Oral Answers to Questions
Wes Streeting Excerpts(1 month, 3 weeks ago)
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Torcuil Crichton (Na h-Eileanan an Iar) (Lab)
The Secretary of State for Health and Social Care (Wes Streeting)
Mr Speaker, on behalf of the Government and Labour Members, may I associate myself with your remarks? Members from right across this House will share those sentiments. As the Prime Minister made clear at Cabinet this morning, and as the Foreign Secretary is making clear in Kyiv, we will stand with Ukraine, whatever is thrown at it, until it has the freedom and security that it deserves.
This Government are restoring the founding promise of the national health service: to bring quality healthcare to all, regardless of how much they earn or where they live. New funding for GPs is being prioritised for areas where the need is greatest, and we are sending more cancer specialists to rural hospitals. As we modernise the health service, the NHS app and NHS Online will bring world-class healthcare to the most remote corners of our country at the touch of a button—lots done, and lots more to do.
Torcuil Crichton
In places like Na h-Eileanan an Iar, going the extra mile to provide care is part of the job, and I pay tribute to the carers in my constituency who travel miles in darkness and bad weather to deliver support for the elderly. In some parts of the Western Isles, and indeed across rural Scotland, there simply is not the working-age population to provide that care, and immigration cannot solve that problem entirely. Does the Minister agree that it is only by increasing wages and paying social care staff properly—something for which Scottish Labour has been calling for some time—that we will increase the number of carers in rural areas, and provide a proper care service?
Wes Streeting
I wholeheartedly agree with my hon. Friend. This Labour Government are introducing the first ever fair pay agreement for care workers. That is better pay and conditions for care workers, and more people recruited into the profession. It is backed by £500 million, and Scotland will receive extra funding through the Barnett formula. The question for the SNP is: where is the money going, and why is it not going into the pockets of Scottish care workers, as Jackie Baillie has demanded?
Layla Moran (Oxford West and Abingdon) (LD)
On Friday, I visited Young Devon, an early support centre in the heart of rural North Devon, where I met young people who told me heartbreaking stories of how they felt left out and let down by the system. Young Devon was quite literally a lifeline for them. It has an open-door, person-centred approach. I am delighted that its funding has been continued for one more year, but it is only one year, and those who run the centre told me that this makes it incredibly difficult for them to plan. Can the Secretary of State clarify what the longer-term plan is for these early support hubs, how they sit alongside Young Futures hubs, and how he can help organisations like Young Devon thrive into the future?
Wes Streeting
I join the Chair of the Health and Social Care Committee in paying tribute to Young Devon and the work it is doing. As she will know, I have enormous sympathy for the challenge she raises about medium-term certainty on funding. As was demonstrated on the Floor of the House yesterday by the Education Secretary, my Department and the Department for Education are working closely together to make sure we are better joining up education, health provision and support for young people. There is more to do. I accept the challenge that she sets down around medium-term certainty on funding; that is why we are doing more through, for example, the medium-term planning framework. I accept, in the spirit of this exchange, that there is lots done, but lots more to do.
Helen Morgan (North Shropshire) (LD)
Last year in Shropshire, which is a fairly typical rural area, 158,000 patients waited more than a month for a GP appointment. That is not surprising, given that, like many other rural areas, we have 50 fewer qualified GPs than we did a decade ago. Meanwhile, already busy GPs are trying to develop integrated neighbourhood teams, but they report that they have not received any dedicated Government funding, and still do not have the model neighbourhood framework. Will the Secretary of State act to ensure that GPs have the resources and guidance that they need to develop those neighbourhood health teams, and ensure that everyone can access an appointment within seven days, or 24 hours if it is urgent, particularly in rural areas, where provision is poor?
Wes Streeting
We have 2,000 more GPs now than when Labour came into office, but the hon. Lady is right to say that we need to ensure that that provision and increased capacity are reflected throughout the country. Because general practices serving more deprived areas receive 10% less funding per needs-adjusted patient than those in wealthier parts of the country, we are reviewing and reforming the Carr-Hill formula to ensure that we can direct the right funding to the areas in greatest need, recognising that amid our rural communities, there is obviously not just plenty of affluence, but enormous pockets of disadvantage and deprivation. Whoever people are and whatever their background, the support and care that they need must be received in the right place and at the right time.
Grahame Morris (Easington) (Lab)
Douglas McAllister (West Dunbartonshire) (Lab)
The Secretary of State for Health and Social Care (Wes Streeting)
Cancer is the canary in the coalmine for the NHS. For far too many cancer patients, under the Tories, the NHS was not there when they needed it. Under Labour, an extra 213,000 patients have been diagnosed, or have received the all-clear on time. Much has been done, but there is much more to do. I pay tribute to the leadership of the Minister for primary care and prevention, my hon. Friend the Member for West Lancashire (Ashley Dalton), and to her national cancer plan. She has poured her heart and soul into that plan, all while living with and being treated for cancer. We are investing an extra £2.3 billion in diagnostic capacity to deliver 9.5 million more tests by the end of this Parliament. Catching cancer earlier, treating it faster and preventing it is how we will save more lives.
Douglas McAllister
I welcome the focus of the national cancer plan on diagnosing cancer faster. That is needed across all cancers, but particularly for leukaemia. Research by Leukaemia UK has found that one in four patients face an avoidable delay in their diagnosis, and that 37% of patients are diagnosed in an emergency setting. How will the implementation of the plan address delays in leukaemia diagnosis, and what steps will the Department take to reduce the proportion of patients who are diagnosed through an emergency route?
Wes Streeting
My hon. Friend is right that leukaemia patients are disproportionately diagnosed too late. We are working with GPs to ensure that they are better prepared to spot symptoms or concerning blood test results, so that we can cut out avoidable delays. The real difference, however, will come with the introduction of genomic testing at birth. That will allow the NHS to leapfrog rare cancers such as leukaemia, so that they can be caught early, or even prevented. Lots done, certainly lots more to do.
James Wild (North West Norfolk) (Con)
When I met Big C in King’s Lynn recently, I heard about the anxiety caused; only 52% of local patients are treated within two months, whereas the national average is 71.9%. What action is the Department taking to support the Queen Elizabeth hospital trust in improving its performance for patients?
Wes Streeting
The hon. Gentleman is absolutely right; this is about not just diagnosis but faster access to treatment. We are meeting the faster diagnosis standard; performance was at 77.4% in December 2025, and we aim to improve that to 80% by the end of March this year. We have to go a lot further, a lot faster, on the commencement of treatment. Although I will be forthcoming about, and proud of, the progress that we are making and the targets that we are hitting, where we fall short—we are still falling far too short, when it comes to access to cancer treatment—we will acknowledge that, address it and make sure that we make more progress, more quickly.
Dame Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
Calum Miller (Bicester and Woodstock) (LD)
The Secretary of State for Health and Social Care (Wes Streeting)
The Prime Minister has made tackling violence against women and girls a priority across the Government and every public service must play its part. In the NHS, we will be supporting GPs to identify, support and refer victims and survivors to specialist services. That will include a specialist support worker for every GP practice to draw on and training GPs to spot the signs of domestic abuse and sexual violence. As part of the Government’s VAWG strategy, the Department will provide an additional £5 million for victim support services and up to £50 million to roll out specialist services for child sexual abuse victims.
Calum Miller
I recently had the opportunity to visit the dedicated staff at Survivor Space, a centre for victims of sexual violence in Oxford that serves my constituents. I was shocked to learn that victims and survivors of sexual violence may wait up to two years for a counselling session. I was further appalled to learn that at least one survivor had been advised that they could not access NHS mental health services until they had first had counselling from Survivor Space. Does the Secretary of State agree that no survivor should have to wait two years for treatment, and would he or one of his Ministers meet me and representatives of Survivor Space to discuss how to get dedicated healthcare funding to the frontline in order to support such services?
Wes Streeting
I wholeheartedly agree with the hon. Member. The voluntary and community sector provides, and should continue to provide, support for victims. The voluntary sector does a brilliant job, in an environment that often feels safer and more inclusive, and we should welcome that. However, the existence of voluntary sector provision does not excuse the NHS from performing its duties. One change that I have led in the leadership culture of my Department is the recognition that investment in services for victims and survivors is a responsibility of the NHS and the DHSC, not of the Home Office, Ministry of Justice or others. We must take responsibility for meeting the needs of everyone. There is of course more to do on waiting times. I would be delighted to ensure that the hon. Gentleman gets the meeting that he asks for.
Dr Beccy Cooper (Worthing West) (Lab)
Harriet Cross (Gordon and Buchan) (Con)
The Secretary of State for Health and Social Care (Wes Streeting)
Today we are publishing a new GP contract. Backed by new funding, it will recruit more GPs and cut waiting times for appointments. The changes and modernisation will diagnose thousands more cases of lung cancer, protect children by boosting vaccination rates, and provide more people with weight-loss jabs on the NHS. That follows an extra £1.1 billion that we have invested in general practice this year, and builds on the 2,000 more GPs that we have recruited since the general election. After 14 years of decline, the Government are fixing the front door to the NHS, bringing back the family doctor, and ending the 8am scramble. Lots done, lots more to do.
Harriet Cross
Inverurie medical practice in my constituency saw its national insurance bill rise by £75,000 thanks to this Government. That has put huge pressure on the practice, which was already operating with one GP for 3,000 patients, which is three times higher than the British Medical Association recommends. When did the Secretary of State last meet the Chancellor to discuss the impact of the NICs rise on GP practices, and what are he and his Department doing about the pressure—
Wes Streeting
I see the Chancellor most weeks. That is why record investment is going into our NHS, which is improving patient satisfaction with access to general practice, cutting waiting lists, and improving ambulance response times—all to fix the mess that the Conservatives left behind. And people should be in no doubt: given the chance, they would do it again. They opposed the investment, they opposed the reform, and they can never be trusted with our NHS.
Alex Ballinger (Halesowen) (Lab)
Stuart Andrew (Daventry) (Con)
In the plan for change, the Government committed to meet the 18-week standard for routine operations, but the latest data suggests that the Government are not on track to meet that commitment by the end of the Parliament. In December, fewer people were treated within 18 weeks than in the previous month. Will the Secretary of State now accept the reality that patients are experiencing and, as the Institute for Fiscal Studies has warned, that the Government will not deliver their commitment on their key milestone to deliver the 18-week standard?
Wes Streeting
I will never surrender to the tyranny of the low expectations of the Conservative party. We have cut waiting lists by 330,000 since we came to office; they are now at their lowest level in three years. We made progress despite strikes, we made progress despite winter pressures, and we have made progress despite every bit of investment and modernisation being opposed by the Conservatives. Instead of criticising our record, the shadow Secretary of State should apologise for his.
Stuart Andrew
Another leadership ambition, I see.
On 29 September, I wrote to the Secretary of State regarding the late Dr Susan Michaelis’s campaign for better research into lobular breast cancer, but sadly I still have not had a reply. She established the Lobular Moon Shot Project and the last Government committed to support its aims. However, despite meeting the Secretary of State, representatives from the project say that they still have no clarity on how the project and research will be expedited. Will the Secretary of State confirm now Government approval for the funding required for this research, which is critical for so many women in this country?
Wes Streeting
I apologise to the shadow Secretary of State for not having replied to his letter—let me make sure that I do that. There is no disagreement across the House on the substance of the issue. I am absolutely supportive of the project and I want to fund the research, but we have to make sure that the research proposal meets the standards and has the confidence of our funders. We are working with the team to try to get the proposal over the line, but that is the only obstacle here—it is certainly not a political decision.
Euan Stainbank (Falkirk) (Lab)
Wes Streeting
The hon. Member highlights a real challenge that we have inherited: the disconnection between undergraduate education and training, and the jobs that are available. We are addressing that through our workforce plan. I want to place on the record my thanks to South Western Ambulance Service, which in December improved ambulance response times by just under 30 minutes for category 2 calls. There are still big challenges in the south-west, but the team deserve real credit for the improvement they have led.
Sarah Edwards (Tamworth) (Lab)
Bradley Thomas (Bromsgrove) (Con)
Several weeks ago, I received a jaw-dropping email from a local Bromsgrove GP, who told me that a 10-month-old child nearly died after ambulance delays. Worse, the same day, another patient—a 66-year-old driving instructor—suffered a cardiac arrest during a driving lesson and died while being driven to the hospital by his wife. My constituents demand a better service and better response times. What are the Government going to do about this, and will the Secretary of State meet me and the concerned GP who wrote to me to address this issue?
Wes Streeting
Nothing is more sobering than hearing experiences of the life-and-death difference between the NHS being there for people when they need it and it not being there when they need it. People will be aware of a tragic case over the weekend involving a woman in her 90s in the Isle of Wight, which we are looking into. Ambulance response times are improving, but I do not pretend that they are good enough; we have done a lot, but there is a lot more to do, and the hon. Gentleman has painfully and powerfully underscored what happens when the NHS is not there for people when they need it. That is the NHS we inherited, and it is the NHS I am determined to change.
Peter Lamb (Crawley) (Lab)
Crawley A&E’s closure was accompanied by a commitment to a 24-hour urgent treatment centre, a commitment that the trust is now breaking. Can the Minister meet me to discuss how local services can be preserved and improved?
Paul Waugh (Rochdale) (Lab/Co-op)
In Rochdale, we need more midwives to provide the safe staffing levels that our mums-to-be rightly expect, but newly qualified student midwives often find it difficult to find jobs when they qualify. Can the Minister explain exactly when the NHS workforce plan is due so that they can give reassurance to those newly qualified midwives that they will have a career in the NHS?
Wes Streeting
I am grateful to my hon. Friend for raising this issue. The NHS workforce plan will be published in the spring. I recognise the challenge he has set out, and we are determined to address it—we desperately need more midwives, and we certainly need good clinical leadership in this area. That is what the Government are working towards.
Andrew George (St Ives) (LD)
Minor injuries units are being phased out in urgent treatment centres such as the brilliant one at West Cornwall hospital in my constituency—its hours were cut under the Conservatives, and have not been restored. Those units clearly help to take the pressure off ambulance and emergency services, so what will Ministers do to ensure that those services are reinforced rather than reduced?
Wes Streeting
One rationale for both the 10-year plan and the medium-term planning we are doing across the NHS is to ensure better integration, with the principle of people receiving the right care in the right place at the right time. Decisions about local configurations are matters for local leaders, but we keep these things under review, and if the hon. Gentleman has concerns, he should certainly write to us.
Lola McEvoy (Darlington) (Lab)
As the Secretary of State knows, Darlington Memorial hospital is part of the County Durham and Darlington NHS foundation trust, which has recently been marred by the scandal of over-operation in breast services. We know that many women came to harm as a result of those failures, but we are yet to find out how many and the full extent of the harm because the trust has not completed the comprehensive look-back. Will the Minister meet me to ensure that our trust has all the resources it needs to learn the lessons necessary to ensure that no women—whether in my area or across the country—have invasive and painful clinical procedures that they do not need?
Puberty Blockers Clinical Trial
Wes Streeting Excerpts(1 month, 3 weeks ago)
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The Secretary of State for Health and Social Care (Wes Streeting)
Today, I am updating the House that the preliminary work to establish the pathways clinical trial into the prescription of puberty suppressants for children and young people with gender incongruence has been paused.
The MHRA, the agency authorising the clinical trial, has written to the trial sponsors, King’s College London, to raise concerns regarding the trial which will now be discussed with clinicians. On Friday, DHSC published a copy of the MHRA letter, which is available here: https://assets.publishing.service.gov.uk/media/6998b06d047739fe61889efb/Sponsor-letter110226.pdf
Discussions between the MHRA and King’s College London will begin this week to address these new concerns. I will review the outcome of those discussions, taking clinical advice.
I have always been clear about the red lines regarding this trial and the prescription of puberty blockers, the safety and wellbeing of the children and young people and always being led by the expert clinical evidence. Those have been—and will remain—the driving considerations in every decision being made.
The clinical trial will not start to recruit until the issues the MHRA raised have been resolved. It will only be allowed to go ahead if the expert scientific and clinical evidence and advice conclude that it is safe to do so.
[HCWS1347]
NHS Agenda for Change Workforce
Wes Streeting Excerpts(2 months ago)
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The Secretary of State for Health and Social Care (Wes Streeting)
Today, I am announcing that from April 2026, over 1.4 million NHS staff on Agenda for Change terms and conditions will receive a 3.3% pay rise.
The uplift is above the Office for Budget Responsibility’s forecast inflation of 2.2% for 2026-27, delivering a real terms pay rise for NHS staff.
It will be in pay packets from April for the first time in six years. We have listened to the workforce and understand the difficulties they face when pay awards are not delivered on time. That’s why this Government committed to speeding up the pay review process, remitting the pay review bodies months earlier than previous years, and submitting written evidence earlier too.
In making this award, I am accepting in full the recommendation from the NHS Pay Review Body for 2026-27. Their report recognises the vital contribution that NHS staff make to our country.
This award is above the Government’s affordability position set out in their evidence to the NHSPRB. As we are delivering the pay round much earlier this year, announcing now in February, the business planning process for the Department of Health and Social Care and its arm’s length bodies is under way. The existing challenging productivity and efficiency commitments required by ICBs and providers to deliver breakeven positions are the foundations of the Government’s ability to fund this within the existing settlement. This additional pressure above affordability will be managed by DHSC and ALBs (including NHSE central budgets) but none of the pay increases will be paid for by cutting frontline services.
As part of the overall AfC pay package for 2026-27, we will progress talks with trade unions and employers at pace, through the NHS Staff Council, to agree and implement funded improvements to the AfC pay structure. These talks will build upon discussions held to date exploring the feasibility of multi-year arrangements, and separate funding will be made available for these reforms as committed to in response to the 2025-26 PRB recommendation on pay structure reform. Once agreed, the reforms will deliver additional pay increases for some staff that will be effective from, and backdated to, 1 April 2026. Our priorities will be to improve pay for those on the lowest pay bands in support of the Government’s commitment to “make work pay” and to improve pay for graduates across all professions. This will recognise and build on the work of the staff council to identify its priorities.
We will continue to implement commitments to improve the support NHS staff receive and their experience at work, as well as improving nursing career progression, investing in job evaluation to ensure that all staff are paid fairly for the work they are asked to do, and supporting newly qualified staff. Improving the experience of work for all staff, ensuring the NHS is a great place to work, is fundamental to improving the patient experience: from reducing the backlog in elective care, to ensuring timely access to GP appointments.
The NHSPRB report will be presented to Parliament and published on gov.uk
[HCWS1340]
Nursing Workforce
Wes Streeting Excerpts(2 months, 1 week ago)
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The Secretary of State for Health and Social Care (Wes Streeting)
Today I am announcing a comprehensive package to recognise the value of the nursing profession. Nurses are essential to leading and delivering the Government’s 10-year health plan, and critical for patient safety and outcomes, but the profession has been undervalued in the NHS for far too long.
Too many nurses are not being compensated appropriately for the work they do, and there is currently no universal preceptorship programme in place for new graduate nurses.
This Government are clear that a constructive relationship with unions is in everyone’s interests. Following engagement with all nursing unions, including UNISON, Unite, and GMB, and a dedicated period of intensive engagement with the Royal College of Nursing, they have agreed a series of measures that will transform the nursing profession and make sure that nurses get the pay and support they deserve.
Today I am committing to invest in the NHS nursing workforce in four ways:
Prioritising increasing graduate pay. It is important that graduate salaries are competitive within the wider labour market to attract graduates into the NHS. I am therefore asking the NHS staff council to prioritise graduate pay in the upcoming discussions on pay structure reform. This will impact all graduates under the Agenda for Change contract, including nurses.
Reviewing the work of every band 5 nurse. Every band 5 nursing role will be reviewed by employers over a set timeframe to ensure that job descriptions and pay bands reflect the work that nurses are being asked to do. Additional national funding will be made available to support the band 5 review process and any resulting salary uplifts. This will be separate and additional to the funding that will be made available for annual headline pay rises and for pay structure reform.
Establish a single national nursing preceptorship standard. I have asked the chief nursing officer for England to lead work as part of the upcoming professional strategy for nursing to improve the quality and consistency of preceptorships for all newly qualified nurses. This work will be delivered in partnership with trade unions, employers and other key stakeholders.
A review of the evidence. We will review the evidence that is gathered as part of the review of band 5 nursing roles to determine whether any further action is required.
We will continue to work together with unions to ensure this work is delivered at pace, and that nurses get consistent support in their early careers and are paid for the work they are asked to do.
[HCWS1329]
Early Support Hubs
Wes Streeting Excerpts(2 months, 1 week ago)
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The Secretary of State for Health and Social Care (Wes Streeting)
This year, the theme of Children and Young People’s Mental Health Week is “This is My Place”, drawing important attention to children and young people’s sense of belonging and the important role that communities and community organisations play in supporting their mental health and wellbeing. As a Government, we rightly celebrate the vital role of community organisations in providing support, compassion, connection, and hope to children and young people where and when they need it.
That is why I am pleased to announce that the Government are investing an additional £7 million so that the 24 early support hubs we are currently funding can continue to operate an expanded service offer for 2026-27. This means that in total we have provided more than £20 million since April 2024 to ensure that thousands more children and young people will continue to receive quicker mental health support, and to enable further continuity in the provision of these services. These hubs help to prevent mental ill health while also bringing care closer to home, both important objectives in our 10-year health plan.
Crucially, this continued investment means that thousands of children and young people will receive earlier, open-access mental health and wellbeing support, where any child can self-refer without an intermediary or prior formal contact. The hubs will continue to offer mental health support and advice to young people aged 11 to 25, and provide continued access to a range of services that are tailored to local need. This could include group work, counselling, psychological therapies, specialist advice, as well as signposting to information and other services. In addition to the mental health offer of hubs, young people may also be able to access advice on wider issues, including sexual health, jobs, drugs, alcohol, and financial worries.
Alongside continuing to support the services offered by these 24 hubs, the funding will ensure continued evaluation of the impact of these services, with early indications suggesting that young people value the holistic approach of the hubs. The evaluation has also highlighted the benefits of easily accessible support for young people, based on interviews with service managers. The evidence and insights collected through the early support hubs evaluation, which aims to publish in the summer, will support the delivery of young futures hubs, alongside best practice and learning from other initiatives. This learning will inform our ambitions for community mental health and wellbeing support for children and young people, ensuring that they have access to what they need, as soon as they need it.
[HCWS1328]
Medical Training (Prioritisation) Bill
Wes Streeting ExcerptsTuesday 27th January 2026
(2 months, 3 weeks ago)
Commons ChamberRead Full debate Medical Training (Prioritisation) Act 2026 View all Medical Training (Prioritisation) Act 2026 Debates Read Hansard Text Watch Debate Read Debate Ministerial Extracts Amendment Paper: Committee of the whole House Amendments as at 27 January 2026 - (27 Jan 2026)
The Secretary of State for Health and Social Care (Wes Streeting)
I beg to move, That the Bill be now read a Second time.
I begin by thanking the Leader of the House, the Chief Whip, their counterparts in the other place, colleagues in my Department and in the NHS, the Bill team and parliamentary counsel, who have moved mountains to prepare this Bill in double-quick time. I once again place on the record my sincere thanks to my counterparts in the Governments of Wales, Scotland and Northern Ireland—as well as the respective Secretaries of State for those nations—for the spirit in which, regardless of party, they have helped us to bring the Bill forward. Last but by no means least, I am enormously grateful to Jackie Baillie, Labour’s deputy leader in Holyrood, for her wise counsel.
The NHS is on the road to recovery, not least because of the herculean efforts and dedication of NHS leaders and frontline staff who, even in the depths of winter, are delivering outstanding episodes of care, hour after hour and day after day. Among the encouraging signs of year-on-year improvement are waiting lists falling at their fastest rate in three years—down more than 300,000 under Labour—and quicker ambulance response times, shorter waits in A&E and speedier cancer diagnoses for more people. December was the busiest month in NHS history for 999 calls, but despite that, and regardless of industrial action and winter pressures, ambulances arrived at heart attack and stroke patients nearly 15 minutes faster compared with last year.
The progress we are seeing is a reminder that nothing positive for the people who use the NHS ever happens without the people who work in our NHS. Our investment and modernisation are starting to restore confidence and renew belief among frontline staff; with that, hope, optimism and ambition are returning too. That is why, outside of the pandemic, staff retention is at its highest in a decade and vacancies are at their lowest since records began in 2017. There is lots done, but, as we know, there is so much more to do.
I will always be honest about the state of our national health service—what is going well and where we need to improve. There is no sugar coating the fact that staff morale is still too low, and the way that some of our NHS workforce is still treated and the conditions in which too many of them still work are nothing short of a national disgrace. Not only is it a stain on our NHS, but it shames us as a country when those who care for us in our hour of need suffer bullying, harassment and racist abuse; have nowhere to rest, go to the toilet or get changed; cannot get a hot meal on a night shift; have limited flexible working options; must book holiday a year in advance; need to log in seven times just to use a PC; spend time form-filling rather than looking after patients; and face basic errors with pay and contracts. Before Christmas, I had a doctor in my constituency advice surgery in tears as she described the way she had been treated by a previous employer. This is no way to treat the people who kept us going when everything else stopped, so we are taking action.
Trusts are now implementing the 10-point plan for resident doctors and my Department, together with NHS England, is developing new staff standards to create better working practices and better conditions.
We have awarded above-inflation pay rises to everyone working in the NHS for this year and last year, which is beginning to recover the pay erosions seen under the last Government. We have begun 2026 with constructive talks with the British Medical Association’s resident doctors committee, as we seek to broker industrial peace. I have also told NHS leaders that they need to step up when it comes to the conditions that their staff face. They cannot expect the Secretary of State to micromanage availability of hot food in their canteen, for example.
However, there are workforce problems that only Government can solve. We have known for years that the treatment of resident doctors is often totally unacceptable and that the very real fears about their futures are wholly justified. Every time I have met a resident doctor, either formally or informally, they have told me without fail how their careers are blocked because there are far too many applicants for training places. Not only do I think that they have a legitimate grievance, but I agree with them.
Dr Kieran Mullan (Bexhill and Battle) (Con)
The Secretary of State is essentially talking about postgraduate training. I wonder what thought he has given to new clause 2 in the name of my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer). I have spoken to students who worked really hard all the way through medical school to get the best exam results and perform highly but then ended up in an allocation system that pays no attention whatsoever to that. Merit has been entirely removed from the system. I think it was wrong for us to make that change. Does he have any sympathy for returning to a merit-based system?
Wes Streeting
I certainly do have sympathy with that argument. We have begun to move the system in the right direction in terms of giving applicants greater preference in placements, but it is not lost on me that the system of rotations, placements and jobs means doctors are moved around the country and families are uprooted. The frictional cost of relocating from one place to another is a challenge that resident doctors in particular face. I do not think that an amendment to the Bill is the right vehicle in which to address that issue, but I am sympathetic to the arguments that the hon. Member makes, and I am sure he will make them again during this afternoon’s proceedings. We will take his arguments seriously and look to work together with the BMA and others to act to improve the experience of training, rotations and jobs.
UK graduates used to compete among themselves for foundation and specialty roles. Now they are competing against the world, because of the visa and immigration changes made by the Conservative Government post Brexit. The situation is compounded by the previous Administration’s total lack of workforce planning, which saw more students going to medical school without the number of specialty training places being increased. That is why we see the training bottlenecks that resident doctors face today.
Several hon. Members rose—
Wes Streeting
I will give way to the hon. Member for Henley and Thame (Freddie van Mierlo) and then to my hon. Friend the Member for Hitchin (Alistair Strathern).
Freddie van Mierlo (Henley and Thame) (LD)
A constituent of mine is studying medicine at Queen Mary University of London but at a campus in Malta. Students at the Malta campus complete the same General Medical Council-approved curriculum, assessments and licensed exams as London-based students, and graduates hold a UK primary qualification. He was given a formal guarantee that he would be at no disadvantage if he chose to study at the Malta campus. Can the Secretary of State reassure me that graduates like my constituent will be prioritised on the NHS foundation medical training programme?
Wes Streeting
Students studying in Malta will not be prioritised in the Bill, but they will still be able to make applications. Queen Mary University’s Malta website is clear that Queen Mary does not administer the UK foundation programme and cannot control whether or on what basis applicants are accepted into the programme, and no one is guaranteed a post on qualification.
Dr Andrew Murrison (South West Wiltshire) (Con)
Will the Secretary of State give way?
Wes Streeting
I will make some progress because, with respect, I have not yet set out the measures that we are to debate today. Let me take the intervention from my hon. Friend the Member for Hitchin, then I will set out the Government’s rationale and take further interventions.
Alistair Strathern (Hitchin) (Lab)
I wonder if the Secretary of State shares my residents’ utter disbelief that the last Government created a system where thousands of UK medical graduates, educated at the cost of billions to the UK taxpayer, were suddenly forced to compete with overseas students, pushing many abroad for their careers and losing a big talent pool that should be powering our NHS and getting it back on its feet.
Wes Streeting
That is right. I have to say, many of my counterparts around the world cannot fathom how we ended up in this situation in the first place. They certainly do not do as we have been doing, investing so much in their home-grown talent only to then see that talent compete on equal terms with anyone from anywhere else in the world.
Let me set out why we need this Bill. There are workforce problems that only Government can solve. We know that the treatment of resident doctors has been totally unacceptable for years and we see the training bottlenecks that resident doctors face today. In 2019, there were around 12,000 applicants for 9,000 specialty training places. This year, that has soared to nearly 40,000 applicants for 10,000 places, with nearly twice as many overseas-trained applicants as UK-trained ones. As a result, we now have the ridiculous state of affairs where UK medical graduates, whose training British taxpayers fund to the tune of £4 billion a year and who want to carve out a career in their NHS, are either being lost abroad or to the private sector. If we do not deal with that, the scale of the issue and the resentment it causes will just get worse. More taxpayers’ money will be wasted, more British medics will turn their backs on the NHS, and patients and our NHS will ultimately suffer.
Seamus Logan (Aberdeenshire North and Moray East) (SNP)
The Secretary of State knows that the SNP believes that this is a pragmatic Bill that will have a net-positive outcome for the health service in Scotland. We welcome the Bill and are glad to support it. However, there are specialty fields, such as general practice, which have a high number of international graduates. Because of Government policy, there are significant challenges in supporting the retention of some individuals. For example, the new requirement for settled status is 10 years with some exceptions, whereas training programmes are often only three years long. I am sure that the Secretary of State does not want the UK to be a hostile environment for our vital overseas medical staff. Will he therefore make representations to the Home Office so that it is aware of the anomaly?
Wes Streeting
I will say two things to the hon. Gentleman. This Bill does not in any way detract from the fundamental point that the NHS has always been an overseas recruiter and we have always been fortunate to draw on global talent from around the world who come and give through their service, their taxes and their wider contribution to the national health service and our country. We will continue to welcome that and people will continue to be free to apply. In future, they will apply on terms that are fairer to our own, home-grown talent.
There is nothing in what the Home Secretary proposes that will stop people who come through our universities and have the skills that we need to contribute to our health and care system applying for jobs and settling and making the UK their home. The Bill supports the Home Secretary to reduce an over-reliance on overseas talent and labour, which contributes to levels of net migration that even bleeding-heart liberals like me can see are too high. That is the issue that the Home Secretary seeks to deal with.
Kevin Bonavia (Stevenage) (Lab)
My right hon. Friend is right that we need to deal with this pressing problem and I support the aims of the Bill. However, as he can imagine, as the only current Member of this House with Maltese heritage, I have had representations from all quarters, both in the UK and in Malta, about the impact on Malta of this. Our two countries have a special health relationship, including the affiliation of the UK foundation programme with the Maltese equivalent. I understand that now may not be the time to have Malta in the priority group, but I note that there is a power in clause 4(6) that allows the Secretary of State to amend that in future. Is that something that my right hon. Friend will think about reviewing in future?
Wes Streeting
My hon. Friend is right about the measures in the Bill. He is also right about the importance of our relationship with Malta, which is long-standing and deep, and this Government place enormous value on that. We will, of course, keep the workings of the measures in the Bill under review. He is also right to say that the Bill provides flexibility to the Secretary of State to adjust, as our needs may demand.
Dr Murrison
The Bill is basically a good one, and we all share the intent to encourage home-grown talent to remain in our national health service, so could the Health Secretary explain why he appears to have set his face against British students who for various reasons train at, for example, St George’s in Cyprus or St George’s in Grenada and who then want to come back and practise in our national health service? They want to come back and practise at home. Amendment 9 would deal with that conundrum. Why will he not support it?
Wes Streeting
We set UK medical school places based on future health system needs. We cannot control how many places the overseas campus universities create, whether they are UK-based universities or not. Prioritising those graduates in the way that the right hon. Gentleman suggests would undermine sustainable workforce planning. It would also undermine social mobility and fair access. Those campuses are commercial ventures; they receive no public funding and students are generally self-funded. The nature of prioritisation is that we set priorities, and these are the priorities that this Government are setting out. We must break our over-reliance on international recruitment.
As I have said, I am proud of the fact that the NHS is an international employer, and it is no coincidence that the Empire Windrush landed on these shores in 1948, the very year our NHS was founded. We are lucky that we have people from around the world who come and work in our health and care service. Since Brexit, however, under the last Government, we have begun to see something much more corrosive, with the NHS poaching staff from countries on the World Health Organisation’s red list because their own shortages of medical practitioners are so severe. The continued plundering of doctors from countries that desperately need them while we have an army of talented and willing recruits who cannot get jobs is morally unacceptable. If some Opposition Members want to defend that record and dismiss the morality argument, I would point out that that position is naive on economic grounds. Competition for medical staff has never been fiercer. The World Health Organisation estimates a shortfall of 11 million health workers by 2030. Shoring up our own workforce will limit our exposure to such global pressures without depriving other countries of their own home-grown talent.
Ben Coleman (Chelsea and Fulham) (Lab)
I congratulate my right hon. Friend on his excellent speech and the strong points that he is delivering. I associate myself with the remarks of my hon. Friend the Member for Stevenage (Kevin Bonavia) about Malta. As a member of the Health and Social Care Committee, I have also been approached by Queen Mary University. It seems to me that we should be approaching this with a sense of fairness, and if students have entered into a GMC-recognised course with the expectation of having priority access for foundation status, we should accept that those who are currently in training still enjoy that, even if we change the rules for people who enter those courses in the future. Is that something that my right hon. Friend will consider?
Wes Streeting
As I have said, the position we have set out is founded on fairness. The basis on which people have applied to these universities has made it clear that the universities cannot guarantee places and that overseas applicants studying at UK universities’ overseas campuses can still apply. There is nothing to prevent those people from applying, but when it comes to prioritisation, we are prioritising UK-trained medical graduates from UK-based universities who have undertaken their training here in the UK. I think that is the right priority to draw.
Wes Streeting
I will take an intervention from the hon. Gentleman. I will come to my right hon. Friend in a moment.
Gregory Stafford
The Secretary of State mentioned the need for more medical staff across the world and, of course, in this country as well. At the general election, he pledged to double the number of medical school places by 2030. Is that still a commitment, and how far has he got with it?
Wes Streeting
With respect, I think the hon. Gentleman has got his chronology slightly wrong. As shadow Health Secretary, I proposed that we should double the number of undergraduate medical school places. That policy was poached by the then Conservative Government, who made modest progress with it. We then came into government, looked at their long-term workforce plan and concluded that it was not a particularly long-term workforce plan, and we are revising it as we speak. The number of medical school places will be determined by future need. We will publish our long-term workforce plan in the not-too-distant future.
Wes Streeting
I will give way to the hon. Lady and then to my right hon. Friend the Member for Oxford East (Anneliese Dodds).
Alison Bennett
The Secretary of State rightly notes that there is international competition for healthcare talent. On Friday, I met Dr Osoba, a GP who trains future GPs. She told me how disheartening it is to train future GPs whose intention is to leave the UK. What is the Secretary of State doing to ensure that British-trained medics stay working in the NHS?
Wes Streeting
The hon. Member puts her finger right on the issue at the heart of the Bill. That is exactly the challenge we want it to address. The Bill is not a panacea—it does not solve all the problems—but reducing competition for specialty places from around four to one to less than two to one, as the Bill will do, will make it far more likely that people who have undertaken their training here in the UK will stay here and contribute to our national health service. Of course, there is much more to do on career structure, pay and conditions, but we will go as fast as we can and as far as the country can afford. We recognise that we need to keep the great people we have invested in, because doing so is in their interest and in our national interest.
Anneliese Dodds
My question relates to exactly that issue. The Secretary of State will be aware, because I have written to his Department about it a number of times, that many disabled medics face a particular challenge. They may have had to take time out of their training because of a medical condition. They are told that they can obtain a certificate of readiness to enter specialty training and go into a training specialism, but the computer says no and NHS England is not sorting this out. Will he please get a personal grip on this and fix it for my constituents?
Wes Streeting
I am certainly aware of my right hon. Friend’s concerns. I can give her that assurance and will report back to her on progress.
Without action to prioritise UK medics, we will also make it tougher than it already is for those from working-class backgrounds like mine to become doctors—or, for that matter, to even consider a career in medicine. The odds are already stacked against them: they are less likely to know doctors, their teachers may be less familiar with how to help students into medical school, they will have fewer opportunities to do work experience, and fewer people in their lives will tell them that they should aim high and reach for the stars. The result is that only 5% of medical school entrants are from lower-income working-class backgrounds. Someone’s background should not be a barrier to becoming a doctor, so our job—especially as a Labour Government committed to social justice—is not just to ensure that a few kids like me beat the odds, but to change the odds for every child in this country so that they can go as far as their talents will take them.
Aphra Brandreth (Chester South and Eddisbury) (Con)
It is vital that we address this issue to ensure that UK-trained doctors are prioritised for vacancies over international applicants—the Secretary of State is making important points about that. We need those places to be opened up for UK medics immediately, so will he explain why the Bill will not come into force immediately after Royal Assent but instead includes provision for it to come into force
“on such day or days as the Secretary of State may by regulations appoint”?
Wes Streeting
It is important that the Bill is workable. A number of factors may well interrupt our ability to move at the pace at which I want to open up those places. One of those factors is the ongoing risk of industrial action. We know that the BMA is balloting for further industrial action at the moment. We respect the process that it is undertaking, and we are not closing the door to discussions while it does so. However, we are clear that that is a further disruption risk. I hope that we will be in a position to open up a new application round very shortly for current applicants, but that will depend on our ability to expedite the passage of the Bill through both Houses, and to ensure that the system is ready to implement it. That is why bringing forward the Bill on this timescale has been particularly important.
Dr Murrison
I am grateful to the Health Secretary; he is being generous with his time. Is he saying that he intends to use this as some sort of lever or bargaining chip in his discussion with the BMA?
Wes Streeting
I am clear that this is about whether the system will be ready to implement the measures in the Bill. I must say that I view the Conservatives’ amendment on this issue with a degree of cynicism. Not so long ago, they were accusing me of being too kind to resident doctors when it came to making changes to pay or conditions without something in return. They seem to have completely changed their position. I am sure that that is not remotely cynical and is for entirely noble reasons, but I will wait for the shadow Health Secretary, the right hon. Member for Daventry (Stuart Andrew), to make his case. Let’s just say that I am not entirely convinced.
The Bill implements the commitment in our 10-year plan for health to put home-grown talent at the front of the queue for medical training posts. Starting this year, it prioritises graduates from UK medical schools and other priority groups over applicants from overseas during the current application round and in all subsequent years. For the UK foundation programme, the Bill requires that places are allocated to UK medical graduates and those in a priority group before they are allocated to other eligible applicants.
For specialty training, the Bill effectively reduces the competition for places from around four to one, where it is today, to less than two to one. That is a really important point for resident doctors to hear, not least because in the debate we had on the Government’s previous offer to the BMA, that point was lost amid some of the broader and, frankly, more contested arguments between the Government and the BMA around pay. It is not just the provision of additional training posts that reduces the competition ratio; it is also the measures in this Bill. I hope that that message is heard clearly by resident doctors as they think about their own futures immediately or in the coming years. For posts starting this year, there must be prioritisation at the offer stage, and for training posts starting from 2027, prioritisation will apply at both the shortlisting and offer stages.
In the 10-year plan, we committed to prioritising international applicants with significant NHS experience for specialty places in recognition of the contribution they have made to our nation’s health. This year, we will use immigration status as a proxy for determining those who are eligible, so that we can introduce prioritisation as soon as possible. From next year, under the terms of the Bill, we will set out in regulations how we are defining significant NHS experience.
Dr Opher
I commend the speed with which my right hon. Friend has brought this legislation to Parliament. I have been a GP trainer for 25 years. Fifty per cent of GP trainees are international medical graduates, and there has been some disquiet from them. Will he reassure our international medical graduates that they are welcome and treasured in the health service?
Wes Streeting
My hon. Friend is absolutely right about the contribution that international medical graduates make, and I have no doubt that that will continue to be the case for many years to come. I hope it is clear to those going through medical school or aspiring to a career in medicine that, in terms of the future of healthcare in this country, general practice is where it’s at. We are looking to shift the centre of gravity in the NHS out of hospital and into the community, with care closer to people’s homes and, indeed, in people’s homes, with GPs as leaders of a neighbourhood health service. I hope that gives encouragement to GPs serving today about the future of their profession, about which they care enormously. I also hope that that message resonates with people who are thinking about a career in medicine, when they think about what kind of career that might be.
Sarah Pochin (Runcorn and Helsby) (Reform)
I recently spoke to a doctor in my constituency who was concerned about resident doctors going abroad to get a training place in their chosen specialty. We in Reform welcome this Bill. Can the Secretary of State make a commitment that we will prioritise our own UK-trained resident doctors ahead of those trained abroad, and will he assure me that the Bill will help UK-trained resident doctors to secure a training post in their chosen specialty?
Wes Streeting
I can give the hon. Member that assurance—that is exactly what the Bill does. Madam Deputy Speaker, I cannot, however, resist the enormous temptation to say that while I welcome the support of the hon. Member and her party, I hope that her party’s position will not change now that it has adopted so many of the formerly Conservative culprits who landed us with this system in the first place. Whether it is the former Home Secretary, the right hon. and learned Member for Fareham and Waterlooville (Suella Braverman), or the former Immigration Minister, the right hon. Member for Newark (Robert Jenrick), I am afraid that Reform looks rather more like the Conservative party that the country rejected at the last election, which I am sure will not be lost on people when they go to the ballot box in May—[Interruption.] As my hon. Friend the Minister for Care says from a sedentary position, Reform UK are increasingly the teal Tories—it is certainly the most successful recycling project currently taking place in the House of Commons. Anyway, that was totally self-indulgent, and very churlish given that the hon. Member for Runcorn and Helsby (Sarah Pochin) is supporting the Bill, so I will slap myself on the wrist and get back to the serious matters at hand.
As we set out these changes, it is important to note that they will have no impact on doctors working in the armed forces, who will continue to be a priority, and neither does the Bill exclude international talent, as people will still be able to apply for roles and continue to bring new and vital skills to our NHS. The principle here is home-grown talent. It is not about where students are born; it is about where they are trained. What the Bill does is return us to the fair terms on which those home-grown medics competed before Brexit.
Robin Swann (South Antrim) (UUP)
I welcome the Secretary of State’s approach to the Bill, and how he has worked across all devolved Administrations. May I seek his assurance that medical students who reside in Northern Ireland, who identify as Irish and who study in an Irish institution in the Republic of Ireland will not be excluded from coming back to work in the national health service in Northern Ireland, where we very much need all the talent we can get?
Wes Streeting
I absolutely give the hon. Member that assurance—the Bill covers medical graduates from the UK and Ireland, for very obvious reasons. I welcome the broad support that the Bill appears to have across the House, because for the changes to benefit applicants in the current round—for posts starting this August—it must achieve Royal Assent by 5 March. Any delay will risk vacancies in August and disrupt planning in NHS trusts, which rely on their new trainees to deliver frontline care. Doctors also need sufficient time to find somewhere to live, sort childcare and arrange other aspects of their lives before their posts start. I am grateful that Parliament has agreed to expedite the Bill’s progress, and confident that we will be able to work at pace with our majority in this House, and with cross-party support in the other place.
Layla Moran (Oxford West and Abingdon) (LD)
I sense that the Secretary of State is about to reach the end of his remarks. We are keen to start the debate, but it would be helpful to get clarity on one thing before we begin. When will we see the workforce plan? It has been delayed a couple of times. We wrote to the Department in November asking for an explanation as to why it has been delayed and when we can expect it. Can the Secretary of State give us some clarity, because that is the context in which the narrow technical measure that we are discussing needs to happen?
Wes Streeting
That is a fair question from the Chair of the Health and Social Care Committee. We are taking longer than I would have liked with the workforce plan. I hope it reassures the hon. Member and the House that we have taken more time because that is what the royal colleges, trade unions, and clinical and NHS leaders asked us to do. Their strong urging was to get it right, rather than rush according to a political timetable, which I thought was a fair challenge. It will be published this spring.
Alex McIntyre (Gloucester) (Lab)
I welcome this legislation. Does the Secretary of State agree with me that the fact that the Government have listened to the concerns of resident doctors about training places, and have acted at pace to bring forward the legislation, shows that we as a Government are committed to fixing the problems left behind by the Conservative Government? Does he agree that the BMA should consider that when thinking about going forward with any potential further action?
Wes Streeting
I agree with my hon. Friend. For context, I say to members of the BMA and resident doctors that to bring forward legislation in this way and at this pace is not easy. We have a packed legislative programme. The clock is ticking on getting everything through that we want to get through in the time that we have available, and I am grateful to the business managers in both Houses for facilitating the Bill. Cross-party support is going to be important, particularly in the other place, where we have lots of expertise to draw on, including from Cross-Bench peers.
We have introduced the legislation because fundamentally we agree with the case that the BMA and resident doctors have been making. In our discussions with BMA representatives, immediately prior to the last round of industrial action and since, it has been very clear that when it comes to jobs, we are not that far apart. We recognise the problems and we are working together to address the solution. On pay, there remains a gap between the expectations of the BMA and what the Government can afford. All I ask of resident doctors and their BMA representatives is some understanding and a bit of give and take about the range of pressures on the Government and the national health service, many of which require funding, which is why there are choices and trade-offs.
I hope that the BMA representatives know and have noticed that, regardless of the fact that we remain in dispute on these issues and have had a number of rounds of industrial action, I have not slammed the door in their faces and stopped talking—we have continued with good-natured and constructive talks—and I have not thrown my toys out of the pram either, and said “Right, we will not proceed with this Bill.” We have continued to work to enact solutions that we think are good for resident doctors, and therefore good for patients and good for the NHS. I hope that this will be the spirit in which we can work together.
The goal is to be in a place, particularly with the BMA and resident doctors although this applies to other groups in the workforce too, where we can work together and make progress outside disputes, so that we can gather around tables as partners, rather than as opponents. That will take some gear shifting from where we have been to where we want to be, but I know that both the Government and the BMA have entered the new year in that spirit, so we will continue to make progress.
Having stressed the urgency of the legislation, I want to address the commencement clause included in the Bill, which has already been raised. First and foremost, it is there as a failsafe. We are running to an extremely tight deadline. I do not want to be in a position where a law is enacted and we are unable to implement it in a timely and orderly fashion. Secondly, there is a material consideration about whether it is even possible to proceed if strikes are ongoing, because of the pressure that they put on resources and the disruption that is caused operationally, particularly among the people I require to help me deliver the measures in the Bill. Of course, I am keeping my options open. We are in a good place with the BMA, and we have entered the latest round of talks in good spirit, but we do not yet have an agreement on their disputes and we are waiting for the outcome of their ballot, so I am not going to do anything now that unnecessarily makes it harder to end the strikes.
The Opposition amendment to remove the commencement clause is designed to make industrial action more likely, not less likely. It tries to bind my hands and make this job even more difficult. It looks like political gameplaying, at a time when we are trying to save the NHS, and it looks like party interest before national interest. I hope that the Conservatives will consider whether their amendment is really necessary.
British taxpayers spend £4 billion training medics every year. We treat them poorly, place obstacles in their way and make them fearful for their futures. We are forcing young people, who should be the future of our NHS, to work abroad, in the private sector or to quit the profession entirely. It is time that we protect our investment and our home-grown talent. This Bill will ensure a sustainable workforce, cut our reliance on foreign labour, halve competition for places and give home-grown talent a path to become the next generation of NHS doctors. I commend this Bill to the House.
Health and Social Care
Wes Streeting Excerpts(2 months, 3 weeks ago)
Written CorrectionsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Laura Kyrke-Smith (Aylesbury) (Lab)
What steps his Department is taking to improve maternity and neonatal care.
The Secretary of State for Health and Social Care (Wes Streeting)
… We have invested more than £131 million to improve neonatal care facilities, brought in a new maternity care bundle, implemented a programme to reduce the two leading causes of avoidable brain injury during labour, and increased maternal mental health services. There is so much more to do, however, to guarantee safety now and into the future, and also to ensure truth, justice and accountability for past failures.
[Official Report, 13 January 2026; Vol. 778, c. 734.]
Written correction submitted by the Secretary of State for Health and Social Care, the right hon. Member for Ilford North (Wes Streeting):
The Secretary of State for Health and Social Care (Wes Streeting)
… We have invested more than £131 million to improve maternity and neonatal care facilities, brought in a new maternity care bundle, we are implementing a programme to reduce the two leading causes of avoidable brain injury during labour, and we have increased maternal mental health services. There is so much more to do, however, to guarantee safety now and into the future, and also to ensure truth, justice and accountability for past failures.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
The maternity and neonatal plan is due in the spring, nearly two years after the Secretary of State took office. The maternity review has been delayed. There are no signs of the 1,000 additional midwives the Secretary of State said he would train. Gynaecology waiting lists are rising, with the number waiting for admission 6% higher than it was a year ago. The Secretary of State has an opportunity to save many lives, and I know that he wants to use all the opportunities available to him. May I ask him to concentrate on making more improvements in maternity care?
Wes Streeting
Let me just point out that in the 18 months for which I have had the privilege of holding this post, we have invested more than £131 million in 122 infrastructure projects across 49 NHS trusts to improve the safety of neonatal care facilities. We have implemented a new programme to reduce the two leading causes of avoidable brain injury during labour…
[Official Report, 13 January 2026; Vol. 778, c. 737.]
Written correction submitted by the Secretary of State for Health and Social Care:
Wes Streeting
Let me just point out that in the 18 months for which I have had the privilege of holding this post, we have invested more than £131 million in 122 infrastructure projects across 49 NHS trusts to improve the safety of maternity and neonatal care facilities. We are implementing a new programme to reduce the two leading causes of avoidable brain injury during labour…
Oral Answers to Questions
Wes Streeting Excerpts(3 months ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Ian Lavery (Blyth and Ashington) (Lab)
The Secretary of State for Health and Social Care (Wes Streeting)
May I associate Labour Members with your condolences, Mr Speaker?
I am hugely grateful to NHS staff for the shift that they have put in through what remains a challenging winter. It is because of them that waiting lists are going down and ambulance handover times are 14 minutes quicker this winter than last winter, and during periods of industrial action this winter, NHS providers kept approximately 95% of elective activity running. We have got to ensure that we invest not just in our service but in our staff, and we are working actively with health unions to achieve that goal.
Ian Lavery
Will the Minister join me in thanking the fantastic employees of Northumbria NHS foundation trust for their continued dedication and commitment, from the top surgeon to the ancillary workers? We know that the NHS is held together by their efforts, but that comes at a severe personal cost to many individuals. A recent YouGov poll showed that 73% of our heroes—the heroes of the NHS—reported suffering from burnout: that is severe exhaustion. Will the Minister tell the House what measures he is taking to ensure that those who put their own wellbeing on the line to protect the health of the nation receive the support and care that they so richly deserve?
Wes Streeting
I am hugely grateful to my hon. Friend for his question and he is rightly proud of his local trust. It is absolutely right that we cannot expect the NHS to rely simply on the goodwill of staff going above and beyond the call of duty to meet the needs of patients. That is why the Government are committed to publishing a new workforce plan, to create the workforce that is ready to deliver the transformed service set out in our 10-year health plan. We are already working with health unions, both on issues around pay, as people would expect, and the conditions that people are working in, recognising, as my hon. Friend rightly does, that this is not just about doctors, important though they are, but about the entire NHS workforce that is delivering the improvements with this Government that the country is crying out for so desperately.
Rebecca Paul (Reigate) (Con)
One of the things that contributes to staff burnout is caring for patients in corridors. I recently visited St Helier hospital and saw that for myself, and it was very concerning and distressing. We are also seeing that at East Surrey hospital in Redhill, in my constituency. Will the Secretary of State confirm when we can expect to see the issue resolved for good?
Wes Streeting
The hon. Member is right to describe the appalling state of corridor care in this country. In fact, under the previous Government, not only was this allowed to emerge as an NHS issue, but it was normalised, with benign nomenclature such as “temporary escalation spaces” used to endorse that normalisation, which should never have been considered normal or acceptable. We will set out our plans shortly to publish data, so that the Government can be held to account as well as the system. I am clear that I want corridor care gone over the course of this Parliament, and I am confident that when we publish all the data for this winter, it will be better than last winter. However, I want to be honest with the House and the country: even on the best days of this winter, patients are still being treated in corridors and in conditions that I do not believe are acceptable and that we should never allow to be normalised. That is why we are committed to year-on-year improvement.
Lloyd Hatton (South Dorset) (Lab)
The Secretary of State for Health and Social Care (Wes Streeting)
Rural and coastal constituencies, like South Dorset, are at the heart of our shift in the 10-year plan from hospitals to communities. Not only does everyone deserve care closer to where they live and work, but people in rural and coastal areas often see the sharp end of health inequalities. After 15 years of damage, this Government are determined to change the current postcode lottery of where people live determining the care they receive. As announced in the Budget, we are committed to delivering 250 neighbourhood health centres across every part of England. There are also now 100 community diagnostic centres across the country, offering out-of-hours services, 12 hours a day, seven days a week. Lots has been done but there is lots more to do.
Lloyd Hatton
I have been campaigning to restore the rheumatology clinic at Swanage community hospital and the chemotherapy clinic at Wareham community hospital. Both of those clinics were closed despite good health outcomes and high levels of patient satisfaction, and local NHS bosses agreed that they were successful clinics before they were mothballed. With all that in mind, does the Secretary of State agree that we must deliver key services and clinics closer to where patients actually live? Will he take the opportunity to encourage local NHS bosses in Dorset to restore our much-needed chemotherapy and rheumatology clinics?
Wes Streeting
I can well understand why my hon. Friend is particularly concerned about the impact of changes on cancer patients. I know that his integrated care board has heard his representations, and it will have heard them again today; I am sure it will be happy to meet with him, as will my hon. Friend the Minister of State for Health. It is important that people have the services that they need on their doorstep. That is one of the reasons why we are devolving so much power, responsibility and decision making closer to communities so that services can be designed around the differing needs of communities in different parts of the country.
Alan Mak (Havant) (Con)
Vital services such as X-rays and scans have been removed from the Oak Park community clinic in my constituency without any prior warning or consultation from the ICB. Will the Secretary of State meet with me to discuss how we can restore those services locally so that my constituents do not have to travel to Portsmouth?
Wes Streeting
The hon. Gentleman should absolutely make representations to his local ICB if he has concerns about service reconfigurations. We are investing more in the NHS, but I recognise that there are none the less big challenges for ICBs to face. I am sure that the ICB would be happy to meet him to hear his concerns.
Rosie Duffield (Canterbury) (Ind)
Laura Kyrke-Smith (Aylesbury) (Lab)
The Secretary of State for Health and Social Care (Wes Streeting)
As the House knows, I am deeply concerned by the state of maternity care in the NHS that we inherited. While the majority of births go well, I know from the courage of families who have spoken up and the concern of staff that devastating impacts are arising from failures in care. That is why I asked Baroness Amos to chair an independent investigation into maternity and neonatal services to drive urgent action, but that has not stopped us from taking action in the meantime. We have invested more than £131 million to improve neonatal care facilities, brought in a new maternity care bundle, implemented a programme to reduce the two leading causes of avoidable brain injury during labour, and increased maternal mental health services. There is so much more to do, however, to guarantee safety now and into the future, and also to ensure truth, justice and accountability for past failures.
Paul Waugh
The new maternal care bundle, to which the Secretary of State refers, is rightly aimed at reversing the recent worrying rise in maternal death and ill health. In particular, the increase in obstetric haemorrhage concerns so many midwives and doctors and the families affected. Given that the Government want to help women to make informed choices about how they give birth safely, can the NHS do more to highlight the well documented risks of severe bleeding and placenta accreta caused by caesarean sections?
Wes Streeting
Everyone accessing maternity care should be offered a personalised care and support plan, informed by a personalised risk assessment. That is so women have more control over their own care based on what matters to them and their individual needs and preferences, as well as to ensure that every woman understands the risk factors that might arise in her case. A caesarean section is generally a very safe procedure, but like any type of surgery, it carries a risk of complications. All women should have the confidence of knowing that the doctors and midwives dealing with them are robustly trained to deal with severe complications, including haemorrhage. That is why the maternity care bundle, as well as other measures, will lead to greater safety, more information and, crucially, the personalisation of care and patient choice for the mother.
Laura Kyrke-Smith
I welcome the new maternal care bundle and its ambition to drive consistently high standards of care for every pregnant and new mum. It is great that maternal mental health is one of the five elements prioritised; I am grateful to the Secretary of State for his focus on that. The challenge now is to drive forward its implementation. Can he say more about how he intends to do that, and in particular how he will ensure that NHS staff are trained and confident enough to better screen and support women who are struggling with their mental health?
Wes Streeting
My hon. Friend is absolutely right to raise that issue, and I commend her for the work she is doing in this area. There is a real risk of post-natal depression. Certainly where there have been complications in birth or, worse still, injury or the most unimaginable experience of loss, we need to make sure that women and their partners and the wider families are supported from day one. That does not just mean training and support for staff and making sure that they are doing emotional wellbeing screening; it also means thinking more thoughtfully about estates. One thing that has really struck me is the experience of women who have suffered loss during labour who are asked, during the care that follows, to go back to the very maternity units where their unimaginable pain was first endured. Those are difficult issues to challenge, and it will require investment, but those are the sorts of areas we are getting into as we think more thoughtfully about how to ensure that we take care of not just the physical health of the mother and baby, but the mental health and wellbeing of mother and the wider family.
Layla Moran (Oxford West and Abingdon) (LD)
An Oxford midwife recently told me that sewage regularly rises through the floor and drips down through the ceiling on to a hospital maternity ward. This has become so common that it is now standard procedure for midwives to move the clinic whenever it happens so that patients are none the wiser. Obviously if the hospital had the money to fix the problem it would have already done so, but equally obviously, the staff should be looking after mothers and babies, not shovelling sewage. Can the Secretary of State confirm that when the Amos review has done its work, there will be a flexible pot of money so that specific issues such as this in specific hospitals can be dealt with to improve patient safety and staff retention?
Wes Streeting
Without pre-empting Baroness Amos’s work, let me say that the hon. Lady is absolutely right. We need to give staff the tools that will enable them to do the job to the best of their ability, and they need the right facilities and environment in which they can work and patients can be cared for. It is completely unacceptable that on top of the other challenges that staff and families face at such an important time—the unique moment of bringing new life into the world—they are having to do so against the backdrop of crumbling estates that the hon. Lady has described. We are putting the largest ever capital investment into the NHS, but she has made a powerful point about the need for capital investment in this area, which was impressed on me at Queen’s hospital in Romford during one of my recent visits, and I will be looking at the issue very closely.
Vikki Slade (Mid Dorset and North Poole) (LD)
I recently visited the Dorset breastfeeding network at the Purbeck community centre, and it was fascinating to hear about the work that the team there are doing, but they told me that since covid, standard NHS antenatal classes have stopped and have never returned. As a result, women are not getting the information that they need in order to make informed choices, which is leading to various decisions about how they give birth and whether they breastfeed their babies. We know that the Pride in Place and Best Start in Life centres are going ahead, but they will not cover most of my area because they are covering only the deprived areas. How will we ensure that there is a universal offer for antenatal care for everyone?
Wes Streeting
I will make certain that my Department and the NHS look into what has happened to provision in the hon. Lady’s area, and I will write to her about it. She is quite right about the need to ensure that parents are given high-quality information from the time of conception so that they can make informed decisions about everything from whether to breastfeed through to the steps that they can take in those formative first 1,001 days to secure the best possible outcomes. I welcome the appointment of Will Quince to lead the 1,001 Critical Days Foundation; although in the past we have crossed swords in the House, I know how committed he is to that agenda.
Wes Streeting
Let me just point out that in the 18 months for which I have had the privilege of holding this post, we have invested more than £131 million in 122 infrastructure projects across 49 NHS trusts to improve the safety of neonatal care facilities. We have implemented a new programme to reduce the two leading causes of avoidable brain injury during labour. We have piloted Martha’s rule in maternity and neonatal units in 14 trusts across six regions to give patients and families the right to request a second opinion. We have launched a package of initiatives and interventions to reduce the number of still births, brain injuries, neonatal deaths and pre-term births. We have held a culture and leadership programme. We have created targeted tools and schemes to promote midwife retention. We have increased the provision of maternal mental health services to help women. We have had to do all that—not wasting a single day in 18 months. Imagine how embarrassed we would be if we had wasted 13 whole years!
Mr Jonathan Brash (Hartlepool) (Lab)
Chris Vince (Harlow) (Lab/Co-op)
The Secretary of State for Health and Social Care (Wes Streeting)
Regardless of the challenges this winter presents, this is a Government who are facing into them. We have vaccinated over 17 million people this winter, which is 350,000 more than this time last year and 60,000 more NHS staff. We are not out of the woods yet by any stretch, but I can give an example of how our investment in modernisation is paying off: new year’s day was the busiest day in NHS history for 999 calls, but despite that, ambulances arrived to heart attack and stroke patients 15 minutes faster compared to this time last year. Backed by £450 million, our urgent emergency care plan will expand same-day and urgent care services. We are delivering new same-day emergency care and urgent treatment centres, more mental health crisis assessments and 500 new ambulances. Lots done, but so much more to do.
Chris Vince
Will the Secretary of State to join me in thanking the extraordinary efforts of the staff at Princess Alexandra hospital in Harlow for their work over the winter period? A few years ago, we saw the shocking statistic that people were waiting in A&E at Princess Alexandra hospital for 13 hours. Can the Secretary of State outline the changes that this Government are making to bring down waiting times, improve GP satisfaction levels and decrease ambulance waiting times, and explain how this Labour Government are ensuring that the NHS is fit for the future?
Wes Streeting
I absolutely join my hon. Friend in thanking NHS staff in Harlow and across the country for their incredible efforts during the toughest winter weeks. I particularly thank all those staff who have supported their colleagues and worked throughout Christmas and new year, sacrificing time with their families to care for ours. Of course, Mr Speaker, I particularly thank the staff at Chorley and South Ribble hospital who facilitated our visit. Your representations from the Chair for longer A&E access have not been lost on me, or indeed the record.
Helen Maguire (Epsom and Ewell) (LD)
Last night, Surrey Heartlands ICB and two hospital trusts in Surrey declared a critical incident, which means that some hospitals cannot guarantee that patients will be treated safely and operations could be cancelled to make urgent care a priority. Will the Secretary of State confirm what action the Government are taking to support those trusts and what funding will be made available to ensure that such incidents do not recur?
Wes Streeting
A number of critical incidents have been running across the country this week. To be clear, a critical incident does not mean that there is unsafe care or that we are unable to provide care. A critical incident means that there is a challenge, and the system mobilises in response to help meet that challenge so that people do receive safe care. As I have said, we are investing more in our urgent and emergency care services and we are seeing the impact of that through year-on-year improvements to date. We are not out of winter yet; we still have lots of hard yards ahead. I am confident that when we emerge from winter, we will be able to tell a story of year-on-year improvement. However, while the NHS is on the road to recovery, I would not want anyone watching—not least the hon. Member’s constituents—to think that the Government believe that what we have seen this winter is acceptable every day, in every case everywhere. Until that is the case, we will continue to strive for further improvement day by day, week by week, month by month, and year on year.
Dr Rosena Allin-Khan (Tooting) (Lab)
Working my shifts in A&E over Christmas and the new year, like many colleagues up and down the country I experienced what has become the undignified norm of corridor care. I welcome the Secretary of State’s commitment to ending it. The all-party parliamentary group on emergency care, which I chair, working closely with the Royal College of Emergency Medicine, is keen that the Government adopt our recommendations on ending corridor care. The Secretary of State previously agreed to meet us. Will he today reaffirm his commitment to meet us to end this scourge in our A&Es?
Wes Streeting
My hon. Friend can be absolutely assured of that. I thank her for her powerful advocacy in this place, as well as for putting her words into action on the NHS frontline. She does not need to do that—she could do the bare minimum to keep her licence going—but she always goes above and beyond to take care of patients and constituents, literally rolling up her sleeves and putting on her scrubs to do that. She has made a number of thoughtful recommendations in her report, and I look forward to engaging with her and the all-party group on that.
Seamus Logan (Aberdeenshire North and Moray East) (SNP)
I genuinely welcome the fact that the Secretary of State is able to praise the efforts of NHS staff this Christmas and new year, but there is good news in Scotland, too: waiting lists have fallen for the longest waiters for the sixth month in a row and threatened industrial action by resident doctors has been called off. However, there is anxiety not just in Scotland but across these islands about the new UK-US medicines deal and its impact on the NHS. Will the Secretary of State change his habit this new year with a new year’s resolution and answer my question? Where is the money coming from for the UK-US drugs deal?
Helen Morgan (North Shropshire) (LD)
I always am, Mr Speaker; thank you very much. Recently, I have heard from Candice, who was interrupted while changing her stoma bag behind a curtain on the emergency ward; Lynne, who waited 17 hours for an ambulance after breaking several ribs; and Sandra, who has bladder cancer and spent 31 hours on a plastic chair in the “fit to sit” area. They all want to share their stories so others do not have to suffer like they did, in pain for hours and hours. Will the Secretary of State commit to ending the waits and back the Liberal Democrat call, welcomed by the Royal College of Emergency Medicine this morning, for a guarantee that no patient will have to wait for more than 12 hours in A&E?
Wes Streeting
We are striving towards meeting those standards, which were met so successfully under the last Labour Government. This Labour Government are having to pull out every stop to repair the enormous damage done by our predecessors. The Liberal Democrat spokesperson is right: safety, of course, is paramount, but so is dignity. When she describes those patients’ stories in those terms, it underscores the fact that behind the two words “corridor care” are countless stories of indignity and treatment in conditions that neither we, nor they as patients, nor staff want to see those people treated in. We are determined to put an end to it.
Tom Collins (Worcester) (Lab)
The Secretary of State for Health and Social Care (Wes Streeting)
Today, we are bringing forward the Medical Training (Prioritisation) Bill. It implements our commitment in the 10-year plan for health to prioritise UK medical graduates and doctors with significant NHS experience for medical training posts. Taxpayers spend £4 billion training medics every year. It is time we protect that investment, ensure that we have a sustainable workforce and give home-grown talent a path to become the next generation of NHS doctors. On that note, Mr Speaker, I also wish to update the House that constructive talks with the British Medical Association’s resident doctors committee are ongoing. Let us see if, collectively, we can do better in 2026 than we did in 2025.
Tom Collins
Patients in Worcester are struggling to access urgent care. Far too many are falling through gaps in our system, with devastating consequences and huge amounts of double work, and patients feel that they have to travel too far for treatment. Will the Secretary of State meet me to discuss the results of my deep dive into the failures in Worcestershire’s NHS?
Wes Streeting
My hon. Friend is right; we have to shift care out of hospitals and closer to people’s homes to make sure that we do not end up with the situation he describes. I know that he is doing a lot of work on that in his community, and I am very happy to meet him to hear about his findings and what we can learn and apply both locally for him and his community and elsewhere.
Stuart Andrew (Daventry) (Con)
With one in five hospice beds no longer available because of increased costs such as national insurance contributions, it is hardly surprising that doctors are raising concerns about the increase in the number of end-of-life patients in our hospitals. It is therefore concerning to hear that the palliative care modern service framework will not now be available until the autumn. Given that the situation is increasingly urgent, will the Secretary of State commit to accelerating that timescale?
Wes Streeting
We are moving at pace on the modern service framework, but we have recognised those financial pressures, whether through the continuation of the children’s hospice grant over multiple years so that hospices can plan or through the capital investment we have put into hospices, providing the biggest funding uplift for hospices in a generation. I recognise that there is more to do, and I enjoy a close working relationship with the hospice movement to look at what more we as a Government can do to support the vital work that it does.
Stuart Andrew
Capital funding is welcome, but we cannot pay doctors and nurses with bricks and mortar. Hospice UK has said that without additional support, there will be
“more unnecessary hospital admissions, more unneeded A&E attendances and more patients not getting the care”
they need, so I push the Secretary of State again to accelerate the timescale. Their lordships are considering the assisted dying Bill and they need to see the palliative care MSF before making such an important decision. We must also make sure that we relieve hospices of this Government’s NIC hikes.
Wes Streeting
I understand the point the shadow Health Secretary makes about capital funding, but I would also say that, through that capital funding, lots of hospices are able to free up their own resources, which would previously have been committed to rebuilding works, to spend on services. I recognise that there is more to do, and we are working closely with the hospice movement. I hope that the right hon. Gentleman is reassured to learn that we will be reporting on the modern service framework initially in spring, so that we can then take on board feedback and reiterate. Then we will get to the autumn, but people will not have to wait until then to hear the direction of travel.
Ben Goldsborough (South Norfolk) (Lab)
Helen Morgan (North Shropshire) (LD)
The social care crisis is piling pressure on hospitals, with beds taken up by patients who are fit enough to be discharged. It is also piling pressure on local councils such as Shropshire, where 80% of the budget goes to social care, yet the Government are shifting funding from counties to cities and dragging their heels on the social care crisis. Will the Secretary of State take action by reinstating the cross-party talks on social care as a priority, because we need to fix social care if we are going to fix councils, care and the NHS?
Wes Streeting
Cross-party working on social care has never been un-instated. I know there is much more to do, but we have been in government for 18 months and we have put in £4 billion of investment, legislated for the first ever fair pay agreements with £500 million committed to that, made significant additional investment in the disabled facilities grant and, in building the workforce plan for the future, we have commissioned Baroness Casey to do her work. She will be reporting soon and we look forward to taking that work forward.
Mr Speaker
Ahem! I am getting a bad throat because of the Secretary of State.
Sojan Joseph (Ashford) (Lab)
Wes Streeting
I am grateful to my hon. Friend for his advocacy on this matter. I know that it has been taken seriously by NHS leaders nationally as well as locally, and they listen carefully to what he says on behalf of his constituents. I have reported to the House this morning on all the action we are taking to drive improvement. We are seeing improvement, but there is so much more to do. We are determined to consign corridor care to the history books, and not just in Ashford but right across the country.
Adam Dance (Yeovil) (LD)
Access to mental health services in rural communities is a challenge when services are stretched and underfunded. What steps is the Secretary of State taking to improve access to mental health services in Yeovil?
Wes Streeting
The Government increased investment in mental health by an extra £688 million in 2025, with all systems forecast to deliver the mental health investment standard. As our medium-term plan makes clear, we need a new approach to mental health to drive down waits and improve the quality of care, but our expectation is that integrated care boards will be required to protect mental health spending in real terms, rising in line with inflation year on year, ensuring that we meet the needs of constituents in all parts of the country.
Julia Buckley (Shrewsbury) (Lab)
Wes Streeting
I am sure that I will be able to swing by on my rounds. It is so important, especially against the backdrop of the crisis that the NHS has been through over many years, that as well as celebrating the best performance, we celebrate when there is real improvement. My hon. Friend knows as well as I do that there is of course more to do, but it is to the credit of leaders and staff that there has been improvement—lots done, and a lot more to do.
Jess Brown-Fuller (Chichester) (LD)
Last summer, Sussex ICB cut its IVF provision from three cycles to one due to budget pressures. There is currently a postcode lottery for IVF, and going through fertility treatment can be harrowing for those families. Given that additional cycles improve success rates, will the Secretary of State commit to a nationally consistent standard for IVF?
Wes Streeting
This is an issue that the Government are looking at. As with all treatments, we should be following National Institute for Health and Care Excellence guidelines, but I recognise that in this area there is a degree of regional variation in provision in a way that, frankly, I find difficult to justify. We are looking at this and, as we make decisions, we will of course report on progress to the House.
Mr Jonathan Brash (Hartlepool) (Lab)
Shockat Adam (Leicester South) (Ind)
Failed private finance initiative schemes from the noughties in three Leicester hospitals resulted in the NHS being sued for almost £30 million, despite no work being carried out. Leicester hospitals are still without any new buildings. I ask the Minister that expensive, inefficient financial packages—£60 billion of private money costing £306 billion of taxpayers’ money—not be utilised for future projects.
Wes Streeting
This Government are putting record levels of capital investment into the NHS to correct more than 14 years of Conservative failure. We are using public investment. We are certainly learning the lessons of the past in relation to PFI. We are able to do that only because people voted Labour and elected a Labour Government. I look forward to working with the city’s Labour MPs to deliver the improvements in services that it deserves.
Rachael Maskell (York Central) (Lab/Co-op)
To date, Baroness Casey’s review of adult social care has been pretty impenetrable, but in York we want to engage and innovate. Will my hon. Friend provide Parliament with a briefing on the progress, scope and scheduling of the review? The clock is ticking and the crisis is growing.
Lisa Smart (Hazel Grove) (LD)
My local mental health trust is commissioned to deliver just 100 autism assessments and 88 ADHD assessments per year. The team is led by Clare, a constituent from Marple. There are approximately 1,600 people on the waiting list for ADHD alone—that is a 12-year waiting list. That is driving constituents to seek private diagnoses, but their GPs then refuse to sign up to a shared care arrangement, as the numbers just do not add up. What plans do the Government have to review the shared care protocols so that they work for patients and GPs?
Wes Streeting
I am grateful to the hon. Member for her question. Although of course we are considering prevalence and what is driving the apparent increase in conditions such as autism and ADHD, we are really driving at ensuring that we meet everyone’s needs. I do not want for this country a future in which those who can afford it pay to go private and those who cannot are left behind. Nor do I want to see a situation in which people who have a diagnosis do not receive the care they need. We are looking at those issues with urgency.
Tracy Gilbert (Edinburgh North and Leith) (Lab)
I and a number of colleagues have concerns about the upcoming PATHWAYS trial. The Secretary of State has powers to use existing medical records for research purposes. Will he therefore consider using those powers to increase the evidence base and prevent the PATHWAYS trial from proceeding?
Ben Obese-Jecty (Huntingdon) (Con)
Mr Speaker, I am not ashamed to say that I have had a finger up my bum—not like that! In all seriousness, as a black man in the target age range, and with a family history, I am a keen advocate for prostate cancer screening. One of my constituents has been told by his GP surgery that, as there is no national screening programme for opportunistic testing, they follow national guidance and patients cannot request a screening without GP authorisation. What advice does the Secretary of State have for those of my constituents who are struggling to get screening for prostate cancer? I say a big thank you to the team at Kingston hospital for their swift action in moving my dad from active surveillance to treatment—he raves about them.
Wes Streeting
I certainly join the hon. Member in his final message and commend him for his declaration, because the more we can break taboo and stigma around these issues and get people talking more openly about the telltale signs of risk, the better protected we will all be. As he will know, we are looking very carefully at the recommendations around screening. I will be convening a group of experts with the chief medical officer to probe some of the recommendations, and I will keep the House informed.
Alex McIntyre (Gloucester) (Lab)
Last Friday, I went on a visit to my fantastic local GP service, Hadwen Health. The team there are already using technology and AI to make sure patients get the right care that they need, but they told me that there is currently no technological solution that allows patients to both be triaged and directed to their hard-working family doctor when booking online. What steps is the Department taking to support the roll-out of technology in GP surgeries like Hadwen Health in Gloucester?
Andrew Lewin (Welwyn Hatfield) (Lab)
In NHS Providers data published just before Christmas, we learned that in East and North Hertfordshire NHS trust, the number of people waiting for treatment has fallen more than in any other trust in the country. That is fantastic news for my community. Will my right hon. Friend commend all the staff involved in this success, and does he agree that this is precisely what people voted for when they voted for change in the NHS?
Wes Streeting
Of course, I endorse what my hon. Friend said. Waiting lists are falling for the first time in 15 years. Lots done, and so much more to do, but with Labour, the NHS is on the road to recovery.
Zöe Franklin (Guildford) (LD)
In Bellfields and Slyfield ward in my constituency, the local GP surgery is squeezed into a unit that is part of a parade of shops, and it is clearly no longer the size needed for the growing community. The team do a great job in spite of the challenges. Will the Minister set out the steps the Department is taking to support community health hubs in areas like this ward, in order to bring GP and wider services together locally and improve facilities and access for my residents?
Wes Streeting
The hon. Member is quite right to hold the Government’s feet to the fire on this issue. We are having cross-Government discussions about this issue and other groups of victims of state failure. We will keep him and the House updated.
Sonia Kumar (Dudley) (Lab)
A constituent of mine who attends Dudley Voices for Choice has autism with complex mental health needs and is at risk of self-harm. Despite not being able to use a telephone, they are still required by mental health services to do so, and therefore they cannot be treated. They were told that they are non-compliant, so their support was reduced. What steps is my right hon. Friend taking to ensure that mental health services offer alternative ways to communicate for those who cannot use a telephone? I would like to thank Sarah Offley and the team at Dudley Voices for Choice.
Blake Stephenson (Mid Bedfordshire) (Con)
Constituents of mine have been reporting that they have been directed to hospital for regular blood tests, rather than having them at their GP surgery. Will the Secretary of State outline how he will ensure that blood tests are done in a community setting, which surely must be much better value for the taxpayer and much more convenient for patients?
Wes Streeting
The hon. Member is absolutely right, and that is why a big part of our modernisation approach is to shift care out of hospital and into the community, making greater use of community diagnostic centres, community pharmacies and GPs. As his question shows, 18 months in, lots done, but a lot more still to do.
NHS Adult Gender Services: Independent Review
Wes Streeting Excerpts(4 months ago)
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The Secretary of State for Health and Social Care (Wes Streeting)
Today, NHS England has published the independent review of NHS adult gender services, led by Dr David Levy. The review was commissioned by NHS England in June 2024 in response to a recommendation in the Cass review final report. The review has sought to pinpoint areas for improvement, drawing attention to where the quality of NHS adult gender dysphoria clinic services could be raised, and recognising the positive existing practice that can be shared across services.
To inform this review, Dr Levy visited all commissioned NHS adult GDCs from October to December 2024. The review included engagement with NHS clinicians, executive and management staff in the hosting trusts, current and former patients, and those on waiting lists.
Although the review acknowledges the positive signs of progress across GDCs, such as patients feeling heard and understood and a strong commitment by staff to patient care, it highlights the challenges faced by GDCs and recommends a co-ordinated system-wide approach for improvement. Key findings of the review are:
Poor productivity across many adult GDCs, coupled with increasing demand, has led to unacceptably long waiting times, signalling the urgent need for an expanded number of services and targeted improvement programmes to enhance efficiency and productivity.
Significant variation exists in the quality and productivity of clinics, pointing to the need for a standardised approach to care that incorporates holistic assessments and a complexity measure sensitive to individual patient circumstances.
The referral process into the GDCs would benefit from streamlining and it is recommended that the current system of self-referral is ended in favour of a single referral route via GPs.
GPs may not always have sufficient experience or confidence to fully support patients with gender dysphoria, particularly in relation to prescribing and monitoring hormone treatments. It calls for GDCs to take responsibility for initiating and managing hormone prescribing during the first year of treatment, prior to transferring care to primary services.
In response to the findings of this review, we and NHS England will take forward a set of immediate priorities:
Creating a new single, national waiting list for adult gender services to be implemented in April 2026.
Raising the referral threshold to 18 years to align with the age of discharge from the NHS children and young people’s service.
Bringing an end to self-referrals into the service and, in parallel, providing advice and guidance for those finding it difficult to secure a referral.
Establishing challenging but achievable productivity goals for every service that can then guide and inform the commissioning of additional services, underpinned by a clear understanding of the regional demand through the national waiting list.
We are making progress beyond this review. NHS England has increased the number of adult gender dysphoria clinics in England from seven to 12 since 2020, and has established a national quality improvement network for adult gender services. In order to support the wellbeing of patients awaiting their first appointment with a GDC, I previously announced the development of a “waiting well” pilot for patients on the waiting list for the GDC in the south-west.
I will place a copy of the review in the Library of both Houses. This Government have always made it clear that anyone accessing gender services deserves the highest quality of care and support, and to be treated with dignity and respect. The publication of this review marks a significant step forward in our commitment to ensuring safe, effective and evidence-based care for anyone accessing gender dysphoria services across the NHS.
[HCWS1214]
Puberty Suppressants Trial
Wes Streeting Excerpts(4 months ago)
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Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the pathways puberty blockers trial.
The Secretary of State for Health and Social Care (Wes Streeting)
Let me just start by acknowledging the sensitivities around this issue and the strong beliefs held around this House. For all the division and divided opinion, I believe that there is a determination shared by everyone in this House to do the right thing by a vulnerable group of children and young people. It is for those reasons that I am taking the course of action that I am. Put simply, that is to follow expert clinical advice and take an evidence-led approach.
The Cass review found shocking levels of unprofessionalism, a lack of clinical oversight and puberty blockers prescribed to children without sufficient evidence that doing so was safe or beneficial to those children and young people. What Dr Hilary Cass uncovered was a scandal. That is why, on coming to office, I made the temporary ban brought in by my predecessor, the right hon. Member for Louth and Horncastle (Victoria Atkins), a permanent one. Dr Cass also recommended a thorough study to establish how best to support children and young people who suffer gender incongruence. That is the pathways study.
The study has four main parts, one of which is the clinical trial to study the effects of puberty-suppressing hormones on young people’s physical, social and emotional wellbeing. The other aspects of the pathways study will track the physical, social and emotional wellbeing of all young people attending UK NHS gender services. It will look at young people’s thinking and brain development, following both those who are and are not taking puberty-suppressing hormones, and it will gather evidence directly from young people, parents and staff about their experiences of living with gender incongruence.
The bar for the trial to be approved was extremely high and oversight will be rigorous. Children cannot consent to being on the trial, so places will require parental consent, as well as the assent of young people. It is because protecting and promoting the health and wellbeing of affected young people is our primary concern that there are also strict eligibility criteria in place to join the pathways clinical trial. As such, the number of young people who would expect to qualify for the trial will also be low. Participants must undergo thorough mental and physical assessments and will be followed over a number of years with regular wellbeing checks. Puberty blockers have also been used to delay puberty in children and young people who start puberty much too early. Use in those cases has been extensively tested and has met strict safety requirements for that use.
The study is led by King’s College London and the South London and Maudsley NHS foundation trust. It has been carefully checked by independent scientists who advise the National Institute for Health and Care Research and by the Medicines and Healthcare products Regulatory Agency, and received approval from a research ethics committee. I am treading cautiously in this area because the safety of children must come first.
Dr Johnson
I must first declare my interest as a consultant paediatrician who has looked after children with gender dysphoria in the past and is likely to do so in the future. We must remember that we are talking about vulnerable children.
The first and most obvious question is: why? Why have this Government chosen to fund experiments with puberty blockers on physically healthy children? Despite saying he was comfortable with this trial in a briefing to MPs, the Secretary of State told the media on Friday and the Select Committee this morning that he is in fact uncomfortable with it. Why is it even being considered before the data linkage study is complete?
Some 9,000 children went through the Tavistock clinic, and many of them came out regretting being encouraged to irreversibly damage their bodies. We should look carefully at those outcomes before we make the same mistakes. What steps is the Secretary of State taking to secure the data from the Tavistock and have it analysed? What steps is he taking to hold to account those obstructing access to data linkage information? What assessment has he made of the motivations of those obstructing that data, when this is a study to safeguard children?
And what of the trial itself? We know that 226 children will go through this trial. Is that a limit or a target? Those children will be randomised to get puberty blockers now or in a year’s time, and all will be analysed at two years. They will still be children. They might be only 11 years old. How can the results demonstrate a meaningful outcome? The control group is not properly randomised, but chosen from the Horizon intensive trial group. Is the Secretary of State concerned that this will introduce bias?
The criteria for getting puberty blockers in this trial require just one parent to consent and the clinician to think that it will benefit the child, but on what basis will the clinician decide? The Cass review said that the vast majority of children with gender dysphoria would recover, with only a few persisting with trans identities into adulthood. It is not possible to predict which those children will be, so does the Secretary of State accept that the vast majority of children in this, his Streeting trial, who will be given drugs will be physically healthy children whose distress would get better without any puberty blockers, and that the vast majority of the children in this trial are therefore being unnecessarily experimented on with risky medications under his leadership?
Wes Streeting
The shadow Minister asks, “Why?” There is a simple answer. It is because this was recommended by Dr Cass in the Cass review, which was commissioned by my predecessor, Sir Sajid Javid. I think that was the right thing to do, and it is why, when my predecessor brought forward the Cass review, I supported it in opposition. I certainly did not try to play politics with an extremely vulnerable group of children and young people.
I will tell the hon. Lady why. It is because, under the previous Government, those puberty-suppressing hormones were prescribed without proper oversight, supervision or safety, yet we did not hear a peep about that fact for years until Dr Cass, commissioned by Sir Sajid Javid—who deserves enormous credit—did the study, which was published and widely supported and which contained this recommendation. The Conservatives may have changed their tune in opposition, but I remember what they said in government when they published the Cass review and supported its recommendations, so I think their response now is a real shame.
The shadow Minister accuses me of inconsistency, so let me be clear. Am I comfortable that this clinical trial has undergone the proper process and ethical approval to ensure the highest standards and supervision? Yes, I am comfortable about that. Am I uncomfortable about puberty-suppressing hormones for this group of young people for this particular condition? Yes, I am—because of risks. It is why I was also uncomfortable when I upheld the temporary ban by my predecessor and then put in place a permanent ban. The reason I was uncomfortable with that, too, is because I had to look children and young people, and their parents, in the eye when they told me in no uncertain terms that that decision was harmful to them, as have many other clinicians who have opposed that decision.
Whatever my discomfort in this extremely sensitive area, the reason that I have made this decision is that I am following clinical advice and, as Health Secretary, it is my responsibility to follow expert advice. Had the Tavistock clinic faced such challenge and scrutiny a decade ago, we would not be in this mess. The Conservatives were right to commission the Cass review and they were right to accept its recommendations. I accept that there is now a difference on this particular recommendation, but I would urge Members not to walk away from the cross-party consensus we built behind that approach but to build on the work that Dr Cass has done.
Let me turn to the important questions raised by shadow Minister. There will be two groups within the trial, as well as a further control group of children and young people with gender incongruence who do not receive puberty-suppressing hormones. At least 226 participants are required in order to detect a statistically significant difference between the two treatment groups. However, this is not a target and no young person will find themselves on this trial because there is a drive to make sure that a certain number of young people are participating. In order for anyone to participate in this trial, it has to have the most robust clinical oversight from clinicians within the service, as well as national oversight and the consent of parents. It is only where young people will be deemed to benefit that they will be on this programme.
The shadow Minister asks about the data linkage study. That is important. The data linkage study will be undertaken, but when it is completed it will not provide us with the same evidence as this clinical trial. That is why Dr Cass made a distinction between this trial and the data linkage study.
The hon. Lady also asks about the motivations of those who withheld data. That is an extremely important question. It is utterly appalling that anyone in a position of responsibility in the NHS withheld data on a very vulnerable group of children and young people. I accept that there were many well-meaning people involved in these services at the Tavistock clinic, but the fact that Dr Cass found such a lack of rigour, such a lack of standards and such a lack of proper oversight is disgraceful. It is the clinicians who are well meaning and ideologically driven who have given me the most cause for concern in this whole debacle and who have done more harm to children, young people and the trans community than most other people who have taken part in this debate.
I appreciate the work that Dr Cass has done, and I am glad that she is in the other place, bringing welcome scrutiny. Were she not supportive of this approach, I might think again, but she has made her recommendation and given her support. I am following clinical advice. It is not comfortable, but I do believe it is the right thing to do, on balance.
Madam Deputy Speaker (Ms Nusrat Ghani)
I call Health and Social Care Committee member Danny Beales.
Danny Beales (Uxbridge and South Ruislip) (Lab)
The hon. Member for Sleaford and North Hykeham (Dr Johnson) asks, “Why?” Well, it is because trans people exist and their health needs exist. As the Secretary of State has clearly outlined, an independent review made a series of recommendations. There were clearly failures of healthcare, and a further recommendation was that a clinical trial should address this issue. I believe that the Conservatives supported the Cass review, but when it comes to implementing this part of it, they suddenly have collective amnesia about what Dr Cass recommended. Does the Secretary State agree that, in the absence of a trial, there will still be access to these drugs? We know that young people are seeking out private provision. They are seeking unregulated providers of these drugs, so is not a clinical trial both appropriate and the best and safest way of managing any potential risks?
Wes Streeting
The risk that my hon. Friend sets out was one of the considerations that I had to when weigh up—first when upholding the temporary ban, and then when making the ban permanent. I do worry that, outside of a trial, we may continue to see unsafe or unethical practice. I think we will be doing a service to medicine in this country as well as internationally if we have a high-quality trial with the highest standards of ethics, approvals, oversight and research from some of our country’s leading universities and healthcare providers to ensure that, for this particular vulnerable group of children and young people, we are taking an evidence-based approach to health and care.
Madam Deputy Speaker (Ms Nusrat Ghani)
I call the Liberal Democrat spokesperson; you have one minute.
Wes Streeting
I can absolutely assure the hon. Member that we are doing that wider research and that of course we will take into account high-quality international evidence, as well as the research we are undertaking domestically. It is so important that we recognise that, for many young people with gender incongruence, even if approved, puberty blockers will never be the right medication. One of the things I have been most saddened by in the discourse among adults in this debate, many of whom should know better, is the elevation of puberty blockers to the status they have received in public discourse and debate; many young people out there think not only is this the gold standard of care, but that it is the only care available, and, of course, that is not true.
NHS England has opened three new children and young people’s gender services in the north-west, London and Bristol, with a fourth planned for the east of England in 2026. We aim to have a service in every region of England in the coming years. These services use a different model with multidisciplinary teams, including mental health support and paediatrics, within specialist children’s hospitals to provide good clinical care. The new services will increase capacity and reduce waiting times so that patients can be seen sooner and closer to home. We have also commissioned additional support for young people waiting to be seen through local children and young people’s mental health services.
Preet Kaur Gill (Birmingham Edgbaston) (Lab/Co-op)
I thank my right hon. Friend for his leadership. As a former children’s services manager, I am concerned that credible safeguarding warnings from clinicians and academics about puberty suppression in children are not being heard. Will the Secretary of State meet those experts and review the younger age limit for participation in this trial, given that children as young as 10 are currently set to be involved?
Wes Streeting
Let me reassure my hon. Friend and the House that I am absolutely open to receiving representations and evidence from clinicians involved in the care of children and young people, with insight, expertise and data, including those who might be critical of the approach that the trial team is setting out or, indeed, critical that the Cass review included this recommendation. That is important because the many things that have gone horribly wrong in this area have included the silencing of whistleblowers and the silencing of rigorous debate and discussion.
We have to have this debate with due care and sensitivity for young people in this vulnerable group in particular and for the wider trans community, who feel extremely vulnerable in this country at the moment, including as a result of decisions I have taken as the Health and Social Care Secretary. We have to consider all of that in the round, but we must make sure that at all times we are following the evidence, that we are open to scrutiny and challenge, and that where we are making these finely balanced judgments, we are doing so with rigorous debate, testing the arguments, the evidence and the data. That is why I welcome the urgent question and this discussion.
Madam Deputy Speaker
I call Health and Social Care Committee member Joe Robertson.
Joe Robertson (Isle of Wight East) (Con)
The Secretary of State said earlier that there is an extremely high bar for him stepping in and stopping these tests using puberty blockers. What bar could be higher than a Government protecting children from being tested on with drugs specifically to stop or alter their sexual development? There is not a unified clinical view on this. It is his choice; he is the Secretary of State. These tests are on him.
Wes Streeting
I certainly do not need to be told what my responsibilities are on this. I always take responsibility for the decisions I take. I acknowledge the extent to which the hon. Gentleman and members of his party seek to weaponise this issue, and to personalise it. [Interruption.] We can simply refer back to his question and to the shadow Minister’s reference to the “Streeting trial”—if that is not personalising, I do not know what is.
I’ll tell you what: I will take an evidence-based approach. I have done that on this issue from day one. Had the Conservatives done so, we would never have seen the Tavistock scandal. We would never have seen puberty blockers dished out willy-nilly to children and young people in this vulnerable patient group. I have sought at all times, including when I sat on the Opposition Benches, to treat this debate with the care, sensitivity and humility it deserves, and not to be tribal in my interactions. I only wish this Conservative Opposition would take the same approach.
Madam Deputy Speaker
We are only at the start of this urgent question, so I ask Members to reduce the temperature in the Chamber.
Rachel Taylor (North Warwickshire and Bedworth) (Lab)
I thank my right hon. Friend for the care and sensitivity he has taken to this subject all along. It has been an undeniably difficult year for transgender people in Britain. I have spoken to young trans people who have been pushed to the brink of suicide by what they hear—that they do not have a right to exist, that they do not deserve rights, that they are legitimate targets for ridicule. We all in this House have a responsibility to lower the temperature and focus on their welfare, health and dignity.
King’s College operates the highest standards of safety. Does the Secretary of State agree that its expertise and rigour will support the wellbeing of participants and ensure that we get the robust evidence we need and that vulnerable children are no longer treated as political punchbags?
Wes Streeting
My hon. Friend is absolutely right that we must engage with due care and sensitivity on this issue. I can share with the House that these exchanges, Government policy, what is said by me and others, are followed extremely closely by this group of children and young people, who are extremely online, and by the wider LGBT+ community. My hon. Friend is right that trans people are often at the wrong end of the statistics as victims of hate crime, discrimination and mental ill health. We must always tread carefully when talking about suicide in this context, and bear in mind the warnings of the Government’s adviser on suicide prevention, Professor Louis Appleby, and the way in which that issue has been deployed irresponsibly by critics of the ban on puberty blockers that was put in place—we bear all those things in mind. I do think we have a high-quality trial set up. I do have confidence in the clinicians. We have had a cross-party briefing from the clinical team. I am happy to repeat that exercise, to keep coming back to the House and to arrange briefings for MPs and peers on a cross-party basis so that we can follow this closely, as we should.
Tom Tugendhat (Tonbridge) (Con)
I welcome the care with which the right hon. Member has approached much of this, and I appreciate that he has before him some very difficult decisions, especially because of the way the report was written. But I must come back to the simple truth that these are very young children, and decisions will be made for them—I appreciate by parents, taking that element of consent—that are genuinely irreversible. Whatever happens, we will see eight, nine, 10-year-olds grow up to be 18, 20, 25-year-olds—at least we hope we will—who have effectively been experimented on. Some of those children will resent greatly not just the system and their parents, but those who allowed this to happen, and here I identify the Department for Health and Social Care, not necessarily the Secretary of State himself. What provision is he putting in place to ensure that should those children wish to bring legal action against the Department, against those who took these decisions at a time when they were not able to give any form of informed consent, they will be able to have redress and their day in court?
Wes Streeting
I first thank the right hon. Member for the way in which he puts his concerns. I know he is concerned about this trial and that he has stated publicly his opposition to it, and I enormously respect the way in which he has done that. These are finely balanced judgments, and I acknowledge that.
The Cass review found that puberty blockers have been prescribed routinely without good evidence for their safety or effectiveness, and that is why a clinical trial was proposed. They are licensed and used safely in much younger children for precocious puberty or in older adults for certain cancers. For adolescents, the interaction with all the different processes of puberty may be very significant, which is why more evidence and a better understanding of their impact is needed in this patient group. Anyone on the trial can choose to stop taking puberty-suppressing hormones and leave the trial at any time; they do not need to give a reason. If a young person decides to stop taking puberty-suppressing hormones, their care in the NHS, including the gender service, will not change in any other way, and their doctors will explain to them and their parents or guardians what treatment options are available.
I know that there are concerns about the longer-term impacts on fertility. Prospective participants will be given comprehensive information on the advantages and potential risks of the hormones, including details about preserving fertility. Doctors will explain the possible long-term consequences and available options. Young people will also be offered consultation with a fertility specialist. The young person and their parent or guardian must clearly demonstrate a full understanding of all these issues—only then, after that, would a clinician sign off on admission to the trial.
Several hon. Members rose—
Josh Fenton-Glynn (Calder Valley) (Lab)
I hope we can all agree that the young people involved should not be used by anyone as a political football. Can my right hon. Friend please assure me that the process and trial will be clinically led, not defined by rhetoric—in this place or anywhere else?
Christine Jardine (Edinburgh West) (LD)
I also welcome the tone and sensitivity that the right hon. Gentleman has taken on this issue—not just today, but throughout. We all recognise that we should be led by evidence, which is absolutely vital. The trans community is a reality. They feel very vulnerable and very attacked. People who have been on the medications for some time are now concerned that they may no longer be available. What can the right hon. Gentleman tell us to reassure those people that they will be safe?
Wes Streeting
As I reported when we put in place the permanent ban, there have been arrangements for people who were previously being prescribed puberty blockers. People who wanted to access them, but could not once the ban came in, have not been able to do so through authorised means.
I recognised when I took the decision, and as a result of representations I have received, both directly and in writing, that it caused considerable pain and distress to a very vulnerable group of children and young people and to the people who care very much about them. I have not been indifferent to that; I have taken it very much into consideration. However, with respect to all the people I have met, no amount of political pressure should move a Health Secretary away from the clinical advice and expert opinion that should underpin these sorts of decisions.
Tom Hayes (Bournemouth East) (Lab)
I welcome the trial. I commend the Secretary of State for following clinical advice and the Government for trying to build a consensus for one of the most minoritised communities in our country.
May I ask the Secretary of State—a man who I know to have empathy and thoughtfulness—to speak directly to trans people who will be watching this debate? At this Christmas time, they may be struggling with estrangement from family and with other difficulties. Can he speak to the dignity and worth to which they are entitled, and send a message that this House has their back?
Wes Streeting
I am grateful to my hon. Friend for that question. I recognise that the decision I took, within days of coming into this office, was received by trans people in particular, and the wider LGBT+ community, as a negative decision that detrimentally impacted their rights and identity. That is why it was an uncomfortable decision for me to take; I knew how it would be received and had to balance up the risk. I believed—and still believe, by the way—that it was the right thing to do, for the right reasons: a clinically led decision.
When it comes to the care and health of children and young people in particular, I make no apology for exercising extreme caution. I do want trans people in our country to know that this Government respect them and their identity, and want them to live with dignity, safety and inclusion. That is the approach that the Government are taking. I realise that decisions that I have personally taken have not been received in that way. That has not been comfortable for me, but I do believe it has been the right thing to do.
Sir Bernard Jenkin (Harwich and North Essex) (Con)
If we were resting this judgment on purely clinical evidence, we would tell every child that whatever sex they were was immutable and could not be changed, and that if they took these puberty blockers they might well find that they had irreversibly changed the course of their lives. How is a child of 10 or 11 going to be capable of making that judgment?
Whatever the Cass review says, in the end this is the Secretary of State’s judgment. I remember the covid inquiry repeatedly saying that it was wrong for Ministers to hide behind “the science”. Equally, there is no single clinical advice on this question: clinicians are as divided as the rest of society. We rely on the Secretary of State’s judgment. I am afraid that I think he has got it wrong.
Wes Streeting
I thank the right hon. Gentleman for his question and for how he puts his criticism, too. As I said earlier, and for the avoidance of doubt, I know what my responsibilities are. I understand the decisions that I take in this office and that I am accountable for those decisions. I do not resile from that. I am following clinical advice; I think that is the right thing to do in this area.
On the question of sex, the right hon. Gentleman is right: sex is immutable. Even if there has been treatment with hormones or surgery, underlying biology none the less means that trans women, for example, would still need to be screened and treated bearing in mind their biological sex, and the opposite is true for trans men. We have to draw that distinction between biological sex and gender identity.
Whatever my discomfort and personal views about this particular trial or about the notion of young people using puberty blockers in this way, I cannot ignore, and should convey faithfully to the House, conversations that I have had with trans young people and adults. They have described in powerful and unforgettable terms not just the life changing, but the life enhancing experience that they have had. I am thinking particularly of the university student I met; if she walked into this Chamber now, we would assume that she was born female. She is living her best life and described in very powerful and unforgettable terms the impact that treatment has had for her and her quality of life. At the same time, I think of high-profile cases such as Keira Bell’s. That is why we have to tread extremely carefully in this area, to follow evidence and to build an evidence base. It is also why these are such finely balanced judgements and why I can be simultaneously uncomfortable with the permanent ban that I put in place and uncomfortable with the clinical trial. I hope that I have reassured people that I think very deeply about these issues before taking decisions.
Jacob Collier (Burton and Uttoxeter) (Lab)
As the Health Secretary has said, this is a deeply troubling time for the trans community; I have heard that loudly from my trans constituents who have come to surgeries and from my postbag, too. When suicide rates among trans people are much higher than among the general population, we know where denying that they exist or denying them life-saving healthcare lead. What reassurances can the Secretary of State give my trans constituents and the families who support them? They are extremely worried that they will not be able to access the healthcare that they need.
Wes Streeting
I am grateful to my hon. Friend for his question. The reassurance that we can provide trans people in our country is that we are committed to making sure that they have access to the highest quality, evidence-based healthcare. That does not just apply in the case of children and young people; I also hope to report to the House before the Christmas recess the work undertaken in the learning disability mortality review into adult services. We are committed to making sure that we provide high-quality care to a particular vulnerable group of children and young people.
Kirsty Blackman (Aberdeen North) (SNP)
Although I disagreed with the permanent ban, it is to the Secretary of State’s credit that he has been very clear about all the competing issues that he is balancing to make his decisions, and I appreciate that. There are young people who are hoping to be part of the clinical trial and to receive puberty blockers, whether that will genuinely make a difference to their lives or they believe that it will make a difference to their lives. How will he ensure that appropriate support is given to those young people who do not get to be part of the trial, when they have been hoping that it will change their lives?
Wes Streeting
I am grateful to the hon. Member for the way that she asks her question, as a critic of some of the decisions that I have taken in this space. The reassurance that I can offer is that the study will look at the holistic care that this group of children and young people receives, and ensure that wider evidence-led therapeutic support, including mental health support, is available, so that regardless of whether a young person receives puberty blockers, they will certainly receive that wider range of support.
Emily Darlington (Milton Keynes Central) (Lab)
I appreciate the science-based approach taken by the Secretary of State. We use puberty blockers for many different conditions, so will the trial look at the data that has been amassed from the use of puberty blockers for other conditions? I wish to state on the record that puberty blockers are reversible. The evidence shows that when people stop taking them, they stop working—that is the science behind them. Finally, young people in my constituency are more likely to age out of gender services than to get their first appointment, so what are we doing to shorten the waiting time, not just for puberty blockers but for the whole range of services provided to trans children by the NHS?
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. If hon. Members do not keep their questions short, I will not get everybody in. The answers need to be just as short.
Wes Streeting
I will try to do that, Madam Deputy Speaker.
We will ensure that young people get good access to wider evidence-led support. I have had to wrestle with the fact that some trans people enter adulthood without ever receiving any sort of healthcare, and I have been heavily criticised by those people in particular for some of the decisions that I have taken. We are working to reduce waiting times, as I have described.
My hon. Friend says that puberty blockers are reversible. We hear contrary views about that from Members across the House, some of whom say that puberty blockers are irreversible. The truth is that the evidence in this area is mixed, which is why we need to build a stronger evidence base.
Sir Julian Lewis (New Forest East) (Con)
The Secretary of State deserves our sympathy for having to negotiate such an ethical minefield. Will he tell us whether the data exists from all the people who had puberty blockers under the old regime? He mentioned having met one person for whom they had worked well and one person for whom they were a disaster. Surely it should be possible to do a systematic survey of the dozens, if not hundreds, of people who went through that. Might that be a more constructive and less dangerous way forward?
Wes Streeting
The right hon. Member is right that we need that data linkage study. That will happen, but it will not produce the same evidence base as a clinical trial, and that is the distinction between the two. It is frankly a disgrace that people have sought to withhold that kind of data and it is really important that we get this right.
I appreciate the right hon. Member’s sympathy. I have wrestled with this issue probably more than any other ethical decision that I have had to make in this office. I do not seek any pity or sympathy for doing so—it is the job that I signed up to and a job that I love doing. I have taken great care and sensitivity in this area because of the particular vulnerability of this group of children and young people.
Peter Swallow (Bracknell) (Lab)
It is fair to say that the recommendations of the Cass review were not welcomed by everyone—not least by all members of the LGBT+ community—but the Conservative party commissioned the review and accepted its findings, and the Labour party supported the review and supported its findings. Does the Secretary of State share my concern that there are those who would now seek to cherry pick which of the findings they agree with and which they do not? Is it not the case that an independent review with such serious and important findings should be accepted in its entirety?
Wes Streeting
When it was published—I was in the Chamber at the time—there was an overwhelming consensus in the House. There were some people who criticised and challenged the Cass review at the time, including some outside the House in the LGBT community. I have always supported the Cass review, which was led by one of our country’s best paediatricians. Because of that, I am proceeding in the way that I am, which is the way that Dr Cass—now Baroness Cass—recommended. I will continue to follow the evidence and implement the Cass review comprehensively.
Sarah Pochin (Runcorn and Helsby) (Reform)
A survey published today by Transgender Trend shows overwhelming public support for non-intrusive medical approaches for under-16s with gender dysmorphia. The public want this state-sponsored child abuse stopped, so will the Secretary of State represent the will of the people, stop the trial and instead introduce statutory legislation to access the evidence data from the 2,000 children and young people already given puberty blockers through the Tavistock scandal?
Wes Streeting
I will take the hon. Member’s question in three parts. First, the opinion polling that she mentions shows that people in this country are overwhelmingly kind, and they want to ensure that trans people, and LGBT people more broadly, are treated with kindness, compassion and inclusion. Secondly, I do not dismiss the opinion polling that shows that a majority are against this kind of trial. Thirdly, the reason I am doing this is that I have to think about this extremely small group of people. I do not know what it is like to walk in their shoes and I have to think very carefully about what is in their best interests. The best way to do that is to build the evidence base that we need to provide high-quality healthcare. I strongly, strongly do not agree with her characterisation of this study, which is in itself irresponsible.
Lizzi Collinge (Morecambe and Lunesdale) (Lab)
Some of the political debate around this subject has saddened me, not least the way that trans people’s reality and experience has been denied. We even have evidence of British trans people from the 4th century—they have existed forever. Will the Secretary of State confirm that the trial is a real attempt to get a proper evidence base for treatment for young people that is really needed?
Wes Streeting
My hon. Friend is correct that the study is about building the right evidence so that we get high-quality, safe healthcare for this vulnerable group of children and young people.
Aphra Brandreth (Chester South and Eddisbury) (Con)
Children struggling with gender dysphoria and their families are trying to find their way through very difficult and often distressing times. We should be helping them, not experimenting on them. Should we not be following the example of other European countries, such as Denmark and Finland, which have shifted their policies towards counselling rather than medical interventions?
Wes Streeting
I assure the hon. Member that as part of this study, and as part of the roll-out of services across the country, we are focusing on the therapeutic support that she describes. We are implementing the Cass review, which recommended this particular trial for this particular purpose, and we will follow the evidence. Of course we look at what other countries are doing, why they are doing it and what research emerges.
John Slinger (Rugby) (Lab)
I have immense respect for my right hon. Friend, in particular for his commitment to equal access to healthcare. Will he say a little more about the mental health support available for children and young people involved in the trial, those who will not be able to be in the trial, those who are currently receiving puberty blockers, and those for whom the ban is causing immense stress or worse?
Wes Streeting
My hon. Friend is absolutely right. Regardless of whether people are receiving this medication or not, we need to ensure that they receive the right therapeutic support to enable them to have healthy, happy childhoods and to understand themselves, the world they live in and how they relate to it in a way that does not cause them distress or harm. That is my objective in this process.
Carla Denyer (Bristol Central) (Green)
For young people questioning their gender, the pathways trial is currently the only route by which they are allowed to access puberty blockers, which are a treatment that can provide vital respite from the anguish of going through puberty in a body that does not match your gender, before long-term decisions may or may not be made as an adult. I therefore welcome the announcement of the trial, while recognising that significant barriers to entry remain. How will the Secretary of State ensure that as many young people as need to can access the trial, including those who need to access puberty blockers as part of support to improve their mental health?
Wes Streeting
I do not doubt the hon. Member’s sincerity and integrity on this issue, but I say to her respectfully that when she talks about barriers to entry, those “barriers” are safety and clinical oversight, as well as parental consent and the assent of the young person. I do not believe that those are barriers; I believe that those are necessary bars for participation in this trial.
Linsey Farnsworth (Amber Valley) (Lab)
May I associate myself with the comments of other Members who have said that we are talking about humans who deserve to be treated with dignity? As a former Crown prosecutor, I firmly believe that evidence is hugely important, and the Cass review said that there is not enough evidence at present that puberty blockers are safe. Does the Secretary of State agree that the responsible thing for the Government to do is not simply to ignore the plight of such young people, but to conduct the clinical trial to obtain the robust evidence needed to direct policy going forward?
Wes Streeting
My hon. Friend is absolutely right. Given that I work for a former Crown prosecutor, I could not possibly disagree with her on evidence.
Iqbal Mohamed (Dewsbury and Batley) (Ind)
I thank the Secretary of State for his response to the urgent question. One thing we should all agree on is that the human rights of all, including trans people, must be protected and delivered by the Government and supported by us all. The reason we are here today is to discuss the risks and potential adverse consequences of the proposed pathways trial. The trial compares the timing of treatment initiation, rather than using a placebo. There is no arm that provides psychotherapy as a treatment option without puberty blockers, and there is no arm to assess children who do not receive any of those options. Will the Secretary of State consider ensuring that all the various arms and channels are tested as part of this trial to get a complete picture, rather than a partial picture, which may be misleading?
Wes Streeting
May I thank the hon. Member for the way in which he put his question? It is so important to emphasise that right across this House, there are many people who oppose this trial, but who do want to see trans people well supported and protected and to respect their identities. That is important for everyone to bear in mind.
The hon. Member talks about placebo. For obvious reasons in this case, a placebo would not be appropriate, because it would be very obvious whether a young person was receiving the real medication or the placebo, but the trial design has included a control group. The way in which the trial is established will help us to distinguish between the benefits of receiving or not receiving this particular medication, and there will be really close oversight of the impact on development, but he is right that we need to judge these things on the question of risk. That is what led Dr Cass to make her recommendation, and that is why I support it.
Steve Yemm (Mansfield) (Lab)
I welcome the Secretary of State’s answers today and his ongoing support for the Cass review. From his previous answers, it is clear that he has seen public opinion. Is he prepared to call an independent clinical review, given the high degree of public concern about the trial?
Wes Streeting
I am very happy to receive further clinical representations on this issue and to hear from experts on it. I hope the public will understand why, on this particular issue, I am not simply led by opinion polling. I have to follow the clinical advice and evidence, particularly given the enormous risks that surround these children and young people, including the risks that weighed on my shoulders and conscience when I denied access to puberty blockers by upholding the temporary ban and then making it permanent.
Carla Lockhart (Upper Bann) (DUP)
It is nigh-on child abuse to give children puberty blockers. This trial will take confused little minds and vulnerable children and place them on a medical pathway with profound, life-altering consequences. Childhood is a time of uncertainty, yet the state is intervening with drugs that many former patients now say they were never even capable of consenting to. How can this Government justify experimenting on children, rather than prioritising safeguarding, evidence and psychological support?
Wes Streeting
The hon. Lady has offered a political opinion, not a clinical judgment. By that logic, we would not have any medicine for children and young people; we would never have undertaken clinical trials or studies, because we would have judged that children and young people could not take part in them. That is objectively not a sensible position.
I understand the sensitivity surrounding this issue, and the hon. Lady is right to say that people in our country have received life-changing clinical interventions that they later regretted. As part of that regret, they have shared that they did not feel, at the time, that they were making or could have made an informed decision. That is why this trial is set up in such a way that it has such strong clinical oversight locally as well as nationally. It cannot happen without not just the assent of a young person but the consent of their parent or guardian. Those are important protections and safeguards. I do not share the hon. Lady’s characterisation of the trial.
Alex Sobel (Leeds Central and Headingley) (Lab/Co-op)
I support the pathways clinical trial, but it is clear that many, many young people presenting with gender incongruence will not be able to access it, for whatever reason. I am concerned about the mental health of those who will not be able to access the clinical trial. What additional support can the Secretary of State provide for those people, particularly around their mental health?
Wes Streeting
The study includes a lot of research around wider therapeutic support and interventions, including mental health support. We are rolling out more clinics and services across the country to bring that care closer to home.
Several hon. Members rose—
Jim Shannon (Strangford) (DUP)
May I thank the Secretary of State for all that he does? He deserves credit. A mother from my constituency phoned me this morning and said:
“Why is money being spent on this pathway when my child has been waiting for clinical support for 3 years and the waiting list is so long she may be moved to adult treatment? Why is Government prioritising the tiny few over the many? With our children’s mental health services at breaking point and parents at their wits end trying to get their child diagnosed”,
how do the Government look in the eyes of the parents with rare diseases whose drugs are not funded by the NHS when they are funding this trial?
Wes Streeting
I say respectfully to the hon. Gentleman, whom I like very much, and to his constituent, that it is because I have also had to look into the eyes of people in this community who have not received the right care and seen the deleterious impact it has had on their mental health and wellbeing. I have had to deal with parents who have suffered loss and bereavement. We have to make sure that we are doing the right thing by everyone. This should not be an either/or choice.
Several hon. Members rose—
Samantha Niblett (South Derbyshire) (Lab)
Trans people do not wake up at 18 suddenly trans; it starts before then. When we talk about protecting children, it means protecting trans children so that they can transition into adulthood knowing that they had parents and doctors who advocated for their needs. But this trial is not a prison sentence, so will the Secretary of State talk about whether people are entitled to withdraw from it if they change their mind?
Wes Streeting
They certainly can, and if they withdraw, they will still get the wider therapeutic support they deserve.
Jonathan Hinder (Pendle and Clitheroe) (Lab)
We are talking here about physically healthy primary school-age children being injected with drugs to stop them growing up. There is nothing medically wrong with these children; what they need is love, support and compassion to help them to accept their healthy bodies. They are perfect just the way they are.
The Health Secretary says that he is “uncomfortable” with this experiment, and his instincts are correct. In the haunting words of Keira Bell, a courageous young woman and a victim of the Tavistock scandal:
“I was an unhappy girl who needed help. Instead, I was treated like an experiment.”
When these children who are now going to be experimented on become adults, they will want to know who did this to them. This time, the truth will be that this was state-sanctioned, out in the open and—I am afraid to say—at the Health Secretary’s say-so. I am begging the Health Secretary to use his power as the politician in charge to do what he must know is right and stop this.
Wes Streeting
I wish I had certainty on this issue, and in some ways I envy my hon. Friend for his certainty. Having occasionally found myself to be a lonely voice in my party when sat on the Opposition Benches, I respect the fact that it is not easy to be a minority, dissenting voice, especially when one feels so strongly about an issue. I respect my hon. Friend’s position, even though I disagree with it—I do think this trial is the right thing to do. He is right that we need love, compassion and empathy for these young people; we also need to understand what health and care support will produce the best outcomes for them, which is what the trial is about.
Dr Scott Arthur (Edinburgh South West) (Lab)
I thank the Secretary of State for his leadership on this issue. Nobody envies him the decisions he has to make, but he has made the right decision on this.
During my election campaign, I met a fantastic mother—no mother could have loved their daughter more. She told me about how, when her daughter entered puberty, she had to come to terms with her biological sex, and about the impact on her mental health. To delay puberty, she stopped eating. She ended up arriving at hospital in an ambulance, so weak that she had to be treated in that ambulance. I welcome the fact that the trial will look at some of the side effects of puberty blockers, but will it also consider the impact of not taking puberty blockers in some cases? Will the Secretary of State also tell us how the House will be kept up to date on the trial as it progresses?
Wes Streeting
I can certainly promise my hon. Friend that we will keep the House regularly updated. The risks he has described have weighed heavily on my conscience when putting in place a permanent ban on puberty blockers; I have understood the risk involved, and the vulnerability of this particular group of children and young people. I also meant to say, in response to my hon. Friend the Member for Pendle and Clitheroe (Jonathan Hinder), that the parents of trans young people love their children very much. That has been at the heart of so many of the representations I have received, from parents as well as from young people.
Josh Newbury (Cannock Chase) (Lab)
The Conservative party welcomed the Cass review on its publication, including its clear recommendation that this trial take place. Eight years ago, the then leader of the Conservative party supported self-ID and declared that trans women are women; now, we have dog-whistle statements such as, “If we leave these children alone, many will get over it,” which the shadow Minister said just yesterday in Westminster Hall. Does the Secretary of State agree that a rigorous clinical trial is the only way we will get the impartial evidence he needs to make informed decisions on gender-affirming care for trans young people?
Wes Streeting
I absolutely agree with my hon. Friend that we need a strong evidence base, that we need to conduct these conversations with great care, consideration and compassion, and that we need to recognise the vulnerability of this particular group of children and young people, and the fear that so many trans people in our country feel about whether this is a country that accepts and respects them. The political climate has changed since we made all the progress we have made on LGBT equality over the last 20 or 30 years, but do I think the character of this country has changed? Do I think we are less inclusive, less respectful, less loving or less caring? Absolutely not—those are the hallmarks of this country and of the British people. We might be having a debate about the efficacy of this trial, but I think the overwhelming majority of people in this House are doing so in the spirit of wanting trans people to live healthy, happy lives in which they feel safe, included and respected in our country.