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12,868 spoken contributions under 12 words (interjections such as “Will the hon. Member give way?”) are hidden. Show them
It is absolutely vital that victims are at the heart of our justice system. My Blaydon and Consett constituents know that for too long, the system has not been working for victims of rape and serious sexual offences. What impact does the Solicitor General believe that the early victims’ right to review will have for victims?
I very much welcome the Foreign Secretary’s statement. The alliance is growing stronger by the week, but it is clear now that national security rests on economic security. Can she update the House on what conversations she had about how the allies will come together to build and enlarge an arsenal of democracy for the 21st century, whereby we collaborate on defence industrial policy and defence finance strategy on a wholly new scale that is fit for this new age of insecurity?
I thank the Minister and the steering group for their work. Their findings that disabled people find the assessment process dehumanising and stressful reflect the conversations that my constituents have had with me. Paragraph 64 of the review finds that “the reliance on PIP has likely increased due to difficulty accessing vital services and support, such as community mental health services” and Access to Work. Does he agree that the reform of disability benefits in the future must go hand in hand with improving those support services, such as by widening Access to Work and, in particular, cutting NHS mental health waiting lists, which are far too long? The Minister referred to falling waiting lists; I gently say to him that while physical waiting lists are falling, mental heath waiting lists have not been falling. The longest waits have increased since last December, and the Government need to get a grip on it.
The hon. Member is doing an excellent job of expressing the moral outrage shared by constituents from Herefordshire to Sunderland to Sheffield, but does she agree that if it is possible for international groups to find origin fraud relating to goods that originate from illegal settlements on the west bank, but are incorrectly labelled as being from within Israel, it is entirely possible for the British Government to do the same? There is no valid reason there for our not implementing sanctions.
The flooding outside Tesco in Stafford is a great example of why holding local authorities to account on drainage really matters. I recently learned that the drains were last cleaned in 2020, during covid; without regular maintenance, they will continue to block. While I am glad that it looks like a fix is finally on its way, routine drain clearance should not require an MP’s intervention. Will the Minister tell me and the House what she can do to ensure that council leadership meets its basic maintenance obligations, before the next rainfall shows that maintenance has not been done again?
Yesterday was one of my favourite days of the year—not because it was the Leader of the House’s birthday but because my Stafford students came down for their summer school. They met the Chancellor, the Speaker, other MPs and a Minister. They are passionate and inspiring young people who are keen to use their voices for good. Will the Leader of the House join me in thanking those people who gave their time for those young people yesterday? More importantly, will he thank those people around the UK who regularly volunteer to support young people and give them a safe space to be themselves?
What strikes me about the support we give to the ceramics sector as a Government is that, while we are making a big commitment—and the right commitment—to give British people homes by delivering 1.5 million houses, we could simultaneously support our bricks industry, and the building sector more widely. Does my hon. Friend agree that while we are backing British, building British and buying British, it is important that we ensure that that sector support comes through from Government?
10. What progress she has made on implementing the waste crime action plan.
I really welcome the three-pronged strategy in the Government’s waste crime action plan—focused on prevention, enforcement and remediation—and I welcome the small number of recent and really significant illegal waste sites, which the Minister mentioned, that will be assessed for clearance. Will the Minister, however, outline how older but equally significant sites such as Brambletree wharf, which has blighted my local community for nearly a decade, can be tackled under the plan?
This year is the 500th anniversary of the battle of Linlithgow bridge, a pivotal moment in Scottish history, and part of a power struggle for the regency of King James V. To mark the occasion, Linlithgow Civic Trust and Battle 500, alongside local historians, schools and volunteers, have a huge programme of summer events, including a battle re-enactment. Will the Leader of the House join me in congratulating all those involved in bringing our local history to life? Will he make time for a debate on local volunteers who promote Britain’s rich heritage?
I thank the Minister for his update and his collaborative approach to the co-production process, as well as the time he spent with me and colleagues earlier in the year to discuss the experiences of those living with conditions such as multiple sclerosis and Parkinson’s. The Minister mentioned that disabled people find the assessment dehumanising and stressful; that is particularly the case for those who live with fluctuating conditions and invisible symptoms, for whom no two days may be the same. Will the Minister provide an update on how the lived realities of those with fluctuating conditions will be better reflected in any new assessment process?
I congratulate my hon. Friend the Member for Sheffield Central (Abtisam Mohamed) not just on the power of her words, but on her extensive work, day in, day out, on this issue. When discussing this issue, we should start from a clear principle: if we support a two-state solution, we cannot trade with those who, through illegal activities, make that less achievable with every passing day. This is about life on the west bank, and whether we are prepared to acknowledge realities that impede the everyday life of Palestinians. Prosperity and dignity depend on very ordinary things that we all take for granted—getting to work on time; children being able to see their grandparents; and accessing water, services and opportunities—but those things are simply not possible for an increasing number of Palestinian communities. I am fortunate to know the Antonine Friendship Link, a humanitarian group in the Falkirk area that advocates for the human rights of Palestinians in Jayyous on the west bank, creating friendships and solidarity across communities and borders. Those long-standing connections gave me the opportunity to hear directly from Sharif, an olive farmer in the village. He gave deeply moving testimony about life at a time when there are extraordinary constraints on people’s liberty, freedom and agency. Sharif spoke to me about regular obstructions that he faced in getting to his land and place of work, intimidation from nearby settlers, and the frustration of lawlessness. He has taken on multiple legal cases, including in the Supreme Court of Israel, and he has won. However, those decisions are not meaningfully upheld in practice, and obstacle after obstacle has been placed, often literally, in his way. His olive groves, his livelihood, and his community remain isolated. Sharif’s account is like much of the evidence available to us, and the only conclusion I feel able to draw is that communities such as Jayyous are being increasingly and purposefully squeezed, isolated and made less viable. For people like Sharif and communities like Jayyous, and for their peace, security and chance to lead normal lives, we must be prepared to examine seriously whether trade with illegal settlements is compatible and consistent with the values and objectives of our overall goal of a two-state solution. In my view it is not.
It is good to see you in the Chair, Dr Huq. I am grateful to the hon. Member for North Shropshire for tabling this new clause. I am sympathetic to its intentions: the security of data, the transparency of use and even realising the value of data. Its principles are in the interests of the public and the NHS, but we do not consider it necessary to achieve our aims. It would impose onerous operational requirements and could have a damaging impact on the ability of the NHS to function. There is also a significant overlap with the role of the independent national guardian and potentially that of the information commissioner. Once the functions of NHS England have transferred to the Secretary of State, the Secretary of State must have regard to the need to respect and promote the privacy of recipients of health services and of adult social care in England, which is in addition to the requirements already set out in UK GDPR. The Secretary of State will be able to issue guidance to the health and care sector relating to the processing of information to which NHS bodies must have regard. The Secretary of State will be under a duty to have regard to guidance given by the Health Research Authority on the disclosure of confidential information. The proposed trust functions would also encroach significantly on the operational role intended for the health data research service, and would place cumbersome constraints on vital data collecting and sharing within the NHS. The new clause would mean that all health data collections and data-sharing initiatives would have to be preceded by public consultation. That would capture any of the essential collections that NHS England undertakes, and indeed any collection by NHS organisations, not to mention the use of that data. The burden would be considerable, with very real consequences for the ability of the NHS to use that data to improve outcomes for patients. Likewise, I cannot see how requiring all health data to be held anonymously and accessed only through a trusted, secure research environment would be compatible with delivering direct care to a patient or using confidential patient information for planning and commissioning services or research. It seems that the new clause would prevent such uses. For those reasons, I ask the hon. Member to withdraw the motion.
Further to that point, I absolutely want to assure my hon. Friend the Member for Worthing West, who is not a member of this Committee, and indeed the members of this Committee that the Government fully appreciate the important role of public health professionals. They bring critical expertise in population health intelligence, epidemiology and community co-design, and those capabilities are integral to the role of ICBs as strategic commissioners. On new clause 11, there is already a statutory duty on ICBs to seek advice, and a statutory duty on local authorities to provide public health advice to ICBs. However, that does not mean that ICBs should be required to employ a director of public health directly. Local authorities already employ a director of public health and we expect ICBs to work collaboratively with their local authority partners and not to duplicate their work. NHS England recently published the strategic commissioning framework and guidance for ICBs on strengthening the public health advice, both of which are clear that ICBs should work with local public health teams and stakeholders to draw upon their expertise to ensure a strong evidence base for commissioning decisions. As the responsibilities of ICBs for commissioning NHS public health services grow, we expect them to continue to draw on the skills and expertise of local authority directors of public health, as well as other specialist public health expertise, including screening and immunisation leads, and the UK Health Security Agency. I absolutely agree that public health expertise is essential for ICBs to commission effectively and we have set out how they will access that; the basis for all this is of course the joint strategic needs assessment. However, I do not believe that it is necessary to require an ICB to appoint a lead director for public health in order to have access to such advice. On new clause 24, as the Committee is aware, local authority directors of public health are advocates for the health of their population. They have a professional leadership role across the three domains of public health: health improvement, health protection and healthcare public health. Their work spans organisational boundaries. Although they are employed by local authorities and appointed jointly with the Secretary of State, their role is designed to bridge local government and the NHS. They are also required to provide objective, evidence-based advice, without political interference, and they are expected to be suitably qualified and regulated public health specialists who take a population-wide perspective to health outcomes and health inequalities. At the heart of their role is their statutory responsibility to prepare an annual report on the health of their local population. That crucial document underpins the plans of health and wellbeing boards and, through them, the ICBs. Directors of public health are also required to be members of health and wellbeing boards, which will be the central mechanism for partnership working between local authorities and ICBs in the new neighbourhood health system. As such, directors of public health will be well placed to help to shape ICB system-wide plans and strategies on public health issues going forward, something that we discussed earlier in the Committee. There is a statutory duty on ICBs to obtain appropriate and expert public health advice, and a legal duty on local authorities in turn, carried out by the director of public health and their team, to provide public health advice to ICBs. Beyond those requirements, the NHS, including ICBs, is of course free to employ its own senior public health professionals. The proposed new clause risks creating some significant ambiguity around accountability and risk, constraining rather than enhancing the independence of directors of public health, which I am sure is not the intention of the hon. Member for Sleaford and North Hykeham or of the Committee. I hope I can offer reassurance to the hon. Member and indeed to the Committee that we are proud of our strong and coherent public health system, that this Bill does not alter its importance and that we will continue to champion the role of directors of public health and ensure clarity in the new architecture. I ask that the new clause be withdrawn.
As the hon. Member was not here at the time, perhaps it eludes his memory, I remind him that it was a coalition Government agreement to move forward with Dilnot, which had cross-party support. As soon as the coalition finished in 2015 and the Conservative party had dumped their friends in the Liberal Democrats, almost immediately after that election, it also dumped all pretence around the Care Act 2014 provisions at the time. We are where we are. I just wanted to help his memory.
To correct the shadow Minister, I do not think my hon. Friend the Member for Bury St Edmunds and Stowmarket said that; he said the waiting lists have gone up. To be clear, in case her memory eludes her again, they were at 4 million before the pandemic and the Conservative party—her party, whose manifesto she stood on—did not meet a single target since before 2015. That is important for people to remember: 4 million people were on waiting lists before the pandemic started. The NHS went into crisis under the Conservatives’ leadership. Even if the hon. Member for Isle of Wight East thinks it is tedious to remind them of their record, no member of the public thinks it is tedious; they will never be forgiven for that record.
It is a pleasure to see you in the Chair, Ms Lewell. I will speak first to new clause 84, tabled by the hon. Member for Sleaford and North Hykeham. I reconfirm the Government’s focus on reducing long waits by improving patient flow, increasing productivity and delivering better emergency care for patients. Last night in the Chamber, we had a good discussion about corridor care in particular; all our comments are on the record, so I will not delay the Committee by repeating everything, but I will take some time to answer the questions raised in Committee this morning. We are clear that the Government will end corridor care in this Parliament. It is completely unacceptable. Longer waits for emergency care can be associated with poorer patient outcomes. That is why, through the urgent and emergency care plan in 2025-26, we are investing more than £450 million to expand urgent and emergency care capacity, including new same-day emergency care services, urgent treatment centres, additional mental health crisis provision and nearly 1,000 replacement ambulances. Alongside that, we are implementing new clinical standards and improving patient flow across hospitals, all to reduce the number of patients waiting more than 12 hours.
My hon. Friend has been a strong campaigner. His health community has a lot of problems, as he well knows, but he is always there first, challenging me about the challenges in his healthcare system. He ensures that the people of Ashford are duly represented. He is absolutely right that what will make a difference to patients is improvement on the ground. I do not minimise how far there is to go, but I think patients are already starting to feel that improvement. In the debate last night, we heard about some great work that is happening. We heard from, among others, my hon. Friend the Member for Ashford; from my hon. Friend the Member for Rossendale and Darwen (Andy MacNae), who talked about the challenged system and the challenged hospital in Blackburn, and the real improvements there; from my hon. Friend the Member for Watford (Matt Turmaine); and from my hon. Friend the Member for Bury St Edmunds and Stowmarket, who talked about progress in West Suffolk. That is really encouraging to see. Earlier in the debate, statistics in the public domain were raised by, I think, the hon. Member for North Shropshire and others on deaths due to long waits and so on. That is a completely unacceptable situation, but I want to put it on the record that those statistics are not Government statistics. We had a bit of a debate about that. My hon. Friend the Member for Bury St Edmunds and Stowmarket highlighted how one can attribute cause of death to certain provisions. It is a really important measure. We do not want anyone waiting, full stop, but the statistics are not verified as Government statistics. I want to be clear about that. On new clause 84, I assure the Committee that trusts are already held to account on the number of patients waiting 12 hours from arrival in A&E to admission, discharge or transfer. The medium-term planning framework published in October 2025 sets out the expectation that trusts will reduce the percentage of patients waiting 12 hours or more, year on year until 2028-29, as part of our overall ambitions to return to meeting the NHS constitutional standards. The Government already produce comprehensive data on urgent emergency care performance, including on waiting times and on 12-hour waits. Those data provide transparency, support the oversight of the NHS’s performance and enable independent analysis of patient outcomes. We have been very keen to ensure that those statistics are published. Another issue raised this morning was bed numbers. We had a bit of a historical throwback to the 1990s; I will not detain the Committee further by doing that again. My hon. Friend the Member for Bury St Edmunds and Stowmarket talked about changes in clinical practice, mental health beds and so on. I could talk for many hours about that. As a junior manager coming into the health services, one of my first tasks was to define what a bed is. That is not an easy thing to do. Most people think they know what a bed is but, as we discussed earlier, a trolley without wheels could be a bed. Counting beds and defining what they are and what they are used for is a complicated business in the health service. I know you will tell me not to deviate from the new clause, Ms Lewell, but this is important. Practice changes, and it is important that we make the most effective and efficient use of NHS resources. That means making changes to bed numbers, where they are and how we count them. In June 2026, an average of 13,618 adult patients in acute hospitals per day were waiting for delayed discharge. We have improved data collection, so we have a better sense of the scale of the problem and, crucially, where it is; it is different in different places. We are seeking to improve that data. I gently remind the Committee that the NHS England website produces an awful lot of really good data so that Members of Parliament and our constituents are able to keep track. As my hon. Friend the Member for Bury St Edmunds and Stowmarket made clear, we need to keep up with best clinical practice, as well as the best use of resources. We are very happy to share that information and keep it transparent. New clauses 12 and 56 were tabled by the hon. Member for North Shropshire, who is right to raise the unacceptable waits for care that some patients experience in A&E after the decision has been made to admit them. That includes patients being treated and cared for in corridors at times because of hospitals’ lack of capacity to admit them. As we discussed last night, the Government are clear that corridor care is not an acceptable standard of care and must not be normalised. We inherited an NHS under severe pressure with long waits and increasing numbers of patients receiving care in non-designated clinical areas. It is unacceptable, but I am afraid it was allowed to happen under the Conservatives. We are committed to eradicating corridor care, and we have a plan to do so. To improve transparency, we have already established a clear national definition of corridor care. Again, the Conservatives could have done so in the past 14 years but chose not to. We have introduced daily reporting arrangements and strengthened the data quality processes. We are working hand in hand with stakeholders, including the royal college. In addition, we have published national guidance to support safe care where such situations cannot be avoided. We are working hard to tackle the causes of corridor care; we are not just reporting on the consequences. That is why we want to improve patient flow. We have had good discussions about patient flow, both pre-admission and post-discharge, involving social care and primary and community care to support people who need care homes. We do not want people—particularly frail, elderly people—turning up at hospitals if it is better for them clinically to be treated where they are. We are improving patient flow, strengthening the discharge arrangement and investing £215.5 million in new and expanded urgent care services across England. We are also providing targeted support to the trusts facing the greatest challenges in relation to corridor care so that improvements can be delivered where they are needed most. I gently remind the hon. Member for North Shropshire—and the hon. Member for Sleaford and North Hykeham, as a clinician, will be clear on this information about admissions—that when a patient presents at A&E, a clinician decides whether to admit them to the hospital, provide treatment, transfer their care to another location or discharge them. Under the current reporting rules, the clock starts running on a patient’s arrival in A&E and stops when one of those actions is taken. As a result, no decision is made to admit to A&E itself. Instead, if someone requires admission, it should be to somewhere elsewhere in the hospital. Although I fully recognise the concerns that underpin these new clauses, I do not believe that further statutory requirements are the right approach. In the debate last night, we outlined in full the Government’s absolute commitment to addressing the issues and improving the situation for all our constituents. I hope that I have suitably reassured hon. Members that these new clauses are not required, and that they will not press them.
I am grateful to hon. Members for bringing this discussion to the Committee. The Government are clearly committed to enabling people to live longer. It is one of the successes of recent years that, at the foundation of the health service, the average life expectancy was I think 60 or 62, while, now, it is in the early to mid-80s. That is a massive change in the last 80 years or so. As well as improving the healthy life expectancy of the population, we are determined to address the stark inequalities that blight our nation’s health. We know that the most disadvantaged in society often face the biggest health challenges, and that the current model of care works least well for those who already experience disadvantage, who are also far more likely to have complex needs. In fact, my own entry into working for the NHS, back in the 1990s, was on the back of the 1980 Black report, which some Members might remember well. The then Conservative Government sat on that for ages; it was such an awful reflection on the first 35 years of the health service, that health inequalities had not improved, that they sought not to publish it. That struck me as so shocking that it led me to want to pursue a life doing something about it. I see that in my own constituency, where the legacy of the tobacco industry—which my hon. Friend the Member for Bury St Edmunds and Stowmarket mentioned—has led to a very high prevalence of smoking-related disease. In some parts of my constituency, that is up to 34%.
I thank my hon. Friend for that point about prevalence in the north-east. Often, the prevalence of these diseases is also to do with post-industrial work, which many people had to do without concern or knowledge about the effects on their health. My hon. Friend the Member for Croydon East mentioned practical examples as well: the opening and building of things such as community diagnostic centres in places that are accessible and open to the public, and neighbourhood health. That is entirely the drive that we have: for services where people are, and where the greatest health need is, and not expecting people to travel. In terms of smoking, one of the greatest legacies of the last Labour Government was of course the ban on indoor smoking. My mother was a barmaid for all her adult life; it is hard to imagine that people were just standing there at her place of work, blowing smoke at her while she was working. I tell my children, “Yes, we used to sit on aeroplanes with people smoking,” and that, unbelievably, some people smoked at the back of buses on the way back from school, and so on and so forth. It is really quite shocking. The Tobacco and Vapes Act 2026, which we have also talked about in this Committee, is also a real testament to the work of this House, but didn’t it take a long time, Ms Lewell? I pay tribute to the right hon. Member for Richmond and Northallerton (Rishi Sunak) for pursuing that in the face of great adversity from his own party at the time. That was not, obviously, by the Members present, who all have a high concern about health, but perhaps by others on the Conservative Benches at the time, and then indeed in the Lords, who sought to thwart it—thwart is a strong word in this context; obviously, they made their points, but they sought to stop that Bill making progress at various stages. Some of my colleagues were coming back at different times, saying that they were working on the Tobacco and Vapes Bill, and I said, “What, still? Really? Has it not come through yet?” That showed how hard it is, when something so well evidenced and so supported by public health experts, on something so detrimental to public health—particularly for people living in poorer communities, such as the one I represent in Bristol South—still takes such a time to get through.
Well, I thank the hon. Member for her support. As I said, I did not expect that people here present, who understand the impact of that work, were the ones who were thwarting that. I do not have off the top of my head exactly when the regulations under that Act will come forward, but I am sure we can furnish the hon. Member with details as soon as possible. We all want to see that happening—in particular, the work going on around high streets, such as prevention of fraud by shops for all sorts of things, not just vapes. Obviously, that is high on the agenda, as it is for some of my colleagues as well. Those places and people are blighting our high streets.
I thank my hon. Friend for his expertise and that work on the Home Affairs Committee. Again, it shows the Committee the wide range of work that goes on. Of course, many hon. Members are campaigning and working hard. Those shops are blights on our communities, and as with most illicit drug dealing, they affect the most vulnerable in places where they can pick on the most vulnerable. They are in areas of high deprivation, and that is something we need to stop. I commend all the communities and community leaders that work so hard to stop that happening in their areas. We must address it. Returning to new clause 14, while I fully recognise and share the ambition that sits behind the new clause, introducing a new statutory duty is not the right way to achieve it. A healthy life expectancy is a long-term outcome shaped by a wide range of factors across society and Government, many of which cannot be meaningfully addressed through a rigid statutory timetable. Requiring the Secretary of State to set a statutory target within six months, publish a refreshed cross-Government strategy every two years and make formal statements to Parliament risks creating a process-heavy framework that prioritises reporting over delivery. What matters most is sustained practical action to improve prevention, tackle health inequalities, expand access to care and address those wider determinants of health. That is why the Government have already published our 10-year health plan to improve the nation’s health, of which healthy life expectancy is one measure. That is central to us in bringing forward the 10-year plan. Publishing a new strategy every two years would be duplicative and would not help to deliver the plan that we already have in place. Work is already underway, and I am sure the House will hold us to account for the progress we make, as it rightly should. I believe we share the same aim that the new clause seeks, but we differ on the best means to get there. On new clause 79, I assure the Committee that the Government are already working across Departments to improve health and reduce inequalities, ensuring that action on health is embedded across Government. For example, through the warm homes plan and rented sector reform, we are supporting healthier homes and reducing health harms associated with poor housing. Through the “Keep Britain Working” review, we are addressing the links between work, health and wellbeing. Through the environment improvement plan, we are tackling the health harms of air pollution, and in lifting hundreds of children out of poverty, we will transform their health and life chances. Those endeavours demonstrate that improving health outcomes is already embedded across Government activity and does not depend on the creation of a new statutory committee. While I have considerable sympathy with the aim of the new clause, and I am a strong supporter, as I hope I have assured the Committee, of supporting those wider determinants of health, I am not persuaded that placing detailed internal Government structures into primary legislation is either necessary or desirable. We heard well from my hon. Friend the Member for Lichfield about some of the unintended complications about the new clause. As we have repeatedly said, in the Bill we are not seeking to be unduly prescriptive or create unnecessary bureaucracy that may risk slowing down delivery. Indeed, we are aiming to reduce that bureaucracy. Furthermore, the Government must retain the flexibility to organise in a way that best supports delivery as the context evolves. The Government already bring Departments together to advance shared goals and will continue to strengthen collaboration wherever it is needed. On new clause 80, I am again not convinced that creating a new statutory duty on every Minister is either necessary or the most effective means of achieving the objective of the hon. Member for Winchester. The Secretary of State for Health and Social Care already has a statutory duty to protect public health and powers to take the appropriate steps to improve the health of the people of England. We have already discussed clause 4, which reformulates the Secretary of State’s duty on health inequalities. Those provide a clear statutory framework for improving health and addressing inequalities. Beyond that, the Government do not operate in departmental silos. Ministers consider the implications of decisions and work collectively in the public interest, including on health impacts where relevant, which is particularly important to this Government. The proof is in the action we have started to take across Government to improve health. Although I agree entirely that health should be considered across Government, imposing a broad new legal duty on every Minister would risk creating unnecessary bureaucracy without meaningfully improving outcomes, as my hon. Friend the Member for Lichfield highlighted. Creating new procedure and reporting requirements is not in the spirit of this Bill, which has flexibility and a focus on delivery at its heart. We also heard that from the shadow Minister. Our focus is and must remain on delivering improvements in health outcomes, supporting prevention and tackling the causes of ill health, rather than creating additional statutory red tape. The objective of new clause 80 can be achieved without placing a new statutory requirement on every Minister. The shadow Minister asked me about plans for a modern service framework for MSK, and we currently do not have plans to develop one. The national quality board will assess all proposals for new MSFs against clear criteria, which we have highlighted before, ensuring that we prioritise the area where a framework will have the greatest impact for patients.
There is a long priority list for MSFs that was left by the last Government for different reasons. There are lots of things will bring down MSK waiting lists, such as more diagnostic facilities. As the shadow Minister knows, 80% of people on the waiting list are waiting for diagnostics, which is why we are fast-tracking and pushing more. As my hon. Friend the Member for Croydon East said, community diagnostic centres in places such as Croydon East will get people through for the diagnostics they need. There are also some things that the shadow Minister’s party seems to continue to oppose, such as advice and guidance for GPs so that, if there are alternatives to deal with MSK, of which there is already a lot of evidence, they can refer people to a more appropriate or faster access route in the meantime. Those actions are being taken. She is quite right that orthopaedics is a large part of the waiting list. However, diagnostics, access to faster treatment and using the independent sector where appropriate will particularly target orthopaedic waiting lists as part of our elective reform plan.
The shadow Minister is tempting me to divert away from addressing the main point, but I will take her point on board. I am glad that the Conservatives do not oppose the principle of advice and guidance, because evidence suggests that it is a good route to patients having care closer to home and getting faster treatment. She knows this because it has been clarified, but if there is any doubt: there is no compulsion on GPs to do that. The hon. Member for Winchester talked about his expertise and blowing his own trumpet with regard to antimicrobial resistance. He jests slightly about that expertise, but he raises a really important point about AMR that I am sure we will talk about more when we discuss new clause 32. He is absolutely right that it is an important public health issue that crosses many divides, and I look forward to discussing that later.
I am happy to talk about the impact of trade arrangements on NHS spending and how arrangements are scrutinised by Parliament. I am grateful to the Liberal Democrats for the new clauses. Our relationship with industry, life sciences and the pharmaceutical sector, as my hon. Friend the Member for Bury St Edmunds and Stowmarket said, is crucial not only to our patients and constituents, but to growth in our country. Many hon. Members will have companies large and small in their constituencies—my hon. Friend the Member for Aylesbury has Lynam Pharma in hers. Important local companies are doing great work, innovating and bringing great people together to work on behalf of the life sciences sector and our country. They make us proud to be a leading country in this area, and I give credit to the Prime Minister for his leadership to put this country back in its rightful place on the international stage, addressing yet another part of our international reputation that was trashed by the Conservative party. [Interruption.] You started it. On new clause 15, parliamentary scrutiny is crucial to ensure that trade deals negotiated by this Government are in the best interests of the UK. That is why the Government are committed to transparency and to enabling effective scrutiny of our trade agenda. Nowhere is scrutiny more important than in considering the potential impact of trade agreements on public services such as the NHS. The Government have a clear framework in place for scrutiny of the trade agreements that we have negotiated. This process strikes the right balance between ensuring that appropriate parliamentary accountability can take place and preserving our ability to negotiate agreements effectively. That is important to ensure that the UK can negotiate credibly with its partners and secure in trade deals positive outcomes for the public and British businesses, while upholding and protecting the role of Parliament.
I understand the intent of the hon. Member for North Shropshire and her commitment to parliamentary scrutiny, as well as that of her hon. Friend the Member for Oxford West and Abingdon. I hope that some of my points will address that. New clause 15 duplicates existing processes and creates responsibilities for the Secretary of State for Health that would cut across our important procedures for scrutiny. No trade agreement can, by itself, change UK domestic law or require new public expenditure without the usual domestic processes being followed. Any changes to legislation necessary to implement a trade agreement would be subject to parliamentary scrutiny in the usual way. It is right that the Government be held to account, to ensure that trade deals deliver for the country. However, those processes are already in place and are working.
I am not party to the negotiations. That is above my pay grade, like the conversation yesterday that the hon. Gentleman alluded to. I will get back to him on any outstanding questions, as the Department will to the Select Committee with other details.
My hon. Friend clearly highlights the advantages for his constituents and the importance, particularly for that university and universities across the country, of such outward-facing arrangements, which benefit constituencies in many ways, not only through employment, but through the pharmaceuticals and medical devices, and so on, that help all our constituents. New clause 76 specifically references the trade arrangement between the United States and the United Kingdom. That landmark partnership with the United States Government on pharmaceuticals pricing and tariffs is in the best interest of UK patients, supporting the NHS and the economy. As a result of the changes to the UK’s medicines pricing, NHS patients will get improved access to lifesaving treatments. New medicines have already been recommended under the updated approach, including a brain cancer drug available to patients as young as 12 and a last-resort treatment for a rare, aggressive stomach cancer—something that I think the entire House and the Committee would support.
Again, this is an area of work that my hon. Friend has led on for many years, as I have seen, often when many others have not been around to support it. With so many organisations and charities lobbying on behalf of so many people who are desperate for rare diseases in particular to be highlighted—those diseases that affect a small number of people, many of them children—that work is crucial. Her work in leading in this place is exemplary. That is exactly where we aim to get by working with our partners in difficult circumstances. Trade deals and negotiations are necessarily difficult—otherwise, they would be easy—but the hard work yields results for people. As I have said, this Government have taken an outward approach to working with our partners and with industry. We have already taken steps towards achieving our commitments, most notably increasing the NICE cost-effectiveness threshold. The Government previously updated Parliament in two ministerial statements, and of course MPs quite rightly have the option to continue to table parliamentary questions. Officials should be able to produce confidential advice for Ministers, to inform trade or other negotiations, and we must maintain that confidentiality in this case, as the impact assessment contains commercially sensitive assumptions. It is scenario-based and remains linked to live policy development. On that basis, I ask the hon. Member for Winchester to withdraw the new clause.
Like the hon. Member for Isle of Wight East, I am grateful to the hon. Member for Winchester for bringing this discussion to the Committee. All Members are committed to ensuring that carers receive the care and support they need. The Government recognise that unpaid carers play a vital role in sustaining the health and wellbeing of millions of people across our country. I pay tribute to them, and recognise all the work they have contributed to. I also note the work done by my hon. Friend the Member for Ashford on the APPG with Members from across the House. The hon. Member for Winchester highlighted the shocking impact on the physical and mental health of people who are caring, which we heard about in the evidence session. That is an important issue, and it is good that we can now talk more about the mental health of carers. As he rightly said, many of us are carers. It is not an easy thing to do. I pay tribute to the hon. Member for Isle of Wight East for his comments about the importance of wraparound care to people who do not want to leave the one they care for. I recognise that respite care is important. I wish the hon. Member for Sleaford and North Hykeham good luck in her campaign in her constituency with the Reform council.
When the hon. Lady gets back to her constituency, I am sure she will be campaigning heavily on behalf of her constituents. We acknowledge the need to support carers’ health and wellbeing, but we do not think new clause 16 is necessary, because the existing legal framework already requires the system to support them. The new clause duplicates existing duties and risks adding complexity, rather than improving support in practice. Carers are explicitly referenced in the NHS constitution, which establishes the principles and values of the NHS in England and sets out the aim of improving the health and wellbeing of the population. The Secretary of State for Health, all NHS bodies, private and voluntary sector providers supplying NHS services, and local authorities in the exercise of their public health functions are required by law to take account of the constitution in their decisions and actions. Local authorities and NHS bodies also have a duty of co-operation in respect of their functions relating to carers. Finally, under the Bill, the Secretary of State will take on NHS England’s role in promoting the involvement of each patient in decisions relating to their illness, care or treatment. That duty includes the involvement of carers and representatives.
I was just moving on to talk about some of the work beyond the legislative framework. Beyond the legislative framework, our focus is on delivering practical improvements because, as my hon. Friend says, that is absolutely what people want. We are committed to ensuring that carers have the support they need. Through measures in the 10-year health plan, we are already equipping and supporting carers by making them more visible, empowering their voices in care planning, joining up services and streamlining their care tasks by introducing a new My Carer section on the NHS app. We are also working with Ministers from the Department for Work and Pensions, the Department for Business and Trade and the Department for Education to consider how best to recognise and support unpaid carers. The Government are preparing a cross-Government action plan for unpaid carers, to be published this year.
I thank my hon. Friend. That is indeed one of the ways in which, working through the DWP and across Government, we have sought to bring in, as my hon. Friend the Member for Blaydon and Consett said, practical measures to make carers visible and to support them. That is exactly the sort of thing we wanted to do and have done, and it does start to recognise the work that people do. Let me turn to new clause 17 and new clause 89, which my hon. Friend the Member for Blaydon and Consett talked about and which was tabled by my hon. Friend the Member for Shipley, whose expertise and commitment in this area are well known across the House. The new clauses look at the identification of, and provision of information to, unpaid carers. I agree on the importance of ensuring that carers are properly recorded and identified in the system and provided with relevant information and advice so that they can be better supported and involved in care decisions. However, we do not believe that explicit requirements to identify and record particular patient and carer groups are appropriate for legislation. We have made clear commitments in the NHS 10-year health plan and are taking practical steps to improve identification, support carers and involve them in care planning. If we need to mandate compliance, that is best done by including requirements in national NHS contracts or in statutory guidance or directions, where we can provide more detail and directly address barriers. Information about unpaid carers will be captured systematically to ensure that their responsibilities are recognised and supported, and developments such as the single patient record, which we have discussed in Committee, will make that easier in the future. That is a really important step forward. We are also looking to support general practice in better identifying and recording which of their patients are unpaid carers, to help ensure that those carers can get the support they need in the community. NHS England recently published guidance to support that, and work is ongoing to ensure more consistent coding of unpaid carers by general practitioners.––[Official Report 16 October 2026; c. 8WC.] Correction. We are also working to improve the quality of local authority data on unpaid carers. The Partners in Care and Health programme, launched with the Local Government Association, is working with local authorities to improve their data and address barriers to data sharing between local systems.
I thank my hon. Friend. I heard audible voices of approval for that point. I think that when any of us know or encounter children, whether it be in our own circle or when we visit schools in our constituency, we are very much struck by those who are at school and are themselves caring. I think most schools do a tremendous job where they recognise that. Often children, like adults, do not want to inform their school or local people that that is what they are doing—they are very proud—and perhaps the person they are caring for does not know how to do that. I have certainly seen in my constituency schools starting to recognise and support the needs of those children, in a way that is dignified and respecting of privacy. I did allude to some of the work that we are doing across Government, including with the Department for Education, to recognise, and to find ways to support, those young people, many of whom want to support their loved ones. I think we have all seen great ways to support them. When we are addressing young children in classrooms, I am always conscious of the need to think about the circumstances in which we are talking to them. There are a lot of teenage carers as well. My hon. Friend the Member for Bury St Edmunds and Stowmarket is absolutely right to highlight that. More broadly, apart from data sharing and addressing barriers, the My Carer section of the NHS app will allow people to securely prove that they are providing care. That will streamline the care responsibilities of carers significantly—again, that can be done without having to confront the situation in public, if that is what people want—while giving them a means to seek advice or reassurance directly from a range of professionals when they need it. I am also not convinced that the challenge of providing effective support would be solved by an additional legal duty. The existing legal framework already requires the system to support carers, including through the provision of information and advice. As the Committee has discussed, practical steps are what is needed. Progress is being made locally through issuing practical toolkits to help hospitals implement their legal duties under the Health and Care Act 2022. This year, the Government will also commission the better care fund support programme, led by the Local Government Association, to work with the NHS and social care partners to strengthen their approach to involving unpaid carers in discharge planning. New clause 18 would establish a national respite care scheme. The Government do not feel that that is necessary, as the legal framework already provides rights for carers to access support, including respite services. Under the Care Act 2014, where a carer appears to have support needs, whether those are current or in the future, local authorities are required to carry out a carer’s assessment. Where carers have eligible needs, local authorities have duties and powers to meet them. That establishes a framework where needs assessments and subsequent care planning focuses on the individual and their circumstances, rather than prescribing a particular service or solution. In other words, respite care is already one of the many forms of care and support that might be offered as part of the process, where it is appropriate to meet the needs of the individual carer. Funding and mechanisms are in place to enable local areas to deliver support for carers. Under the better care fund framework, there is £9 billion for integrated care boards and local authorities to make joint plans and to pool budgets to deliver better, joined-up care. In developing their better care fund plans, ICBs and local authorities should consider how pooled funding can help the NHS and local authorities to meet duties on unpaid carers, including around short breaks and respite services. The Government are also making available more than £4.6 billion of additional funding for adult social care in 2028-29, compared with 2025-26, to support the sector to make improvements. Local areas will determine how best to use the money to support carers, depending on local need and with reference to their statutory responsibilities. For those reasons, I ask the hon. Member for Winchester to withdraw new clause 16, and hon. Members not to press new clauses 17, 18 and 89 to a vote.
I am grateful to the hon. Member for Dewsbury and Batley for tabling new clause 25, and grateful to the hon. Member for Sleaford and North Hykeham for her comments on it. It is a genuine pleasure to hear the expertise of clinicians such as her who work in the field of children’s health. She is obviously very passionate about that, and I thank her for bringing her expertise and commitment to looking after children, including critically ill children, to the Committee. I recognise the profound impact that receiving a diagnosis of a life-threatening condition has on a child and their wider family. At such an overwhelming time in their lives, it is vital that families feel supported, informed and able to navigate the care and services available to them. We recognise that families can face huge variation in the support available and that they have to navigate complex systems at a particularly difficult time. I know that many hon. Members support many families in such circumstances in their constituencies. The Government are committed to ensuring that families have access to the support they need in the most straightforward way possible. New clause 25 seeks to place a duty on the Secretary of State to issue guidance to integrated care boards on communications with parents of critically ill children and on parents’ involvement in decision making in respect of the treatment or care of their child. We heard from the Opposition spokesperson about some of the operational issues with some of its provisions, but there are no issues with its intent: of course parents should be involved and have good decision making at such a time. Decisions about the care of a critically ill child can of course be distressing. We need to ensure that we get the process right from the beginning. That starts with good communication, sensitive handling and ensuring best practice across the system. Healthcare professionals should always act in the best interests of their patients; the views of parents are of course very important, but the child’s best interests are paramount, and we should not do anything that undermines that crucial principle. It is important that families and medical professionals communicate and, where possible, reach agreement on the care and treatment that is in the best interests of the child. To support that, there are already many excellent examples of guidance and best practice across the health system. The Royal College of Paediatrics and Child Health is currently updating its framework for clinical practice on navigating decisions to provide, limit or withdraw treatment towards the end of a child’s life. That framework will include communication principles, legal and ethical principles, and clinical and practical considerations, including the role of clinical ethics services. It will also include guidance on navigating disagreements for professionals, children, young people and their families. An e-learning platform is available to staff working at all levels in children’s healthcare. The training programme provides professionals with a suite of resources to enhance knowledge, skills and confidence. It supports healthcare providers to recognise, manage and de-escalate conflict between families and healthcare providers where it occurs, and to signpost to both professional resources and resources for families. The actions I have outlined will continue to help and support the existing best practice.
I am sure that the college will make best use of the hon. Member’s clinical expertise and her expertise as a legislator to get that guidance right. We work with royal colleges to ensure that we get the best clinical evidence into guidelines. I hope the actions I have outlined will continue to help and support the existing best practice, training and guidance on shared decision making and dispute resolution, so that it is embedded across the system. There are a number of other important measures in this group that have not been mentioned. Let me just say that, alongside some of the things I have outlined, we want to progress system-wide reforms to improve the way children and young people, and their families, are supported across many conditions. We are working to bring forward a modern service framework for children and young people that will set out how we will improve quality for children and young people’s services in the longer term, as part of our 10-year health plan.
May I add to the comments of the hon. Member for Farnham and Bordon by paying tribute to the families in my constituency of Bristol South who are also struggling? The care of a child is obviously one of the most difficult and important things that a person can do. When that child is in distress and not supported by the system, it is a very hard place for a parent to be. As I think all hon. Members have said, that is an issue that arises a lot in our inboxes, our emails and our constituency surgeries, and it has been difficult to address. I commend the Education Secretary and her team of Ministers for bringing this work forward and starting to tackle the issue.
I thank my hon. Friend for that. I put on record my thanks—our thanks—to his wife for her work in this area and for making him so aware of the issues, because he is absolutely right. This is a long-in-gestation issue that some of us have watched sadly get worse in our constituencies over recent years. Children only get one chance to come through this system, which is why people feel so passionately about it.
I thank my hon. Friend for his description of what has happened in Kent, which has been under Conservative administration for so long. He is absolutely right about the White Paper. The hard work that my right hon. Friend the Secretary of State and the ministerial team have done across the country, regardless of the local political administration, is exemplary. I will come on to talk about the tribunals. The Government’s SEND reforms aim to transform outcomes for children and young people with SEND and their families, ensuring that the right support is available at the right time and preventing needs from escalating or reaching crisis in the first place. That is why the reforms aim to build a system that parents can trust with collective responsibility in local areas and strong partnership working across education, health and care. That is what parents expect us to be doing.
I thank my hon. Friend for going to hear directly from her constituents. She is right: that message is fairly consistent. Last year, my hon. Friend the Member for Bristol East (Kerry McCarthy), my right hon. Friend the Member for Bristol North West (Darren Jones) and I played a pivotal role in bringing our ICB and local authorities together as local Members of Parliament. That was a result of our experience with parents and constituents. Members of Parliament from across the House—this is not a party political point—can bring parents together to highlight this issue and use parliamentary power to bring together organisations that sometimes do not listen or know the best way to communicate. Our role in that has been pivotal. The Secretary of State for Education has taken that learning forward across the country. That is why we are taking the steps to deliver the programme. ICBs have been asked to work with local authorities to develop local SEND reform plans. Those plans will lay the foundation for long-term reform, enabling ongoing monitoring of progress, and draw on knowledge, skills and lived experience held locally. That builds on work that is under way to improve accountability and set expectations of joint working, which is what parents and families expected to happen, but was not happening. Each ICB is expected to have an executive lead on SEND. The NHS medium-term planning framework for the next three years made it clear that ICBs and providers must meet their statutory duties and support delivery of the reforms. Ofsted and the Care Quality Commission will continue to check how local services, including health, work together for children and young people and hold them accountable. We will also update the SEND code of practice and publish new guidance so that local SEND partnerships have clearer expectations to work to. That is why we have not proposed changes to health and social care appeals to the SEND tribunal or made the decisions binding. This reflects the need for ICBs and NHS providers to retain the flexibility to plan services across their wider populations and prioritise support according to clinical and population need. This aligns with our commitment in the 10-year health plan to create a new NHS operating model where ICBs are the strategic commissioners of local healthcare services. It is worth noting that while tribunal decisions on health and care are non-binding, local authorities and ICBs are expected to follow them, and in most cases do. If they do not follow recommendations, they must send a response setting out the next steps they have decided to take and why. There is no doubt that health and social care have crucial roles in SEND reforms, with shared ambitions across education, health and care for earlier intervention and support. I reassure the Committee that we are exploring further opportunities to strengthen accountability, as stated in the SEND consultation document. We are considering responses to the consultation, which closed on 18 May, and will set out our next steps in due course. For those reasons, I ask the hon. Member for Winchester to withdraw the new clause.