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Showing every spoken contribution, including 12,942 under 12 words. Hide short remarks
T3. Will the Chancellor explain why she is now clawing back VAT on the compassionate medicines scheme, which means that this Labour Government are taxing free cancer drugs given to children? Will she reverse that decision? Patients are starting to miss out on the treatments they really need.
Shameful!
The challenge we have at the minute is that not only do we have a shadow Opposition, but we have a shadow Government—a whole set of Ministers who will soon be in place. We have someone who is potentially about to become Prime Minister, but we know almost absolutely nothing about his priorities on defence, on the strategic challenges or on welfare. Does it concern my hon. Friend that we are going to get somebody new, when we know very little about his position on these incredibly important issues?
It is a pleasure to speak to clause 4 and this group of amendments. Health inequalities are commonly defined as the systemic differences in health status and distribution of health resources between different population groups. There are limits to how far the state can equalise health in a free society, but I am sure all Members would agree that the service should not preside over differences in access to health resources. Unequal access runs contrary to the vision of the NHS as a comprehensive service, available to all and based on clinical need, not ability to pay. Those principles are violated when people without fixed addresses struggle to access general practice, or patients in rural areas, such as my constituency, miss out on treatments—for example, specialist cancer treatments—that are available in more urban areas. The Health and Social Care Act 2012 inserted section 1C in the National Health Service Act 2006, placing a duty on the Secretary of State to consider the need to reduce inequalities in the benefits that people obtain from the health service. As the explanatory notes to the 2012 Act made clear, the intention of that was to “include consideration of the need to reduce inequalities in access...and the outcomes”. Clause 4 of this Bill takes that which was understood and makes it more explicit. The Minister will be pleased to hear that I support updating that duty—she is smiling. The word “benefits” in the original section is a nebulous and subjective term. The wording introduced by the clause is less imprecise and requires the Secretary of State to consider the whole health pipeline. None the less, I have some questions about the lens that clause 4 and its predecessor, section 1C of the 2006 Act, invite the Secretary of State to look through, particularly in relation to other statements made by the Government. In the Government’s policy paper “ICBs as strategic commissioners”, they say that increasing the commissioning responsibilities of integrated care boards will result in them being “better placed to support innovation” and “design new models of care”. Innovation can produce disparities; that is true in healthcare as well. If one ICB decides to innovate and produces a better service, that area will have a better service than another, and the Secretary of State will have the job of undoing that. That could be done by spreading the innovation across the whole of the country, but if the innovation is expensive or difficult to roll out, it could in effect be quashed. Does the Minister recognise that empowering health leaders to innovate and do things differently could widen inequalities, at least in the short term? Is she willing to accept that? A problem with using inequalities as a stand-alone metric is that it does not really tell you whether things are getting better or worse; it must be taken into consideration alongside a wide range of other metrics. An often forgotten fact is that disparities can be reduced by levelling down as well as by levelling up. Fixating on determining the size and cause of disparities can, in some cases, come at the expense of eliminating them. I recently tabled a written question to ask the Government if and when they plan to “set an explicit target to close the Black and Asian maternal mortality gap.” I note that the Minister stood on a manifesto pledge to close that gap. The Government response to my question indicated that they are waiting for Baroness Amos to finish looking at the drivers of inequalities before they do anything. It is possible to produce tomes on the nature of disparities; I suggest that energy would be better spent on addressing them. Amendment 13 would require the Secretary of State to consider health inequalities arising from differences in general health determinants. I understand the sentiment behind the amendment, as statistically, those with lower earning capacity, limited access to green space or unhealthy lifestyles have comparatively worse health outcomes, but would placing a duty to take stock of that on the Secretary of State make the health service any better for such groups, or for the population as a whole? What would be the practical purpose of the amendment? As somebody said to me yesterday evening, do we have a section in education legislation stating that the Education Secretary has to consider that their job is to ensure that people are educated? Do we have clauses in defence Bills saying that the Defence Secretary must consider the defence of the realm? I cannot be sure, but the amendment seems to be a statement of the blindingly obvious, so what effect would it have? Does the Member who tabled the amendment think that the Secretary of State will not consider those factors—essentially, that he will not do his job properly? Do they not have confidence in him or in future Secretaries of State? Under the amendment, the Secretary of State would need to consider inequalities arising from people’s employment, environmental conditions and lifestyle choices, which his Department has little to no control over. If poverty is the problem, the solution is employment and welfare policy, which is not in his gift. If poor environment is the problem, the solution is environmental policy. If a well-informed adult chooses, despite knowing the detriment it may cause them, to consume unhealthy food or an excessive volume of alcohol, or not to exercise, what can and should the Minister do about it in a free society? Amendment 13 would risk distracting from the focus of clause 4, which is, as I see it, to ensure equal access to health resources regardless of a person’s standing in society. What is the practical effect of making it a duty on the Minister to do these things? Will it cause a whole load of bureaucracy? Will the Minister have to produce impact statements for every new hospital? If, for example, one opened on the Isle of Wight—my hon. Friend the Member for Isle of Wight East was talking about that—would we need to consider what effect it would have on smokers, people who do not exercise or people who have a lower earning capacity, and produce an endless list of assessments? It would take a lot of money and effort and not really add anything. The amendment would also risk the Government getting bogged down in litigation, as people who disagreed with the Government’s or the ICB’s decision would spend their time litigating the question whether something that may or may not even be relevant was considered properly. Members will not be surprised to hear that my thoughts on amendment 29 are similar to those on amendment 13. I do not doubt for a minute that its supporters have the best intentions, but this type of public sector equality duty language does not do anything to improve public services. Too many arms of the state have been so concerned with disparities that they have become incompetent at getting on with the job that they are actually meant to be doing; they are distracted by trying to measure all these different equalities. Amendment 30 would require the Secretary of State to involve all Departments in reducing health inequalities and take all reasonable steps to ensure that all other Departments “consider the impact of their policy proposals on health inequalities.” Is this spreading the bureaucracy and the impact assessments more widely? If the Government decide to buy a new submarine, do they have to consider what effect it would have on people who smoke on the Isle of Wight? It does not make sense to me. It is a statement of the obvious that members of the Cabinet and Government have to work together to deliver better health for the country. Of course that is true, but what would be the practical effect? The Minister may be able to tell us. New clause 19 would require the Secretary of State to publish a health improvement and health inequalities strategy within six months, and an annual report thereafter. Again, that would invite more glossy brochures from the Government, using the precious time of civil servants. The new clause seeks a cross-Government approach by mandating that all Ministers of the Crown must have regard to the strategy when carrying out their functions. Again, it is basically stating what their job is.
I agree. The amendments include, in many cases, a statement of what someone’s job is. Does the Member who tabled them think that the Secretary of State is not doing his job and therefore needs to be told what his job is? That could create a whole load of bureaucracy detracting from the actual job in hand. Amendment 34 concerns transport access. I understand that that is a problem for many people in rural areas, such as my constituency. They often have a harder time, as the distance they need to travel is longer and public transport services are infrequent. Healthwatch, which will be cancelled by this Bill if the Government get their way, has heard from patients who struggle to book transport online, and whose transport turned up several hours early or was cancelled with little or notice at all. Those problems are well documented. I visited Lincoln county hospital, which has a unit for renal dialysis, where I heard that although transport is provided for individuals having dialysis, which is good, it often does not turn up when it should or does not pick people up at the time that it is supposed to. More concerning is the fact that if they need a transplant and transplant assessments, most have to go to Leicester to have that done, which is several hours’ drive from some parts of Lincolnshire. Most disturbingly, I heard concerns that some people would choose not to go through the transplant programme, and a factor in that decision would be the ability to get to the transplant centre to have the significant amount of testing and follow-up that needs to be done. Clearly, that is not equal access, so I urge the Minister to look at that. Imposing a duty on the Secretary of State to consider reducing inequalities is a good thing, but it does not magic up the resources necessary to fix them. In exercising his functions, it is a problem the Secretary of State is already capable of addressing. I am sure the Secretary of State, like the Minister, is a good person and wants people to be able to access the services. If Members believe the Government are failing in that regard, I would advise that adding another legislative duty is not likely to bring about the change desired. If we are being honest with the public, we must challenge the premise that every disparity is evidence of a policy failure. The duty placed on the Secretary of State should be to ensure that care is of an equally high standard across the board.
I beg to move amendment 59, in clause 5, page 4, leave out lines 2 to 4 and insert— “(1) In exercising functions in relation to the health service, the Secretary of State must act with a view to enabling patients to make choices with respect to aspects of health services provided to them, including to make choices as to the provider of those services. (2) For the purposes of subsection (1), the Secretary of State must ensure that patients who are referred for a service to be provided outside a hospital setting (‘out-of-hospital services’) are offered a choice of provider of that service from among the providers available in their integrated care board area and, where relevant, in neighbouring areas, in accordance with regulations made under section 14Z45B. (3) Regulations under section 14Z45B must provide that, where an out-of-hospital service is to be provided to a patient, the integrated care board must— (a) offer the patient a meaningful choice of at least two providers capable of providing the service, which may include NHS bodies and independent sector providers approved to provide that service under arrangements with the integrated care board; (b) provide the patient with information to support an informed choice, including for each available provider— (i) indicative waiting times; (ii) the location at which the service would be provided; (iii) the quality ratings or outcomes data applicable to that provider for that service where such data is available; and (iv) whether any costs would be incurred by the patient in travelling to or receiving the service at that provider; (c) not exclude from the list of available providers any provider approved solely on grounds of commercial interest or organisational type; and (d) take all reasonable steps to give effect to the patient's choice within a clinically appropriate timeframe. (4) For the purposes of this section, ‘out-of-hospital services’ means services— (a) provided in community, primary care or ambulatory settings rather than in a hospital inpatient or outpatient department; and (b) which the Secretary of State specifies by regulations as being within the scope of the choice obligation under subsection (2), and may include diagnostic services, audiology and hearing aid care, podiatry, dietetics and nutrition, physiotherapy, ambulatory cardiac monitoring and such other services as the Secretary of State may specify. (5) In specifying services under subsection (4)(b), the Secretary of State must have regard to— (a) the potential for the expansion of choice to reduce waiting times for the relevant service; (b) the availability of sufficient independent and NHS providers to make genuine choice meaningful; and (c) the desirability of ensuring access to choice for patients in all parts of England, including in rural and deprived areas. (6) The Secretary of State must publish, and lay before Parliament, within 12 months of the date on which this Act is passed, a statement setting out— (a) the out-of-hospital services for which choice obligations under subsection (2) will initially apply; (b) the timetable for extending the choice obligation to further services; and (c) the support that will be made available to patients, in particular those with limited digital access or literacy, to exercise the choices to which they are entitled under this section. (7) The Secretary of State must review and update the statement required by subsection (6) at intervals of not more than two years.” This amendment strengthens the new patient choice duty inserted by Clause 5 from a general aspiration into a specific, enforceable right to choose between providers for out-of-hospital services.
This group is about how patients can exercise choice. When the national health service was founded in 1948, patients could select their own GP, but it was difficult to change things and exercise choice elsewhere in the system. The health service has come a long way since then. Successive Governments believed that they could make state institutions more responsive by treating the public, to some extent, like customers. Today, patients can choose their GP, hospital, consultant and different types of end-of-life care and mental health service, but choice is about more than just selecting among providers.
When I met surgeons, they said that one reason they like working in elective independent sector hospitals is that they can do more operations on a given day. The shadow Secretary of State visited a provider of cataract treatment yesterday. It is able to perform more treatments on a given day, partly for organisational reasons. The NHS, which is quite frustrating for surgeons, could learn from that. Does my hon. Friend agree?
I beg to move amendment 58, clause 6, page 4, line 10, leave out from “promote” to end of line 11 and insert— “(a) innovation in the provision of health services and in the arrangements made for their provision; (b) take steps to ensure the timely adoption and spread of clinically effective innovations across the health service in England; (c) identify and seek to remove barriers to the uptake of innovation by NHS bodies, including procurement barriers, regulatory barriers and cultural barriers to change; (d) promote access to innovation so that patients in all parts of England, and patients from all socioeconomic backgrounds, have equivalent access to effective new technologies, medicines and care models; and (e) have regard to the economic and industrial benefits to the United Kingdom of developing and deploying healthcare innovation in the NHS.” This amendment would further define the meaning of promoting innovation in health services in England.
In healthcare, as in many parts of life, innovation is the way in which new ideas, products and services are developed to solve problems and improve patient outcomes. Here, the entire country has a record to be proud of that goes back a long time. Dr John Preece, a GP and research fellow at the University of Exeter, was the first general practitioner to use a computer in a patient consultation. He co-designed a model with IBM in 1969, and his work led to the creation of the electronic patient record, the forerunner of the electronic patient record that we will discuss later. Innovators working with NHS England have also been seeking to reduce single-use plastic in gastrointestinal procedures, improving outcomes for haemodialysis patients, as well as improving the environment.
The hon. Gentleman is right, but there are pressures and challenges for clinical academics, which he will be aware of. I am sure the Minister, in summing up, will tell us what she is doing about those. We need to support innovation in all parts of the health service, not just in university hospitals. One of my concerns is that there has been a drive towards a hub and spoke model. There are good reasons for that, and there have been some good outcomes for patient care, but in some cases it restricts innovation in the peripheral parts of the model; it can disincentivise innovation and make it more difficult. We need to consider how we support innovation in all areas of the NHS.
The hon. Lady is absolutely right. When I was a very junior doctor, whether one wanted to work in a small hospital in the countryside or a large teaching hospital in a big city mostly related to whether one wanted to study a specialist, narrow field of medicine or a wider, broader field of medicine with a variety of different conditions. During my career, I have seen consultants make choices that meant they had to move from their district general hospital to a teaching hospital in order to make progress—in one case, a consultant was told he would not get a professorship unless he moved. The hon. Lady is right: we need to carefully consider how we support innovation. I have concerns with the clause as it is drafted. Section 13K of the NHS Act 2006 gave NHS England the power to award prizes in support of innovation. Clause 6 ensures the Secretary of State has that power, but there is a big difference between an arm’s length body of technocrats awarding prizes and a political office holder awarding prizes, because then the prizes come out of taxpayers’ money and Governments are particularly short of that—not because they are not taking higher rates of tax, but because they are squeezing the economy. There is a risk that those awards, and funding for innovation more broadly, become exposed to political cycles. When Governments face a fiscal straitjacket, Ministers are often quick to slash discretionary spending, even though it provides a long-term return on investment. There is also a risk that prizes will be awarded on the basis of who shouts loudest. Certain charities will want the Government to focus on awarding innovations in cancer care, for example; some unions will want the Government to focus on awarding innovators who achieve greater equity in service delivery. There is little doubt that Ministers will have a tough time batting away lobbyists calling for more funding to incentivise this or that type of innovation. Clause 6 also gives the Secretary of State the power to set up a committee to provide advice on awarding prizes. It is right that the Health Secretary should solicit expert advice when determining which trusts, teams or individuals deserve incentive payments, but does that require the power to set up what is effectively a whole new quango? The Government created more than 25 arm’s length bodies and advisory councils in their first six months. Does the Secretary of State require the power to pay members of the advisory committee when there are many experts in their field who can give their time charitably? I notice there is no requirement for any prize committee to include the chief scientific officer or representatives from ICBs. It is ultimately an unchecked spending power.
My hon. Friend, as ever, puts things very succinctly. Much of what is said about the Bill is different from what it seems to mean in practice. We have heard the Government talk about the decentralisation of power so decisions are made locally, but in the oral evidence session, even the union rep said that the Bill is more of a centralisation of power. I agree that creating new bureaucracy to replace old bureaucracy—particularly if that involves redundancies—does not help to save money or to make the system more efficient. I tabled amendment 58 to make the duty on innovation more robust. It would make clause 6 specifically require the Secretary of State to promote innovation in the provision of services, ensure that innovations are spread and adopted across the NHS, tackle barriers to innovation and consider the wider economic benefits of innovation. That is important, because when we talk to people in the life sciences industry, they tell us that one of the biggest challenges is the roll-out of innovation. They can develop innovations in the UK, but it can take a long time to get them on to the shop floor, which is a disincentive to innovating in the United Kingdom. That process needs to move more quickly. As currently drafted, the clause does not make it clear what innovation is for or whom it is meant to benefit. Amendment 58 would make it clear that innovation should be to benefit patients, no matter their location or socioeconomic status. I welcome the principle of keeping innovation on the statute book, but innovation is an organic process, and it does not begin in the Department of Health and Social Care or in NHS England—that is a fundamental principle that I think the Government fail to understand across many areas. Innovation begins with the frontline workers: the scientists, the technologists and the people who have ideas about better ways to care for patients. I am encouraged that the Minister understands that. The Government’s vision for ICBs is that they will have more responsibility and more freedom to innovate—although we will discuss whether the legislation actually delivers that later in the Committee’s consideration—and I hope that vision extends to other areas of health policy. The clause is not disagreeable, but it must be made more robust. If Committee members agree, I hope they will support amendment 58.
My hon. Friend is describing something a little like “Dragons’ Den”, which is a very good TV programme—perhaps it will be televised or livestreamed. How will the Government ensure that there is no conflict of interest?
The Minister talked about the flexibility of the committee, and my hon. Friend the Member for Farnham and Bordon explained why it is helpful to have some direction. Could the Minister explain why there is no stipulation for the chief medical officer or the chief scientific officer to be part of the committee?
I declare an interest as a member of the NHS workforce and an NHS consultant paediatrician. In England, around one in every 17 working people is employed by the national health service. That is quite a shocking statistic. It is the largest employer in the country and, indeed, in Europe. It has grown significantly over time, in part because the needs of the population have changed. Life expectancy is longer, which is something to be cherished—that is a good thing—but it brings challenges to the health service, as people are more likely to be living with multiple chronic conditions rather than easily treatable ailments. They require more tests, medicines and clinical care. Demographic change requires a larger NHS workforce, particularly in secondary care. The previous Conservative Government not only recognised the scale of that challenge but took swift action to increase staffing levels across the board, adding more than 42,000 doctors and 55,000 nurses, health visitors and midwives. Conservative Ministers also supported the pipeline responsible for producing the next generation of medical practitioners. They funded 1,500 additional medical school places and opened five new medical schools, including in Sunderland, Lancashire, Chelmsford and Canterbury, and one just outside my constituency in Lincoln. Emergency care became the fastest-growing specialty, with the number of emergency care doctors doubling. That is what support for the NHS workforce looks like. Conservative investments in the workforce helped to improve survival rates for cancer, increase the number of GP appointments and deliver the fastest vaccine roll-out in Europe. Under existing legislation, the Secretary of State has a responsibility to ensure that there is an effective system for planning and delivering education and training to current and potential staff. Health Education England has been rolled into NHS England, so it is ultimately NHS England that has the duty to ensure sufficient and appropriately trained staff to meet NHS workforce needs. Now that NHS England is to be abolished, it is right that this duty is to be given to the Secretary of State through clause 7, although to some extent it is a statement of the obvious that that is part of his job. The job of members of this Committee is to improve the Bill, not just wave it through, and that means recognising that the existing legislation had some inadequacies. Clause 7 states: “The Secretary of State must exercise functions…with a view to ensuring” several things about the workforce. It is not a cast-iron requirement; the Secretary of State must just think about it, but actually he should not just think about his job; he should get on with it. I have a bit of a bee in my bonnet about legislation that creates obligations that are easy to proclaim and that are virtuous but are difficult to measure. Such legislation makes legislators feel good about themselves because they are writing nice things into legislation, but they are not really robust. What does “sufficient people with appropriate education” mean? What is “sufficient”? One reason concerns are particularly acute is the Government’s shambolic record on workforce planning. They came to power saying that they had a plan, but their workforce plan has still not been published, almost two years since they came into office. I heard the Minister say “imminently”, but I had a written answer last week, I think, saying “imminently”. I appreciate that “imminently” is probably better than “soon”, but what does it really mean, and how soon can we expect the plan to be published? Does she mean that it is coming this week or next? Can she guarantee that it will be published before the summer recess? Has the Prime Minister’s resignation yesterday put all this up in the air once again? The Royal College of Radiologists has said that the shortfall in clinical radiologists has grown from 29% to 32% since 2024, and the Royal College of Nursing has released data showing that the growth in the nursing workforce slowed last year to its lowest level in eight years. Newly qualified midwives are finding themselves with no jobs to go to in the health service, despite the fact that there is a maternity staffing crisis in some areas. Will the Minister explain the reason for the delay? She said earlier in this sitting that it was not NHS England, but what is causing the delay? We were told that stakeholders wanted more time to have conversations, test ideas and work together. One would think that after the many months of deliberation, Ministers would have put together an exceptional workforce plan, but the Royal College of Nursing, the British Medical Association, of which I am a member, Unite the union and several other organisations wrote to the Health Secretary earlier this month to urge for the plan, which they have but which has not been published, to be “paused”, because they are “concerned that the current direction falls significantly short of the scale of workforce growth required to meet patient need and relies too heavily on assumptions about the current state of NHS services, productivity and technology that are not borne out of frontline experience.” I recently tabled a question asking who had been given advanced sight of the workforce plan, and I received confirmation that the royal colleges and unions have been involved. As I mentioned, I am a member of the Royal College of Paediatrics and Child Health. We now have a situation where a workforce plan is being delayed, and it has been brought before other organisations for discussion rather than elected Members of this House. It is taking far too long. In the meantime, things are going backwards. It is simply not good enough. Ministers are now about to roll out a plan that has mortified seemingly everyone who has seen it, while expecting members of the Committee to rubber-stamp a rather flimsy legal duty. In May, the Financial Times reported that plans drawn up under this Government would see recruitment cut back. The article reads: “A workforce plan being finalised by health officials says the NHS in England will have to use technology to get by with hundreds of thousands fewer staff than envisaged under the previous Conservative government.” Is that clinical staff? Are we going to have fewer doctors? It is not clear because we have not seen the plan and it has not been published. A draft of the plan seen by the newspaper said that the NHS “does not need anything like the…numbers…set out in its 2023 workforce plan.’ Will the Minister confirm whether those press reports are accurate? She previously said that her plan “will ensure that the NHS has the right people in the right places with the right skills for patients when they need them”.—[Official Report, 13 January 2026; Vol. 778, c. 737-738.] Does that mean fewer people and more AI?
Before the lunch break I was saying that, in essence, clause 7 states what the Secretary of State’s job is. It moves the function of planning the workforce from NHS England to the Secretary of State, which is a reasonable thing to do. I talked about the previous Government’s record on opening new medical schools and how that has helped with the number of clinical staff. We also talked about workforce planning. The Government are due to produce a workforce plan, but it is not clear when it is due to come out. It was due to come out at the end of last year, but it did not; it was then due to come out in the spring, but now it is the summer. Given the Prime Minister’s resignation, it is not at all clear when it will come out. Will the Minister let us know whether it will come out before the summer recess, this week or whenever? I quoted some of the concerns of the Royal College of Nursing, the British Medical Association, of which I am a member, and others. Those concerns include the workforce plan. Those organisations have seen what we have not seen, so they have been asked to comment on something that we have yet to see. That brings me to new clause 44, which is in my name. Before the general election, Labour promised that it would double the number of medical school places. The now Chancellor of the Exchequer promised to double the number of medical school training places, as did the now Secretary of State for Science, Innovation and Technology. Once the general election had passed and Labour was in government, the promise was reiterated. At oral questions in October 2024, the now former Health Secretary said: “This Government are committed, as we were in opposition, to doubling the number of medical school places”.—[Official Report, 15 October 2024; Vol. 754, c. 683.]— but there has not really been any progress. During a debate this year on the junior doctors’ foundation programme, I asked the Minister for Care whether the Government’s intention was still to honour that pledge. He said: “Yes, that is the Government’s intention.”—[Official Report, 22 April 2026; Vol. 784, c. 133WH.]— only to later submit a written correction stating that the Government had never committed to doing so. Are they going to, or not? It is not clear. Labour promised to double the number of medical school places, but now that pledge appears to have been airbrushed out of history. Can the Minister please explain why she and her colleagues deemed the workforce pledge essential before the election but not after it? Can she tell us whether it is Government policy? In essence, my new clause 44 asks Members on the Government Benches to vote for what they promised before the election and have promised since. New clause 44 is very simple: it stipulates that the Secretary of State must double the number of medical school training places by 2031-32. That is what Labour promised, so it should be fairly easy for Labour Members to vote for it. I hope that the Committee will support the new clause, which only requires Ministers to do what their party promised before it came into government. If the Government are not keen on committing to clear targets, they can at least commit to full scrutiny of their workforce plans. Of course, there is a risk that the House has been misled. Either the promise was made or it was not. The Minister for Care said that it was promised and then submitted a written correction to say that that was inaccurate and that it was never Government policy, but if it has been stated by the Secretary of State at the Dispatch Box, representing the Government, then it is Government policy. Can the Minister help to clarify that point? If the House has been misled by either her former boss or the Minister for Care, perhaps she can clear that up for us. Perhaps the vote will help.
The hon. Gentleman is right. When all the new doctors that the Government have promised have been trained, they will need jobs and postgraduate medical training, and there are issues with that. Nevertheless, the Government asked the public to vote for them on the basis that they would double the number of medical school places. Many of the hon. Gentleman’s colleagues produced little videos to that effect, which can be viewed on Twitter. They toured the newsrooms saying, “Please vote for us, we’re going to double the number of medical school places.” They suggested that there would be a revolution in Government to make sure that there were enough doctors. This is important—more doctors would help. All new clause 44 does is ask the Government to commit to doing what they have said that they will do—or to say that they will not. Either way, we have had the Secretary of State saying one thing and a Minister saying the opposite and then correcting it, so we need clarity. The public deserve that. The Minister herself said that they would double the number of medical school places so that we have the doctors that our NHS needs. If they do not double the number of medical school places, it follows that they will not have the number of doctors that the NHS needs. Presumably that is in their workforce plan, but it needs to be cleared up. Amendment 50 would put a duty on the Secretary of State to publish independently audited forecasts of the NHS workforce every five years. The logic is straightforward: if the Government believe that their plans are sufficient, they can be compared to an impartial assessment of the workforce. The previous Government published a workforce plan in 2023, setting out how to tackle existing and future workforce challenges over several years. That included doubling the number of medical school places. Yet three years later, this Government are on course for a new plan that is reportedly far less ambitious—we will find out in a minute. The workforce affects whether patients can be seen on time, maternity wards are safely staffed and elderly patients get the dignity they deserve. It is the difference between the NHS meeting the challenge of an ageing population or slipping into decline. If Labour Members are confident that the Minister’s workforce planning is robust, I expect that they will support my amendment, which requires an independently audited forecast. If they are not willing to support it, that suggests that they know this Government cannot be trusted to deliver the workforce that patients need. Amendment 54 and new clause 45 were also tabled in my name. Amendment 54 would require the Secretary of State to look at the amount of clinical work that NHS managers undertake. As a clinician, I have increasingly noticed that highly qualified clinical practitioners come in, become the person on the ward who can be relied on, and then go off because they get promoted to a nine-to-five job that is easier and pays more, but does not deliver clinical care. The chief medical officer, for example, still delivers clinical care, and the amendment probes the Government to consider how many nurses and clinicians in hospitals are delivering clinical care. I asked that in written questions, and the Government did not know the answer. It is materially important information, particularly when looking at the Dash report, which talks about an explosion in the number of people who are clinically trained but not providing clinical work—instead, they are creating guidelines and monitoring whether other clinicians are doing the work. If more of those people were engaged in clinical activity, that might improve the quality of both the guidelines and care, because more junior staff would have senior staff around to help them.
I am talking predominantly about clinicians working in trusts who are trained and very experienced, but then move to work in the same trust but in a more managerial role that does not involve clinical care. I am not saying that every single person needs to be delivering clinical care—there may be exceptions, of course; people do have career changes—but I encourage the Government to reflect on the number of posts being created that take people away from the clinical arena, and on the effect that that has. When the Minister is presented with the number of nursing or midwifery-qualified staff working in a particular department, that may not reflect the number who are delivering clinical care and, by their own admission, the Government do not know which is which. Amendment 33 would place a duty on the Secretary of State to ensure that the workforce is trained on the wider determinants of health, such as housing standards, air pollution and the use of harmful substances. In my many years as a paediatrician, I have yet to meet a nurse, doctor, surgeon, porter or care co-ordinator who does not know that damp and mould are bad for people’s health, and I have yet to meet a fellow employee who does not know that air pollution causes asthma, or that tobacco use increases the risk of chronic obstructive pulmonary disease, cancer and a whole host of other ailments. Considering the many pressures on NHS workers, I do not believe that mandating a new programme on health determinants is a good use of time. I fear that it is rooted in the agenda of creating more and more mandatory training, and I would actually encourage the Minister to look at rationalising mandatory training to that which is absolutely necessary. Control of the curriculum for such staff is dealt with separately, so I object to amendment 33.
Clause 8 is essentially about the control that the Secretary of State has over ICBs. When we discussed the clause abolishing NHS England, we talked a lot about the balance between democratic accountability on the one hand and independence from political interference on the other. The Government suggest that the Bill is a decentralising Bill. What this clause does is essentially to recentralise by default. As the Minister has just said, the Secretary of State can change what the ICB is doing if they think that it is inappropriate. What does “inappropriate” mean exactly, and how will that power be used? It may be used very infrequently—perhaps the current and previous Secretaries of State think that the power would be used infrequently—but equally it could be used in response to considerable pressure from MPs, lobbyists and campaign groups. Instead of issuing directions sparingly, we may end up in a position where the Secretary of State is issuing day-to-day instructions. The Government want ICBs to take greater responsibility for commissioning decisions, but then they want to be able to undermine them by direction from the Health Secretary. The Health Secretary will never have as good a grasp of the situation in the local geographic area as local leaders, but he has the power to tell them what to do and issue blanket instructions with different characteristics. That will be inherently inefficient. ICB leaders will be under pressure, knowing that if they make a particular decision they can be removed or be told to do something different. They have the job and they have the power, but they haven’t really—all at the same time. There is also the plan, as the Minister outlined, to make directions something that the Government publish. The clause says that directions must be published by the Secretary of State, but only “as soon as reasonably practicable”. The intention behind requiring the prompt publication of directions is to reduce the surface area for back-room pressures, but the lack of a clear timeframe makes it rather a weak measure. We currently have a Government who seem open to greater use of the private sector, whether in financing projects or in delivering out-patient care. Well, our Prime Minister resigned yesterday, and there is no guarantee that the Government of the right hon. Member for Makerfield (Andy Burnham) will take the same approach. Will the Minister confirm whether the powers in clause 8 could be used by a Health Secretary to instruct ICBs to stop using a specific type of provider? I would not dispute the idea that the Secretary of State needs to be able to exercise some control over the health service now that NHS England is being abolished, but the clause seems contrary to the Government’s stated vision for health management. I am not sure whether it is in the best interests of patients.
The Minister is talking about flexibility. I understand that if a Minister is responding to an unforeseen circumstance, he or she may be very busy, but where a direction has been made, it should not take very long for a member of staff to publish it, because it will already have been written and sent. I understand that a Minister might take a day or so to sign it off because they are so busy, but it should not take months. The addition of a deadline is therefore not an unreasonable request.
Will the Minister give way on that point?
In a system as large as the NHS, covering an area as diverse as England, it is necessary that the Government be able to deal with unexpected situations. The pandemic may be half a decade behind us already, but the Committee will remember that the previous Government had to act quickly and part with a lot of money in a short time. In such instances, it is essential that Ministers have the power to provide financial assistance. It is not only about crises, however; ordinarily, there are occasions when a Government will want to roll out a new prevention programme or address deficiencies in care in particular areas. I know that health policy is always evolving, and the case for flexibility is clear. The Health Secretary may need to be able to provide financial assistance in pursuit of supporting the health service. I am sure that hon. Members are familiar with the existing legislation. Section 12D of the National Health Service Act 2006 gives the Secretary of State, NHS England, an ICB or the local authority the ability to make direct financial payments as an assistance to persons or bodies. Clause 9 would new section 12DA of the Act, under which the Secretary of State would be empowered to provide assistance to any person or body carrying out, or proposing to carry out, activities that they deem beneficial to the service. This is where semantics are important. The existing legislation allows the Secretary of State to make payments, but clause 9 is different: it would allow the Secretary of State to provide financial assistance and to make available persons employed by the civil service or any other resources that the Secretary of State has. This is a remarkably open-ended power that would allow the Secretary of State to spend taxpayers’ money while bypassing standard scrutiny. When NHS England spends money, there is transparency: the public can see how much has been spent on different types of care, ranging from hospitals to public health programmes. The public can see how much money has gone into trusts, into the independent sector and into procurement. Transparency builds trust in the system and disincentivises wasteful spending. Where will parliamentarians or the public be able to see the financial expense of civil servants, or literally any other resource that the Secretary of State may offer in support? For the first time, the Health Secretary will have the power to insert politically directed civil servants into elements of the health service that are not under public ownership. As clause 9 is drafted, the Secretary of State could provide civil service labour to private or mutual health providers that work within the NHS. Will the Minister elaborate on how that would be used, and how it would be beneficial to the taxpayer and the health service? The number of civil servants taking home more than six figures has increased under this Government. Their time should be focused on delivering public services, not propping up providers, especially ones that are private businesses. It is also unclear where the legal liability lies under such arrangements. If something goes wrong and the human resources provided by the Secretary of State are responsible, is the Secretary of State responsible or the entity into which those staff have been inserted? Can the Minister clarify that? It may be politically beneficial in the short term to provide state support, but it can be costly to the public purse and damaging to markets in the long term. By allowing the Health Secretary to issue assistance in the form of free civil servant labour, clause 9 effectively creates a new type of off-the-books subsidy. How can Members of the House or NHS providers tell whether assistance is operational support or a de facto subsidy? It could undermine the idea of a level playing field for firms contracted to deliver NHS services. There is also the question of when assistance crosses from operational support into running a provider or firm. We do not necessarily want to be in a position where the Bill is used to bail out failing private firms with NHS contracts. I return to the phrase “any other resources of the Secretary of State”. It is difficult to understand why the legislation was written in this way, allowing financial assistance, the provision of labour, and then the use of absolutely any other resource at the Health Secretary’s disposal. As with several other provisions in the Bill, it seems another sign that the legislation was rushed. Instead of circumscribing power tightly where it is needed, the Bill gives huge sweeping powers while claiming that it decentralises. The Minister has described clause 9 as a discretionary power intended to support the effective functioning of the health service and its workforce. Although that may be what she sought to achieve, that is not the reality. The clause paves the way for arbitrary and unaccountable deployments of state resources, and that should concern all hon. Members.
I beg to move amendment 53, in clause 10, page 6, line 21, leave out from “interests” to end of line and insert “of patients”. This amendment would only allow the Secretary of State to vary the balance between the public and private sectors in the NHS where it is in the interests of patients to do so.
This is perhaps the oddest provision in the Bill. Since time immemorial, the Labour party has accused its political rivals of wanting to privatise the health service. In the early 2010s, the then shadow Ministers indulged the idea that the Health and Social Care Act 2012 was a Trojan horse for privatisation. Several years later, after the Minister had herself joined the House, claims continued. The then leader of the Labour party urged the previous Government to “undo the very damaging privatisation of so much of our NHS”. —[Official Report, 23 October 2019; Vol. 666, c. 960.] In the 2019 election, the public were even presented with a dodgy dossier—not Labour’s first—that purported to show that the NHS was on the table in negotiations for a trade deal. We now have a trade deal and the NHS is still intact. Even though Members know full well that no sensible opposition party is advocating for abandoning our NHS system, they keep saying that Governments have been selling off the health service through the back door. Today, private providers deliver only about 10% of NHS care and the system continues to be free at the point of use. That brings us to the deep irony of today’s debate. After years of peddling the NHS privatisation myth, the Labour party has introduced legislation to make privatisation possible. The Health and Social Care Act 2012 inserted a safeguard against privatisation, section 12E, into the NHS Act 2006. That section prohibits the Secretary of State from exercising his functions for the purpose of “causing a variation” in the proportion of services provided by the public or the private sector. Clause 10 substitutes the text in that section and makes two small but significant changes. The first change is to expand the type of providers beyond public and private to “different kinds of legal entity”. That is probably a good change, because it encompasses the mutual and voluntary sectors, which do have an important role to play in health provision going forward. The second change is what has caused alarm. The Secretary of State cannot alter the provider mix unless they deem it to be “in the interests of the health service.” Could the Minister set out some scenarios when it would be deliberately beneficial to privatise provision or, indeed, when it would be beneficial to deliberately nationalise provision? I cannot recall an instance where Ministers needed to privatise an entire service to ensure patients did not lose access to care. In February, the Minister of State for Secondary Care told the House that lessons had been learned from private finance initiatives. Yet the Government announced that 80% of neighbourhood health centres will be privatised through public private partnerships. The Government are able to use these partnerships to loan money outside their limits, but it tends to be more costly than public sector borrowing. Essentially, it is borrowing, but not borrowing on the balance sheet. What is the effect of these private initiatives? I remember receiving my own office on being promoted as a doctor to consultant. It is quite an exciting moment; before that, resident doctors share an office. I had my own space, my own desk, my own computer and a big whiteboard for notes. When I asked whether I could place the whiteboard on the wall, I was told I could not—it was £800 to stick it on the wall under the private finance initiative contract. So my great big whiteboard sat there, propped against the wall. Periodically, I would move a piece of paper, knock the bottom of the whiteboard and it would tip and fall on me when I was sat at my desk. I did suggest putting it up myself, but that would also incur a charge through the PFI contract—for modifying things without getting them to do the modifications—so I just had to sit there with it propped up against the wall, ad infinitum. The Government are on the hook for more than £100 billion of payouts, simply for the use and maintenance of PFI facilities. The Labour scheme was a shambolic waste of taxpayers’ money that could have been spent on improving care. When my hon. Friend the Member for Hinckley and Bosworth (Dr Evans) asked the Minister about public private partnerships, she told him she was “very proud of the capital investment under the last Labour Government”.—[Official Report, 4 March 2026; Vol. 781, c. 386WH.] But is clause 10 simply a mechanism for Ministers to develop further private finance initiatives? If Government spending is under pressure, may Ministers seek to shift provision even if it proves more costly in the long run? There is another side to the conundrum of clause 10. Instead of a Health Secretary intent on privatisation, what if we get one intent on squeezing out private sector provision? Who our new Prime Minister will be, we do not know, but one of the candidates has called for the country to abandon 40 years of neoliberalism. Perhaps the Minister could elaborate on what that means, since the tax take as a percentage of GDP is the highest it has been in 40 years. To me, it signals a potential hostility towards choice and competition. We do not want to be in a situation in which the decision is made to alter the provider mix in service of ideology, rather than in the best interests of patients. I am aware of several private firms that provide services to the NHS and are concerned that clause 10 could be wielded against them. If a future Health Secretary decided to reduce private provision on the basis of ideology, what would happen to the 10% of planned activity that is currently delivered by for-profit entities? NHS providers could not feasibly handle such a surge in demand, waiting lists would increase further, and patient choice would suffer. It would also be expensive. If private providers fear that the NHS is no longer a reliable customer, and that they may suddenly lose their contract if this clause is invoked, they will charge a risk premium on their services—that is what firms do when they face shifting regulatory goalposts. That would only damage the public purse. Under clause 10, it would be legally possible for the Health Secretary to alter the provider mix. As a result, it would be worth it for several types of providers and ideologically motivated groups to spend vast sums of money hiring lobbyists to convince Ministers that their sector deserves favourable treatment and that they serve the interests of the NHS. Organisations would invest less in resources and more in influencing the rules, which is not a good outcome either. All those issues are compounded by the fact that clause 10 is imprecise. What does the Minister define as “the interests of the health service”? I am not trying to catch the Minister out; I just want to illustrate the problem with legislation drafted in such terms. It is difficult to prove that the Health Secretary has not acted in what they thought were the best interests of the health service. What could that refer to? It could refer to the interests of patients, to the interests of NHS staff or to the financial stability of the health service—it is entirely subjective. What is the health service there for? It is there for patients, which is why I tabled amendment 53. Amendment 53 would revise clause 10 to specify that the Secretary of State must not alter the provider mix unless doing so is in the interests of patients. I would like to place patients at the centre of the Bill’s changes, in recognition that we do not have the numbers on the Committee to change the clause altogether. My revision would make it harder for the Health Secretary to justify altering the provider mix if it harms patient access or reduces their choice. It would make NHS providers less fearful to know that the Health Secretary would be subjected to a better defined legal threshold.
It does raise questions about the point of new section 12E. That provision was not there before; there must be a reason for adding it. Either the Government want ideologically to reduce the amount of private provision in the NHS, or they want to increase it. The clause gives them the power to do both. Labour politicians very often tell the public that the NHS is being privatised. Data has shown that that is not happening, but that did not matter; they found the myth politically advantageous and repeated it ad nauseam. Now, the Minister and her colleagues are in office—they have the levers of power—and are proposing to change the law to make it easier to change the provider mix. That is not only ironic but deeply misguided. I tabled amendment 53 to require any changes to the provider mix to be in the interests of patients. If the Minister is unwilling to support that, will she offer a compelling explanation why? Clause 10 has alarmed stakeholders across the health sector and the political spectrum. That really ought to tell us something. I look forward to her response.
Will the Minister give way on that point?
If I heard the Minister right, she said that the clause did not provide for changes on the basis of ideology. However, it says that changes are not to be made “unless the Secretary of State considers that to do so is in the interests of the health service.” A Secretary of State whose ideology is that the private sector is bad, good or whatever else could well believe that it is in the interests of the health service to be private or not private. How does the clause prevent an ideologically driven Secretary of State from changing the health service on the basis simply of his ideology, rather than of patient or clinical need?
I beg to move amendment 47, in clause 11, page 8, leave out lines 15 to 30. This amendment prevents the Secretary of State from removing the Chief Executive of an integrated care board.
Clause 11 is particularly interesting. In August 2025, Alan Milburn was asked about the abolition of NHS England on the Health Foundation podcast. He said that the Government wanted to see a model that was “more delegated…more devolved” and “more diverse”, which necessitated the centre being smaller. Considering that he is a former Labour Health Secretary and a non-executive director at the Department of Health and Social Care, I do not doubt his understanding of what the Government wanted to achieve. When the former Health Secretary, the right hon. Member for Ilford North (Wes Streeting), announced the 10-year plan to the House, he also talked about dissolving power. He spoke of a “brave new world of devolution of power, resources and control”.—[Official Report, 3 July 2025; Vol. 770, c. 469.] That was repeated in the Government publications that accompanied the Bill: “Empowering ICBs as strategic commissioners will support putting patients at the centre of care by devolving decisions to a local level where different services can better integrate… Reforms to the NHS FT model will give providers more flexibility to design and deliver healthcare around local needs.” Between the announcement of the abolition of NHS England and the publication of the Bill, Ministers articulated a vision for a more decentralised system. There is expert consensus that decentralisation boosts performance, reduces health disparities and fosters innovation. After listening to remarks this morning, I have no doubt that Members are clued up on the importance of innovation to the health service, but a problem—a philosophical contradiction—at the heart of the Government’s reform programme and the Bill is that Ministers talk about decentralisation while these provisions constitute a recentralisation of power.
I beg to move, That this House calls on the Government to take steps to prevent the PATHWAYS clinical trial into the effect of puberty suppressing hormones on children with gender incongruence. Before I start, I declare an interest as an NHS consultant paediatrician, a member of the Royal College of Paediatrics and Child Health, and a member of the British Medical Association. It is also important for us to recognise at the beginning of this debate that we are talking about the protection of children—vulnerable children who are troubled, and who need our care and compassion and the very best quality of healthcare. The healthcare of children distressed about their gender is an area in which attempts have been made to shut down debate with threats and accusations of transphobia; we saw the way that the hon. Member for Canterbury (Rosie Duffield) was treated when she raised concerns. As adults and as elected Members of this House, we have a duty to safeguard children in our country. That means protecting them from adults who—with whatever motivation, good or bad—could do them harm. As a children’s doctor, I have recruited patients for trials, and I have cared for children and babies participating in clinical trials. I recognise the value of a well-designed clinical trial in improving clinical care, but today the House is not being asked to consider the principle of performing clinical trials in general, or on children in particular—I hope we can all agree that a well-designed trial can improve care. Rather, we are being asked to consider the Pathways trial: whether it meets ethical tests, what it does, the cohort, the protocol and the consent. I will go through each of those points in turn. The Pathways trial is part of a group of studies run by King’s College London and funded by the Government. So what does it do and why are we so concerned? The trial will take 226 children who are physically healthy—who are developing normally—and inject them with powerful drugs to delay that normal development in a way that may weaken their bones, affect their ability to think, damage their sexual function, and leave them unable to have children of their own. We are told that the purpose of this is to treat a diagnosis of gender incongruence. So what is gender incongruence? The International Classification of Diseases states that it is “characterised by a marked and persistent incongruence between an individual’s experienced gender and the assigned sex, which often leads to a desire to ‘transition’”. We know that gender incongruence is a condition that is subjective. It is based on how someone tells us they feel. There are no blood tests and no lab markers that can be used to diagnose it. As a paediatrician myself, I understand that how patients feel, particularly in relation to their mental health, is very important. We know from the Cass review that the vast majority of children with gender incongruence will get better on their own. Again, as a paediatrician, I am used to providing supportive treatment for conditions such as respiratory viruses and gastroenteritis, which generally get better on their own, but I am not used to giving powerful drugs to children that can cause permanent long-term damage for subjective, self-resolving difficulties during adolescence.
This is not a form of gene therapy. It is a medication that is a GnRH analogue, and what it essentially does is delay puberty. It was designed as a drug to treat children who go into puberty much earlier than they would be expected to, and to delay it until, as it were, the right time. The effects of the use of puberty blockers in older children and for a much longer period, at an age when they ought to have started puberty, are not fully understood.
My hon. Friend raises a very good point, and I will come to the data linkage study shortly. What we do know from the Cass review is that the vast majority of children who went on to puberty blockers in adolescence went on to receive cross-sex hormones, which are known to have permanent effects. One fact that is crucially important is that it is not possible for clinicians to confidently determine which children with gender incongruence will persist with the trans identity into adulthood, and which will not. How can the clinicians possibly know that they are not injecting potentially dangerous drugs into children whose incongruence will resolve itself? The answer is that they cannot. Will the Secretary of State tell us whether he is aware of new evidence allowing clinicians to work out confidently which children will persist with the trans identity at 11 and which will not? We need to think about the risk involved in the treatment, and whether it is worth the benefits that they will purportedly receive. The trial researchers suggest that they will take a wide approach to looking at potential benefits, that they will look at quality of life and body satisfaction, and that there must be a reasonable prospect of benefit; but how can they know whether there is a reasonable prospect of benefit when they do not know whether or not the condition will persist? Some have suggested that giving puberty blockers will help the few adults who retain their trans identity into adulthood to pass as the opposite sex. Does the Secretary of State think that the long-term damage to many is worth it for the cosmetic benefit of a few? The Medicines for Human Use (Clinical Trials) Regulations 2004 specify that “anticipated benefits” must justify the risk. This is an ethical rather than a medical question. Does the Secretary of State think that the benefits justify the risk? I regret that we have ended up discussing the details of a clinical trial in the Chamber—the reality is that things should be done impartially by scientists in most cases—but with this topic we have seen the quashing of open debate, which is why we have ended up where we are. I will move on to the point made by my hon. Friend the Member for Farnham and Bordon (Gregory Stafford). Even if the Secretary of State thinks the principle of the trial is right, he must surely agree that it is unnecessary and unethically broad. For example, if someone was designing a trial to treat children with a specific form of cancer, the children who would be entered into the trial would have that specific form of cancer. We would not include children with any disease, because that would make the results unreliable in terms of benefit to the target group and children would be unnecessarily put at risk of receiving experimental drugs that they did not need. The same applies to this trial. The Cass report tells us that many of the children in the proposed trial will get better on their own. The Secretary of State said yesterday that “we are talking about a very small subset of a very small group.”—[Official Report, 22 June 2026; Vol. 788, c. 56.]
Well, one of the things with doctors is that if you ask two doctors, you might get two different opinions. I completely respect Baroness Cass. She has been president of the Royal College of Paediatrics and Child Health, of which I am a member, and she has done great work on the report that we commissioned in the last Parliament. I know she is concerned that people may obtain these drugs illegally if they are not provided, but I do not share that concern. Personally, I think the important thing is whether the people obtaining such drugs legally are using them in a way that is safe, and I am not convinced that that is the case.
I am sorry, but I just do not support that. We would not give children cocaine on the basis that they wanted it and would get it illegally otherwise. These are not sweeties; they are powerful drugs and need to be treated with respect. Even if we accept the premise that a very small number of people might benefit from treatment, how could clinicians decide which children to treat? On what ethical or moral code would we want to inject powerful drugs into children who are likely to have a self-limiting illness and therefore do not need it? That is what the Government have chosen to do, and it is not necessary. Following on from the point made by my hon. Friend the Member for Farnham and Bordon, they have this data already. The Tavistock was a travesty, but it means that the Government could analyse the data from the outcomes of those children. They could establish the outcomes as children went into adulthood, and Baroness Cass tried to do this using the data linkage study. Shockingly, six out of seven adult gender clinics refused to provide the Government with the data. Even when a specific piece of legislation was passed by the previous Government to clarify that it was legal to provide the information to this trial, the gender clinics still did not provide it. I understand that NHS England is working on the data linkage study, but I ask the Secretary of State why it is taking so long. Is the abolition of NHS England causing delay? Why is he letting this trial, which he has expressed reservations about, go ahead in the knowledge that it is unnecessarily broad and in advance of the data linkage study?
The hon. Gentleman is exactly right, and he expresses my point succinctly. Why is the Secretary of State going ahead with a trial—experimenting on more children unnecessarily—when he has the data to analyse already? Why has he chosen to fund this trial? Is he worried about the children who will be put on a medical pathway that may lead to cross-sex hormones and a lifetime of medicalisation when they would have got better by themselves anyway? I want to talk about the age of these young people. The Medicines and Healthcare products Regulatory Agency warned in February that the youngest patients are at the greatest risk, and may end up on puberty blockers for a much longer period. They have a higher risk to fertility because sperm and eggs have not yet fully developed at Tanner stage 2, but this Government have chosen to include children of 11 or 12. Some will wonder why it is 11 for girls and 12 for boys—indeed, I was asked that question yesterday—but as a paediatrician I am aware that puberty starts earlier in girls than in boys. It is somewhat ironic that a trial based on the premise that girls could be boys recognises this biology, but I am glad that in this respect it does. However, that means some of the participants will be primary school-aged children with the merest form of puberty. How can they possibly meet the eligibility criteria, which includes “sufficient understanding of the treatment advantages and disadvantages, including discussion of fertility preservation”? How can a child of 11 understand what it means to lose sexual function, to be unable to have children when they are older, to have difficulties in thinking and to have weak bones? Remember that this Government think that 14-year-olds are not old enough to watch social media, but they think 11-year-olds are capable of understanding this.
I thank the hon. Gentleman for his intervention on devolution, and I am sure the Secretary of State was listening and considering what he has said. To go back to the age of the young people, I am reminded of the judgment in Bell v. Tavistock, which says: “We do not think that the answer to this case is simply to give the child more, and more detailed, information. The issue in our view is that in many cases, however much information the child is given as to long-term consequences, s/he will not be able to weigh up the implications of the treatment to a sufficient degree.” I draw right hon. and hon. Members’ attention to the next part of the quote: “There is no age appropriate way to explain to many of these children what losing their fertility or full sexual function may mean to them in later years.” Yet, as Secretary of State confirmed yesterday, the children must consent or assent to being in this trial. Another question that he did not answer yesterday is why the Government did not heed the MHRA recommendation for a minimum of 14 years. Having established that the Government are going to put a group of physically healthy children with a self-resolving condition at a risk they may not fully understand, the remaining question is why they would they want to do this. The trial itself has an interesting design. We are told that it is a randomised controlled trial—as a doctor, I am familiar with that term—but in this case it is a bit of a fudge. Yes, this Government-sponsored trial will randomise which children get the drugs now and which get them in a year’s time, but the comparison group that does not receive puberty blockers—300 children from the Horizon Intensive trial, with whom the trial will seek to compare—may not be considered a reliable comparison, because the group is a different group with different eligibility criteria. When the results of this trial are published, this fact is bound to be used by people who dispute or disagree with the findings. The Secretary of State said this trial will resolve the dispute over the issue, but that is one of the reasons why I think it will not. I want to discuss sexual function, because yesterday the Secretary of State said that the trial would involve the completion of a number of questionnaires, and one of my hon. Friends raised the question about what happens to children’s sexual function in the long term. What is sexual function? It is desire, arousal and orgasm. The trial organisers are clearly concerned about this, because they put into the trial the ALSPAC—Avon longitudinal study of parents and children—romantic relationships questionnaire. I read the questionnaire on the Health Research Authority website, and children from the age of 12 and over will be asked these questions, one of which is: “In the last year have you had oral sex with another person? (This is when they put their mouth or tongue on your penis/vagina or you put your mouth or tongue on their penis/vagina)”. Let us be clear: if that is happening to a 12-year-old, that is sexual abuse and the police should be called. Is the Secretary of State content for the Government to be asking these questions of such young children? Can he believe that they will be paid £20 for completing their questionnaires, alongside £30 for completing the assessment of cognitive ability and £15 for completing physical and height assessments, in addition to travel expenses? There will be lots of talk this week about the Prime Minister’s legacy. Putting children as young as 11 on puberty blockers, with irreversible life-changing consequences, would be the most disturbing final chapter in what has been a troubled book of leadership. Today, right hon. and hon. Members will be asked to vote to consider their approval or disapproval of the trial. I urge them to look at their conscience, read the trial protocol—it is online—and remember that these are vulnerable children who deserve the best care. One day, the children caught in the middle of this debate will be adults. It is our responsibility to ensure that when they look back on their one childhood, their one adolescence and their one chance to enjoy growing up, they must know that every decision was made with the utmost care, caution and respect for their future. The power to make that happen is in our hands today. I urge hon. Members to protect children’s futures.
Does my hon. Friend agree that Ankara is going to be extremely interesting this year, especially at a time when characters like Foreign Minister Sikorski are pointing out that Poland will be spending 4.8% of its GDP on defence while we spend £4.5 billion on cycle tracks? Mr Sikorski has pointed out that that is indicative of the priorities of this Government, and, as a committed Anglophile, fears that it is indicative of this country retreating into the shadows. It is difficult to avoid that conclusion, isn’t it?
I am fascinated by the Minister’s remarks about the withdrawal of troops after the cold war, many of them to Salisbury plain in and around my constituency where they continued to train for current operations. Is she seriously saying that she would recreate the British Army of the Rhine? Is that Government policy—for this Government, or for the Government to come? If so, how is she going to fund it?
The hon. Gentleman is being very generous with his time. The Liberal Democrats are famously known for their love of bicycling. Does he agree that it would be a good idea for the Government to drop their plan to spend £4.5 billion over five years on creating cycleways and rededicate that money to defence?