Department of Health and Social Care

Nusrat Ghani Excerpts

Tuesday 30th June 2026 Commons Chamber

[Sadik Al-Hassan]

First of all, Medicines UK does not disagree with me; its members disagree that the value from the UK-US trade deal will go to people other than them. Medicines UK actually thinks that companies are not paid enough for drugs in this country. Unfortunately, you might need to go and have a chat with the association about that, because you might have misunderstood.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. You mean “the hon. Member”, not “you”—I do not need to go anywhere. I ask the hon. Member please to wrap up as soon as he can, because we have many speeches to get in.

[Sadik Al-Hassan]

In conclusion, I welcome the deal. I hope we find a way to pay for drugs correctly in this country, so that we value them properly and can value the rest of the system.

[Madam Deputy Speaker]

I will give Front Benchers a heads-up: we are not going to have a huge amount of time, so please edit your speeches accordingly.

--- Later in debate ---

[Sam Carling (North West Cambridgeshire) (Lab)]

I, too, thank the Chair of the Select Committee, the hon. Member for Oxford West and Abingdon (Layla Moran) for securing this debate, and I, too, wish we had more time. I also thank my hon. Friend the Member for North Somerset (Sadik Al-Hassan), who made some difficult, but really important points.

This is a timely debate, because pharmaceuticals are core both to supporting a healthier population and to delivering economic growth. The main estimates memorandum outlines an expectation of just under £2 billion of R&D expenditure over the coming year from the DHSC, which is roughly equal to the figure in the previous estimates, and I welcome that.

Of course, private investment also plays a significant role in drug development. That is why I am so pleased to see increasing confidence from the private sector in the UK as an environment in which to do impactful research. Last month, we saw AstraZeneca commit £300 million in investment across the UK, after this Government’s work to agree a pharmaceutical deal with the US enabled that investment. However, there is much more to do to create a regulatory environment that encourages investment into clinical research in the UK. I encourage the Department of Health and Social Care and the Department for Science, Innovation and Technology to consider simplifying and consolidating our regulatory landscape.

I am not here to criticise our regulators, who I believe do a very good job in their respective roles. I have regular engagement with research scientists, universities and professional bodies through my work as chair of the all-party parliamentary group known as the Parliamentary and Scientific Committee. This is the oldest APPG, which was established in 1939 to better connect scientists and parliamentarians in the interests of better policy. The overwhelming message is that, actually, regulators get it and want to enable research and growth, not hinder it, but that the overall landscape is just so complex that approvals are taking far longer than they need to.

In a contribution to the King’s Speech debate last month, I listed a range of regulators: the MHRA, NICE, the Health and Safety Executive, the Human Tissue Authority, the Health Research Authority, the Human Fertilisation and Embryology Authority, the Animals in Science Regulation Unit, and so on. That is just too many regulators and that is not even all of them. I very much hope the Government will use the upcoming regulating for growth Bill to look at how to reduce overlap and streamline the environment. Having to get so many decisions slows down research and innovation enormously, particularly when researchers have to apply for clearance from them sequentially in most cases, rather than in tandem, stretching the overall timeline.

I propose another solution. Why do we not create a single front door for study approvals: a unified application process that collects all the information that different regulators might need, so that researchers can fill in one form, and a team of recruited staff whose job it is to liaise with all the regulators, establish who needs to approve the individual study in question and pass along the information necessary, ideally in tandem rather than each approval being sequential and relying on the last?

I hope the Minister will take some of those ideas on board. There are many reasons to be optimistic. The UK has been, and in many areas still is, a world leader in drug development. Let us keep building on that.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson, who I thank for agreeing to make a very short speech.

[Helen Maguire (Epsom and Ewell) (LD)]

Today we are being asked to approve a motion on the main estimates for the Department of Health and Social Care for 2026-27, in which pharmaceutical spending is not separately identified, in either the estimate or its accompanying memorandum. We are being asked to approve spending without clear visibility of exactly how much is budgeted for medicines. That is against the principle of estimates day, which is to scrutinise spending before it is authorised.

This is yet another example of the lack of transparency around the murky UK-US pharmaceutical deal. It was drawn up in secret and the Government are refusing to publish the impact assessment. The Government must be clear on how much is budgeted for medicines, how much they expect the deal to cost and the risks to the frontline associated with diverting money from elsewhere in the NHS.

The UK-US pharmaceutical deal should never have been allowed to go ahead. The deal will see the NHS paying out at least £1.5 billion more in higher medicine costs by 2028, rising to over £9 billion by 2036. The Government have made it clear that there will be no additional money to fund that over the next spending period. That means frontline NHS services will be plundered at the behest of a foreign Government, while patients suffer in crammed hospital corridors and cannot get a GP appointment.

We must support the British life sciences sector. We can find ways to achieve that, but it must be a domestic matter for the UK Government to solve holistically through negotiations with the sector. It should not be dictated from Washington. The Government refused to publish an assessment of the impact of the deal. What are they trying to hide? The bottom line is that medicine procurement should be based on sovereign health needs. This is not a matter of being pro or anti the pharmaceutical industry. We need to find a solution that works for patients, the NHS and the life sciences sector.

Rather than defund vital NHS services in a knee-jerk deal, the Liberal Democrats would take real action to strengthen our life sciences sector by: developing a long-term plan with the sector to ensure certainty on issues such as VPAG—the Voluntary Scheme for Branded Medicines Pricing and Access—and rapid licensing by ensuring that the needs of our society are reflected in the approach of NICE and other regulatory bodies; promoting investment into upscaling UK life sciences manufacturing; encouraging investment in vaccine, medicine and antibiotic medicine manufacturing plants; reviewing the relationship between research and development tax credits and manufacturing; and establishing a fellowship programme for scientists working on health conditions, such as cancer, so they can continue the research Trump has defunded in the US. We would also cut the cost of visas for researchers, as well as boost R&D funding to 3.5% through a decade-long programme of public investment. Rather than spending billions to pay off a bully in the White House, the Liberal Democrats would oppose the deal, develop a plan for our life sciences that reflects our national interest and invest money in vital frontline services that are in dire need of funding. The Institute for Fiscal Studies has indicated that the deal could cost as much as £9 billion by 2036. That money would be transformative for so much of the NHS: it would end corridor care, hire thousands more staff, buy countless radiotherapy machines, or deliver high-quality care and help for elderly and disabled people.

Any choices over money spent in our NHS must be made by the British people, not Trump. It is unacceptable that Trump thinks he can meddle in our NHS, and, worse still, that the Prime Minister lets him. That is why the Liberal Democrats wrote to the Prime Minister in December, demanding that the deal was put before Parliament for a vote. If the Prime Minister cares as much about the NHS as he claims, I encourage him to set the record straight, show his true feelings on the deal and, at the very least, bring it before the House for approval.

This House, and the voters who elected us, decide matters of national importance, not the White House. That is why the Liberal Democrats tabled new clause 76 to the Health Bill, which would bring the deal before the House for a vote. Any deal that diverts billions of pounds away from NHS frontline services must be subject to democratic process and parliamentary scrutiny.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister.

--- Later in debate ---

[Dr Evans]

Or guesstimates day, for want of a better pun. That is part of the problem. If the Government are so confident, why do they not produce the impact report so that they can justify this? At the end of the day, we have seen that those decisions are not isolated; they are different companies, making different decisions, but all with the same concern. It is a pattern: tax rises, more regulation, more red tape—a more toxic concoction.

The Government will say that the deal is part of the answer, but Ministers cannot point to potential benefits while avoiding certain costs. The House of Commons Library is clear that the Department’s main estimate for 2026-27 does not include budget cover to meet the expected increase in pharmaceutical spending associated with the UK-US arrangement. That is the central problem. The Government say that the total cost in the current spending review period is expected to be around £1 billion, but the former Minister, the hon. Member for Glasgow South West (Dr Ahmed), also said,

“Total costs over the Spending Review period are expected to be approximately £1 billion. The final costs will depend on which medicines NICE recommends and the actual uptake of these.”

That is an important admission, because the final cost depends on future NICE decisions and uptake, and other estimates are higher.

The Library briefing cites analysis suggesting that spending could be around £1.7 billion by the end of 2028, and around £14 billion by 2036, depending on the assumptions. Is the £1 billion the central estimate, and if so, what are the lower and higher ends of the estimate range? Why will the Government not publish the modelling so that we can see? My next question is even sharper: where is the money coming from? We know from leaked WhatsApp messages that Labour MPs have been asking who they can tax to pay for benefits, so where is the money coming from? Both the House and the public are right to ask.

The Government have said that additional costs will be funded from existing NHS budgets, with future funding settled at the next spending review. However, if the money is coming from existing NHS budgets, it is coming from somewhere within the NHS. It might be the workforce, services, capital or future growth, but it will not be cost free. As Jonathan Benger, the chief executive of NICE, put it,

“If they choose to spend money on defence, they’ve got to pay for that somehow, either by raising taxes or removing money from somewhere else. If they choose to spend money more on medicines, similarly, that has to be paid for.”

That is the reality.

The former Secretary of State told the House that the Government would not cut NHS budgets to fund the pharma deal, but the former Health Minister, the hon. Member for Glasgow South West, later turned around and said:

“The deal will be funded by allocations made at the Spending Review, where record funding for the NHS was secured. Future funding will be settled at the next Spending Review.”

Those statements need reconciling. If it is funded from NHS allocations, that is NHS money. Can the Minister rule out any cuts from the frontline?

Finally, I will turn to transparency. I want to point out that the UK-US pharmaceutical arrangement is not a treaty-based free trade agreement. It has not been through the Constitutional Reform and Governance Act process. We have not seen what is going on. The Government need to publish their impact assessment, and yet they cite commercial sensitivity. Of course, there is a way round that: the Minister could redact it and give that to the Committee so that we and this House can see what is going on.

I will cut my speech short there. I will simply pose—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Very quickly, shadow Minister. Ten seconds.

[Dr Evans]

What is the policy’s true cost? How will it be paid for? What will be displaced in the NHS to make it happen?

--- Later in debate ---

[Layla Moran]

I am frustrated, because everything the Minister is saying is in the press release. Can she please answer the question? Will the Government release the impact assessment? If they will not, will they at least allow a Select Committee to see it confidentially?

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. We are running out of time. Minister, please respond as briefly as you can.

[Preet Kaur Gill]

I recognise the Committee’s request for the impact assessment, but the analysis is scenario-based, contains commercially sensitive assumptions and remains linked to live policy development. Officials should be able to produce confidential advice for Ministers to inform trade and other negotiations, and we will not apologise for maintaining such confidentially where doing so is in the national interest.

[Madam Deputy Speaker]

I call Layla Moran to wind up the debate briefly, in under a minute.

[Layla Moran]

I am happy not to.

Question deferred (Standing Order No. 54).

Neuropsychiatric Conditions: PANS and PANDAS

Nusrat Ghani Excerpts

Thursday 25th June 2026 Commons Chamber

[Wendy Chamberlain]

I am sure the Minister can address that in her closing remarks. We absolutely need to ensure that. As the right hon. Member has said, amoxicillin might be one of the antibiotics that could be used. It is straightforward to use, and in the vast majority of cases it works, but if it does not, potentially PANS and PANDAS could be ruled out.

Too many families face rejected referrals, long waits and, in some cases, misdiagnosis. Only a small proportion of cases are diagnosed within the NHS, and many people are forced to travel long distances or turn to private care. That is not possible for all families; getting the private care needed for their child can bring families to their knees. To give an example from my constituency, in the same GP practice, one GP will provide support and the other does not recognise the condition. That makes things very difficult.

A number of families whom I have engaged with have had to seek private support, and that makes me ask—I hope the Minister is sympathetic to this—what about the children from families who are reliant on NHS support, and do not get the diagnosis? They may be absent from school for long periods. Their family may be written off as problematic, and the children as having problematic behaviours, when ultimately the condition could be at the root of the problem. From the point of view of our ongoing economic wellbeing, we need to support children’s being in education as much as we can. That is why the research is so important—because we need to ensure that families can get the support that they need, no matter their financial situation.

A National Institute for Health and Care Research-funded evidence synthesis is under way; that has changed since the last time this topic was debated. It is already highlighting significant gaps in our understanding, particularly around effective treatments. Also, with other members of the all-party parliamentary group on PANS PANDAS, which I chair, we met doctors some time ago who are researching how the brain functions. Their work suggests that there may be biomarkers that indicate a higher likelihood of developing the conditions, and they have produced fascinating research that I encourage colleagues to read. We need to understand how severe the impact of PANS and PANDAS can be on a child. It is clear that further research is urgently needed to aid both diagnosis and treatment, which often needs to be ongoing.

Awareness and training are fundamental. Without them, as has been mentioned, healthcare professionals miss the signs, and teachers misinterpret symptoms. Children who experience sudden neurological decline are too often viewed through the lens of behaviour, anxiety or neurodivergence, rather than as having a medical emergency. From the children that I have engaged with through the youth board, I have learned that it is a terrifying experience for a young person to deal with those symptoms.

I am pleased to say, however, that we are at an important turning point. The UK clinical guidance, which the hon. Member for Harlow (Chris Vince) mentioned, is expected later this year, and there has been significant work since the last debate, which I held in September 2023, to bring PANS and PANDAS further into the policy landscape. I pay tribute to PANS PANDAS UK for that, because the charity has been the key driver in making that happen. Guidance alone will not be enough, however; it must be consistently embedded across the NHS, so that we end the postcode lottery in diagnosis and care. I suspect that we will hear about some of that from other Members. The consequences are profound; the human cost of delay and misdiagnosis is devastating. Children lose the ability to attend school, lose previously secure skills, and experience severe psychiatric and physical symptoms.

Just a few months ago, I hosted a roundtable in Parliament, at which the PANS PANDAS UK youth board members were able to speak directly to MPs about their experiences. As MPs, we engage with parents in the first instance, but it was very powerful to hear directly from children who are experiencing the condition. They might not be in the Gallery, but many of them will be voting; as we were informed, they are the voters of the future and are paying attention to what we do right now. It was an eye-opening session, particularly for those who had not heard of the condition. The children spoke about wanting to be believed and understood, and wanting to get help more quickly. Their message was clear: earlier recognition could change everything. They explained how PANS and PANDAS have impacted their lives; they described watching their peers progress, while they feel stuck behind, and being too unwell to attend school and so having to repeat years. That adds to a feeling of isolation. We can all remember when we were younger and times when childhood was quite cruel.

Families have described watching their child disappear in front of them. Parents leave work to provide care: 36% report having to stop working entirely, and many families face financial losses as a result, as well as from seeking private care. At the youth board roundtable, we also heard from the siblings of children diagnosed with PANS and PANDAS—I believe that my hon. Friend the Member for Henley and Thame (Freddie van Mierlo) has a constituent in Parliament this afternoon who is part of the sibling community. It was a stark reminder of how these conditions impact entire family units; there is the financial impact of having to seek healthcare, and of a parent leaving their job, and the impact of home becoming an unstable and unpredictable environment.

The conditions also have a devastating effect on learning. Nearly half of affected children miss more than six months of school, and over a third miss more than a year. They often experience the sudden loss of core learning skills. Under the current system in England, which is designed to support gradual, stable learning needs, rather than acute onset, as well as under aspects of the proposed special educational needs and disabilities reforms, there is a real risk that those children are misunderstood. Without clear guidance, education professionals default to familiar frameworks. A sudden loss of skills can be misinterpreted as a behavioural issue or neurodivergence, leading to inappropriate support and a delay in the medical intervention required. That is why the alignment between health, education and local authorities is so critical.

I obviously speak as a Scottish MP. We must ensure alignment across the UK, so that there is no postcode lottery in the level of support available. My Scottish Liberal Democrat colleague Adam Harley, the new MSP for Strathkelvin and Bearsden, recently raised a constituent’s case in the Scottish Parliament; I was particularly disappointed in the response of First Minister John Swinney, who referred to PANS/PANDAS as a “rare disease”. It was clear that he knew nothing about it. Despite my own correspondence with his Government, we have seen limited progress in Scotland. I must emphasise that it is not a potentially rare disease; it is an undiagnosed one. I genuinely believe many children with PANS/ PANDAS have not been diagnosed and are therefore not getting the support they need. That underlines the need for close engagement with devolved Governments to ensure a truly joined-up approach to improving support.

Today’s debate will largely focus on children and young people with PANS/PANDAS, but it is equally important to recognise the challenges faced by adults. One adult with PANS/PANDAS shared with me that she has experienced mostly neuropsychiatric symptoms, rather than physical ones. Research shows that PANS and PANDAS can be associated with systemic inflammation and autoimmune responses affecting the whole body, including conditions such as arthritis and other inflammatory diseases. In that person’s case, tests revealed ongoing systemic inflammation that has damaged tissues and organs over time, as the immune system mistakenly attacks healthy cells, rather than protecting them. Too often, the symptoms that PANS/PANDAS can manifest are put in the “too difficult to deal with” basket.

These are the practical steps that we are asking the Government to consider. First, when the UK clinical guidance is published later this year, there must be a clear commitment that steps will be taken to ensure that it is embedded consistently across the NHS, not left to chance, and that appropriate stakeholders are engaged to support its dissemination.

Secondly, we need training for healthcare professionals and those working in education, so that symptoms are recognised early and acted on appropriately. Thirdly, we must have a renewed commitment to research funding, building on the work of the National Institute for Health and Care Research, to address the significant gaps in evidence and improve treatment pathways. I ran the London marathon—my first ever—at the end of April, and one of the charities I was fundraising for was PANS PANDAS UK. It should not take fundraising to deliver the funds that are needed for the research that will provide the right support for these children.

Finally, there must be clear signposting and alignment with the forthcoming local authority guidance to ensure that schools and services are equipped to meet their legal duties. As one clinical psychologist working with a young person with PANS has stated,

“Without training…pupils risk unnecessary and avoidable long-term loss of skills.”

I will be pushing on exactly this matter in Scotland.

This debate is an opportunity to put these issues firmly on the record, to raise awareness across Parliament and to ensure that families living with PANS and PANDAS feel heard. I am grateful to colleagues here today and look forward to hearing their contributions and the Minister’s response.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I am in awe of the hon. Member for running the marathon and, of course, for raising funds for PANS and PANDAS.

--- Later in debate ---

[Freddie van Mierlo]

I wholeheartedly agree with the right hon. Gentleman. There are very few downsides of prescribing an antibiotic, especially in this instance, given the seriousness of the condition. As he says, there is really no good reason to withhold this medication.

A second challenge facing families is the impact on a child’s ability to participate in education, as they miss months of school because they are too unwell to attend. That not only affects their learning but limits opportunities to socialise, make friends and have a community beyond home. Every child has a right to an education. PANS/PANDAS does not limit ambition or ability, but our education system is placing limits on children with the condition. Section 19 of the Education Act 1996 is in place to stop that happening, and it requires local authorities to arrange suitable education for children who cannot attend school due to illness. However, the provision is not always effective for children living with PANS/PANDAS, and parents still need to be advocates for their own rights, rather than being proactively told them and guided through the process.

There is a wider point. Families are often left fighting for support from multiple systems at the same time, including healthcare, education and local authorities, while trying to take care of a very unwell child. It is the last thing they need. There are steps that the Government can take to limit the challenges. First, PANS/PANDAS must be researched in greater depth. It is currently unknown how many people are affected by PANS/PANDAS in the UK, and there is no official guidance on the diagnosis and treatment of those conditions in the NHS. Secondly, we need training of health professionals to recognise and treat the condition. PANS and PANDAS are conditions with a high risk of long-term disability, exclusion from society and failed education. Families express that if only their children’s condition had been recognised sooner by health professionals, it could have had a significant impact on their child’s wellbeing and outcomes.

Thirdly, we must improve the support offered to children in education. The publication of local authority guidance is anticipated this summer, and it is important that it ensures that schools and services meet their statutory duties for children with PANS/ PANDAS. Thousands of families are fighting for support from multiple systems while taking care of unwell children. It is time for the Government to do their part, and eliminate the barriers to diagnosis and treatment for those living with PANS/PANDAS.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Albie is a superstar, as is his mum!

I call the Liberal Democrat spokesperson.

[Susan Murray (Mid Dunbartonshire) (LD)]

I am grateful to my hon. Friend the Member for North East Fife (Wendy Chamberlain) for securing this debate, and for all her work to raise the profile of these childhood conditions. I also thank the Backbench Business Committee for selecting this topic for debate.

As she said, my hon. Friend first raised PANS/PANDAS in this House more than three years ago and has pushed for change ever since. Indeed, I was pleased to meet the impressive PANS PANDAS UK youth board on their visit to Parliament. For families, the onset of PANS/PANDAS is often sudden and deeply distressing. A child who was well one week can, the next, be gripped by anxiety, tics or obsessive behaviours. What follows is too often not treatment, but a search from GP to specialist and back again for someone who can provide a diagnosis.

Almost three years ago, my hon. Friend asked the Government for a small number of reasonable things. I am sorry to say that families still have not seen the change that they are entitled to expect, but I hope that what we heard earlier means that it will be coming soon. The Department of Health and Social Care has said that it does not hold data on how many children are affected, and NICE has not yet produced guidance, after concluding there was insufficient evidence to produce useful guidance. Clinicians are still left without a clear national pathway to follow, even if they are aware of the conditions.

The result, as we have heard, is a postcode lottery. A survey for PANS PANDAS UK found that just 2% of families said their GP even considered PANS/PANDAS as a possibility for their child’s symptoms. Families who can pay go private to see specialists; children whose families cannot pay, lose their childhood, miss school and fail to thrive. Such delays are not administrative inconveniences; they are a risk to children’s lives. According to PANS PANDAS UK, 43% of parents say that their child has talked about taking their own life, and 61% say that their child has expressed a desire to no longer be here. These are young children, made desperately unwell by a treatable condition, yet they are waiting months or years for someone simply to recognise what is wrong.

There are two mothers in the Gallery today, one from my constituency of Mid Dunbartonshire, and one from just next door. Both have been forced to spend significant sums of their own money on diagnoses and treatment, including travelling down to London to see specialists in private clinics. As we have heard, that is not unusual. Nearly a third of affected families report a financial impact of more than £50,000, and one in eight report an impact of more than £100,000, simply to get their child diagnosed and treated. We have a system in which a recognised diagnosis is reserved for those who can afford to pay for it, and those who cannot are often left behind.

Two weeks ago, my Liberal Democrat colleague Adam Harley MSP, who represents many of the same families that I do, raised one of the cases with the First Minister in the Scottish Parliament and called for properly recognised NHS guidance. Health is a devolved matter, but families across Scotland face the same barriers as families anywhere else in the UK, and they frequently end up in England to access treatment. Has the Minister had any discussions with the Scottish Government on taking a unified approach to tackling the issue? Given that we are expecting clinical guidance to be released in August, I am sure that families in Scotland would greatly appreciate co-operation between the Governments in Holyrood and Westminster to help bring the postcode lottery they currently face to an end.

PANS/PANDAS are treatable conditions, and children can get their childhood back. To make that happen, I urge the Government to help plug the current gaps in evidence and knowledge around these conditions, including the number of children affected, through supporting research. The Liberal Democrats have called for an increase in research and development spending to 3.5% of GDP to help drive British research, to develop a greater understanding of conditions like PANS/PANDAS, and to evidence the efficacy of available treatment.

An effective treatment can change a child’s life—children like Isa and Hugo—for as little as £9. Effective diagnosis and treatment will save the NHS money. Our NHS was founded on the idea that it would treat according to need, not ability to pay. Sadly, in the case of children with PANS/PANDAS, too often that principle is not being upheld. Families simply trying to find treatment for their children are being failed and we must rectify that, wherever in the UK they live.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister and welcome him to the Dispatch Box.

--- Later in debate ---

[Mrs Hodgson]

I thank the right hon. Gentleman, who I have worked closely with on a number of health matters over a number of years, and he mentions the work that we did together on mesh. I studied my speech after listening to your earlier intervention and the conversation about antibiotics—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. It was not my intervention, but that of the right hon. Member for New Forest East (Sir Julian Lewis).

[Mrs Hodgson]

Thank you, Madam Deputy Speaker. I should know better after 21 years in this House; it just goes to show—you can always teach an old dog new tricks.

Following the right hon. Gentleman’s intervention on antibiotics, I noticed that there was nothing about that in my speech, so I have come to the conclusion that that will come forward in the guidance later this year. I will be looking for that closely, and I am sure that my officials heard the point mentioned in the debate. As the right hon. Gentleman says, if a simple course of antibiotics is going to make all the difference, we would want to ensure that it is provided.

In closing, I want to emphasise that the experiences of children and families affected by PANS/PANDAS are real and significant, and that we are taking action to strengthen the system and deliver meaningful change. Our responsibility is to respond with compassion, to listen carefully, and to ensure that support is accessible, timely and appropriate. By strengthening clinical awareness, improving integration across services and continuing to build the evidence base, we can move towards a system that delivers better recognition, more effective support, and improved outcomes for children and young people, and their families.

Puberty Blockers

Nusrat Ghani Excerpts

Tuesday 23rd June 2026 Commons Chamber

[Esther McVey (Tatton) (Con)]

I thank the hon. Lady for giving way; I am listening to her very intently. Does she know what a measure of success would be in this puberty blocker trial? If 80% of the children on it were happy with the outcome, would that be a success? What are the ultimate measurements of success?

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. The hon. Member for Luton North (Sarah Owen) is making an important speech, but before she gets back to her feet, I must tell her that I need to get 12 more Members in to speak.

[Sarah Owen]

I know that further details will be coming from the Secretary of State as to what a marker of success is, but I think we have to ask ourselves what a marker of success is for the individuals and families. For some, staying in their sex from birth may look like success. For others, that will not be the case. This is very much on the individual.

--- Later in debate ---

[Rebecca Paul (Reigate) (Con)]

I frankly cannot believe that we are here again. When the Pathways clinical trial was paused earlier this year, I felt that there had finally been—[Interruption.]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Forgive me—there is a five-minute time limit, which is the only way that I can incorporate all the Back Benchers who wish to contribute.

[Rebecca Paul]

Yesterday, even the Secretary of State for Health and Social Care conceded—the second one to do so—that he is “uneasy” and even “uncomfortable”. I suggest that his discomfort is nothing next to the lifelong damage that the trial will potentially do to an extremely vulnerable cohort of children, whom we should be protecting. That funny feeling in his stomach—[Interruption.] Oh, he has left. That feeling is his good judgment trying to be heard—he will not hear this if he has left—and it is not too late for him to listen to it. I agree with what one of my hon. Friends said yesterday: he is a good man who is being placed under intolerable pressure on this issue. But he needs to find his courage.

The number of children and young people presenting to the NHS with gender distress increased dramatically in the years after 2009, with an exponential rise from around 2014. What is behind the increase among Gen Z is unclear, but the reasons are likely to be multifaceted. It is speculated that the factors may include 24/7 internet access, the increased acceptance of trans identities, or even peer social and cultural influences. Over the past 20 years, groups such as Stonewall and Mermaids have called for better access to treatment and more rights for trans people. Large corporates have gone big on diversity and inclusion to boost their brands.

--- Later in debate ---

[Rebecca Paul]

I thank the hon. Member for that excellent question. I obviously always respect and listen to different clinicians, but what is happening with this debate is that one set of clinicians with one view is being listened to. Let me remind everyone about lobotomies. Lots of very respected people came out for lobotomies; in fact, the person behind the idea won a Nobel prize. I think we would all agree that those clinicians got that wrong, so it is incumbent upon us in this House to always question. It is absolutely right that we listen to clinicians, but unfortunately we are seeing only one set of clinicians with one set of opinions being listened to here.

A Finnish study was published in April that looked at more than 2,000 adolescents and young adults who had been referred to gender services. It found that medical interventions did not reduce psychiatric problems and may even be associated with worsening mental health. How many times have we heard it said that puberty blockers offer a pathway towards improved mental health and reduced psychiatric distress for those struggling with gender identity? I have lost count. But there is hard evidence that not only says different; it says the opposite. I would be keen to understand from the Minister and the Secretary of State whether that study was taken into account before deciding to go ahead with the trial.

I want to point out that children and young people who grow up to be same-sex attracted are over-represented in this cohort, and that is something we need to think about. If we look at the case of Keira Bell, she was a lesbian struggling with her sexuality, and instead of people saying, “It’s okay to find other women attractive—there’s nothing wrong with that. You do not need to change your body,” they said, “Ah! You’ve got gender dysphoria.” They put her on puberty blockers, and then she went on to testosterone shots. She then had her breasts removed in a double mastectomy, and then she detransitioned. This is a deeply homophobic approach to healthcare. Those on the other side of the argument think they have the progressive position. I am sorry, but you are repeating mistakes that have been made historically—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Obviously, I have not said anything, so I am not repeating anything. No “yous” and “yours”.

--- Later in debate ---

[Olivia Blake (Sheffield Hallam) (Lab)]

It is a pleasure to follow the hon. Member for Edinburgh West (Christine Jardine), and I agree wholeheartedly with her comments about homophobia.

I remind the House that I am a former biomedical scientist, and I have probably read lots more medical publications than many in this Chamber. I have also volunteered many times for medical research, either as a healthy patient in my younger years or as a patient now in my slightly older years, so I know the process from both sides. I think it is really important that we recognise that the UK has some of the highest standards for medical research, especially when it involves patients. There is talk about why there is no placebo, but sometimes it is not ethical to do a placebo-based trial. If we are withholding a form of medical intervention from someone just to prove that the next best thing will be the next best thing, that is not ethically right, because we are withholding medical care when someone needs it. That is very different from a healthy patient model, in which we are treating healthy patients to see if there is a biological change that would be harmful to all patients.

All too often, healthcare for the trans community is marked by lengthy wait lists, inconsistent treatment and discrimination—we have heard some of that stigma today—and there needs to be a concerted effort to change that. We have heard a lot about safeguarding children, and I think everyone in the Chamber agrees that that must be paramount, but I fear we are dividing trans children from other children when it comes to their medical needs and what support should be in place.

I am pleased that my right hon. Friend the Secretary of State for Health and Social Care confirmed yesterday that the Pathways trial will go ahead. We have heard many Members mention that young people getting better is a way through this, but that is very stigmatising for those who do hold on to their trans identity into adulthood. In fact, very many—the majority—of young trans people will go on to be trans adults, and we also know that those who detransition do in some instances retransition, because they detransitioned for the social reasons of not having a supportive family and other social pressures. This is not as static as some may think, and in fact young people often raise that fluidity with me.

Young trans people need this trial to move forward. For many, this represents the only legal route to access puberty suppressants at the moment. A pathway can be profoundly impactful, and we have heard people describe it as lifesaving. This has not fallen from the sky. There are well-established scientific and clinical precedents for the use of puberty-suppressing hormones, supported by decades of research and medical practice, and for a variety of different conditions. Even fertility clinics use these drugs in some of their regimes with certain patients. As I have mentioned, placebos are not the solution to making this a safer trial.

Puberty-suppressing hormones are not new and they are not experimental. They have been used safely since the 1980s, and we have decades of clinical experience of supporting their use in controlled settings. But instead of engaging seriously with the potential benefits of such a trial, the Opposition have framed the issue as part of a broader culture war that is trying to erase trans children’s identities. By removing healthcare, we are not going to remove trans children; they will look for alternative access to treatments, including, as we have heard, starving themselves to prevent puberty starting. That is horrific to hear—as someone who has been very active on eating disorders, that is really quite terrifying.

We should be focused on ensuring that the voices of those people who will be most impacted—the young people and their families—are part of the discussion. The way in which the trial has been put together is of course not perfect—no medical trial is perfect—but it is really, really important, and the risk of harm from not going ahead with the trial has to outweigh the risk of harm from doing the trial. We need the data and the understanding, so we can make the right decisions when designing the clinical interventions and services that should be available to young people. Anyone who is denying that should think again about why they are making that argument. This issue is not about whether trans young people exist; it is about whether we choose to respond with the real—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. I call Carla Lockhart.

--- Later in debate ---

[Sir John Hayes]

That experience clearly contradicts the Cass review’s findings, but it is for the hon. Lady to have that debate, no doubt, with Dr Cass.

What is certain is that we have no indication from the Government about what success in the trial will look like. When challenged on that subject, answer came there none. How will we gauge whether the trial is a success or a failure? Are these children really guinea pigs to be used to provide the evidence that the hon. Lady says is already freely available in her anecdotal experience of communicating with her constituents and others?

We know that there is certainly evidence from other countries. Have the Government looked to draw on that, rather than engaging in this dangerous trial? We know that there is evidence too from the 2,000 or more children who went through Tavistock. Some have suggested that we should look at the data already available rather than putting any more children at risk. Yet despite the Secretary of State’s agonised decision—I do not intend that to be sarcastic or pejorative; I appreciate that the Secretary of State was completely straightforward about how difficult it was to make the decision—the trial goes ahead. I accept that there are additional safeguards—this is not Tavistock; it is something different—but none the less it brings immense risk alongside the determination to try to gain facts. Instead, let us look at Finland and Denmark and at other countries that have already gathered evidence. Let us look at what we know of those who have already been through this process.

G. K. Chesterton said:

“children are innocent and love justice”.

I fear that this trial will steal their innocence and deny them justice. I hope that even at this late stage the Government, recognising that, will abandon this awful trial and save innocent children from that fate.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

We come to the wind-ups; I invite the shadow Secretary of State.

Isle of Wight Dementia Patients: Discharge to Mainland Care Homes

Nusrat Ghani Excerpts

Tuesday 16th June 2026 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Preet Kaur Gill)]

I am grateful to my hon. Friend the Member for Isle of Wight West (Richard Quigley) for raising this very important issue, and I recognise the deeply concerning experiences that he has highlighted of families on the Isle of Wight, including the story of Maggie Bennett and the café that she runs.

For people living with dementia or complex disabilities, being moved away from their homes and loved ones can be profoundly distressing. Familiar surroundings, routines and relationships are often central to their wellbeing, and it is entirely understandable that families feel anxious when those links are disrupted. The Government are clear that people should be discharged from hospital safely, promptly and with appropriate care and support in place. This is essential not only for patient outcomes but to ensure that hospitals can continue to treat those in greatest need.

Local authorities have a statutory duty under the Care Act 2014 to shape their local care markets, ensuring that there is a sufficient range of high-quality, person-centred services available to meet local needs. Decisions about care placements are made at a local level based on clinical need, the suitability of available services and the individual’s circumstances. Where a person requires specialist or higher-intensity support, it is essential that the placement meets those needs in full.

However, I do recognise that local capacity pressures, particularly in geographically isolated areas such as the Isle of Wight, can mean that suitable placements are not always immediately available. My hon. Friend spoke about the impact of care home closures in his constituency and shared Phyllis’s story. While temporary placements further away are necessary to ensure that a person is discharged safely and without delay, those situations clearly have a huge impact on families.

On the Isle of Wight, local partners are working to improve access to more seamless pathways across health and social care so that people can move more easily between services and receive the support that they need. This includes strengthening co-ordination and expanding care in the community so that wherever possible people can be supported at home or close to home. As my hon. Friend said, because of the island’s size and physical isolation, that also requires close working with mainland partners to ensure that residents can access the full range of care that they need, including specialist provision where it is not available locally.

We will continue to explore and build on opportunities to deliver services for the benefit of the Isle of Wight community so that care can be delivered at the right place at the right time. We expect local systems to plan for demand and work with providers to strengthen capacity, including for people with dementia and complex conditions.

As we heard from my hon. Friend, it is vital that when a difficult decision is made to close a care home, the process is handled as sensitively as possible. Local authorities should have procedures in place to minimise disruption, with time allowed to support a safe transfer that supports the wellbeing of individuals, families and carers. Providers should ensure that proper arrangements are in place to support the transition of residents to their new position. Our expectation is that every effort should be made to provide care as close to home as possible and to take account of family connections and personal preferences wherever practicable. It is also essential that individuals and their families are involved in decisions about discharge and ongoing care. The guidance is clear that planning should begin early and that patients and carers should be supported to make fully informed decisions where appropriate.

We know that people who are discharged in a timely way with the right care and support in place experience better recovery and health outcomes. That is why we expect local systems to work together to ensure discharge processes are as effective as possible, particularly for people with dementia and other complex needs. The Government are therefore working with the NHS and local authorities to strengthen the local health and care system so that it can better meet those challenges.

Through the better care fund, more than £9 billion is being used to support integrated working between the NHS and local authorities, enabling more joined-up services and improving the planning of care outside of hospital. We will also reform the better care fund to support more effective joint planning and delivery between health and social care. That will be focused on improving how services are co-ordinated and supporting care that helps people regain their independence, reduces unnecessary hospital stays and enables people to receive care closer to home.

We also recognise the importance of improving care and support for people living with dementia. According to NHS data, NHS Hampshire and Isle of Wight integrated care board recorded that as of March more than 18,000 people had a diagnosed form of dementia. The Government want a society where individuals with dementia and frailty receive high-quality, compassionate care from diagnosis through to the end of life. That is why we will deliver the first ever modern service framework for frailty and dementia to deliver rapid and significant improvements in the quality of care and productivity. That will be informed by phase one of Baroness Casey’s independent commission into adult social care, which is under way and expected later this year.

We are committed to feeding into the NHS and local government planning cycles in September and aim to publish the full framework by the end the year, as recommended by Baroness Casey. We intend to engage with a range of partners over the coming months and will ensure that the voices of people with lived experience are at the centre of our work to develop the modern service framework.

I thank my hon. Friend for bringing his constituents’ voice to the House. I reiterate that we recognise the very real concerns raised by families on the Isle of Wight, particularly when people with dementia or complex needs have been moved away from their homes and communities. While there will be circumstances where temporary placements further from home are necessary, care should be provided as close to home as possible in a way that respects the individual’s needs, preferences and connections to their family and community.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I did not have time to congratulate the Minister, a fellow Brummie, on her promotion. It is good to see those from Birmingham here in the Chamber.

Question put and agreed to.

Health Bill

Nusrat Ghani Excerpts

2nd reading
Monday 1st June 2026 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Interventions are going to make it very difficult for everyone to speak in the debate. I call Dr Beccy Cooper.

[Dr Beccy Cooper (Worthing West) (Lab)]

I will try to keep my remarks brief. The NHS is one of the most unifying institutions in our country today. It is a huge employer, a major source of pride, and a safety net for us all at our moments of greatest need. We all know that it has been creaking under significant strain for some time now, so it is good to see new life and new energy in the 10-year plan. I welcome this Bill as a response to some of the purpose outlined in the strategy.

A lot of the detail in the Bill has been covered by colleagues already and will doubtless be covered further in the Bill Committee, so I will limit my remarks to single patient records and the role of public health in the Bill. I am fully supportive of a single patient record finally being realised. Our health and care system should revolve around patients, rather than patients revolving around it. It is over 20 years since I was a junior doctor, but I still remember my and my patients’ frustration when I once again had to ask them for their clinical history after they had already told it to the GP, the paramedic and the triage nurse.

This endeavour has been tried several times before. The financial cost of NHS Digital and the litany of platforms, software and systems that have been tried and abandoned provide a wealth of lessons learned to ensure that it is successful this time—which, let us face it, is long overdue. Public trust is very important for health data systems. We could consider new safeguards such as a public interest test for sharing data or bringing back requirements to report to Parliament. The NHS must ensure that the technical know-how is sound, as well as being fleet of foot.

I turn to the role of public and population health in this NHS Bill. Public health must be front and centre to provide the right health services in the right place at the right time. At an ICB level, there is now an explicit requirement for population health considerations to be understood. Integrated care boards will be responsible for commissioning the vast majority of our local NHS services, so they need to know the population health need.

That has been demonstrated in my ICB area of Sussex over the past couple of weeks. In the discussions about proposed sites for neighbourhood health hubs, it became clear that the population needs of my constituency of Worthing West had not been entirely understood when considering sites: there is a large area containing several villages with an ageing population and limited access to transport, whose requirements had not hit the radar of the ICB.

To be clear, this is not about blame—anyone who thinks that planning for population health needs is straightforward is welcome to sit the public health exams in epidemiology and statistics. Expertise is there to be used, and we should draw on it. I therefore suggest that we require a statutory appointment of a lead director of public health to represent the area covered by each integrated care board.

Finally, to guard against a focus solely on reorganisation, alongside this NHS Bill and as a key focus of the 10-year strategy we must have a whole of Government approach that recognises health as a strategic and shared asset—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. To ensure that the final four speakers can get in, the speaking limit will become two and a half minutes.

--- Later in debate ---

[Sureena Brackenridge (Wolverhampton North East) (Lab)]

Given the lack of time remaining in this debate, I will focus my remarks on the long-overdue move to a much-welcomed single patient record.

Many Members will have had constituents get in touch with casework, raising blunders and delays that stem from fragmented patient records. When they have been in severe pain or at their most vulnerable, patients have been asked to repeat the same medical history again and again to different clinicians, whether in hospital or in the GP setting. It is frustrating, and in some cases distressing, especially if the patient is elderly or with neurological conditions such as dementia. A single patient record will ensure that clinicians have the right information at the right time, including on allergies, medications and previous diagnoses, so that they are better placed to make the right decision quickly. Today, we have heard of surgeons who have had to cancel operations because patient histories were incomplete or did not arrive quickly enough. There is consensus that a single patient record will make a significant difference in A&E, for paramedics at the roadside and even in routine care, where small details can have significant consequences.

I must, however, also make clear the concerns of many of my residents in Wolverhampton North East. Bringing together such large volumes of highly sensitive personal data into a single system will inevitably raise questions about cyber-security and data protection. We know that patient data in the UK would be extremely lucrative to some, and many will be acutely aware of international interest in getting hold of our data-rich NHS in order to profiteer. As such, can the Minister set out in more detail the safeguards that will be built into the system from the very start to guard against cyber-attacks and unauthorised access? How will this be controlled, and what oversight will exist to ensure that public confidence is maintained if threats evolve?

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister.

Tobacco and Vapes Bill

Nusrat Ghani Excerpts

Consideration of Lords amendments
Monday 23rd March 2026 Commons Chamber

Consideration of Lords amendments

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I inform the House that Lords amendments 21, 22, 29, 32 to 34, 37, 38, 43 to 48, 51 to 59, 62, 77 and 78 engage the Commons’ financial privilege. If any of these Lords amendments are agreed to, I will cause the customary entry waiving the Commons’ financial privilege to be entered in the Journal. I call the Minister to move the motion. I believe it is her debut, so congratulations and welcome—enjoy.

Clause 1

Sale of tobacco etc

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

Thank you, Madam Deputy Speaker. I beg to move, That this House agrees with Lords amendment 1.

[Madam Deputy Speaker]

With this it will be convenient to discuss:

Lords amendments 2 to 27.

Lords amendment 28, and Government amendments (a) to (c) consequential on Lords amendment 28.

Lords amendment 29, and Government amendments (a) to (c) consequential on Lords amendment 29.

Lords amendments 30 to 123.

[Mrs Hodgson]

Before I address Lords amendment 1, I would like to take this opportunity to pay tribute to my predecessor, my hon. Friend the Member for West Lancashire (Ashley Dalton), for her work on the Bill and the wider prevention agenda. I also extend my thanks to Baroness Merron for her work in the other place, ensuring that the Bill was expertly steered through the legislative process.

This is a landmark Bill, and I am honoured to have taken on responsibility for it as the House considers the amendments made in the other place. Creating a smoke-free generation is the most significant public health intervention since the ban on smoking in public places in 2007, under the last Labour Government. Tobacco claims around 80,000 lives every year, and in England it is responsible for a quarter of all cancer deaths. Someone is admitted to hospital almost every minute as a result of smoking, and up to two-thirds of deaths among current smokers can be attributed directly to smoking. Those are not abstract figures; they represent lives cut short by an entirely preventable harm.

The Bill also takes decisive action to tackle the rapid rise in the use of vapes and other nicotine products, particularly among young people, protecting a new generation from nicotine addiction. All the amendments to be considered today have been accepted by the Government, starting with Lords amendments 1, 2, 39 and 40, which change the parliamentary procedure for age verification regulations from negative to affirmative in England and Wales, and in Northern Ireland. The regulations will set out how retailers may ensure compliance when verifying a customer’s age. The changes were made as a result of a recommendation from the Delegated Powers and Regulatory Reform Committee, which the Government accept.

--- Later in debate ---

[Mrs Hodgson]

We are content that the measures in the Bill, which are intended to apply to Northern Ireland, are compatible with the obligations under the Windsor framework. I hope that answers the hon. and learned Gentleman’s concern.

We hope that the review will be a clear demonstration of the Government’s commitment to monitoring progress against our smokefree ambition. Finally, Lords amendments 5, 8, 36, 41, 60 and 61, 63 to 76, 79, and 81 to 88 are technical amendments, some of which are consequential to the commencement of several other Acts. They also improve consistency in drafting across the Bill.

I encourage all Members to support all the amendments. These are meaningful changes that strengthen the Bill and respond to concerns raised by Members across the House and in the other place. The Government amendments tabled today will return to the other place for consideration, and I look forward to their timely agreement, and to the Bill completing its final stages.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister.

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

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

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

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

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

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

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

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

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

--- Later in debate ---

[Mary Kelly Foy]

I totally agree with my hon. Friend. We must keep in mind the fact that it is smoking that causes harm and death, not vaping, which can be a very successful cessation tool. I hope that the Bill will continue to push that.

Powers in the Bill cover marketing, display, packaging and product design, as well as flavours and their descriptions. However, there is a crucial balance to strike: reducing youth appeal without limiting access or effectiveness for those using the products to quit smoking. We must keep the harms of smoking firmly at the forefront of our minds.

A review after four to seven years feels appropriate to assess how the regulations are affecting usage and the market, and whether we are striking the right balance. This should be considered alongside the disposable vape ban and the forthcoming vape excise tax. I would welcome reassurance today that the review will place the harms of smoking and the needs of smokers at its centre.

Many of the other amendments are technical in nature. I welcome the comprehensive definition of tobacco coming into force on Royal Assent, through Lords amendments 89, 90 and 91, as there is no need for a transition period. The exemption for vape-vending machines in Lords amendments 3 and 4 is also welcome, as others have noted, because we must ensure that vulnerable smokers are supported as much as possible to quit.

As my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson) has recently taken up her role, I welcome her to her position as Minister for Public Health. I look forward to working with her as this Bill, soon to be an Act, progresses, so that we can continue our work, and hopefully set out a road map for a totally smokefree country and to look again at introducing a polluter pays levy.

Finally, as someone who has spent many years advocating for a smokefree future, free of death and disease from tobacco, I know from speaking and listening to many people affected by smoking just how much the public want and need this action. We have already shifted the social norms around smoking and now, thanks to the work of organisations such as Action on Smoking and Health and Fresh, and the work of colleagues across the two Houses, a smokefree future is now possible. That is truly something to celebrate.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson.

[Dr Danny Chambers (Winchester) (LD)]

I also welcome the hon. Member for Washington and Gateshead South (Mrs Hodgson) to her position as Minister for Public Health. I had the privilege to serve on the Bill Committee, as other hon. Members did—indeed, I see some familiar faces in the Chamber. One of the things that struck me most was when the chief medical officer gave his evidence: he said that the Bill was not only the most significant piece of public health legislation in 30 years, but probably the single of piece of legislation that will most help to address inequality. Inequality is multifactorial, but one of the main factors in the difference in life expectancy between certain wealthier areas and certain more deprived areas is the rate of smoking. This Bill will have a huge impact, especially on the communities for which we are really trying to improve life expectancy.

I am very pleased that the Government accepted so many amendments in the Lords. Some of the amendments that the Liberal Democrats are really keen on are regarding fixed penalty notices and require all the money from those fines to go to local public health initiatives, as directed by local authorities. We know that public health is so important, yet funding for such organisations is usually extremely limited, given the pressures on local authorities. Without the Lords amendments on fixed penalty notices, the money would go straight back to the Exchequer. We fundamentally believe that if we are serious about making a meaningful difference to people’s lives, that money must be used in local smoking-cessation initiatives.

As the mental health spokesperson for the Liberal Democrats, I am acutely aware of the benefits of the Lords amendments that support those with long-term mental health conditions, who have higher rates of smoking than the general public. We know that going cold turkey is simply unrealistic and can even be dangerous. The exemption on vape vending machines in secure mental health hospitals ensures that people are supported professionally in quitting in a sustainable and maintained way that will not further damage their mental health.

I welcome the Lords amendments on regulating filters, which have cross-party support. Not only are filters an environmental issue, but they provide a false perception of safety to smokers. Ensuring that there is awareness of the lack of protection that these filters provide and of smoking as a whole is imperative if we are to ensure that people can make informed decisions about their health and wellbeing.

I am very pleased to support this Bill as it goes through Parliament; it is momentous and significant. We really appreciate the Government’s accepting the Liberal Democrat Lords amendments, which will slightly improve how the Bill will be delivered. We are very pleased that this will be a strong and impactful Bill. We hope that it will deliver meaningful change on public health for generations to come and that we will have a smokefree generation growing up.

Palliative Care

Nusrat Ghani Excerpts

Thursday 5th March 2026 Commons Chamber

[Alison Bennett (Mid Sussex) (LD)]

I thank all hon. Members for their thoughtful and moving contributions this afternoon. The hon. Members for Worcester (Tom Collins) and for St Helens South and Whiston (Ms Rimmer) spoke so movingly about their own very personal loss. Of course, we would not be holding the debate were it not for the hon. Member for York Central (Rachael Maskell), who set out the frame of this debate so brilliantly and has done so much outside the Chamber to strive for better palliative care.

The hon. Member for York Central concluded her remarks by talking about bereavement support, and that is where I will begin mine. Last week, I was out in Burgess Hill. I saw an elderly gentleman who was standing by the edge of the pavement holding on to a walking frame. I got talking to him, and it turned out that he was waiting for a lift to St Peter and St James hospice, where he was going to a bereavement café. He told me that he had lost his wife two and a half years ago, but he had no recollection of the first two years following her loss—I think it had been a blur for him. For the past six months, he has been going back to St Peter and St James for the bereavement café, and he is beginning to feel a little better with that support each week. My thanks go to St Peter and St James, and to all the hospices that support our constituents, for what they do.

Our palliative care system is at tipping point, with a funding cliff edge approaching. Some 75% of hospices are running a deficit, two in five are planning reductions in clinical services in the year ahead, and 380 hospice beds across England lie empty, not because there is no need for them, but because there is no funding to staff hospices, as many hon. Members have said. Around 300,000 people are cared for by hospices every year, yet around 100,000 more need it. One in three of those who need hospice care miss out, and demand is rising sharply.

Over the next decade in England, just over 5.75 million people will die. Around 90% of them—an estimated 5.18 million people—will have palliative care needs. New research commissioned by Marie Curie and published earlier this month showed that nearly one in three dying people have both unaddressed symptoms and concerns and insufficient access to GP services at the end of life. That equates to nearly one person dying with unmet needs every three minutes. Without intervention, around 44,400 more people are projected to have unmet palliative care needs in 2050 compared with 2025. That is the scale of the challenge before us.

Hospices are essential pillars of our health and care system, especially at a time when the NHS is under such immense strain. The economic case for funding them properly is overwhelming. Approximately 15% of all emergency hospital admissions in England involve people in their last year of life—nearly 1 million admissions in 2023 alone. Those patients account for around 30% of all emergency hospital bed days. In the last six months of life, around 360,000 people spent a total of 8.4 million days in hospital. With the average acute bed day costing around £500, and with roughly 40% to 50% of the NHS budget concentrated in acute settings, the potential for a more appropriate allocation of resources is obvious.

Around 69% of people are admitted as in-patients in the final six months, with a median stay of 13 days, and 80% of those who die in hospital had an emergency admission in their final month of life. These are real people—people who, with better planning and properly resourced hospice, community nursing, GP, pharmacy and paramedic services, might have experienced a calmer, more dignified end of life and spared the NHS considerable cost. But the very sector that relieves this pressure is itself under extraordinary strain. Between 2022 and 2024, there was a £47 million real-terms cut in hospice funding. As the hon. Member for Cannock Chase (Josh Newbury) noted, the disastrous rise in employer national insurance contributions alone is costing hospices in England an estimated £34 million a year.

Hospices collectively raise about £1.4 billion themselves. Government funding amounts to just over £500 million—barely a quarter of the income—and in some areas, hospices receive as little as 8% of their funding from NHS grants. There is no robust national methodology underpinning these variations. It is a postcode lottery and, as the right hon. Member for New Forest East (Sir Julian Lewis) noted, the variation in funding for children’s hospices is even more acute than that in the adult hospice sector. Access to compassionate end-of-life care should not depend on geography, the strength of an area’s ability to raise funds or whether someone is an adult or a child.

Hospices, of course, welcome the capital funding from the Government, but it quite simply does not pay nurses’ salaries. Staff account for around 70% of hospice costs. Without revenue funding for core services, capital investment does not keep beds open or prevent service reductions. This is a national, structural problem, but it is also a very real one for all our areas across the country, particularly for my area in Sussex, where the Southern Hospice Group is consulting on how to cut its costs.

Marie Curie and others have warmly welcomed the Government’s commitment to developing a palliative care and end-of-life care modern service framework, with an interim report expected in the spring and a final report in the autumn. It will be the first national plan for palliative and end-of-life care since 2008. That is, of course, good news. The Government have rightly identified five core challenges: delays in early identification, inconsistent commissioning, workforce shortages, gaps in 24/7 provision, and limited uptake of personalised and advance care planning. But those are not new problems that need solving—we have known about them for some time—and if this framework is to succeed, it must go further.

My Liberal Democrat colleagues and I are campaigning to double the funding for bereavement support payments, reversing the last Conservative Government’s cuts since 2017. We would also reduce isolation following a bereavement, by improving access to social prescribing and through the work of a dedicated Minister for tackling loneliness. We would improve support for children who have lost a parent by appointing a Cabinet member for children and young children, and extend pupil premium plus funding to children in kinship care. The Government must provide stronger national leadership and oversight, and they must place palliative and end-of-life care at the heart of plans for a neighbourhood health service, looking beyond hospices. They must deliver a new funding and commissioning model that ends the postcode lottery. They must invest properly in the workforce, and scale up proven models of care that shift support from hospital to community, improving patient experience and delivering better value for taxpayers.

The Government seem happy to talk about moving care from hospitals to the community, but we need a material change. The Liberal Democrats believe that the Government have a choice: they can allow hospices to drift from crisis to crisis, with beds closed, staff lost, and unmet need rising year after year, all while still struggling to plug gaps left by the struggling NHS; or, they can seize the moment, through the modern service framework, to build a sustainable system that matches funding to need and delivers dignity for all. No one should face death in avoidable pain, no family should be left unsupported, and no responsible Government should ignore the evidence that properly funded palliative care is both the compassionate and the economically responsible choice.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Secretary of State.

--- Later in debate ---

[Rachael Maskell]

Will the Minister give way?

[Madam Deputy Speaker (Ms Nusrat Ghani)]

The Minister has finished speaking, but the hon. Member does get to wind up the debate.

Brain Tumour Survival Rates

Nusrat Ghani Excerpts

Monday 9th February 2026 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call Dame Siobhain McDonagh, who will speak for up to 15 minutes.

--- Later in debate ---

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

It is an honour to speak in this debate. I thank my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh) and the hon. Member for Witney (Charlie Maynard) for securing it. We have heard many fine and very heartfelt speeches this evening, particularly those recounting personal stories about Members’ families.

Our new cancer strategy was announced last week. Sadly, political events of the past few days have somewhat submerged its importance, but we should be talking about it, as it is much the most important political development as far as I am concerned. We have seen little progress in brain tumour care—that is the truth of the matter. Those tumours are devastating; they rob victims of years of life, and wreck families. I have seen such patients over the years, and I can say that diagnosis may be very difficult, even with the help of hindsight.

An average general practitioner will see a new brain tumour once every seven years, but they will see thousands of patients in that time, so it is not surprising that the tumours are difficult to diagnose. I hear that a patient with a brain tumour will often have visited their general practitioner five or six times before a diagnosis is made. We must do what we can to raise awareness. In ear, nose, and throat care—which, as Members may know, is my specialty—we see a condition called acoustic neuroma. It is a brain tumour on the nerves that lie between the ear and the brain—the balance nerves. Such tumours are rare, even in ear, nose and throat clinics. I would see only a handful of them each year. Sometimes they present with a little hearing loss in one ear, or with just a little ringing. Sometimes they present incidentally.

Some of the other brain tumours we see in the ENT world are very rare. One that sits in the roof of the nose —an olfactory neuroblastoma—is so rare that I probably saw fewer than six or seven cases throughout my career, yet it presents with a loss of sense of smell, which is a very common problem for people who come to see ear, nose and throat surgeons or general practitioners. We must not deceive ourselves that we are dealing with an easy condition, for this is a difficult one.

I believe that we must support research into these mysterious diseases. As I have said before in this Chamber, this country is desperately short of medical researchers and clinical academics. Many of our clinical academics are getting towards the end of their careers, and we are not doing enough to recruit new academics in the early part of theirs. I would like us to think about what policies we might develop to encourage that—this is a political problem. My hon. Friend the Member for Mitcham and Morden said that given we have made so little progress, we must be content with the status quo. I beg to differ; we are not content with the status quo, and that is why we are all here this evening to discuss this matter.

We know that this is a promising time for some areas of medical research. Genetic research, for instance, is now becoming very important. I am not sure that whole genome sequencing, if that were available for everybody, would solve the problem, but it is the way we are going. Before I came to this place, I was involved in research into a rare ear disease called cholesteatoma. We did genetic research on that—genome sequencing—and we were able to identify some of the genes that probably cause the condition, but that does not make it any easier for us to prevent it, for we cannot choose our genetic code.

The problem with brain tumours is that they are deep-seated and inaccessible. We cannot see them or feel them, which is why curative approaches are so elusive. We can debate this in the Chamber until the cows come home, but that debate will not bring the cure, so we must decide what politically we can do to help. I welcome the £32 million boost to brain cancer research, and our new approach to clinical trials. I thank my hon. Friend the Member for Edinburgh South West (Dr Arthur) for his Rare Cancers Bill, and I congratulate him on getting it to advance so far. Like me, he is a new Member of Parliament, and I am in awe that you have managed—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

He has managed—not “you”.

[Peter Prinsley]

Yes, I am in awe that my hon. Friend has managed to achieve so much; you see, Madam Deputy Speaker, I am a new Member of Parliament!

Let us encourage clinical trials, for as Lord Vallance has said:

“Clinical trials are the route by which promising research can be turned into treatments”,

which will save lives.

NHS Dentists

Nusrat Ghani Excerpts

Thursday 5th February 2026 Commons Chamber

[Alex Easton]

I congratulate the hon. Member on securing that funding. I totally agree with all her sentiments. Maybe you can give me a clue how to get that funding as well for Northern Ireland.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Not “you”, Mr Easton—it was not me that you were referring to. You have lots of time, so enjoy it.

[Alex Easton]

Apologies, Madam Deputy Speaker. We all understand that there are regional differences in how dental contracts work across our UK nations. However, a common theme is identified: many of our NHS dentists feel that they are being asked to do more to address complex needs with resources that simply do not match the reality on the ground. My research indicates that in some parts of the United Kingdom, the very way that dentists are paid actively works against the long-term interests of patients. The current system rewards quick, high-volume work rather than the kind of long-term, preventive care that is essential if we are serious about keeping mouths in Britain healthy.

Many of our newly qualified dentists tell me that the NHS contracts are inflexible, overly bureaucratic and in many cases financially unsustainable for anything beyond the most basic level of service.

Puberty Suppressants Trial

Nusrat Ghani Excerpts

Wednesday 17th December 2025 Commons Chamber

[Wes Streeting]

The shadow Minister asks, “Why?” There is a simple answer. It is because this was recommended by Dr Cass in the Cass review, which was commissioned by my predecessor, Sir Sajid Javid. I think that was the right thing to do, and it is why, when my predecessor brought forward the Cass review, I supported it in opposition. I certainly did not try to play politics with an extremely vulnerable group of children and young people.

I will tell the hon. Lady why. It is because, under the previous Government, those puberty-suppressing hormones were prescribed without proper oversight, supervision or safety, yet we did not hear a peep about that fact for years until Dr Cass, commissioned by Sir Sajid Javid—who deserves enormous credit—did the study, which was published and widely supported and which contained this recommendation. The Conservatives may have changed their tune in opposition, but I remember what they said in government when they published the Cass review and supported its recommendations, so I think their response now is a real shame.

The shadow Minister accuses me of inconsistency, so let me be clear. Am I comfortable that this clinical trial has undergone the proper process and ethical approval to ensure the highest standards and supervision? Yes, I am comfortable about that. Am I uncomfortable about puberty-suppressing hormones for this group of young people for this particular condition? Yes, I am—because of risks. It is why I was also uncomfortable when I upheld the temporary ban by my predecessor and then put in place a permanent ban. The reason I was uncomfortable with that, too, is because I had to look children and young people, and their parents, in the eye when they told me in no uncertain terms that that decision was harmful to them, as have many other clinicians who have opposed that decision.

Whatever my discomfort in this extremely sensitive area, the reason that I have made this decision is that I am following clinical advice and, as Health Secretary, it is my responsibility to follow expert advice. Had the Tavistock clinic faced such challenge and scrutiny a decade ago, we would not be in this mess. The Conservatives were right to commission the Cass review and they were right to accept its recommendations. I accept that there is now a difference on this particular recommendation, but I would urge Members not to walk away from the cross-party consensus we built behind that approach but to build on the work that Dr Cass has done.

Let me turn to the important questions raised by shadow Minister. There will be two groups within the trial, as well as a further control group of children and young people with gender incongruence who do not receive puberty-suppressing hormones. At least 226 participants are required in order to detect a statistically significant difference between the two treatment groups. However, this is not a target and no young person will find themselves on this trial because there is a drive to make sure that a certain number of young people are participating. In order for anyone to participate in this trial, it has to have the most robust clinical oversight from clinicians within the service, as well as national oversight and the consent of parents. It is only where young people will be deemed to benefit that they will be on this programme.

The shadow Minister asks about the data linkage study. That is important. The data linkage study will be undertaken, but when it is completed it will not provide us with the same evidence as this clinical trial. That is why Dr Cass made a distinction between this trial and the data linkage study.

The hon. Lady also asks about the motivations of those who withheld data. That is an extremely important question. It is utterly appalling that anyone in a position of responsibility in the NHS withheld data on a very vulnerable group of children and young people. I accept that there were many well-meaning people involved in these services at the Tavistock clinic, but the fact that Dr Cass found such a lack of rigour, such a lack of standards and such a lack of proper oversight is disgraceful. It is the clinicians who are well meaning and ideologically driven who have given me the most cause for concern in this whole debacle and who have done more harm to children, young people and the trans community than most other people who have taken part in this debate.

I appreciate the work that Dr Cass has done, and I am glad that she is in the other place, bringing welcome scrutiny. Were she not supportive of this approach, I might think again, but she has made her recommendation and given her support. I am following clinical advice. It is not comfortable, but I do believe it is the right thing to do, on balance.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call Health and Social Care Committee member Danny Beales.

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

The hon. Member for Sleaford and North Hykeham (Dr Johnson) asks, “Why?” Well, it is because trans people exist and their health needs exist. As the Secretary of State has clearly outlined, an independent review made a series of recommendations. There were clearly failures of healthcare, and a further recommendation was that a clinical trial should address this issue. I believe that the Conservatives supported the Cass review, but when it comes to implementing this part of it, they suddenly have collective amnesia about what Dr Cass recommended. Does the Secretary State agree that, in the absence of a trial, there will still be access to these drugs? We know that young people are seeking out private provision. They are seeking unregulated providers of these drugs, so is not a clinical trial both appropriate and the best and safest way of managing any potential risks?

[Wes Streeting]

The risk that my hon. Friend sets out was one of the considerations that I had to when weigh up—first when upholding the temporary ban, and then when making the ban permanent. I do worry that, outside of a trial, we may continue to see unsafe or unethical practice. I think we will be doing a service to medicine in this country as well as internationally if we have a high-quality trial with the highest standards of ethics, approvals, oversight and research from some of our country’s leading universities and healthcare providers to ensure that, for this particular vulnerable group of children and young people, we are taking an evidence-based approach to health and care.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson; you have one minute.

[Helen Morgan (North Shropshire) (LD)]

I hope that everyone in this House can agree that medical treatment should always follow the evidence on safety and effectiveness. It is right that expert clinicians are building this evidence base and therefore right that the Government are seeking to run this trial, because it should be led by evidence and not by ideology.

Given that the numbers on the trial will be very small and the waiting list for talking therapies, which are so important for children and their parents, is very long, with hundreds of thousands waiting, can the Secretary of State explain how he will increase access to NHS talking therapies so people can get the help they need and deserve? In a field with so little research, will he confirm if the pathways trial will look at international best practice in order to take learnings from abroad?

--- Later in debate ---

[Wes Streeting]

Let me reassure my hon. Friend and the House that I am absolutely open to receiving representations and evidence from clinicians involved in the care of children and young people, with insight, expertise and data, including those who might be critical of the approach that the trial team is setting out or, indeed, critical that the Cass review included this recommendation. That is important because the many things that have gone horribly wrong in this area have included the silencing of whistleblowers and the silencing of rigorous debate and discussion.

We have to have this debate with due care and sensitivity for young people in this vulnerable group in particular and for the wider trans community, who feel extremely vulnerable in this country at the moment, including as a result of decisions I have taken as the Health and Social Care Secretary. We have to consider all of that in the round, but we must make sure that at all times we are following the evidence, that we are open to scrutiny and challenge, and that where we are making these finely balanced judgments, we are doing so with rigorous debate, testing the arguments, the evidence and the data. That is why I welcome the urgent question and this discussion.

[Madam Deputy Speaker]

I call Health and Social Care Committee member Joe Robertson.

--- Later in debate ---

[Wes Streeting]

I certainly do not need to be told what my responsibilities are on this. I always take responsibility for the decisions I take. I acknowledge the extent to which the hon. Gentleman and members of his party seek to weaponise this issue, and to personalise it. [Interruption.] We can simply refer back to his question and to the shadow Minister’s reference to the “Streeting trial”—if that is not personalising, I do not know what is.

I’ll tell you what: I will take an evidence-based approach. I have done that on this issue from day one. Had the Conservatives done so, we would never have seen the Tavistock scandal. We would never have seen puberty blockers dished out willy-nilly to children and young people in this vulnerable patient group. I have sought at all times, including when I sat on the Opposition Benches, to treat this debate with the care, sensitivity and humility it deserves, and not to be tribal in my interactions. I only wish this Conservative Opposition would take the same approach.

[Madam Deputy Speaker]

We are only at the start of this urgent question, so I ask Members to reduce the temperature in the Chamber.

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

I thank my right hon. Friend for the care and sensitivity he has taken to this subject all along. It has been an undeniably difficult year for transgender people in Britain. I have spoken to young trans people who have been pushed to the brink of suicide by what they hear—that they do not have a right to exist, that they do not deserve rights, that they are legitimate targets for ridicule. We all in this House have a responsibility to lower the temperature and focus on their welfare, health and dignity.

King’s College operates the highest standards of safety. Does the Secretary of State agree that its expertise and rigour will support the wellbeing of participants and ensure that we get the robust evidence we need and that vulnerable children are no longer treated as political punchbags?

--- Later in debate ---

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. I ask colleagues to keep their questions short and the Secretary of State to keep his responses on point. I call Health and Social Care Committee member, Josh Fenton-Glynn.

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

I hope we can all agree that the young people involved should not be used by anyone as a political football. Can my right hon. Friend please assure me that the process and trial will be clinically led, not defined by rhetoric—in this place or anywhere else?

--- Later in debate ---

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. If hon. Members do not keep their questions short, I will not get everybody in. The answers need to be just as short.

[Wes Streeting]

I will try to do that, Madam Deputy Speaker.

We will ensure that young people get good access to wider evidence-led support. I have had to wrestle with the fact that some trans people enter adulthood without ever receiving any sort of healthcare, and I have been heavily criticised by those people in particular for some of the decisions that I have taken. We are working to reduce waiting times, as I have described.

My hon. Friend says that puberty blockers are reversible. We hear contrary views about that from Members across the House, some of whom say that puberty blockers are irreversible. The truth is that the evidence in this area is mixed, which is why we need to build a stronger evidence base.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

We need a short question. I call Jim Shannon.

[Jim Shannon (Strangford) (DUP)]

May I thank the Secretary of State for all that he does? He deserves credit. A mother from my constituency phoned me this morning and said:

“Why is money being spent on this pathway when my child has been waiting for clinical support for 3 years and the waiting list is so long she may be moved to adult treatment? Why is Government prioritising the tiny few over the many? With our children’s mental health services at breaking point and parents at their wits end trying to get their child diagnosed”,

how do the Government look in the eyes of the parents with rare diseases whose drugs are not funded by the NHS when they are funding this trial?

[Several hon. Members rose—]

[Madam Deputy Speaker]

I call Samantha Niblett for a short question.

[Samantha Niblett (South Derbyshire) (Lab)]

Trans people do not wake up at 18 suddenly trans; it starts before then. When we talk about protecting children, it means protecting trans children so that they can transition into adulthood knowing that they had parents and doctors who advocated for their needs. But this trial is not a prison sentence, so will the Secretary of State talk about whether people are entitled to withdraw from it if they change their mind?