Women’s Health

Luke Evans Excerpts

Thursday 27th February 2025 Westminster Hall

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

May I, too, welcome the Minister? Gosh, what a debate to come into—it is such a wide-ranging field. I am so glad that she has been ably supported by the hon. Member for Hastings and Rye (Helena Dollimore) who put in a fantastic effort and managed to cover so many topics.

When I came to look at this debate, I thought about the best way I could try to touch on many of the topics. I thought a physiological view might be quite useful, starting with birth. Earlier this week, we had a debate on maternity services. The point is this: there is an explicit risk in pregnancy and birth, but we should do all we can to mitigate those risks. We know from the last 10 years that the maternal mortality gap has reduced from five times to two times, but much more can still be done. I am pleased that we heard that the Government are working through getting the Ockenden recommendations in place.

That leads me on to talk about postpartum depression, breastfeeding, and supporting recovery post-caesarean section delivery or episiotomy. We have heard about infertility and miscarriage. We have not even mentioned looking after a newborn. These are tough things to go through.

Young girls have to deal with body image, which is a personal hobby horse of mine. We heard about eating disorders. In 2023, we saw an investment of £4 million into new research, but there is still much more to do. Of course, that leads us to cosmetic surgery and when we need to regulate there. There is the issue of menarche and managing periods, not only from the contraceptive angle, but what to do when they are too heavy, too painful, irregular or do not happen at all. All these things require time, dedication and compassion to find out what works for that individual and what can be done to support, inform and empower that woman.

Returning to medical problems, Members have spoken eloquently about incontinence, as well as polycystic ovary disease and endometriosis, which are really common problems that are hard to diagnose and even harder to treat. I hope that the roll-out of 161 community diagnostic centres, which the new Government commit to carrying on with, make a giant leap forward in allowing women to get the diagnosis they need.

There is, of course, screening. We talked about breast screening, but cervical screening has not been mentioned. Screening is so important, and I urge every woman to consider it. What about the successful roll-out of the HPV vaccine, over a decade ago, to dramatically reduce cervical cancer? From 2019, it has also been offered to boys to help reduce that further. We need support for both lobular and ductal breast cancer. We have not really mentioned ovarian cancer and how difficult it is to pick up, often happening far too late.

Working through life, there is the menopause and the impact it can have on women: confusion, depression, anxiety and sexual dysfunction. It is still not well understood. The last Government, along with many from across the House, campaigned for better understanding to create a supportive environment. This is still developing, and long may it do so. Choice is hard too. Non-HRT or HRT? There are pros and cons. Of course, we had difficulties with shortages during the pandemic. Linked to the menopause, and not mentioned today, is the risk in old age of osteoporosis and fractures. That is critical. We know that women are significantly more affected by that than men, and prevention is much better than dealing with a broken hip or a broken wrist. I could go on.

Women’s health was rightly a priority under the last Government, which had almost 100,000 responses to their call for evidence to deal with the gender health gap. The last Government published the country’s first women’s health strategy in 2022, and expanded specialist women’s health hubs across England to improve access and quality of care for services such as menstrual problems, contraception, pelvic pain and menopause. They improved access to hormone replacement therapy and addressed barriers to health services faced by women who suffered from trauma from things like domestic abuse. Further still, the Government appointed Dame Lesley Regan as the first women’s health ambassador to step up efforts to improve women’s health, and Helen Tomlinson as a cross-Government menopause ambassador to find out the experiences of women employed in different sectors.

Turning to the issues here and now, I have some questions for the Minister, and some context. The Royal College of Obstetricians and Gynaecologists wrote to me on 29 January, just before the announcement by the Labour Government, with the following:

“We express our deep concern about the speculation of the Government’s decision to remove the target for all ICBs to set up and run a women’s health hub in the planning guidance”.

It went on to say:

“Removing the target may well lead to women’s health hubs being closed down, and a worrying rollback on the progress made in improving women’s health services for your constituents. It is self-defeating for the UK Government to close women’s health hubs when they are a clear success story for reducing waiting lists and moving care closer to home—they should instead be given ringfenced funding and expanded.”

I know the Minister cares deeply about improving women’s health, but it is hard not to see this is as a potential row back.

My first question is: what commitment can the Government give, in the light of dropping these targets, that women’s health remains a priority? Secondly, to help demonstrate this commitment, would the Government consider the call by the Royal College of Obstetricians and Gynaecologists for sustained investment in expanding women’s health hubs? Considering what we have heard today from the hon. Members for Walthamstow (Ms Creasy) and for Luton North (Sarah Owen), would the Department make a request in the spring statement and spending review to see that this would be the case? If not, why not?

I have spoken in the past in this Chamber about learning from previous work, so my third question is, how many times have the Government met with the women’s health ambassador since the general election? Can the Minister set out how this role would work alongside the Government’s new menopause ambassador? I hope that in asking these kinds of questions, it will kickstart the system into looking at how we can improve women’s health.

In the short time I have left, it would be remiss of me not to pick up on some of the key issues at the moment: osteoporosis, menopause, workforce and waiting lists. There has been some concern about the Labour Government’s commitment to their own promise of universal fracture liaison services by 2030. The Royal Osteoporosis Society has said:

“We all want to believe that Ministers will honour their promise, but people with osteoporosis tell us their faith is waning. It doesn’t need to be like this—we appeal to Wes Streeting to restore trust and confidence in the specific, measurable pledge that he campaigned on, and for which many people voted.”

[Sonia Kumar]

Will the hon. Member give way?

[Dr Evans]

I am really sorry; I am tight on time. Question No. 4 is, could the Minister kindly clarify, confirm and commit to that promise? If not, why not?

On the menopause, when the women’s strategy was announced in 2022, the then shadow Health Secretary—now the current Health Secretary—said:

“I challenge the Secretary of State to go further than the proposal he outlined to train incoming medical students and incoming doctors. What plans do the Government have for clinicians who are already practising? We need to upskill the existing workforce, not just the incoming workforce. However, let us be clear: informing clinicians is no good if we do not also improve access to hormone replacement therapy, so where is the action in the strategy to end the postcode lottery for treatment?” —[Official Report, 20 July 2022; Vol. 718, c. 977.]

As we are now eight months into the Labour Government, question No. 5 is, when will the strategy document he talked about be produced and presented to the House? Has he made an assessment since July 2024 of HRT medication access in terms of locality?

Turning to workforce, we know that the demand for women’s services is outstripping the supply of generalist and specialist support. The Royal College of Obstetricians and Gynaecologists has highlighted ongoing problems with maternity workforce staffing and agreed that the NHS long-term workforce plan was a good first step on the way to properly staffed maternity services. Therefore, question No. 6 is this: we know that the Government will be looking at a refresh of the plan this summer, so will the Minister give an undertaking today that women’s health will be a priority in both primary and secondary care? Will she update the House on the obstetrics workforce planning tool, which the DHSC commissioned to help maternity units calculate staffing requirements, and when it will be rolled out across the country?

Given that time is tight, I will close by saying that I have heard it said that a healthy woman means a healthy family, a healthy community and a healthier world. That is hard to dispute that; it is now for the House to deliver it.

[Dr Rupa Huq (in the Chair)]

Finally, for what we think is her first outing as a Minister in Westminster Hall—although she is a veteran of the Chamber already— I call Ashley Dalton.

--- Later in debate ---

[Ashley Dalton]

That is something that we will take on board and consider as we move forward.

We have heard a lot about menopause and peri- menopause from many Members, including my hon. Friend the Member for Broxtowe (Juliet Campbell). We are supporting women through the whole menopause process. Menopause and perimenopause symptoms can be wide-ranging and debilitating. NHS England is developing a range of tools and interventions to help upskill more GPs in menopause care, including awareness of mental health symptoms during menopause, and developing a menopause workforce support package for employees. I can also confirm that we are using community diagnostic centres to pilot pathways for women who suffer from post-menopausal bleeding.

[Dr Evans]

Can the Minster comment on HRT medication and making sure that there is equal access to it across the country?

[Ashley Dalton]

I will come back to the hon. Gentleman on that, but I thank him for raising the issue.

We have also talked a lot about what underpins this topic: research and innovation, and my hon. Friend the Member for Stafford raised that point in particular. We are taking strides in vital research. By the spring, the NIHR expects to launch its sex and gender policy, which will ensure that research is designed, conducted and reported in a way that accounts for sex and gender—a point raised by the hon. Member for Canterbury. That will support our understanding of how women might be impacted differently by health conditions.

The hon. Member for Bath (Wera Hobhouse) talked about eating disorders and also about breast cancer, which a number of people raised. As I am sure the hon. Lady appreciates, that issue is important to me, as I was diagnosed with a breast cancer when I was under the age of 42. It is an important issue.

Health in the workplace continues to be an important issue for us, and we are dealing with that through our make work pay strategy and the Employment Rights Bill, which will set out some of those steps, including support for women experiencing menopause in the workplace.

On sodium valproate and pelvic mesh, the Cumberlege review made nine recommendations, of which the then Government accepted seven. I can confirm that the national pause remains in place.

Maternity Services

Luke Evans Excerpts

Tuesday 25th February 2025 Westminster Hall

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

I am pleased the hon. Member for North Shropshire (Helen Morgan) pointed out that many people actually do have a good birth. I think that is really important, as there is a danger we scare potential mothers. There is good-quality care up and down the country, but it could be better.

The hon. Member for Redditch (Chris Bloore) pointed to my work. I never actually served in Redditch in the obs and gynae and the paeds there; my time was done in the early 2010s over at Worcester. One of my favourite times as a doctor was being on the elective C-section list, and seeing the mothers go in, having the music there, and seeing birth after birth. It was fantastic. I also experienced one of the worst things that I have ever had to do as a paediatrician—being handed a lifeless baby and trying to sort that out. Worse still was an emergency C-section after a baby went into the mother’s bladder. Both went off to the intensive care units, and I had to go and speak to the father, who was expecting a normal delivery, to tell him what was going on.

This is the reality of what happens, because having a baby does carry inherent risks. What we are talking about here is what we can do to mitigate them. I think that is the heart of what the hon. Member for Chichester (Jess Brown-Fuller) so eloquently set out; this is about the safety of mitigation. Her story about Bendy and Steph will stick with many people, because that is exactly what this House and the NHS should be trying to avoid. The aim should be to mitigate as much risk as we can.

We have also heard talk about breastfeeding and post-partum mental health, which is really important. Those things should form part of a strategy. Not all patients receive a safe and timely assessment when they are being triaged, with instances of phone triage going unanswered and some women discharging themselves before even being seen or picked up, due to the delays. That was backed up by the Care Quality Commission, which found that unsafe practices in triage form the basis of 81% of the enforcement actions issued to providers and were found to be a safety concern in about a third of all inspections.

The hon. Member for Epsom and Ewell (Helen Maguire) pointed to the fantastic quality of care that exists, despite the conditions—we know that 18% of the NHS estate has been described as not fit for purpose and lacking the space for facilities. In my constituency, we have a plan to bring forward an improved maternity centre for Leicestershire. That, too, has been delayed in the future hospitals programme, but at least funding is coming forward to try to deal with that.

Looking at the record of the previous Government, from 2010 to 2022, the rate of stillbirth decreased by 19.3%, the neonatal mortality rate for babies born over 24 weeks gestational age of viability decreased by 36%, and maternal mortality decreased by 17%. In 2015, the then Government launched the national maternity safety ambition, which was to halve the 2010 rates of stillbirth, neonatal and maternal deaths, and brain injuries in babies occurring during or soon after birth by 2025. The current Government have not yet set out an updated ambition for the next decade, so I would appreciate it if the Minister would bring that forward.

As of December 2023, there were 2,361 full-time equivalent midwives working in NHS trusts and other core organisations. That was an increase of 3,700, or 18.9%, since 2010. On the other hand, the birth rate is falling while the number of midwives is rising. I recognise that births are taking place and are somewhat more complex than they used to be, due to things like diabetes, weight and age. It is really important that we have a plan to deal with that; I hope the Minister will comment on that going forward.

That leads me on to community midwives and continuity of care, which we know is inextricably linked to improved care. A report by Cochrane, a non-profit organisation that produces global research to improve health outcomes, showed that women who experience continuity of care—in other words, seeing the same midwife or teams of midwives in pregnancy—have far better outcomes. During the last Parliament, funding was provided for the implementation of continuity of care models. As of April 2024, an additional £186 million had been allocated to improve the quality of care for mothers and babies and to increase the number of available midwifes in post.

I further welcome the £6.8 million in funding provided by the previous Government to help to implement continuity of care for black and ethnic minority groups living in the most deprived areas. As we have heard in the debate, that is a real concern—the hon. Member for Worthing West (Dr Cooper), with her professional experience, pointed to the disparities we see in seeking behaviours among those from BAME backgrounds when it comes to having babies. We also saw that in our work on the Health Committee—I have asked the Minister to look at the two reports on litigation and the Ockenden report in the last Parliament. There is a lot of good cross-party work there that could help to inform current thinking.

Of course, far more remains to be done in the area of saving babies. NHS England published its own delivery plan for maternal and neonatal services in March 2023. Commitments included updating the “Saving babies’ lives” care bundle by 2024 and introducing a national maternity early warning score and updated newborn early warning trigger and tracker to follow up the babies in those cases. The “Saving babies’ lives” care bundle is helping to provide the best practice for providers to reduce neonatal mortality and is rightly a major component of NHS England’s maternal and neonatal services delivery plan. Will the Minister provide an update on the implementation of version 3 of the care bundle?

There are a few closing questions that I would like to pose. The maternal mortality gap has been reduced over the years, from five times to two times, but clearly we need to do more. What further action will the Government take to address the issue of the black and Asian maternal mortality gap, and what ambition will be set out? At the general election, the Government stood on a manifesto to recruit more midwives. Will the Government confirm how that fits into the long-term workforce plan? I am pleased that they have stuck with the previous Government’s plan, and are looking to amend it.

In the new operational planning guidance, NHS England has committed to implementing the key actions in the three-year delivery plan. Will the Minister update us on progress against some of those actions, including the commitment to introduce a national maternity early warning score system and an updated newborn early warning trigger and track tool? As part of their response to the East Kent review, the previous Government established a group overseeing maternity safety services nationwide chaired by my former colleague, Maria Caulfield. Will the Minister provide an update on the national oversight group’s work? Are she or any of her ministerial colleagues part of those discussions?

My final question is about litigation, which was raised by my right hon. Friend the Member for Godalming and Ash (Jeremy Hunt). Under his chairmanship, the Health and Social Care Committee produced a report looking at different maternity models, including in the likes of Japan, and at how can we reduce the cost for taxpayers while improving clinicians’ ability to have the honest discussions we need, and to feel that they can come forward and blow the whistle.

Birth is not about making babies; it is about making mothers—strong, competent and capable ones. We do that by supporting, respecting and informing mothers every step of the way. That is an admirable aim for this House and the NHS, and I look forward to the Minister’s comments.

Cardiovascular Disease: Prevention

Luke Evans Excerpts

Thursday 13th February 2025 Westminster Hall

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

Before I start my speech, I think it was Gandalf who said:

“A wizard is never late…Nor is he early; he arrives precisely when he means to.”

I think it is correct protocol to be here at the start of a debate, although I for one would certainly like to see the Minister sprinkle his magic on this topic, because I hope that he will provide some enlightening answers in response to such an important debate.

Once again, I thank the hon. Member for Strangford (Jim Shannon) for his industrial strength in always securing these debates. I believe it is said that the man who moves a mountain begins by carrying away small stones; the hon. Member for Strangford is moving the metaphorical health mountains, one Westminster Hall debate at a time. I raise my hat to him, because I have had the chance to respond to a debate of his at least half a dozen times. He always conducts himself in an incredible manner and provides incredible detail, so I thank him for that.

If we can tackle the risk factors behind cardiovascular disease and identify it at an early stage, we can make a significant difference by reducing the number of people lost to premature deaths every year. The hon. Member for Ilford South (Jas Athwal) spoke movingly about his mother and his father. That was followed up by the hon. Member for Mid Sussex (Alison Bennett), who spoke about her father 13 years on; her father will be very proud to see his daughter in this debate. I am sure the parents of the hon. Member for Ilford South would be proud of his achievements as well, and the fact that he is raising such an important topic.

I come to this topic as a GP, and this is pretty much the bread and butter of life for a GP: advising on healthy lifestyles, and managing blood pressure, angina, obesity, smoking, heart failure, strokes and many more conditions. I pay tribute to the hon. Member for Dudley (Sonia Kumar), who pointed out how important that is. It is not just the doctor’s role any more; this is the MDT approach, and actually a quality MDT really helps the GP to understand where they need to look and to manage their workload, which is so important not just for clinicians but, most importantly, for the patients. It is an honour to take part in this debate and to help to shape it.

From a public health perspective, the last Government made significant progress on things such as calorie labelling, salt and sugar reformulation and smoking cessation, which are all contributors to cardiovascular disease. It was just three years ago that the NHS published its CVD prevention recovery plan, which set out four high-impact areas for every part of health services to focus on risk factors, detection and management. Examples include the rolling out of blood pressure checks in high street pharmacies and allowing people to measure blood pressure at home. The NHS long-term plan set out five ambitions to detect and treat people at risk of developing CVD. The plan has been revised twice, in 2022 and 2024.

This work was reinforced by the introduction of the NHS digital health check in spring 2024, which aimed to prevent 400 heart attacks over four years. The National Audit Office report into CVD, which was published in November 2024, said the disruption to the NHS caused by the covid pandemic has had substantial impacts on elective care, and this has undoubtedly had an impact on the prevention and treatment of cardiovascular disease. We do not have to look back too far to think about lockdown and the effect that that had on people’s physical activity, their ability to seek help and some of the preventive and advisory medicine that would have normally taken place. Following the NAO report, the Government committed to reviewing the NHS health check programme. Will the Minister confirm the timescales for the review and when the reports on the outcome will be published?

The hon. Member for Strangford rightly pointed to cholesterol and lipids. Lipids are often not given the attention needed; they are hugely important when addressing cardiovascular disease, so I thank the hon. Gentleman for mentioning them. I have done constituency casework on this topic as a Back-Bench MP. He mentioned lipoprotein(a), and I have been questioning Ministers about the development of genetic testing for familial hypercholesterolaemia and the development of a familial hypercholesterolaemia service in Leicestershire. Although this is a complicated and involving space, given the great advances in the testing and understanding of lipids, it is really important that we get to the bottom of it to understand the environmental impacts that are causing this, as well as the genetic ones at play.

To that end, work has also included looking at how bodies can track patients and the difficulties that familial hypercholesterolaemia services have in cascading to local people’s relatives, which I think is what the hon. Member for Strangford was pointing to. This is probably beyond the scope of this debate, but given the hon. Gentleman’s success with this debate, it would be great if he were to secure a Back-Bench debate on lipids. Will the Minister consider asking the Department to look at improving the clinical pathways for familial hypercholesterolaemia and the possible roll-out of screening for both patients and family members? I appreciate that this has to be done through an evidence-based approach.

More people are living with multiple long-term conditions; that is no different for many people living with CVD, who are also living with other conditions, such as diabetes. That is why the last Government were developing the major conditions strategy to try to improve outcomes across major conditions, including cardiovascular disease, as well as cancer, diabetes, respiratory disease, mental health and musculoskeletal disorders. Since the general election, Ministers have decided to go in a different direction, so will the Minister reassure me that the NHS 10-year plan will address the impact of those long-term conditions? As the hon. Member for Mid Sussex pointed out, inequality plays a role when it comes to cardiovascular disease, so I would be grateful if he would comment on that.

I think the quote goes, “Study the past if you would divine in the future,” and I am always keen to gain insight from across the House of what has previously happened. I note that almost a year ago today, there was a debate held in the main Chamber on the topic of heart and circulatory diseases by the then MP for Watford, the brilliant campaigner Dean Russell, who talked about his experience of having a heart attack. Of course, the debate was just a few months before the general election, but it gives us a good insight into what the then shadow Health team were thinking before they came into government, which they were successful in doing. The then shadow Minister, now the Minister for Secondary Care, was responding. She said:

“Labour has a mission to reduce deaths from heart attacks and strokes by a quarter within 10 years…Under our ‘Fit for the Future’ fund, we would double the number of scanners—speeding up heart and circulatory disease diagnosis”.

What is the amount in that fund? Has it been deployed, and what is the timescale? What scanners were specifically commissioned for cardiovascular disease? The then shadow Minister went on:

“We would also incentivise continuity of care in general practice, which would improve care in our communities for people living with heart and circulatory disease.”—[Official Report, 22 February 2024; Vol. 745, c. 940.]

No one has to tell me, as a GP, about the importance of continuity of care, so will the Minister explain what this would look like in the GP contract? What incentivisation is being considered for GPs?

The then shadow Minister went on:

“That is why Labour will introduce a child health action plan that will put prevention at the top of the agenda”.

Forgive me, but looking on the Government’s website and speaking to the House of Commons Library, I cannot see a report or plan on this topic; if I have missed it, will the Minister provide it? If there is not one, will the Minister set out the goals and timelines for achieving the plan, if the Department will provide them, and place it in the House of Commons Library?

On research, the then shadow Minister went on:

“That is why Labour’s regulatory innovation office would make Britain the best place in the world to innovate by speeding up decisions and providing a clear direction based on our modern industrial strategy, alongside a plan to make it easier for more patients to participate in clinical trials.”—[Official Report, 22 February 2024; Vol. 745, c. 941.]

Eight months into the new Government, I believe a chair has not been found, so will the Minister update me on when the role will be filled? Given that this was the stated aim of the Labour party in the CVD debate, what conversations is he having with the Department for Science, Innovation and Technology about speeding up cardiovascular trials?

I thought it fitting in closing to use the lines of Dean Russell, who used his closing remarks back then to point to the importance of data, education, protection and research in dealing with cardiovascular disease. I think the entire House can get behind that. The story of the hon. Member for Ilford South is a testament to the life advice that Dean gave to us then:

“if anyone at home is worried, they should get checked. If they are concerned that they have symptoms, they should get them looked at. It is better to get rid of fears before the event than to wait for them to become a reality and have to deal with the outcomes of that.”—[Official Report, 22 February 2024; Vol. 745, c. 944.]

I think we can all agree on that, too.

[David Mundell (in the Chair)]

I am sure that the Minister will begin with an apology to me, to Mr Shannon, as the Member in charge, and to all other participants, because it was very clear on the Order Paper that these proceedings would begin at 3 pm.

--- Later in debate ---

[David Mundell (in the Chair)]

I am sure the Minister will have heard the three points that Mr Shannon raised. On that basis, I will put the Question.

[Dr Evans]

On a point of order, Mr Mundell. In perfect symmetry, this debate has taken a somewhat different procedural pathway than usual; that is indeed what can happen to patients with cardiovascular disease—things surprise them, although we have systems for dealing with cardiovascular disease. My concern is that some of the questions I raised on behalf of His Majesty’s Opposition have not had the chance to be answered. I would be grateful if the Minister would take them away and write to me—perhaps I could put them in a letter. Would it be within the scope of the Chair’s powers to allow that to be the case, Mr Mundell?

[David Mundell (in the Chair)]

That is not technically a point of order, but I am sure the Minister has heard what you have had to say. I am sure he and, indeed, the hon. Member for Glasgow South West (Dr Ahmed)—who was here from the start—will have noted all the points that Mr Shannon raised. If the points that Mr Shannon raised at the end—and indeed earlier, in his contribution before the Minister spoke—were unaddressed, I am sure that the Minister will write to him.

Oral Answers to Questions

Luke Evans Excerpts

Tuesday 11th February 2025 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

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

The Labour Government’s elective reform plan says that there are plans for 10 straight-to-test pathways. Can the Secretary of State name them, or give one example?

[Wes Streeting]

It is absolutely ridiculous, Mr Speaker. Conservative Members turn up, criticising and carping about this Government’s elective reform plan, but I remind the hon. Gentleman that when his party was in office, it delivered the longest waiting lists in the history of the NHS. If he wants to do a pop quiz, he can use Google.

[Dr Evans]

This is the Secretary of State’s own plan. There was one example in the plan, but as an article in The BMJ on 17 January helpfully pointed out, that one example—which featured Sarah, who had sinus pain and hearing issues—was quietly removed from all online and future drafts after

“a flurry of GPs pointed out that her treatment”

was “wholly inappropriate.” That article went on to say that

“Sarah can pick up her dose of unnecessary radiation along with her weekly shop.”

On this part of the Government’s plan, The BMJ concluded:

“Sarah’s story is one of over-investigation, fragmented and inappropriate care, spurious choice, and a lack of senior decision making at first presentation. Activity for activity’s sake has little to do with high quality care.”

Does the Secretary of State agree with The BMJ, and if not, why not?

[Wes Streeting]

I always believe in holding our hands up when mistakes are made. I am happy to say that the reason that case study was removed from the published elective reform plan is because it was a genuine mistake, for which I accept responsibility as the Secretary of State. Now, maybe the Conservative party might like to accept responsibility for the highest waiting lists and lowest patient satisfaction in history, and finally have the decency to apologise to the country for the mess it left us in.

Draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2025

Luke Evans Excerpts

Monday 10th February 2025 General Committees

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

It is a pleasure to serve under your chairmanship, Sir Desmond.

I thank the Minister for stepping in, and we agree that this SI needs to be passed with urgency. I also agree that it is not the place for a discussion of the CQC and its failings. She highlighted a couple of issues of concern, on which I would like to probe the Government a little, such as ending the exemption for sports arenas and cultural events. Given the Manchester Arena bombing and inquiry, it is clear that protections need to be in place, but the Opposition are concerned about the burden on small businesses and charity groups, which may well have to deal with the red tape involved in being regulated by the CQC. I would therefore be grateful if the Government considered producing an impact assessment of that red tape and how it will work in practice. CQC registration makes perfect sense when there are medical interventions in arenas, but how is it likely to work for a small football club run on a voluntary basis, or for a charity? At this point, I declare an interest: my brother is a sport and exercise medicine consultant and the medical director of the Lawn Tennis Association and so could in theory come within scope of some of these changes.

As part of the consultation response, the Government stated that

“further policy and operational consideration”

was needed. Will the Minister clarify what that means in practice? I also want to ask the Minister a question about regulation 5 of the 2014 regulations, which set out the criteria for an individual to be considered a fit and proper person to take up a role as a director of a health service body or provider. The last Government started a review of the duty of candour expected of healthcare professionals. Will the Minister provide an update on when the Department will publish the outcome of that consultation, and have the Government made an assessment of how the outcome of the consultation may affect the provisions of the 2014 regulations as they relate to criteria for directors of health and care providers?

Overall, the Opposition are supportive of the direction in which the Government want to go with this legislation. We understand the urgency of the timetable in front of us, but the concerns felt by Opposition Members will need to be addressed, so that we do not inadvertently overburden some of these institutions, which are already feeling difficulties when it comes to regulation. I would be grateful for the Minister’s answers.

Medicinal Cannabis

Luke Evans Excerpts

Thursday 30th January 2025 Westminster Hall

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

I am grateful for the honour of responding for His Majesty’s Opposition in this debate, Ms McVey.

I thank the hon. Member for Strangford (Jim Shannon) for his tireless dedication to health issues—not just this one, but many others. In my short career on the Front Bench, I think this is already the fourth time in the space of six weeks that I have responded to a debate that he has secured; I congratulate him on his success in doing so. He never ceases to amaze me, because not only does he represent his own constituents—he has told us so passionately about Danielle, Sophia and their story—but he even represents others’ constituents as well, bringing forward and championing their issues. His ability to step forward and raise those issues is a true testament to the parliamentarian he is, and he has my full admiration and respect for doing so.

Today we have heard some moving stories about the difficulties faced by patients who are suffering, and about the plethora of conditions that could benefit from having these medications. I thank Medcan Family Foundation and the Medical Cannabis Clinicians Society for their advocacy on the issue, and for repeatedly bringing that information to the fore so that this country can debate such an important topic.

The debate has focused on the challenges that many children and adults face with accessing medical cannabis, but we appear to be in a new phase when it comes to managing the fact that such prescribing is becoming more prevalent. It is worth recognising, as we have done, that there was no legal route for such treatment only seven years ago. It was Sir Sajid Javid, who, as the Home Secretary, listened to the families and commissioned a review into that area to allow the creation of legal routes for accessing those medications. That decision has led to significantly more people being able to access licensed cannabis-based medicines.

Between January 2018 and September 2024, written answers show that 24,395 NHS prescriptions for licensed cannabis-based medications such as nabilone, Sativex and—even as a doctor, I am struggling to say it—Epidyolex were dispensed across the community in England. However, it must be recognised that that is dwarfed by the number of private prescriptions currently being issued. Where there have been challenges with access to licensed medications, as with Sativex, the last Government worked with the NHS to take steps to increase uptake of prescribing. On 6 September 2021, the NHS wrote to local trusts and integrated care boards reminding them about NICE’s guidance relating to that medication, and their responsibilities to prescribe in line with NICE recommendations. My understanding is that the letter contributed to an increase of prescriptions of Sativex.

However, challenges remain with access to unlicensed cannabis-based medications. We have heard that those medicines must be accessed through individual funding requests, but clinicians are wary of prescribing them, because of concerns about both the evidence base and the legal responsibilities involved. I can attest to the fact that, as a doctor who prescribes unlicensed medications, one looks for guidance on the best way to do so safely. The law was changed in part to encourage more research and clinical trials so that robust evidence can be collected, potentially leading to marketing authorisation and licensing. In the meantime, it is notable that NICE guidance does not prohibit healthcare professionals from considering unlicensed medications. In 2021, NICE stated:

“The fact that NICE made no such population-wide recommendation should not however be interpreted by healthcare professionals as meaning that they are prevented from considering the use of unlicensed cannabis-based medicinal products where that is clinically appropriate in an individual case. Patients in this population can be prescribed cannabis-based medicinal products if a tertiary paediatric epilepsy specialist considers that that would be appropriate on a balance of benefit and risk, and in consultation with the patient, and their families and carers or guardian.”

However, a recent report by Medcan Family Foundation has highlighted that more restricted prescribing in some areas may be leading to serious or unintended consequences. It is concerning to see, when reviewing their research, that three online forums identified 382 families in the UK who are giving their child illegal cannabis products specifically to manage epilepsy. Given the nature of that research, it could be argued that the figure may be significantly higher nationwide. Is that just the tip of the iceberg?

It is worth reflecting on some of the debates that have taken place in this House that have been mentioned previously. I think it was Mark Twain who said, “The past doesn’t repeat itself, but it does rhyme,” which I feel is apt in this case. To that end, it is always wise to try and learn from previous experiences. After all, advice from the wise is like the torch in the dark; it does not walk the path for us but it does light the path. So I looked at Hansard for the last debate and noted a particularly strong contribution from the then shadow Health Minister, the hon. Member for Bristol South (Karin Smyth), who is now the Minister with the power at her disposal. I think it is fair to ask her the questions she posed to the then Minister:

“It would be helpful if the Minister could set out what steps he is taking to empower and accelerate research in this space. I hope he will not dodge the question by saying that the issue is simply one for clinicians. The Government have a responsibility—the Minister is nodding, and we await his reply with interest, but there seems to be a lack of urgency on the issue, which is concerning. People are suffering right now. We have heard again this afternoon about children who are fitting, sometimes 100 times or more. Accessing care is, in some cases, pushing families to the brink of destitution. We should do everything we can to support those people.

If research is needed before clinicians feel comfortable prescribing, then it is incumbent on the Government to support clinicians. We need more streamlined clinical trials and better engagement with clinicians. We do not want to be back here in another two years, having a rerun of this debate. In 2020-21, the then Minister said:

‘It will take time to generate further evidence and see the results of clinical trials. The Health Secretary and I are committed to doing everything in our power to accelerate this work.’

If the Minister could update us on where this work has got to, and whether the Government are any closer to finding a solution, that would be welcomed by people tuning in today, and to the families present.

Finally, I would be grateful if the Minister set out what action he has taken to support people in the system right now—those living in extreme pain who are paying thousands of pounds to access treatment. There is consensus on this issue, as we have heard. The debate has been had and a decision has been made, but we can and should do better. In that spirit of consensus, we would all like to see some progress from the Minister.” —[Official Report, 20 April 2023; Vol. 731, c. 223WH.]

The Minister is clearly a strong advocate, and she is now in a position of power. She has been in post for over half a year, so what steps has she taken to empower and accelerate research in that area? What action has she taken to streamline clinical trials? Since taking office, what steps has she taken to empower clinicians to prescribe and to feel more comfortable? Since being in post, what action have her Government taken to support people in the system now?

It seems to me that the debate has moved on, but it is still rhyming. We are two years on and progress has been made. More than 24,000 prescriptions clearly represent an improvement. As has been said today, however, there is more to do, and we have new problems. The right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) talked about the legal farming industry, the Hilltop Leaf situation and trying to create a virgin industry. My hon. Friend the Member for Broadland and Fakenham (Jerome Mayhew) talked about the clinical pathways and how they need to be specifically looked at. The hon. Member for Strangford highlighted policing, given that there is a growth in use. I will not tempt the Minister to stray into the Home Office brief, but I want to ask what conversations she is having with her Home Office counterparts about legal medical cannabis.

I hope the Government will continue to progress in this space as the issue evolves. They will have the Opposition’s support as they continue to research, educate and raise awareness. I hope the Minister will agree to meet Medcan and the Medical Cannabis Clinicians Society, if she has not done so already. Given the concerns that have been raised today, perhaps as a first step she will write to trusts and ICBs again to highlight the guidance on prescribing these medications. After all, we all want the safest, most effective medications to treat patients as soon as they are needed, and they should be uniformly accessible. I believe that noble aim is distinctly achievable, and I hope the Minister does too.

Auditory Verbal Therapy

Luke Evans Excerpts

Tuesday 21st January 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Western. I congratulate the hon. Member for Washington and Gateshead South (Mrs Hodgson) on leading this debate and pay tribute to Auditory Verbal UK for its tireless advocacy in this area. I know that, to obey parliamentary protocol, I should never direct comments to the audience but I would like to say thank you to Sam for his advocacy and for being here to watch this debate. Maybe one day he will be on these green Benches, advocating for further changes, although I hope the Government will have served that purpose by then. If Sam is listening, I hope it is okay, Mr Western, to put those comments to him through you.

As Members have noted, the provision of auditory verbal therapy was previously discussed in the House in December 2023. In the aftermath of that debate, I understand that AVUK held discussions with the Department of Health and Social Care and received support from two Ministers in the last Government: Maria Caulfield, the former Member for Lewes, and Dame Andrea Leadsom, the former Member for South Northamptonshire. I also understand from the charity that, before the election, the last Government were considering how to roll out training for auditory verbal therapy and to upskill the existing speech and language therapist workforce. That is part of the workforce plan for the NHS and I am pleased to see that the current Government are continuing in that vein.

Helen Keller said that the only thing worse than being blind is having sight but no vision. Since the election, it appears that the Government are possibly stepping back from this area. Recent responses to written questions have indicated that the Government have no plans to review the adequacy of the provision of AVT and have stated doubts about the strength of the current evidence supporting its effectiveness, but today we have heard arguments made about a range of studies that suggest AVT really can support deaf children to develop age-appropriate spoken language and attain educational outcomes on par with hearing children. It is not for us, at this point, to make a decision but it is for this House to raise this topic. As a first step, will the Minister commit today to meeting Auditory Verbal UK so that it can present the latest evidence and research from the UK and abroad?

We know that integrated care boards are responsible for commissioning services for their local communities, including the provision of auditory verbal therapy. Thanks to charitable funding and efforts from AVUK, there are now 33 certified AV therapists across the UK. However, as other Members have noticed, there are still major gaps in provision, particularly in the public sector. Will the Minister therefore commission a review about the impact and effectiveness of the AVT that is currently taking place in the NHS? Although there are five AV therapists in Manchester, there is just one for the whole of the west midlands, and, as the hon. Member for Washington and Gateshead South mentioned, there are currently no AV therapists in the north-east. The hon. Member for Bolton North East (Kirith Entwistle) also said that there are none in the north-west. That highlights the postcode lottery, which needs to be addressed—especially when, as we have heard, there are 50,000 deaf children in the UK.

AVUK has argued that national guidance to ICBs could help to improve provision across England. Although the National Institute for Health and Care Excellence has guidance on hearing loss for adults, there is no such guidance for children. We know we need an evidence base for guidance, and, given that NICE is the organisation responsible for that, it seems reasonable to focus our attention on it. Can the Minister commit to speaking to NHS England and NICE about current guidance for hearing loss and whether it needs to be updated in the light of the emerging evidence around AVT?

Much has been said by Members today about the return on investment we can see from putting more money into AVT. AVUK has said that for every £1 invested in therapy, there could be as much as a £4 return. We have seen in other areas—for example, the children’s hospice grant—how a small amount of national funding can go a long way in supporting community services across England. Therefore, as decisions are made on the allocation of NHS funding announced in the autumn Budget, will the Minister consider AVUK’s ask to provide funding to train more public sector workers in AVT? I think it was also Helen Keller who said, “I cannot do everything, but I can do something. I must not fail to do something that I can do.”

I congratulate the hon. Member for Washington and Gateshead South on securing this important debate and raising these issues. Deaf children across the land are lucky to have an advocate in her—she is doing her part. I thank the hon. Members for Strangford (Jim Shannon), for Bolton North East, for Bury North (Mr Frith), for Bolton South and Walkden (Yasmin Qureshi), for Derby South (Baggy Shanker) and for North Shropshire (Helen Morgan); they too, are doing their part by raising the issue in this debate. I thank AVUK for all it does; it is doing its part. I hope, in raising constructive questions as His Majesty’s Opposition, I am doing my part, too. In turn, I hope that the Minister will answer my questions and others raised today, meet AVUK and assess its evidence, and make appropriate recommendations and changes with the Department of Health and Social Care and the NHS so that deaf children can reach their full potential—in doing so, he will fulfil his part.

--- Later in debate ---

[Stephen Kinnock]

I can certainly tell my hon. Friend that this is a very dynamic situation. A system never stands still. For a system to work, we have to be constantly reviewing its performance and whether it is delivering to its objectives. I believe that the 10-year plan that we are producing will absolutely lead to a radical rewiring of the way our health and care system works. It will be driven by three big shifts: from hospital to community, from sickness to prevention, and from analogue to digital.

There is no doubt at all that where there are therapies and treatments that are working—that are clearly delivering big results, and value for money for the taxpayer—it is right that we give those priority in the way that we deliver. It is clear that AVT has huge potential, and it appears to have unexplored potential. I cannot pre-empt today how this is all going to pan out in terms of the system and the reforms that we are looking to push forward, but I can assure my hon. Friend that we are committed to innovating and to building a system that is fit for the future.

In 2019, with input from the National Deaf Children’s Society, NHS England produced a guide for commissioners and providers who support children and young people with hearing loss. The guide provides practical advice on ensuring that non-hearing children receive the support they need. Auditory verbal therapy is one type of therapy to support children with hearing loss, and it is important that local commissioners know their population and have the discretion to decide how best to meet its needs. When it comes to commissioning and providing services for children with hearing loss, we have been crystal clear with ICBs and NHS trusts that they must take the relevant guidelines into account.

We recognise the real need to improve access to therapies for all children who need them, including children with hearing loss. In recent years, in very difficult circumstances, the NHS has increased the number of speech and language therapists working in the service, but we know that more needs to be done. That is why the Government are committed to fixing the NHS and building a service that is fit for the future, with the workforce it needs to get patients seen on time.

[Dr Luke Evans]

The Minister rightly points out the need to try to deal with the postcode lottery and to ensure that there are reviews and sharing of best practice, but may I draw him back to my comments about guidelines? One thing he could do is ask NICE to look at the current evidence and consider what national guidance should be in place. ICBs have the right to choose what kind of treatment they think works best, and they will be driven by the clinical evidence and clinical guidelines; if there are no clinical guidelines, they will simply make their own decisions. Will the Minister commit to doing that?

[Stephen Kinnock]

The hon. Gentleman will know that NICE has a prioritisation board, and ultimately that is the decision-making process for prioritising guidelines and the entire operating framework for what falls under NICE’s remit. This is something that absolutely should be on the radar, and of course we are constantly in conversation with NICE about its prioritisation, but it is important that it takes an objective clinical stance on the question.

We have committed to develop a 10-year plan to deliver a national health service that is fit for the future. The engagement process has been launched. As we work to develop and finalise the plan, I encourage those concerned about the availability of services to support children with hearing loss, including auditory verbal therapy, to engage with that process to allow us to fully understand what is not working, as well as what should be working better and the potential solutions. I encourage all hon. Members present to go to change.nhs.uk to make their voice heard.

This summer, we will publish a refreshed long-term workforce plan to deliver the transformed health service we will need to build over the next decade to treat patients on time and deliver far better patient outcomes. We are also in the process of commissioning research to understand the gaps between the supply and demand of different therapy types for children and young people with special educational needs and disabilities. That will help us to understand the demand for speech and language therapists and inform effective workforce planning.

New Hospital Programme Review

Luke Evans Excerpts

Monday 20th January 2025 Commons Chamber

[Edward Argar]

And Madam Deputy Speaker. [Laughter.]

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

She’s happy with that!

[Lincoln Jopp]

I also congratulate the Secretary of State on coming to the Chamber with such a massive capital expenditure announcement and eliciting a saving with his answer to the first question from the hon. Member for Mitcham and Morden (Dame Siobhain McDonagh).

One of the plans that went by the board in May, for reasons I have not quite got to the bottom of, was for the Staines health and wellbeing centre, which is one of only six community diagnostic hubs that NHS England has allocated in England. The funding got pulled in May; will the Secretary of State please have another look at it?

Medicines and Healthcare Products Regulatory Agency

Luke Evans Excerpts

Thursday 16th January 2025 Commons Chamber

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

I congratulate my right hon. Friend the Member for Tatton (Esther McVey) on securing this debate, and on giving Members from across the House the opportunity to raise issues such as Primodos, breast implants, mesh, SSRIs, vaccines and MMR. As a clinician, I have seen patients who have been affected by all these issues, and I know the heartfelt difficulties that they have faced—not only in what has happened to them, but in trying to resolve the problems. It is a testament to her that she has given the House the chance to debate these issues, and I am not sure that the public have ever paid so much attention to a regulator, even in the financial crisis. The MHRA has suddenly become something that people know.

I often used to explain to patients that a regulator should be like a good referee: we should not see them, but they should be there to hold people to account and know the rules. However, modern refereeing is about more than that. A referee has already met the players beforehand, and speaks to the public about how things work. They help to shape the way in which the rules should be interpreted, allowing us to improve the game.

The hon. Member for Great Yarmouth (Rupert Lowe) asked who regulates the regulators, and the answer is that this House is accountable. That accountability is key.

What are the functions of the MHRA? They are: to ensure that medicines, medical devices and blood components for transfusion meet applicable standards of safety, quality and efficacy; to secure safe supply chains for medicines, medical devices and blood components; to promote international standardisation and harmonisation to ensure the effectiveness and safety of biological medicines; to educate the public and healthcare professionals about the risks and benefits of medicines, medical devices and blood components, leading to safer and more effective use; and to enable the development of innovation and research that benefit public health.

I welcome the MHRA’s new chair, Professor Anthony Harnden, who was appointed at the start of the year. I hope he is listening to this debate, as it will be important for him in setting his priorities. I pay tribute again to my right hon. Friend the Member for Tatton because, whether or not the MHRA knew this debate was happening, I noticed during my research that all the guidance was updated on the MHRA’s website only yesterday. That is testament to the power of this place, even if inadvertently.

The last Government did a lot in this space, particularly focusing on patient safety and access. They introduced new regulations on medical devices, with the classic example being diabetes monitoring, but they also set out to attract innovation. Their reforms have helped to make the UK an attractive market for medical technologies. I am pleased that both sides of the House agree that this is a great place for the UK to find growth.

These developments were based on a consultation-led approach, following the changes we have had since 2021, when there was a consultation on the future regulation of medical devices. This led to a proportionate and phased approach that minimises supply disruptions and supports system readiness.

Under the last Government, a road map for implementation was set out on 9 January 2024. Again, I am pleased to see that the current Government updated the road map in December. This has the regulatory aims of adapting new technologies, strengthening patient safety and providing clarity for manufacturers that are trying to bring products to market.

All these significant changes try to balance medical technology advances, market capture, patient access, affordability and clinical outcomes. However, as we have heard in this debate, this is all well and good, but “perception versus reality” comes to mind. We arguably have one of the best regulatory regimes in the world and, post Brexit, there is a real opportunity to lead the way. Counter to what the Lib Dem spokesperson, the hon. Member for Mid Sussex (Alison Bennett), said, it is because of Brexit that we were able to regulate around our vaccines.

As has been said today, there are still serious concerns about the system, surveillance and resources, given the medical tech boom. This is a wide debate, so I will focus my remarks on three areas: the current medical market, the emerging medical market, and communications with the public, perceptions and beliefs.

When it comes to the system for current medications, we need only consider what we heard earlier about SSRIs, and particularly their impact on sexual dysfunction —I happen to have that casework on my desk at the moment. Do the Government believe that the yellow card system works, or will they consider a review?

When it comes to emerging markets, we have to remember that the MHRA has a statutory role not only in regulating but in the advertising and promotion of medicines in the UK. We have seen thousands of online adverts for weight-loss injections, such as Ozempic. The Times found approximately 6,500 adverts that mention GLP-1 on Meta’s ad library between January 2022 and the end of June 2024. And Sky has reported that, according to Simple Online Pharmacy, which has access to wholesale figures, 500,000 people in the UK are currently using things like Wegovy.

I would be grateful if the Government could set out what support they are offering the MHRA to ensure that it can fulfil its roles and functions properly, given that it has to manage promotion, safety and supply in all these areas. Are there any plans to review whether the MHRA is able to meet these conditions in a changing medical world?

Finally, and most importantly, if I were to be critical of the MHRA, I would say that the key thing missing on the list of objectives, as set out by the new chair, is communication. Let me finish where I started: a regulator has never been more in the public eye. As a clinician, I know how difficult it is to wade through complex medical data that is both conflicting and opaque. As my right hon. Friend the Member for Tatton pointed out, freedom of information requests and transparency are key to our understanding of this area. Will the Government look to review how the MHRA interacts with the public, how it communicates with grassroots professionals, and what it can do to explain the hugely important work that it does?

To conclude, as my hon. Friend the Member for Christchurch (Sir Christopher Chope) and the hon. Member for Dewsbury and Batley (Iqbal Mohamed) pointed out, this is all about trust. I think it was Reagan who said, “Trust, but verify”. That seems particularly apt for this debate—for that is the role of a regulator, but it is also the role of the Government and the public. We must build a regulatory system that all can trust, and do so inherently, but that is also easily verifiable at any point. If we can achieve that, we can build a trusted ecosystem that is good for innovation, good for the economy, and, most importantly, good for the people.

Hospice and Palliative Care

Luke Evans Excerpts

Monday 13th January 2025 Commons Chamber

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

I thank the hon. Member for Wimbledon (Mr Kohler) for securing this debate. I was going to test the patience of the House by reading out all the hospices that have been named, but we got to 45 and I realise that time is short, so I will not do so. It is, however, a testament to those hospices’ services that so many Members have spoken so fondly about them.

On behalf of His Majesty’s Opposition, I would like to discuss three areas: the conversation about death; palliative services and the ecosystem; and some specific technical questions. It is rare in this House that we debate a topic that impacts literally everyone, and it is an honour to play my part in highlighting something I have long argued is not talked about nearly enough—that is, death and dying. We all know that the only certainty is death, but there is a variable, which is the quality of death. That has been the focus of today’s debate. After all, it was Woody Allen who said:

“I’m not afraid of death, I just don’t want to be there when it happens.”

Palliative care services dedicate their lives to making sure that people who will die do so with dignity. Many people think of hospitals or hospices in relation to death, and their staff do fantastic work, but we must not forget the pivotal role played by the likes of district nurses and GPs in ensuring there is palliative care in our nation. In my constituency, I am blessed with hospice care from Loros for adults and Rainbows for children, both of which are much loved by the public and, most importantly, supported by armies of volunteers. Those people deserve this House’s and the public’s recognition and respect for what they contribute to our society.

Dying can be a difficult subject to talk about, as I know from my clinical days, but that does not make it any less important. I pay tribute to this House for the way in which it handled and discussed the assisted dying debate. Whatever position people take, it is fantastic to see a national debate now taking place across dinner tables up and down this country. So my first question to the Government is: what is being done to ensure that people look to plan their deaths better?

When we talk about the wider ecosystem, we have to consider the roles of hospices, hospitals and primary care providers such as district nurses, who are all key stakeholders, and the nature of how they have ended up being involved in palliative care and the different journeys they have made to do so. That is beyond the scope of this debate, but it is important because it informs the make-up and patchwork of palliation across this country. As we have heard, there is a balance between charitable funding and NHS funding, and even this House is divided on what that formula should look like and whether it should be solely state funded or charitable.

My second question to the Government is: will they consider consulting on a long-term funding model that allows this debate to take place, so that we have a better balance between the two? Building on that, looking at it from the clinical point of view, part of the issue at play is what the provision should even look like.

My third question to the Government is: will they commit to establishing agreed basic standard criteria for service-level provision, and to getting a national agreement on the provision of palliative care services and what they look like for whatever a person should choose?

On the record of the last Government, we legislated in the Health and Social Care Act 2022 to ensure that commissioning was taking place. As part of the NHS response to covid, £350 million was given to support hospices in those difficult times. NHS England also put in grant funding for a 24/7 single point of access for palliative care support. As we have heard, the last Government also increased the funding for the children’s hospice grant from £15 million in 2020-21 to £25 million, and I am pleased to see the Government continue that trajectory. To help manage staff, the last Government brought forward the first ever NHS workforce plan, and I commend this Government for continuing to commit to that.

With the debate about assisted dying and the concerns expressed by the Health Secretary about provision, however, my fourth question to the Government is: what assessment have they made of the impact of assisted dying on provision? I believe the Secretary of State was commissioning work on this, so when will the results be released?

On assisted dying and the ability to provide the services, this is not the right place to suggest whether they are right or wrong, but whether or not the Bill passes, I hope we will not let it distract us from the mission of continuing to improve palliative care and end of life services, for which there is momentum in the House and among the general public.

On the specific questions from the sector, it would be remiss of me not to raise the concerns about Labour’s Budget and its impact on the palliative care sector. The employer national insurance contribution increases are a tax on charities—fact. Charities are not covered by the NHS exemption. Hospices are charities, so they are being taxed—fact. GPs provide palliative care and support. They are not covered by the NHS exemption, so they are being taxed—fact.

Hospice UK has estimated that an additional £30 million will need to be found. This means that charities and non-profit organisations such as Sue Ryder, Macmillan and Marie Curie are being hit with additional wage bills, requiring more money just to provide the same level of care. The Government have said that they will give £100 million to hospices, but it has been made abundantly clear in this debate that it is for capital expenditure only, unless the Minister would like to correct me.

What assessment have the Government made of what the spending review will look like when it comes to palliation? It is hard not to see this as a Labour Government giving with one hand while taking with the other—taxing GPs and hospices in order to give them money back in a way that they do not want.

On staffing and contracts, some staff are employed by the NHS, while others are directly employed by the hospices. Have the Government made an assessment of the impact that will have on recruitment? For example, palliative care consultants face a postcode lottery of terms. Will the Government consider looking at that?

Palliative care consultants’ contractual arrangements throw up another oddity in the sector: some NHS palliative care consultants have Crown indemnity, while others employed by hospices do not, costing them thousands of pounds. Will the Government consider looking at that?

On the allocation of funding process, Together for Short Lives has called on the Government to confirm whether the £26 million will be ringfenced for children’s hospices and distributed centrally to avoid delays. Previously, the decision was made to give it to ICBs to better help local decision making. Although well meaning, that has resulted in delays. Are the Government aware of this issue and, if so, will the Minister commit to working to smooth it out?

There is much more that I could say on the topic, and I sure that the same is true for many others. The UK has an ageing population, and demand for palliative care will continue to rise in decades to come. In this House, we have the opportunity to make a difference for all who come after us. At the heart of looking after the dying is compassion. True compassion means not only feeling another’s pain, but being moved to help relieve it. This Government have the power to do that, and I hope they will.