General Practitioner Recruitment

Stephen Kinnock Excerpts

Tuesday 8th April 2025 Written Statements

[The Minister for Care (Stephen Kinnock)]

General practice sits at the heart of our NHS and is its front door, but it has been neglected for far too long.

We are committed to getting primary care back on its feet and have already taken decisive action to get more GPs onto the frontline. This Government inherited a ludicrous situation where patients could not get a GP appointment, while GPs leaving training could not get a job.

Within weeks of coming into office, we committed to recruiting over 1,000 recently qualified GPs through an £82 million boost to the additional roles reimbursement scheme over 2024-25, as part of an initiative to address GP unemployment and secure the future pipeline of GPs. I am delighted to announce the Government have exceeded this target.

By cutting red tape and investing more in our NHS, we have put an extra 1,503 GPs into general practice to deliver more appointments. See: GPs recruited through the Additional Roles Reimbursement Scheme (ARRS) - NHS England Digital. https://digital.nhs.uk/supplementary-information/2025/arrs-claims-for-gps---to-31-march-2025

The recruitment boost, part of the Government’s plan for change, will help to end the scandal of patients struggling to see a doctor—easing pressure on GPs and cutting waiting times. Alongside changes to the GP contract for 2025-26, these additional GPs will help end the 8 am scramble for appointments, which so many patients currently endure every day.

Previously, primary care networks were limited in how they could use their funding. We have changed that. Now they can hire recently qualified doctors through the additional roles reimbursement scheme—a practical solution that is boosting GP numbers across the country. For 2025-26 we have gone further, delivering more flexibilities to the scheme to allow local systems to respond better to local workforce needs. GPs will be central to our 10-year health plan and shifting healthcare from hospitals to the community.

In February we reached agreement with the British Medical Association on a new GP contract for the first time in four years. We are investing an additional £889 million in general practice to fix the front door of the NHS. That comes alongside reforms to improve access, incentivise greater continuity of care and streamline targets to focus on preventing the biggest killers. And at the autumn Budget, the Chancellor announced £100 million of capital for GP estate upgrades over the next financial year, the biggest central GP capital investment since 2019-20.

Thanks to these decisions, the Government have already delivered over 2 million additional elective appointments since July, meeting their target seven months early, and brought the referral to treatment waiting list down by 193,000. But we are not complacent, and we know the job is not done. We are determined to go further and faster to deliver more appointments, faster treatment, and an NHS that the British public deserve as part of our plan for change.

[HCWS586]

Congenital Hyperinsulinism

Stephen Kinnock Excerpts

Tuesday 8th April 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Ms Butler. I thank my hon. Friend the Member for Warrington South (Sarah Hall) for securing this important debate, which really is a tribute to her and to her constituents, Ibbie and her family, who have clearly been through a very challenging time but have shown tremendous strength, bravery, love and compassion. I would be grateful to my hon. Friend if she could pass on our very best wishes to the family and thank them for helping us to look at this issue.

The birth of a new member of the family should be a moment of excitement, celebration and, indeed, exhaustion. Realising that their baby might have a serious illness should be the last thing on any new parent’s mind. That is why getting help quickly is so important, as is ongoing support. Around 95 children are born with congenital hyperinsulinism in the UK each year. Although that means it is a rare disease, it should not be overlooked.

The Government are committed to improving the lives of people living with rare diseases. On that point, I have carefully noted the seven asks that my hon. Friend the Member for Warrington South listed, including her request to meet the relevant Minister. I should say that the lead Minister in this area is our colleague the Minister of State for Health, who is not present today—I am standing in for her. My officials will pass on to her all my hon. Friend’s asks, including the one for a meeting. I am sure that the Minister of State for Health will be happy to follow up on those points.

Rare diseases like congenital hyperinsulinism are individually rare but collectively common. There are more than 7,000 rare conditions, meaning that one in 17 people will be affected by one over their lifetimes. Each condition will have different symptoms and experiences, and every person is unique. Despite that, across all rare diseases there are shared challenges, which have shaped the approach of the UK rare diseases framework and England’s annual action plans. The national conversation on rare diseases in 2019 identified four priorities for the framework: ensuring that patients get the right diagnosis faster; increasing awareness of rare diseases among healthcare professionals; the better co-ordination of care; and improving access to specialist care, treatment and drugs.

[Graeme Downie (Dunfermline and Dollar) (Lab)]

I congratulate my hon. Friend the Member for Warrington South (Sarah Hall) on securing this important debate. I had not intended to intervene, but my hon. Friend raised issues similar to those in my constituency in respect of young boys diagnosed with Duchenne muscular dystrophy, who are having difficulty accessing the drug Givinostat in Scotland. I am aware that the Minister might not be able to respond immediately, but will he meet me to discuss access to that drug in Scotland, and how we can help other young people affected by a rare disease?

[Stephen Kinnock]

I am happy to look into that. Healthcare in Scotland is devolved, but all the nations of the United Kingdom can learn a huge amount from each other—nobody has a monopoly on good ideas—and it would be excellent to find out a little more about the issues my hon. Friend referred to.

The four framework priorities form the “what” of what we do, and are supported by underpinning themes—the “how” of how we get there. The themes include keeping the patient voice at the heart of all we do. I pay tribute to advocacy groups such as the Children’s Hyperinsulinism Charity and Genetic Alliance UK for their excellent work supporting families and continuing to raise important issues that help to make things better for people with congenital hyperinsulinism.

In England, we published the fourth rare diseases action plan on 28 February, which is otherwise known as Rare Disease Day. The plan provides updates on the progress made since the beginning of the framework in 2021. I am pleased to say that it also includes three new actions for the future, which aim to improve the co-ordination of care, make things easier for families who need to visit multiple specialists, and improve the environment for research on rare diseases in the UK.

Receiving the right diagnosis as soon as possible is vital, particularly for conditions that present in infants and young children, such as congenital hyperinsulinism. The Exeter Genomics Laboratory is the national provider of hyperinsulinism genetic testing and the research centre of excellence. That lab, the paediatric endocrinologist community, and highly specialised service units have a close relationship, so patients can be diagnosed rapidly and managed effectively via a multidisciplinary team framework.

A diagnosis means that the right treatment can be given early, ultimately helping to improve health outcomes. Advances in genomics represent a huge opportunity to find children with rare diseases as soon as possible. The generation study, which commenced last year, is run by Genomics England and is piloting the use of whole-genome sequencing in newborns to identify more than 200 rare conditions, including congenital hyperinsulinism. The study is now under way and recruiting across 18 NHS trusts. It aims to screen 100,000 babies.

Diagnosis is only the start of managing a rare disease, and I know that there is still unmet need. Too many people continue to struggle with challenges, including lack of access to reliable information or specialist treatment. Only 5% of rare conditions have an approved and effective treatment—that is a shocking statistic. To improve the situation, we have made pioneering research another underpinning theme of the UK rare diseases framework. The highly specialised technologies programme of the National Institute for Health and Care Excellence evaluates technologies for very rare, and often very severe, diseases. We are working with the regulatory system to look at access schemes such as the early access to medicines scheme, the innovative licensing and access pathway, the innovative devices access pathway and the innovative medicines fund. Those schemes are all designed to support the earlier availability of innovative treatments to patients who need them, and they must also work for rare diseases.

Many people struggle to access reliable information on rare diseases. With over 7,000 different rare diseases, which often need highly specialised input, the NHS website is not always the best place for such information—although I note the point that my hon. Friend the Member for Warrington South made about the website, and we will look into that. Patient organisations and charities play an important role in creating high-quality information on rare conditions. Therefore, in this year’s action plan we have set out the steps we are taking to support organisations to get the information they produce accredited under the Patient Information Forum’s trusted information creator—or PIF TICK—scheme, so that families will know they can rely on trustworthy information.

Living with or caring for someone with a rare disease can be mentally tough. We know that people living with rare conditions, and their families and carers, often struggle to access mental health and psychological support. This is not right. Alongside the wider steps that we are taking to improve mental health access, the NHS genomics education programme has this year published new resources on rare diseases and mental health, aimed at healthcare professionals. It has also developed a communications tool to help healthcare professionals with sensitive conversations, to ensure that patients and families feel supported throughout the diagnosis of a rare condition.

I close by again thanking my hon. Friend the Member for Warrington South, as well as those affected by congenital hyperinsulinism and organisations that advocate on their behalf. Although the five-year UK rare diseases framework will come to a close at the start of next year, we remain committed to improving the lives of those with rare diseases. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire (Ashley Dalton) will work with officials and colleagues in the devolved Governments to chart a course forward and maintain the momentum we have built.

Question put and agreed to.

Hospice Funding

Stephen Kinnock Excerpts

Tuesday 8th April 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I thank the hon. Member for Beaconsfield (Joy Morrissey) for securing this important debate. I wish to take this opportunity to thank all those who work or volunteer in the hospice and palliative care sector for the care and support that they provide to patients, families and loved ones when they need it most.

This Government want a society in which every person receives high-quality, compassionate care from diagnosis through to end of life. We are determined to 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.

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 this duty, NHS England has published statutory guidance and service specifications. Although 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 the 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 that each charitable hospice receives varies, both within and between ICB areas. This variation is dependent on demand in that area and on the totality and type of palliative and end-of-life care provision from both NHS and non-NHS services, including charitable hospices within each ICB footprint.

This Government understand the financial pressures that hospices have been facing, which is why we have announced the biggest investment to hospices in England in a generation. We are ensuring that hospices in England can continue to deliver the highest quality end-of-life care possible for patients, and for their families and loved ones. We are supporting the hospice sector with a £100 million capital funding boost for adult and children’s hospices, to ensure that they have the best possible physical environment for the care they give.

We are pleased to confirm that the Government have released the first £25 million tranche of the £100 million capital funding, with Hospice UK kindly allocating and distributing the money to hospices throughout England. An additional £75 million will be allocated in the coming weeks for use in the 2025-26 financial year. The £100 million capital funding will help hospices to provide the best end-of-life care to patients and their families in a supportive and dignified physical environment. Funding will help support hospices and will enable much-needed improvements, including refurbishments, the overhauling of IT systems and improvement of facilities for patients and visitors.

We are also providing £26 million in revenue funding to support children and young people’s hospices. This is a continuation of the funding that, until recently, was known as the children and young people’s hospice grant. ICBs will once again administer the funding to their respective children and young people’s hospices on behalf of NHS England. This is in line with NHS devolution policies, and it promotes a more consistent national approach by supporting commissioners in prioritising the palliative and end-of-life care needs of their local population. I am pleased to confirm that NHS England has now communicated the details of the 2025-26 funding allocation and dissemination to individual hospices.

I do accept that there is unwarranted variation and inequality in access to, and quality of, palliative and end-of-life care in England, but we are working to reduce these variations. NHS England has published statutory guidance and service specifications to support commissioners in prioritising palliative and end-of-life care. It has also developed a palliative and end-of-life care dashboard, which brings together all 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.

NHS England has also published the ambitions framework, which sets out our vision to improve end-of-life care through partnership and collaborative action between organisations at a local level throughout England. Additionally, NHS England has developed an assurance system with specific steps and deadlines to ensure the timely dissemination of the £26 million revenue funding to children and young people’s hospices, because we know that there were some quite significant problems last year with the transmission from NHS England through the ICBs to hospices. These steps include regular oversight sessions with ICBs, regions and hospices and giving ICBs a hard deadline within the first quarter of the financial year by which they are expected to disseminate the funding to hospices, including escalating to NHS England if any ICB is unable to meet the deadline. If the deadline is missed, NHS England has put steps in place to ensure that all hospices receive the funding within the timescales outlined.

We, alongside key partners and NHS England, will continue to engage proactively with our stakeholders, including the voluntary sector and independent hospices on an ongoing basis to understand the issues they face. In fact, I recently visited Katharine House hospice in Stafford and heard from staff how important our record investment has been to them. More widely, in February I met key palliative and end of life care and hospice stakeholders in a roundtable format to discuss long-term sector sustainability in the context of our 10-year health plan.

I recognise the concerns that hon. Members have raised about funding and employer national insurance contributions. In July last year we inherited public finances in their worst state since the second world war, and we took the necessary decisions to fix the foundations in the public finances at the autumn Budget, enabling the spending review settlement of a £22.6 billion increase or uplift in resource spending for the Department of Health and Social Care from 2023-24 out-turn to 2025-26.

I gently point out to the Conservative party that while I believe it has welcomed that unprecedented settlement, to my knowledge it has been silent on its preferred means of generating that revenue. I gently say that Opposition Members cannot have it both ways. They cannot welcome the £22.6 billion on the one hand but, on the other hand, condemn the way in which the money is to be raised without coming up with their own plan and proposals for how they would raise those funds.

[Rachael Maskell]

We have to recognise that the hospice sector is in quite a difficult place financially. However, if there is good advance care planning, money currently spent in secondary care could be invested in the hospice sector and in more community provision. Surely that must be a first step that would not only get better clinical outcomes but be better for the whole of the palliative care pathway.

[Stephen Kinnock]

My hon. Friend speaks with tremendous and deep knowledge of the sector. I welcome the work that she is doing on the commission on palliative and end-of-life care, and we very much look forward to seeing the outcomes and results of that.

My hon. Friend is right that if we are to make the three big shifts at the heart of our 10-year plan—the shifts from hospital to community, from sickness to prevention, and from analogue to digital—the delivery of that will require a left shift in terms of both funding and reform. It is absolutely right that we take a hard-headed look at funding across our NHS and ensure that funding is going to where it is needed. She will know that the share that hospitals get of overall NHS funding has gone up dramatically since the early 2000s, to the detriment of primary care, community care and palliative care—all the things that happen outside hospital. That is something that we must address and shift upstream, because we will never solve the considerable challenges that our NHS is facing until we make that left shift.

I note that the funding announcement was warmly welcomed by the sector. Toby Porter, chief executive of Hospice UK, said:

“Today’s announcement will be hugely welcomed by hospices, and those who rely on their services. Hospices not only provide vital care for patients and families, but also relieve pressure on the NHS. This 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, when and where they need it.”

I hope that the measures I have outlined in my response to the hon. Lady will go some way to reassuring all Members of this Government’s unwavering commitment to the sustainability of the hospice and wider palliative and end-of-life care sector.

[Joy Morrissey]

I thank the Minister for outlining what the Government are doing. Will he consider looking at the exemption to the national insurance increase for workers and at allocating more funding directly to hospices so that they can conduct the palliative care that is needed in the out-of-hospital care provision? Although the Government may want to give it to palliative care, there is no directive that does so at this time, aside from capital expenditure. Therefore, could more money be allocated to hospices for operational costs?

[Stephen Kinnock]

The definition of where employer national insurance will be levied is based on the Office for National Statistics’ definition of where it should be, and it is the same definition used by previous Governments. I do not think that point is up for debate.

[Joy Morrissey]

To clarify, the NHS and the staff within it are exempt from the changes. How is that part of the national statistical average, when everyone in healthcare who is under the NHS umbrella is exempt from the changes? All I am asking is for hospice care, which is out-of-hospital care provision and which technically falls within adult social care, to be incorporated into the exemptions already given to the NHS.

[Stephen Kinnock]

The exemption was given to 100% full-time workers within the NHS; in essence, hospitals. As regards GPs, dentists and care providers, ENICs are being levied on those other parts of the health and care sector. Every aspect of my portfolio is therefore seeing ENICs being levied.

[Rachael Maskell]

A suggestion to the Minister would be to integrate the staff working in hospices into the NHS payroll. It would be that simple to exempt them from those national insurance increases.

--- Later in debate ---

[Stephen Kinnock]

The decisions on ENICs and where they are being levied have been made. I think it was made very clear that the line was drawn where it was drawn. Any attempt to try to reverse engineer where that line should be drawn would not really be aligned with the policy decisions that were made at the Budget.

[Sir Bernard Jenkin]

Was it the Government’s intention to put an additional tax on hospices? Is that exactly what the Government intended to do, or is that an unforeseen consequence?

[Stephen Kinnock]

I would not dare to speak from this Dispatch Box on behalf of the Chancellor, but I am absolutely clear that when she did the autumn Budget, she knew that she had to dig us out of a very deep hole indeed, and that required levying taxes that she had to levy. The line had to be drawn somewhere and that is where the line was drawn.

On the other questions asked by the hon. Member for Beaconsfield, the funding has gone through Hospice UK, so it is not direct funding in that sense. Hospice UK has kindly co-ordinated the process because it is extremely well informed about which hospices across the country have opportunities to upgrade their infrastructure, whether that be IT infrastructure, refurbishment or whatever it might be. It has reviewed those proposals, worked at tremendous pace and, as a result, we have managed to deliver the entire £25 million of the first tranche. We are now working closely with Hospice UK on the £75 million and I am confident that that money will be out of the door and into hospices in very quick time this year, based on the outstanding performance on the first £25 million tranche. I therefore hope the hon. Lady will be reassured on that point.

In closing, I hope that we at least have a consensus on the vital importance of hospices. The Government are committed to working at pace to ensure that we secure a sustainability and solidity for the sector going forward. I thank the hon. Member for Beaconsfield once again for securing this important debate. I also thank and wish everybody in this Chamber all the very best for the recess, and I look forward to seeing them all on the other side.

Question put and agreed to.

Eating Disorder Awareness

Stephen Kinnock Excerpts

Tuesday 1st April 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your maiden chairship today, Mr Stuart. I am extremely grateful to the hon. Member for Bath (Wera Hobhouse) for securing the debate and raising this important topic. I know that, as a Member of this House and chair of the APPG on eating disorders, she has been a doughty champion for those living with eating disorders, their families and supporters. I am also grateful to other hon. Members for their valuable contributions, many of which were deeply personal and profoundly moving. I pay tribute to hon. Members for making those contributions.

I share the desire of the hon. Member for Bath to improve the lives of people affected by an eating disorder. Raising awareness of eating disorders and improving treatment services is a key priority for the Government, and a vital part of our work to improve mental health services. We know that living with an eating disorder can be utterly devastating, not just for those battling the condition but their loved ones and those who witness their struggle. We know that eating disorders can affect people of any age, gender, ethnicity or background. However, we also know that recovery is possible, and access to the right treatment and support can be lifechanging, as we have heard today.

Although record investment and progress has improved access to eating disorder services, the reality is clear: demand has surged, especially since the pandemic, outpacing the growth in capacity. We must do more to ensure that everyone who needs support can get it without delay.

[Wera Hobhouse]

The Minister is making a powerful point. Demand is surging, yet it seems that investment from ICBs is going to fall. How can that be possible, and how is it morally acceptable?

[Stephen Kinnock]

National funding has increased over the years, as the hon. Lady will know. The question is whether that funding channels through to ICBs. The Government’s view is that ICBs are best placed to make decisions as close as possible to the communities that they serve and to target and, if necessary, reallocate funding accordingly. As a Government, we are constantly trying to get the balance right between setting frameworks and targets and ensuring that those are being met, while also ensuring that ICBs are not being micromanaged from the centre. We do not think it is right that people sitting in Whitehall or Westminster micromanage what is going on at a local level. We are absolutely clear that every ICB must meet its targets, while also being clear that it is up to the ICB to take decisions as close as possible to the communities that they serve.

Sadly, we have seen the prevalence of eating disorders in children and young people sharply increase since 2017. In 2023, NHS England published follow-up results to its survey on the mental health of children and young people. The report found that the prevalence of eating disorders in 17 to 19-year-olds rose from 0.8% in 2017 to 12.5% in 2023. Unfortunately, we are also seeing the prevalence of eating disorders rising among adults. The 2019 health survey for England showed that 16% of adults over 16 screened positive for a possible eating disorder. The figures do not mean that the individual had a confirmed eating disorder, but they present a worrying situation that we must address by continuing to promote both awareness and early intervention.

The surge in demand has inevitably made meeting our waiting time targets more challenging. However, our services and clinicians, backed by new funding, are supporting more people than ever before. These services are changing and saving lives. As hon. Members will know, we have kept in place the access and waiting time standard for children and young people who are referred with eating disorder issues. This sets a 95% target for children with urgent cases to begin treatment within one week, and for children with routine cases to start treatment within four weeks.

Figures released last month show that although the number of referrals and demand for services has begun to stabilise during the past year, the number of children entering treatment reached a record high of 2,954 last quarter. This shows that the extra funding is enabling services to begin to meet the extra pressures caused by the pandemic. Similarly, the number of children entering treatment within the target time has reached a record high. Of the 2,954 children entering treatment last quarter, 2,414 were able to access that treatment within the one-week urgent target or the four-week routine target—a rate 81.7%. That is the highest figure recorded since NHS England began collecting that data in 2021.

However, we recognise that there is still far more to be done to ensure that patients with eating disorders can access treatment at the right time. The hon. Member for Bath rightly focused the debate on the importance of awareness. Raising awareness of eating disorders is the first step towards early intervention to prevent the devastating impacts that eating disorders can have on people’s lives. To support this, NHS England is currently refreshing guidance on children and young people’s eating disorders.

The refreshed guidance will highlight the importance of awareness and early recognition of eating disorders in schools, colleges, primary care and broader children and young people’s mental health services. A number of colleagues asked when that guidance will be published; my officials are working hard with specialists on that, and it will be published later this year.

The existing mental health support teams, supplemented by the specialist mental health professionals that we will be providing access to in every school in England, will support school staff to raise awareness and identify children and young people showing potential early signs of an eating disorder. Through these interventions, children and young people can be given early support and help to address problems before they escalate.

Community-based early support hubs for children and young people aged 11 to 25 also play a key role in providing early support for young people’s mental health and wellbeing. Early support hubs provide open-access drop-in mental health services that assist children and young people with a range of issues, such as eating disorders, at an early stage without the need for a referral or doctor’s appointment.

I am pleased to say that this year, thousands more young people will receive support with their mental health, thanks to £7 million of new funding for 24 existing community-based early support hubs to expand their current offer. That funding will deliver 10,000 more interventions such as group sessions, counselling therapies and specialist support over the next 12 months. Looking forward, we are also committed to rolling out open-access young futures hubs in communities. This national network is expected to bring local services together and deliver support for young people facing mental health challenges, including support for those with eating disorders.

We should also be concerned about the widespread availability of harmful online material that promotes eating disorders, suicide and self-harm, which can easily be accessed by people who may be vulnerable. We have been clear that the Government’s priority is the effective implementation of the Online Safety Act, so that those who use social media, especially children, can benefit from its wide-reaching protections as soon as possible. Our focus is on keeping young people safe while they benefit from the latest technology. By the summer, robust new protections for children will be enforced through the Act to protect them from harmful content and ensure that they have an age-appropriate experience online.

It is right to focus on awareness and early intervention, but we know that some people simply need access to high-quality treatment in order to get better. A key priority of this Government is therefore to expand community-based services to treat eating disorders, so that people can be treated earlier and closer to home. NHS England is working to increase the capacity of community-based eating disorder services. By improving care in the community, the NHS can improve outcomes and recovery, reduce rates of relapse, prevent children’s eating disorders continuing into adulthood and, if admission is required as a last resort, reduce the length of time that people have to stay in hospital.

I am pleased to say that funding for children and young people’s eating disorder services has increased, rising from £46.7 million in 2017-18 to a planned £101 million in 2024-25. With this extra funding, we can focus on enhancing the capacity of community eating disorder teams across the country. We are also committed to providing an extra 8,500 new mental health workers across child and adult mental health services to cut waiting times and ensure that people can access treatment and support earlier. Through the 10-year health plan, this Government will overhaul the NHS and ensure that those with mental health needs, including those living with eating disorders, are given the support that they need.

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

Hon. Members also raised concerns about BMI. It is not right that any individual is being refused treatment based on their weight or BMI alone. National guidance from the National Institute for Health and Care Excellence is clear that single measures such as BMI or duration of illness should not be used to determine whether to offer treatment for an eating disorder. I am ready to receive any representations from colleagues who have evidence that that is happening, and I would be happy to raise that with the appropriate channels.

[John McDonnell]

I raised with the Minister the reform of disability benefits, which will have implications for sufferers and their carers. My understanding is that the universal credit health element is to be denied to those under the age of 22. In addition, it will be halved and then frozen, and the PIP criteria are changing. As I said, I simply want the Minister to check with his colleagues in the Department for Work and Pensions what the implications are for sufferers of these conditions and their carers. We need specific action to protect them in the consultation; otherwise, people who are already suffering financially as a result of such conditions—particularly when the whole family supports the sufferer—will be further harmed.

[Stephen Kinnock]

I will follow up on those points and write to the right hon. Gentleman. As he knows, the Green Paper is out for consultation. Although the Government have made decisions about some measures, we are consulting and engaging on a number of others. It is very important that we see all the issues that he raises in the round, and I will follow them up with colleagues, particularly in the DWP, and write to him.

I again thank the hon. Member for Bath for raising this important issue and for her tireless efforts in this House to raise awareness of eating disorders. I thank all hon. Members for their thoughtful and moving contributions on behalf of their constituents and, in some cases, their loved ones. One person afflicted by an eating disorder is one too many, so the Government will strain every sinew to combat this profoundly debilitating condition.

Access to Dentistry: Somerset

Stephen Kinnock Excerpts

Tuesday 1st April 2025 Westminster Hall

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship again this morning, Mr Stuart. I thank the hon. Member for Frome and East Somerset (Anna Sabine) for securing this important debate on access to dentistry in Somerset.

We know that there are challenges in accessing NHS dentistry across the country, with some areas facing acute challenges. Put simply, too many people are struggling to find an NHS appointment. In the two years up to June 2024, just 31% of adults were seen by an NHS dentist in Somerset’s integrated care board, which covers the hon. Lady’s constituency, compared with 40% across England. In the year to June 2024, only 42% of children in Somerset ICB were seen by an NHS dentist, compared with 56% across England. The fact that the number of adults and children in Somerset ICB accessing an NHS dentist is even lower than the already struggling rate across England is concerning.

Somerset is facing significant workforce pressures, and there are not enough NHS dentists available to do the job. As of March 2024, there were 334 vacancies in the south-west for full-time equivalent NHS general dentists. The 29% vacancy rate is the highest of any English region.

It is a shocking fact that the No. 1 reason for children aged five to nine being admitted to hospital in our country is to have their teeth removed, with a primary diagnosis of tooth decay. It is a truly Dickensian state of affairs.

[Chris McDonald (Stockton North) (Lab)]

We have heard about the dental desert in Somerset. Stockton in my constituency has also been branded a dental desert. I welcome the 4,000 new appointments that the Government have granted for Stockton North and the surrounding area. However, given the urgency that he has described, particularly for children’s health, I ask the Minister whether the Government are taking any measures to accelerate the roll-out of those appointments.

[Stephen Kinnock]

We will absolutely ensure that integrated care boards are delivering to the target they have been set. If we see any evidence of slowing down or backsliding, we will certainly intervene to ensure that appointments are accelerated. I would also be more than happy to receive representations from my hon. Friend if he feels that performance in his ICB is not delivering.

The state of NHS dentistry in Somerset, and the nation as a whole, is simply unacceptable and it has to change.

[Olivia Bailey (Reading West and Mid Berkshire) (Lab)]

I welcome the action that the Government are taking to fix our dentistry crisis. In my constituency, only two dental practices accept adult patients, and vast swathes of the rural areas have no practice at all. Will the Minister set out how the Government’s plans will support my constituents to access the dental care that they need?

[Stephen Kinnock]

My hon. Friend puts her finger on the fundamental problem, which is that the NHS dental contract simply does not incentivise dentists to do NHS work. That is the fundamental reason why we are in this bizarre situation where demand for NHS dentistry is going through the roof, yet there is a consistent underspend in the NHS contract. It is a classic example of a false economy. The Conservatives thought they were being terribly clever by structuring a contract in a way they thought would deliver value for money, but in fact, it simply failed to incentivise dentists to do NHS work and they drifted more and more into purely private sector work. That is the very definition of a false economy.

[Anna Sabine]

I just draw the Minister back to my specific point about whether he can confirm that he is having discussions with the British Dental Association. The association agrees that the contract is wrong, and it wants to speak urgently to the Government about how it can be amended.

[Stephen Kinnock]

I am pleased to confirm that I am meeting the BDA in the coming days. The negotiations are moving forward. There is no perfect payment system, and there is a need to get the balance right between ensuring that we have a viable system that does not deliver underspends in the NHS contract, which is absurd, and that we deliver as much NHS dentistry as possible to the communities and people who need it. That is a complex process and it will take some time. The Government have taken intermediate measures, such as the 700,000 urgent appointments and supervised toothbrushing, which we will work on at pace over the course of the coming financial year while also working on a radical overhaul of the contract.

By the time I came into government, the Nuffield Trust was describing the state of NHS dentistry as

“at its most perilous point in its 75-year history.”

As of March 2024, there are over 36,000 dentists registered with the General Dental Council in England, yet there are fewer than 11,000 full-time equivalent dentists working in the NHS.

[Sir Ashley Fox]

I understand that at least 100 Ukrainian dentists in this country are unable to practise with the NHS because they are waiting to take examinations. Can the Minister do anything to expedite their ability to practise in this country?

[Stephen Kinnock]

I absolutely agree. Two big things need to happen. First, the General Dental Council needs to do more to get more exams in place for those very well-qualified dentists. Of course, they have to pass the British exam. We cannot have people practising in Britain who have not passed that exam, but the availability of the exam has been too limited and that needs to change. The other thing is provisional registration. Some work can be done to expedite the registration of an international dentist, but more needs to be done on that as well. I will meet the head of the General Dental Council shortly, and I will convey those messages to him.

Recruitment and retention issues are not limited to dentists; there are difficulties across the whole dental team, including dental nurses, hygienists, therapists and technicians. In the past five years, there has been a 15% reduction in courses of dental treatment being delivered across England, and 28% of adults in England—a staggering 13 million people—have an unmet need for NHS dentistry. As a result, we hear too many stories about people who are unable to access the care they need, and some horrific accounts of DIY dentistry that nobody should have to resort to.

Dentistry rightly receives a lot of attention because of its dismal state, and I am grateful to the National Audit Office and Public Accounts Committee for their interest in the previous Government’s dentistry recovery plan. It is evident that the plan did not go far enough.

[Richard Foord]

The Minister talks about the previous Government’s dental recovery plan, and part of that was to impose a firmer ringfence on dentistry spending so that there was not an underspend that was reallocated elsewhere. The previous Government tasked NHS England with collecting monthly returns from ICBs to establish spending as against the allocation. Now that NHS England is being scrapped, will we still see that monitoring of ICBs to ensure that the spending matches the allocation?

[Stephen Kinnock]

I take the hon. Gentleman’s point about the ringfence, but in a way, ringfencing addresses the symptoms, rather than the cause, of the problem. The fundamental cause of the problem is the amateurish way in which the previous Government set up the NHS dentistry contract so that it does not incentivise dentists to do NHS work. That is what leads them to drift off. In a sense, we can do all the ringfencing we like, but if the workforce that we need is not incentivised to do the work that we need them to do, we are going to have that problem, because they vote with their feet. That is why the radical overhaul of the dentistry contract is the key point. However, I agree with the hon. Gentleman that once we have got a contract that works, we must ensure that every penny that is committed to NHS dentistry is spent on NHS dentistry, rather than the absurd situation that we have now, in which we constantly have underspends in the NHS dentistry contract while demand for NHS dentistry goes through the roof. It is a truly bizarre situation.

I return to the subject of the dentistry recovery plan. The new patient premium, introduced by the previous Government, aimed to increase the number of new patients seen, but that has not happened. In reality, since the introduction of the previous Government’s plan, there has been a 3% reduction in the number of treatments delivered to new patients. It is clear to this Government that stronger action is needed, and we are prepared to act to stop the decay.

[Rachel Gilmour]

In Minehead, in my constituency, a dental surgery responded to the ICB in October and said that it would provide 12 NHS appointments a week for people who currently do not have a dentist. I have chased that ICB on five occasions, but we still do not have a result. That is 48 appointments a month that my constituents are missing out on. Would the Minister please agree to write a letter, on my constituents’ behalf, to the Somerset ICB?

[Stephen Kinnock]

We are very keen to ensure that targets are being met, and the ICB clearly needs to ensure that that is happening, so I would be happy to do that. Perhaps the hon. Lady could write to me so that we can get all the facts on the table, then we can take action accordingly.

We will make the difficult decisions necessary to restore NHS dentistry to ensure that patients can access the care that they need, at the best value for taxpayers. Since coming into office, we have focused on implementing new initiatives and stopping the things that are not working. From today, 1 April 2025, the public will see 700,000 additional urgent dental appointments being delivered every year, as we promised in our manifesto. The urgent appointments will be available to NHS patients who are experiencing painful oral health issues, such as infections, abscesses, or cracked or broken teeth. Somerset integrated care board has been asked to deliver 13,498 of those appointments. That is 13,498 more chances for the hon. Lady’s constituents to get the urgent dental support that they need, every single year.

Across the south-west region, there will be 106,776 extra appointments—that is more chances for patients in urgent need of care. However, to have a truly effective dental system, we cannot focus just on those who are already in pain; we must have a system that prioritises prevention. A cornerstone of the Government’s mission to prevent ill health is supporting children to live healthier lives. We want to ease the strain on the NHS and create the healthiest generation of children ever. As colleagues will be aware, too many children are growing up with tooth decay, which is largely preventable. That is why we have invested £11.4 million to roll out a national supervised toothbrushing programme for three to five-year-olds that will reach up to 600,000 children a year in the most deprived areas of England.

The latest data shows that the rate of tooth decay for five-year-olds in Somerset is 20.2%, which is lower than the 22.4% for England but still far too high. We are taking a targeted approach to support those in the most deprived areas, which is why we have been able to allocate £50,000 of funding to Somerset to support around 2,000 three to five-year-olds. Our additional funding will help to secure and expand supervised toothbrushing based on local needs. This is extra resourcing to support targeted work by the local authority and its partners.

I am determined that we will reduce inequalities faced by children living in the most deprived areas, helping them to brush their teeth daily in the nurseries and schools that they attend. Alongside this, we have launched an innovative partnership with Colgate-Palmolive, which is donating more than 23 million toothbrushes and toothpastes over the next five years. This is of incredible value for the taxpayer, and a fantastic example of how business and Government can work in partnership for the public good.

A strong dentistry system needs a strong workforce. We recognise the incredible work that dentists and dental professionals do, and we know that the current NHS dentistry contract is not fit for purpose. We need to build an NHS system that works for patients and their dentists. A central part of our 10-year plan will be workforce, and we will ensure that we train and provide the staff, technology and infrastructure that the NHS needs to care for patients across our communities. We will publish a refreshed long-term workforce plan to deliver the transformed health service that we will build over the next decade, and to treat patients on time again.

We know that some areas face challenges in recruiting and retaining the dental workforce they need. The golden hello scheme offers 240 dentists a £20,000 joining bonus to work in underserved areas of the country for three years. The recruitment process is well under way, with posts being filled by dentists in these areas as we speak.

[Sir Ashley Fox]

I ask the Minister to reply to my suggestion that students from the University of Bristol Dental Hospital do some part of their training in Somerset, where they can benefit the population.

[Stephen Kinnock]

I thank the hon. Member for that intervention. It is an excellent idea, and it is something that we have seen in other parts of the country. If he would care to write to me about that, I would be more than happy to take that issue up.

In the south-west, the golden hello scheme has already led to seven new dentists on the ground delivering NHS dentistry to patients, and a further six have been recruited and are waiting to start their roles. With 64 live adverts across the region, we are confident that the numbers will grow. And, for the first time in more than a decade, we have increased payments for practices training a foundation dentist. We will not stand idly by while the fundamental reforms to the contract are developed. Where we identify opportunities, we will make improvements to the current system when those can increase access and incentivise the workforce to deliver more NHS care.

I am pleased that work to improve access has also been taking place at the local level, and that Somerset ICB is opening three new practices in Wellington, Crewkerne and Chard. Those services will provide much-needed additional capacity in Somerset. The ICB is committed to delivering additional urgent dental appointments and increasing access for residents facing the greatest health inequalities—although I do recognise what the hon. Member for Tiverton and Minehead (Rachel Gilmour) said about the concerns that she raised.

Fixing our broken dentistry system will not be easy, but I want to reaffirm our commitment to making bold changes and tough decisions to stop the decay and to rebuild the foundations of NHS dentistry. This is an immense challenge—there are no quick fixes and no easy answers—but people in Somerset and across the country deserve better access to dental care, and we are determined to make that a reality. We are committed to rebuilding a system that puts patients first, ensuring that no one is left without the dental care that they need.

Question put and agreed to.

Community Pharmacy Funding 2024-25 and 2025-26

Stephen Kinnock Excerpts

Monday 31st March 2025 Written Statements

[The Minister for Care (Stephen Kinnock)]

I am delighted to announce we have now concluded our consultation on funding for community pharmacy for 2024-25 and 2025-26. We have agreed with Community Pharmacy England that in 2025-26 the funding will increase to £3.073 billion, an increase of £375 million compared to 2024-25. This means, in addition to other changes, that on a like- for-like basis the value of the funding will increase by 15.0% compared to 2024-25, compared to 5.8% growth to the budget of the NHS as a whole. This is on top of a consolidated increase in 2024-25 of 4.1%.

This investment will enable us to embed and build on the range of clinical services that we commission from community pharmacy as we seek to improve access through reform and better use the skills of pharmacy teams to keep people well in their communities.

In addition, we have agreed to allow pharmacies to keep £193 million of funding that was paid to them primarily over the pandemic period to support the vital supply of medicines. This will bring more certainty of funding for contractors and support pharmacies in purchasing the medication prescribed for patients.

We know that community pharmacy has been neglected. We are determined to work with the sector to get it back on its feet and delivering for patients. This agreement with CPE will provide much needed investment and start to stabilise the community pharmacy sector. It marks a show of confidence in this Government to deliver the left shift—moving care from hospital to community, and moving from sickness to prevention.

I would like to pay tribute to CPE’s committee. I am grateful to them for working constructively and at pace with officials to agree how best to use this significant new investment to support the sector, and to continue to provide services to patients across the country. We have prioritised patient access to medication, support and advice. We are also embedding and extending the clinical service offer. We will provide additional support for people newly prescribed medication for depression, as well as offering access to NHS provided emergency hormonal contraception across the country for the first time.

We have also committed £215 million to grow the Pharmacy First service, as we look to build on the over 1.9 million consultations already delivered as of November 2024 and provide a platform for prescribing services in the future.

These services will continue to increase the access and support available for people close to home, in the heart of their communities.

I am therefore very pleased to share this announcement and look forward to continued collaborative working with Community Pharmacy England and the wider sector as we build on what we have announced today and deliver what we all want for community pharmacy, a service fit for the future.

[HCWS570]

Oral Answers to Questions

Stephen Kinnock Excerpts

Tuesday 25th March 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

Rebuilding our broken dentistry system is a priority for this Government. We are already rolling out 700,000 extra urgent dental appointments a year, as promised in our manifesto; we have launched a supervised toothbrushing scheme for three to five-year-olds; and we are committed to reforming the dental contract and making NHS dentistry fit for the future in the long term.

[Rosie Wrighting]

In Kettering, we know the scale of the challenge facing NHS dentistry after 14 years of Tory failure. My constituents regularly tell me how impossible it is to get an appointment. Some are driving tens of miles to see a dentist, and it is simply a scandal how many children are admitted to hospital with tooth decay. While it cannot be rebuilt overnight, in Kettering we welcome the extra 17,000 urgent appointments, which are a vital first step. Can the Minister confirm that it is this Government who will make NHS dentistry fit for the future?

[Stephen Kinnock]

My hon. Friend is absolutely right. After 14 years of Tory neglect and incompetence, far too many people are still struggling to find an NHS appointment. This Government are tackling the challenges for patients trying to access NHS dental care by delivering 700,000 more urgent dental appointments a year and by recruiting new dentists to areas that need them. My hon. Friend’s local integrated care board has been asked to deliver nearly 17,000 of the additional urgent appointments. I am in no doubt that she will continue to campaign tirelessly on behalf of her constituents.

[Anneliese Midgley]

My constituent, Kevin Buckley, had his NHS dentist shut with no notice. NHS dentists in Knowsley are not taking on any new patients and he is stuck. This is not just a local issue, but a national crisis. What action will the Minister take to address the shortage of NHS dentists?

[Stephen Kinnock]

I am sorry to hear of the difficulties faced by Mr Buckley. Sadly, that is a challenge we face nationally after 14 years of abject failure from those now on the Opposition Benches. There are no quick fixes or easy answers, but we are committed to reforming the contract and helping those who need it most. My hon. Friend’s local ICB has been asked to deliver more than 46,000 additional urgent care appointments from April onwards, getting care to those constituents who need it most. The north-west has also been allocated 21 posts in the golden hello scheme to recruit dentists into underserved areas.

[David Williams]

More than one in three five-year-olds in Stoke-on-Trent has tooth decay. That is the worst rate in the west midlands and is 10% above the national average. Children in deprived areas, like much of my constituency of Stoke-on-Trent North and Kidsgrove, are twice as likely to suffer, and that is not acceptable. Can the Minister please outline what steps the Government will take to reduce regional inequalities in NHS dental access for children?

[Stephen Kinnock]

It is shameful that tooth decay is the biggest reason for hospital admissions of children aged between five and nine, and the inequalities surrounding that are stark. On 7 March, we confirmed a £11.4 million investment in supervised toothbrushing for three to-five-year-olds. The scheme is targeted at children in the most deprived areas—those in index of multiple deprivation groups 1 and 2—and will reach up to 600,000 children. Our innovative partnership with Colgate-Palmolive will result in the donation of more than 23 million toothbrushes and toothpastes, providing outstanding value for taxpayers’ money.

[Alex Baker]

Aldershot and Farnborough are dental deserts. My constituent Nick had an infected wisdom tooth and was in agony. He had been registered with a practice in Farnborough, but it kicked him off its patient list. He obtained an emergency appointment through 111, but two weeks later the infection was back. He was left with little choice but to go private, which cost him £700—10 times what the treatment would have cost on the NHS. Can the Minister explain how Labour’s plan for change will help to prevent such cases from being repeated as we end the 14 years of dentistry failure that we saw under the Conservatives?

[Stephen Kinnock]

My hon. Friend has demonstrated again that she is a tireless campaigner for the people of Aldershot, and I am sorry to hear of the challenges faced by her constituents. This Government will deliver 700,000 more urgent dental appointments a year, and will recruit new dentists to the areas that need them most. My hon. Friend’s local ICB has been asked to deliver nearly 7,000 of those additional urgent care appointments in the year from April. In the long term, we will reform the dental contract with the sector, with a shift to focusing on prevention and improving the retention of NHS dentists.

[Melanie Onn]

The Secretary of State and Ministers’ commitment to 700,000 more emergency dental appointments is already taking effect in my NHS area, with an extra 27,000 slots, and the feedback is excellent. However, constituents have told me that some dentists seem to be removing non-emergency patients from their lists. Can the Minister please reassure them that their NHS dentists will be there when they need them?

[Stephen Kinnock]

As my hon. Friend says, we are delivering 700,000 additional urgent appointments. Patients are not limited to a registered practice in England, and practices are required to keep their status up to date on the NHS website. Anyone struggling to find a dentist should go to nhs.uk or call 111. It is also clear that while NHS England is not mandating an approach to the purchasing of these additional appointments, ICBs could consider either buying more appointments through new or recommissioned contracts or modifying existing contracts, and/or using flexible commissioning.

[Sir Roger Gale (Herne Bay and Sandwich) (Con)]

The Minister is aware of my concern about the inability of some 200 fully qualified Ukrainian dentists to practise because of the restrictions placed on them by the General Dental Council. I know that the Minister has written to the GDC about this, but has he received a reply?

[Stephen Kinnock]

I thank the right hon. Gentleman for the constructive meeting and discussion that we had on this matter. As he will know, we are exploring the use of provisional registration for overseas dentists, and we are urging the GDC to arrange more examinations for dentists. I have a meeting set up in short order with the head of the GDC, and I will keep the right hon. Gentleman posted on that conversation.

[Manuela Perteghella (Stratford-on-Avon) (LD)]

My constituents are being forced to travel out of county to Coventry or Evesham to obtain basic NHS dental care. Does the Minister agree that it is a disgrace that access to an NHS dentist has become a postcode lottery? What urgent steps are the Government taking to end this dental desert and restore NHS services to rural communities such as mine?

[Stephen Kinnock]

I absolutely agree. The state of NHS dentistry in our country is shameful. The golden hello scheme enables 240 dentists to receive a £20,000 joining bonus payment to work in dental deserts, and we are negotiating with the British Dental Association the long-term reform of the contract. The issue is not the number of dentists in the country, but the paucity of dentists who are doing NHS work.

[Aphra Brandreth (Chester South and Eddisbury) (Con)]

The north-west has some of the worst levels of children’s oral health in England, with Cheshire and Merseyside falling below the national average. In rural villages in my constituency like Bunbury, where bus services have been cut, and Kelsall, where a dentist is keen to open an NHS practice but faces barriers due to city centre prioritisation, residents are struggling to access NHS dental care. Given the challenges of rural access, what steps is the Minister taking to ensure that NHS dental provision is available in those rural communities?

[Stephen Kinnock]

I find it quite striking when Conservative Members stand up and describe the abysmal state of NHS dentistry. It makes me think, “Well, who created this mess in the first place?” But that is as an aside. The fact is that we have the golden hello scheme for dentists to come and work in so-called dental deserts. We recognise that the fundamental problem is around incentives for dentists to do NHS work. That is why we are doing a long-term contract negotiation to ensure we have an NHS dentistry contract that is fit for purpose and where every penny allocated to NHS dentistry is spent on NHS dentistry.

[James Wild (North West Norfolk) (Con)]

There is an urgent need for dental training in Norfolk, so can the Minister confirm that the Government will enable the Office for Students to allocate new dental training places in the east of England to start in 2026?

[Stephen Kinnock]

I thank the hon. Gentleman for that question. I have met hon. Members from the area and made it clear that in principle we support any creation of new teaching capacity for dentistry. What I have also set out is that, before we can give an instruction to the Office for Students to go ahead with that work, we have to have the settlement of the comprehensive spending review, so we know what our financial envelope is. We will not have that until June, but certainly we will be looking at that as and when we know whether the funding will be available.

[Mr Speaker]

I call Jim Shannon.

[Jim Shannon (Strangford) (DUP)]

There’s only one Jim Shannon, by the way, you know? [Laughter.] Mr Speaker, thank you very much for your birthday wishes. I am terribly embarrassed. I thank right hon. and hon. Members for their kind wishes. As I often say, I don’t count the years, I make the years count. That is the important thing.

Can I ask the Minister a very important question? What discussions has he had with the Education Secretary on providing more financial support to young students who want to study dentistry, to ease the burden of high costs associated with studying dentistry which many young people may find off-putting?

[Stephen Kinnock]

I thank the hon. Gentleman for that question and I congratulate him again on his 60th birthday. [Laughter.] He raises an important point on teaching and training in dentistry. There is not enough capacity in the system. We absolutely want to ensure that we are building that capacity. As I said, a lot of that will depend on the comprehensive spending review settlement in June. I would be more than happy to discuss the issue with him in greater detail once we have a better sense of where we are on the funding.

[Paulette Hamilton (Birmingham Erdington) (Lab)]

3. What assessment he has made of the adequacy of the provision of health services for women.

--- Later in debate ---

[Sarah Hall (Warrington South) (Lab/Co-op)]

8. What recent progress his Department has made on implementing the hub and spoke model for community pharmacy.

[The Minister for Care (Stephen Kinnock)]

This Government recognise the vital role that community pharmacies play as an integral part of our health system and local community. We are working with Community Pharmacy England on the pharmacy contract, which will start to stabilise the sector and make it fit for the future, and we will announce the outcome very shortly. On hub and spoke dispensing, we intend to lay draft secondary legislation in the coming weeks to come into force later this year.

[Sarah Hall]

Community pharmacy funding is at a critical juncture, with many pharmacies in my constituency facing financial challenges. With running costs increasing and uncertainty around the date of the upcoming settlement, community pharmacies are concerned that there may be disruption to their business. What steps is the Department taking to ensure that input from community pharmacies is considered, and prior to any further legislative or regulatory changes relating to the hub and spoke model?

[Stephen Kinnock]

My hon. Friend is right that we inherited a community pharmacy system that had been neglected for far too long, such that over the past two years, on average six pharmacies have been closing every week. A wide range of community pharmacies and representative organisations fed into the public consultation on hub and spoke reform, and I am pleased to confirm that their responses were overwhelmingly positive in support of model 1 of hub and spoke, which we will be going with.

[Rishi Sunak (Richmond and Northallerton) (Con)]

I recently visited Well pharmacy in Northallerton, which, like so many others, plays an important role in providing community health services. One valued service is the provision of free blood pressure checks to those over the age of 40. Will the Minister to join me in urging anyone with health worries or a family history of high blood pressure to take advantage of this fantastic free, pharmacy-led, preventive community health service?

[Stephen Kinnock]

The right hon. Gentleman is right that a big part of the Government’s shift from hospital to community is the pivotal role that community pharmacies will play in that process. We are committed to the Pharmacy First model of enabling community pharmacies to do more clinical work, such as the type that he just described. That is at the heart of our 10-year plan.

[Mr Speaker]

I call the shadow Minister.

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

Now that the Secretary of State is abolishing NHS England, will he listen to the calls from the National Pharmacy Association and the Independent Pharmacies Association, and publish immediately the independent report commissioned by NHS England on pharmacies’ finances?

[Stephen Kinnock]

We will publish the economic analysis imminently. He mentioned the National Pharmacy Association, which gives me the opportunity to say that I think that the collective action that it is taking is premature, unnecessary and detrimental to community pharmacy patients. I urge the NPA to reconsider its position and wait for the outcome of our negotiations with the CPE, which will come very shortly. We will announce that very soon.

[Dr Evans]

The National Pharmacy Association, which has been waiting for months to get the answer, is advising all its 6,000 pharmacy members to reduce services and hours, for the first time in 104 years. That has never happened before under a Labour Government, or under the Lib Dems or the Conservatives, but it is happening under this Government. Its chair said:

“The sense of anger among pharmacy owners has been intensified exponentially by the Budget”,

citing unfunded national insurance contributions and national living wage increases. The Minister acknowledges that there is potential action. What contingency plans does the Department have to ensure that we keep patients safe if pharmacies close their doors in industrial action next week?

[Stephen Kinnock]

On the NPA, it has taken us a while to clean up the utter mess that we inherited in community pharmacy. That involved agreeing financial envelopes and getting into negotiations with CPE. Those negotiations have been constructive, and I am delighted to confirm again that we will soon announce the outcome of those negotiations. What we see here is the shadow Minister apparently taking the side of people taking collective action in a premature way that is detrimental to patients. They would be better off waiting for the outcome. The Government are taking industrial relations into the 21st century, as opposed to the performative nonsense that we saw for 14 years.

[Caroline Voaden (South Devon) (LD)]

11. What steps he is taking to support families of patients who have been sectioned under the Mental Health Act 1983.

[The Minister for Care (Stephen Kinnock)]

When someone is detained, family involvement is extremely valuable, and families should be supported to maintain contact with their loved ones. Our Mental Health Bill will strengthen requirements to involve families in people’s care. We will require clinicians to involve patients and their families where possible when developing new statutory care and treatment plans.

[Caroline Voaden]

I have two ongoing constituency cases with adult men who have serious and long-term mental health issues. One of my constituents believes that her life is in danger because of her son’s threatening behaviour towards her—her own mental health has been seriously affected by the fear and stress. The other case involves a young man causing serious distress to his neighbours with his behaviour, which recently led to an incident where he reportedly threatened a police officer with a knife. Both men are living alone in unsupported accommodation, both are at risk of coercion and abuse because of their mental health problems, and both are causing serious distress to their families and neighbours. Will the Minister tell the House whether he is working with other Departments to ensure the availability of more provision to support people such as my constituents to live safely in the community and not cause harm or distress to those around them?

[Stephen Kinnock]

I know that the hon. Member has met my right hon. Friend the Secretary of State about at least one of those constituency cases. NHS England has asked mental health trusts to review the care of high-risk patients and has published national guidance on the standards of care that are expected. Ultimately, the Mental Health Act is there to protect people and provide the necessary powers to enable clinicians to manage and support such patients—and to do so, where possible, in the community.

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

Yesterday I met Essex partnership university NHS foundation trust and spoke to it about the need to support the families of those suffering with mental health issues in Harlow, and particularly those with caring responsibilities. Will the Minister consider how mental health services can better identify and support young carers?

[Stephen Kinnock]

My hon. Friend will be aware that we are bringing forward the Mental Health Bill, and an important part of that legislation will enable family members—when they are chosen as a nominated person—to have powers to request assessment under the Act, challenge decisions and request considerations of discharge in line with the nearest relative powers.

[Sarah Smith (Hyndburn) (Lab)]

13. What steps he is taking to ensure special educational and disability needs are met by the NHS.

--- Later in debate ---

[Patricia Ferguson (Glasgow West) (Lab)]

T5. Since being elected, I have been contacted by a number of constituents registered with a GP in Scotland who find themselves unable to get medication for which they have a prescription while visiting England. Will my hon. Friend take steps to encourage NHS England and NHS Scotland to work together to find a solution that works for patients?

[The Minister for Care (Stephen Kinnock)]

I am very sorry to hear about my hon. Friend’s constituents’ experience. Accessing vital medicines while travelling between nations should be seamless, and I will ask NHS England to work with NHS Scotland to better understand what needs to change to make things easier for patients across the UK.

[Ian Sollom (St Neots and Mid Cambridgeshire) (LD)]

T7.   In the light of the recently announced 50% staffing reductions across integrated care boards, has the Secretary of State made any assessment of how those cuts to the Cambridgeshire and Peterborough ICB will delay the delivery of essential new primary care services for my rapidly growing constituency, particularly in Northstowe, Cambourne and St Neots, where thousands of constituents are already facing unacceptable difficulties in accessing care?

[Jenny Riddell-Carpenter (Suffolk Coastal) (Lab)]

In Saxmundham in my constituency, Dr Havard has led a campaign for 20 years to transform the healthcare centre into a one-stop community healthcare hub. His practice has already expanded services, transforming health locally. Does the Minister agree that the Saxmundham healthcare hub is an excellent example and model for what this Government are trying to do to transform community healthcare?

[Stephen Kinnock]

My hon. Friend is absolutely right that shifting care from hospitals to the community is at the heart of our 10-year plan. I would be happy to meet the doctors leading this pilot to find out more about the excellent work that she describes.

[Christine Jardine (Edinburgh West) (LD)]

For eight years, I have seen how a young constituent has been able to completely control his previously life-threatening seizures with medicinal cannabis, but at huge cost to his family—a cost that is prohibitive for other people. Will the Secretary of State meet me to discuss how we can make access to such treatments more affordable, accessible and safe, so that we can help more people?

[Mohammad Yasin (Bedford) (Lab)]

In the ongoing discussion on assisted dying, one point on which we all agree in this House is the urgent need to improve palliative care. I therefore welcome the Government’s recent £100 million commitment to supporting hospices, including those that help my constituents. Can the Minister confirm whether long-term funding for hospices will be a priority in the upcoming 10-year health service plan?

[Stephen Kinnock]

My hon. Friend is right that the hospice sector has been provided with the largest capital spend in a generation—£100 million. We are also providing £26 million of revenue funding to children and young people’s hospices. I can confirm that hospices will play a key role in our shift from hospitals to the community, as he set out in his question.

[Victoria Collins (Harpenden and Berkhamsted) (LD)]

Tragically, Ed was just 24 years old when he decided to take his own life, and that is why the family have joined us today in the Gallery. What urgent action are the Government taking to improve mental healthcare and suicide prevention for young people like Ed?

[Stephen Kinnock]

The hon. Member raises an important issue. We are investing in 8,500 more mental health specialists, as well as specialists in every school, and in Young Futures hubs across the country, to ensure that we do whatever we can to prevent these tragedies.

[Markus Campbell-Savours (Penrith and Solway) (Lab)]

An early day motion from 2007 noted that women were typically waiting eight years to be diagnosed with endometriosis. Shockingly, nearly 20 years later, that wait has increased to nine years. The Government are right to tackle the appalling waiting lists for surgery, but the one in 10 women who suffer with endometriosis often struggle with years of pain before surgery is even suggested. What plans does the Department have to deal with these delays, and how we can ensure that those working in primary care recognise this debilitating condition earlier?

--- Later in debate ---

[Chris Hinchliff (North East Hertfordshire) (Lab)]

Do Ministers agree that a logical conclusion of the Darzi report is that the national care service that we are committed to creating must be free at the point of use? As Lord Darzi found, as long as the social care system remains means-tested and the NHS is a universally free service, unmet care needs will continue to put unsustainable pressure on our health services.

[Stephen Kinnock]

That is a vital issue. The Casey commission will look at how best to create a fair and affordable adult social care system, and at which structural reforms will be needed where health and social care meet, because reform must always be married with investment.

[Cameron Thomas (Tewkesbury) (LD)]

General practitioners in my constituency have consistently restructured over 10 years of constant systemic and economic pressures. How will the Minister convince the Treasury to exempt GPs from the increase to national insurance contributions, and show my GPs that he has their back?

--- Later in debate ---

[Mr Richard Holden (Basildon and Billericay) (Con)]

Smile Dental Centre is in one of the least affluent parts of my community in Basildon. It is looking to expand and provide more NHS dental services, but it has come up against a few issues. Will the Minister, or one of his officials, meet me and Smile Dental Centre to see what we can unblock to deliver more dental health services for local people?

[Stephen Kinnock]

We are always looking for opportunities to unblock more capacity, and I would be happy to meet the right hon. Gentleman.

[Tom Hayes (Bournemouth East) (Lab)]

Coastal constituencies such as mine in Bournemouth East suffer significant health inequalities. What are the Government doing to address them, and will the Minister meet me and coastal Labour MPs to address the issue?

Male Suicide in Rotherham

Stephen Kinnock Excerpts

Monday 24th March 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I am grateful to my hon. Friend the Member for Rother Valley (Jake Richards) for securing this debate and for raising the extremely serious issue of male suicide. I also congratulate him on obtaining his first Adjournment debate. I am sure that it will not be the last. He is a doughty campaigner for his constituents. I thank other Members for their valuable contributions, particularly my hon. Friend the Member for Portsmouth North (Amanda Martin), who made a powerful speech. I offer my deepest condolences to those who have been tragically bereaved by suicide.

Men tend to seek help for their mental health less than women. As my hon. Friend the Member for Rother Valley said, men are also more likely to die by suicide, accounting for three out of four suicides. Rates in Rother Valley sadly reflect that statistic.

Today, mental ill health is on the rise, and the shocking fact is that suicide is the biggest killer for men under 50. Just as we are determined to end the injustices that women face in healthcare, we will not shy away from the need to focus on men’s health too. That is why the Government will publish a men’s health strategy to tackle those problems head-on.

In November, my right hon. Friend the Secretary of State for Health and Social Care brought together leading campaigners, experts and the Premier League to gather ideas and inform our strategy and our 10-year health plan. We take suicide prevention extremely seriously, because every suicide is a tragedy that has a devastating and enduring impact on families, friends and communities. With that in mind, I would like to express my gratitude for the hard work and dedication of local frontline services, including the voluntary sector, which play such a vital role in supporting people who experience suicidal thoughts or contemplate taking their own lives. Such organisations include Andy’s Man Club, Rotherham Samaritans and James’ Place, to name just a few.

The cross-sector suicide prevention strategy for England, which was published in 2023, has made some progress, and we are working closely with local authorities, health systems and our partners in the voluntary community to see that progress through. The strategy identifies middle-aged men as a priority group for targeted support at a national level. It rightly focuses on key drivers that we know can affect men’s lives, such as gambling, financial difficulties and substance misuse.

Rotherham council has developed a three-year plan for suicide prevention and self-harm, which I understand is currently out for consultation with local partners. I commend the council and all local partners involved in the development of the plan. I hope that it will provide a strong foundation for a new partnership between local government and national Government, because people in my hon. Friend’s constituency deserve backing at every level.

My hon. Friend raised the shocking issue of young men taking their own lives as a result of problem gambling. The NHS has expanded support for those who need help to overcome gambling addictions. Individuals can self-refer to specialist gambling clinics in England, where they can be supported by psychiatrists.

Our suicide prevention strategy for England identifies gambling as a common risk factor and lists actions to reduce suicide as a result of gambling. We will explore opportunities to go further to support people with gambling addictions. It can be hard for a young man in today’s society, particularly for boys in the most deprived areas of England, who are expected to live almost 10 years less than those in the wealthiest areas.

We are committed to improving the nation’s mental health services to ensure that individuals can get the support they need when they need it. We are recruiting 8,500 new mental health workers, who will be trained to support people at risk of suicide. We are also committed to improving the support available to those experiencing a mental health crisis. This year, the Government are providing £26 million in capital investment to open new mental health crisis centres, reducing pressure on busy A&E services and ensuring that people have the support they need when and where they need it. These new centres will include crisis houses, providing overnight accommodation, sanctuaries and safe havens, calm environments for people to visit during the day and mental health-specific spaces in or adjacent to A&E departments.

I am also grateful to my hon. Friend the Member for Rother Valley for raising the important issue of technology, which can have a profoundly damaging effect. We should all be concerned about the widespread availability of harmful content online that promotes suicide and self-harm and can be easily accessed by people who may be vulnerable. The suicide prevention strategy for England identifies online safety as a priority area for action across Government. We are working closely with our colleagues at the Department for Science, Innovation and Technology in this area, including to deliver the commitments in the strategy and to look at what else can be done to address online harms, including harmful content shared on pro-suicide websites and forums.

There is still uncertainty about the relationship between screen time, social media use and child development. However, I look forward to seeing the results of DSIT’s research into the impact of smartphones on children, which is due to be published in May this year. Our current focus is on keeping young people safe while also benefiting from the latest technology. By the summer, robust new protections for children will be in force through the Online Safety Act 2023 to protect them from harmful content and ensure that they have an age-appropriate experience online. Alongside getting those laws in place, we are committed to building the evidence base to inform future action to protect young people online.

It is not only the dangers of technology that are a concern for young people. Young people present unique challenges, and early intervention is vital if we want to stop children and young people from reaching crisis point today or developing mental health issues in the longer term. Schools and colleges play an important role in that early support, which is why we are providing access to a mental health professional for every school. We know that mental health support teams, such as the With Me In Mind team based in Doncaster and Rotherham, help to meet the mental health needs of children and young people in education settings.

We are also committed to rolling out open access Young Futures hubs in communities. This national network is expected to bring local services together and deliver support for young people facing mental health challenges. The Department for Education is also reviewing the relationship, sex and health education statutory guidance, and the Secretary of State for Education is clear that children’s wellbeing should be at the heart of it. The DFE will look carefully at the consultation responses, considering relevant evidence and talking to partners, including on mental wellbeing and suicide prevention, before setting out next steps and engaging with wider experts. As part of this process, the DFE will explore whether additional content is required, including on suicide and self-harm.

Mental health is, and remains, a priority for the NHS. It is backed by the mental health investment standard, which continues in 2025-26 to ensure that mental health funding is ringfenced to support delivery of our commitments, including those outlined in the NHS planning guidance. The Government have a statutory requirement to publish an annual statement setting out expectations for NHS mental health spending before the next financial year begins. My right hon. Friend the Secretary of State will publish that statement in due course.

I will end with a call to action. Suicide is everyone’s business; when we improve men’s health, the benefits can ripple through families, communities, societies and the economy. When we strive to improve men’s health, it will not just transform the lives of boys and men, but those of their wives, mothers, sisters, partners, mates, neighbours, children, teachers and doctors. That is why I strongly encourage all the men listening to this debate to go to the Change NHS online portal, to give their views on how to build an NHS that is fit for the future through our 10-year health plan. Together, we will transform healthcare for men in the Rother valley, in the north of England, and across our country.

Question put and agreed to.

Face-to-face GP Appointments

Stephen Kinnock Excerpts

Thursday 20th March 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I thank the hon. Member for Boston and Skegness (Richard Tice) for raising GP access, which is a vital matter to many of our constituents. I want to start by paying tribute to Laura Barlow’s family, friends and loved ones and to her husband Michael, who is in the Gallery. It is a terrible tragedy that Laura’s cancer was not caught earlier, and I absolutely agree with the hon. Gentleman that the significant number of people who signed the petition shows real strength of feeling on this heartbreaking case.

When people are asked what their top priority for the NHS is, the chances are they will say, “Fix general practice” because GPs are the front door to our national health service. They are the first port of call for millions of people, and they perform a vital service by delivering care in communities across our country. Let me be crystal clear from this Dispatch Box: GPs must provide face-to-face appointments, alongside remote consultations. Online services must always be provided in addition to, rather than as a replacement for, in-person consultations. Patients have a right to request a face-to-face appointment, and practices must make every effort to meet their preference unless there are good clinical reasons to the contrary, such as in cases where the patient tests positive for an infectious disease.

There are clear benefits to attending an appointment in person. GPs pick up cues from body language and foster a more personal relationship with their patients, and that is important if we are to bring back the family doctor. Last year, GPs delivered 380 million appointments throughout England. Two thirds of those were in person, and I can tell the hon. Gentleman that the figures for his integrated care board in Lincolnshire are in line with the national average at 65%. It is possible that, in some practices, defaulting to remote appointments was a temporary and necessary measure during the pandemic, but in some cases, that may have become a habit that has become difficult to shake. Let us be clear that this is not the fault of GPs per se; it is the fault of the last Government, which left them underfunded, understaffed and in crisis. That is why we are doing everything we can to remedy the downward spiral that GP services have found themselves in after 14 years of Tory neglect and failure.

I was absolutely delighted that the general practitioners committee England voted in favour of this year’s GP contract last month. It is the first time that the contract has been accepted in four long years. The reformed contact agreed between the Government and the GPC will improve services for patients, make progress towards our health mission and, crucially, require practices to make it possible for patients to go online to request an appointment throughout the duration of core opening hours. That will free up time for patients who prefer to call or visit in person.

Those changes are backed by an extra £889 million, representing a cash growth of more than 7% in overall contract investment, bringing total spend on the GP contract to £13.2 billion this financial year. That is the largest uplift to GP funding in a generation, and it means we are beginning to reverse a decade of a dwindling share of NHS resources going to general practice.

It is not just about resource and funding, however. We are bulldozing bureaucracy for GPs, so that they spend less time pushing paper and more time seeing patients like Laura. We are training thousands more GPs, modernising the booking system, ending the 8 am scramble and bringing back the family doctor. Those measures should make it possible for GPs to guarantee a face-to-face appointment for all who want one.

The Government are committed to shifting the focus of our NHS from hospital to community. We will move towards a neighbourhood health service, improve continuity of care for those who would benefit from seeing the same clinician regularly, which is associated with better health outcomes and fewer A&E attendances, and we will drive the shift from analogue to digital by ensuring that all practices are employing the full functionality of GP Connect.

Let me turn to cancer. The Government are determined to tackle the biggest killers. My right hon. Friend the Health Secretary has announced that a national cancer plan for England will be published later this year. The plan will put patients at its heart and will cover the entirety of the cancer pathway, from referral and diagnosis to treatment and ongoing care. It will seek to improve every aspect of cancer care and the experience and outcomes for people with cancer. Our goal is to reduce the number of lives lost to cancer over the next 10 years. The plan will spell out how we will improve outcomes for cancer patients, speed up diagnosis and treatment and ensure patients have access to the latest treatments and technology. We will bring this country’s survival rates back up to the best in the world.

Our NHS belongs to the people. Those are not just my words; they are in the NHS constitution. Fourteen years of Tory failure left our NHS broken but not beaten. Everything this Government have done since the election has been geared towards saving the NHS and giving it back to the people. We are putting power back in patient hands, because it is their health service and it must work for them. Last week, my right hon. Friend the Prime Minister announced reforms that will shift power away from the centre. Patient choice is at the heart of this Government’s commitment to build an NHS fit for the future, and all patients should be offered face-to-face appointments when it is in their best interests.

Question put and agreed to.

Terminally Ill Adults (End of Life) Bill (Twenty-fourth sitting)

Stephen Kinnock Excerpts

Committee stage
Tuesday 18th March 2025 Public Bill Committees

[Danny Kruger (East Wiltshire) (Con)]

I will speak briefly to amendment 316 in the name of the hon. Member for York Central (Rachael Maskell). She has tabled a sensible suggestion that if a patient makes a statement after the second period of reflection, there should be an automatic referral to palliative care. We have heard how expected and usual that is anyway, and the hon. Member for Spen Valley has frequently made the point that people who are having an assisted death, or going through the process, are likely to be in palliative care anyway—it is not an either/or. It is important that we clarify that expectation.

It will obviously be the case that the patient is not required to take up the referral, and if the referral already exists, that case is dealt with, but let us be absolutely clear that the decision to take an assisted death is not a fork in the road, as would be my concern. If that is not the case and that, in fact, palliative care and the assisted death process go hand in hand and will be seen as part of an integrated package of support for patients, my view is that we should specify clearly that in the event of a decision to proceed down the road to an assisted death, a palliative care referral should be made.

Bluntly, I want to make this as clear as we can, although I am not sure that we will ever be able to do that fully. It really has to be very plain to healthcare commissioners and managers that there is to be no cost saving as a result of an assisted death referral. I very much doubt that a single commissioner or manager would have that at the forefront of their mind; nevertheless, incentives apply in healthcare decisions. Ultimately, we have a ration system, and resource allocation necessarily is the job of commissioners.

If, as we are saying, a decision to proceed with an assisted death will be in parallel with palliative care, let us make that plain, so that if indeed it is the case that the patient requires the investment of palliative care services—hospice treatment or otherwise, even though, as we know, hospice care is inadequately funded through public money—nevertheless, there is a resource requirement. It is important that we specify to everybody in the system that an assisted death is not a way of avoiding the expense of proper end-of-life care.

I hope that Members will recognise that amendment 316 is consistent with the arguments that have been made consistently by advocates of the Bill, which is that there is not an either/or between palliative care and assisted death, and that, in fact, it is appropriate for patients to be on both tracks simultaneously.

[The Minister for Care (Stephen Kinnock)]

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

The purpose of amendment 457 is to exclude a person who has less than one month to live from being eligible for the shorter second period of reflection of 48 hours if that person has voluntarily stopped eating and drinking. That person would instead be required to comply with a second period of reflection of 14 days under clause 13(2)(a). The amendment could create uncertainty as to the required length of the period of reflection. It is unclear, for example, if “voluntarily” would include where someone’s appetite has naturally declined as they approach the end of life, and therefore whose decision to stop eating or drinking may not be deliberate.

As I have said previously, the Government have worked with my hon. Friend the Member for Spen Valley on certain amendments to bolster the legal and workability sides of the Bill, and the purpose of amendment 471 is to clarify that the co-ordinating doctor needs to be satisfied that, immediately before witnessing the second declaration, the criteria set out at subsection (4) are met, and not at any time before. That also ensures consistency with the duty on the co-ordinating doctor in respect of the first declaration.

Amendment 316 would require that where the co-ordinating doctor reasonably believes that the person seeking assistance has less than one month to live from the court declaration, they must refer that person for urgent specialist palliative care. As the referral must be made whether the patient wants that referral or not, this may result in unwanted referrals. The effect of this amendment is unclear.

As drafted, clause 13(2)(b) sets out that where the person’s death is likely to occur within one month, the period of reflection is then 48 hours. Amendment 316 sets out that the referral to urgent palliative care must be made alongside the co-ordinating doctor making the statement, which is the last step to be completed before the provision of assistance under clause 18. That would mean that in some circumstances, there may be insufficient time to make a referral before the person is provided with assistance to end their life.

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

I want to emphasise that at the moment the patient reaches that point, they will have had their palliative care options explained to them extensively, under the Bill, and it is highly unlikely at that point, as my hon. Friend the Member for East Wiltshire said, that anyone would not be in receipt of palliative care, given the very late stage of their disease.

[Stephen Kinnock]

I happened to be at a hospice in Stafford yesterday on a ministerial visit and was extremely impressed by the work that the hospice staff were doing on family counselling, and advice and engagement both with the patient and family and loved ones, so the right hon. Gentleman is right that the hospice sector, among others, plays a vital role in that holistic engagement with patients throughout the process.

Amendment 374 requires that the co-ordinating doctor must notify the voluntary assisted dying commissioner where they witness a second declaration and where they make or refuse to make the supporting statement under clause 13(5), and that the commissioner must be provided with a copy of the second declaration and any statement. I hope that those observations were helpful to the Committee.

[Kim Leadbeater (Spen Valley) (Lab)]

It is a pleasure to serve under you this morning, Ms McVey. My amendments 374 and 471 serve to clarify that the second declaration must be made before it is witnessed—it is a drafting amendment—and to bring clause 13 in line with the reporting requirements elsewhere in the Bill. For the functions of the commissioner to be carried out effectively, including supervising the assisted dying panels and making annual reports on the legislation’s operation, it is essential that all relevant details and reports are made available.

I am unable to support amendment 457, in the name of the hon. Member for Richmond Park. As I said when we started discussing the amendment, I do not fully understand why it has been positioned at this stage in the process. The shorter period of reflection is a recognition that a person’s death is expected within a month, so they literally have a few weeks left of life.

--- Later in debate ---

[Danny Kruger]

The hon. Lady is right, and her point goes to the question that runs through all of these clauses: why? As a Committee, we rejected the obligation on the doctors to ask, “Why are you doing this?” It was suggested by one hon. Member that it was nobody’s business why somebody was trying to take their own life and that if that person qualified, they should be able to summon the agents of the state to provide them with lethal drugs without any question about their motivation.

I agree with the hon. Lady. There is an equal expectation in my mind that doctors should ask the question, “Why are you changing your mind?” I would expect that. The clause could clarify what further referrals would need to be made, if they had not already been; as we have acknowledged, we would expect appropriate care to be provided by doctors anyway.

I conclude with a factual question. Clause 14(1) lets a patient cancel a first or second declaration, but subsection (4) says only that the duties of the doctor stop when a first declaration is cancelled. I would be grateful if the hon. Member for Spen Valley would explain what happens if the patient cancels a second declaration. It strikes me that there would be a need for urgency because if a patient decides to change their mind at that point, that is arguably a more dangerous situation. What would be the obligations on the doctor at that point? Should we read across from subsection (4) that their duties stop in the same way? Perhaps that could be clarified in later drafting, if necessary.

To conclude, my general point is that the issue of a cancelled declaration is about more than the paperwork. Although, of course, we respect the autonomy of a patient to make their own decision to cancel a declaration—obviously, I would insist that that right should be in the Bill—it nevertheless raises a question in my mind: why is that happening, and what should we expect the patient’s medical team, or others, to do in that circumstance?

[Stephen Kinnock]

The Government have worked with my hon. Friend the Member for Spen Valley on amendments 375 and 376. The amendments require that where the co-ordinating doctor, or any registered practitioner from the person’s GP practice, receives a notification or indication from the person seeking assistance under the Bill that the person wishes to cancel their first or second declaration, the doctor or practitioner must inform the voluntary assisted dying commissioner as soon as practicable. Where a registered practitioner from the person’s GP practice has received a notification or indication from the person to cancel their first or second declaration, they must also inform the co-ordinating doctor. I hope those observations are helpful to the Committee.

[Kim Leadbeater]

I repeat what I said earlier about what will happen to the patient if they choose to cancel: their care will continue. From a medical practitioner perspective, it is inconceivable that those patients would be abandoned, as the hon. Member for East Wiltshire is suggesting. That would not happen.

I understand that cancellation of the second declaration does not need to be included in clause 14(4) because of when in the process it would happen. The first declaration comes much earlier, so clauses 7 to 9 would be applicable; the second declaration comes further down the process, so does not need to be included. However, I am happy to look at that in further detail and come back to the hon. Member on that, if necessary.

Amendment 375 agreed to.

Amendment made: 376, in clause 14, page 10, line 12, after “doctor” insert “and the Commissioner”.—(Kim Leadbeater.)

This amendment requires a practitioner other than the coordinating doctor to notify the Commissioner (as well as the coordinating doctor) of a cancellation of a first or second declaration.

Clause 14, as amended, ordered to stand part of the Bill.

Clause 15

Signing by proxy

--- Later in debate ---

[The Chair]

I confirm that amendment 411 has been withdrawn. I see no other Members bobbing; I call the Minister.

[Stephen Kinnock]

Amendment 321 would require a proxy to record, when signing the declaration on behalf of the person, the reason why the person they are acting as a proxy for is unable to sign their own name. The recording of the reason may make the use of a proxy more transparent. It may also assist others involved in the scrutiny of the process to understand why a proxy was used.

Amendment 431 seeks to restrict who can be a proxy under the Bill to attorneys with a lasting power of attorney, or LPA, for health and welfare decisions—that is, those people who are able to consent to or refuse life-sustaining treatment. The amendment raises significant practical issues. First, not everyone has an LPA. Secondly, where a person has made an LPA, they will have decided whether to give the attorney the authority to refuse or consent to life-sustaining treatment. That is not automatic and means that not all attorneys would be able to meet the eligibility requirement of the amendment. Thirdly, the Mental Capacity Act 2005 enables an attorney to exercise power under an LPA only if and when someone has lost capacity.

[Kit Malthouse]

Does the Minister agree that, unfortunately, my hon. Friend the Member for East Wiltshire seems to be labouring under the misapprehension that there is some reputational test in becoming an attorney? In truth, I can appoint anybody I want to be my attorney. There is no verification or otherwise until there is some form of dispute around the exercise of the power of attorney. In fact, the regulations may mean that we have stronger verification of the bona fides of the person who is a proxy than we would have through the LPA route.

Does the Minister not also find it slightly sad that, given the type of Conservative I know my hon. Friend the Member for East Wiltshire is, he thinks the concept of being of good standing in society is somehow meaningless?

[Stephen Kinnock]

I am not a lawyer, but thankfully I am sitting next to a very eminent and distinguished one—my hon. and learned Friend the Member for Finchley and Golders Green—who has confirmed that everything the hon. Member for East Wiltshire said was correct from a legal standpoint, so I shall leave it at that.

Clause 15(5) of the Bill defines a proxy as

“(a) a person who has known the person making the declaration personally for at least 2 years, or

(b) a person who is of good standing in the community.”

Amendment 473 would remove subsection (b) from the definition of proxy, instead introducing a regulation-making power to specify the persons who may act as proxy. That would avoid any ambiguity around the meaning of a person who is of good standing in the community and retain flexibility to amend the specified list in regulations.

[Danny Kruger]

Will the Minister confirm that the Secretary of State could simply reintroduce that ambiguous term at their own discretion? If they are being given the freedom to decide who can be a proxy, they might decide that it should be a term of equal ambiguity. My right hon. Friend the Member for North West Hampshire is absolutely right that I have great respect for the concept of “standing”; nevertheless, I do not believe that the Government have yet been able to define exactly what that means. Does the Minister agree that there is still the opportunity for ambiguity? We are just leaving it completely blank at this stage and hoping that some future Secretary of State will have more clarity than we do.

[Stephen Kinnock]

I would not want to pre-empt the regulations, because clearly that is the point of the process. If this Bill gets Royal Assent, we then move on to making regulations, and I have confidence in the good offices of parliamentary counsel, legal advice and the drafting process. I absolutely agree with the hon. Gentleman, however, that the purpose of those regulations must be to remove ambiguity, not to increase it. I am confident that the system will produce regulations that address his concern.

[Kim Leadbeater]

Does the Minister agree that it will be on the record that we have had this conversation, and that many of us—including myself—have expressed our concerns about the concept of good standing in the community? I would like to think that that will be taken into consideration.

[Stephen Kinnock]

I am acutely conscious that every word we say in this Committee is on the record. My hon. Friend makes a valid point in that context.

The purpose of amendment 253 is to clarify that a person acting as a proxy can both sign and revoke a declaration on behalf of a person seeking assistance under the Bill. This amendment would extend the provisions under clause 15 to a person who is acting as proxy to the person seeking assistance under the Bill, enabling the proxy to act on behalf of the person to cancel their first or second declaration if they are unable to sign their own name by reason of physical impairment, being unable to read or for any other reason. I note that the cancellation of a declaration is governed by clause 14, and the cancellation may be given orally, via writing, or

“in a manner of communication known to be used by the person”.

It does not require the signature of the person seeking assistance under the Bill, so a proxy may not be required for some people in relation to revoking a declaration, even if they have been required under clause 15.

[Naz Shah]

On the point made by the Bill’s promoter, my hon. Friend the Member for Spen Valley, should the issue of proxy end up before a court, what will be relied on—the conversation that we are having here and the intentions stated in Committee, or a future statutory instrument and what the Secretary of State puts in the guidance?

[Stephen Kinnock]

The regulations will have primacy, and will be shaped by a range of inputs, including the conversation we have just had in Committee. The process is that the Bill gets Royal Assent, then the regulations are drawn up based on a range of consultations and inputs—including the Hansard. The regulations then become the basis on which this proxy process is managed, enforced and executed.

[Naz Shah]

I genuinely want to understand this issue. Even though we have had this conversation in Committee, what if the Secretary of State, following those consultations, decides otherwise? What recourse do we as a Committee have to challenge that?

[Stephen Kinnock]

The Bill, once it becomes an Act, places a legal duty on the Secretary of State to produce those regulations. The Secretary of State would be in breach of the law if he were not to enforce the conclusions of the Act.

--- Later in debate ---

[Sojan Joseph (Ashford) (Lab)]

Record keeping is a huge issue in our healthcare system. A huge number of coroners’ reviews have identified that record keeping has been an issue. By specifying only that clinicians need record a “recordable event”, we are leaving it as the responsibility of individual clinicians to decide what a recordable event is.

It is important that a good record be available to prevent future incidents and learn good practice. Leaving it open to a clinician to decide whether something is a recordable event could lead to most issues not getting recorded. For example, if a clinician has identified that there was coercion, it will be for the clinician to decide how much documentation to do. In my view, if they have identified a coercion, that should be recorded as an incident and further investigation should be done, but the Bill leaves it up to the clinician to decide. There is no standard for record keeping across the healthcare system, so a care home’s may be different from an NHS ward’s. I think it is for the Committee to look into what “recordable event” actually means.

[Stephen Kinnock]

The purpose of amendments 474 to 478 is to improve the drafting of the Bill by creating a new definition of “recordable event”. Recordable events are the events set out in clause 16(1) related to the recording of declarations and statements.

The amendments would also make consequential changes to clause 16, which refer to the occurrence of the recordable event, as per the new definition, and include reference to a report in addition to a statement or declaration. The reference to a report is consequential on the amendments already agreed by the Committee to clauses 7 and 8.

[Kim Leadbeater]

I have nothing further to add.

Amendment 474 agreed to.

Amendments made: 475, clause 16, page 11, line 19, leave out from second “the” to “in” in line 21 and insert

“occurrence of the recordable event”.

This amendment is consequential on amendments 209 and 377.

Amendment 476, in clause 16, page 11, line 24, leave out from “the” to “, and” in line 26 and insert

“occurrence of the recordable event”.

This amendment is consequential on amendments 209 and 377.

Amendment 477, in clause 16, page 11, line 27, leave out from “the” to “in” in line 29 and insert

“occurrence of the recordable event”.

This amendment is consequential on amendments 209 and 377.

Amendment 478, in clause 16, page 11, line 30, leave out from second “a” to end of line 32 and insert

“declaration, report or statement within subsection (1) must include the original declaration, report or statement.”—(Kim Leadbeater.)

This amendment is consequential on amendments 209 and 377.

Clause 16, as amended, ordered to stand part of the Bill.

Clause 17

Recording of cancellations

--- Later in debate ---

[Kim Leadbeater]

The amendment, which would clarify the drafting, speaks for itself. The important point is that the record of cancellation be with the GP practice as soon as is practicable. It is not necessary for that to take place physically at the practice, as that could potentially delay its delivery.

[Stephen Kinnock]

Clause 17(2) provides that where a notice or indication regarding a cancellation of a first or second declaration is given to a registered medical practitioner “at” the person’s GP practice, that practitioner must record the cancellation in the person’s medical records as soon as possible. Amendment 479 seeks to clarify that the requirement to record the cancellation applies not just where the cancellation is given to a registered medical practitioner physically at the GP practice, but where the cancellation is given to a registered medical practitioner “with” the person’s GP practice, irrespective of whether the notice was given at the GP practice. I hope that that explanation is helpful.

[Kim Leadbeater]

I commend the amendment to the Committee.

Amendment 479 agreed to.

Clause 17, as amended, ordered to stand part of the Bill.

Clause 18

Provision of assistance

Amendment made: 378, in clause 18, page 12, line 9, leave out paragraph (a) and insert—

“(a) a certificate of eligibility has been granted in respect of a person,”.—(Kim Leadbeater.)

This amendment is consequential on NC21.