Children’s Health

Caroline Johnson Excerpts

Thursday 10th July 2025 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Before I start, I should declare my interest as a consultant paediatrician and a member of the Royal College of Paediatrics and Child Health, which the hon. Member for Stroud (Dr Opher) mentioned earlier. I congratulate him on securing this important debate.

Getting the right start in life is one of the most important factors in adult health and wellbeing. We must ensure that the NHS is providing the best treatments and preventive care available for children, while prioritising safety and convenience for patients and cost-effectiveness for taxpayers. I have seen significant improvements in paediatric care in my career. We must look broadly at the social and environmental factors that affect children’s health and ask what more we can do to help protect and prevent illness in children. Prevention is better than cure, which is one of the Government’s three shifts, with which I agree and on which I wish to focus today.

Often children brought to hospital to see consultant paediatricians have conditions that have been caused, or further complicated, by social and environmental factors. These are things that medics cannot treat on their own, and, as every professional knows, we must work with parents, families and children to achieve the very best outcomes. One very clear example is the childhood obesity crisis, which many right hon. and hon. Members have mentioned already this afternoon. Research shows that 36% of children in year 6—these are 10 and 11-year-olds—are now overweight or obese. I have seen some extreme cases in my practice—for example, a nine-year-old who weighed over 80 kg—of young patients who have suffered serious illness because of their weight. These are the tip of the iceberg, but they are undoubtedly part of a much broader shift.

We know what causes obesity: lack of exercise and a diet too high in calories. But this is more complicated than that. There are complex problems with roots in broader issues such as poverty and family work patterns. The Government cannot determine what each child eats, but there are things that they can and should do to help support parents and their children. What is the Minister doing to encourage exercise, participation in sport and active travel to school? What is she doing to improve the quality and availability of food for parents and families? What is she doing to improve the quality of school food, to build nutrition education into the curriculum and to help children learn about managing their own health and how to cook healthy food?

I know the 10-year plan includes reference to the reformulation of some products, but there is a risk that manufacturers encouraged to remove sugar from products will simply replace it with sweeteners and other chemicals. What is the Minister doing to ensure that they do not solve one problem and then walk unwittingly into another?

The hon. Member for Lowestoft (Jess Asato) mentioned tooth brushing. We often hear that tooth extractions are the leading cause of hospital admissions among young children. Can the Minister provide details on the steps that she is taking to improve youth dental outcomes, such as broadening access to NHS dentists, pursuing fluoridisation schemes and encouraging the use of fluoride varnish?

Parents have a responsibility here too. According to the chief dental officer, who I spoke to the other day, children who brush their teeth twice a day with a fluoride toothpaste, reduce the amount of high-sugar drinks they consume and reduce the sugar in their diet can significantly reduce the risk of needing fillings and having dental decay.

Another area raised today is mental health. Young people face mental health pressures from home and school worries, friendship concerns and many other factors. In particular, we know that the covid lockdown had a serious impact on children’s development and socialisation. We also know that social media is causing increasing harm to children—whether by contributing to anxiety about body image or personal achievements, or by exposing children to harmful material and ideas. The previous Government’s Online Safety Act 2023 was a welcome step in addressing some of these issues, but the Government rejected a Conservative amendment to the Children’s Wellbeing and Schools Bill to help reduce the use of phones in schools. What more does the Minister plan to do to encourage children away from their screens and back towards a healthier existence with their friends and families?

I also want to discuss neglect. A total of 25,350 children are currently on a child protection plan for reasons of neglect—a marked increase from 20,970 in 2014. Organisations such as the National Society for the Prevention of Cruelty to Children have highlighted the fact that numbers are typically underestimated in neglect cases, but we should not underestimate the harm caused to health and development by neglect. What steps are the Department and the Government in general taking to get a more accurate picture of neglect and to intervene on behalf of the children who are suffering?

One area of improvement is the balance of acute and community care, and, again, the Government have talked about this in their three shifts. We know the Government are keen to move acute care into the community, but does the Minister agree that we should ensure that core community care is available more widely and more quickly in the community first before giving them extra work to do? Too often in my practice I see children with paediatric problems who have been referred to hospitals because of long waits and capacity problems in the community. What steps is the Minister taking to ensure that there is enough supply in the community sector to deal with the problems that children face?

In summary, children’s health is a large and complex policy area. We know that we can make good progress when we treat these complex conditions with new research and novel treatments. We know that most children will get better—in fact, one reason that I enjoy paediatrics is that almost all the patients get better, because they are robust, resilient and great fun. We must help parents do things that help protect children’s health today and prepare those children to manage their own health tomorrow.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I now call the Minister, who has up to 5 pm, although we do need a few minutes at the end for the lead Member to wind up.

Alcohol and Cancer

Caroline Johnson Excerpts

Tuesday 8th July 2025 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Mr Stuart. I congratulate the hon. Member for Lancaster and Wyre (Cat Smith) on securing the debate, and declare an interest as an NHS consultant paediatrician.

We have a complex relationship with alcohol. On the one hand, it is a very social drug that is associated with celebration, religious observance in some cases, and small amounts of alcohol with meals. In other respects, it is an antisocial drug that is associated with violent crime, domestic abuse—particularly in cases of binge drinking—and, in some cases, addiction and dependency.

Does alcohol cause or increase the risk of cancer? Yes. We know it is metabolised into acetaldehyde, which can damage our DNA and reduce our cells’ ability to repair themselves. Alcohol changes chemical signals, particularly of oestrogen and insulin, causing increased cell division, and it increases the ability of the mouth to absorb harmful chemicals. It is therefore associated with seven types of cancer: breast, bowel, mouth, larynx, pharynx, oesophagus and liver.

Risk also increases with consumption: small amounts of alcohol are not as risk-provoking as very large amounts. The medical officers recommend a limit of 14 units of alcohol per week, shared over three-plus days a week, with some drink-free days. One in five people in the UK drink more than that. Risk is dose responsive. Education is important; we heard earlier that only 7% of people know that alcohol is a risk factor for cancer.

I was on the Tobacco and Vapes Bill Committee with the hon. Member for Winchester (Dr Chambers). I personally promoted the Bill very strongly, but smoking is different. It is exceptionally addictive and kills two thirds of users if used correctly, whereas alcohol does not have that level of risk for people who use small volumes of alcohol infrequently, and in most cases does not provide the level of addiction that nicotine does.

Life is full of risk. Obesity, processed food, ultraviolet light and infections all cause forms of cancer. Exercise is good for us, but again, it is not without risks to our health. I am not saying that we should not reduce the use of alcohol, but we must understand the risk in relative terms, and ensure that the population are educated about it and can make informed decisions about their lives.

In understanding that risk, evidence is important, so I have some questions for the Minister. What is she doing to improve the evidence that we have on the risks of drinking and the risks related to different levels of consumption? How does she intend to ensure that the public are able to make educated and informed decisions? The “Fit for the future” document published last week talks of labelling coming in on nutrition and calory content. When does she expect that labelling to appear on packets?

Hon. Members have talked about the number of units of alcohol that people drink. Many people do not understand what comprises a unit of alcohol and how to measure it relative to the different types of alcoholic drink. How does the Minister intend to improve understanding of units of alcohol?

I was shocked by the statistic in the “Fit for the future” document that 4% of people drink 30% of alcohol. That is a really shocking statistic, and it is worth repeating: 4% of people drink 30% of the alcohol in this country. There are, to my mind, two issues for the Minister to consider: how the Government can reduce the consumption of alcohol across the board and how they should treat heavy drinkers and dependent alcoholics.

Turning to the latter first, 4% of people drink 30% of alcohol and one in five drinkers drink more than 14 units per week. The hon. Member for Easington (Grahame Morris) talked about an alcohol strategy; I would like to know whether the Minister plans to develop one. One of the disappointing things about last week’s long awaited “Fit for the future: 10 Year Health Plan for England” document was that it did not contain the cancer plan, the workforce plan, the dental contract information or the HIV plan, which are all set to be published in due course. Perhaps an alcohol strategy could join them.

The previous Government rolled out alcohol care teams, which were designed to provide the patient and their family with hospital-based community support, as well as data collection and research. It was found that, for every £1 spent on alcohol care teams, £5 was saved. Those teams supported excessive drinkers and focused on those with the greatest need. Can the Minister talk about how she intends to support those with alcohol dependency and high levels of drinking?

Advertising is an interesting one. The newspapers trailed a suggestion that the Government would ban alcohol advertising. That was, perhaps, an informal U-turn, as it was trailed in the papers rather than announced to the House. We know from the evidence that alcohol advertising can influence brand choice, but it does not appear to affect overall alcohol consumption. Could the Minister enlighten the House as to whether that is why she dropped that measure? We need to be careful with the hospitality sector, which we know is reeling from the changes to the minimum wage and taxes such as national insurance contributions. We do not want people to be put out of business at the scale at which that is currently happening.

It is important to note that general alcohol consumption in the UK is steadily declining. Between 2019 and 2023, the alcohol sales volume in the UK declined by nearly 10%. Revenue from alcohol duty is also projected to fall by 5% this year, according to data from His Majesty’s Revenue and Customs. That shift is particularly observable among younger adults. Since the mid-2000s, there has been a cultural shift. Gen Z, as it is known, is the most teetotal generation in recent memory, and a quarter of 16 to 24-year-olds do not drink at all.

A study produced by KAM and Lucky Saint found that moderation of alcohol has also become a habit for UK adults, with three out of four adults who drink alcohol stating that they have been actively moderating their consumption across 2024. Although raising awareness of the health risks associated with heavy drinking is an important part of the strategy, we must avoid punishing responsible drinkers and damaging the hospitality industry, which is already under significant pressure.

NoLos, no and low-alcohol products, can currently be sold to under-18s. The Government have talked about banning that, which seems sensible to me when it comes to low-alcohol products, but how will the Government define a no-alcohol drink and when do they intend to introduce a ban? There is some evidence that no and low-alcohol beverages displace higher-percentage alcohol drinks, and therefore reduce alcohol consumption. What are the Government planning to do to increase sales of those products?

The previous Government were planning to change an EU directive preventing wine from being described as wine if it did not contain more than a certain percentage of alcohol. I believe that fell due to the general election. Do the Government intend to bring that proposal back?

Personally, I also welcome policies under which the Government plan to define no and low-alcohol products clearly, so that the public can be well informed on what constitutes “low” and “no” alcohol. I had presumed, before reading this, that no alcohol meant no alcohol, but it does not; it means a very low percentage of alcohol. It is important that people are aware of that.

The Government have rightly emphasised the importance of parity between mental and physical health, and socialising and being part of a community are vital components of positive mental wellbeing. Pubs and social venues play a central role in our communities. In a recent survey, 73% of respondents agreed that pubs in the area have helped to combat isolation; 72% that they have a positive impact in the communities; and 81% that they are important in bringing people together.

Ultimately, with more than 80% of the population consuming alcohol within Government guidelines, our focus should be on helping the minority who drink at harmful levels, and on improving decision making and education for those who drink at lower levels. We must work with industry to avoid policies that jeopardise the survival of community spaces, or lead to higher taxes for the majority of people who drink low levels of alcohol responsibly.

Rare Cancers Bill

Caroline Johnson Excerpts

Committee stage
Wednesday 2nd July 2025 Public Bill Committees

[Robin Swann (South Antrim) (UUP)]

It is a pleasure to serve under your chairship, Mr Stuart. I thank and congratulate the hon. Member for Edinburgh South West on bringing forward this private Member’s Bill, which will have life-changing effects for many individuals across the entirety of the United Kingdom. I applaud him for it, because I know some of the driving reasons behind him doing that.

I have a couple of points to make about the Bill. I am fully supportive of it, but I note the geographical challenge it brings. The Northern Ireland Assembly passed a legislative consent motion for clause 1 on Monday, so we are already stepping into line for this legislation. Much of the relevant work was discussed in the Northern Ireland cancer strategy, which was published in 2022 when I was Minister of Health there. It looked at our specific challenges with regard to research and clinical trials. At that point, cancer charities highlighted that only 15% of cancer patients in Northern Ireland are offered the opportunity to take part in cancer trials, compared with 31% across the rest of the UK. I hope the Bill increases awareness among Northern Ireland patients and cancer sufferers, and their families, of what is out there and their ability to take part.

The other concern often raised by some of my Northern Ireland colleagues—you are aware of this, Mr Stuart—is the EU implications. I can state that novel treatments do not fall under the scope of the EU, so hopefully any medication, treatment or supply that comes forward will be equally accessible and applicable to the entirety of Northern Ireland. The only difficulty and challenge we have in progressing the Bill’s other provisions is the legislation that allows Northern Ireland to use secondary data for cancer registries. I am aware that the current Health Minister in Northern Ireland, who is my party colleague, has a one-clause Bill ready to move forward to rectify that.

I wanted to make that small contribution in support of the work done by the hon. Member for Edinburgh South West in bringing forward the Bill. It has been a pleasure to serve on this Committee.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Mr Stuart. I congratulate the hon. Member for Edinburgh South West on bringing forward this very important piece of legislation. I declare an interest as a consultant paediatrician who has looked after a number of children with rare conditions such as teratoma, rhabdomyosarcoma, Wilms’ tumour and retinoblastoma, to name but a few.

One of the issues with rare cancers, which transposes to rare diseases in general, is that they are often diagnosed late, because people do not recognise that they have symptoms of a rare disease and their health professionals are not as familiar with them because they are rare. The presentation and diagnosis are then late and, as such, the treatment is more difficult. That is compounded further because there has been less research on those topics, so it is not clear what the best treatment for those conditions is. On top of that, the patient may have to travel very long distances to see a specialist who is familiar with the condition, adding both logistical difficulty and cost to that patient’s care.

Some steps are in place to try to improve the situation. The orphan drug regime gives market exclusivity for 10 years, and it provides for lower and refunded fees from the Medicines and Healthcare products Regulatory Agency for the services it provides. Nevertheless, it can still be non-commercially advantageous to put money into developing a drug that is going to be used on no more than a handful of people, however beneficial it is for the individuals concerned.

I welcome the Bill, but wish to make a couple of points. First, in principle it is best that trials are first broached with the patient by a member of their healthcare team. Of course, a member of any given healthcare team—I speak as one myself—will never be aware of all the trials available to all patients at any one time. I welcome the Lord O’Shaughnessy review—commissioned by the last Government and accepted by the current one—which talks about getting a consensus on how best patients can be informed of trials. I wonder whether we should have a system in which patients opt out of not the trial itself but being asked about trials. At the outset, they could be asked, “Would you like to receive information on trials—yes or no?”, so that more people can be aware of how they can contribute. When people are diagnosed with something rare, they often want to contribute to helping others who will come after them.

Will the Minister tell us more about the national cancer plan, which was consulted on earlier this year? I welcome the fact that the children and young people cancer taskforce, which was paused, is being reinstituted. Also, how will the Bill apply to repurposed drugs? Sometimes new medicines are developed for a particular condition, but we often find that medicines can be reformulated and used in a different way to provide a different form of treatment to help individuals with a different condition. How will that apply in respect of both the measures in the Bill and the O’Shaughnessy review?

As a paediatrician, I am very pleased that the Bill applies to children. Overall, I think the Bill is great. It offers hope for many in the future. Will the Minister say something about other rare conditions? As well as rare cancers, people get other rare conditions, and they are affected by the same challenges with research and treatment, and by delays in diagnosis and travel.

Overall, doctors are able to save people’s lives, and improve people’s lives, one at a time, but Parliament and research offer the opportunity to do that on a much bigger scale. I am very grateful to the hon. Member for Edinburgh South West for what he is doing today.

[The Parliamentary Under-Secretary of State for Health and Social Care (Ashley Dalton)]

It is a pleasure to serve under your chairmanship, Mr Stuart. I congratulate my hon. Friend the Member for Edinburgh South West on his Bill reaching Committee stage. That is a huge achievement for any colleague, but especially for one who has served in this place for almost exactly a year to the day. The Government welcome contributions from Back Benchers, we welcome effective scrutiny from Committees, and we value the vital role that Parliament plays in holding us to account.

In April, my right hon. Friend the Prime Minister announced that clinical trials would be fast-tracked to accelerate the development of the medicines and therapies of the future. Through this new drive, patients will have improved access to new treatments and technologies. We see the Bill as contributing to that ambition. We want to go further for patients with rare cancers, and this legislation will act to incentivise recruitment, oversight and accessibility of rare cancer research, so that NHS patients are at the front of the queue for cutting-edge treatments.

Clause 1 will ensure our regulatory competitiveness. It places a duty on the Government to publish a review of the legislation around orphan drugs within three years of the Bill becoming an Act. The review will examine our legal framework and compare our approach to that of our international partners. We want the UK to lead the world in this space, as the prime destination for clinical research.

Clause 2 will raise the profile of research for rare cancers by placing a new duty on the Secretary of State for Health and Social Care to facilitate and otherwise promote research in this area. The Government want to give patients greater choice and control over their healthcare, and rare cancer patients should have access to research if they choose.

The clause also ensures that the Government will develop a bespoke registry service for rare cancers, to be delivered through the “Be Part of Research” programme—our groundbreaking research registry service provided by the National Institute for Health and Care Research—and that we will appoint a national specialty lead for rare cancers, which we will designate within the NIHR research delivery network, who will have oversight of the overall rare cancer studies portfolio in England.

The Government are committed to going further for rare cancer patients, and that means making clinical trials more accessible. Clause 3 will introduce an innovative solution to allow rare cancer patients to be contacted as quickly as possible about clinical research. The clause creates a new power to allow patient data to be shared from NHS England information systems.

IVF Egg Donation: Young Women

Caroline Johnson Excerpts

Thursday 26th June 2025 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Mr Efford. I, too, congratulate the hon. Member for Strangford (Jim Shannon) on securing an important debate at such short notice.

IVF counts as a medical miracle, in many respects. Since the technique was pioneered in the 1970s, some 12 million babies have been born by IVF or associated procedures. In the UK, there have been more than 70,000 donor births since 1991, when we started counting egg, sperm and embryo donations. Such births now account for one in 170 live UK births. For many families and individuals, those treatments have given hope where they otherwise would have none. Those suffering from fertility problems have been able to pursue their dreams of having a family with the help of IVF, and success rates have increased over recent decades. The children born as a result of these treatments have given great joy, love and happiness to their families.

With that in mind, the previous Government committed to broadening access to these services. As the hon. Member for Chichester (Jess Brown-Fuller) said, the women’s health strategy for England, published in 2022, included removing barriers to access for same-sex couples. The previous Government also changed the law so that same-sex couples would not have to go through specific infectious diseases screening before pursuing reciprocal IVF. Those measures were designed to ensure that as many as possible could enjoy safe and equal access to treatment.

In my constituency, I was approached by a lady who has medical reasons for her infertility, and is married to a gentleman who had a child many years ago in a previous relationship. She found that she was not eligible for access to IVF. If she said she had no partner, she would be eligible for a sperm donor. If she said she had a female partner, she would be eligible for a sperm donor. Since her partner, however, had a child from a previous relationship, she was not able to have treatment for her medical condition. Personally, I did not think she should be denied access to that, so I have been campaigning with the local ICB, which is currently doing a review. I hope that review is not disrupted by the changes the Government have made to ICB funding.

IVF is a highly complex procedure, with several different approaches now available to doctors and patients. One of those approaches involves an intending parent receiving donor eggs from another woman. That can be a lifeline for those who cannot use their own eggs, whether due to age, quality or other physiological factors. It relies on the generosity and selflessness of the donor women who contribute their own eggs so that others may have a chance of raising children. That process contains risk, and although we recognise the huge opportunities that IVF offers and the generosity of the donor women, we must make sure that the procedural risks, advertising and regulation are properly managed.

Typically, egg donors must be between 18 and 35, be in good health, have no inheritable conditions, and pass a variety of screening and suitability tests. Those requirements are designed to provide reassurance for intending parents, but in order to find as many potential donors as possible, many companies pursue aggressive advertising strategies to attract eligible donor women. When I first thought about this, I thought, “I haven’t seen any adverts for such a process.” Then I recognised that, of course, I am not in the target audience, because I am too old.

With social media, when we think about something, before we know it, it has appeared on our phone or another device, in the corner of the screen as an advert. I am advised by women who are of the right age that they feel they get a lot of adverts to encourage them to be egg donors—more than they would like to see. Does the Minister agree that the guidance on internet advertising in particular needs to be updated, especially in the light of the targeting of adverts at particular demographic groups? Will she commit to investigating how many women are targeted by adverts for a service that they would not consider engaging with, and ways of being able to avoid those?

There are also risks to the process. It is especially important that women know the full extent of the risks before they agree to a medical elective procedure, in particular one that is not for their own benefit. Ovarian hyperstimulation syndrome is one of the main risks for egg donors and causes symptoms rising from mild discomfort and bloating to serious respiratory problems, renal failure and, in extreme cases, death. A 2023 review study in the Journal of Assisted Reproduction and Genetics found that severe ovarian hyperstimulation syndrome occurs in 1% to 10% of stimulation cycles. That is quite a wide range of uncertainty, and it is partly why many donors have argued for more research to be done to support informed consent and proper regulation on how the risks are communicated to donors.

We have already heard in this debate about the long-term risks. Given that the HFEA will know who all the ladies who have generously given of their eggs are, does the Minister have any plans to look back at that data in an anonymized fashion to see whether any long-term health risks can be identified? Will she also talk about the steps that the Department is taking to ensure that high-quality research is accessible for those considering egg donation, and about whether companies are mandated to conduct and provide it as part of their advertising?

We have talked about compensation during the debate. Fertility companies make much of the altruism motivating donors to give their eggs, and that no doubt forms part of the reasoning of donors who admirably wish to help others less fortunate than themselves by contributing their eggs. It is also true, however, that fertility companies provide compensation payments. Those are capped at £986, a limit intended to ensure that women are not enticed to donate eggs due to financial need, but a risk remains that women more in need of financial assistance may be attracted by the payments. Recent coverage has highlighted that some services present donation as a second income stream.

Clearly, however, women who put themselves through a lengthy, often uncomfortable and potentially dangerous process in the name of helping others should not be out of pocket as a result. Getting that balance right requires careful attention. The Government must ensure that they review the compensation rates and how it is provided —as a flat sum or on receipt—to ensure that we get this right.

Beyond the financial cap, companies are also allowed to advertise benefits in kind, such as discounted egg freezing for women who donate some of their eggs to others. In essence, therefore, they are saying to ladies, “If you come to donate some of your eggs, we’ll allow you to store your own eggs for a much reduced price, in case you need them later.” Some women might see that as a reason to donate eggs—that they cannot afford to freeze their own otherwise. What are the Government doing to manage the kind of additional incentives that might encourage women to donate eggs when otherwise they would not? Does the Minister plan to regulate non-monetary incentives in the future?

[Jonathan Hinder]

Whatever we think about the motivations of the women involved, we can agree that private companies are concerned with profit, and they are the ones that are in many cases running such adverts. Does the hon. Lady agree that it is unethical to make profit out of the practice?

[Dr Johnson]

I am not clear whether the hon. Gentleman is referring to companies making profit out of providing IVF services, or whether he is talking about those who profit from egg donation itself.

[Jonathan Hinder]

I am talking about egg donation.

[Dr Johnson]

I think it is reasonable for companies to provide IVF as a service in the private sector, but making profit out of the specific egg donation itself is a separate issue. I agree with him on that.

Regarding other ethical issues, we must think about the longer-term impacts of egg donation and ensure that women are properly equipped to deal with them. Children born from egg donation have a legal right in the UK to contact the woman who donated the egg from which they were born, and to obtain their name, age and last known address from the HFEA. The first cohort of children with that right were able to use it only relatively recently, in 2023, so it may be too soon to know what the long-term impacts might be for the children or donors concerned, or to what extent it may affect their family relationships or emotional wellbeing. Will the Minister tell us how many children are known to have exercised that right since 2023? What is the Department’s assessment of the likely long-term impacts on those children, their families and the donors?

IVF offers a lifeline that can transform people’s lives for the better, but where women are donating eggs to others, we must make sure that they are aware of the risks, and that they are doing it for the right reasons, not because they are being enticed financially. The Government must ensure that compensation does not become financial incentivisation, that advertising is accurate and unbiased, that women’s wellbeing is put first, and that the public have the information they need to make informed choices about their bodies and their healthcare.

Care Settings: Right to Maintain Contact

Caroline Johnson Excerpts

Tuesday 24th June 2025 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Ms Butler. I declare my interest, as an NHS consultant.

I know from my own professional experience that hospitals and other care settings can be distressing places for patients and their relatives. Even with our excellent NHS staff on hand, patients want more assurance and familiarity while they undergo care and treatment. For many, that support comes from the family and friends who visit them during their hospital stay, or while they are in a hospice or receiving care in a care home. I pay tribute to the very many excellent staff who work in those settings and provide care around the clock and during public holidays, and put themselves out to care for others.

For residents, care homes are just that: their home. They should be entitled to have relatives and friends visit them as they would in any other home. Visitors also improve care. An inability to visit one’s relative in hospital leads to an increased feeling of not knowing how they are this morning—whether they are getting worse or better, whether they are in pain or are comfortable, or whether they can reach what they need to get. Relatives fear not being able to help the resident, and worry about whether they are lonely or stressed because they are not there to support them. That adds to the relatives’ stress.

The patient or the person in the care home knows that staff are busy and may not want to bother them for small things, such as reaching a book or their glasses, passing them a drink—which is so important for hydration—helping them eat a meal, moving the curtains so the sun is not in their eyes or providing an extra blanket. Instead, many wait hours for their relative to come. Sometimes, they just want a cuddle and to hold hands with the person they love. Clearly, that is in the best interests of their health and wellbeing.

Relatives know the person they are seeing the best, and are able to identify changes in condition that may go unnoticed by staff. I remember visiting a relative of mine who was getting better following surgery and was stepped down from the high-dependency unit to the ward. When I arrived, I realised that he looked grey, pale and unwell. He was indeed in shock and required urgent fluid resuscitation. I shudder to think what would have happened had that not occurred at the beginning of visiting time.

It was with those things in mind that the previous Government introduced the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and, in particular, regulation 9A. Like others, I pay tribute to my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) for doing so. The regulations were designed to ensure that patients staying in hospital or residential care settings could receive visitors in a fair and consistent way. They also aimed to ensure that care home residents would not face barriers or discouragement if they wanted to take their visitors outside, and they made provisions for those attending non-residential hospital or hospice appointments to have guaranteed rights for friends or family members to accompany them.

However, now that these regulations are in place, we need to ensure that they are working effectively and that systems are in place to detect any attempts to water down or remove the rights that they provide. I want to raise the exceptional circumstances limitation with the Minister. Members will know that the regulations grant visiting rights unless there are exceptional circumstances. The CQC guidance states that providers should base this assessment

“on the health, safety and welfare of people using the service or other people involved. This should include giving consideration to the appropriate balance of a person’s rights, the needs of people using their service and any identified risks”.

If concerns have been raised about current levels of compliance with visiting regulations, we must begin by identifying how and why this caveat in the rules is being used. Can the Minister tell us what kinds of circumstances private providers deem to be exceptional? Who is making these decisions and who is overseeing that process? The CQC guidance also states that where additional precautions or restrictions are needed, they should represent

“the most proportionate and least restrictive option”

that is available. Is the Minister confident that this principle is being followed, and what is she doing to provide transparency for patients and their carers about decision making?

In summary, can the Minister tell us how many times the exceptional circumstances provision has been used in the last year by each institution and how many visits or accompanying visits have been blocked as a result? Is she monitoring such blocking? What steps is she taking to ensure that those with reduced mental capacity have their rights to visits upheld?

It is important that these rules are followed. The vast majority of care settings provide excellent care, but the concern is that the better care settings are more open than others, and as the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) said, sometimes, visiting times may be restricted to cover up poor care, adding to the stress of the patient or resident and their carers. It is important that the Minister does what she can to improve the education and training of staff, and change the culture of settings so that everyone is able to receive the visits they need.

Some providers are even using the realms of infection control measures to exclude visitors. Surely, if infection control measures are frequently being used to restrict visiting, that is a red flag that the infection control measures in that institution are not providing adequate safety for residents. What steps is the Minister taking to ensure that staff follow the requirements placed on them and to make sure that individual providers are not being selective in their adherence to the rules?

It is clear from what we have heard today that more needs to be done to ensure that patients receive the visits and accompaniments that they are entitled to. If we are serious about putting patients and residents first, more needs to be done to guarantee them the social and emotional support that they need to be comfortable, as well as the best treatment or palliative medical care available.

As others have already said, the CQC is not able to prosecute for breaches of regulation 9A, although it can take action such as civil enforcement measures. Does the Minister believe that is a strong enough incentive for providers to meet their obligations, or does she recognise that increased enforcement powers might be needed to ensure that the rights of patients are protected? What other schemes has the Department considered to help providers to better facilitate contact and visiting arrangements?

I will finish by saying that I work as an NHS consultant paediatrician, and in paediatrics we always have open visiting for parents. Parents are really helpful in providing the care and looking after the children as part of a teamwork approach between parents and staff. Can the Minister say why such visiting arrangements are not available for people of all ages when they are at their most vulnerable, because I cannot see why they should not be? Indeed, I think that it would help quite dramatically.

[The Parliamentary Under-Secretary of State for Health and Social Care (Ashley Dalton)]

Thank you, Ms Butler, for chairing this important debate at such short notice, and I thank my hon. Friend the Member for Liverpool Walton (Dan Carden) for securing it.

The Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), has asked me to pass on his apologies; he is unable to represent the Government in this debate as he is currently in session on the Mental Health Bill Committee. However, he joins me in thanking my hon. Friend the Member for Liverpool Walton not only for securing this debate, but for all the work he has done in advocating for relatives and friends to have the right to visit care home residents and patients in hospitals and hospices.

I also thank all those who have shared their personal stories and those who are in the Public Gallery today. I can say without hesitation that the Minister for Care and I agree with my hon. Friend on the importance of visiting in care settings. Contact with family and friends is a crucial part of a person’s care. Indeed, there is evidence that supporting people to be actively involved in their own care, treatment and support can improve outcomes and experiences for people receiving care. No one should be denied reasonable access to visitors when they are in a care home, a hospital, or a hospice. That includes receiving assistance from a care supporter or simply going for a walk with a family member or friend.

Before the covid-19 pandemic care homes, hospitals and hospices set visiting policies based on their specific local circumstances. During the pandemic, restrictions on visiting were implemented to prevent the spread of covid-19. Those restrictions were in response to clinical advice and were designed to protect people living in care or in hospital, who were often among the most vulnerable to the virus. Visiting and accompanying is one of the fundamental standards against which the Care Quality Commission assesses quality of care.

The Government recognise how important visiting is for the health and wellbeing of residents in care homes and patients in hospitals and hospices. We have monitored the position since the new fundamental standard was introduced in 2023. We know that the majority of health and care providers are facilitating visits and recognise their importance. The capacity tracker, a digital tool where adult social care providers self-report data, shows that 99.3% of care home providers are facilitating visits. That figure has been stable since September 2022. However, we also know that there are times when it is necessary for movement in and out of care settings to be temporarily restricted.

[Dr Johnson]

Can the Minister clarify what constitutes a visit in those circumstances? Would an hour’s visit once a week count, or is there a specific timeframe that qualifies?

[Ashley Dalton]

I do not have that data to hand, but I will make sure that it is provided to the shadow Minister afterwards.

While there is sometimes the need for temporary restrictions or modifications to minimise significant risks, the Government hope that such instances are a rarity. It is our aspiration to ensure that visiting policy and practice strike the best possible balance between individual wellbeing and public health needs. I have been really moved by, and taken note of, the evidence put forward by many Members that that may not always be the case.

The right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) talked about her experience with her mother, and brought to life the value that family and friends bring to the emotional wellbeing of the person being cared for and how, as partners in care, they play a key role in delivering that care.

Department of Health and Social Care

Caroline Johnson Excerpts

Tuesday 24th June 2025 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I congratulate the acting chair of the Health and Social Care Committee, the hon. Member for Birmingham Erdington (Paulette Hamilton), on securing this important debate. It is almost one year since the Labour Government took office. They came to power promising that they had a plan to improve our NHS. However, what they actually had was a plan to get a plan by launching a consultation asking professionals and the public for ideas. The consultation was launched in October last year, and I understand that more than 220,000 people have contributed, but despite it being promised for spring, there is still no sign of it. Will the Minister commit to publishing a plan before the summer recess?

While the Secretary of State considers what the plan should say, over in No. 11 we have seen the Chancellor follow the usual Labour playbook: higher spending, higher borrowing and higher taxes. There will be more funding for the NHS, yet as the chief executive of NHS England noted, the NHS budget is now equivalent to the entire GDP of Portugal, reaching £226 billion in 2028-29. That is around 50% of public spending. It is said that 18th-century Prussia was an army with a state attached to it; 21st-century Britain is at risk of becoming a health service with a country attached to it. This is not the Government’s money; it is taxpayers’ hard-earned cash, yet the Government have provided no clarity—no meaningful detail and no credible plan—on how such vast sums will be used.

In the autumn Budget, an additional £10.6 billion in extra funding was promised for 2025-26. However, Julian Kelly, NHS England’s former chief financial officer, told the Health and Social Care Committee that most of it will be consumed by pay settlements, the national insurance hikes and non-pay inflation. Today, 64% of NHS spending goes towards personnel wages and pensions, which is a far higher proportion than in other comparable systems, but the NHS still faces staff shortages and expensive agency costs. Will the Minister confirm how much of the overall funding will go to salary increases? How much will be diverted into covering the national insurance increases for hospitals, social care, pharmacies, GPS, NHS contractors and social care providers?

As we speak in this Chamber, resident doctors and nurses are balloting for industrial action. Strikes would only add to the disruption and delay in care for sick and vulnerable people. Do the Government have a plan to minimise the impact of strikes, should they occur?

Let us look at one proposal that the Government have announced: the scrapping of NHS England. This Government by press release announced NHSE abolition without adequate planning. Ministers have dodged basic questions about costs, staffing changes and structural reform. There is, once again, no plan. The details that we know about do not inspire confidence. NHS England has asked the ICBs to reduce their costs by up to 50% by October 2025. ICBs will have to cluster, with the number expected to fall from 42 to 27 in two years. Many have warned that services will be cut, and redundancy payments linked to those restructurings could reach £1 billion in 2025-26. Has the Minister costed that in the Department of Health and Social Care revenue settlement?

The Government promised to restore the 18-week hospital waiting time within this Parliament. However, their departmental modelling shows that only 80% of patients may meet that standard for routine operations. Will the Minister confirm that the Government will deliver that promise?

Moving on to capital spending, the Minister says that she wants to continue the new hospitals programme, albeit more slowly than we would have done, and invest in technology, but capital budgets remain flat in real terms. The chief executive of the NHS Confederation says that this leaves

“a major shortfall in capital funding”.

The Nuffield Trust said that

“it will be difficult for the NHS to invest in the technology and facility upgrades it needs to meet the government’s…targets.”

Will the Minister explain how they will prioritise, and what will be delivered?

The Government have said that they want to shift funding from hospitals to primary and community care. Will the Minister confirm or deny reports that the NHS 10-year plan will delay the planned increase in spending on primary community care until 2035, instead of 2029, as was originally promised? A key part of community care is social care, but as Daniel Elkeles, the chief executive of NHS Providers, noted,

“social care…hasn’t been given the focus it needs”,

and that is

“a significant blocker on progress for the NHS.”

Cross-party talks on reform have quietly been abandoned in favour of an independent commission led by Baroness Casey, but that process is not due to complete until 2028. Yet again, we see headline-grabbing announcements from the Government, with no delivery plan and no real reform, leaving patients, staff and families waiting for the care they desperately need. The Government aim to deliver £13.8 billion in efficiency savings by ’28-29, with more than £9 billion of that total expected to come from DHSC alone. Will the Minister clarify where, within the Department, those savings will be found, and what impact assessments have supported those decisions?

The Government say that prevention is better than cure, and I agree. A good example is the “Act FAST: face, arms, speech, time” campaign, which we will all be familiar with, but just last week, in an answer to a written parliamentary question, the Minister admitted that

“the Government have made reductions in the Department and NHS England’s communications and campaigns.”

Can the Minister tell us which public health campaigns are to be affected?

Finally, the dental contract requires reform. The Government started negotiations a year ago, yet the Public Accounts Committee has noted:

“NHSE and DHSC do not yet know what reform might look like or to what timescales it can be delivered”.

Will the Minister tell us when the Government expect to conclude negotiations and get on with dental reform? In summary, the Government need to stop governing by headline. They need to publish a robust evidence-based plan, and start delivering.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 17th June 2025 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

Last health questions, I asked about delays to crucial medications in A&E and the Secretary of State said he was interested to hear more, but his office said he would delegate it to a Minister and we still have not been offered a date, so could I encourage him to look into that, please? The U-turn on winter fuel will help the elderly to stay warm and healthy this winter, but another way to help elderly people would be to protect them from the respiratory syncytial virus. Will the Government extend the vaccination to the over-80s?

[Stephen Kinnock]

I thank the hon. Lady for that question, but I did not quite catch the word she used. The virus was called? [Interruption.] Oh—RSV, yes. We are certainly looking at increasing the coverage of the RSV vaccination. I do not have the statistics to hand at the moment, but I would be happy to write to her on that point.

[Dr Johnson]

Many of those on waiting lists are elderly and have chronic conditions; rather than seeing consultants at regular intervals, which may coincide with them being relatively well, they are often kept on open appointments so that they can call when they are ill. This is efficient and responsive care. Is the Minister aware that this provision is being stopped in some areas in order to improve figures? I will quote from a letter about an elderly patient:

“I regret cannot keep him on my waiting list under the open appointment”

for treatment, and,

“I have explained the politics of everything and where we are at.”

Being re-referred to a GP each time is expensive and a waste of time. Can the Minister explain why doctors are being asked to make decisions for political reasons, instead of clinical ones?

Terminally Ill Adults (End of Life) Bill

Caroline Johnson Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Patricia Ferguson]

My hon. Friend makes a valid point. The point of my amendment, as I will come on to, is that we need to ensure as much scrutiny as possible in this regard.

From what I have outlined, this is clearly an exceptionally important post, which carries great responsibility and significant power; indeed, it seems the postholder will require the judgment of Solomon to be able to fulfil their role. It is therefore surprising that, as the Bill stands, there is no requirement for pre-appointment scrutiny by the relevant Select Committee, despite the profile of the post and the controversy it will inevitably attract.

Considering that such pre-appointment scrutiny is required for the chair of the Competition and Markets Authority, the chair of the BBC, the chair of the Charity Commission, the Information Commissioner, the chair of the Care Quality Commission, the health service commissioner for England, the chair of the Judicial Appointments Commission and the chair of the UK Statistics Authority, the omission of such scrutiny in this case is clearly a serious oversight, which my amendment seeks to remedy by ensuring that the correct Select Committee has the power of scrutiny.

In my view, we need to guard the rights and privileges of Parliament jealously. We must ensure that Parliament is involved in the scrutiny of this legislation going forward as much as we possibly can. The Bill itself requires this to be as rigorous and transparent as is possible. No matter what side of the debate we are on, it is important to ensure that the Bill is as strong and as good as it possibly can be; we owe it to the people who send us here—the people who have been writing to us in such great numbers. My amendment seeks to strengthen the Bill in respect of the voluntary assisted dying commissioner.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I refer right hon. and hon. Members to my entry on the Register of Members’ Financial Interests—I am an NHS consultant paediatrician.

The debate so far has focused primarily on ethical considerations, legal frameworks and who will be eligible—the who, the when and the why—but I want to focus my remarks on the how. As a doctor, I know that various drugs in different combinations can be fatal; in other words, there is more than one way to kill people. Which would be the best drug, if that is what we wished to do? Which would be the most comfortable, and how do we know?

Some forms of assisted dying use neuromuscular blockades, which, in common parlance, means that they paralyse the body. Imagine a situation where someone in a lot of pain is given such a drug; from the outside they would look relaxed and peaceful as their muscles relaxed, but inside they would be in a lot of pain, and unable to express that to anybody else. Do we want people to be comfortable and to know that they are comfortable, or only to appear comfortable to us? Clearly, we want them to be comfortable inside as well. We therefore need to have drugs that are properly understood and regulated for this purpose.

Assisted dying is often portrayed as safe, peaceful and controlled, but the reality in comparable countries where it has been legalised so far is more complicated. Technical difficulties frequently arise, leading to complications causing greater suffering, requiring intervention and potentially leading to a prolonged and painful death.

A report in The BMJ by Dr Suzy Lishman, former president of the Royal College of Pathologists—who, I should say, works at the same trust as me—showed that there is a lack of reliable data on the effectiveness and safety of the drugs used, largely due to inconsistent reporting in jurisdictions where such dying is legal. In Belgium it is estimated that only 52% of euthanasia cases are reported to the Federal Commission for the Control and Evaluation of Euthanasia.

During a Select Committee visit in the last Parliament to Oregon to discuss assisted dying, which I and two other hon. Members from the Labour Benches went on, we heard about the complications being unknown in 71% of cases. No healthcare professional was present when the drugs were given so we could not really know, and we did not even know if the drugs had been taken in some cases. Where we did, we found a history of seizures, vomiting and prolonged deaths. On having been given the drugs, patients in nine cases in Oregon in 2023 had reawakened later. How they felt in the intervening time is difficult for us to know.

In Washington, a 2018 report found that 31% of patients took more than 90 minutes to die. I also remind hon. Members that an absence of evidence that things are not going well is not evidence of an absence of things going wrong.

[Anna Dixon]

I thank the hon. Lady for so eloquently describing some of the variation in the use of drugs in the case of assisted dying. In normal practice we have a yellow card scheme, which allows for any adverse events from ingestion of prescribed medication to be reported. Is it her understanding that, under the current proposals, that would not happen for assisted dying? Is she also aware of a review that shows a great variation in the range and dosages of drugs used?

[Dr Johnson]

I think one of the key problems with this form of intervention, compared with others, is that we cannot ask the patients afterwards how that felt. We cannot get their feedback, because they are dead. If we are going to give them things such as neuromuscular blockers or sedatives, we may not be able to tell what they feel. There are physiological ways in which we can monitor patients and get some idea—perhaps in their heart rate or blood pressure—but we will not be doing that. That is, therefore, one of the reasons for my tabling the amendments, to ensure that the drugs are properly regulated by the MHRA, so that we know that they have been properly tested on the purpose for which they are to be used.

[Sadik Al-Hassan]

Will the hon. Lady give way?

[Lizzi Collinge]

Will the hon. Lady give way?

[Dr Johnson]

I do not have much time and I do not want Madam Deputy Speaker’s cough to return. [Laughter.]

If one examines the litany of drugs involved in other jurisdictions where assisted dying is legal, it makes for troubling reading. It is often an ad hoc cocktail of lethal substances, including sedatives, analgesics, cardiotoxic agents, neuromuscular blockers and antiemetics. There is no internationally agreed drug regime. Jurisdictions such as Oregon, Canada and the Netherlands use varying combinations of barbiturates, sedatives, opioids and antiemetics. In 2020, the official Oregon report stated that, compared with single barbiturates,

“All drug combinations have shown longer median times until death”.

As the Bill currently stands, doctors will have to consider prescribing untested drugs or drug combinations, which could potentially breach the General Medical Council prescribing guidance that a doctor must be satisfied that the drug serves the patient’s needs. To address some of those concerns, I have tabled several amendments.

Amendments 96 and 97 ensure that no drug can be approved under the Act unless there is a scientific consensus that it is effective and does not cause undue pain or side effects, and that it has been specifically licensed for that purpose by the MHRA. I cannot really understand why anyone would disagree with that.

Amendment 98 clarifies that the Secretary of State is not compelled to approve any drug if, after consultation, it is concluded that no substance is appropriate or safe enough to meet the standard.

Amendment 99, alongside amendment 100, mandates that before any regulations are laid before Parliament, a comprehensive report must be provided. That report must include time to death, possible complications including pain, and any likely side effect of the proposed substances. Again, I cannot see why that would be controversial, because surely we all want everybody to be fully informed and make fully informed decisions, and that is part of making an informed decision.

Amendment (b) to new clause 13 requires any medical devices for self-administration be approved by the MHRA and that the Secretary of State consult the MHRA before making any regulations. That is a basic safeguard that we would expect in any medical intervention, and it should be a non-negotiable condition here.

Finally, amendment 42 removes a time limit and therefore the pressure on the Secretary of State. I understand other people’s concerns about that. There is often a narrative that it will lead to patients being able to die at a time and in a place of their choosing. However, the regulations in the Bill require the doctor to stay with the patient from the moment the drug is given until they are dead. We have heard that that could take quite a long time. Do we really have enough doctors to do this at people’s homes at a time of their choosing? At the moment, I do not think we do, and I do not see how, in a short period of time, that will be achievable either.

[Mr Alex Barros-Curtis (Cardiff West) (Lab)]

I stand in support of new clauses 20 and 21, along with amendments 89 and 90 and 92 to 95, all of which are in the name of my hon. Friend the Member for Spen Valley (Kim Leadbeater). Colleagues need not fear—I will not speak to all of them.

I am a proud Welsh MP, and a lot of the debate today has centred on differences or confusion about the distinction on devolution on aspects of the Bill. Focusing on new clause 21 and consequential amendment 90, I pay tribute to my hon. Friend the Member for Spen Valley and to the right hon. Member for Dwyfor Meirionnydd (Liz Saville Roberts) for their work together on this issue to ensure that people in Wales can access the assisted dying process in the Welsh language, if that is their preference.

In the last few months, I have met with many constituents about this Bill, including medical professionals and palliative care consultants. One of their overarching concerns is a fear that the language barrier may inadvertently impact on the ability of a relevant person in Wales properly to access and understand the assisted dying process. I am grateful to those constituents, including Dr Siwan Seaman and Professor Mark Taubert.

Accordingly, new clause 21 and amendment 90 are important. They seek to replace clause 47 and provide Welsh versions of the forms for the first or second declaration, the report about the first or second assessment of a person, and the final statement. Further, they stipulate that where a relevant person informs the voluntary assisted dying commissioner that they wish to communicate in Welsh, the commissioner must take all reasonable steps to ensure that that wish is respected and that communications by the relevant assisted dying review panel are in Welsh. These are important amendments, as they are about accessibility and respect, ensuring that language is never a barrier to compassionate end-of-life care. They uphold the principle of linguistic equality, which is well-established in public services in Wales, and I trust that that should not be controversial to colleagues when they come to vote later on.

As a Welsh MP, I am pleased to see the inclusion of amendments 92, 93, 94 and 95. While they may appear to be small amendments, they are important. As my hon. Friend the Member for Spen Valley said, they fully respect the devolution settlement by ensuring that Welsh Ministers have all necessary powers on devolved aspects of the Bill—health—while retaining the powers of UK Ministers over aspects that are not devolved. I think that was slightly misunderstood earlier by some in this debate.

Taken together, the amendments provide clarity and legal certainty and offer reassurance to patients, clinicians and Government agencies in Wales. That principle should be uncontroversial. I know from my own discussions with the Welsh Government and the Welsh Health Minister that he is extremely grateful for the interactions he has had with my hon. Friend the Member for Spen Valley, and he is confident this measure is workable from the Welsh perspective.

New clause 5 seeks to mandate that the Secretary of State must, within six months, publish a report setting out the impact of this legislation on the civil procedure rules and probate proceedings. During the debate and the streams of evidence we have heard, I do not recall a suggestion that this Bill is likely to result in any serious changes to those specifically referenced matters. On the contrary, England’s CMO, Professor Sir Chris Whitty, warned against creating a “bureaucratic thicket”, saying that the best safeguards are the simplest ones. Let us keep that at the centre of our minds when we consider this legislation and avoid inserting amendments that are no doubt well-intentioned but would create such a thicket.

I conclude by sharing one story from a constituent of mine who was focused very much on safeguards, which has been the debate on all these amendments and new clauses.

--- Later in debate ---

[Stephen Kinnock]

I can confirm that it is absolutely the policy intent of the sponsor for that to be a backstop. The Government are working on that basis to ensure that it is a backstop and not a target.

Amendment 42 seeks to remove the four-year backstop. Although that is a matter for Members to decide, we note that if both that amendment and amendment 94, tabled by my hon. Friend the Member for Spen Valley, were accepted, nobody would have the power to commence reserve provisions in Wales. That would create major workability concerns for the service in Wales.

[Dr Johnson]

The advocates of the Bill talk about the point of choice and autonomy in the decision about when and where a person will die. Can the Minister confirm whether we have enough doctors to provide a service for people to die at home at the time of their choosing?

[Stephen Kinnock]

I refer the hon. Lady to the impact assessment, which is of course not a forecast but a set of scenarios. In it, detail is given on expected numbers and the capacity of the system to deal with the service.

Amendments 13 and 82 to 85 relate to the appointment of the voluntary assisted dying commissioner and panel members. The amendments would put the process for the appointments out of kilter with standard practice for public or non-judicial appointments and could significantly limit the pool of individuals available. Amendment 86 would give the panel the same powers, privileges and authority as the High Court, which are significant in scope and are set out across different court rules and legislation. It is unclear how those would apply to panels in practice. They may be unworkable given that the panel is not designed to be a court.

New clause 4 and amendment 28 would put various responsibilities on the chief medical officers for England and Wales. Imposing duties in primary legislation on an individual civil servant may cause difficulties in the future if the role does not exist or if the title changes. It is usual practice for duties in primary legislation to be conferred on the Secretary of State, who may decide to delegate to the chief medical officer.

I would like to briefly respond to a number of questions directly asked of the Government. The hon. Member for South Antrim (Robin Swann) asked about medicines regulation in Northern Ireland. The amendments will not affect the application of EU law; they will instead ensure coherence between the different legislative frameworks. The sponsor will lead engagement with the devolved Governments, supported by officials.

The hon. Member for Richmond Park (Sarah Olney) asked about the equality impact assessment. The EQIA considers the nine protected characteristics alongside socioeconomic background, geography and mental health. The hon. Member for West Worcestershire (Dame Harriett Baldwin) asked about the Suicide Act and advertising. I can confirm that encouraging or facilitating suicide will remain a crime under the Suicide Act. On advertising, new clause 14, if passed, would oblige the Secretary of State to make regulations prohibiting certain forms of advertising that promote voluntary assisted dying services. The exemptions to that, which may be provided under subsection (2), will not cut across the criminal offences elsewhere in the Bill or in the Suicide Act.

I hope that those observations were helpful to Members in their consideration of the technical workability of the amendments that we have debated today.

NHS Funding: South-west

Caroline Johnson Excerpts

Wednesday 11th June 2025 Westminster Hall

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

It is a pleasure to serve under your chairmanship, Dr Huq, and a privilege to contribute to this important debate. I congratulate the hon. Member for Torbay (Steve Darling) on securing the debate at such a timely point, following today’s spending review.

The focus on NHS funding, particularly in underserved regions such as the south-west, is welcome, so that every area of the UK is properly equipped to meet the healthcare needs of all communities. I, too, represent a predominantly rural constituency, so I am keenly aware of the unique challenges in healthcare provision facing remote areas. Geography should not be a barrier to treatment, but for many in the south-west and beyond, it still is.

We heard in the spending review today that the NHS will receive a substantial cash uplift. We must ensure this money is spent in the most effective way possible. We do not have the allocations yet, but can the Minister enlighten us on whether there will be an amount allocated particularly for rural healthcare. The spending review document talks about efficiencies of £9 billion to be achieved by the Department of Health and Social Care. Can the Minister elaborate on how those efficiencies will be achieved?

Much has been said already about the financial pressures facing integrated care boards. The Government’s proposal to restructure NHS clusters in the south-west into larger conglomerates is presented as a move towards greater efficiency, but care must be taken that this does not come at the expense of local responsiveness or patient outcomes. NHS England is legally required to assess the performance of each ICB annually and publish its findings. However, the Government have decided at the same time to abolish NHS England—a decision they took without a proper impact assessment.

[Fred Thomas (Plymouth Moor View) (Lab)]

The hon. Member mentions patient outcomes, but in Plymouth we have patients awaiting assessments for attention deficit hyperactivity disorder being left in limbo and unable to move forwards. Does she agree that the current refusal by some GPs to enter into shared care agreements is effectively blocking access to a diagnosis for adults pursuing ADHD assessments through the right to choose?

[Dr Johnson]

I would need to look at that separately and come back to the hon. Member on it, although he should perhaps direct his question to the Minister, as she has control at the Department at the moment.

The problem with cutting both the ICBs and NHS England is that it risks destabilising the very structures that are designed to deliver care simultaneously. The chief executive of NHS England has stated that legislation will be required to change the duties on ICBs. When do the Government intend to introduce the health Bill and, when they do so, can the Minister rule out the removal of the duty in the Health and Care Act 2022 requiring integrated care systems to commission dental services?

In paragraph 5.12 of the spending review, the Government say that 92% of patients will start consultant-led treatment for non-urgent health conditions within 18 weeks, but The Times has reported that the figure is closer to 80%. Can the Minister please clarify where the 92% figure has come from, and if she is unable to do so today, will she write to me?

Much of this debate has been about infrastructure. Since the last general election, Ministers have pledged to deliver the new hospitals programme in full, without caveats or conditions. However, in Torbay, for example, the rebuilding has been pushed back, with construction now expected to begin between 2033 and 2035. Thanks to the efforts of my hon. Friend the Member for South West Devon (Rebecca Smith), Ministers have given the greenlight to rebuilding Derriford hospital’s new accident and emergency facility. Can the Minister confirm if there are plans to bring any of the other projects forward?

Let me turn to national insurance contributions. The Royal College of General Practitioners has described the national insurance increase as,

“the straw that breaks the camel’s back, forcing them to make tough decisions on redundancies or even closing their practice”.

The Government’s promise to recruit more GPs is welcome, but hiking national insurance puts that pledge in jeopardy, as GPs will have no choice but to cut staff numbers. This is a false economy, so will the Minister use any of the money allocated today to help those services, such as GPs, air ambulances, hospices, pharmacies and others, that are affected by the national insurance contribution rise?

It will not have escaped Members’ notice that, despite the Chancellor promising that the NHS plan would arrive by spring, we are now at the start of summer—indeed, the Government promised that they had one before the election last year. Will the Minister provide some clarity on when we can expect this long-awaited plan?

Access to NHS Dentistry

Caroline Johnson Excerpts

Thursday 22nd May 2025 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I congratulate the hon. Member for Great Grimsby and Cleethorpes (Melanie Onn) on securing this debate. Dentistry is important. Dentists do not just deal with our teeth; they deal with our mouth and gums, they identify physical diseases that include cancer and they prevent sepsis. Last month, I visited The Dental Design Studio in Sleaford to celebrate its 20th anniversary of great dentistry and I met some fabulous, committed professionals. Somewhat unexpectedly, given the venue, I was asked to help judge a cake competition. Members and my dentist will be pleased to know that I brushed my teeth very well afterwards.

Access to NHS dentistry has been a problem for a very long time. When I moved house in 2001, there was no NHS dentist available and I travelled two hours to Redcar to see the wonderful dentist Mr Dixon for many years until he retired. After that, there was no dentist at all. Are we therefore short of dentists? No, we are not. The Conservative Government increased the number of new trainee places and the number of new dentists, and although the population increased, there are still more per capita than in 2010. As the Minister for Care has said,

“The issue is not the number of dentists…but the paucity of dentists who are doing NHS work.”—[Official Report, 25 March 2025; Vol. 764, c. 766.]

I encourage the Minister for Secondary Care to consider more dental places, because we see that one in 15 of the youngsters who want to become a dentist is turned away and, as such, they go overseas to train or train to do something else. Will she commit to a dental school not just in Norwich, but in other underserved areas, such as Lincoln?

The main problem, as many have identified, is the 2006 contract with the UDA bands for procedures, and there are several issues with that. First, the amounts vary between practices based on historical volume data; secondly, there is a disincentive to treat new or high-need patients; and thirdly, the UDA simply do not cover all the costs. The Conservatives improved that a little bit, ironing out some of the bizarre UDA contract terms and setting a new, higher floor for minimum UDAs. Yet there is much more to do, as we have heard today, to reform it completely. How are the Government getting on with that? Will the Minister give us an update, please? As the Public Accounts Committee notes,

“NHSE and DHSC do not yet know what that reform might look like or to what timescales it can be delivered”,

beyond a vague assertion that some reform is imminent.

[Alex McIntyre]

Will the hon. Lady give way on that point?

[Dr Johnson]

I will not because there is not much time at all.

I met Eddie Crouch from the BDA recently, who talked about the national insurance costs. Before today’s announced pay rise, dental practices were facing a 9.5% increase in staff costs, again pushing more of them further to private practice. Will the Minister ask the Chancellor to exempt NHS dentists from the national insurance contribution rise? There has also been discussion about compelling dentists to do a proportion of their work in the NHS, either by compelling dentists who are newly trained or by incentivising with the use of student loan repayments. Have the Government considered that?

We have many overseas trained dentists—some are British students who were trained overseas, some are foreign nationals—but the overseas registration exam has 2,000 people on its waiting list. Somewhat bizarrely, those who pass can work in the private sector, but not in the NHS without supervision. That seems somewhat incoherent. Does the Government have confidence in the exam or not? It is illogical to allow a person to practise as a private dentist but not in the NHS. It is also a clear disincentive to NHS practice. What good discussions have the Government had with the General Dental Council about this issue?

My right hon. Friend the Member for Herne Bay and Sandwich (Sir Roger Gale) has repeatedly raised the issue of Ukrainian dentists. There are 200 Ukrainians dentists in the UK. Why not assess them and allow them to work? It is better for them and for us.

Dentists form part of a wider team of hygienists, nurses, technicians and therapists. What are the Government doing to help people in each of those roles practise at the top of their skill range to provide greater dental care? What are the Government doing to support rural areas since they cancelled the mobile dental vans? What are they doing to ensure they deliver the 700,000 promised appointments a year, since they have delivered hardly any of them so far?

[Sam Rushworth]

Will the hon. Member give way?

[Dr Johnson]

I will not give way because there is very little time.

It has been clear today that the NHS is not fit for purpose when it comes to dentistry. The Government need to get grip of this, and soon.