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12,832 spoken contributions under 12 words (interjections such as “Will the hon. Member give way?”) are hidden. Show them
The Government are on the side of young people—both young graduates and those who pursue technical education. As the Prime Minister set out in his first two weeks in power, we want to ensure parity between technical education and university education, and to drive good growth in every postcode, including in my hon. Friend’s constituency.
I thank the right hon. Member for his question. We were once parliamentary neighbours, so I understand the concern that he is expressing. Over the weekend, I spoke to the Business Secretary about this issue. We are holding a consultation, which will be a quick one.
I can absolutely do that. May I thank my hon. Friend for the work he does to further the cause of co-operatives and mutuals? When I was Economic Secretary, I very much enjoyed working with the sector, because building societies often offer more innovative products—to first-time buyers in particular—and do sterling work.
I do not believe in trashing nature and the climate either, but if we want to tackle climate change, we cannot stop every renewable project from going ahead, which is what the Greens would have us do, just as they would prevent the building of new nuclear power.
May I reassure my hon. Friend? One of our trailblazer projects in the place-based business cases is with Birmingham, which is obviously the beating heart of the west midlands.
The hon. Member will know that rural communities are close to my heart, given my previous ministerial role and because I have a semi-rural constituency. There is huge potential in rural communities. The Prime Minister visited rural Cornwall in his first few weeks in the job. We will do more, and we are doing more, to improve local transport and rural connectivity, including the £2 cap on bus fares. She is right to say that there is great potential, which we must realise.
I can absolutely give my hon. Friend that reassurance. The Government are intent on driving good growth and job creation opportunities across the country—in the north, the south, the midlands and every other part, too.
The Green Book discount rate is a tool of economic analysis. It does not change the cost of the deal.
We are working with the mayor on that issue. Our colleagues will get back to you on that.
The Prime Minister is clear that the hospitality sector is close to his heart. It is one that he worked closely with when he was Mayor of Greater Manchester. Earlier this summer we announced the business rate reductions for pubs, social clubs and live music venues, and we will go further in the Budget.
As I outlined to the hon. Member for Glastonbury and Somerton (Sarah Dyke), it is right that we focus on rural communities as well as urban areas and city regions. I will convey that message to the Chancellor, but I will not be writing the Budget right now.
As I said to the hon. Member for Glastonbury and Somerton (Sarah Dyke), we take the economic success of rural communities really seriously. We are improving connectivity, whether digital connectivity or local transport connectivity, to ensure that the areas are more successful, but there is obviously more to be done.
The right hon. Gentleman is right to raise this issue. As I have said, we have given strategic steers to the public financial institutions to ensure that they are focusing on regional growth, and that is also about opening up opportunities for the kinds of businesses that he has mentioned.
I can reassure the right hon. Gentleman that when I was Environment Secretary I visited the port of Belfast and saw the kinds of checks that were going on there. The sanitary and phytosanitary agreement that we are negotiating with the EU will help to reduce that friction.
It is money that already sits with the British Business Bank, but the change is the focus on the north, on scale-up businesses, to ensure that we unleash their growth potential. We are not announcing new funding; we never said we were.
The trade deals that we are doing, and also the reset of the relationship that we are taking forward with the EU, will bring down barriers with our biggest and closest market.
UKRI—UK Research and Innovation —invests in that sort of research, and the Government will continue to do that through UKRI.
I can reassure the hon. Gentleman; the east midlands and the west midlands are really important. The changes that the Chancellor outlined to the discount rate today will benefit places such as his constituency, because they will ensure that we value the longer-term benefit of regional investment projects more fairly. As we have said, we will drive growth in every postcode and that includes his constituency.
I would disagree, because the mayoral strategic authorities are about local authorities coming together in a combined authority and working together across the borders of the west midlands—an area I know extremely well. This is about driving growth and driving good decisions across the region.
We are working in close partnership with business, and the hon. Gentleman is right to say that we have to unleash talent and business investment in his own constituency and elsewhere, but as I said to the Chair of the Treasury Committee, the way that the public financial institutions work is by independently assessing the potential of firms and then backing them. That is what the Chancellor was talking about today. We set the strategic priorities and those independent economic organisations assess projects for their potential.
My remarks will focus mainly on new clause 69, which is in my name. Getting rid of NHS England is one of the best things that this Government have done. As working clinicians, we can at least now get away from so much admin and management. My amendment is a simple one about self-care and health literacy. Demand for healthcare has increased enormously. Since 2019, for example, GP consultations in Stroud have gone up 30%. When I started work as a GP, patients saw me on average three times a year; it is now about eight times a year. Indeed, A&E attendance has gone up 20% over the last decade, yet the health of the nation remains the same. This is the demand side of the NHS that we very rarely discuss, and this is what I am asking the Secretary of State to address. Let me turn to the causes of this increase in demand. There is a concept in medicine called the symptom iceberg. Most of us get symptoms every day, but we do not go to the doctor. We only go to the doctor when we have certain symptoms, and it is a very small number of symptoms, but that has increased over the last 20 years. Then there is the role of something that we call lay referrals; people used to have mums who lived next door, but now they are often much further away. We are socially isolated in an atomised society. We also have a much higher expectation for our health. We cannot fault that, but it means that, for example, people go to the doctor with very minor things. There are also factors such as AI. In my surgery, we use AI, but I believe that creates its own demands. There is also good old Dr Google, who in this country is consulted over 50 million times every year—and those who go to Dr Google usually end up thinking that they have cancer or need an ambulance, so that is clearly driving demand. There are also doctor factors. If we carry on treating sore throats with antibiotics, people will carry on coming back. Earaches generally get better, and people do not usually need to see a doctor for headaches. We are over-diagnosing and over-medicalising everything. NHS factors includes the algorithms for 111 and litigation. I would also like to talk about health literacy. That means knowing about our health, and understanding that we are not always in totally good health, but we do not have to consult the health service just because we are feeling a little bit low or a little bit tired. One of my colleagues in Stroud, Dr Hugh van’t Hoff, started Facts4Life, a school-based education service that goes into schools. In the last 10 years, he has worked with over 200 primary schools. He has shown that if we teach young children about health and how it is normal sometimes to feel tired or have a sore throat—stuff like that—we can reduce consultations in the NHS. We can also teach children how to understand information on the internet, so that when they look at statistics, they know what they mean, instead of thinking, “Ooh, my risk of cancer has been doubled by doing this.” That is really important. We are also over-medicalising patients. In this country, 9 million patients in England alone—one in five adults—are on antidepressants. That is a scandal.
I thank the hon. Member for that comment. He is right. NHS and GP data is a massive resource for our scientists in this country, and I agree with him that it should be owned by the UK. It should be a sovereign wealth issue. I would like to ensure that we realise that over time. I will return to over-medicalisation. I would like to try to divert patients with mild to moderate mental health symptoms to social prescribing, such as access to nature, arts and culture and exercise—and indeed comedy. Let us try to reduce that figure of 9 million on antidepressants, so that people do not have to come back for review. There would be fewer harms, such as suicide, in the first couple of weeks. Let us also look again at neurodivergence, and try to look for a way of not medicalising so many children with the condition. If we are serious about reducing waiting lists and making the NHS sustainable for the future, we cannot focus only on supply; we must address rising demand, too. Giving people the knowledge and confidence to look after their own health will empower them, free up clinicians to care for those who need them most, and ultimately build a healthier population. That is what new clause 69 seeks to achieve. I urge the Government to accept it.
This Government aim to shift the focus from treatment to prevention, and it is in that spirit that I have tabled new clauses 90 and 91, which would strengthen the frameworks around health inequalities and address the wider determinants of health. New data from Health Equals reveals a shocking reality: there is a gap of up to 18 years in life expectancy between different parts of the UK, and indeed between nearby neighbourhoods. Health Equal shows that in my constituency just a golf course separates two areas with an average life expectancy gap of eight years and 11 months. Reaching old age is somewhat of an aspiration in my more deprived areas. Indeed, in the most deprived communities people spend an average of just 52 years in good health. The stark inequalities are driven not only by healthcare, but by the wider determinants of health, including poverty, housing, education, employment and the environment. Within Stoke-on-Trent, healthy life expectancy at birth has fallen by 6.6% for men in the last decade. For women, the picture is even worse, with a 9.6% fall in healthy life expectancy to just 53.5 years over the past 10 years. This Bill represents a real opportunity to enshrine in law a statutory duty for the Secretary of State to go beyond reducing inequalities in NHS access and outcomes, and to reflect wider cross-Government goals for health improvement. Our health is shaped by the world around us—the food we eat, the money in our pockets, the air we breathe and the home we live in. In other words, every part of Government has an opportunity to influence people’s health. The purpose of new clause 90 is to ensure that the Government take greater responsibility for improving the nation’s health. That includes mitigating any increase in health inequalities, such as those seen in my constituency. The new clause would make improving health a duty, placing prevention on the same footing as treatment. But a stronger duty alone is not enough. That is why new clause 91 would require the Government to publish a new health improvement and inequality strategy within six months. The strategy would include long-term targets for adults and children, public reporting on progress, a duty on Ministers across Government to have regard to the strategy, and independent accountability arrangements. The Minister, who has worked very hard on the Bill—I commend her for her engagement—has alluded to the fact that pre-existing guidance and processes are in place, and these are designed to tackle health inequalities, and she is right. However, I argue that they are clearly not working, because health inequality has increased. I ask again what the harm would be of embedding this duty in the Bill to tackle the most fundamental issue in health across England: health inequalities. These amendments have cross-party support, and I note that they are also supported by the Health and Social Care Committee. I thank Health Equals for its work on these amendments. Again, I thank the Minister for her engagement and urge the Government to consider accepting these new clauses. I will briefly mention new clause 109, which also stands in my name. It was written by myself and Haris Shuaib, with whom I worked on the standard BS 30440 and a validation framework for the use of AI within healthcare. I previously worked with the AI and digital regulations service for NHS England, working with NICE, the MHRA, the CQC and the Health Research Authority. In the interests of time, I will say that in that duty I identified a number of accountability and regulatory gaps that certainly need further addressing. I ask that the Minister responsible for health tech meets me so that we can discuss these further. They partner quite well with new clause 108, which I had not spotted, so I apologise for not signing the amendment of my hon. Friend the Member for Liverpool West Derby (Ian Byrne).
Yesterday I visited the Shri Guru Ravidass Sikh gurdwara in my constituency, where I was told about the weekly drop-in they run to help rough sleepers without the right to stay in this country and advise them on how to reconnect with family and go home with dignity. Would the Secretary of State congratulate the work of the gurdwara and tell us how we can further help those kinds of organisations?
When I am out on the doorsteps in Stoke-on-Trent North and Kidsgrove, residents tell me that too often they feel distant from decisions that affect their lives. I want residents to feel that decision making is being brought closer to home and that locally we are taking better decisions about improving our buses and houses and giving young people the skills that match their potential. Can the Secretary of State please confirm that devolved powers are still coming to Stoke-on-Trent and Staffordshire and that they are coming at speed, because we cannot be left behind?
I beg to move, That this House has considered e-petition 763161 relating to surrogacy law and legal parenthood. It is always a pleasure to serve with you in the Chair, Mr Pritchard, and I am sure today will be no different. The petition calls for a change in the law so that the intended parents of babies born through surrogacy can be considered to be the legal parents from the moment of their child’s birth. Under current law, that is not possible. Intended parents must go through a months-long process in the courts and be visited by a social worker before they are considered to be the parents of the children in the eyes of the law. Ahead of this debate, I met the petition’s creator, Adam, his fiancé, Jamie, and their daughter, Leven, who was born via surrogacy in Connecticut. I am pleased to say that Adam and Jamie have joined us in the Public Gallery today. Although baby Leven has not joined them, she made a cameo appearance on our call ahead of the debate. Adam and Jamie are listed as Leven’s parents on her birth certificate in the United States, but more than six months after her birth, they still are not recognised as her legal parents at home in the UK. That is what prompted Adam to create this petition. When we met, he said, “We’re changing Leven’s nappies, we’re putting her to bed—we are her parents, we’re bringing her up” and yet he says that babies like her are in “legal limbo” under current legislation. My role today is to introduce the petition by setting out the petitioners’ views and framing the debate to follow. It is good to see so much interest from Members across the House. In preparation, as well as meeting Adam, I have drawn on the expertise of a range of organisations and individuals, with the expert support of the petitions team. They are often not thanked enough, so I place on record my thanks to the entire team for their support in preparing for the debate. We met groups such as Surrogacy Concern, Stop Surrogacy Now UK and Brilliant Beginnings, and Dr Herjeet Marway of the University of Birmingham, who is the founding chairperson of SurrogacyUK’s ethics committee. We also met Professor Nick Hopkins of University College London, a former law commissioner for England and Wales, and Professor Gillian Black of the Scottish Law Commission and the University of Edinburgh. Together, they authored the joint Law Commission report on surrogacy reform, which was published in 2023. I will start with the current state of the law and the reforms proposed by that Law Commission report. When a child is born to parents via surrogacy, whether in this country or abroad, as baby Leven was, the surrogate mother is considered the legal mother at birth under UK law. If she is married or in a civil partnership, her partner will automatically be the second parent on the birth certificate, irrespective of the child’s genetics. There are children out there today whose parents, as considered under UK law, have no genetic relationship to the child at all. That is because in UK law, the person who gives birth to a baby, and no one else, is considered the mother. That has led to a complicated reality in today’s world, where a growing share of babies are not born via natural conception. If you give birth using a donor egg, you are considered to be the child’s mother in the eyes of the law. But if you cannot carry a baby, and if you and your partner have an embryo that is biologically yours carried by a surrogate, you are not considered to be the legal parents when your child is born. Intended parents and their surrogates can draft a surrogacy agreement setting out how they want parental rights to be arranged for the child, but those documents have no legal standing in the UK. To become legal parents, intended parents must apply for a parental order through the courts. They have to make that application between six weeks and six months after the baby’s birth. Organisations that specialise in assisting intended parents say that the process normally takes between six and 12 months to complete. In that time, the baby will almost invariably be living with the intended parents, but legally, they are strangers to that child.
It is always a pleasure to see the hon. Member for Strangford (Jim Shannon) in his place in this Chamber. I will touch on health later, so I ask him to hold fire.
My hon. Friend is right to raise the issue of finance, which I will touch on briefly, so I ask him to bear with me as I get to that part of my speech. Opponents say that the parental order process is really complex. The document that intended parents have to submit is 200 pages long, meaning that many will seek legal advice. Adam and Jamie say that they expect legal fees for their parental order to be in excess of £10,000. We have just heard from my hon. Friend that it can be even more costly in other parts of the United Kingdom. That money is very real, and intended parents face very real financial difficulties. As the hon. Member for Strangford (Jim Shannon) said, the process can cause real practical problems. In fact, I have heard of cases in which surrogates have had to dial in to medical appointments for their child in the US for months after birth, because the hospital at home is unable to recognise the intended parents as responsible for their child’s health decisions. Experts say that, in their experience, the most distressing part of the process for most intended parents is the court-mandated social worker visit. Supporters of the current arrangement compare it to a visit from a health visitor, but opponents say that there is no comparison. The Children and Family Court Advisory and Support Service is the agency that advises the courts on children’s welfare, and in the vast majority of cases it is involved where a child is believed to be at risk. However, CAFCASS is also involved in surrogacy cases. Its assessments for a parental order involve criminal checks, child protection reports, home visits with parents and a full, detailed report. Although it is incredibly rare to see CAFCASS reports on intended parents that are anything but wholly positive, parents find it extremely distressing to be questioned and scrutinised in a way that parents conceiving without the need for a surrogate simply do not experience. In 2018, as a result of those difficulties, a previous Government asked the Law Commission for England and Wales and the Scottish Law Commission to jointly consider reforms to UK surrogacy law. It was a significant piece of work, and the report was published in 2023. It recommended “a new pathway to legal parenthood” in surrogacy cases, with the screening of intended parents taking place before birth, so that they could be recognised as legal parents from birth. The proposed pre-birth arrangements included an agreement between the surrogate and the intended parents, with independent legal advice provided to all parties, a preconception assessment of the child’s welfare, and the agreement of a regulated surrogacy organisation to recognise the surrogacy agreement. If the surrogate then withdrew consent, the existing parental order process would apply. If the surrogate changed their mind before the birth, they would be the legal parent at birth. If they changed their mind in the six weeks following birth, they would be able to apply for a parental order. The authors of the report strongly felt that that struck a balance between protecting all parties—the surrogate, the parents and the children—and, crucially, keeping the child’s welfare as the central concern. Having said that, it is really important to bring in the voices of Professor Hopkins and Professor Black, who made it very clear ahead of this debate that they never intended that part of their proposal to be carved out and delivered in isolation. They proposed a wider package of reforms, and they say that it was only part of a comprehensive solution. Although some who advocate changes to surrogacy law argue that the issue of parental orders can be dealt with as a quick win, the professors believe that it should be addressed as part of a wider package. That package includes, for example, creating a mandatory surrogacy register so that children could find out more about their birth mother and, with their consent, her family, if they wish. It is also important to note that the Law Commission’s proposal for a new pathway to legal parenthood for intended parents would only apply to surrogacy arrangements here in the UK. It is proposed that the existing parental order system would continue to apply when babies are born abroad via surrogacy. The Law Commission report concluded that it would be impossible to ensure that laws abroad are in line with what we would consider UK norms. That concern is flagged by some of the groups opposed to surrogacy arrangements, as the second most popular destination for UK surrogacy is Nigeria—a country currently subject to special restrictions when it comes to adopting a child due to child welfare concerns. In preparing for this debate, I heard worrying reports of surrogate mothers, often living in real poverty abroad, being pressed to sign legal agreements under extreme time pressure and without independent legal advice. That is far from being the case everywhere. However, it can never be acceptable, and we should make sure there are proper legal safeguards in place. The Law Commission’s hope is that, by maintaining the UK’s altruistic approach to surrogacy—that is, keeping it not for profit—and updating the law, more intended parents will be able to pursue surrogacy here in the UK and make use of a new parental pathway to be recognised as legal parents from birth. The petition focuses on a specific part of surrogacy law, but it feeds into a much wider debate. There are some quite stark divisions on the issue, which is understandably very emotive for a large number of people. However, what seems clear is that the current law on surrogacy is no longer working and that a wider conversation about how we should change the legislation in this area would be welcome. I know the Government have said that they will look at this issue when time and capacity allow, but I am very interested to hear more from the Minister about what that might look like and when we might be able to expect it.
It is always a pleasure to sum up these debates and thank hon. Members for their contributions. The hon. Members for South West Devon (Rebecca Smith) and for Leicester East (Shivani Raja) and my hon. Friends the Members for Edinburgh North and Leith (Tracy Gilbert), for Mansfield (Steve Yemm) and for Pendle and Clitheroe (Jonathan Hinder) brought to the table points on the balance of rights between the different parties involved, how disagreements between intended parents and surrogates can be worked through and the importance of surrogates’ rights, and a focus on the rights of the child. We also heard about the legal complexities around devolution from a number of Members, particularly in Holyrood and Stormont, but I am sure that is also the case for Cardiff. My hon. Friends the Members for Cannock Chase (Josh Newbury) and for North Warwickshire and Bedworth (Rachel Taylor)—I always say it should be pronounced “Beduth”—highlighted the difficulties faced by intended parents and families navigating a very complex process, the importance of consent as we navigate it, the value of surrogacy to families and how families find a way to start using the process. It was also great to hear contributions from the hon. Member for Horsham (John Milne), my hon. Friends the Members for Glasgow South (Gordon McKee) and for Bolton West (Phil Brickell), the hon. Member for Strangford (Jim Shannon), the party spokespersons—the hon. Member for Chichester (Jess Brown-Fuller) for the Liberal Democrats and the hon. Member for Solihull West and Shirley (Dr Shastri-Hurst) for the Conservatives —and the Minister. It was clear today that this is an incredibly complex and detailed debate, and one that needs to be considered fully. While I am sure the petitioners would have preferred to hear a further update from the Minister, she was very clear when she outlined the current legal position and advice from the Government on surrogacy and that the Government are staying exactly where they are and will get to this when time allows—that was a very paraphrased version of her conclusion. I thank everybody for their time today, and especially you, Mr Pritchard, for chairing. Question put and agreed to. Resolved, That this House has considered e-petition 763161 relating to surrogacy law and legal parenthood.
I welcome my right hon. Friend back to her role and thank her for her statement. I am sorry that the right hon. Member for New Forest West (Sir Desmond Swayne) is no longer in his place, because I wanted to assure him that, far from being swallowed up, his constituents would have had a warm welcome and excellent local public services as part of Southampton. I understand the difficult decision that the Secretary of State has had to make, but I must express disappointment that after all the hard work across councils and across parties, the five unitaries for Hampshire and the Isle of Wight will not be going ahead. Will she confirm that, after her rapid review, Southampton and the surrounding councils will still have the opportunity to reorganise if they so wish, or is this the last we will hear of LGR?
I thank my hon. Friend for his work on the all-party parliamentary group; he is a real champion of this cause. AJM Healthcare, the contractor in my constituency, has a similar level of failure. People are left for months—sometimes six months—without a wheelchair, bed-bound and unable to get out of the house. Does he agree that ICBs seem completely at sea on this issue, and are totally unaccountable? Does he agree that we need much tougher measures, such as those he suggests, to hold them to account?
There is much to support in the Bill, and I support its ambition to enable many of the provisions of the welcome 10-year plan for the NHS. The plan is the right one; the three shifts are correct, and we have to fundamentally reform the health system if we are to meet the modern health and care challenges that we all see in our constituencies. To some extent those challenges are not new, and neither are these ambitions—we have seen similar initiatives before—but the systems, the structures, the bureaucracy and the siloed budgets push against change in the health sector. They have been a hinderance, reinforcing silos and making the same investment choices. They have prevented digitalisation, kept care in acute settings and stopped joined-up working. This Bill could and should be a key lever in overcoming those challenges, which we need to do if we are to achieve those ambitions. I very much support the digital single patient record, which is a key ambition in the shift from analogue to digital health. We have all heard from patients who have to tell their story over and over again at every single health appointment—between care and health, between community and secondary care—so a genuine single patient record has the potential to be transformational. We have, however, heard from pharmacies and community mental health services that if this is to work, they have to have a seat at the table. While this Bill enables the architecture, I hope that the delivery will ensure that the whole of the health and care system is part of the decision-making process when the single patient record is designed. That is crucial. Turning to the abolition of NHS England, the idea of streamlining bureaucracy at the centre is a good one, and delivering power—including decision-making power—budgets and resources locally is also admirable. Success, however, will mean the right decisions being taken at the right scale.
I thank my hon. Friend for that contribution. Having worked in neonatal care services and areas of specialised services in the NHS for 10 years, I understand that one of the benefits of NHS England was that it brought together highly specialised services, ensured consistent service specifications and uplifted the quality and availability of care across the country. I hope that when we make decisions about which specialised services will be devolved to ICBs, consideration will be given to that point. Equally, we have heard from national population health programmes such as the Diabetes Prevention Programme, which has been a huge success. As we make the final decisions about the level at which decisions are made, we cannot lose the benefits of public health initiatives at scale, such as vaccinations and prevention programmes. I would welcome the Minister’s thoughts and reflections on that. Integrated working is also important—as I say, we have to blend budgets and bring together decision makers across current silo divides. In that spirit, I very much welcome the change made by Government amendment 60 to give local authorities a seat back at the table. We need a bigger voice for public health and social care in health decision making, not less, so I thank the Minister and the Government for listening to the Health and Social Care Committee and moving on that. In the view of the NHS Alliance, this is not enough; it would like to see a reciprocal duty to collaborate, which is an interesting suggestion. However, the Government’s amendment is an important start.
My hon. Friend might have read my speech, because I was about to turn to her amendment’s proposal of a report on integrating health and social care. It is an interesting idea that has a great deal of merit, and I hope that the Minister, in her response, will outline the Government’s approach to enabling more progress on integrating health and social care, particularly with the ongoing Casey review. Inequalities have already been mentioned in the debate. Obviously, one of the Government’s key ambitions is growth in every postcode; another is good health in every postcode. Time and again we see disproportionality and inequalities that are seemingly hardwired into our health system. To change that, we are going to have to do something differently, and I welcome new clauses 90 and 91, tabled by my hon. Friend the Member for Stoke-on-Trent South (Dr Gardner) which would definitely reinforce the Government’s 10-year plan commitment to halve the gap in healthy life expectancy between the richest regions and the poorest, and to raise the healthiest generation of children ever. Unfortunately, we have moved away from those goals over the past 10 years, and we will have to do something differently if we are to bridge that gap. In my own constituency, from north to south, there is a huge divide in the quality of health and outcomes based on postcode. That must change. Although the Government are not minded to accept those amendments, I know that the Minister is passionate about inequalities and that the Bill requires neighbourhood health plans to be developed. That will be an important new measure when responding to neighbourhood health needs, and in preparing those plans, “the responsible local authority and…partner integrated care boards must have regard to any guidance issued by the Secretary of State.” I hope that the Minister will explore using this guidance to ensure that as they are developed, neighbourhood health plans specifically address inequalities between neighbourhoods. Finally, I turn to the SEND system, which is another major challenge with which the Government are rightly grappling. I thank my hon. Friend the Member for Thurrock (Jen Craft), a fellow member of the Health and Social Care Committee, for new clause 85, which would address the chasm between the education system and the health system. While this is fundamentally a health Bill, it is right to ask what more the health system could and should be doing. As the Chair of the Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), has rightly said already, the “H” is far from present in EHCPs. Decision makers are not required to come round the table, and the specialists are not provided. I have been to specialist schools in my constituency where there is no nursing provision, so people miss school days, and where there is no specialist transport, so people cannot even get to school, because bus drivers do not have the proper health knowledge. We need to have an education and health response. I therefore hope that the Minister will address in her closing remarks how, if this Bill is not the right mechanism, future SEND reforms may pick this issue up and how the Department of Health and Social Care will contribute. There is a great deal to support in this Bill. It is a major step forward, particularly for digital healthcare, giving people control of their records and joined-up care. I hope that the Government will continue to drive forward reform of our health system.
I begin by welcoming the Government’s decision at the start of the summer to pause the application of VAT on medicines donated for free to patients through compassionate access, early access and related schemes. The health charities, patients and industry bodies that I have worked with are grateful to Ministers for recognising that this issue needs to be addressed, and in particular for the ministerial statement setting out the Government’s intention to introduce a new approach to VAT on free-of-charge donations of medicines. I know that my right hon. Friend the Financial Secretary to the Treasury, and previously my hon. Friend the Exchequer Secretary, have both worked a great deal on this issue. I thank them for their commitment to find a resolution. Without a permanent solution, however, pharmaceutical companies do not have the legal certainty to fully re-engage with early access programmes. Although, to date, only Bayer has withdrawn from these schemes outright, I have heard from a number of other companies that tell me that the uncertainty is causing them to reconsider, drug by drug, whether they can afford to continue offering free access, for fear of creating open-ended VAT liabilities. Tragically, the people who are paying the price for the delay are patients. I know that the Government recognise the consequences for patient outcomes, which is why they have committed to bringing forward a new approach, either through changes to VAT rules or through a reimbursement scheme. I welcome the fact that the new approach, once introduced, will apply to donations made on or after 23 June 2026. However, a pause is simply not good enough to resolve this issue fully. I called for this debate to ask the Government to reconfirm their commitment to find a permanent solution and to ask them to move forward as quickly as possible in determining that comprehensive solution.
I thank my hon. Friend for that. As chair of the all-party parliamentary group on access to medicines and medical devices, I have heard those stories far too often. I completely agree that we should be removing every single barrier.
I agree that we do need to find a permanent and comprehensive solution. Hopefully we can air those issues fully today. Fundamentally, the principle underlying this issue is very straightforward: if a pharmaceutical company is willing to provide a lifesaving medicine to a patient free of charge because that patient has a serious or life-threatening condition and has exhausted the available standard treatment options, the tax system should not make access to those lifesaving drugs more difficult. That reflects the points raised by the hon. Member and my hon. Friend the Member for Morecambe and Lunesdale (Lizzi Collinge). Pharmaceutical companies already operate these schemes at a loss. For example, over the last four years, AstraZeneca alone has given more than 2,500 patients access to innovative, lifesaving medicines free of charge, costing millions of pounds. This is clearly not a commercial transaction. It is a moral, compassionately motivated decision and programme, and in my view that means it should be supported, championed and facilitated by Government, not blocked, disincentivised, or made administratively more burdensome—but unfortunately that is exactly what has been happening since HMRC started charging VAT on those donations. This is not just a line on a tax return, impacting on the bottom line; the impact is also having real-world consequences on patient groups. The consequences of this delay are gut-wrenching and deeply frustrating for clinicians, patients and their families. Every day, every week and every month that we wait for a permanent solution to move forward, more severely ill patients are denied access to drugs that could save or extend their lives, at no cost to the NHS. It is also important to note that patients with rarer cancers are disproportionately affected by this issue, as they generally have fewer treatment options. In August, I was contacted by Emma and her husband Ian. Ian and Emma are currently watching this debate online from Ian’s hospital room at University College hospital, as they could not be here in person. Ian has an advanced, rare and aggressive bile duct cancer. Following his latest chemotherapy, his consultant Professor Bridgewater recommended regorafenib as Ian’s next treatment. Regorafenib was previously supplied free of charge by Bayer through a compassionate use programme. However, since Bayer became liable for VAT on the medicines it was donating, it withdrew from the programme, meaning that Ian lost free access to this potentially life-extending treatment. Ian and Emma are now urgently trying to find the money to pay privately for Ian’s treatment, and the cost is thousands of pounds per month. It goes without saying that many families cannot afford to pay thousands of pounds, each and every month, for treatment. Working with Sarcoma UK, I have also heard from Dr Robin Young, a consultant medical oncologist at Weston Park cancer centre. He reported that a 62-year-old patient with metastatic leiomyosarcoma, whose disease had progressed through all the standard chemotherapy options, was also denied this drug in January 2026 because of Bayer’s withdrawal. That patient subsequently self-funded an alternative treatment at a cost of £3,500 for one month, before deciding that he could not afford to continue with that treatment. These are heartbreaking decisions for patients and their families. I have also heard from Dr Alex Lee, a consultant medical oncologist at the Christie NHS foundation trust, who has reported that two patients with advanced osteosarcoma were refused access to the drug earlier this year, with Bayer citing the VAT position. Tragically, one of those patients has since died. She was just 20 years old. I hope these stories make clear the urgency of resolving this issue as soon as possible. This would not only enable Bayer to re-engage, but ensure that existing participants could continue to access their drugs through the programme and enable potential new drugs to enter early access and compassionate access schemes in the future. On paper, this might be a niche and complex part of tax policy, but in real life it is a desperately ill patient, it is a family and it is a clinician having to explain why a medicine that had previously been made available can no longer be provided. I shall turn now to the position of the pharmaceutical industry. Patients, clinicians and the Minister will be pleased to hear that the pharma companies are keen and willing to re-engage with compassionate, early access and other similar schemes once a suitable solution has been finalised with Government. However, I have heard concerns from the industry about the pace and scope of negotiations since the Government announced the pause. The first issue is about the breadth of the definition of the products that will be exempted from VAT liabilities. The definition used to determine any VAT exemption should include the full range of schemes that pharma companies engage in to provide these medicines free of charge. These include: compassionate use, where a clinician requests a specific medicine as a last resort once other options are exhausted, usually off-licence; early use, for new patients immediately after a trial; post-trial provision, for patients who responded well during a trial and need to continue; and bridging prescriptions, for patients where a drug has been approved but is not yet funded on the NHS. However, I have been told that the definition initially suggested by HMRC during negotiations has been too narrow to cover all those uses. I encourage the Minister to look again at this, given that compassionate use of off-licence drugs accounts for a substantial proportion of the patients who benefit from donations to the programme. I understand that the Government may be now moving to a better position on this point, and I would welcome confirmation of that from the Minister. The second issue I have heard is that HMRC is considering attaching two conditions to any VAT exemption: first, that the patient must be treated on the NHS rather than by a private clinician; and secondly, that medicines must be supplied directly by the company to the NHS. I am sceptical of the merits of both those points. First, patients should not potentially lose access to a lifesaving free treatment, which is at the cost of industry, just because the clinician recommending the treatment is a private doctor. On the second point, I would be grateful if the Minister would explain how such an arrangement would work on a practical level. We know that the NHS can refer to private clinics and that clinicians can, particularly for specialist issues, work regularly between NHS practices and private clinics. The fundamental question must surely be whether the medicine is clinically needed and whether it is free at the point of use for the patient. The third issue raised by pharma pertains to the question of historical liabilities. My understanding is that many pharma companies have already paid VAT for historical liabilities, and it is important to say that we do not expect that they will be able to recover that in full. However, given the upcoming changes, it would be helpful if the Government provided some clarity on the legal position on historical liabilities before the pause. I urge that settlements should be negotiated constructively and with understanding based on the nature of these liabilities. Closely related to the issue of historical liabilities is that of co-ordination between Departments on this issue. AstraZeneca has told me that, despite ongoing negotiations with HMRC and the pause announced in July, it is currently being pursued by His Majesty’s Treasury for accounts by the end of September, which it has been indicated should include VAT liability on compassionate access—a position AstraZeneca is not confident is consistent with what it is hearing from HMRC. Business needs certainty to prepare accounts. I encourage the Minister to ensure that HMRC and the Treasury are working from the same hymn sheet. On the method and pace of resolution, my understanding is that the Government are looking at creating an exemption for the compassionate donation of medicines through a legislative change to the Value Added Tax Act 1994. However, have the Government considered issuing a business brief from HMRC to clarify the new position, given that this could be a faster and more effective route? I would be grateful for the Minister’s perspective on that. As well as the patient benefits, there is also a key strategic opportunity for us as a country to be a global industry leader in life sciences research. Many other countries have complex schemes in place, and sometimes charge VAT or the equivalent on such things. However, I understand that although liabilities technically exist in the Netherlands, they are not enforced in practice. If the UK were to fully resolve this issue and put it beyond doubt, this would be a genuine point of competitive advantage in attracting life sciences investment, research and clinical trials to this country, at a time when our overall competitiveness in the sector is under pressure from other directions and policies. It would also encourage the participation of innovative new drugs and potential wider patient applications of them, driving forward potential research opportunities and improving healthcare practice. To sum up, my questions to the Minister are as follows. First, can he confirm that a permanent solution will define eligible products as widely as possible, to include the full range of schemes that are currently used? Will he reconsider the proposal to restrict eligibility to NHS-treated patients only? Secondly, the Government have said that they will act as soon as possible, but for a patient with a life-threatening disease, that phrase can feel like a very long time. Will the Minister set out a clearer timetable about actions and next steps, and when the consultation with industry is likely to conclude? Will the Government decide to bring forward a reimbursement mechanism? Can the Minister explain why a business brief route has not been preferred, or whether one can be explored? When is detailed guidance likely to be published and operational? Finally, what is being done to repair the relationships with industry, which have been damaged as a result of this policy? Where a company such as Bayer has withdrawn, I hope that it will be strongly encouraged to re-engage as soon as possible, so that the patients we have heard about today can gain access quickly. Will the Treasury work with the Department of Health and Social Care to engage industry and be in direct communication with clinicians to help to identify which patient groups have been most affected, so they can be notified as soon as possible that the treatments may become available again? This is, on paper, a narrow, technical issue of tax policy—not always the thing that makes the front pages of newspapers or the most engaging social media videos—but in practice, a clear and quick resolution to this issue is a life-and-death issue for many thousands of people. It is the difference between a patient like Ian fighting to save thousands of pounds a month—just to be able to focus on his health and his loved ones— or not. It is the difference between a clinician having to explain why a medicine that was available last year is not available now, and being able to provide that innovative and lifesaving drug to them and many more patients besides. It is the difference between a pharmaceutical company that wants to do the right thing, providing drugs to patients for free or at a low cost, and it withdrawing its drugs completely because the costs become significant. Once again, I strongly welcome the ministerial statement and the pause from June. I thank the Minister and his predecessor considerably for their work to date, which has made a difference. I know that he is committed to engagement on this issue and to finding a way forward.
The Minister is being very generous in giving way, as ever, and I appreciate his response about the limitations of the business brief process. If amending the VAT Act 1994 is the right route, does the Minister know roughly how long that would take to find a resolution? I fully his support his point about Bayer re-engaging. The Government have moved in good faith, and I hope Bayer will, too.
I welcome the Government’s plans to deepen devolution, but can the Minister reassure me that they will mean no alteration to the commitment to a Cambridge development corporation?
Devolution and local government reorganisation are different things. To be honest, they should probably be considered separately, but they have become so interlinked and intertwined in this debate that it is impossible to do so. If we are to have a stronger devolution settlement, it is right to spend more time getting it right. Does the Secretary of State agree that any new structures that emerge should be based on economic growth and dynamism, rather than having to be built on existing districts? Those building blocks were established in a very different economic era.