are getting the support they need, and I am sure that my hon. Friend the Member for Bolton North East will be supporting them.

On access, my hon. Friend will be aware that part of our negotiations with doctors has been about increasing online access, which was rolled out on 1 October. That is helpful to know if that is available in her patch. New funding for the advice and guidance scheme is helping GPs to work more closely with hospital specialists to access expert advice quickly and speed their patients through the system, so they get care in the right place as soon as possible.

[Dr Luke Evans]

Hearing Leah’s story was very concerning and upsetting. When it comes to further online access, one of GPs’ biggest concerns is about what to do with the emergencies that may come in through a computer at 6.20 pm as a result of that access, having to make that assessment when the system is supposed to be closing, and the ability to move GPs to take them away from face-to-face consultations to deal with online access. How will the Government square the circle of access versus patient safety? That is at the crux of the dispute.

[Karin Smyth]

The shadow Minister opens up a discussion that could take some time. Clearly, practices regularly manage emergency situations. The system that we have put in place aims to make sure that patients have access during the day. Different practices will obviously have different opening times—that is a matter for the local system—but I know that if an emergency comes forward, practices all over the country do all they can to make sure that patients are safe. There are also disclaimers on their websites about the times of operation and so on. If there are any individual cases that he wants to raise, we will look at them, but that urgent emergency interface is a matter of negotiation locally and I think most practices understand how to manage it.

I am pleased to report that we are investing more than £1 billion extra in GP services and £82 million in the primary care workforce to ensure that places such as Bolton get the resources and GPs they need. On infrastructure, a new £102 million fund will create additional clinical space across more than 1,000 practices in England. As a result of those efforts, 8 million more appointments have been delivered this year compared with last year. Our shift to a neighbourhood health service is exactly about the joined-up, accessible and locally accountable care that we all want to see, and that my hon. Friend the Member for Bolton North East rightly highlighted. That is also what staff in the system want to see.

On waiting lists, we published our elective reform plan to deliver the change that we promised at the last election. Between July 2024 and June 2025, we delivered more than 5 million additional appointments compared with the previous year. There has also been a reduction in the number of people on the waiting list of over 200,000. I think patients and members of the public are seeing and feeling that progress, and although there is a long way to go, staff are starting to feel it too.

Since June 2024, the number of people on the waiting list at Bolton NHS foundation trust has reduced by more than 7,000, and the number of patients waiting over a year has more than halved. Those are tangible improvements in a very short time, and we thank the staff for their hard work to achieve that. Patients deserve better, but they are seeing progress. We know there is more to be done.

I thank hon. Members for bringing their knowledge and experience of Bolton’s health services to this debate. I know that they and my hon. Friend the Member for Bolton West (Phil Brickell) will continue to advocate strongly on behalf of the people of Bolton, continue to work closely with local leaders, and continue to hold the Government to account for the promises we are making. That conversation between local Members of Parliament about what is actually happening on the ground, which we all hear about in our inboxes, in our surgeries and when we talk to local people, is an important part of what they are doing to raise these issues. I hope that my response shows how much the Government are committed to addressing these issues and working to improve healthcare for the people of Bolton.

Jhoots Pharmacy

Luke Evans Excerpts

Wednesday 15th October 2025 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister.

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

Only this weekend, the National Pharmacy Association chief executive, Henry Gregg, said that he is concerned that

“reports of Jhoots Pharmacy branches across England failing patients risks damaging community pharmacy’s reputation and could imperil its ability to secure a good 2026-27 funding settlement.”

Communities across the country have been left without functioning pharmacies. Doors have been locked without notice, patients have arrived to find no pharmacist, no prescriptions and no stock, and staff have gone unpaid and been threatened with the sack. Jhoots Pharmacy faces allegations of not paying wages, having premises repossessed and serious regulatory breaches. The General Pharmaceutical Council has already intervened several times, yet for many patients it is too late—they simply cannot get their medicines. This is not an isolated business failure; it exposes a deeper fragility in the community pharmacy network on which local people depend for basics and often lifesaving care.

I have four questions for the Minister. First, when was NHS England first made aware of these closures, and has the Minister met the Jhoots leadership? If not, why not? If he did, what was the outcome? Secondly, has the Department assessed how many people have been left without local pharmacy access as a result of Jhoots’s actions, and what is the Minister doing to remedy this, considering it is happening across the country? He mentioned ICBs, but there are several involved. Thirdly, what mechanisms exist to ensure continuity of care when a contractor collapses or walks away? Again, he mentioned ICBs, but is there a national contingency plan? Finally, will the Government now review whether the current model, under which chains are expanding rapidly through acquisition and debt, is fit to safeguard community pharmacies in the long term? Linked to that, can the Minister definitively confirm that the funding settlement has not been compromised?

The 10-year NHS plan states that it wants to move more care into the community, yet it is completely missing a delivery chapter on how to achieve that. At the same time, we have issues such as Jhoots. I hope the Minister will be taking steps to investigate this issue in its entirety and to safeguard against this type of incident happening again, and will spell out the delivery aspect of the 10-year plan.

[Stephen Kinnock]

I thank the shadow Minister for his questions. He asked about first awareness of what was happening with Jhoots. He will be aware that it entered the market through the purchase of a number of Lloyds pharmacies that were no longer a going concern in 2023, so the question about due diligence on Jhoots as an operator is probably something he should be asking one of my predecessors from his party, which was in power at the time. Since those purchases, Jhoots has expanded rapidly, and that has been where we have seen the question marks around its ability to operate and the serious downgrading of services.

I have not met the management of Jhoots. We are looking at a whole range of legal and regulatory enforcement procedures, and the decision we have taken is that it is better not to interfere in any way in those processes, but I am certainly monitoring that very closely. If we receive legal advice that suggests that such a meeting would be a good idea, I will of course be open to it. However, the current legal position based on the advice we have received is that it would not be appropriate at this time.

On local pharmacy access, integrated care boards have a statutory responsibility to ensure adequate pharmacy provision. Some ICBs, for example, have allowed dispensing GP practices to provide dispensing services to affected patients, while others have worked with local GP practices to advise patients to nominate alternative nearby pharmacies for their prescriptions. We have looked at the impact geographically, and our view is that in most cases there is alternative pharmacy provision to Jhoots within striking distance. However, there are four or five areas of the country where that is not the case, including in the constituency of the hon. Member for West Dorset (Edward Morello), who secured this urgent question. I am very conscious of that. In those cases, extra provision needs to be made through ICBs and GPs—that may be through distance selling or by other means—to ensure that patients have pharmacy access.

The shadow Minister asks about continuity of care and national contingency. The situation is challenging because, as I mentioned in my remarks and as officials have said, we have not seen this rapid decline in service before. We are working at pace to strengthen the regulatory framework and we are looking at contingency plans. I do not see any reason why the overall funding settlement for pharmacy should be undermined. We will continue to protect community pharmacy as a crucial part of our NHS.

Mental Health Bill [Lords]

Luke Evans Excerpts

Report stage
Tuesday 14th October 2025 Commons Chamber

[Madam Deputy Speaker (Judith Cummins)]

Members will have noticed that many people are standing to speak and there is not a significant amount of time for the debate, so with the exception of Front-Bench contributions, there will be an immediate four-minute time limit. I call the shadow Minister.

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

When we last debated the Bill on Second Reading, I said that protecting someone’s freedom for their own safety is not a licence to own their life, but a duty to help them find it again. That principle still guides us today, because good intentions alone do not mend a troubled system. Compassion without competence is not care; it is sentiment without substance.

On Second Reading, I spoke of bridges and rough roads, and of how resilience and recovery depend on the strength of the structures that carry people through their hardest times. Tonight, we return to that bridge. The question before us is not whether we believe in reform—after all, there is cross-party agreement on that—but whether the Government have built the foundations to make it stand. Warm words are plentiful, but the reality is that too many people are still falling through the gaps: detentions are still present, community services are stretched, and families are left navigating a maze of bureaucracy while waiting for help that may never come.

We all know that reform cannot be delivered on aspiration alone. It requires a delivery plan, a workforce and a system capable of learning from its own mistakes. We know the chapter on delivery is missing from the 10-year NHS plan and there is further risk tonight that we miss another opportunity. After all, the principles in the Bill are the right ones. They are even on the face of the Bill—choice and autonomy, least restriction, therapeutic benefit, and treating the person as an individual—but those principles need power behind them and that power lies in delivery.

This Report stage is our chance to turn those words into commitments. New clause 31 requires the Government to publish a fully costed delivery plan within 18 months of the Act passing into law, setting out how integrated care boards and local authorities will deliver adequate community services. Crucially, the plan must be developed through consultation with those who know best. That is vital, because although we support the many aims of the Bill, the Government already have a pretty dismal record of announcing reforms without any credible plan to deliver them.

Let us take the ongoing NHS reorganisation. In March, Ministers made a surprise announcement of the abolition of NHS England and its absorption into the Department of Health and Social Care, yet six months on they cannot say what it will cost, how many staff will be lost or how it will be paid for. The Health Service Journal reports growing confusion inside the system and warnings from NHS leaders that the lack of clarity risks paralysing decision making. Written questions to the Government simply receive the answer

“some upfront cost in the millions”

yet independent estimates say the cost is over £1 billion. Even the chief executive, Sir Jim Mackey, points out that the Treasury must agree funding for integrated care board redundancies within weeks or the NHS will have to turn to a plan B.

The same chaos is playing out across integrated care boards, with local leaders warning that there is already destabilisation due to the 50% reductions. If Ministers cannot manage their own top-down reorganisation, why should anyone believe they can deliver a more ambitious overhaul of mental health services without a clear costed plan, especially when waiting lists have risen in the last three consecutive months?

This Labour Government have already cut the proportion of spending on mental health. As Dr Lade Smith CBE, the president of the Royal College of Psychiatrists, said at the time:

“It is illogical that the share of NHS funding for mental health services is being reduced at a time of soaring need and significant staff shortages.”

Going on, she said that:

“The proportion of NHS funding allocated to mental health services will decrease”,

which will

“equate to these vital services missing out on an estimated £300 million or more that they would have received if their share…had been maintained.”

[Layla Moran (Oxford West and Abingdon) (LD)]

It is a decrease in the proportion of the mental health investment standard for the first time in, I believe, nine years. It is incredibly concerning. It was hard-won, cross-party support that made that proportion go up over time. It was incremental, but it was starting to make a difference to the system. Does the hon. Gentleman agree that it would be helpful if the Government clarified whether that will continue in 2025-26? When Baroness Merron came to our Committee, she could not confirm that. If there is not going to be a continuation, the system needs to know by now, frankly, so that it can prepare adequately for it.

[Dr Evans]

The Chair of the Health and Social Care Committee is absolutely right. A simple answer from the Minister today, on Report, would go a long way to alleviating those fears from the mental health sector. I look forward to his response on that.

Amendment 40 would add a simple but important requirement that each care and treatment plan must include an assessment of the levels of risk to public safety posed by the patient in the community. The purpose of the Bill is right; the Government want to make the system more compassionate, therapeutic, patient-centred and modernised, and we strongly agree with that ambition. However, modernisation must go hand in hand with public confidence, and the public and patients themselves must know that every plan for treatment and discharge is rooted not only in care, but in safety.

In Committee, I argued that the framework still omits one dimension, which is public safety. As far as I can see, there is still no explicit requirement in the Bill for clinicians to assess and record the level of risk posed to the public.

[Joy Morrissey (Beaconsfield) (Con)]

My hon. Friend is making an excellent point. Constituents have come to me about patients with schizophrenia, for example, who had been released before their psychosis had fully passed, with one such instance tragically ending in the death of another resident. All of these situations could have been prevented if the patient had been kept safely in a bed until they were at a proper level of medication and the psychosis had passed. Does the shadow Minister agree that that is something we need to take forward in this Bill? It is a win-win for all parties.

[Dr Evans]

I thank my hon. Friend for raising that tragic case. Those are the kind of cases that this amendment seeks to deal with. We have only to look at the tragic cases of Nicola Edgington and Valdo Calocane to see how escalating risk happens, with huge consequences for the families, patients and victims.

When I raised this matter in Committee, the Minister gave a very thoughtful answer. He said that:

“if any risk at all to public safety is perceived, that must be documented… It is a basic expectation of the professional management of a particular patient that any risk identified to public safety and protection must be in there.”

I welcome that.

With amendment 40, I am simply asking, if that is indeed the Government’s position, why not make it clear in the Bill? The Minister conceded in Committee that

“I take the hon. Gentleman’s point on whether or not it should be in the Bill. I will come back to him on that, because I would be rather surprised if it were not made very clear somewhere that that is a basic expectation; if it were not, that would obviously need to be looked at, but I am reasonably confident that it is.” ––[Official Report, Mental Health Public Bill Committee, 12 June 2025; c. 171.]

Unfortunately, expected in practice is not the same as required in law. We know from past reviews that there is a gap in the risk assessment and that communication can be too inconsistent. Putting such a requirement in statute would not be bureaucracy; it would simply clarify that. The Minister may argue that it already exists in professional codes, in the Mental Health Act code of practice or even in risk management frameworks, but the statutory duty does not. Our amendment would put that duty squarely in the Bill.

Talking of safety, I will turn to new clause 29, which would ensure that no child is placed on an adult mental health ward except in truly exceptional circumstances, and only when it is demonstrably in their best interests. The Government argue that guidance already covers that, but this guidance has no teeth; it can be ignored or inconsistently applied. Again, guidance without legal backing is too easily ignored. That was why the Joint Committee on Human Rights argued in its letter that this part of the Bill needs strengthening. The Minister also said that placing these safeguards in legislation would remove flexibility for clinicians in emergencies, but new clause 29 does allow for exceptional circumstances; it simply requires that they are justified, recorded and subject to oversight.

Research from University College London found that there has been a 65% increase in the number of children and young people admitted to adult wards for mental health disorders, and this increase is sharpest among teenage girls with eating disorders. They are the most vulnerable, and they are the ones who bear the brunt of this.

[Joy Morrissey]

That is another reason why I am shocked that the mental health budget is decreasing. I am seeing an increase across my constituency—and I am sure it is the same in many others—of girls in secondary school presenting with severe mental health issues, suicidal tendencies and eating disorders, and they are desperately crying out for additional mental health support.

[Dr Evans]

My hon. Friend is absolutely right that that support needs to be there. Fortunately, it is not the budget that is reducing but the proportion of funding, and it shows the priorities of this Government when it comes to mental health.

I am concerned that without new clause 29, a child may be harmed or traumatised and placed in an adult ward without proper justification—and it will be little comfort for the family to hear that guidance was breached.

Amendment 41 stands up for the simple but vital principle that when a child is detained under the Mental Health Act, the person legally recognised to act for them—their nominated person—should hold parental responsibility. Only where there are legitimate safeguarding concerns should that be set aside. At first glance, this may seem technical, but it speaks to something profound about how the law views childhood, family and the balance between protection and autonomy.

The Government are right to use the Bill to modernise the old “nearest relative” system, which was too rigid, too bound by bloodline and at times blind to the complexities of family life. Under the Bill, however, a child under 16 deemed competent could nominate any adult—that could be a 19-year-old boyfriend or peer or someone exercising control—and once nominated, that person gets full control. It is a legal authority. We need to ensure that protection is there for the person if there is a breakdown on the family side. [Interruption.] I see that Madam Deputy Speaker is encouraging me to wind up, so I will solidify my comments into a more erudite approach.

The point is that in law this principle is already clear in the Children Act 1989, which defined it as the foundation stone of what families should look like. With this amendment, I believe we have solved the concerns the Minister had at Committee stage about the state of a family in the modern era. In any other walk of life the legal framework exists, so why would we weaken it when it comes to mental health?

We discussed the issues with A&E and the grey area there in Committee, and I was grateful to the Minister for meeting beforehand to discuss them. I know that he took on my comments about solving the practicalities, and I hope he will look at them seriously.

For this House, there is no greater moral burden than deciding for someone who cannot decide for themselves—where care ends and where control begins. That is exactly what the House is addressing with this Bill: how to protect without diminishing, how to act with compassion without surrendering precision, and how to empower without imposing. Involuntary care must never be the reflex of a system, be it under pressure or out of principle. The House agrees on this position; the challenge is delivery. Compassion demands more than good intentions. It demands delivery, discipline and detail. With this Bill, the Opposition lays the challenge of delivery. It must be not just a pledge but a plan. The public will judge us all not just on how kindly this House speaks, but on how faithfully it serves those who depend on us most.

[Mr Richard Quigley (Isle of Wight West) (Lab)]

I will speak to new clauses 28 and 36 and amendment 39, which I tabled not just as an MP but as a father. After what my family have been through, I believe that any parent would do the same.

Yesterday, alongside the right hon. Member for Salisbury (John Glen), I had the privilege of hearing Dr Kate Szymankiewicz speak about her daughter Ruth. She shared not only the tragic circumstances of Ruth’s death but the type of person Ruth was: her dream of becoming a vet, her kindness, and how friends described her as a character straight out of an Enid Blyton novel. That is the Ruth her family remember and cherish. As parents, we became part of a world we never wanted to know. I am privileged to have met Kate, but we agreed that we wished our paths had never crossed because of what that meant.

Ruth was admitted to an in-patient facility for treatment of an eating disorder, but instead of receiving the care she needed, her family were shut out and allowed only two two-hour visits per week. They spent more time travelling than they did with their daughter. Ruth was just 14 years old when she fatally self-harmed, just five months into her stay.

Three months from that date, my family were faced with the same hospital, Huntercombe, as the only choice of a bed for our daughter. At that same hospital, when a child asked if they could have an extra type of jam for breakfast in the morning, they were told it did not have the budget, and when asked why Minstrels were no longer part of snack time, they were told that they were eating too many. That is the problem with NHS-funded private provision: even at £900 a night, the operators plead poverty.

My wife and I have two vivid memories of our youngest being prised from us without any warning. We thought that was normal. Six months of nasogastric tube feeding—we thought that was normal. Illegal restraint so bad that it caused post-traumatic stress disorder—we thought that was normal. Forgetting to feed our daughter 11 times—we started to realise that that was normal, but not acceptable. Instead of wishing to improve its practice, the hospital has accused me of making this up.

If a child is facing any other physical illness such as cancer, or even something more short-term that requires a hospital stay, parental visits and involvement are quite rightly seen as a means of enhancing care. I genuinely struggle to understand why our clinical consensus around mental health continues to support a model where already vulnerable children are isolated from their parents—the very people who know and love them most. Children on these wards are treated as wilful—they are not; they are children—and without empathy or sympathy. Many consultants we encountered opted not to apply the National Institute for Health and Care Excellence guidelines. Staff were poorly trained and in fear of psychiatrists, who ruled the roost and prevented people from speaking up. The private equity firms are focused not on long-term treatment but just on turning mental health into money.

My amendments do not seek to undermine the Bill’s strengths, nor the important work undertaken by the Department. In fact, the cross-party support I have received, including from the right hon. Member for Salisbury, reflects how uncontroversial they are.

The Minister and I have had robust and constructive discussions on the matter, but I ask him to confirm that he will do everything in his power to ensure the following. Parents must not be shut out of their child’s care, as evidence shows that regular parental contact enhances care outcomes. The placement of children on adult mental health wards under the Mental Health Act must be limited strictly to exceptional circumstances, and practitioners must be actively compelled where appropriate to involve themselves in the development and delivery of a child’s care and treatment plan.

We have a duty to ensure that the tragic circumstances surrounding Ruth’s death are never repeated. The Government were elected with a phenomenal majority, winning places we never thought possible—including my own constituency of Isle of Wight West—on a platform of meaningful change. If we do not use this moment to do the right thing and acknowledge that children in mental health services need their parents more often than not, I fear that we may never get another chance.

--- Later in debate ---

[Dr Danny Chambers (Winchester) (LD)]

I begin by thanking colleagues across the House who have worked so constructively on this long-awaited Bill. There has been a shared recognition that the current mental health system is failing too many people and that reform is urgently needed. I thank the Minister for engaging with us so constructively throughout the process, including as recently as yesterday; it is much appreciated.

When I speak to people in Winchester—I know that hon. Members have very similar stories—mental health is one of the issues that comes up the most. We have families waiting months or even years for treatment, we have parents watching their children deteriorate, and we have people languishing on waiting lists when they would rather be working or studying.

The Bill represents the biggest reform of mental health care in over 40 years. It strengthens patient autonomy, modernises detention procedures and rightly removes police stations from the definition of places of safety. These are vital and much needed steps forward and I know that Members on all sides welcome them.

I will speak briefly to several new clauses tabled in my name, each aimed at strengthening the Bill’s impact for some of the most vulnerable people it seeks to protect. New clause 26 would ensure that every hospital has a dedicated liaison service for the carers of patients detained under the Mental Health Act. This is a vital step to support carers during what can be an unimaginably difficult time and to close blind spots that too often exist when someone is caring for a loved one with serious mental illness.

We know that parental mental health concerns are now the most common factor in children’s social care assessments, and that those children are at much higher risk of developing mental ill health themselves. Yet only about a third of mental health professionals in in-patient settings ask whether a patient is a parent. These children and the carers who support them are too often invisible. By identifying and supporting carers properly, new clause 26 would help close those gaps and ensure that no family has to struggle in silence.

[Dr Luke Evans]

We did not discuss this specifically in Committee, but I would be interested to know about the interaction between the independent mental health advocates, which are being expanded and which we all agreed with in Committee, and a new liaison service. I worry about the duplication. Will the hon. Member explain how that crossover would work in practice?

[Dr Chambers]

That is a prescient point. At the moment, there is no responsibility to ensure that children in particular, and other carers too, are identified. Even if they are put in advance choice documents, if the person making those decisions does not identify them, that will not come about. We would have to be careful that there is not unnecessary duplication; however, the initiative the hon. Gentleman puts forward is not a belt-and-braces approach to identifying young carers and other carers who are struggling.

New clause 7 seeks to end the detention of children on adult wards, requiring the number to be reduced to zero within five years—other Members have discussed that today—and the Secretary of State to set out how that will be achieved. It simply cannot be right that children are still being treated on adult wards. It is unacceptable and can seriously hinder recovery and effective care.

Although the Bill rightly focuses on hospital-based treatment, the process has also laid bare how fragile our wider mental health services have become, with the lack of early support in primary and community care and the shortage of initiatives that help people long before they reach crisis point. That is why new clause 14 would place a duty on integrated care boards to ensure that community services have the resources they need to meet the demand and report on that regularly. Keeping people well in their communities must be at the heart of any modern mental health strategy, because if we get the community care right, we prevent crises, reduce pressure on hospitals and help people live healthier, more independent lives.

Finally, new clause 22 would establish a veterans’ mental health oversight officer. That dedicated role would ensure that those who have served our country receive the understanding and tailored care they deserve when they come into contact with mental health services. Too often, veterans experience mental ill health, sometimes linked to their service, and they find themselves in systems that do not fully recognise their unique experiences. The proposal would help change that by providing proper oversight; encouraging joined-up working across the NHS, veterans’ services and the third sector; and ensuring that compassion and accountability sit at the heart of how the Mental Health Act is applied to veterans.

Taken together, the proposals are about making our mental health system even more humane, more joined up, and more focused on prevention and recovery. I hope the Government will take them in the spirit in which they are intended, which is to strengthen this important Bill, which we very much support, and deliver a system that truly supports those who need it most.

--- Later in debate ---

[Gregory Stafford (Farnham and Bordon) (Con)]

As a member of the Bill Committee, I had the opportunity to closely examine the development and scrutiny of this Bill alongside my Opposition colleagues. We sought to strengthen the legislation, particularly in relation to safeguarding children and ensuring robust protections for those admitted under the Mental Health Act framework.

Given the shortness of time, I will speak only about amendments 41 and 42. They make the vital clarification that the nominated person for any patient under the age of 16 must have parental or guardian responsibility unless there are clear and established safeguarding concerns. In essence, that would ensure that the parents remain the lawful decision-makers and the first and most natural safeguards for their child’s welfare.

Let us consider, for a moment, what is at stake. Imagine a vulnerable 14-year-old girl, frightened and confused during a psychiatric admission. In that moment of distress, a well-meaning adult—or, worse, someone with a hidden agenda—could persuade the child to nominate them as their representative. That individual would then gain legal powers to object to treatment or discharge decisions, while the parents—the very people who know the child best and have both a moral and legal duty to protect them—could be sidelined.

Once such a nomination is witnessed, it carries legal force. The rights and responsibilities of parents could, in effect, be overridden. Although that may sound hypothetical, it is not. Family courts have seen precisely how manipulative individuals exploit vulnerable young people. Groomers, traffickers and abusers thrive in the legal grey zones. If we are not crystal clear that only a court may displace parental responsibility, we risk leaving the door ajar for such exploitation. I ask the Minister to assure the House in winding up that no child under 16 will be permitted to override parental authority simply by nominating someone else, without a full and proper judicial process.

The Bill does have fallback provisions, which are of course welcome, but they are not watertight unless the law explicitly confirms that only a court can transfer or restrict parental rights.

[Dr Luke Evans]

My hon. Friend makes an excellent point. The only protections that I can see in schedule 2 are an age requirement, a stipulation not to be disqualified by a previous court order, and the presence of a witness. There is therefore no pre-emptive way of protecting people, which is why amendment 41 is so important.

[Gregory Stafford]

My hon. Friend is absolutely right. Both he and I made those points in Committee. I am surprised that the Minister does not see the risks here. The safeguard that my hon. Friend talks about must be beyond any doubt. The amendment in his name provides exactly that clarity. It would prevent unrelated or loosely connected individuals from stepping into a role that rightfully belongs to those with both a legal duty and an emotional bond—the parents or guardians—and it would preserve the fundamental principle that parents should not find their role diminished by accident or administrative oversight.

As I was saying, this is not an abstract risk; it is a very real and foreseeable consequence of the unclear drafting. These amendments do not weaken the rights of patients. They strengthen the protections around them. They ensure that in modernising this law, quite rightly, we do not inadvertently undermine the oldest and most important protection of all: a parent’s duty to safeguard their child. We must ensure that the state can only curtail that right under the strictest judicial scrutiny, with evidence tested and the child’s welfare paramount. In doing so, we will make this legislation not only legally sound but, in my view, morally right.

New clause 31, tabled by my hon. Friend the Member for Hinckley and Bosworth (Dr Evans), would require local authorities and ICBs to supply a fully costed plan to ensure they are able to provide adequate community services for people with learning disabilities and autistic people. I support that entirely. As vice-chairman of the all-party parliamentary group for special educational needs and disabilities, and from speaking to groups in my constituency such as Last Wednesday and Growing Hope, I know that the process around SEND is complicated and not fit for purpose. Fortunately, we have a chance to help it slightly with this Bill, so I ask the Minister to support new clause 31.

Suicide Prevention

Luke Evans Excerpts

Thursday 11th September 2025 Commons Chamber

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

I thank the hon. Member for Doncaster East and the Isle of Axholme (Lee Pitcher). He honours John by securing the debate. All hon. Members who have spoken have honoured respectively the people they held so dear, in the most powerful way possible by turning personal grief into public purpose. I therefore thank them all for giving their time to speak.

There was a TikTok video that went viral. It opens with a young woman energetically and innocently asking:

“Be honest: who do you call whenever you’re at your lowest? Who’s that one person?”

The stitched video replies come in, with men answering. The replies are harrowing and insightful:

“Nobody. I’m a man. No one cares.”

“Not a single soul.”

“Nobody.”

“No one, cause I am all alone.”

“I think I speak for a lot of people when I say I don’t call anyone.”

“Nobody. I’m a guy—no one gives a s***”

“Speaking for the guys, literally no one.”

“You all call someone?”

“There’s no one. Nobody who cares.”

“No one. I’m a man. No one cares.”

“Not a single person. I wouldn’t turn to a single person on this earth as they will use it against me.”

“I wouldn’t call anyone.”

“What—we can call somebody?”

That small insight from a seemingly jokey platform hits on what we—the House and wider society—must look at to try to understand why men feel they are not valued. Why do they feel they cannot call someone? Why do they fear doing so will be used against them? Why do they fear asking for help? Many hide in plain sight, struggling and battling until it is too late. After all, we know from the Samaritans that about two thirds of suicide victims are not known to mental health services.

Hon. Members may wonder why I am choosing to focus my comments on men when the latest data from the Office for National Statistics shows that suicide rates are at their highest level since 1999. As we have heard, men account for three quarters of all suicides in the UK. The latest paper by the Centre for Policy Research on Men and Boys puts that in stark light. It showed that more men under 50 die in the UK due to suicide than for any other reason; 14 men every day die by suicide in the UK; 74% of all suicides are male; three times as many men die by suicide every year than die in a vehicle accident; and by 2023, over 90,000 men in England and Wales had died by suicide this century. That is enough to fill Wembley stadium.

There is so much to do in this area. I want to highlight the focus and progress of the previous Government. Through the NHS long-term plan, an additional £57 million was provided by the former Conservative Government between 2019-20 and 2023-24 to fund suicide prevention and bereavement services in every local authority. My former colleague Sajid Javid, who was touched tragically by the experience of losing his own brother to suicide, was instrumental in starting the development of the suicide prevention strategy, which was published in 2023. Key initiatives included the development of a new nationwide, near real-time suspected suicide surveillance system that aimed to provide early detection and timely action to address changes in suicide rates. The strategy in its entirety set out over 100 actions to make progress across Government Departments, the NHS, the voluntary sector and national partners.

In 2021, the previous Government also announced £150 million of funding for crisis mental health facilities and patient safety in mental health units. In January 2023, it was announced that £7 million of funding would be allocated to new mental health ambulances, with £143 million going towards 150 new projects, including schemes providing alternatives to A&E. That is welcome, but the stats show that, even with all that focus, the trend is worsening.

Despite all that work and prioritisation of funding, we have yet to hear anything substantial from this Government about what they are doing on suicide prevention. As we know from one example, training can make a difference. Samaritans reports from its rail team that, for every one life lost, it is estimated that six lives are saved by interventions made thanks to the training given to National Rail and rail operating staff. That is proof that things can be done.

Just yesterday it was World Suicide Prevention Day and the Prime Minister was asked twice about the topic. In response he said, first:

“May I also thank those dealing with suicide prevention? Probably everybody in this House knows someone who has taken their life. It touches all of us and we must do everything we can, together, to prevent suicide.”—[Official Report, 10 September 2025; Vol. 772, c. 862.]

Secondly, he said:

“I think that suicide prevention matters to everybody in this House. I will reaffirm our commitment and I will work across the House with all Members to deal with suicide prevention.”—[Official Report, 10 September 2025; Vol. 772, c. 868.]

Those are positive, warm words from the Prime Minister, which we are all pleased to hear. However, I think that we, across this House and among the public, would be interested in hearing the tangible actions taken by this Government after one year in office. Will the Minister provide an update on what direct, practical steps this Government are taking on suicide prevention, including the implementation of the recommendations in the strategy? What points—for example, disparities in the difference across ethnicities and races in the UK—are being addressed?

I know that the Government have been consulting on a wide range of issues, particularly when it comes to men’s health and the men’s health strategy. I have been shining a light on those issues since I was elected in 2019, so I thank the Government for taking that important step forward. I understand that the Government are due to publish the mental health strategy and I commend them for that. Indeed, I note than in an Adjournment debate earlier this year, the Minister for Care stated:

“In November, my right hon. Friend the Secretary of State for Health and Social Care brought together leading campaigners, experts and the Premier League to gather ideas and inform our strategy and our 10-year health plan. We take suicide prevention extremely seriously, because every suicide is a tragedy that has a devastating and enduring impact on families, friends and communities.”—[Official Report, 24 March 2025; Vol. 764, c. 757.]

His Majesty’s Opposition welcome that step forward, but in looking at the 10-year plan, I note that suicide is mentioned only three times. I think that everyone here hopes to see it feature heavily in the upcoming men’s health strategy. Will the Minister provide an update on timescales for the strategy and how it will consider suicide prevention?

Will the Government look at the prospect of a Minister for men and boys if the evidence points in that direction? We have a Minister for Women, as we believe that women have different problems across society. By that very logic, men and boys have different needs too. If we are to go down the route of segregating policies on sex, there appears to be a compelling argument to have a men’s Minister to work across Departments. That cannot be starker if we consider that for every woman who dies by suicide in the UK three men die.

Another achievement by the previous Government was the launch of the suicide prevention grant fund, as we have heard, providing £10 million to 79 organisations between August 2023 and March 2025. In my constituency, the charity First Step Leicester, Leicestershire and Rutland received £76,845 and the grant was used to improve specialist counselling work in prisons and to build on pilot projects. It is therefore a regret that the suicide prevention grant came to an end in March 2025 and has yet to be renewed or replaced. In response to a written question in April, the Minister for Care stated:

“There are currently no plans to run another grant fund.”

Will the Minister explain the basis behind the decision earlier this year not to renew or replace the suicide prevention grant fund, and what alternative provision, if any, is being provided?

[Liz Twist]

I thank the shadow Minister for his comments. There is no question but that we all want to work together to achieve the best outcome. May I remind him, however, that the £10 million voluntary services grant was a one-off grant and that the last Government failed to renew the funding—the £57.1 million that was mentioned—for local authorities’ prevention work?

[Dr Evans]

I thank the hon. Lady for all the work she does with the APPG. I am looking holistically at the different parts of what we are trying to do in this space. I have already outlined all the funding that the previous Government put in, and I will come on to some of the other problems, such as the national insurance rise, because she will know that they will have a devastating impact.

At the time, the Minister also stated:

“We will be evaluating the impact of the fund, and the services that have been provided by the grant-funded organisations. Learning from this evaluation will help to inform…the Government’s mission to reduce the lives lost to suicide.”

Could the Minister provide further details about that evaluation, such as when it will be completed and whether the Government would reconsider their decision to end the grant funding if the results show that it has had a positive impact in supporting suicide prevention?

Charities were not exempted from the increase in employer national insurance contributions in the Budget. That has significantly hampered their financial situation. We just have to listen to what the Samaritans said in response to the spending review last year:

“The reality is that funding for suicide prevention has dwindled down to next to nothing. To deliver our life-saving work, charities are reliant on donations—on the generosity of the public. And this is even more precarious at a time when many people across the country are facing economic hardship.”

I point that out not to score political points, but to draw attention to the fact that the Labour Government need to set a direction and plan to deal with the leading killer of men and women under the age of 30.

In closing, I want to recognise that yesterday was World Suicide Prevention Day. Every year, 720,000 people across the world take their own lives. The theme this year was, “Changing the Narrative on Suicide”. It calls on us all to challenge harmful myths, reduce stigma and foster open, compassionate conversations about suicide. That leads me to where I started: if men do not know their value, if they do not know they have someone to confide in and if they do not truly believe that we care, we will not break the cycle, we will not make a difference and, ultimately, we will not save lives. That is the challenge laid before society, this House and, ultimately, this Government.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I believe we have a new Minister, Dr Zubir Ahmed—congratulations on the promotion and welcome to the Dispatch Box. Just in case you need to know, we have been touched by young male suicide in my constituency of Sussex Weald, so I will be listening closely to your response.

Eating Disorders: Prevention of Deaths

Luke Evans Excerpts

Tuesday 2nd September 2025 Westminster Hall

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

The hon. Member for Isle of Wight West (Mr Quigley) said that he wants to push for change, and he is a tremendous advocate for doing exactly that. We are six months on from a very similar debate on eating disorders. The fact that so many Members across the parties are here to support the debate shows the strength of feeling.

In the short time that I have, I will not repeat everything that I said last time. Following the debate in April, I wrote to the Government to find out more and ask some questions. I received a letter from Baroness Merron on 12 June. The first question I had asked was whether the Government had a plan for eating disorders. The reply stated:

“The Department has no current plans to create an eating disorder strategy”.

It went on to say:

“NHS England is currently refreshing guidance on children and young people's eating disorders. The refreshed guidance will highlight the importance of awareness and early recognition of eating disorders within schools, colleges, primary care, and broader children and young people’s mental health services.”

I hope that the Minister can provide us with an update on when that updated guidance will be brought forward.

Back in April, I also posed the question whether the Government would be open to having a cross-party meeting or roundtable with experts in APPGs. I have not yet had a response to that question, either in a debate or in the letter that I received, but I think it would go a long way towards helping to explore this issue in a way that would make a difference.

In the previous debate, the hon. Member for Bath (Wera Hobhouse) raised an issue around the recording of death. She said:

“Accurate recording will raise awareness and ultimately save lives.”—[Official Report, 1 April 2025; Vol. 765, c. 30WH.]

The Minister responded:

“I share the concern of the hon. Member for Bath about accurate recording of deaths to understand the extent to which eating disorders and other factors have caused or contributed to deaths. This matter is being explored with the national medical examiner for England and Wales, the Office for National Statistics and the Coroners’ Society of England and Wales.”

Can he provide an update on where that has got to and what the outcome is?

Back in April, the Minister also gave us great expectations about the 10-year health plan:

“Through the 10-year health plan, this Government will overhaul the NHS and ensure that those with mental health needs, including those living with eating disorders, are given the support that they need.”—[Official Report, 1 April 2025; Vol. 765, c. 49WH.]

He also said:

“Raising awareness of eating disorders and improving treatment services is a key priority for the Government, and a vital part of our work to improve mental health services.”—[Official Report, 1 April 2025; Vol. 765, c. 47WH.]

I will be grateful if the Minister can respond to the Beat CEO, who has said:

“We’re very disappointed to see that mental health hasn’t been consistently highlighted as a priority throughout the Government’s 10 Year Health Plan, and that there are no specific commitments on eating disorders.”

That is a concern—not as a party political point, but because people who are suffering can now see it written that there is no strategy, and it is not mentioned in the 10-year health plan. I will be grateful if the Minister can alleviate the concerns about whether this issue is truly a priority.

Finally, one of the big plays that the Government have made is changing integrated care boards. In the last debate, the Minister said:

“The Government’s view is that ICBs are best placed to make decisions as close as possible to the communities that they serve and to target and, if necessary, reallocate funding accordingly.”—[Official Report, 1 April 2025; Vol. 765, c. 47WH.]

The changes brought forward by this Government have seen a reduction in staffing of 50% in many ICBs. Are the Government concerned? Has any analysis been done of whether there will be an impact on commissioning in respect of eating disorders, given the severity that has been highlighted across the Chamber?

It is often said that treatment is about progress, not perfection. I guess that much the same could be said about formulating policy as we deal with the rising number of people with eating disorders. To that end, I hope that the Government will take these questions as part of the process, helping to highlight this area in which we all want to see progress as the Minister brings his policies to bear on this country.

--- Later in debate ---

[Stephen Kinnock]

I will come on to talk about the guidance that is being produced. There is a risk that we can end up with a proliferation of documents, strategies and plans. Our view is that the more streamlined we are and the clearer the lines of accountability, the better the performance becomes. We are committed to the guidance, and I will talk a bit about that, but we are not convinced that having strategies alongside guidance, plans and other documents will help the process.

Members here will be well aware of the increase in the prevalence of mental health conditions, including eating disorders, since the pandemic. The increase in demand has placed significant pressure on services, but the extra funding is making a difference. The latest quarterly figures from NHS mental health services monthly statistics show that, between April and June 2025, 3,138 children successfully entered treatment in community eating disorder services. That is the highest figure on record since NHS England began collecting this data in 2021.

At the same time, waiting lists to begin routine eating disorder treatment have shortened by 20% from the year before. NHS England has also commissioned the Royal College of Psychiatrists to carry out a national audit of eating disorders. That audit is collecting data on eating disorders across community and in-patient settings to drive improvements in the identification and treatment of eating disorders. The audit will monitor how services are performing against standards, and highlight any inequalities in access to care. That will help services to provide safe, effective, patient-centred, timely, efficient and equitable care.

In addition to improved services for the treatment of eating disorders, we are also working to tackle their underlying causes. In particular, we are deeply concerned about harmful online content that promotes negative body image, harmful eating behaviours, suicide or self-harm to those who are most vulnerable. The Online Safety Act 2023 has now come into force and delivers on our commitment to make the United Kingdom the safest place to be online. By now, all sites with a significant user base in this country are required to have conducted children’s access and risk assessments, and to follow the new children’s safety codes to prevent them from accessing harmful content, such as promotion of eating disorders. Ofcom now has the ability to investigate or carry out enforcement action against any site that will not abide by those codes.

Hon. Members today have raised the need for early intervention to lower the numbers of hospital admissions from eating disorders. We know that the earlier the treatment is provided, the better the chance of recovery, and we are committed to ensuring that everyone with an eating disorder can access specialist help. As part of our mission to build an NHS that is fit for the future, there is a critical need to shift the treatment of eating disorders from hospital to community, including children’s community eating disorder services, crisis care services and intensive day-hospital or home-treatment services. Improved care in the community will give young people early access to evidence-based treatment involving families and carers, thereby improving outcomes and preventing relapse. By preventing eating disorders from progressing into adulthood, we will build on our aim of raising the healthiest generation of children.

We have also committed to expanding mental health support teams to reach full coverage in England. To date, we have expanded MHSTs to 52% of pupils; they are working hard in schools to support staff and students alike in meeting the mental health needs of children.

[Dr Luke Evans]

I thank the Minister for giving way. I am pleased that his Government have continued the roll-out, because we share the aim of trying to deal with this early. On that point, there was mention of the updated guidance, and clearly these hubs are going to need that guidance if it is updated. Will he set out when that guidance will be brought forward?

[Stephen Kinnock]

I absolutely will; that is just coming up in my comments. I am not sure that the shadow Minister will be satisfied with the answer, but I will refer precisely to the question that he is asking.

The MHSTs will continue to provide assistance to school staff in raising staff understanding, recognition and awareness of eating disorders, ensuring that they can provide crucial early intervention for children at risk.

Early intervention is also a priority for adults with eating disorders, as set out in the NHS’s adult community mental health framework. NHS England has established 15 provider collaboratives focusing on adult eating disorders. Those collaboratives are working to redesign care pathways and focus resources on community services. By providing treatment earlier and closer to home, we will see better outcomes for adults with eating disorders and their families.

Turning to the guidance, which a number of hon. Members, including the shadow Minister, have raised, we are producing updated guidance to help services to implement those transformations. NHS England first published guidance in 2019 for adult eating disorder services to ensure that they are integrated with day-patient services or in-patient care. A new service specification for adult eating disorder in-patient provision has been through a public consultation and will progress to publication this year. So I can guarantee that it will be published before 1 January, but I cannot give the shadow Minister a precise date.

[Dr Evans]

Forgive me if I misheard, but the Minister said that that was for adults. Can he comment on children and schools?

[Stephen Kinnock]

Can I come back to the hon. Gentleman on that? I will double-check. My understanding was that this was for both. My notes do say “for adult eating disorder services”, but my understanding was that this was a holistic process that would include children and schools. I will come back to him to confirm that point, so apologies if that is not entirely clear. Actually, I am sorry—it is next in my comments. NHS England is also producing updated national guidance for eating disorders in children and young people. That will reflect the full range of eating disorders in children and young people, and the treatment options available to CYP and their families to address them. It will focus on early identification and intervention, community treatment and support, and it will highlight the importance of integrating schools, colleges and primary care to improve support. Before the hon. Gentleman intervenes, he will have noted, as I have, that there is no specific date for that, so I will come back to him on that. The adult one will be before 1 January.

I would like to address the very serious concerns that have been raised about reports of people with eating disorders being offered end-of-life care. Let me be absolutely clear: these reports are deeply troubling, and I acknowledge the distress that they will have caused to families and all those affected by eating disorders. The Royal College of Psychiatrists has been crystal clear that eating disorders are not terminal illnesses. It has updated its guidance to re-emphasise that important point, so that no person, nor their loved ones, should ever feel that treatment has reached a point of no return.

NHS England is clear that all those with severe, complex or long-standing eating disorders should have access to eating disorder services, including hospital care when needed. A personal recovery model, with a focus on harm minimisation, symptom management and quality of life, is well established in providing hope and opportunities for recovery for many people with eating disorders. English law provides a robust framework for safeguarding a patient’s best interests.

I assure hon. Members that we take these concerns very seriously. We will continue to work with clinicians, NHS England and families to ensure that the highest standards of care are upheld, and that every person is given hope and support in their recovery.

Hon. Members have raised how those with eating disorders are disproportionately at risk of self-harm or suicide. The national suicide prevention strategy has highlighted the increased risk, and is committed to working with policy, clinical and personal experience experts to explore bespoke suicide prevention activity when needed. Specialists in eating disorders must ensure that they take a holistic approach to eating disorder treatment, and ensure that they are not likely to inadvertently increase the risk of suicide.

Several hon. Members, as well as the APPG report published in January this year, have raised the creation of a national register for eating disorder deaths, and the holding of a confidential inquiry into all eating disorder deaths. I reassure colleagues that the Department of Health and Social Care is wholeheartedly committed to learning from deaths, in order to prevent future tragedies and to improve quality of care.

The Department receives and responds to prevention of future deaths—PFD—notices relating to eating disorders, and it uses that work to inform practice going forward. For example, the medical emergencies in eating disorders—MEED—guidance was created following a coroner’s report and has since been rolled out nationwide. This Government are determined to focus funding directly to frontline services, in order to best support those currently struggling with this deadly illness.

Similarly, we share the concerns that have been raised about eating disorder deaths not being accurately recorded. It is vital that the extent to which eating disorders have caused or contributed to deaths is properly known. That matter is currently being explored with the national medical examiner for England and Wales, the Office for National Statistics and the Coroners’ Society of England and Wales.

To draw my remarks to a close, I would like to thank all the hon. Members here today. The fact that the debate was so well attended reflects how important the issue is to all of us and our constituents. The service that we provide can often be a matter of life and death. We are all very conscious of the gravity of the responsibility that we hold in that context. I thank all those in attendance for advocating for their constituents and all those across the country who have been affected by an eating disorder.

NHS Pensions: Frontline Patient Care

Luke Evans Excerpts

Thursday 17th July 2025 Commons Chamber

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

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

[The Minister for Secondary Care (Karin Smyth)]

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

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

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

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

[Dr Evans]

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

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

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

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

[Karin Smyth]

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