Health Bill (Fifteenth sitting)
I think that the hon. Member has spoken very well, too, and I am grateful to him for airing this important subject through his new clause.
Showing every spoken contribution, including 5,731 under 12 words. Hide short remarks
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Health Bill (Fifteenth sitting)
I am grateful to the hon. Member for Winchester for introducing these new clauses and for the debate that that is allowing us to have. Unpaid carers are too often a silent and fundamentally unappreciated part of society, which the system could not cope without. They are family members who are thrown into the role of looking after their loved ones, which they did not expect to have to do. Most of them have no formal qualifications, but through love and family ties, they provide unpaid support, which in many cases has a negative effect on the financial wellbeing of the household and involves a huge amount of emotional toil. The crisis in social care has lasted for decades under different Governments, who have struggled to tackle it, and it is putting increasing pressure on family carers. Many do not see themselves as a carer—they see themselves as a husband, wife, daughter, son or friend—but they provide millions of hours of care and support, year in and year out. My former role was at a national nursing charity that seeks to support the families of those living with dementia. I saw for myself how much wraparound care can achieve in relieving pressure and unnecessary suffering, not just for the person living with dementia—it does not have to be dementia, but that is what I have experience of—long-term frailty or conditions that require support, but for their family and carer. Very often, the biggest care need for the person living with dementia is the biggest need their family carer has; if we can sort the family carer’s biggest need, they can go on and do so much more for the person they love. I thank the hon. Member for Winchester for allowing us to have this debate. I urge the Government, if they do not adopt these new clauses, to do all they can to relieve the pressure on unpaid carers up and down the country and to provide support for them.
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Timms Review: Interim Report
I thank the right hon. Member for his statement. What a shame he has been asked to look at this issue only now, when his party had 14 long years in Opposition to work out what they wanted to do. Given that he acknowledges the system needs reform—as every new Government acknowledge—does he accept that, in today’s world, a system of cash payments to some people with conditions such as attention deficit hyperactivity disorder, where half the claimants are aged between 16 to 24, is not what they need most? Indeed, some of them have no financial needs at all. Does he accept that the money would be best saved—will he confirm that there will be savings?—and some of it invested in better health and community services, technology, and incentivising businesses to employ the six in 10 young people who are not in education, training or work?
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Business of the House
Mr Speaker, I thank you for your gracious words, and I echo your thoughts and thanks to David Weir for all his service. Will the Leader of the House give us the forthcoming business?
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Business of the House
What a sporting week this has been! Youth, vitality, incredible physical stamina in the most testing of environments—and that is just the Leader of the House, whose birthday it was yesterday. He has never begrudged me my own naivety and inexperience, and I know that everyone present will join me in wishing him a massively happy birthday. In other news, the England football team decisively defeated Mexico at the Azteca, and we look forward with keen anticipation to their taking on Norway on Saturday evening. We send our congratulations and commiserations to the United States of America on the tragic wrong turn it took towards independence 250 years ago. Edmund Burke famously said: “In this character of the Americans, a love of freedom is the predominating feature”. Whatever temporary disagreements we may have, let us never forget this deepest of shared commitments. Kim Jong Un himself would admire the North Korean precision of the Labour leadership vote, which has opened today, with precisely one candidate on the ballot paper. How very different from the forthcoming by-election in Clacton, which appears to be a choice between a novelty comedy act with no real policies, and Count Binface. It is a long time since we had a count in the House of Commons, and when the time comes—as it surely will—we will have to leave to you, Mr Speaker, the delicate question of whether and how to suspend the rules on headgear in the Chamber for the new Member. On a more serious note, the House has already expressed its great sorrow at the recent death of Sir George Howarth. I would also like to draw attention to the very sad death on Monday of James Mackay, Lord Mackay of Clashfern, at the age of 99. He was a brave, energetic and imaginative reformer of the law as Lord Advocate in Scotland, and then as Lord Chancellor. It is hard to think of a man more widely respected in public life. We send our very best to his wife Bett and their family. I have just one item of business today. It is related to the River Wye, which the House will know is not only a particular obsession of mine, but an issue of national importance. When the last Government cancelled the action plan for the Wye, it also cancelled the accompanying commitment to £35 million in clean-up funding, and replaced it with a paltry £1 million, supposedly aimed at research. I was very distressed to receive the news this week that only £115,000 of that £1 million will actually be spent on research, that even that tiny sum will be spent over three years, and that the balance of the £l million will be consumed by administrative costs. Will the Leader of the House instigate an immediate inquiry and ensure that Ministers clarify to me, my constituents and national campaigners on this issue that the full £1 million will be kept intact and used for the purposes for which it was intended?
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Business of the House
Oh!
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Jury Trials
At Justice questions last Tuesday, the Minister for Courts and Legal Services restated her total support for the Government’s attack on jury trials. She described it as “pragmatic structural reform”, and suggested that those who oppose it are burying “their heads in the sand”—[Official Report, 30 June 2026; Vol. 788, c. 743.] She also said that it is a point of principle to limit trial by jury, and that she would pursue the policy regardless of the crisis in the courts. Whatever the practical concerns, are the proposed changes to jury trials also a point of principle for the Solicitor General—yes or no?
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Jury Trials
The right hon. Member for Makerfield (Andy Burnham), likely the next Prime Minister, has said that jury trials are the “lynchpin of a fair society” and that the plans to curb them should be paused. When he takes over, can we look forward to the Solicitor General’s supporting the scrapping or watering down of the very same changes that she has robustly supported? Does she think that any jury would believe a defendant whose story changed quite as often as this Government’s?
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Health Bill (Fourteenth sitting)
It is a pleasure to serve under your chairmanship again, Dr Huq. New clause 6 raises an important question on how we govern health data, which one of the greatest assets of the NHS. The development of the single patient record platform and database, and the wider use of the linked NHS data, present enormous opportunities. When used responsibly, healthcare data can support much more personalised care, improve NHS planning, accelerate medical research, enable earlier diagnoses and help develop new medicines and treatments. It can also improve efficiency and strengthen the evidence base for healthcare decisions. However, those benefits can be realised only if the public have the confidence that their data will be used safely, ethically and transparently. Public trust must be the foundation of any successful health data policy. NHS health data is currently overseen by NHS England, following the merger of NHS Digital into that organisation. With the Government proceeding with the abolition of NHS England and the transfer of its functions elsewhere, it is right that we consider future governance arrangements. In principle, I agree that an independent body may be needed to ensure and maintain the security, integrity and responsible stewardship of NHS data. There is definitely scope for an independent body to oversee the management and regulation of the public’s health data. That proposal places patient privacy at its heart, and would strengthen safeguards against misuse, give patients greater control over how their information is used, and provide meaningful mechanisms to opt out of certain forms of data sharing. It also promotes the use of anonymisation and trusted research environments, allowing valuable research to take place while reducing the risk of inappropriate disclosure. We have discussed inappropriate disclosure by a malign actor, or even inadvertent disclosure, during debate on other clauses. The Liberal Democrat new clause also seeks to address a concern that has attracted significant public attention: where commercial organisations derive substantial value from NHS data, the NHS itself should share in that benefit. Although we did not support a number of Liberal Democrat proposals because of the inadvertent implications of their drafting, I still have sympathy with the overall thrust of what they were trying to achieve. There is a strong argument that the value generated from the data contributed by NHS patients should help to support future patient care and research. Transparency is another important feature. Publishing data-sharing agreements, increasing openness around decision making and consulting the public on significant new data initiatives would help to strengthen public confidence. The proposed trust would bring those principles together by overseeing data use, monitoring compliance with governance standards, ensuring transparency and, where necessary, suspending access for organisations that misuse their data. Of course, any new governance framework must avoid creating unnecessary bureaucracy or delaying important research. To reassure the Committee that the framework would not create a block or dampener, or insert inertia into the system, will the hon. Member for North Shropshire tell us what evidence she found when drafting the new clause? If we are going to do something like this, the oversight should be proportionate, and it should complement, rather than duplicate or frustrate, any existing regulatory responsibilities. Ultimately, the new clause has potential benefits. It would establish a clear social contract for NHS health data, which would hopefully protect privacy, support research and innovation, maintain public trust and ensure that patients and the NHS share in the benefits arising from the responsible use of a very valuable national asset. In terms of what it could be used for, that data is probably second to none in the world, but I am concerned about adding extra bureaucracy and inertia to the system, when we want a vibrant life-sciences industry that is able to use the data for the benefit of British citizens and patients. What does the hon. Member for North Shropshire think would happen in that case?
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Health Bill (Fourteenth sitting)
I do not mean this as a cheeky point, but is it not the case that clearly, as with everything, the Liberal Democrats think that the European Union can do no wrong? They do not see the same problems of data that they have expressed in other clauses because they want to rejoin the European Union. Therefore, they conceive that it can have no possible harm to British subjects.
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Health Bill (Fourteenth sitting)
Is that not part of the problem with the wording of the new clause? It is not clear, from the new clause, what is NHS data and what is the patient’s data, and who owns which bit of it. The problem with the drafting of the new clause is that it appears to cover every single piece of data held by the NHS, whether it directly relates to a patient or not. Additionally, if the Government were to collect any other sort of data, even if on an aggregate basis, it would come under this. That would be totally unworkable and put an enormous burden of bureaucracy on the health service.
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Health Bill (Fourteenth sitting)
It is very important that we consider these new clauses and amendments carefully, not least because, as my hon. Friend has just outlined, the hon. Member for Worthing West, who tabled them, has considerable expertise, being a public health consultant herself. I have the pleasure of sitting with the hon. Member on the Health and Social Care Committee and she brings her expertise to every single sitting. I am sure that the Minister has welcomed her questioning when she has appeared before that Committee. It is really clear that, if we are going to make a success of the Bill, public health in all its guises needs to be at the forefront of our thinking about how we achieve better patient outcomes, better health and, more specifically, the Government’s stated aims in the 10-year plan to, first, shift care closer to home and, secondly, focus more on prevention rather than treatment. I am sure that across the House we agree with that ambition and therefore I can totally understand why the hon. Member for Worthing West has tabled these new clauses. I suspect that the new clauses are also a reaction to something that we have already discussed in this Committee, which is the dislocation and now the separation of local authorities from ICBs, with the removal of their statutory functions on those boards, to be given to strategic mayoral authorities. Some of those strategic mayoral authorities exist but, as we have discussed at some length in the Committee, many of them do not exist and might never exist. I can see why the hon. Member for Worthing West is trying to ensure that the vital work of directors of public health in local authorities for their population areas is somehow safeguarded and included in the Bill. That being said, I have some reservations about how these new clauses are currently drafted. My hon. Friend the Member for Sleaford and North Hykeham has already outlined many of them. Although strengthening public health leadership is an essential objective, new clause 24 defines the statutory role and legal status of directors of public health in this context without providing sufficient clarity about accountability or governance, or about how these new powers would interact with existing NHS and local authority structures. Potentially, there is a risk of creating overlapping responsibilities, blurred lines of accountability and additional bureaucracy at a time when integrated working should be simplified rather than made more complex. Obviously, the hon. Member for Worthing West is not here to answer my questions. I ask the Minister this: if these new clauses are not pressed to a vote, or if they are but are not accepted by this Committee, how can she reassure me and the hon. Member for Worthing West that public health will still be at the forefront of the Bill, and that the removal of local authorities from ICBs will not have the impact that I think the hon. Member, who tabled these new clauses, is concerned about?
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Health Bill (Fourteenth sitting)
I rise to support a lot of what my right hon. Friend the Member for Melton and Syston said. Across the Committee, I think we all agree that corridor care and care in other inappropriate settings should have no place in the NHS. No patient should be assessed, treated or left waiting in a corridor, in a cupboard or anywhere else because there is nowhere for them to go. We owe it to patients and our constituents to be honest about the scale of the problem and be serious about ending it. That starts with measuring it properly, because if we do not collect the data, publish the evidence and track progress, inappropriate care settings risk becoming normalised. In May, nearly 3,000 patients were in corridor care, which was a 2.5% increase from the same time last year. In the same month, 50,000 patients waited in A&E for more than 12 hours, which was a 17% increase from the same period last year. The Government continually miss their target on the 12-hour wait. I am not making a political point; this is a serious problem, and successive Governments are still struggling to ensure that it does not happen. We all know from our casework and our inboxes, and some of us know through personal experience or from loved ones, that too many patients are experiencing unacceptably long waits in A&E after a decision has been taken to admit them. That is bad for patients, bad for staff and bad for the wider functioning of our hospitals. New clause 56 in the name of the hon. Member for North Shropshire acknowledges that the causes of delays extend far beyond the emergency department itself, and I will touch on that in a moment. Challenges in social care, discharge processes, step-down provision and workforce capacity all contribute to bottlenecks that leave patients waiting longer than they should. Although there might be legitimate questions about the precise mechanisms proposed in the new clause, I do not think there is any disagreement among the Committee about the principle that patients deserve timely access to a hospital bed and that excessive admission delays should not be accepted as the norm. That is why I fully support new clause 84 in the name of my hon. Friend the Member for Sleaford and North Hykeham. Publishing data on avoidable deaths associated with waits of more than 12 hours would help to ensure that we, as a Parliament and as policymakers, remain focused on outcomes for patients, not just performance indicators. I am particularly persuaded by the proposal to publish that information at ICB level, notwithstanding the concerns raised by my right hon. Friend the Member for Melton and Syston, which I agree with entirely. It would at least give some allowance for those making decisions to look at the local variation and ensure that it is identified, however less local that will become. Hopefully, good practice will be able to be shared between different areas, and the areas that face the greatest challenges will be able to receive both appropriate scrutiny and appropriate support. Of course, collecting and publishing data will not by itself reduce waiting times, but we cannot effectively tackle a problem that we do not properly measure. Sunlight is often the best disinfectant in these cases, and greater transparency can be a powerful driver of improvement. At the heart, new clause 84 recognises the simple truth that every statistic represents a person, a family and a life, and if avoidable deaths are occurring as a consequence of prolonged A&E waits, we should have the courage to measure them, publish them and learn from them. That is why I support the new clause. As has been touched on in other speeches, and as I mentioned earlier, the issue of corridor care does not sit in isolation. In fact, it is not a cause of the problem; it is the symptom of many other problems within our health and social care network.
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Health Bill (Fourteenth sitting)
I respect immensely the hon. Gentleman’s experience. He described being a young doctor, but he is still a very young doctor/politician now. Of course, capacity is an essential part of this. He is a clinician, so I will not lecture him on this, but my suggestion would be that it is not about just capacity within hospitals. The Government’s shift is to try to get people out of hospitals and into community settings as much as possible, so it is capacity within the whole system that needs to be looked at. Going back and putting loads more beds into hospitals would not somehow solve this problem or create a healthcare system that is aligned with what the Government want, which is hopefully treating more people at home. On his general point, I accept that the more capacity there in the system as a whole, the more likely we are to solve some of the problem. That neatly moves me on to my next point, which is about the whole-system approach to this. As hon. Members have mentioned, we have a potential problem with ambulances waiting in carparks, and unfortunately, trusts gamify the system when targets are put in place—they do not admit people through the door because it will hit their targets. As my right hon. Friend the Member for Melton and Syston mentioned, that has a knock-on effect for the people sitting in the ambulances and those who are potentially not receiving an ambulance because the capacity is not there. Likewise, at the other end of the system—though I suppose it is both ends of the system—social care needs to improve significantly. I am deeply disappointed that the Government have pushed another social care review that is probably not going to report until 2028, which is kicking the can down the road. I think it is essential that we get social care correct.
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Health Bill (Fourteenth sitting)
I am grateful to the hon. Member; she makes an interesting point. She talks about irony, and I respond in the same manner as that which she intervened on me with a gentle response, which is to ask why, if everything was going so swimmingly well, she and the rest of her colleagues got rid of the Prime Minister?
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Health Bill (Fourteenth sitting)
My hon. Friend is absolutely right. The public do not want to hear about the last 14 years or the rhetoric around them.
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Health Bill (Fourteenth sitting)
I will give way to the hon. Lady after I finish my sentence, if I may. The public want to know what the solutions are. I think we could look back through history at successive Governments since prehistory and say, “They got some things right, and they got some things wrong.” What the public want to know now is what the current Government will do. On the point about social care, I was not a member of the last Government, but I stood on an election manifesto commitment, as the Labour party certainly did and I think most political parties did, that essentially said that the Dilnot review had decided how we were going to deal with social care, and we were going to get on with it. It strikes me as very strange that the last Secretary of State, the right hon. Member for Ilford North (Wes Streeting), decided to have another review; he has said himself in interviews since he resigned that it looks like the stalling on social care means that we will not get any movement on it before another general election. I do not think the public should put up with that.
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Health Bill (Fourteenth sitting)
I will do that. As I have already said, no party has necessarily covered itself in glory with this issue. It might have taken us four years to dump it; it took the Chancellor of the Exchequer less than two weeks.
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Health Bill (Fourteenth sitting)
I look forward to the new Prime Minister coming in and, I hope, providing a position where the hon. Member is able to achieve some of that. [Interruption.] I note for Hansard that that received acclamation across the Committee Room. Getting back to the Bill, as you have suggested I do, Dr Huq—I take your suggestions very seriously—the social care element is extraordinarily important. It is important to ensure that people do not enter the secondary care system if at all possible, especially through attending A&E. When I worked on the Getting It Right First Time programme, our accident and emergency reports put forward some interesting methods that could potentially help with that. Some of that has been implemented and some has not, but I recommend all hon. Members look at that report, because it contains a number of interesting proposals. This is not only about stopping people entering the system, but about ensuring that people come out of the system in a timely manner, freeing up the capacity we have just talked about. In my constituency, Haslemere hospital had 16 step-down inpatient rehabilitation beds. Unfortunately, last year, that service was “temporarily paused”—that is how it was described, but it has been over a year now, so it has essentially stopped. That service is not happening in my constituency, which is down to the fact that it was a GP-run service and the trust could no longer get a GP who was willing to run that service. Haslemere hospital and the Royal Surrey NHS Foundation Trust that runs the hospital have some really fantastic ideas, very much in keeping with the Government’s push towards neighbourhood health, and I fully support those proposals, but it is a shame that we have had 16 beds sitting empty for more than a year, which could have been used for rehabilitation. We as a body politic should be looking at how we can improve and expand our step-down/step-up capacity, so that people do not have to go into acute settings. I turn briefly to the specifics of new clause 12. I am concerned about subsections (3) and (4), which talk about a tribunal system. I do not quite understand how that would work. The way it is set out almost gives it an adversarial, inquiry-type, case-by-case element. It would include patients, bereaved or affected families, and frontline NHS staff. I can see how that kind of body might work if one was investigating a failure around a single patient or at a single trust, but I would be grateful if the hon. Member for North Shropshire could expand on how she sees the national report coming forward and then a group of people being selected to interrogate it. It is also not clear what would be the consequences of the interrogation, or otherwise, once it has happened.
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Health Bill (Fourteenth sitting)
I am, too.
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Health Bill (Fifteenth sitting)
It is a pleasure to serve under your chairship, Ms Lewell. Like the shadow Minister, I will be relatively brief. [Interruption.] It was not clear whether that was a sound of appreciation or disappointment from the Minister. I will assume that she receives everything I say with the same noise and grace. Yesterday, the Secretary of State appeared before the Health and Social Care Committee—on which my hon. Friend the Member for Isle of Wight East and I sit—and was questioned at some length by the Chair, the hon. Member for Oxford West and Abingdon (Layla Moran), about the UK-US trade deal. It was striking that the Secretary of State appeared unable to answer the basic question of whether an impact assessment could be presented to the Committee—under whatever terms of secrecy or confidentiality the Department wanted to place on it—to allow us to assess the costs, as the hon. Member for Winchester outlined, and, one would hope, the benefits. The Secretary of State was very clear that there were benefits, but he was unable to outline what they were. He cited commercial confidentiality, which I do understand; there will be commercially confidential elements to the deal. What was really striking, however, was that even though the Select Committee was very happy to receive the information under whatever strictures he wanted to put on it, so that we could scrutinise it, it was not given. That is serious cause for concern. I understand what the hon. Member for North Shropshire seeks to achieve through new clauses 15 and 76, but there are some problems in their drafting. There will be commercially confidential elements to the deal, so laying it before the House essentially completely unredacted, as new clause 15 would require, might pose real problems. Likewise, I assume that the intention of new clause 76 is to focus specifically on the UK-US trade deal as currently formulated.
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Health Bill (Fifteenth sitting)
I certainly agree with the hon. Gentleman’s penultimate point: we need to support home-grown clinical academics and the life sciences industry in this country. As he has drawn me down that line, I declare that my wife works in the life sciences industry in the UK. I entirely agree with him on that point. However, if he is saying that a corollary is that we should not do pharmaceutical trade deals with other countries, I do not agree, because UK patients need the best medicines no matter where they come from. If that was not what he was saying and I am putting words into his mouth, I apologise, but that is how it sounded to me. I agree that we should support the home-grown, but obviously we need access to medicines from around the world. That brings me to my concerns about new clause 76. I understand why the hon. Member for Winchester supports it, but the way it is written means that, for the lifetime of the Act, any trade deal with America would have to follow those strictures. Although I accept that he does not like the current deal or the incumbent in the White House, it seems odd that we are singling out in statute, and putting a stricture on, one country over every other. I still probably would not have voted for it, but the new clause might have been more acceptable had it referred to any trade deal with any country, or even a group of countries—I know he is a big fan of one particular group of countries. That might have made it difficult. It would be dangerous essentially for the Bill to put a stricture on a trade deal with one specific country—especially one that is probably our strongest ally. I think that sits very badly.
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Health Bill (Fifteenth sitting)
Yes, I agree entirely with the hon. Gentleman. It would be a very slippery slope to write that into legislation. I understand the motivation—as I often do—behind Liberal Democrat new clause 76, but I do not think its drafting is appropriate in this context, and I cannot support it.
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Health Bill (Fifteenth sitting)
I rise briefly to speak on this as well. I should note for the record that I am the vice-chair of the all-party parliamentary group on special educational needs and disabilities. The hon. Member for Winchester, on behalf of the hon. Member for Oxford West and Abingdon, made the case very strongly. I am a member of the Health and Social Care Committee, and we took evidence as he described. The lack of a statutory obligation in the current EHCP process is a fundamental problem. We need to ensure that the health elements are put on the same footing as the social care ones. As I am sure is the case in every hon. and right. hon Member’s constituency inbox, the number of children who are receiving or require support with special educational needs and disabilities, and the frustrations with the process both locally and nationally, are rightly something that we, as parliamentarians and policymakers, need to get a grip on.
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Topical Questions
The beautiful River Wey runs through my constituency, but storm overflows from the Farnham sewage treatment works are increasingly polluting the river, affecting my residents and businesses and those further afield, including the Peper Harow Park fly fishers in the constituency of my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt). What discussions is the Minister having with Thames Water about stopping the discharges from the Farnham sewage works?
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Israeli Settlements: Trade Ban
I thank Members from across the House for their contributions today, and I congratulate the hon. Member for Sheffield Central (Abtisam Mohamed) on securing this debate on trade—granted, of course, by the Backbench Business Committee. Before I turn to the specifics of what we are debating today, it is important to be clear from the outset that Conservative Members, like all Members who have spoken, want to see an end to violence and conflict in the west bank and in Gaza. Israelis, Palestinians and people across the region deserve to live in peace with security, and it is my party’s long-held position that this can be best achieved through a two-state solution. We also want to see the Abraham accords expanded and wider regional barriers to peace overcome. At the same time, the official Opposition’s view is that settlements are not conducive to achieving long-term peace. We believe that the Israeli Government should firmly clamp down on settler violence, and we are against the expansion of settlements.
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Israeli Settlements: Trade Ban
I am very grateful for the hon. Lady’s intervention. I will address the point that she raises later in my speech, but our shared aim across this House, which is peace in the region, cannot be achieved without Britain maintaining an enduring relationship with Israel and with our allies in the region. It is through engagement that we will be able to achieve the resolution we all want. Engagement is vital to achieving the peace that unites the House today. That is why I regret that, in my view and the view of the official Opposition, Britain’s influence has been diminished to such a degree due to a series of misjudged decisions. These include the decision to cancel trade talks while Hamas were still holding hostages after the 7 October attacks; the decision to impose export licence suspensions while Israel was burying hostages so barbarically taken from their loved ones; and the decision to recognise a Palestinian state when no formal peace process had been agreed. Of course we support a two-state solution, and it is right that we would recognise a Palestinian state, but recognition of a Palestinian state is only meaningful if it is part of a formal peace process. As my shadow ministerial colleagues have pointed out, the Government’s actions to date have left our relations with Israel in a deep freeze, with our ability to influence the situation in the region severely diminished.
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Israeli Settlements: Trade Ban
The hon. Lady is wrong to suggest that we are saying we should do nothing. If Members remember, it was a Conservative Foreign Secretary in 2024 who imposed sanctions on the settlements. The House has heard me say from this Dispatch Box that the expansion of settlements is wrong. She is being unfair. What I am talking about is a point of execution. We have to engage with our allies—Israel is a critical ally of the United Kingdom—and that is not done by banning trade with Israel.
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Israeli Settlements: Trade Ban
We can be critical of our allies and we can be critical friends—of course we can—but what I am saying is that disengagement is not a solution to achieving what the House wants, which is peace in the middle east.
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Israeli Settlements: Trade Ban
I will make a little progress in the interests of time, because I know that Members will want to hear from the Minister. It is the official Opposition’s view that a proposed ban on the trade of Israeli settlement goods and services will bring about the same result as I have been talking about and will prove counterproductive and ineffective. Secondly, aside from the ineffectiveness of the policy, it is not even clear that it could be implemented, according to the Labour Government. The Government have repeatedly pointed out, as have many Members today, that a ban on settlement goods would be difficult to enforce. At the Dispatch Box last week, the Minister for the Middle East, the hon. Member for Lincoln (Mr Falconer), said that countries imposing such a ban are encountering “technical difficulties”. Will the Trade Minister address that point when he responds to the debate, and confirm that the Government still hold these concerns about practicality? Labour Members have been questioning that. It is all well and good making a point and arguing for an action, but the Government say that it cannot be executed, and it needs to be explained. I realise that many anti-Israel campaigners will not be concerned with the answers to these questions that I am posing of the Minister. They may not care whether a ban is effective or having an impact, but only that it should be in place. By the way, I have heard nobody in this debate mention that one in seven medicines dispensed by the NHS comes from Israel. Those who have suggested that we should have an outright ban on Israeli trade have offered no solution to that point. I am sure that the Minister agrees that it is vital that the Government take the full impact of any policy into consideration.
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Israeli Settlements: Trade Ban
Not right now, and I have already taken an intervention from the hon. Lady. Finally, and more broadly, we worry that the campaigners ultimately want this ban to become a gateway to a wider ban on trade with Israel. If that is the case, they simply do not accept the importance of the relationship that we have with Israel. On trade and the economy, Israel is a technology and health superpower, with the UK-Israel trading relationship worth £6 billion. When the last Government launched bilateral trade talks in 2022, we estimated that the reduction in trade barriers could benefit almost 7,000 UK businesses in all Labour Members’ constituencies, including 5,600 SMEs employing 1.7 million people. I would be grateful if the Minister updated the House on the status of the trade agreement discussions. [Interruption.] I see that you are asking me to conclude, Madam Deputy Speaker. We firmly believe that the proposed trade embargo would have no practical effect whatever on the situation in the region. We are concerned that it is part of a broader push by Israel’s opponents to isolate the Jewish state politically and economically. The ban would be legally and administratively complex, it would have limited economic effect, and it would hinder diplomatic efforts to find a sustainable, long-term peace agreement between Israel and the Palestinians. No matter what Members might say or shout, the ban would not bring about peace in the middle east. We have already seen Britain’s voice marginalised and Britain’s ability to influence Israel diminished. To go further down this path would not serve British, Israeli or Palestinian interests at all, so we cannot support the proposed ban.
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Health Bill (Fourteenth sitting)
I agree with the broad thrust of the points made by the hon. Member for North Shropshire in highlighting the impact of corridor care on patients, on families and on those seeking to provide the care for those patients. I suspect that pretty much all of us, in our own lives or as constituency MPs, will have come across examples of that and the impact that it has on our constituents, or on our friends and family members, so it is a very important point. Before I turn to new clauses 12 and 56, I will briefly address new clause 84, tabled by my hon. Friend the Member for Sleaford and North Hykeham. It is a very moderate and reasonable proposal, in that it seeks simply for data to be made available and published on where 12-hour-plus waits in A&E have contributed to avoidable deaths. That should not be a challenge; I suspect that that data is already extant in some part of the system. She is proposing a very moderate measure, which would pull all that together in one place, and allow it to be focused on and looked at in the round, rather than in disparate little penny packets of data. That is a very reasonable proposition. The only challenge that I see is, sadly, in proposing it for integrated care board areas. Were the ICBs still what the Conservatives had conceived them to be—a number of geographical areas mapping on to an upper-tier authority social care provider—that data would have been even more meaningful, because it would have been more granular. The risk with the mergers and acquisitions—for want of a better phrase—among ICBs to form ever-larger areas is that that granularity is increasingly diluted. I fear that the genuinely positive benefits of what my hon. Friend is proposing might be somewhat diluted by virtue of what the Government are doing.
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Health Bill (Fourteenth sitting)
The hon. Gentleman makes a valid point, and I suspect that he has seen this issue in his professional career. Often, when a death occurs in a clinical setting, multiple factors are contributory. I think that that is why my hon. Friend the Member for Sleaford and North Hykeham framed this as she has, as “a contributory factor”—not the sole factor or the individual most significant factor, but that it could reasonably be deemed by a clinician or by those collecting the data that the long wait contributed to the death, because had that patient been seen, for example, in two hours rather than 12 hours, better clinical outcomes might have been achievable. I take the hon. Gentleman’s point, however, that with many of these things—both clinicians and coroners grapple with this—it is often complex to determine the actual most significant contributory factor. My hon. Friend the Member for Sleaford and North Hykeham may correct me, but I think that is why she framed new clause 84 as she did, to allow for that degree of a lack of total certainty in such contexts. Nevertheless, the hon. Gentleman makes a reasonable point. I can see what the hon. Member for North Shropshire is seeking to do in new clauses 12 and 56: not unreasonably, she seeks to cast light on the impact of corridor care on patients, families and those caring for people. My only challenge would be—I will enlarge on this in a little more detail—that a narrow focus on corridor care, while understandable, slightly loses the bigger picture. Corridor care is, for want of a better way of putting it, a subset, a consequence, of a much broader systemic challenge. The Minister will probably know this as well; when I was first appointed to her job, one of the first conversations I had in the context of secondary care was about the importance of flow through our acute hospital systems, from a patient either presenting at A&E or arriving by blue light at A&E, to being treated, and the ability of A&E to function through those patients being seen, treated, and discharged or put into a hospital bed to become an in-patient. The ability to achieve the latter is dependent on the ability to discharge.
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Health Bill (Fourteenth sitting)
The hon. Lady pre-empts me— I am afraid I have rather a few more remarks to come to. I planned to through the subsections and paragraphs of her new clauses to acknowledge exactly that. For example, in proposed new clause 56(4), she highlights capacity, and in proposed new subsection (5) she mentions Baroness Casey’s independent commission and the need to pay heed to it. All that is important, but my slight fear relates to the drafting. While the new clauses note such factors, they do not necessarily reflect the overall interdependency of all parts of the system. I believe that what the hon. Lady seeks to achieve is perfectly reasonable, but I am not convinced by how the new clauses are drafted. The hon. Lady was right to highlight in her remarks the importance of timely discharge from hospital as a key element of whether we can achieve that flow into hospital beds and have hospital bed capacity to allow an A&E department or emergency department to function. I looked at this issue four years ago, so the situation may well be very different today, but post the pandemic I inherited about 13,000 acute beds across the system occupied by patients who were medically fit for discharge, but whose discharge had been delayed due to a variety of factors. Some were because hospital pharmacies were not open through the night to provide the drugs when patients were signed off to go home; some were because of the unavailability of patient transport; some were because all the necessary clinicians were not present to sign in the appropriate order. The single biggest factor, as the hon. Member for North Shropshire has alluded to, was the availability of step-down or social care provision, so that patients could safely go home or to another NHS or care facility and be looked after. We managed to get the delayed discharge total down from 13,000 at a given time to about 10,000—possibly just a bit under. I would be interested to hear from the Minister what the current total is for beds occupied by those medically fit for discharge at a given time. I see where the hon. Member for North Shropshire is coming from with her suggestion of a tribunal comprised of a mixture of people to interrogate the figures and interrogate the Secretary of State. I can see that she is seeking to make the experiences of those undergoing corridor care and their families real to Ministers, who will be accountable. I gently say that I suspect that the Minister and her boss, the Secretary of State, are only too aware of the consequences of corridor care. Such patient experiences very much weigh on them as Ministers, as they did on me and others, day in, day out. We were always very cognisant of them. I can see the hon. Member for North Shropshire’s intention with new clause 12(4), where she suggests that Healthwatch should be involved in helping put such a tribunal together. I fear that the Government’s direction of travel may have rendered subsection (4) redundant, but I do not disagree with the intention, because I think she and I both share a view on the importance of healthwatch groups and the value that they bring locally to our healthcare system. While I can see the point about waiting 12 hours from arriving at the hospital to being taken into A&E, but the new clause does not reflect how the system might seek to manage that. It does not explicitly reference ambulance handover times and waiting times. A challenge we have seen in the past is that, in a desire to avoid hospital corridor care, some trusts have not admitted patients from ambulances until they feel that they could manage them in the hospital. Arguably, that is less safe than corridor care, for two reasons: first, because the ambulance is not able to offload and be available in the community again and, secondly, because although corridor care has negative consequences, none the less in a hospital corridor there is a consultant or clinician very nearby, should a medical crisis occur. That is better than someone being in an ambulance in the car park—or waiting at home, having called an ambulance that is not coming, and not having their condition assessed because the ambulance is still holding a patient that a trust does not want to admit, in order to avoid congestion and corridor care. I worry that, although the new clause has the best of intentions, the way the system might react and the impact on ambulance handovers and the ability of ambulances to pick up patients might have been overlooked. That is not a reason not to try to solve the problem of corridor care, but we must acknowledge the ambulance part of the challenge in A&E and emergency care, and encourage and incentivise the system to work as a whole to solve the problem, rather than focusing purely on the ED. In saying that, I acknowledge that the hon. Lady has referenced social care, step-down beds and community care, which are all hugely important, and I listened to her speech with interest, as I always do her contributions. I would be grateful if the Minister could update the Committee on the latest daily figure for how many patients who are medically fit for discharge are still in an acute hospital bed. Perhaps, when the hon. Member for North Shropshire winds up on this group, she might be able to address the ambulance point—she addressed the social care point, but I would be grateful for her thoughts on ambulances.
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Health Bill (Fourteenth sitting)
Does my hon. Friend recognise the statistic that between 1997 and 2007, the then Government closed 32,000 hospital beds—more than double the number closed between 2010 and 2022? That is when the big reductions took place, and they failed to put in place an expansion of community beds to match that.
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Health Bill (Fifteenth sitting)
The hon. Gentleman will probably be aware of the King’s Fund report from late last year, which covers the years 2010 to 2025. It highlighted that the growth rate was only 5% for managers during those 15 years, but 94% for children’s nurses and 55% for doctors, and other groups had similar increases. We are seeing investment and workforce increases in the right areas. It is right that we acknowledge, as I suspect the hon. Gentleman will, that the one group where we have not seen that same growth is community health visitors and community health workers. Alongside the massive investment and increase in doctors in the past 15 years, that group, and the role it plays, deserves focus from whichever party is in government.
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Lobular Breast Cancer: Moon Shot Project
It is a pleasure to serve under your chairmanship today, Mrs Hobhouse. I am grateful to the hon. Member for Horsham (John Milne) for securing today’s debate, and to the Members from across the House who have given their voice to this campaign over a number of years. It is entirely right that Parliament should pause today to consider not just the science, the policy and the funding, but the human reality that sits behind all three of those things. Behind the words “lobular breast cancer” are people who knew something was wrong, but the system could not prove it. That is the point at the heart of today’s debate. This is not a call for special treatment or a demand that we place one cancer above another; it is a recognition that different cancers behave differently, present differently and may require different approaches if we are serious about improving outcomes. Today, we are also remembering Dr Susan Michaelis. Many people in public life are described as courageous, but in Susan’s case that word feels insufficient. She was, as we have heard, a commercial pilot, a researcher, a campaigner, a wife and a woman whose instinct, when faced with injustice or uncertainty, was not to turn away from it but to investigate it. She had already devoted much of her professional life to public safety, particularly in the aviation sector. We have heard about how she challenged assumptions, gathered evidence and pursued truth in an area where the consequences mattered for passengers, crews and the wider public. In 2013, she received her devastating diagnosis of invasive lobular breast cancer. As we have heard today, her symptoms were not dramatic; they presented as just a tiny mark on her breast. Two mammograms and two ultrasounds failed to identify the disease, and it was ultimately identified by an MRI scan. We have heard how that revealed what appeared to be a relatively small lesion of about inch that was later confirmed to be over 7 cm. That single account tells us why this debate continues to matter and shows the particular challenge of a cancer that can be harder to detect through standard imaging. Remarkably, Susan did not live her final years in retreat from the world; she continued with her work and her research, and continued campaigning. As we have heard, nine days before her death, she travelled to Manchester to help launch the scientific programme for the lobular breast cancer Moon Shot Project, knowing full well that any breakthrough would come too late for her. That is an extraordinary act of generosity and a challenge to all of us in this place. If someone is living with advanced cancer and can spend her final days and the last of her strength ask for progress for others, surely it is our responsibility and Government to find the clarity and urgency to respond. As we have heard, lobular breast cancer is not rare. It is the second most common type of breast cancer, accounting for around 15% of cases, but despite that it too often remains hidden in plain sight.
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Lobular Breast Cancer: Moon Shot Project
The hon. Gentleman is right; there is collective support for doing more on this issue. That starts with getting the research right. Without the research, we do not know how to plan for the treatments of the future. I will move on to the other points, but he is also entirely right that this is not a party-political issue, but one that affects all of us and all of our constituents. We have to work with a sense of urgency around it. As we have heard, the lobular breast cancer Moon Shot Project is looking for £20 million over five years to advance the understanding of invasive lobular breast cancer and to support better detection, treatment and surveillance. We cannot dispute that that is a significant sum, but we have to look at it in the context of national health spending and what cancer costs: the cost to families and patients and the cost to the NHS when it is detected late or treated inadequately. We have to bear those factors in mind. We should also be clear about what research funding means in practice. It does not mean a guarantee of easy answers. Science does not work like that, but it does mean giving our best minds the chance to ask the right questions. It means building the evidence base and moving beyond a generic understanding of breast cancer and towards a more precise understanding of this specific disease. That is the direction of travel that we have seen over a number of years in modern healthcare. We have seen it in genomics and targeted therapies and we see it in the increasing recognition that treatment must be shaped by the biology of the disease and the needs of the patient. There is no reason that lobular breast cancer should be left behind in that progress. There has been movement—it is right to acknowledge that. The National Institute for Health and Care Research has issued a highlight notice encouraging applications for research into lobular breast cancer; the Government have published their own national cancer plan; and the Health Bill speaks of research duties and innovation. Those are by no means meaningless, but they are not yet enough. That is why today’s debate must focus on delivery, so I ask the Minister whether the Government will set out a timeline to fund the lobular breast cancer Moon Shot Project. If the answer is yes, campaigners deserve to know how and through what mechanism that will happen. If the answer is no, they deserve an honest explanation. Is it a financial barrier? Is it a scientific one? Is it procedural? Are the Government waiting for further proposals, reviews or assessments? The people who have campaigned with such dignity on this issue should not be left trying to decode in silence. I also ask the Minister to address the issue of guidance. Lobular breast cancer is referred to only in limited form in existing national breast cancer guidance, and campaigners have called for the National Institute for Health and Care Excellence to review whether the guidance properly reflects the disease. That guidance, of course, shapes clinical practice and influences what clinicians look for, what tests are considered and how treatment is approached. If the evidence is not yet strong enough to support separate recommendations, that should strengthen the case for targeted research, not weaken it. We cannot use the absence of evidence as a reason not to gather it. That would be a circular argument. The patients affected by this disease deserve much better. There is also a wider lesson here about women’s health. Too often women’s symptoms have been dismissed as vague, complex or difficult to categorise. Too often women have had to become their own advocates at the very moment when they are frightened, unwell and least able to fight. One duty of a good health system is to reduce the burden on the patient and prove that they are worth listening to. Susan Michaelis understood that deeply. As we heard earlier, on 24 June last year, while on oxygen and clearly in pain, she stood outside Downing Street as part of a silent vigil representing the 22 people diagnosed every day with lobular breast cancer in the United Kingdom. She delivered a letter asking for help. Two weeks later she died wearing her Lobular Moon Shot Project T-shirt. That is an image that should stay with all of us today, not because policies should be made on emotion alone—clearly they should not. Policy has to be evidence-based, financially responsible and clinically sound. But should policy not be stripped of a moral seriousness, either. Evidence tells us what may work. Compassion reminds us why we keep working. Responsibility requires us to bring those two factors together. The last Government invested in cancer research, including support for the Institute of Cancer Research and the Royal Marsden biomedical research centre, along with wider work relevant to lobular breast cancer. In opposition we have continued to press the Government on the Moon Shot Project, including through the shadow health team and other colleagues. But this should not, as we have discussed, become a party political contest. Cancer does not observe party lines, and neither should our determination to improve the outcomes for patients. The test for the Government is relatively simple. Can they turn sympathy into a plan? Can they gave campaigners a clear route forward? Can they match the scale of the problem with a response that is specific, funded and time-bound? What those affected by lobular breast cancer need is not another expression of admiration for their bravery and courage. They need progress: a system that sees their cancer sooner, treatments shaped by its biology, surveillance that reflects the risk of recurrence and spread, guidance that recognises the particular character of the disease and research funded at a level that gives discovery a fair chance. Susan Michaelis gave the final chapter of her life to this cause. She did so not for herself, but for women she would never meet and families she would never know. That legacy is worthy of more than a mere tribute; it is worthy of action. I hope the Minister will leave this debate having listened carefully, but also prepared to act decisively. The Government should not only meet the campaigners, but set out the remaining barriers, publish a route to a decision and make clear whether they will fund the Moon Shot project. Dr Susan Michaelis spent her life making hidden risks visible; the task before us now is to ensure that lobular breast cancer is hidden no longer.
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Business of the House
Solihull’s Men Walking and Talking group is a huge success. It can lay claim to being if not the most successful one in the country, then certainly among them, and it improves both physical and mental wellbeing. Will the Leader of the House join me in paying tribute to all those who are organising that group and making it a success? Can he set out what more we can do in this place to promote such groups?
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Pig Farmers
A crucial way to support pig farmers is ensuring healthy pigs, and that requires strong biosecurity and stopping illegal meat imports. When I asked DEFRA about those imports, it said that data are now not available, but alarmingly, Dover Port Health Authority reported seizing 14.2 tonnes of illegal meat in just one week in March. DEFRA has admitted to me that in the first quarter of the year, 28% of vehicles flagged at Dover did not turn up for checks at the Sevington border control post. When we have foot and mouth in Europe just last year and African swine fever advancing up the continent, we run the risk of a catastrophic animal disease outbreak. For the sake of pig farmers and all livestock farmers, when will this Government wake up, tighten our biosecurity and strengthen border controls before it is too late?