Terminally Ill Adults (End of Life) Bill (Thirteenth sitting)

Stephen Kinnock Excerpts

Committee stage
Tuesday 25th February 2025 Public Bill Committees

[The Chair]

I have received a manuscript amendment from the hon. Member for East Wiltshire that he wishes to move. As the hon. Gentleman knows, a manuscript amendment requires a very high bar and exceptional circumstances. I do not believe that exceptional circumstances are present, and he will be aware that further amendments can be proposed to the clause for consideration on Report. That is my decision on the matter.

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Mr Dowd. Although it is for Parliament to progress any Bill, the Government have a responsibility to make sure that legislation on the statute book is effective and enforceable. For that reason, the Government have worked with my hon. Friend the Member for Spen Valley; where changes have been agreed mutually between her and the Government, I will offer a technical, factual explanation of the rationale for those amendments. That applies to amendment 181 in this group.

This group of amendments is linked to how the Bill’s definition of a terminal illness applies to those with a mental disorder or disability. Amendments 399 to 401 would remove the term “medical condition” from the Bill’s definition of a terminal illness, so that only those with an inevitably progressive illness or disease would be able to request to end their life, rather than, as under the current drafting, those with a “disease or medical condition”.

The amendments could narrow the scope of those who may access assisted dying services. However, clinical advice suggests that the use of the terms has changed over time, may not be used consistently and remains debated in both medical and lay circumstances. Removing the term “medical condition” may lead to disputes or protracted debates about whether a particular condition is or is not a defined disease or illness, despite there being medical consensus around whether it will lead to death within six months.

[Danny Kruger]

I am grateful for that clarification, but it rather concerns me. Can the Minister elucidate exactly which conditions might fall into the category of medical condition that would not be captured by “illness” or “disease”? Does he accept the point that I made in my speech—that the interpretation of the law by the court will be that the phrase expands the definition of a terminal illness beyond illness or disease, as it is in the current law? What are the new conditions that will be captured by the term?

[Stephen Kinnock]

What the hon. Member will have picked up throughout this debate, on every day that we have met, is that the Government are concerned about adding or taking away terminology that delivers clarity, stability and familiarity.

I have to say that I am quite torn on the hon. Member’s amendment 399, because I absolutely see where he is coming from. It is one of those situations in which my position as a Government Minister is made somewhat more complex by my personal view that his amendment is perfectly reasonable. My instinct—speaking personally as a Member of Parliament, rather than as a Government Minister—is that the remaining terms in the Bill, if we removed “medical condition”, would continue to cover the waterfront or spectrum of conditions. It is possible that this is a case in which there has been an overabundance of caution on the part of the Government. I am delivering the Government’s position, but I want the hon. Member to know that that will not necessarily determine how I vote if this amendment does go to a vote.

[Danny Kruger]

I was going to remind the Minister that he is, in his strange Jekyll and Hyde personality, speaking as a Minister but voting as a Member of Parliament, so if he has given the Government’s view that my amendment is not acceptable, but he personally thinks that it is, I hope that he will vote for it.

[Stephen Kinnock]

It is a well-made case; I am still reflecting on it, because of the somewhat complex nature of my role on this Committee, but I am inclined to support the hon. Member’s amendment.

Amendment 11 also seeks to amend clause 2(3). Our assessment of the effect of this amendment is that a person who has a mental disorder and/or a disability may not qualify under the Bill as terminally ill, even if they have an inevitably progressive illness and can be reasonably expected to die within six months. There might be concerns from the point of view of the European convention on human rights and the Equality Act if the amendment were passed as currently drafted, because its effect would be to exclude people from the provisions of the Bill if they had a disability or a mental disorder. That may not be the intention of the hon. Members who tabled the amendment.

I turn to amendment 181. In executing our duty to ensure that the legislation, if passed, is legally robust and workable, the Government have advised my hon. Friend the Member for Spen Valley in relation to the amendment. It clarifies that a person who seeks assistance to end their own life based only on a mental disorder or a disability, or both, would not be considered terminally ill for the purposes of the Bill. Such a person would therefore not be eligible to be provided with assistance to end their own life under the Bill. Someone who has a disability or a mental disorder, or both, and who also already meets all the criteria for terminal illness set out in the Bill would not be excluded by the amendment, as drafted. The amendment therefore brings important legal clarity to the Bill.

Amendment 283 sets out that a person who has one or more comorbidities, alongside a mental disorder within the meaning of the Mental Health Act 1983, would not be considered terminally ill by virtue of those comorbidities alone. The reality of modern healthcare is that many patients, not least those towards the end of life, will be dealing with several conditions or comorbidities. The term “comorbidity” in a clinical context can sometimes be used to distinguish the main problem that someone has experienced experiencing from additional but less serious problems, but it can also be used by those specialising in one or more other aspects of a patient’s care to distinguish their area of focus from other issues.

In the context of the Bill, the essential test is whether any morbidity, comorbidity or otherwise, meets the requirements in the Bill. Although it is unlikely that a terminal morbidity would be thought of as a comorbidity, it is not inconceivable that it might be, for the reasons that I have set out. The phrasing of the amendment, notably the term “alongside”, potentially increases that possibility. The effect might be that a condition that would otherwise be considered terminal would instead be considered a comorbidity alongside a mental disorder. The amendment would prevent a person with a mental disorder who would, but for the amendment, have been considered terminally ill from accessing assisted dying services under the Bill.

As I have said, the Government have taken a neutral position on the substantive policy questions relevant to how the law in this area could be changed. However, to ensure that the legislation works as intended, we have advised the sponsor in relation to amendment 181, to further clarify the Bill such that only having a disability and/or mental disorder does not make a person terminally ill and eligible for assistance in accordance with the Bill.

[Jack Abbott (Ipswich) (Lab/Co-op)]

Most of the discussion on amendment 181 has centred on the word “only”. Just to get clarification on this point, would someone with an eating disorder who was later diagnosed with a terminal illness still be able to access an assisted death, if that were required under the amendment?

[Stephen Kinnock]

My answer to that question is yes. My understanding is that so long as the terminally ill, six-month criteria are met, that person would qualify for assistance under the Bill.

[Jack Abbott]

Just to be absolutely clear for everyone in the room, and in case I was not specific enough, if that terminal illness is a result of the eating disorder, rather than, say, of that person also being diagnosed with a terminal illness such as cancer, would they be covered under amendment 181?

[Stephen Kinnock]

My understanding is that amendment 181 is clear that the qualification for accessing assisted dying has to be based on the definitions in the main body of the Bill. If passed by the Committee, the amendment will make it clear that an eating disorder does not qualify for access to that service. There has to be another, clear definition that does qualify under the terms set out in the main body of the Bill.

[Kit Malthouse (North West Hampshire) (Con)]

I just want to illustrate to the Committee that people with eating disorders, certainly as they come towards the end of their life, are already subject to quite assertive action by the state. For example, over the past few years, generally, where hospitals have detected that an individual is effectively trying to starve themselves to death, they have applied to the Court of Protection and got orders for forcible treatment. In that application, it is determined that that person does not have the mental capacity to make decisions about their own medical care.

I do not want the Committee to labour under the illusion that people with anorexia or other eating disorders are going to wander up and suddenly ask for an assisted death. If there has been a detection that they are trying to get themselves eligible by effectively causing organ failure by starvation, the system would have intervened well before then, effectively to force them to be treated.

[Stephen Kinnock]

The right hon. Member makes an excellent point. I think it goes back to our basic view that there are some amazing health professionals in our healthcare system who do fantastic work. Eating disorders are a truly tragic condition and, of course, there is all sorts of support in place. It is not always perfect or exactly how we would want it to be, but I think it would be a false move for the Committee to think that this is an either/or situation. This is a both/and situation. Of course it is not always perfect, but I think we should pay tribute to our amazing health professionals, who look after all sorts of people with all sorts of conditions, including eating disorders.

[Dr Marie Tidball (Penistone and Stocksbridge) (Lab)]

Does the Minister agree that the language of clause 2(1)(a)—

“cannot be reversed by treatment”—

is reassuring? Indeed, the written evidence from Professor Emily Jackson notes:

“Someone with a condition that is not inevitably progressive, or which could be reversed by treatment, would be ineligible under the Act.”

That covers the case raised by my hon. Friend the Member for Ipswich.

[Stephen Kinnock]

My hon. Friend makes an excellent point. She brings us back to the fundamental point made in the Bill, which is that it has to be “an inevitably progressive illness”. Eating disorders do not fall under that definition: that is very clear. I hope that that explanation and the observation that I have made on the other amendments are helpful to members of the Committee in their consideration.

[Kim Leadbeater]

I will keep my comments brief, because we have had a very thorough discussion today. I will first speak briefly to amendment 123, tabled by my hon. Friend the Member for Broxtowe. Amendment 123 would change “an inevitably” progressive disease to “a typically” progressive disease. [Interruption.] Is that the next grouping? Oh, I am peaking too soon—my apologies, Mr Dowd.

I will come back to my hon. Friend the Member for Broxtowe, but let me turn to amendments 399, 400 and 401, on the exclusion of “medical condition”, which the hon. Member for East Wiltshire submitted a few days ago, before the end of the recess. I looked at them over the weekend and was very interested to hear his reasoning for them today. This is the purpose of the Committee; I have listened carefully to what the hon. Gentleman has said, and he has made some valuable points. All along, I have taken the view that this legislation must not only be the strongest anywhere in the world, but be very clear in its intentions and leave no room for ambiguity regarding who is entitled to request assistance under its provisions.

I am very comfortable with the definition of terminal illness in the Bill, but across the world—I have done lots of research into this, as I know other colleagues have—some jurisdictions use the term “medical condition” or, actually, just the term “condition”, and others do not. Many in Australia do, but in New Zealand, for example, which has a similar law to what is being proposed here, “medical conditions” do not feature, nor do they in a number of states in America.

While I do not necessarily think that it would definitely be problematic to include the term “medical condition”, I appreciate the argument that the hon. Gentleman has made. We have to be as cautious as possible to ensure that the Bill achieves its purpose but does not create a lack of clarity. That point has been very well made.

The advice that I have received from officials is that, as the hon. Gentleman suggested, “medical condition” does not have a clear legal definition and could therefore be seen as imprecise. That does worry me. The purpose of the Bill is clear—it is in the title. It is to give choice to terminally ill adults at the end of life. They must have a clear, settled and informed wish, and be expected to die within six months, in circumstances that are inevitably progressive and cannot be reversed by treatment. The hon. Gentleman has, I believe, helped to make that even clearer, and I am grateful to him for doing so.

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[Lewis Atkinson]

I do, and I thank my hon. Friend for bringing my attention to that; I was struggling to put my hands on it.

In my view, clause 2 does a difficult job very well in tightly drawing eligibility criteria so that the Bill does what it says on the face of it—that it allows access for terminally ill adults, at the end of their life. By having a six-month prognosis, rather than anything else, it allows individuals to put their lives in order and have the best last months of their lives possible. I therefore speak against the amendments and in favour of the clause as drafted.

[Stephen Kinnock]

As usual, I will make brief remarks on the legal and practical impact of amendments, while emphasising that the Government continue to remain neutral on the Bill and on assisted dying more broadly. This series of amendments, which I will take in turn, seeks to change the definition of “terminally ill”, either widening or narrowing the cohort of people able to access assisted dying services.

Amendment 123 would change what it is to be “terminally ill” for the purposes of the Bill from having an “inevitably” to a “typically” progressive illness, disease or medical condition that cannot be reversed by treatment. That would widen the pool of those able to access assisted dying services by reducing the level of certainty that a doctor must have that the illness, disease or medical condition in question is progressive—from one that is “inevitably” progressive to one that is “typically” progressive.

Amendment 9 seeks to amend the definition of “terminally ill” such that it would not include a person who has an inevitably progressive illness, disease or medical condition that can be reversed, controlled or substantially slowed by treatment. The effect of the amendment is that such a person would not be eligible for lawful assistance to voluntarily end their own life. Should the amendment be accepted, the effect would be to restrict the eligibility for assisted dying services to a narrower category of patients than is currently set out in the Bill. The amendment may make assessment of a person’s prognosis and eligibility under the Bill more extensive, as it would be likely to require an assessment of a broader range of treatment options.

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[Naz Shah]

I apologise to my hon. Friend the Member for Sunderland Central; I was actually incorrect. The girls did not have capacity, so he was correct. However, in the cases that went before the court, those nine girls did not have capacity yet the judge made a decision that they should not be force-fed to keep them alive, and they should be allowed to die. Perhaps the Minister could comment on how the amendment would not meet that criteria. Would it fix that loophole?

[Stephen Kinnock]

I thank my hon. Friend for her intervention. I am just talking about the amendment to reduce the time from six months to one month. I will come on to the issue of eating and drinking in a second.

As amendment 282 would reduce the time within which the person is expected to die from six months to one month, it would also limit the number of people with a terminal illness who would be eligible for assisted dying under this legislation. Furthermore, there may be very challenging workability issues in delivering a service within one month, given the other time-dependent safeguards elsewhere in the Bill.

Amendment 51 would remove the requirement for the patient to have a six-month prognosis to be defined as “terminally ill”. If agreed to, it would expand the pool of people eligible for lawful assistance to voluntarily end their own life beyond those with a life expectancy of six months or less. In other words, it would remove the timeframe requirement of when death can be reasonably be expected.

Amendment 234 would widen eligibility to include cases of neurodegenerative diseases, illnesses or medical conditions where a person is reasonably expected to die within 12 months. Matters such as this are for the Committee, and ultimately for Parliament, to decide, but it is clear that the effect of the amendment would be to broaden the number of people eligible for lawful assistance to voluntarily end their own life under this legislation.

Amendment 10 would provide that, if treatment exists for a person’s progressive illness, disease or medical condition that alters the overall prognosis of that person’s condition, they are not terminally ill and would not be eligible for assisted dying services.

Amendment 402 would exclude a person who would not otherwise meet the definition of “terminally ill”—namely, being diagnosed with an inevitably progressive illness with six months or less to live—if that person meets that definition as a result of stopping eating or drinking. The effect of the amendment would be to prevent a person from being defined as “terminally ill” as a result of their own actions of stopping eating or drinking, or both. The Government’s analysis suggests that this may also exclude people who are terminally ill under the definitions of the Bill and who are, for various reasons, unwilling or unable to eat or drink. For example, it may include those with conditions such as oesophageal cancers, which could result in their being unable to eat or drink.

Furthermore, it is unclear whether someone who is on intravenous fluids or being fed through a feeding tube would be considered to have stopped eating or drinking under the amendment. I think that addresses the concern expressed by my hon. Friend the Member for Bradford West, but she is welcome to intervene again if she would like to. The amendment could therefore lead to uncertainty over the person’s eligibility for assistance under the Bill.

The Government have taken a neutral position on the substantive policy questions relevant to how the law in this area could be changed. Questions around the definition of terminal illness and who should be eligible to access voluntary assisted dying under the legislation are matters for the Committee and for Parliament as a whole. However, I hope that these observations are helpful to the Committee in considering the Bill and the amendments tabled by various Members.

[Kim Leadbeater]

Colleagues will be pleased to know that, despite my copious notes, I do not intend to speak for very long, because I believe we have had a very thorough and robust debate on these issues. The Minister makes a valuable point on amendment 402, which I do not think anyone else raised. Coincidentally, it relates to the person in the Public Gallery this morning, whose mum had a horrible form of cancer and had to have her tongue removed. She would have stopped eating or drinking, but it was not a choice; it was an inevitable result of her condition. She would have been excluded from having an assisted death, which I am sure is not the intention of my hon. Friend the Member for Bradford West.

We have had an excellent debate and covered a lot of ground. I do not intend to add anything more on this group of amendments. I will only say that if we get a move on, we might be able to get through clause 2 before we close at 5 o’clock.

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[Lewis Atkinson]

I rise to speak briefly in opposition to the amendments. When the chief medical officer gave oral evidence to the Committee, the hon. Member for Richmond Park asked him:

“Is it possible to come up with a list of illnesses that are terminal that would qualify under the legislation?”

The response was very clear:

“If I am honest, I think it would be extremely difficult.”

It is difficult in both directions, because some illnesses or diseases can be terminal, but are not necessarily terminal. People can live with prostate cancer for many years. Setting out in the Bill a list of specific diseases or illnesses that would be eligible risks achieving exactly the opposite of the amendment’s intention. To quote Professor Whitty again:

“Equally, there are people who may not have a single disease that is going to lead to the path to death, but they have multiple diseases interacting…I therefore think it is quite difficult to specify that certain diseases are going to cause death and others are not, because in both directions that could be misleading.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 32, Q5.]

Further to the point that the hon. Member for East Wiltshire made about on judicial oversight, my understanding is that giving power to the Secretary of State to make a list that includes only some diseases is absolutely inviting action through the courts on the reasonableness of why one disease is on the list while others are not. We would end up in much more of a legal quagmire than we otherwise would. The safeguards that we have talked about, as to eligibility criteria, terminality and capacity, are in the Bill as drafted. Those are the safeguards that we need. A list would further muddy the water and would create confusion.

[Stephen Kinnock]

I have some brief comments to make. Amendments 12 and 13 seek to further define a terminal illness for the purpose of the Bill; I will set out some details about their effect. The amendments would add a requirement that a list of a terminal illnesses for which people are eligible to seek assistance under the Bill be specified in regulations made by the Secretary of State. The effect would be that only a person who has an illness, disease or medical condition listed in regulations, and who meets the other eligibility criteria, would be eligible to be provided with lawful assistance to voluntarily end their own life.

I draw the Committee’s attention to the chief medical officer’s oral evidence given on 28 January, which was well articulated by my hon. Friend the Member for Sunderland Central. The CMO said that multiple diseases may interact, making it

“quite difficult to specify that certain diseases are going to cause death and others are not”.––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 32, Q5.]

It is also the case that many illnesses, diseases or conditions that may be terminal in one case may not be so in another. Committee members may therefore wish to consider where a focus on specific illnesses or diseases, rather than on the facts of an individual case, could aid clinicians in their decision making.

The amendments also include a discretionary power for the Secretary of State to make regulations that expire after 12 months in order to make temporary additions to the list of illnesses that meet the definition of terminal. It is not clear what types of illnesses, diseases or medical conditions are intended to be captured in such regulations. I hope that those observations on the purpose and effect of amendments 12 and 13 are helpful to the Committee in its considerations.

[Danny Kruger]

I sense that the wish of the Committee is probably not to accept the amendment, so I do not propose to press it to a Division, but we have just heard quite clearly, in response to the amendment, that the Bill is essentially permissive. Once again, we have declined to put clear parameters around the eligibility for this new law. We have heard specific conditions mentioned so many times in the course of the debates over the preceding months. It is a shame that we are not prepared to state those conditions clearly in the Bill, with the opportunity for Parliament to amend them over time.

I end by echoing a point that the hon. Member for Spen Valley made about the importance of good data. I hope that if the Bill passes, we will have the best data collection in the world. I am afraid to say that data collection is not good in other jurisdictions. Nevertheless, it is possible to see how often in Oregon, Australia, Canada, and Europe, albeit in a minority of cases, conditions that most people would not recognise as deserving of assisted dying, including anorexia, arthritis, hernias and diabetes, are listed as causes of death. Indeed, so is frailty, as I discussed earlier.

My fear is that if we pass the Bill, we too—if we do data collection properly—will have a shameful appendix to the annual report showing that people have had an assisted death for reasons that most people would regard as inappropriate. I will leave it there. I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendment made: 401, in clause 2, page 2, line 5, leave out “, disease or medical condition” and insert “or disease”.—(Danny Kruger.)

This amendment is consequential on Amendment 399.

Amendment proposed: 402, in clause 2, page 2, line 6, at end insert—

“(2) A person who would not otherwise meet the requirements of subsection (1), shall not be considered to meet those requirements as a result of stopping eating or drinking.”—(Naz Shah.)

This amendment means that someone who is not terminally ill within the meaning of subsection (1) cannot bring themselves within that definition by stopping eating or drinking or both.

Question put, That the amendment be made.

Cardiovascular Disease: Prevention

Stephen Kinnock Excerpts

Thursday 13th February 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a great pleasure to serve under your chairship, Mr Mundell. I am indeed starting with an apology. I am very embarrassed by the fact that the debate was put by my officials in my diary as starting at 3.30 pm, and it is completely unacceptable that I arrived late. I apologise to you, Mr Mundell, and to the hon. Member for Strangford (Jim Shannon). It is a very embarrassing situation, and I am not happy about it at all.

I thank the hon. Member for Strangford for securing this debate on such an important issue and for the vital work he does as the chair of the APPG on vascular and venous disease. For their excellent contributions, I also thank my hon. Friend the Member for Dudley (Sonia Kumar), who spoke powerfully on the basis of her extensive real-world experience and expertise, my hon. Friend the Member for Ilford South (Jas Athwal), who spoke so movingly about his family and personal experiences, and the hon. Member for Mid Sussex (Alison Bennett), who spoke passionately about the shocking health disparities that blight our country, caused by 14 years of Tory neglect and incompetence.

Before I begin my remarks, I want to pay tribute to people working in local government, our NHS staff and GPs up and down the country for their efforts to find, treat, and manage people at risk of cardiovascular disease—also known as CVD. As hon. Members will know, health is a devolved issue, so my remarks will be limited to matters in England; however, I am happy to pick up on many of the broader points that the hon. Gentleman for Strangford has made.

The last Labour Government made significant progress on reducing premature deaths from CVD through the introduction of big-hitting interventions such as the ban on smoking in public places and increases in statin prescribing. However, as the hon. Member for Strangford said, among the many appalling findings of Lord Darzi’s report, there is clear evidence that progress on CVD stalled, and even went into reverse in some areas, between 2010 and 2024. That is why it is this Government’s mission to invest in the health service, alongside fundamental reform to the way that healthcare is delivered. We will build a health and care system fit for the future by moving from sickness to prevention, hospital to home, and analogue to digital. Tackling preventable ill health is a key part of these shifts.

As part of our 10-year health plan, we are committed to helping everyone to live a healthy life for longer, and as the hon. Gentleman also outlined in his remarks, too many lives are cut short by heart disease and strokes. In 2022, one quarter of all CVD deaths in the UK occurred among people under the age of 75. Tackling CVD is not just the right thing to do for patients; CVD is also having an impact on growth. People with CVD are more likely to leave the labour market than people with poor mental health, and we must dispel the fiction that people with CVD are always old and infirm. Around one in three people who have a heart attack, one in four people who have a stroke, and two in five people with coronary heart disease are of working age.

The hon. Gentleman referred to premature deaths, and we know from the most recent figures that I have, from 2023, that in England alone over 130,000 people died from CVD and over 30,000 people died before they turned 75. The best estimates show that the annual cost of CVD to the NHS is a staggering £8.3 billion, with knock-on effects of £21 billion to the wider economy. This is a huge challenge, which is why we are meeting it with great ambition: to reduce premature deaths from heart disease and stroke in people under 75 by one quarter within a decade. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire (Ashley Dalton), will be spearheading our work in this area, and will also be picking up on many of the issues that the hon. Gentleman raised in his speech.

We know that around 70% of the CVD burden is preventable and due to risk factors such as living with obesity, high blood pressure, high cholesterol and smoking—all of which can be reduced by behaviour changes, early identification and treatment. In England, the NHS health check is a free check-up for people between 40 and 74. The NHS health check is a wide-reaching programme delivered by local authorities in England. This CVD prevention programme aims to prevent heart disease, stroke, diabetes, and kidney disease—and also dementia for older patients. 

In the very short period of time that I have left, I just wanted to say that the hon. Member for Strangford called for the introduction of Lp(a) tests. As I understand it, lipoprotein(a) measurement is not currently recommended by NICE guidance, and there are no treatments available that specifically target Lp(a).  Instead, our focus is to improve the uptake of lipid-lowering therapies for prevention of CVD and to treat people with established CVD to NICE treatment targets. We will look closely at new tech and innovation and the essential role they will play in reducing health inequalities.

[Jim Shannon]

I apologise, but at the end of my speech I asked for three things. I asked whether there would be a willingness to meet me and representatives from the Lp(a) taskforce to discuss the essential steps that are needed, and that—

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[David Mundell (in the Chair)]

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

[Stephen Kinnock]

I absolutely will. I would be happy to complete my remarks, but I do not know that would work, given that Mr Shannon has made his second contribution.

[David Mundell (in the Chair)]

I will make the determination that Mr Shannon’s contribution was an intervention—although an excessively lengthy one, which he will not repeat at the conclusion of the debate.

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[Stephen Kinnock]

This has been an interesting debate on so many levels. I thank you for that clarification, Mr Mundell.

I was just talking about the fact that around 70% of the CVD burden is preventable, and that the causes include obesity, high blood pressure, high cholesterol and smoking. All those factors can be reduced by behaviour changes, early identification and treatment. In England, the NHS health check is a free check-up for people between 40 and 74. It is a wide-reaching programme delivered by local authorities in England. This CVD prevention programme aims to prevent heart disease, stroke, diabetes and kidney disease, as well as dementia for older patients. It engages over 1.4 million people a year and, through behavioural and clinical interventions, prevents around 500 heart attacks or strokes annually.

I agree with the hon. Member for Strangford that the National Audit Office report shows that there is still so much more to be done. That is why we have asked officials to be more ambitious, developing policy proposals for how that programme can go even further. In the meantime, we are focused on delivering a new digital NHS health check, available through the NHS app, so that people can assess, understand and act on their CVD risk at home. We want to make it easier for people to access that programme, especially our constituents who have caring or childcare responsibilities, or cannot easily get to their GP surgery during opening hours. The creation of a state-of-the-art national digital NHS check service will improve access to this lifesaving check.

The hon. Member was right to mention diabetes as a key risk for CVD. Each year, the NHS health check identifies 22,000 people with high blood sugar who are referred on to primary care for further assessment and management. GPs can refer people at risk of developing type 2 diabetes into the Healthier You NHS diabetes prevention programme. The programme has been highly effective: some 35,000 people have been referred to it by their GP, and over 20,000 have started the programme since September 2020. For people who complete that programme, it can cut the risk of developing type 2 diabetes by 37%. For those who already have diabetes and are overweight or obese, the NHS type 2 path to remission programme is available. This joint initiative between NHS England and Diabetes UK aims to support eligible people with type 2 diabetes to achieve clinically significant weight loss, improve blood glucose levels and reduce the need for diabetes-related medication. A recent study found that almost a third of patients with type 2 diabetes who completed the programme went into remission.

Around half of heart attacks and strokes are a result of high blood pressure. A third of adults have high blood pressure and, worryingly, almost a third of these conditions are currently untreated, meaning that over 4 million people do not know that they have high blood pressure. It is often referred to as the silent killer, as high blood pressure is largely symptomless. The tragedy is that the treatment is so cheap and effective. We could prevent around 17,000 heart attacks and save more than £20 million in healthcare costs alone over three years just by treating 80% of patients on target.

The hon. Member for Strangford also mentioned high levels of cholesterol as a key risk factor in CVD. For every three NHS health checks delivered, one person is found to have high cholesterol, and there are well-known health inequalities in CVD affecting underserved communities in England. Addressing undetected and poorly managed high blood pressure and raised cholesterol is key to preventing CVD and reducing health inequalities.

There are effective drug treatments. Statins are readily available and very cheap. They can reduce an individual’s risk of CVD in four to six weeks. If we improve treatment rates for people with CVD to 95%, more than 18,000 CVD events, such as heart attacks and strokes, may be prevented over three years. We will look closely at how we can get that done. The hon. Member for Strangford called for the introduction of Lp(a) tests. As I mentioned, that is not currently recommended by NICE guidelines. I have taken account of his other remarks, including his request for a meeting and engagement with system partners. The Minister for Public Health and Prevention will take all those requests on board. She is the right person for him to meet, given that she leads in this policy area.

Smoking costs health and care services £3 billion a year—resources that could be freed up to deliver millions more appointments, scans and operations. The cost of smoking to our economy is even greater, with around £18 billion lost in productivity every year. Smokers are a third more likely to be off work sick, which is why we introduced the Tobacco and Vapes Bill: the biggest public health intervention in a generation. It will break the cycle of addiction and disadvantage, and put us on track towards a smoke-free UK. That will make a real difference in constituencies where smoking contributes to the cycle of poverty and ill health. We are also supporting local stop smoking services with an additional £70 million this financial year.

Today’s debate has shown what a challenging and complex area this is. The shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), raised a range of issues. I will ask the Minister for Public Health and Prevention to write to him on all his points, many of which I think would be best dealt with in correspondence.

[Jas Athwal]

The Minister makes powerful points. Does he agree that we should consider a wider, holistic approach, taking into account planning and advertising—for instance, children going to school and having access to the proliferation of chicken shops and fast-food shops, and being exposed to, on average, 13 to 15 junk food adverts? That would help to limit the number of heart diseases later down the line.

[Stephen Kinnock]

My hon. Friend is right that prevention should focus on as early as possible in the life of our young people. Bad habits form at early ages. That is not helped by the behaviour of some aspects of our economy, and the way in which products are advertised. It is essential that we move to a model of prevention that is a partnership between the Government, our communities and business. We are taking action against the advertisement of certain products before the 9 o’clock watershed. We are also cracking down on energy drinks, which are really pernicious in terms of the amount of sugar, caffeine and other deeply unhealthy components they contain.

My hon. Friend is right that we are genuinely all in this together. We need that partnership with the private sector, and a change in mindset around healthy and nutritious food. That needs to be put into schools through community health, and through working with parents and communities to change the habits of our country. We have a gargantuan challenge ahead of us, but our Government are absolutely committed to facing it, and that prevention strategy will be at the heart of our 10-year plan. It is one of the key shifts from sickness to prevention.

That leads me to my closing remarks. We have seen today what a challenging and complex area this is. It is a challenge that requires sustained action on a number of risk factors, but I assure colleagues that this Government will leave no stone unturned in getting premature deaths from heart disease and stroke down by a quarter for people under the age of 75 within the next year.

In my contribution, I have sought to demonstrate our commitment to getting on with the shift from sickness to prevention with our cast-iron commitment to expanding NHS health checks, the shift from hospital and community by making it easier for people to get checks at their convenience and at home, and the shift from analogue to digital through an innovative and expanded digital service. I once again thank the hon. Member for Strangford for securing this important debate, and thank all hon. Members across all parties for their excellent contributions. Watch this space: we will continue to work on this issue with focus and at pace.

Telecare National Action Plan

Stephen Kinnock Excerpts

Tuesday 11th February 2025 Written Statements

[The Minister for Care (Stephen Kinnock)]

The digital phone switchover is a necessary upgrade to our underlying national digital infrastructure as the old analogue landline network is becomingly increasingly unreliable. The safety of telecare users throughout the switchover is the Government’s utmost priority. That is why I am pleased to publish a joint telecare national action plan with the Minister for Data Protection and Telecoms, the hon. Member for Rhondda and Ogmore (Chris Bryant), setting out the steps that stakeholders need to take to safeguard telecare users during the digital phone switchover.

The digital phone switchover means that traditional analogue devices, such as telephone handsets and telecare units that are currently connected to the analogue landline network, will need to be reconnected to the digital network. There is a risk that the process of migrating telecare users to digital landlines will disrupt their telecare services. Telecare users must be protected during the digital phone switchover and every effort must be taken to avoid these risks.

Our action plan is predominantly aimed at communication providers, local authorities, housing providers, third sector organisations and commercial providers. It demonstrates the Government’s commitment to working with the telecare and telecommunications industries and ensuring that telecare users’ safety is put first during the switchover. Officials have worked closely with stakeholders to develop and agree the actions set out in this plan.

This telecare national action plan sets out the actions that the Government expect to see delivered. The actions are set out against the following outcomes:

No telecare user will be migrated to digital landline services without the communication provider, the user or the telecare service provider confirming that the user has a compatible and functioning telecare solution in place;

Use of analogue telecare devices is phased out to ensure that only digital devices are being used. DHSC will be working with stakeholders over the coming months to set a deadline for this;

Telecare users, their support networks and their service providers understand what actions they need to take to ensure a safe migration to digital phone lines; and

Stakeholders identified within the plan collaborate to safeguard telecare users through the digital phone switchover.

The Government are committed to improving adult social care for those who draw on it, helping people to stay independent in their own homes, joining up services and improving the quality of care. The Government recently announced an independent commission into adult social care led by Baroness Louise Casey as part of their critical first step towards a national care service. While the Casey commission carries out its work, the Government are getting on with the job of reforming the system and have announced immediate actions to improve adult social care services. This includes the development of new national standards and trusted guidance for technology in social care. The new standards and guidance will make it easier for providers, commissioners and people who draw on care and support to identify the technologies that will work best for them.

The transition to digital telephone networks will lay the foundations for a next generation of telecare services that will support more personalised and early preventive interventions, and support the Government’s reforms to adult social care. The plan includes examples of where local areas have utilised the opportunities presented by the digital phone switchover to advance the use of technology within their social care provision.

Given the complexity of the issue, it is possible that additional necessary actions might be identified. We will review progress against the telecare nation action plan every six months and identify new actions as needed. A copy of the telecare national action plan will be deposited in the Libraries of both Houses and will also be published on www.gov.uk.

[HCWS434]

Oral Answers to Questions

Stephen Kinnock Excerpts

Tuesday 11th February 2025 Commons Chamber

[Munira Wilson (Twickenham) (LD)]

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

[The Minister for Care (Stephen Kinnock)]

After 14 years of Tory neglect and incompetence, we inherited a broken NHS, and nowhere is that more apparent than in our mental health services. Too many people are waiting too long to access the care they need. To fix that, we will recruit 8,500 more mental health workers; provide access to specialist mental health professionals in every school, as the hon. Member has called for; roll out Young Futures hubs in communities; and modernise the Mental Health Act 1983.

[Munira Wilson]

With the Terminally Ill Adults (End of Life) Bill being amended to include a panel that will involve psychiatrists who will determine whether a request for assisted dying should be granted, as well as a number of cross-party amendments rightly calling for the involvement of mental health professionals earlier in the process, what assessment have Ministers made of whether there is sufficient capacity in mental health services, which the Minister has just noted are overstretched, to meet those demands, and on the potential knock-on impact on both waiting times and treatments for those with mental health conditions?

[Stephen Kinnock]

The hon. Lady will know that the Government’s position on the Terminally Ill Adults (End of Life) Bill is one of neutrality. I am on the Bill Committee simply to speak about the Government’s position on the workability and operationalisation of the Bill. We look forward to seeing the amendment that will be brought forward by my hon. Friend the Member for Spen Valley (Kim Leadbeater). Any comment we make or position we take will be based on the operationalisation of that amendment, should it become part of the Bill and, ultimately, should the Bill gain Royal Assent.

[Jen Craft (Thurrock) (Lab)]

Thurrock community hospital does fantastic work on integrated care, particularly on integrated mental health care. On a visit, representatives said that what makes the hospital successful is a commitment to working across integrated care boards, the local authority and other relevant partners in the community, as well as a commitment to meeting people where they are, finding out what is important for them and working from there. Does the Minister see that model as integral to the reform of mental health care in this country? Will he join me on a visit to Thurrock community hospital to see what it does and what can be learned from how that work is undertaken?

[Stephen Kinnock]

My hon. Friend is a doughty campaigner on this issue in her constituency. She is right that the integration of services is crucial to ensuring that we get the best possible outcomes for people who are struggling with their mental health. I would be very happy to discuss with her the possibility of me visiting her constituency.

[Jeremy Hunt (Godalming and Ash) (Con)]

Is the Minister aware of the brilliant work done by Mersey Care NHS foundation trust in reducing in-patient mental health suicides to zero, which is an extraordinary achievement. Under a former Health Secretary, who may be standing not a million miles away from where I am standing now, that became an objective for all mental health in-patient units across the NHS. Will the Minister look into whether that objective still stands? If not, can it be reinstated?

[Stephen Kinnock]

I am not familiar with the detail of the case that the right hon. Gentleman mentions, but it sounds like a positive and interesting development, and I would be happy to consider it further. The Government are committed to delivering the cross-sector suicide prevention strategy for England, published in 2023. The 8,500 new mental health workers who we will recruit will be specially trained to support people at risk.

[Andrew Cooper (Mid Cheshire) (Lab)]

I am regularly contacted by constituents who are concerned that their children are not receiving the mental health care they need. Having met GPs in Winsford, I know that there are clear concerns that access to child and adolescent mental health services is being rationed to the point that it has become almost inaccessible to all but the most severe cases. Will my hon. Friend tell me what progress has been made towards our commitment to provide specialist mental health professionals in schools, ensuring that there is early intervention that prevents issues from escalating?

[Stephen Kinnock]

After the disastrous 14 years that we have had, we are facing a very serious situation in terms of mental health provision. It will take some time to get the workforce in place, but we have a clear commitment to having a specialist in every school. The appointment and training of those specialists will take some time. We are also rolling out open-access Young Futures hubs in every community. I am confident that the combination of those two interventions will get us back to having mental health services that this country can be truly proud of.

[Mr Speaker]

I call the Chair of the Health and Social Care Committee.

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

I welcome the Under-Secretary of State for Health and Social Care, the hon. Member for West Lancashire (Ashley Dalton), to her place. I look forward to working with her, as I do with other Ministers.

As the Minister for Care will know, 20% of the burden on the NHS is due to mental health, yet only 10% of the budget is allocated towards it. The mental health investment standard has been a welcome maintenance under this Government. However, the Select Committee heard from Amanda Pritchard the other day that the standard is guaranteed for only the next two years. Does the Minister agree that the standard has had a positive effect on mental health community services, and would he commit to protecting it?

[Stephen Kinnock]

The Chair of the Committee will have seen that we have made an explicit commitment to the mental health investment standard—we are absolutely committed to that. In addition, we have to drive reform in the system so that it is about not just the amount of investment going in, but how we ensure that it is working properly. I am absolutely confident that the commitment to 8,500 new specialists, the Young Futures hubs and having a mental health specialist in every school will facilitate the delivery of services in a far more effective way than is currently the case.

[Chris Vince (Harlow) (Lab/Co-op)]

I thank the Minister for his continued commitment to supporting mental health in this country. Does he also recognise that mental health involves supporting NHS frontline staff? I had the wonderful opportunity of spending time with the East of England ambulance service on Saturday morning. They work incredibly long hours and work incredibly hard. Obviously, we need to think about their mental health as well.

[Stephen Kinnock]

We in this Chamber should, whenever possible, pay tribute to the people providing those frontline services, who every day work heroically in very difficult circumstances. My hon. Friend is absolutely right about the pressures on the workforce—we are very conscious of that. We will bring forward a workforce plan in the summer, and we are working at pace to recruit the 8,500 mental health workers.

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

Last week, the Secretary of State issued a new mandate for the NHS in which a number of mental health targets were dropped. I accept that targets that drive perverse behaviours should be dropped and that some sharpened focus is necessary, but mental health waiting lists are at a record high, huge numbers of people are not at work because of poor mental health, and our young people are being let down badly by CAMHS, not least in my constituency of North Shropshire. Does the Secretary of State accept that mental health targets should be reinstated and that mental health should be treated with equal priority to physical health?

[Stephen Kinnock]

What we know about targets is that if we try to overload a system with too many targets, it causes confusion and ends up with, as the hon. Lady rightly says, perverse outcomes. We are clear that we do not want to have a system based on just making policy by press release, as was the case under the previous Government, putting out press announcements about loads more targets. It all makes for nice front-page headlines, but it does not lead to any serious delivery of the strategy that we need to deliver. I am with her on the point about focus. We are absolutely committed to mental health, as is set out in the planning guidance. It is also one of the priorities in the planning guidance, and we will continue to deliver on that priority.

[Monica Harding (Esher and Walton) (LD)]

3. What discussions he has had with the Secretary of State for Foreign, Commonwealth and Development Affairs on the UK’s leadership on global health and immunisation.

--- Later in debate ---

[Harpreet Uppal (Huddersfield) (Lab)]

20. What assessment his Department has made of the adequacy of long-term funding for hospices.

[The Minister for Care (Stephen Kinnock)]

Hospices provide vital care and support for patients and their families at the most difficult time. I am very proud that this Government have provided a £100 million capital funding boost for adult and children’s hospices over this year and next. We are currently finalising the delivery mechanism for this funding, and we are pleased that Hospice UK is standing ready to distribute the money to local hospices across England. We are also providing £26 million of revenue funding for children’s hospices in England in 2025-26.

[James Naish]

While I wholeheartedly welcome the £100 million capital funding boost for hospices announced before Christmas, 17 members of staff at Nottinghamshire hospice, which is a large community-based hospice serving my constituency that provides care for family members in their own homes, have recently been told they are at risk of redundancy. Can the Minister please expand on how the Government will support organisations such as this to continue to deliver excellent care in the community?

[Stephen Kinnock]

I thank my hon. Friend for this important question, and I commend the work of hospices such as Nottinghamshire hospice in his constituency, which I know does a wonderful job for people in his area. The investment I referred to in my earlier answer will help hospices such as Nottinghamshire hospice to provide quality end-of-life care to patients and their families this year and next. It can be used to improve IT systems, make it easier for GPs and hospitals to share vital data on patients, and help to develop and improve outreach services to support people in their own homes, when needed.

[Kate Osamor]

North London Hospice in my constituency has a site in Winchmore Hill that receives one third of its funding from the NHS, with the rest coming from the generosity of the public. Many of its services, such as out-patients and wellbeing, are funded entirely by donations. While it welcomes the announcement of the £100 million in funding, what assurances can the Government provide about long-term hospice funding, given the significant delays in accessing funding from integrated care boards this year? Hospices are anxious to seek clarity about the allocation and distribution of this funding.

[Stephen Kinnock]

I thank my hon. Friend for that question. On her point about long-term funding, last week I chaired a roundtable with key stakeholders from the sector, and we were absolutely focused on developing a plan to secure the long-term sustainability of the sector. We cannot go back to the cliff edge that we have had over the last few months, primarily due to the utterly chaotic and shambolic way in which the Conservative party managed our system in the past.

[Harpreet Uppal]

I have had the privilege of witnessing at first hand the exceptional work of my local hospices, Forget Me Not children’s hospice and the Kirkwood. However, as my hon. Friends the Members for Rushcliffe (James Naish) and for Edmonton and Winchmore Hill (Kate Osamor) have stated, they are also struggling with long-term funding pressures and have had to make the difficult decision to reduce services and staff. What further work are the Government doing to ensure that hospices thrive, and to ensure that end-of-life care is included in the 10-year NHS plan?

[Stephen Kinnock]

I thank my hon. Friend for that question. One of the three shifts that the 10-year plan will deliver is shifting more healthcare out of hospitals and into the community. In the context of the plan, we are having discussions about the long-term sustainability of the palliative and end-of-life care sector, including hospices. As we develop the plan, we will be carefully considering policies in this area, with input from the public, patients, health staff and our stakeholders. As I mentioned in response to my hon. Friend the Member for Edmonton and Winchmore Hill (Kate Osamor), last week I was pleased to chair a roundtable to discuss long-term strategies for hospices to get palliative and end-of-life care, including hospices, on to a more sustainable footing after 14 years of Tory neglect and incompetence.

[Mr Peter Bedford (Mid Leicestershire) (Con)]

Leicestershire is home to some superb hospices, such as Rainbows and LOROS, both of which are set to be massively impacted by the hike in national insurance contributions. Given the important work that these hospices do, particularly for people at the end of their lives, will the Minister urge the Chancellor to reverse this pernicious tax rise?

[Stephen Kinnock]

I am once again struck by the fact that Conservative Members seem to welcome the additional investment that the Chancellor has put into our health and care service, but do not seem to have any plan or proposals at all about how the revenue should be generated for that funding. Until we get an answer to that question, we will struggle to get much further in this House, although I note that Toby Porter, the chief executive of Hospice UK, has said that the

“funding will allow hospices to continue to reach hundreds of thousands of people every year with high-quality, compassionate care. We look forward to working with the government to make sure everyone approaching the end of life gets the care and support they need”.

[Stephen Gethins (Arbroath and Broughty Ferry) (SNP)]

First, may I pay tribute to those who work in hospices? I think we can all agree that they do an astonishing job. The Minister will agree that the national insurance hike has had an impact on those who work in hospices. Can he assure me that when it comes to the Scottish Government’s funding—I acknowledge the 14 years of Tory misrule and the funding settlements that were handed down—any Barnett consequentials will be passed on in full to the devolved Administrations?

[Stephen Kinnock]

We have seen the biggest settlement in many years for our health and care system across the country. It is now up to the SNP Government in Edinburgh to absorb and deliver that funding in a way that will actually improve services in Scotland—something that we have not seen for a very long time under the misrule of the Scottish National party.

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

The magnificent work done by those who work in hospices, including the four in Northern Ireland, needs to be reflected in the funding formula. Will the Minister undertake to discuss with ministerial colleagues the need for the Treasury to review that funding formula, particularly in relation to devolved settlements?

[Stephen Kinnock]

From the roundtable discussions, and from subsequent discussions we have been having with the sector, it is clear that we need to look at the long-term funding issue. We faced a cliff edge towards the end of last year. That is not the right way to do things. We must start getting the funding discussions moving so that, well in advance of the end of this financial year, the funding situation for the palliative and hospice sector is much clearer.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

8. What steps he is taking to reduce inequalities in healthcare.

--- Later in debate ---

[Charlotte Cane (Ely and East Cambridgeshire) (LD)]

11. What steps his Department is taking with Cabinet colleagues to increase access to assessments for special educational needs.

[The Minister for Care (Stephen Kinnock)]

Children and young people with special educational needs are waiting too long for the NHS services that they need, in large part because local authorities have been hollowed out by 14 years of austerity. We are supporting earlier intervention through the partnerships for inclusion of neurodiversity in schools—PINS—programme, which is backed by £13 million of funding. NHS England has also launched a taskforce to look at how support can be improved for people with attention deficit hyperactivity disorder. We look forward to its report later this year.

[Charlotte Cane]

Cambridgeshire has some of the lowest funding in England for GP practices and schools. Given the Government’s focus on growth for the area and the record demand for special educational needs and disabilities and young people’s mental health services, will the Minister work with colleagues across Government to ensure that high-growth areas no longer suffer lower than average funding?

[Stephen Kinnock]

Our commitment to improving SEND conditions is universal. We are looking at this from the point of view of improving provision right across the country. I am very pleased that the PINS programme is making progress. I draw the hon. Lady’s attention to the early language support for every child—ELSEC—programme, in which nine pathfinder sites over two years will provide early identification, and targeted and universal support for children with speech, language and communication needs in early years and primary school settings. We are working very closely with colleagues across the Department for Education and NHS England on that.

[Alistair Strathern (Hitchin) (Lab)]

Local authority resources are a big driver of some challenges in the SEND system, but it is clear to anyone working in it that a systemic under-prioritisation of children’s health, all too often by local NHS trusts, is a big contributing factor. Young people right across my constituency waiting for assessment and lacking support are paying the price. As part of our 10-year plan to reform the NHS, how will we ensure that children’s health is front and centre again, with much more support for people with additional needs?

[Stephen Kinnock]

I am working very closely with colleagues in the DFE on how we mainstream SEND provision more effectively, get more rapid education, health and care plans and autism diagnoses, and on a whole range of issues that require strong cross-party work. I would be happy to brief my hon. Friend on that separately.

[Joe Robertson (Isle of Wight East) (Con)]

12. What steps his Department is taking to help reach the national dementia diagnosis rate target.

--- Later in debate ---

[Catherine Atkinson (Derby North) (Lab)]

After 14 years of Conservative government, 77% of people in Derby cannot access an NHS dentist. Can the Minister tell us what caused the rot to set in and how we can fill the cavities in provision?

[The Minister for Care (Stephen Kinnock)]

I see what my hon. Friend did there, and she should brace herself as we drill down into this answer. The Conservative party is the cause of the rot: spending on NHS dentistry fell by a staggering 18% between 2010 and 2024, so it is little wonder that dentistry is on its knees. We will shortly set out plans to introduce supervised tooth brushing for three to five-year-olds in the most deprived communities, and we are working with the dental sector to implement our rescue plan.

[John Lamont (Berwickshire, Roxburgh and Selkirk) (Con)]

T6. New research from Marie Curie has found that 85% of public expenditure on people in the final year of life in Scotland is spent in hospitals and only 14% on community care. The figures are very similar for England. What work is being done to ensure a minimum standard of community treatment for people in the final year of life?

[Stephen Kinnock]

It is vital that we have a palliative and end of life care service that works and is on a sustainable footing. I have had discussions with the sector. We want to ensure that we do not have the cliff edge that we had at the end of last year. The hon. Gentleman is right to point to this, and we will report back in due course.

[Sally Jameson (Doncaster Central) (Lab/Co-op)]

The Minister will be aware that the contract uplift for dentists is facing a near 11-month delay. Can he confirm that dentists will be receiving their uplift? What will be done to make sure that they receive enough money to cover the costs of NHS dentistry?

[Stephen Kinnock]

I can reassure my hon. Friend on that point. We implemented the contract uplift on 29 January. Dentists will therefore be receiving their uplifted payments in March, backdated to 1 April 2024. For the first time in more than a decade, we have also increased payments for practices training a foundation dentist.

[Sir John Whittingdale (Maldon) (Con)]

T7. In Maldon, the number of patients per GP is already 50% above the number for England, and that will only increase with the amount of proposed house building. GPs are struggling to cope with ever increasing costs, and I have one practice still undertaking so-called collective action. Will the Government review the whole system of GP funding before it breaks down completely?

[Stephen Kinnock]

We are in negotiations about the future contract with the General Practitioners Committee England of the British Medical Association. Those negotiations are proceeding, and the right hon. Gentleman is right that we need serious reform; we will be pushing reforms through on that basis. On his point about the estate, we have a £102 million commitment on capital for the primary care estate, which I think will go some way towards reassuring him.

[Clive Lewis (Norwich South) (Lab)]

I thank my hon. Friend the Minister for all the support he has given the University of East Anglia to set up its dental school, but he will be aware that all those shiny new dentists coming out in a few years’ time will be going into the private sector, not the NHS, unless we can sort out the NHS dental contract. Can he give us any kind of timeline for when we can expect to hear an announcement on that critical factor?

[Stephen Kinnock]

I wish my hon. Friend all the best with his efforts to get that dental school up and running. As for the need for serious reform, there is no perfect payment system, but we have to get a payment system in place that makes NHS dentistry attractive—at least as attractive as doing work in the private sector. We are working at pace on that, and I will report back on that as rapidly as possible.

[Vikki Slade (Mid Dorset and North Poole) (LD)]

T10. Some 44,066 children—one in six—are waiting more than a year for medical treatment, compared with one in 100 adults. Waits are at their worst in community medicine. In Dorset, there are waits of up to two years in child development, and delays of a year are normal for child and adolescent mental health services. Fifty-three per cent of all community health referrals take more than a year. Will the Minister confirm whether the 18-week target will apply to community referrals and not just hospitals? If not, when can we expect a target, so that children are not badly affected?

--- Later in debate ---

[Josh MacAlister (Whitehaven and Workington) (Lab)]

Shortly after the election, the new Government announced £4.3 million for a new community mental health hub in Whitehaven. Unfortunately, the local mental health trust followed that decision by announcing the closure of the Yewdale ward for acute mental health services. Does the Minister agree that we need to get early intervention right before we close acute services, and will he bring together a meeting to scrutinise that decision?

[Stephen Kinnock]

Integrated care boards are responsible for providing mental health services to meet the needs of their local populations. As part of our plan for change, we will reduce delays and provide faster treatment. We are working with NHS England to transform mental health services, shift care from hospitals to local communities, and increase access to support for people across the country, including in rural areas.

[Robbie Moore (Keighley and Ilkley) (Con)]

Insomnia affects many patients, including my constituents, who are being advised by their GPs to try cognitive behavioural therapy as an alternative to medication. However, digital CBT programmes are not available on the NHS, leaving many without access to drug-free treatment. Will the Minister outline what steps the Government are taking to ensure that patients have access to digital therapies, so that more people can get access to evidence-based, drug-free support?

[Daniel Francis (Bexleyheath and Crayford) (Lab)]

The NHS South East London integrated care board provides services to my constituents, and I have discussed some ways in which we could better deliver services by redeveloping the Erith community hospital site in Northumberland Heath. Is the Minister able to provide an outline of the Government’s plan to provide capital funding for expanding community services like those at Erith hospital?

[Stephen Kinnock]

I would be delighted to meet my hon. Friend so that we can get into a bit more detail about what is happening in his constituency, but he is absolutely right to point to the need for more and better community health services. That will be at the heart of our shift from hospital to community in the 10-year plan that we are delivering.

[Steve Darling (Torbay) (LD)]

Health authorities in Devon are set to trial the relocation of a vital coronary service from Torbay to Exeter, which is 24 miles away. Will the Minister meet me and fellow south Devon MPs who have grave concerns about the impact on patient safety?

Maternal Mental Health

Stephen Kinnock Excerpts

Wednesday 5th February 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Ms Furniss.

I am so grateful to my hon. Friend the Member for Aylesbury (Laura Kyrke-Smith) for securing this debate, for raising a number of important issues and for making such a powerful and moving contribution. I was very saddened to hear of the utterly heartbreaking circumstances of her friend’s passing. I offer my sincere condolences to her and to Sophie’s family and loved ones. I am also thankful to all Members for their contributions, the sheer number of which, in such a short Westminster Hall debate, illustrates the importance of this issue.

The Government take this matter extremely seriously, which is why are placing a renewed focus on mental health and suicide prevention, including for women during the perinatal period. The figures show that the challenges are sobering, and many of the issues raised today are symptomatic of an NHS that is simply not addressing needs. Perinatal mental illness affects over a quarter of new and expectant mothers and covers a wide range of conditions. Research shows that in the UK around one in three women experience traumatic births, and one in 20 women every year develop post-traumatic stress disorder after giving birth. Between 2021 and 2023, 26 women died from mental health-related causes within the six weeks following pregnancy. Over a third of maternal deaths occurring between six weeks and one year after the end of pregnancy are from suicide, drugs, alcohol or other mental health-related causes. It is unacceptable that so many women are not receiving the maternal mental health care they need, and we are determined to change that.

That is why NHS England’s three-year delivery plan for maternity and neonatal services commits to offering all women a personalised care and support plan, considering physical health, mental health and social complexities, with an updated risk assessment at every contact. Ten years ago, fewer than 15% of localities provided specialist perinatal mental health services for women with complex or severe conditions at the full level recommended in National Institute for Health and Care Excellence guidance, and more than 40% provided no service at all. Today, specialist perinatal mental health services are available in all 42 integrated care systems across England. Those services are available for women with or at risk of mental health conditions who are planning a pregnancy, are pregnant or have a baby up to two years old. That care includes increased access to evidence-based psychological therapies.

A record 62,723 women were reported to have accessed community perinatal mental health services and maternal mental health services in the 12 months to the end of November 2024. Women can be referred to services by any healthcare professional, including midwives, health visitors, GPs, hospital-based teams, mental health services and social workers. Self-referrals are accepted by some services. GPs also now deliver six to eight-week post-natal consultations that include a focus on perinatal mental health.

The services are provided by multidisciplinary teams to cover every aspect of women’s health, often including a psychiatrist, nurses, mental health social workers, occupational health workers, health visitors, peer support workers and nursery nurses. The specialist perinatal mental health community workforce has almost doubled in the last five years. Furthermore, 165 mother and baby unit beds have been commissioned, 153 of which are currently operational. Mother and baby units provide in-patient care to women who experience severe mental health difficulties during and after pregnancy.

When a mother goes through the heartbreak of losing her baby, we must do everything we can to support her through bereavement. Many trusts have specialist bereavement midwives who are trained to care for and support parents and families who have suffered the loss of their baby. All trusts in England are signed up to the national bereavement care pathway, which covers a range of circumstances of baby loss, with the aim of offering every bereaved parent the high-quality, safe and sensitive care that they deserve. In October, the Government extended the baby loss certificate service to help mums and dads who go through the nightmare of a pregnancy loss.

In addition, health visiting teams are well placed to provide mental health support to new parents. They can offer assessment at each contact, appropriate interventions and referrals when necessary. Some areas have health visitors who specialise in perinatal mental health to strengthen provision for families who need it.

However, service provision can and must be made stronger. That is why we are working with partners to improve the current health visiting services, including by looking at how we can best improve support for parental mental health, and by ensuring that it is sustainable for an overstretched workforce.

This Government want every child to have the very best start in life. Last month, we announced £126 million of funding until 2026 through the family hubs and Start for Life programme. That will provide a raft of support for families with babies, from pregnancy up to the age of two. It includes funding for bespoke support for parents and carers with perinatal mental health difficulties, and for parents-infant relationships.

This Government are committed to tackling suicide, which is one of the biggest killers in this country. My hon. Friend the Member for Aylesbury makes a very good point about building awareness and good allyship in order to reduce suicide risk. The suicide prevention strategy targets pregnant women and new mothers as a priority group for additional support, so that fewer loved ones will go through the heartbreak of losing a friend or relative to suicide. More than 100 measures have been outlined in the strategy, aimed at saving lives, providing early intervention and supporting anyone going through the trauma of a crisis.

The Voluntary, Community and Social Enterprise Health and Wellbeing Alliance, managed by the Department of Health and Social Care, NHS England and the UK Health Security Agency, has sponsored a project, led by the Tommy’s and Sands Maternity Consortium, which explores experiences of perinatal suicide and self-harm and their risk factors. We have allocated funding to 79 organisations up and down the country from our £10 million suicide prevention fund over the two years to March 2025. Those organisations, many of which are grassroots and community-led, are delivering a broad and diverse range of activity that will prevent suicide and help save lives.

I have taken careful note of the four proposals that my hon. Friend the Member for Aylesbury set out clearly in her speech, and I will work with my officials to give them the detailed consideration that they deserve. Although it takes huge courage to speak out about such painful matters in public, I have always thought that that is a vital part of our public discourse, which is enriched when we bring our experiences to these debates. I again pay tribute to my hon. Friend and all hon. Members who have taken part in this debate.

Question put and agreed to.

Terminally Ill Adults (End of Life) Bill (Fourth sitting)

Stephen Kinnock Excerpts

Committee stage
Wednesday 29th January 2025 Public Bill Committees

[The Chair]

For the benefit of our guests, the next questioner, Stephen Kinnock, is our Health Minister.

[The Minister for Care (Stephen Kinnock)]

Q I have a specific question about the period between the legislation passing in your Parliament and the commencement of its provisions and the implementation of voluntary assisted dying. Can you say a little more about what had to be done in that period: the institutional arrangements that were needed between the Act’s passage and its commencement, and the training, capacity building and practical measures that you had to put in place? Did you do that from a standing start, so that in that 18-month period you went from having no training and no institutional set-up to being ready to take the system forward?

Dr Fellingham: Our law was passed on 19 December 2019 and came into effect on 1 July 2021. Ostensibly we had an 18-month period, but of course something fairly dramatic in health happened in 2020. Despite that, what happened at Department of Health level began first. The Department of Health set up an implementation leadership team and gathered specialists together from all across Western Australia in various different aspects. They had eight different workstreams looking at the eight different parts of the Act that they had to operationalise—the pharmacology, the substance and what that was going to look like, the doses and how it was going to be administered, the set-up of the pharmacy, and things like that. Each of those eight workstreams worked everything out at a Department of Health level.

Approximately six months before the law was enacted—on reflection, that was probably not long enough, but covid was very much complicating everything at the time—they set up a working group with the clinical leads in the various health service provider organisations. We were then tasked with taking that broad overview and turning it into a service at the point of delivery, on the understanding that we understood the nuances and expectations of the different hospitals and health systems in which we operated.

I will not lie: it was an enormous task. I leant very heavily on our wonderful Victorian colleagues who had gone first. I do not know what I would have done if I had been the first to pave the way. Subsequently, I have been able to offer that level of assistance to each of the other states and territories that have gone after Western Australia, and then of course to the UK, Scotland and Jersey, which I have been working with quite a lot. There is a wonderful international, collaborative sense of information sharing and wanting to get this right, learning from experience and not reinventing the wheel.

The vast majority of the laws that apply across the whole of Australia and New Zealand are quite similar, and they are similar to what you are planning to legislate for in the United Kingdom. A lot of fantastic groundwork has been laid already, and it can be done even in a challenging healthcare context, like covid or our resource limitations.

[Stephen Kinnock]

Thank you very much for that very comprehensive answer. Is there anything that our other guests would like to add?

Dr Mewett: As I was on the very first implementation taskforce, running blind, I probably could not add much more, except to say that it can be done. One has to focus on the readiness of practitioners, the readiness of health services, the readiness of the population and a whole range of other issues, including the pharmacy service. We have a state-wide care navigator service, which assists patients and doctors in the space. We had to set up a lot of services, and that gave us the time to do so. It was very successful and very challenging, but fortunately we did not have covid in our way.

[Danny Kruger (East Wiltshire) (Con)]

Q I am very grateful for your evidence; it is really useful. I want to state, for the record and for information, that we have before us today three professionals from Australia, all of whom support the laws in that country, and that we heard yesterday from two American doctors, who were also supportive of assisted suicide laws, even though in both countries there are many doctors who oppose what is happening. I regret that we are not hearing evidence from them, but it is very helpful to have your input.

Dr Fellingham, I was interested in your point about the distinction between the Australian model and the model in Canada and elsewhere. You are suggesting that most people who seek assisted death do so for what I think you called “existential reasons”. It is certainly not because of an absence of care, although we do see evidence of that in many countries. Can you expand on why you think it is so important that we have the terminally ill definition in the Bill, rather than recognising pain and suffering as the reason for seeking assisted dying, when I think most of the public who support a change in the law do so because they recognise that many people would naturally want to avoid pain and suffering? Yesterday, we heard from people who said that that is the right reason and that we should write that into the law. Why should we not do that?

Dr Fellingham: That is a very good question and I am grateful that you have asked it. We absolutely have to keep at front and centre that pain and suffering are primary drivers for people seeking access to relief of suffering, whether that is at the end of life or in any interaction that they have with healthcare providers. I speak to remind you that these laws apply to terminally ill people, because I feel that that is a lot easier for us to understand and get our heads around, but it does not detract from the fact that suffering can be a feature of non-terminal illnesses. There are people who can suffer terribly for very long periods of time—dementia being a clear example, but one that would be incredibly challenging to legislate for at this early stage.

What is interesting about the parallels you draw between pain and suffering is that it is a quite common conception that pain is suffering and suffering is pain, and that people seek access to relief of suffering at the end of life because it is the physical symptoms that are the most debilitating. Of course, the physical symptoms can be horrendous—pain, nausea, vomiting, anorexia; there are a multitude—but they are symptoms that we tend to be really quite good at treating. We have a whole range of medications in our palliative care spectrum that are very good at treating those physical symptoms, so it is quite rare that people prioritise those when thinking about this.

But suffering is subjective and it is context-dependent. What suffering is to me might be completely different from what it is to you, even if we are suffering from what looks to be, from the outside, the same disease. Suffering and distress—the thing that makes us human: the existential overlay of our own interaction with the world and how that is impacted by our disease process—is an incredibly personal journey and one that is extremely challenging to palliate, and it is very, very distressing for patients, their families and their practitioners if we cannot support people who are suffering at the end of life. Does that answer your question?

Speech and Language Therapy

Stephen Kinnock Excerpts

Monday 27th January 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Mr Vickers. I congratulate my hon. Friend the Member for Lichfield (Dave Robertson) on introducing this important debate, and on the passionate, moving and powerful way in which he spoke, particularly about his mother. I would really like to thank him for sharing those personal experiences. I also thank every Member who has spoken today. We have heard really compelling accounts about access to speech and language therapy for both children and adults.

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

I thank my hon. Friend the Minister for giving way, and my apologies, Mr Vickers; I had to leave earlier for a ministerial appointment.

In 2018 my father suffered a stroke, and the staff at my local hospital, the George Eliot, could not do enough for him—they were absolutely fantastic. I know that my father stayed in hospital longer than he needed because that was the only way in which he could access the speech and language therapy that he needed, as well as the help to enable him to swallow. It was fantastic to see him recovering that speech because of their intervention. As he had served for nearly 50 years as a volunteer magistrate, it is wonderful to see him now being able to challenge my ideas and give his comments on my contributions in this House.

Last week, I held a consultation event in my constituency where a dietician told me that she felt there was not enough ability for her and her team, as well as speech and language therapists, to give help in the community. She was quite excited about our ideas for virtual wards and asked me, on her behalf, to plead with the Minister to ensure that we give recognition to putting more speech and language therapy in the community. I know that my dad would have been very pleased to receive that.

[Martin Vickers (in the Chair)]

Order. Interventions should be brief— I was very generous.

[Stephen Kinnock]

I thank my hon. Friend for that wonderful example of the personal experience that so many Members on all sides of the House have of this service, which can be life-changing for so many people. I pay tribute to her father for coming through in the way that he has, and I also pay tribute to all those in the community care services. The care that he received was obviously vital and life-changing for him, and that is wonderful to hear.

My hon. Friend raises an interesting point on virtual wards. It is absolutely right that we build on the innovation and opportunities that they offer. Later in my speech I will say a word or two on the three big shifts that we will put at the heart of our 10-year plan: from hospital to community, from sickness to prevention and from analogue to digital. I think the virtual wards are a great illustration of how we can bring those three seismic shifts together to transform our health and care system. I can tell my hon. Friend that the 10-year plan is the right forum and opportunity for that, and I encourage her and all Members to get involved in that plan, which can be accessed at change.nhs.uk. Hon. Members may also wish to organise roundtables and discussion fora in their constituencies to talk exactly about the kind of innovations that we are looking to bring to the fore.

It would be remiss of me not to pay tribute to Mikey Akers; he is an outstanding young man and truly an example to us all. Of course, I also pay tribute to Chris Kamara and the whole team campaigning with such vigour and verve on this vital issue. I would of course be delighted to meet Mikey, Chris and the team at a mutually convenient time to discuss the project and how to take it forward.

As our debate today has shown, speech and language therapists work with people of all ages, providing specialist care and support. Their work takes place across a range of different settings in health, care and education. It responds to a wide range of communication needs, from those of children whose speech is slow to develop to those of older people whose ability to speak has been impaired by illness or injury, for example as a result of Alzheimer’s, a stroke or head injury. Speech and language therapists also support patients who have difficulties with eating, drinking and swallowing.

The variety of support that speech and language therapists provide means that they play a key role in a wide range of care pathways. A speech and language therapist is a core part of the multidisciplinary stroke rehabilitation team, providing long-term rehab for stroke patients. It is not just patients they support—a speech and language therapist also works with a patient’s family or carers on how best to facilitate communication and support the patient, sharing their expertise to upskill the support network of the person they are caring for.

Another example of the work of speech and language therapists is the role they play in supporting autistic people. They can offer interventions to improve communication skills where needed. For individuals who are unable to speak, speech and language therapists can design alternative communication systems.

Moreover, as part of a wider multidisciplinary team, speech and language therapists also contribute to a young person’s education, health and care plan. A therapist will carry out a detailed assessment of an individual’s speech, language and communication abilities, which will help to determine the additional support they may need to access education.

However, it is the key role that speech and language therapy plays in care and support pathways that creates complexity in funding and commissioning models for it. In some cases, full care pathways are commissioned as opposed to individual services within a particular pathway, while in some areas community health services are commissioned using block contracts. Both these things create challenges in clearly identifying specific funding streams for specific services.

Speech and language therapy is generally commissioned locally by integrated care boards and in some cases by local authorities. Funding is allocated to ICBs by NHS England. The allocations process uses a statistical formula to make geographical distribution fair and objective, so that it more clearly reflects local healthcare needs and helps to reduce health inequalities. This process is independent of Government, and NHS England takes advice on the underlying formula from the independent Advisory Committee on Resource Allocation. NHS England is also continuing to work with ICBs to develop their financial plans.

NHS planning guidance sets priorities for systems, and the Secretary of State has confirmed that this key document will be published in due course—indeed, imminently. Each ICB will then commission the services they need for their local area, taking into account their annual budget, planning guidance and the wider needs of the population they cover. Local commissioners are responsible for ensuring that their offer is tailored to the local population and that their communities are able to access the specific support they need. NHS England continues to work with ICBs to develop their financial plans, to ensure that communities can access the healthcare support they need when they need it. A complex patchwork quilt of systems and processes needs to be gone through by the people who know best about what is required in their community—those at the coalface—to deliver the care that is needed.

That said, I reassure hon. Members that the Government are committed to funding the NHS properly. We recently provided a £26 billion boost for health and social care at the Budget through the policies and choices that the Chancellor laid out. We have been clear that funding must go hand in hand with reform, and we will ensure that every penny of extra investment in the NHS is well spent.

The community health services data plan, published by NHS England last year, goes some way to improving data about community health services. The plan sets out how the NHS aims to improve the quality and relevance of data, and the timeliness of its publication. It will improve our understanding of demand and capacity across community health services, including speech and language therapy, with high-quality data to generate helpful insight to shape interventions and improvements to services.

Data and clear funding lines are not the only challenge facing speech and language services. Our children and young people are stuck on waiting lists, some for more than two years. More than 65,000 children and young people were on a waiting list for speech and language therapy in November 2024. We know that more than 23,000 have been on those waiting lists for longer than 18 weeks. That is simply too long. Waiting times for adults are not as bad as those for children and young people, but there were more than 23,000 adults on waiting lists for speech and language therapy in November 2024.

We hear a lot about the increasing demand for speech and language therapy, and about the fact that our existing workforce are struggling to meet the increase in referrals—pretty much every hon. Member said that in the debate. The reason for the increase in waiting times is multifaceted. Although services are still recovering from the pandemic, there has also been an increase in demand, and analysis from the Royal College of Speech and Language Therapists shows that demand is increasing faster than the workforce are growing.

Speech and language therapy covers a broad spectrum of support. Therapists are often dealing with complex long-term cases, requiring a resource-intensive approach to supporting their patients, and referral pathways are often complex. Those referral pathways, and the services offered, also vary regionally.

As my hon. Friends pointed out, we are coming off the back of 14 years of failure, which have led to serious workforce challenges, and the reality is that we have a mountain to climb on recruitment and retention. The speech and language degree apprenticeship is now in its third year of delivery and offers an alternative pathway to the traditional degree route into a successful career as a speech and language therapist. We think that that has had a positive impact on recruitment, but much more needs to be done. We want to remove the barriers to training in clinical roles, which is why eligible students get a non-repayable grant of £5,000 a year. Further financial support is also available for childcare, dual accommodation costs and travel, but we know that that does not go far enough.

The training and retention of our talented NHS staff are absolutely key to our mission of rebuilding a health service that is fit for the future. A central part of the 10-year plan concerns our workforce and how we ensure that we train and provide the staff, technology and infrastructure that the NHS needs to care for patients across our communities.

This summer, we will publish a refreshed long-term workforce plan to deliver the transformed health service that we will build over the next decade and that will treat patients within the 18-week constitutional standard once again. We will ensure that the NHS has the right people in the right places, with the right skills to deliver the care that patients need when they need it. We must acknowledge that tackling this will take time, but we are committed to training the staff we need to ensure that patients are cared for by the right professionals and in a timely manner.

Community health services, and speech and language therapies in particular, speak to the three seismic shifts that will drive our 10-year plan: shifting healthcare from hospitals to communities, focusing on prevention, and embracing digital care. Effective, user-centred services are invariably delivered by multidisciplinary teams that are based in the communities they serve. The early language and support for every child—ELSEC—programme provides an example of different professions coming together to support children and young people, with local authorities, schools and the health and care system working together in the community. In our view, that is a potential building block for how our neighbourhood health service should work.

Nine regional pathfinder partnerships are trialling new ways of working to better identify and support children in early years settings and primary schools. We have asked the pathfinders to consider how to make the model sustainable after the project period. The therapy assistant roles have the potential to attract individuals to train to become speech and language therapists through the apprenticeship route. The ELSEC workforce model focuses on recruiting pre-qualification speech and language therapy support workers into the workforce to improve the capacity and knowledge of staff who support children with emerging or mild to moderate speech, language and communication needs in early years and school settings.

That will be important, because we hear a lot about the challenges our workforce face in meeting the increasing demand for speech and language therapy. Across all community health services, increasing demand and workforce availability are frequently cited as the main reasons that systems are struggling to reduce waiting times and get on top of the demand. The interim programme evaluation is due to be published in February, at which point we can explore insights into the effectiveness of ELSEC delivery at a local level. Reporting data shows that therapy support teams have supported around 13,000 children so far, and just over 1,000 staff in settings have been upskilled in delivering interventions. That is an encouraging set of achievements, and I will continue to work with my ministerial colleagues and officials across my Department and the Department for Education to support this important programme.

I referred earlier to our ambition to build a neighbourhood health service. We are firmly committed to moving towards our vision for such a service, and community health services will be an essential building block of it—keeping people healthy at home and in their communities, and providing more preventive, proactive and personalised care. Later this year, we are going to trial neighbourhood health centres, which will bring together a range of services and will ensure that healthcare is closer to home and that patients receive the care they deserve.

We have heard about the importance of adequate funding and timely access to speech and language therapy services for children and adults with communication and swallowing needs. The importance of such services is not in doubt, nor is the life-changing impact that timely access to high-quality services can have, from helping a child to develop the right skills to engage with education to supporting adults to regain their ability to speak. Speech and language services are facing challenges, but sustainable, accessible and high-quality community health services are vital, and I will continue to work closely with NHS England, the Department of Health and Social Care and the Department for Education on this critical issue.

[Dave Robertson]

I place on record my thanks to all the hon. Members who have contributed to the debate, starting with the hon. Member for Meriden and Solihull East (Saqib Bhatti), who made an excellent contribution, as I think we would all expect. I congratulate him on his campaigning on this important issue. I thank my hon. Friend the Member for Wolverhampton North East (Mrs Brackenridge) for raising the story of her constituent Samantha, who I am sure will be watching the debate closely.

I thank the hon. Member for Leicester South (Shockat Adam) and my hon. Friend the Member for Hyndburn (Sarah Smith) for reminding us of the importance of supporting the next generation and all those who come after. I thank my hon. Friend the Member for Altrincham and Sale West (Mr Rand) for raising the issue of unacceptably long wait times for speech and language therapy. I thank my hon. Friend the Member for Stoke-on-Trent North (David Williams) for highlighting the caseload faced by speech and language therapists in Stoke-on-Trent and the great county of Staffordshire. I also thank my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) for discussing the need for early intervention and the remarkable impact that it can have.

I thank my hon. Friend the Member for North Warwickshire and Bedworth (Rachel Taylor) for the story of her father’s experience in speech and language therapy. I thank the Liberal Democrat spokesperson, the hon. Member for Winchester (Dr Chambers), for his excellent contribution on the need to raise awareness around aphasia, which does not necessarily get spoken about enough in the community.

I thank the hon. Member for Sleaford and North Hykeham (Dr Johnson), on behalf of His Majesty’s official Opposition, for her considered remarks and for avoiding making the issue a political football. It is really important to highlight where we do agree, because there is often more agreement than people realise in this place. By working together, we can achieve those goals.

I especially thank the Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock)—did I get that right?

[Stephen Kinnock]

Not bad.

[Dave Robertson]

Mam never quite got round to teaching me the Welsh that she speaks. I thank the Minister for his kind words about her and for outlining the complicated funding scenario that currently exists for speech and language therapy, along with the Government’s desires for the future of this therapy as an example of the three shifts that the Government will introduce in the NHS, and the need for people to engage thoroughly with the NHS 10-year plan consultation as a vehicle to securing those changes.

I thank the Petitions Committee for allowing me to lead the debate. It has been a real pleasure, not least because my constituency was the fourth most supportive of the petition. Finally, on behalf of all hon. Members who have been able to contribute today, I say an enormous thanks to Mikey, without whose campaigning we would not be here discussing this issue.

Question put and agreed to.

Resolved,

That this House has considered e-petition 657935 relating to speech and language therapy.

Terminally Ill Adults (End of Life) Bill (Money)

Stephen Kinnock Excerpts

Money resolution
Wednesday 22nd January 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I beg to move,

That, for the purposes of any Act resulting from the Terminally Ill Adults (End of Life) Bill, it is expedient to authorise the payment out of money provided by Parliament of:

(1) any expenditure incurred under or by virtue of the Act by the Secretary of State, and

(2) any increase attributable to the Act in the sums payable under or by virtue of any other Act out of money so provided.

The Government are of the view that the Bill is a matter for Parliament rather than the Government to decide. In order for the Public Bill Committee that is now scrutinising the Bill to consider the clause that would have spending implications, the Government must first table this money resolution. This is purely to allow the Bill to be debated in Committee, and the Government have taken the view that tabling this motion does not act against our commitment to remain neutral. Only the Government can table such motions, so tabling it allows further debate to happen. To assist that debate, the Government will also assess the impacts of the Bill, and we expect to publish the impact assessment before MPs consider the Bill on Report.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister, Dr Kieran Mullan.

--- Later in debate ---

[The Minister for Care (Stephen Kinnock)]

I thank Members for their continued contribution to the debate. The Government are of the view that the Bill is an issue of conscience for individual parliamentarians and it is rightly a matter for Parliament, not the Government, to decide. The money resolution allows the Bill to be debated in Committee, where its detail will continue to be scrutinised. As I have said, the Government will also be assessing the impact of the Bill and we expect to publish an impact assessment before MPs consider the Bill on Report. I therefore commend the money resolution to the House.

Question put and agreed to.

[Jim Shannon (Strangford) (DUP)]

On a point of order, Madam Deputy Speaker. The right hon. Member for North West Hampshire (Kit Malthouse) made a comment that I feel impinged upon my integrity. I have spoken to the right hon. Gentleman and he knows what I am referring to. I underlined and highlighted that the Terminally Ill Adults (End of Life) Bill Committee went into private session; some 15 Members, who support the Bill, voted for the private session and nine Members, who oppose the Bill, voted against the private session. The record must be corrected about what the right hon. Gentleman said about the comments I made about that. Facts are facts; they matter to me, as does my integrity.

Auditory Verbal Therapy

Stephen Kinnock Excerpts

Tuesday 21st January 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a great pleasure to serve under your chairship, Mr Western. I thank my hon. Friend the Member for Washington and Gateshead South (Mrs Hodgson) for securing this vitally important debate, and for her powerful and moving contribution to our discussion.

I would also like to break with protocol and welcome Sam to Parliament today. He is clearly a remarkable young man, and an inspiration to us all—thank you for being here, Sam. Like the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), I thank hon. Members for their excellent contributions today. We have had a range of contributions, including from the shadow Minister, and from the hon. Members for North Shropshire (Helen Morgan) and for Strangford (Jim Shannon), and my hon. Friends the Members for Bury North (Mr Frith), for Bolton North East (Kirith Entwistle), for Derby South (Baggy Shanker) and for Bolton South and Walkden (Yasmin Qureshi). I think that may be all, but huge apologies if I have missed anybody. All their contributions were excellent and very well put.

My hon. Friend the Member for Washington and Gateshead South has done so much work to champion the interests of children with special educational needs and disabilities, including non-hearing children. I know that she also has an excellent partnership with Auditory Verbal UK, which I welcome to Parliament today. I would, of course, be happy to meet its representatives to follow up on all the points made in this debate.

This Government are committed to raising the healthiest generation of children ever. We will deliver on this ambition through the health and opportunity missions, and through the Government’s child poverty strategy. This is not about silos, with each Department delivering one part of a puzzle that does not fit together properly; this is about systemic, holistic change, and ensuring that we join up analysis, expertise and delivery across Government. Our mission-driven Government will drive long-lasting and sustainable change for children now and in the future. We will break down barriers to opportunity and ensure that every child has the best start in life. This includes all children and young people with special educational needs and disabilities, including non-hearing children.

We know that developing early communication skills is a key foundation for life, and there are serious knock-on consequences when that development is delayed. That is why we are committed to improving access to early interventions so that every child can find their voice. With the right support, children with hearing loss can develop effective communication skills, live fulfilling lives and enjoy the same opportunities as everyone else. The Government recognise the importance of the earliest days of an infant’s life. There is strong evidence that the 1,001 days from conception to the age of two set the foundations for our cognitive, emotional and physical development. That is why we are giving a £126 million boost for families to give every child the best start in life.

Thousands of families across England will be able to access family hubs, which will act as a one-stop shop for help with infant feeding advice, parenting classes and perinatal mental health support, among other things. Figures from the National Deaf Children’s Society show that there were more than 45,000 deaf children and young people in the UK in 2023. Between one and two babies in every 1,000 are born with permanent hearing loss in one or both ears. This number increases to about one in every 100 for babies who have spent more than 48 hours in intensive care. Early and effective support is crucial for these children and their families. Permanent hearing loss can significantly affect a baby’s development, so early and effective support is crucial for these children and their families.

It is vital that we intervene at birth. The NHS newborn hearing screening programme—the NHSP—aims to find babies who have hearing loss as early as possible so that the right support and advice can be offered right from the start. As we all know, language is linked to social, emotional and learning outcomes. From birth through to childhood, children and young people with hearing loss might need a range of therapies, such as speech, language and auditory verbal therapy. However, as we have heard today, those children are not always receiving the support that they need.

We recognise the important role of auditory verbal therapy as one of the therapies that can be useful for children with hearing loss. NHS audiology services, including the provision of therapies for children with hearing loss, are locally commissioned, and responsibility for meeting the needs of children with hearing loss lies with local NHS commissioners, because local systems are best placed to meet the needs of their own communities.

After 14 years of Tory neglect, incompetence and austerity, our NHS and care service are on their knees, but this Government are committed to properly funding the NHS, and we recently provided a £26 billion boost for health and social care in the autumn Budget. NHS England is responsible for determining allocations of financial resources. Each ICB will then commission the services they need for their local area, taking into account their annual budget, planning guidance and the wider needs of the population they cover. NHS England is supporting integrated care boards to make informed decisions about the provision of audiology services so they can provide consistent, high-quality and integrated care to non-hearing children.

In July 2016, NHS England published “Commissioning Services for People with Hearing Loss: A framework for clinical commissioning groups”. The framework supports NHS ICBs to make informed decisions to address inequalities in access and outcomes between hearing services.

[Mr Frith]

Does the Minister agree that, for all the good intentions of ICBs, our healthcare system is atomised, but that if they were to take instruction from guidance provided nationally, the pillar-to-post experience of a lot of families seeking auditory verbal therapy would end? Will he commit to updating the nine-year-old guidance to ICBs, or at least acknowledge that it needs updating, with a national pilot that proves the efficacy of AVT for families seeking that intervention?

[Stephen Kinnock]

My hon. Friend will know that one of the constant challenges in the system is getting the right balance between empowering those operating at the coalface—those who are close to the communities and know them best—to ensure they are delivering the best possible services, and ensuring consistency and coherence, both strategic and operational, across the entire system. It is safe to say that we are not always getting that balance right. One of the key objectives of the 10-year planning process that we are going through will be to address the so-called postcode lottery—variation between regions—across the whole range of health and care. Without that cross-cutting strategic look at the system, it will not be possible to get the balance right. I absolutely take the point, but one thing I will say is that we are crystal clear when we issue guidance to ICBs that they must take that guidance into account, and their performance is monitored on that basis.

[Mrs Hodgson]

Am I right in thinking, from what the Minister has just said, that he will issue revised guidance following today’s debate? Am I right that the Government, having given an extra £26 billion to local areas, will give them guidance that they should be looking to commission these services on a much bigger scale, so that we have more than 33 AVT therapists?

[Stephen Kinnock]

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

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

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

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

[Dr Luke Evans]

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

[Stephen Kinnock]

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

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

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

[Helen Morgan]

I am pleased to hear that the Government have increased the number of speech and language therapists, which is so important for young people who are struggling to achieve their potential in an educational setting, but will the Minister address the specific point on commissioning by local authorities? Often, they are so strapped for cash that they are effectively trying to limit demand.

[Stephen Kinnock]

Commissioning is led by ICBs. It is important that ICBs have open channels of communication with local government. We in the Department of Health and Social Care have close contact and engagement with colleagues in the Ministry of Housing, Communities and Local Government, and it is important that that relationship and interaction feeds down through the entire system, but the leading organisations on commissioning are the ICBs.

A number of colleagues raised the question of a pilot scheme to identify how our existing workforce can work differently. The early language and support for every child programme is an excellent example of different professions coming together to support children and young people—local authorities, schools, and the health and care system working together in the community to support our children and young people. The ELSEC workforce model focuses on recruiting pre-qualification speech and language therapy support workers into the workforce to improve the capacity and knowledge of staff who support children with emerging or mild to moderate speech, language and communication needs in early years and school settings.

Nine regional pathfinder partnerships are trialling new ways of working to better identify and support children in early years settings and primary schools. We have asked pathfinders to consider how to make the model sustainable after the project period. The therapy assistant roles have the potential to attract individuals to train to become speech and language therapists through the apprenticeship route. I understand that Auditory Verbal UK is progressing a National Institute for Health and Care Research grant application to support a pilot, and I would welcome an update from AVUK about how that is going when we get the chance to meet.

We welcome the work that AVUK is doing to upskill health professionals to deliver auditory verbal therapy. On the point made by the shadow Minister, the hon. Member for Hinckley and Bosworth, there are as yet no NICE guidelines on hearing loss in children, and NICE has not made any recommendations on AVT specifically. Decisions on the need for guidelines on new topics and updates to existing guidance are made by NICE’s prioritisation board, in line with NICE’s published common prioritisation framework. I understand that NHS England met with AVUK and discussed the need for more high-level research evidence for the intervention and the need to develop evaluations of impact. I am pleased that AVUK has been invited to join the chief scientific officer’s audiology stakeholder group, where it will contribute to decision making.

We recognise the impact on the lives of children of timely access to high-quality services, including different therapies to help children to develop the right skills to engage with education. The Government’s ambition is that all children and young people with SEND or in alternative provision receive the right support to succeed in their education and as they move into adult life. We will strengthen accountability on mainstream settings to be inclusive, including through the work of Ofsted, by supporting the mainstream workforce to increase their SEND expertise and by encouraging schools to set up resourced provision or SEN units to increase capacity in mainstream schools. That work forms part of the Government’s opportunity mission, which will break the unfair link between background and opportunity, starting with giving every child, including those with SEND, the best possible start in life. We will work with the sector, as essential and valued partners, to deliver our shared mission and restore parents’ trust.

I again thank my hon. Friend the Member for Washington and Gateshead South for securing this debate and sharing her insight on the vital issue of early interventions for non-hearing children. We recognise the importance of such services and the life-changing impact they can have on the lives of children. We are committed to ensuring that all children receive the support they need to live healthy, fulfilling lives. I will continue to work closely with NHS England and the Department for Education as we strain every sinew to deliver on those commitments.

Hospice and Palliative Care

Stephen Kinnock Excerpts

Monday 13th January 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I pay tribute to the hon. Member for Wimbledon (Mr Kohler) for securing the debate and making such a powerful and thoughtful opening speech. I thank hon. Members from across the House—there are too many to list. It would be impossible to capture the richness of the contributions made. Something like 28 Back-Bench Members made speeches—I am sure Madam Deputy Speaker will correct me if my numbers are not quite right. It was an excellent debate, and I thank everybody for their contribution. I thank all those who work or volunteer in the hospice and palliative care sector for the deeply compassionate care and support that they provide to patients, families and loved ones when they need it most.

This Government are committed to building a society in which every person receives high-quality, compassionate care, from diagnosis through to the end of life. We will shift more care out of hospitals and into the community, to ensure that patients and their families receive personalised care in the most appropriate setting. Palliative and end of life care services, including hospices, will have a vital role to play in that shift. The reality is that we have a mountain to climb. Our health and care services are on their knees, but this Government will strain every sinew to build them, and to create a health and care system that is once again fit for the future.

In England, integrated care boards are responsible for the commissioning of palliative and end of life care services to meet the needs of their local population. To support ICBs in that duty, NHS England has published statutory guidance and service specifications. While the majority of palliative and end of life care is provided by NHS staff and services, we recognise the vital part that voluntary sector organisations, including hospices, play in providing support to people at end of life, as well as to their loved ones.

Most hospices are charitable, independent organisations that receive some statutory funding for providing NHS services. The amount of funding each charitable hospice receives varies both within and between ICB areas. The variation is dependent on demand in the area, and on the totality and type of palliative and end of life care provision from NHS and non-NHS services, including charitable hospices, within each ICB footprint.

We understand the financial pressures that hospices have been facing, which is why last month I was truly proud that this Government announced the biggest investment in hospices in England in a generation. It will ensure that hospices in England can continue to deliver the highest-quality care possible for patients and their families and loved ones.

[Danny Kruger]

I also welcome that, and congratulate the Minister on getting that money out of the Treasury, but will he acknowledge that there is a difference between capital and revenue? Hospices urgently need support for their day-to-day running costs, not just more money to support the capital. They also need capital support, but that is less crucial.

[Stephen Kinnock]

I take the hon. Gentleman’s point, but hospices face a range of pressures. The capital expenditure injection that we have provided will help them in the round. Clearly, anything that helps a hospice with its budget in the round, be it capital or revenue, will help the hospice.

We are supporting the hospice sector through a £100 million capital funding boost for adult and children’s hospices, to ensure that they have the best physical environment for care. There is also £26 million in revenue funding to support children and young people’s hospices. The £100 million in capital funding will deliver much-needed improvements—from refurbishments to overhauling IT systems and better facilities for patients and visitors—during the remainder of 2024-25 and throughout 2025-26. The investment will help hospices to improve their buildings, equipment and accommodation, so that patients continue to receive the best care possible.

Hospices for children and young people will receive a further £26 million in revenue funding for ’25-26 through what was known until recently as the children’s hospice grant. That investment demonstrates the Government’s recognition of the importance of integrating services to improve the treatment that patients receive. Furthermore, through our plans for neighbourhood health centres, we will drive the shift of care from hospitals to the community, which will bring together palliative care services, including hospices and community care services, so that people have the best access to treatment through joined-up services.

[Warinder Juss]

Money is not always the only solution, so will my hon. Friend confirm how the commission on palliative care that the Government announced last month will improve end of life care?

[Stephen Kinnock]

The Government announced a commission on the future of adult social care. A separate commission was announced by my hon. Friend the Member for York Central (Rachael Maskell) on palliative care. We will certainly monitor the findings of that commission very closely.

We will set out details of the funding allocation and distribution mechanisms for both funding streams in the coming weeks.

[Jim Shannon]

In my contribution, I made the House aware that the Northern Ireland hospice has to cut its beds from seven to six for five days of the week, and at the weekend, there are only three. The Minister knows that I respect him greatly. It is all very well to have capital money available, but there has to be money to run the system and provide beds. Otherwise, we can buy beds, but might not be able to keep them and run a service. There must be something seriously wrong with what he is putting forward.

[Stephen Kinnock]

As I said in a previous answer, hospices face a range of pressures that financial contributions from the Government will help to ease. The funding will, of course, have a knock-on impact on hospices budgets in the round.

In spite of the record-breaking package that we have announced, we are certainly not complacent. There is more work to be done, and through the National Institute for Health and Care Research, the Department is investing £3 million in a policy research unit on palliative and end of life care. The unit launched in January 2024 and is building the evidence base that will inform our long-term strategy. A number of hon. Members requested a long-term strategy and plan, which is sorely missing after 14 years of Conservative neglect and incompetence. I agree that we need a long-term plan, and assure Members that conversations are taking place between my officials and NHS England. The research needs to be based on evidence and facts, which the unit will help us to get.

[Dr Ben Spencer]

It is important that this debate is not a political ding-dong, and I really appreciate the tone that all Members, including the Minister, have taken. On evidence and facts, will he look into the impact of the national insurance contribution rises on hospice care and provision, how many hospices are running a deficit, and how many will likely go into deficit as a result of his policies?

[Stephen Kinnock]

The hon. Gentleman will not be surprised to know that I have a section in my speech on employer national insurance contributions. I will get to it.

A number of colleagues raised concerns about regional variations. Facts and evidence are very important in that context. To address that issue, NHS England has developed a palliative and end of life care dashboard, which brings together all the relevant local data in one place. The dashboard helps commissioners to understand the palliative and end of life care needs of their local population, enabling ICBs to put plans in place to address, and track the improvement of, health inequalities, and to ensure that funding is distributed fairly, based on prevalence.

[Gregory Stafford]

Will the Minister give way?

[Stephen Kinnock]

I will, but I have to finish at 9.58 pm, so there is only about five minutes left of my contribution.

[Gregory Stafford]

It is generous of the Minister to give way, so I shall be brief. Would funding continue to be produced through ICBs, or will the system be funded centrally?

[Stephen Kinnock]

That is precisely the topic of conversation for officials in my Department and NHS England, who are looking at this issue in the round and deciding how we will work. We need a system that empowers ICBs to deliver at the coalface, but we also need accountability from the centre to ensure that things are delivered. Getting the balance right is never easy, as I am sure the hon. Gentleman will understand; that is what we are trying to navigate.

Alongside NHS England, my officials and I will continue to proactively engage with our stakeholders, including the voluntary sector and independent hospices, to understand the issues that they face. In fact, I will meet the major hospices and palliative care stakeholders, including Hospice UK, early next month to discuss potential solutions for longer-term sector sustainability. That will inform our 10-year health plan.

[Munira Wilson]

On the children’s hospice grant, will the Minister confirm that it will be ringfenced, and that it will go beyond the one-year settlement?

[Stephen Kinnock]

Again, that is on the agenda for discussion with officials. Having inherited a disastrous situation, we are using 2025-26 to stabilise and to try to enable the sector to survive. The hon. Lady will understand that as well as doing that, we are looking at long-term reform solutions, but when we came into power on 4 July, it was one minute to midnight, and we had to rescue the sector. That is what we are doing, and we will look at the long-term issues in due course.

A number of Members have raised the concern around employers’ national insurance contributions. Since we came to office in July, we have been completely focused on repairing the catastrophic legacy of 14 years of Conservative neglect and incompetence. The first step was to fix the foundations of the public finances at the autumn Budget, and that enabled the spending review settlement of a £22.6 billion increase in resource spending for our health and care system. Our approach to ENIC exemptions has been consistent with the Office for National Statistics definition and the approach taken by previous Governments. It does not include an exemption for independent contractors, including charities like hospices, although December’s record funding announcement was a clear recognition of our commitment to financially supporting this vital sector more broadly.

I ask Opposition Members from all parties who luxuriate in criticising the means by which we have raised the record funding for hospices what they would do. How would they have raised the £22 billion that our autumn Budget delivered? Which taxes would they raise? Which public services would they cut? Answer comes there none. The Government recognise the need to protect the smallest businesses and charities, such as hospices, which is why we have more than doubled the employment allowance to £10,500, meaning that more than half of businesses and charities with ENIC liabilities either gain or see no change next year.

While the debate is not about assisted dying, I want to say a word on the matter. My hon. Friend the Member for Spen Valley (Kim Leadbeater) put forward her Bill, and it has received its Second Reading. It is vital that our approach to end of life care and patient choice is holistic and driven by an in-depth understanding of patient need.

I thank everybody across the House for this excellent debate. Actions speak louder than words. This Government have acted to deliver the biggest financial contribution to hospices in a generation.