Junior Doctors’ Foundation Programme

Caroline Johnson Excerpts

Wednesday 22nd April 2026 Westminster Hall

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

It is a pleasure to serve under your chairship, Mrs Barker. I congratulate the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) on securing this debate and giving a great speech. I need to declare an interest as a consultant paediatrician in the national health service, a member of the Royal College of Paediatrics and Child Health, and a member of the British Medical Association.

Going back a little while to when I was young—in fact, we are going back 25 years—I graduated as a doctor in 2001. I had done a five-year degree and I had provisional registration with the General Medical Council. In order to get full registration, I had to complete a year as a pre-registration house officer, most commonly referred to as a house officer. That was six months of medicine and six months of surgery in adult care in either order. It was, to some extent, an extension of medical school. Indeed, it was supervised by the medical school in terms of placements, and almost everyone—I say “almost”; I will come back to that in a moment—stayed local.

In the process that I followed in Newcastle, where I was a student—I am recollecting this from 25 years ago—we had to apply for two medical and two surgical jobs. I applied for the Royal Victoria Infirmary and the Freeman hospital, but there were other options across the north-east where people were involved in training and medical school placements, such as Carlisle, Sunderland, North Tyneside—which was particularly popular at that time—South Cleveland and others. As with any other job, one was shortlisted, interviewed and potentially offered a job. The system worked so that, if a person was offered both jobs, they had to pick one. When the first round went out, people said which job they wanted and that was theirs. All the other jobs that were not allocated were put back into round two, people applied again, and by the time it got to round three essentially everyone had a job.

The benefit of the system was that everyone knew that they had a job in the region where they trained to complete their full registration with the GMC, and the Government knew that all the people they had invested in for that training would become fully qualified doctors, provided they put in the requisite effort and attainment.

However, changing over deaneries was extremely difficult. I applied for the RVI and the Freeman, and I got offered both. That was straightforward, but then I fell in love. I was proposed to, I accepted and I planned a wedding for no more than a week before I graduated. I did not fall in love with another member of hospital staff; I fell in love with a farmer, and farms are quite difficult to shift.

I then decided that I wanted to move to Nottingham deanery. It is fair to say that Newcastle deanery was not keen on that idea, although it was supportive, and Nottinghamshire deanery was really not keen on the idea because it had to fit an extra person into the system. It made that clear, saying, “Well, you’re not having a job in a big teaching hospital.” That was fine: I just wanted a job near to where my husband’s farm was. I was allowed to move deaneries under those special circumstances.

I first spent time at Lincoln under Dr Patterson, a wonderful consultant, as a young doctor. He was a respiratory physician, and I very much felt part of his team. I then went to Mansfield, where I worked for Mr Moulton, an orthopaedic surgeon. He was a lovely man; we used to do French verbs together during knee operations. After that, I worked for Miss Patterson, a vascular surgeon.

As the hon. Member for Bury St Edmunds and Stowmarket put it, I very much felt part of a firm or part of a team. There was continuity of care, as I was looking after my consultant’s patients. I was not part of a massive group of people performing a list of tasks for a whole range of consultants on a group of patients who I did not know, which is how it can be for many junior doctors now.

The other thing provided at that time was accommodation. Part of the system with a PRHO job was that accommodation was provided for free, on the hospital site or very close to it, for the first year. That meant that when junior doctors were doing those two six-month jobs straight out of medical school, they had accommodation.

In their wisdom, the people negotiating the pay and conditions decided to give that accommodation up for a little bit of extra money. At the time I thought that was mad, but since I had passed that stage, at the time I considered that it was really none of my business. However, I think that it caused a problem, particularly because the European working time directive has meant that instead of working really long shifts, people work much shorter shifts but have much longer travelling times. I was working long shifts but not having to do a lot of travelling. Junior doctors now have to do shorter shifts—more of them, on a much less flexible rota, to get all the required shifts in—and they are also travelling for miles at the beginning and end of each shift. I think that change has been counterproductive; I wonder whether the Minister has any thoughts about it.

The other thing is that the system was based on merit—whether or not I got the job at the RVI or the Freeman was based on merit. I had to apply. I had to say that I had done things such as presenting at an international conference as a final-year student. That sort of thing was considered important, as was getting good grades in my exams or in my project work at medical school; now it is not.

I just wanted to examine what happened between that time and now. In 2005, the then Labour Government introduced a modernising medical careers programme, which changed the one-year foundation programme to a two-year foundation programme—I am not clear why that was thought necessary—and the placements were changed from six months to three or four months in duration. I agree with the hon. Member for Bury St Edmunds and Stowmarket that that is too short for someone to really get into a job, and to understand the team they are in and what they are doing, before they have to move on again. People have virtually just arrived and then they are going.

There was then the medical training application scheme, or MTA scheme, in 2007, which was a national scheme. There were lots of errors and data breaches. The Secretary of State apologised, and we went back to the deanery approach. There was then a lot of concern that that system was not fair, and that it was stressful; it required people to perform well in exams, and people did not like that very much.

So we have gone to the Oriel system—this preference-informed allocation system that matches people with places. In the engagement process before it was brought in, there were 14,500 responses, mostly from students, and 66% of respondents said they wanted the system, while about 30% said they did not, so it was brought in. The education performance measure and the situational judgment tests, which have been referred to, were removed, and a lottery system was brought in. Essentially, it means that junior doctors are given a completely randomly allocated number, based on nothing but chance. Junior doctors are then allowed to express a preference for particular foundation programmes.

However, when I refer to foundation programmes, I mean areas of the country. As I said, in the case of Newcastle that can mean an area that goes all the way from one coast to another—for example, right down to Middlesbrough and up to Hexham and Berwick. Those are not small areas; they are quite chunky bits of the country to travel around, requiring many hours of travel, from north to south to east to west, in some of them.

Nevertheless, applicants get to express a preference. The computer system will allocate places on the basis that if someone’s first preference is available, they get it, but if it is not they effectively get put back in the box for later. The computer will go down the list until it has allocated all the first preferences and, as the hon. Member for Bury St Edmunds and Stowmarket said, quite a lot of people do get their first preference although, as he also said, whether or not it was their first preference in truth is another matter.

Then an applicant gets to look in the foundation area that they have been allocated to, and to express a preference regarding the jobs within that region. The computer, using the same number—if the student was lucky the first time, they are lucky the second time—goes down the list and allocates them. If they are not allocated, it has to go round again and allocate them a later preference. That means that people either get their first preference or go very much further down the list: a Newcastle medical student, as I was, could get sent to Penzance, which is a lovely place but a long way from Newcastle. There is nothing the student can do about that. They have no control over their life. Even if they are the best-performing medical student in every capacity in the whole country, they still get sent where they get sent—and that is tough.

[Peter Prinsley]

Some time ago, when I came here, I had working with me an intern, Dr Harry Dunn, who was a medical student at Cambridge University. He graduated last year. He came top, not only of the University of Cambridge medical student cohort, but of the whole of the University of Cambridge, so he was the top student of his year. He was offered a foundation post in Northern Ireland. He chose not to take it, and has now gone into consulting, having given up medicine. That is an extremely sad example of an unintended consequence of this crazy lottery.

[Dr Johnson]

I congratulate that person on his prowess in university. He is clearly an incredible person, and it is a shame that he has been lost to medicine. I am sure Northern Ireland is a great place to work, and it is disappointing that he did not want to go there, but he should have been able to apply for the jobs that he wanted in places where he wanted to work, and to compete fairly for them. That is a bit stressful and competitive—but getting into medical school is competitive.

You may not know this, Mrs Barker, but the hon. Member for Bury St Edmunds and Stowmarket and I grew up on the same street, in the same town, and went into similar-ish careers. We competed for medical school places and for our jobs. We are all here today having competed against others for election—that is the reality of life. To remove the competition, which is based on meritocracy, and replace it with a random allocation is more unfair and stressful than the alternative.

One of the issues raised about the old scheme was that it was difficult to recruit in some areas. The competition for the best jobs, or at least those perceived to be the best or most wanted jobs, means that some areas of the country and some specialties could find themselves with the people who did not succeed in getting the jobs they wanted. How do we manage that? It used to be managed with rotations. When people went to the interview for specialist jobs, they would be called in one at a time and told, “These are the rotations available. Which one do you want?” The best jobs—the most popular ones—would be mixed with the least popular, so that would mitigate the problem.

There is one issue that I want to raise briefly. Some medical schools in the UK, including Newcastle, have overseas campuses in Malta, Cyprus and Malaysia. Some British people have gone to those branches of UK medical schools and have found themselves completely excluded from places in the United Kingdom under the medical training changes that the Government have made in the past couple of months, which seems wrong. We talked about that when the Bill went through, and the Minister was keen to reassure us that all would be well, but we have found that British students have not been able to get jobs in the British training programme. Will the Minister look at prioritising at least those who went to medical school before the changes for British jobs?

The current system gives junior doctors—resident doctors, as they are called now—no agency, no control, no appeal and no alternative. It is clearly unfair. Could the Minister update the House on how he intends to fix the system?

[The Minister for Care (Stephen Kinnock)]

It is a real pleasure to serve under your chairship, Mrs Barker. I congratulate and thank my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for securing this vital debate, and all the hon. Members who have contributed. I pay tribute to my hon. Friend’s significant and distinguished career and experience in our NHS. I take the opportunity to thank resident doctors up and down the country for the vital contribution they make to our NHS and to treating the patients it serves.

As my hon. Friend said in his opening speech, the UK foundation programme is a central part of the pathway to becoming a doctor, bridging the gap between medical school and specialty or general practice training in the NHS. It supports newly qualified doctors to develop the clinical and professional skills needed to deliver safe and effective care, preparing them for progression into core, specialty or general practice training. Resident doctors who currently work in the NHS have made it clear that they have concerns and frustrations with their training experience. We are committed to listening to and addressing that and to improving the training pathway for the medical workforce, for the benefit of NHS services and patients.

Through phase 1 of the medical training review we conducted extensive engagement to ensure that doctors, patients and NHS leaders had the opportunity to describe what works well in medical education and training and what needs to improve to meet the needs of both resident doctors and patients. The phase 1 diagnostic report was published last year and made 11 recommendations centred on four key priorities: more flexible training; removing the divide between service and training; ending the damaging recruitment bottlenecks and rewarding teams where doctors feel valued.

The implementation team, led by Dame Jane Dacre, who has been appointed as the independent chair for this work, will now work with doctors, the General Medical Council, the Medical Schools Council, royal colleges and other bodies to drive this much-needed change.

[Dr Johnson]

Could the Minister highlight the timing of that in relation to the workforce plan, and when that will be published?

[Stephen Kinnock]

The workforce plan will be published this spring, so there is not too long to wait. It has taken a little longer than we initially hoped, but we think it is really important to ensure that it is anchored in very solid engagement with our partners and stakeholders.

Earlier this year, the Government delivered fast-track legislation to put UK medical graduates at the front of the queue for foundation and specialty training places, reducing uncertainty and ensuring that they can progress to full registration as doctors. We have confirmed that all eligible UK medical graduates will be offered a place on the foundation programme this year. Of course, our fast-track legislation seeks to rectify the unforgivably reckless and damaging decision made by the previous Government to remove the resident labour market test after Brexit, which in many ways is the root cause of the mess created by the neglect and incompetence of the previous Government over 14 years.

I turn now to the process for allocating places to applicants for the UK foundation programme and the steps the Government are taking to improve it. We recognise that the location a foundation doctor is assigned for training has both professional and personal impacts. The four UK Health Departments determine the number of places available each year based on workforce planning across the continuum of postgraduate medical education and training. Applicants are allocated across the UK using a nationally applied preference informed allocation system, which has been extensively commented on in the debate.

The PIA system was introduced in 2024, following extensive engagement with the four UK statutory education bodies, medical students and key stakeholders. The move to the new system aimed to address concerns that the previous system was unfair and stressful for applicants and that there was a lack of standardisation within and across schools. It is worth mentioning that the consultation on the PIA system received over 14,500 responses, 66% of which favoured a move to the PIA option against the status quo. There were 106 organisations among those 14,500 responses. It was an extensive consultation with fairly conclusive feedback on the change that was required.

[Stephen Kinnock]

It is worth highlighting that around 82% of applicants get their first preference. That is a significant improvement—it was 71% in 2023. We are taking steps in the right direction, but we would love to get to 100%. It is difficult to get to 100% of anything in a large and complex system, but that is our aspiration. Of course, those who do not get their first place are welcome to re-engage with the system, and efforts are made to ensure they get their preference, although we do not always succeed in that process. I will take the hon. Member’s question away and discuss it with my colleague the Minister of State for Health—she leads on this portfolio, although she was not available for this debate—and we will write to him with further clarifications on the important point he makes.

The introduction of the PIA was broadly supported by stakeholders, and I am pleased that we have seen an improvement under this system in the number of students allocated their first preference programme. As I said, 82% of applicants to this year’s foundation programme were allocated their first preference, up from 71% in 2023. However, we are committed to ensuring that the system remains fit for purpose. NHS England will conduct a review to ensure that it is still working for applicants. The timelines of that review will be confirmed in due course.

Furthermore, although some individuals may want to move away from their university area for foundation training, some need greater certainty, for a range of reasons, about their foundation placements. In the last two years, we have supported a portion of students in three UK medical schools by allocating them to foundation programmes in their local area. Last Friday we went further, announcing that we will work with medical schools and foundation schools to extend that support to trainees across the country from disadvantaged backgrounds. Providing a post close to where they live will mean more stability for trainees and will support employers in developing a local workforce.

I would like to say a final word on the PIA. I think we all accept that it is not perfect—it is very difficult to have a perfect system—but I take issue with the characterisation by some Members in the debate that it is a random system. We do not agree with that characterisation. We are clear that the system in place is enabling people to clearly articulate their first preference, and in the overwhelming majority of cases they are getting their first preference. That does not feel like a random system to us, but we absolutely accept that it is not perfect, and there is always room for improvement.

Let me turn to rotations. We recognise the importance of stability for doctors in training and the impact that frequent relocations can have on wellbeing, retention and workforce planning. Following the 2024 resident doctors agreement, the Department of Health and Social Care conducted a review of rotational training and found that rotations can provide valuable breadth of experience. However, we know that in some cases they can disrupt learning, wellbeing, team integration and patient care. To tackle that, NHS England is developing pilots under the medical education and training review to test longer placements and more flexible arrangements for less-than-full-time trainees. The evaluation of those pilots will inform future policy decisions on placement length and continuity benefits.

I turn now to the wider working conditions for resident doctors. It is essential that we create a supportive environment for doctors throughout their training that looks after their health and wellbeing. NHS England’s resident doctors’ working lives programme continues to implement several measures aimed at supporting resident doctors, encouraging them to stay in training and the NHS and reducing overall attrition. That includes measures such as the less-than-full-time training options to allow trainees to continue to work in the service and progress with their training on a reduced working pattern where that is beneficial for their personal circumstances.

We have made significant progress over the past year to improve the working lives of resident doctors, including agreeing an improved exception reporting system, which will ensure that doctors are compensated fairly for additional work, and rationalising statutory and mandatory training to reduce unnecessary burden and repetition.

[Dr Johnson]

The Minister talked about less-than-full-time training, which has obviously had an impact on the number of doctors we need. The Secretary of State said before the general election that if Labour was elected, it would double the number of medical school places. Is that still the Government’s intention?

[Stephen Kinnock]

Yes, that is the Government’s intention. Obviously, we have had some challenges in April around our hope that we could create 1,000 additional places. We have not been able to do that, unfortunately, because of the reckless decision of the BMA to go back out on strike. The absorption of huge capacity, as well as operational issues, has meant that we have not been able to do that.

--- Later in debate ---

[Dr Johnson]

I thank the Minister for that answer, but I believe that it relates to postgraduate training places. I was asking whether it is still the intention to double the number of medical school places?

[Stephen Kinnock]

Sorry; I misunderstood the question. Yes, it is still our intention to double the number of medical school places.

The Government remain committed to publishing a 10-year workforce plan this spring to set out how we will create a workforce ready to deliver the transformed service that we set out in the 10-year health plan. The 10-year workforce plan will ensure that the NHS has the right people, in the right places, with the right skills to care for patients when they need it.

NHS staff told us through the 10-year health plan engagement that they are crying out for change. The workforce plan will set out how we deliver that change by making sure staff are better treated and have better training, more fulfilling roles and hope for the future.

I thank all hon. Members for taking part in this important debate.

--- Later in debate ---

[Stephen Kinnock]

The short answer is yes, absolutely—our door is always open. We have to find a constructive way through this. I accept that it is not always just about pay; it is also about broader terms and conditions—exactly the things we have been debating today. That is why I was so excited by the fast-track legislation we brought forward specifically to address the bottlenecks and the impact of the disgraceful decision under the previous Government to remove the resident labour market test. We are seeking to fix all those problems, and we need a constructive partner on the other side of the table to do that. We are starting to see in opinion polls that public support for the action taken by the BMA and resident doctors is eroding quite seriously, and I hope they take that into account before they make their next decisions.

[Dr Caroline Johnson]

As a doctor, I feel uncomfortable with the morality of going on strike and leaving patients to suffer in order to get more money for oneself. I think the morality of the strikes is outrageous. However, does the Minister regret the repealing of the minimum service levels legislation, which could have enabled the Government to put in firmer boundaries around the strikes to prevent harm to patients? Will the Government consider banning doctors from striking altogether, as a Conservative Government would, in the same way that people in the Army and the police are banned from striking?

[Stephen Kinnock]

The hon. Lady’s point about morality is important and interesting, but people also have to be able to put bread on the table, pay the mortgage or rent, and feed and clothe their kids. Morality is fine, but it does not put bread on the table. The two things are very important.

On the retrograde steps the Conservative party is proposing around industrial relations, that is just not what the Labour party is about. The Labour party is about constructive, positive industrial relations and respect. It is about treating the workforce and unions with the respect they deserve and finding a constructive solution. We do not want to move to some kind of police state, where we restrict the rights of trade unions. We see the right to organise and go on strike as a fundamental right of citizens in our country, and it would be a retrograde step to remove it. It is pretty extraordinary to hear that suggested by the Conservative party when we live in a liberal democracy. So the answer to the hon. Lady’s question is no. I believe we will find a way through this dispute. It will be hard going—it will be two steps forward and one step back, I am sure—but in the end I believe we will get there.

[Dr Johnson]

I thank the Minister for being extremely generous with his time. He says the Government will not consider removing the right of doctors to strike, but he seems to be going further and suggesting that doing so would be wrong in principle. Do the Government therefore intend to allow the right to strike for those who are currently not allowed to, such as the police and armed forces?

[Stephen Kinnock]

We have those restrictions on the right to strike in the police and the armed forces for obvious reasons of national security. I think that is a very different issue; our critical national infrastructure must be protected, and there cannot be any dispute about that.

We are dealing with a workforce whose pay and conditions had clearly been neglected. The previous Government used the moral argument the hon. Lady was trying to make as leverage to keep pay and conditions down, which I would say is a deeply immoral position to take. The right to be a member of a trade union and to go on strike is relevant to certain sectors of our labour market, and that right, where it exists, should be protected; where it does not exist, that is a completely different debate.

I thank all Members for taking part in this important debate. The Government are taking important steps, and we remain committed to improving the working lives and prospects of resident doctors, and to ensuring an effective foundation programme.

Maternity Commissioner

Caroline Johnson Excerpts

Monday 20th April 2026 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Jardine. I declare an interest as an NHS consultant paediatrician. I have attended more than 1,000 deliveries of babies over my career. More recently, they have been more likely to be the ones where things were going wrong and where there were more concerns about the baby, as my role is about looking after the infant.

I have also had my own three children. The hon. Member for Esher and Walton (Monica Harding) described having a mixed experience; I had three healthy children, but the first one was a normal delivery, the second a somewhat chaotic emergency caesarean section and the third a nice and smooth, peaceful elective caesarean section, so I had a range of experiences.

I congratulate the hon. and learned Member for Folkestone and Hythe (Tony Vaughan) on his opening speech. I particularly thank Theo Clarke—my friend and former colleague—and Louise Thompson for their campaign on maternity safety. They have shown incredible bravery in talking about their experiences and challenging the taboos around the troubles related to pregnancy. In particular, I commend Theo for her talk about perineal injuries, because this has been something spoken about in hushed tones and quietly among women and not something discussed in the public arena, but once it is spoken about in the public arena, that courage enables other women to find the courage to come forward and talk about it. That is how we will ensure that these injuries become less likely and the treatment becomes better, so I thank them for their work on that.

Since the petition was launched, it has received more than 150,000 signatures, including 270 from my constituency. As a parent, I know that bringing a child into the world is one of the most rewarding and exciting experiences in life. As has also been said, it generally goes well—reasonably smoothly, if not completely smoothly—and the outcome is generally good. But for too many women, their experience is deeply traumatic. Every year, 30,000 women suffer negative experiences during pregnancy, and one in 20 of those goes on to suffer from PTSD.

The APPG on birth trauma ran an inquiry into birth trauma, soliciting 1,300 submissions. What it detailed painted a shocking picture. It spoke of mothers left unattended to in hospital beds and some left in their own blood or faeces for hours on end; vaginal examinations undertaken without consent and in some cases triggering a mother’s waters to break; mothers belittled; concerns torn from the records; a baby dying during delivery after concerns were raised 44 times in vain; and significant mental health consequences and debilitating effects of perineal injury.

Every single failing we have heard about today is one too many. As I have said, maternity care is generally safe, but it is not safe enough yet. I am proud that the previous Government identified maternity care as a priority and began making some improvements. There is a way to go, but the previous Government launched a maternity and neonatal safety strategy, funded the saving babies’ lives care bundle, setting out evidence-based practices for providers and commissioners of maternity care in England, and rolled out maternal medicine networks in 2023. They established 17 centres of excellence to help women with high-risk conditions to get the care that they need when they need it. The previous Government’s reforms were backed by £127 million of investment specifically for maternity and neonatal care, and much of that was focused on the workforce.

Because of these efforts, more babies are delivered safely than ever before. Between 2010 and 2022, stillbirths fell by 25% and maternal mortality fell by 17%. The improvements were in large part overseen by my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt). He has saved countless lives with these improvements and deserves much credit for that.

I am concerned about the trajectory that we are currently on, because as has been said, there is still quite a lot left to do. In June, the Health Secretary agreed. He said that

“we’re not making progress fast enough on the biggest patient safety challenge facing our country”,

but he has responded with another inquiry. He did say that it would be a rapid inquiry, but it took months—in fact, till September—to decide which trusts would be involved in that inquiry, and then that was changed in and of itself. It was announced almost a year ago, has been much delayed and has still not reported. Hopefully it will be a great report when it has reported, but the delay means that action is not taking place quickly enough.

As has been mentioned, Baroness Amos found in her interim report that 748 recommendations had been made over the last decade, but progress in delivering on them had been too slow. Could the Minister update the House on how many remained undelivered on at the point of the general election and how many she has delivered on since?

In June, Ministers also announced a maternity and neonatal taskforce; and in November, I tabled questions asking how many times the taskforce had sat and who was on it. The answer was that they had not decided yet. In January, the question was raised again and they still had not decided. It took until last month for the Government to decide who was going to be on their urgently created taskforce from last year.

[Michelle Welsh]

Does the hon. Member agree that working with the families to get the taskforce right, which has never happened before with any Government, is key? Getting the taskforce working and getting the right people on that taskforce is essential as well.

[Dr Johnson]

I completely agree with the hon. Lady that it is important to get the taskforce right, I am just not sure that it needed to take quite so long to do so. We heard a statistic earlier about how many babies are born and how often; I think about how many babies have been born in the intervening time, while the membership of the taskforce was being finalised.

[Michelle Welsh]

There are more than 2,500 families involved in the Nottingham inquiry, some of whose cases were never reported appropriately. Given that, does the hon. Member agree that it is important to get the taskforce right, because so many bad things happened under the previous Government’s watch that were not reported to the inquiry and are not in the statistics and data that she has spoken about?

--- Later in debate ---

[Dr Johnson]

I understand the hon. Lady’s point, but putting together a taskforce should not take months and months, because it is too important that we get on with it quickly. The Minister may be able to give us a reason for the delay because, if this is hitting the ground running, the Government must be wearing lead boots.

I also want to talk about the workforce. The Labour party manifesto included a commitment to train thousands of additional midwives. Can the Minister confirm how many more midwives are in training than under the previous Government, how many additional study places have been funded for each year, and how many places will be available this September? Some midwives have spoken about a lack of more senior midwives on shifts and the balance of care. Can the Minister tell us what figures she has on the number of midwives who are now in more senior roles and not providing clinical care, and what proportion of midwives are still spending at least a day a week providing clinical care?

We know that many midwives are not happy with the Government’s proposed 3.3% pay award—health unions have called it a betrayal and an insult. With resident doctors already striking, what is the Minister doing to avoid yet another industrial dispute, which I worry would contribute to poorer maternity care? At the same time, the Government’s plans to reorganise NHS services and ICBs have put them under financial pressure. Can the Minister confirm what effects she thinks that will have on maternal services and maternal mental health services used by women?

The Government promised 1,000 speciality training places; how many of those that have now been cancelled were for obstetrics and gynaecology? Will the delayed workforce plan, when it comes, have details of the number of obstetrics and gynaecology trainees that are needed, and will the Government have a plan to deliver the right number so that we have the best number of doctors for care?

Hon. Members talked about how births are becoming more complex—there are fewer births, but there are more complex births. What are the Minister’s plans for prevention, for example by ensuring that women have folic acid? We know that around four in five women take folic acid, but what can be done to improve that? I give the Government credit for the Tobacco and Vapes Bill, but what is being done to reduce smoking in particular among women who are planning a pregnancy or who are pregnant? Obesity and the effects of chronic illness are also important in making pregnancies as healthy as they can be. Given the Government’s focus on prevention, can the Minister update the House on what is being done in those areas?

The speech by the hon. Lady for Morecambe and Lunesdale (Lizzi Collinge) explained the workforce culture extremely effectively. Where errors happen—I agree with her that errors will always happen—it is important that the response is honest, open and transparent. Those who blow the whistle should be safe to do so, and the balance between accountability and blame needs to be in the right place so that we get improvements in maternity care. I share the hon. Lady’s concerns about the “normal birth” culture.

As many hon Members have said, listening to women is important. I asked the Minister about the abolition of Healthwatch the other day, but I do not think I got an answer. Organisations will always try to represent their interest group as effectively as they can, but there may be women who fall through the cracks. The benefit of Healthwatch is that it will listen to all and any women, whereas groups will just represent cohorts of women.

On travel, it is not uncommon, where there is a baby with a cardiac or neurological condition or extreme prematurity requiring surgery, for the baby to have to be transported significant distances, sometimes hours away from their parents’ home, in order to receive the best care. That can be very challenging for people in the cost of travel, and accommodation local to those units. Some units have excellent accommodation onsite in the hospital for mothers and fathers who have a baby who is particularly sick, but others do not. I asked some written questions on this topic following the neonatal estate review, but I got answers back about bereavement suites, which are a different issue.

I have heard examples of women being asked to stay on the postnatal ward when they have a baby in the neonatal unit. One woman described to me being in a bay with three other women who all had their babies with them; that woman was told to stop pressing the buzzer for help after a caesarean section, as there were other women with babies who needed to be looked after—I thought that was particularly cruel.

In summary, I understand that the Minister is very dedicated to this cause, and I am sure that the Secretary of State is too, as we all are. However, I feel that the delay, the report and the endless inquiries are not creating the actions that we need, so I would be grateful for the Minister’s response.

Women’s Health Strategy

Caroline Johnson Excerpts

Thursday 16th April 2026 Commons Chamber

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

I am glad to see that the much-delayed women’s health strategy is finally here, and I thank the Minister for her work on that and for advance sight of her statement. I am particularly pleased that Ministers have pledged to prioritise medical health conditions such as endometriosis and to continue the roll-out of the HPV testing that we piloted.

Today it is one year since the For Women Scotland judgment in the Supreme Court confirmed that sex is biological sex. At the time the Secretary of State told the public:

“We will be issuing guidance in the coming weeks before the summer”.

To be fair to him, he did not say which summer. This week, a Minister told the House that the guidance on single-sex spaces could not be published under purdah rules until after the local elections. Will the Minister explain why it is okay to announce policy on other aspects of women’s health but not on single-sex provision in the NHS?

I find it remarkable that the Minister has the audacity to talk about women harmed by pelvic mesh when, after almost two years in office, the Government have still not responded to the Hughes report. When do they intend to do so?

I was disappointed not to find a commitment in the strategy to the lobular breast cancer moon shot project. Will the Minister give us a timeline for what I understand is a commitment to that project by the Government?

The Minister talked about waiting lists. While it is welcome that gynaecology waiting lists have fallen in the past year by 1.9%, for those requiring some sort of procedure or admission, waiting lists are 4.5% higher than they were a year ago. One way to make waiting lists shorter is to not start counting until someone has been waiting for a few days already—more targets can certainly be hit that way—so will the Minister clear something up for me? The Government have decided to prevent GPs from directly referring patients to consultants, insisting that they request advice from consultant-led teams instead. If the consultant then decides to offer an appointment, the clock starts, but that will be a few days after the original request is received, making the waiting time a few days shorter. This is where it gets really confusing: the Minister for Care said that the rules are going to change so that the clock will start when the advice request is received, so that patient waiting times are accurately reflected, but the Minister for Secondary Care has said that that will only happen from October.

Who is right? Do the Government intend to try and fiddle the figures by making people’s waits look shorter between now and the autumn? Given that we have heard different answers from two different Ministers, do they not know what is going on? Or can they confirm that with their new process and with immediate effect waiting times will be calculated from the moment that the advice and guidance request is received, in the same way as happens with referrals now?

The first chapter of the strategy is about acting on women’s voices and listening to women, which of course is welcome, but the Government plan to abolish Healthwatch in favour of listening to organisations. Why are the views of organisations that may or may not accurately represent the voices of women more generally being prioritised, and the voices of women themselves being somewhat deprioritised?

In the strategy, the Government commit to increasing capacity for surgical—in other words, later—abortions. They commit to making the morning after pill available free from pharmacies; they have made the oral contraceptive pill available from pharmacies too, and they have said that they will improve workforce capacity to provide long-acting reversible contraception. At a time when sexually transmitted infections are on the rise, with potential significant short-term and long-term consequences for women, there is no mention of condoms in the strategy. Given that some men can be reluctant to use condoms and there is discussion of eliminating misogyny throughout the document, will the Minister explain the choice not to include those too?

Another issue I want to raise is that of fracture liaison services. On entering Government, the Secretary of State said that one of his first jobs would be to establish universal fracture liaison services by 2030, yet that is moving at such a slow pace that he will not meet his target. Will the Minister set out how many of the dual-energy X-ray absorptiometry—DEXA—scanners are new, how many are replacements and how many will be used to set up new fracture liaison services?

There are many more questions that I can ask, but I understand that I have run out of time. In summary, while there are a few good points, it has taken a long time to produce a strategy that is rather disappointing. Women deserve much better.

[Karin Smyth]

It is hard to know where to start. I heard the word “welcome” somewhere in the hon. Lady’s remarks, so thanks for that.

In launching what we call a “renewed strategy” we have given credit to the previous strategy, which we welcomed when we were in opposition. However, on issues where there could be cross-party agreement, from going to war to the women’s health strategy, the Conservatives’ modus operandi is now to give nothing for us to work on together on behalf of the people who we represent. It is disappointing that they choose to start on a negative and really they could have done better.

In opposition, we welcomed the initiative to have a women’s health strategy and we supported that work going forward, which has led to the publication of this renewed strategy, because the diagnosis of many of the issues was right. However, as I have made clear, we are upending the system because for decades the health service was built around the work and health needs of men and the predominance of men working in the system, despite the fact that 77% of our nursing staff are women. We are upending that to put women’s voices and choices front and centre, including control of the budget and through NHS Online. Those are the game changers.

The Conservatives do not recognise the total game-changing nature of NHS Online in facilitating services for women wherever they live across the country, whether they live near highly specialised centres, such as those that I am privileged to have in my city of Bristol, in the coastal and rural communities represented by Members from across the House, or near tertiary centres. Any woman, from any part of our country, can access NHS Online and have that specialist service. We are trialling that with gynaecology. They will then get support from our rapidly expanding community diagnostic centres, about whose expansion we made an announcement this week, in order to get quicker diagnosis and the support that they need, closer to home in their neighbourhood health services.

I am happy to respond to the other issues that the hon. Lady raises, including the For Women Scotland judgment, and to set out the work that we have had to do to clear up the mess that the Conservatives left. Everything that happened to women under that system happened on the watch of the Conservative Government, from self ID to the issues at the Tavistock and everything else. There was a lack of rules, a lack of governance and a lack of clarity, and they did not take control. That is the mess that we inherited from the Conservative Government.

The Minister for Women and Equalities, my right hon. Friend the Member for Houghton and Sunderland South (Bridget Phillipson), is doing an excellent job: she is made of steel and good experience, and she has had to navigate a difficult landscape. The Conservatives understand the rules of purdah like the rest of us, so let us not pretend that they do not. My right hon. Friend will be laying that guidance as soon as she can after the election.

I will go on to talk about the DEXA scanners that we are investing in and fracture liaison services bringing people together, which were promises in our manifesto. This strategy is about specialists coming together and working together in fracture liaison services and women’s health hubs. Those have led the way among clinicians about how we can work better for women. That is why we are building on and expanding them, and it is disappointing that the Conservatives do not want to work with us on that.

Draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026

Caroline Johnson Excerpts

Wednesday 15th April 2026 General Committees

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

It is a pleasure to serve under your chairmanship this afternoon, Mr Stringer. Before discussing the regulations, I want to acknowledge their origin. The horrific Manchester Arena attack killed 22 people and injured more than 1,000 others. I express my condolences and good wishes to all those affected by that vicious attack.

Those running events such as concerts are required to comply with the law, to follow Health and Safety Executive rules, including the purple guide, and—of particular relevance to this debate—to ensure that they have appropriate medical cover. I thank Sir John Saunders for his work on the inquiry. He found very severe deficiencies in the medical cover that night.

SMG had contracted Emergency Training UK to provide medical cover. The person leading that organisation said he had a valid major incident medical management and support qualification—I am sure the Minister has done that qualification, as I have, because hospital MIMMS covers the response to a major incident. He also said that he had an Advanced Life Support Group qualification in advanced life support, but he did not. Again, that is a qualification that both the Minister and I have. I have taught on one of its courses.

This individual was not a health professional, so he was not regulated by the General Medical Council or the Nursing and Midwifery Council. He did not provide adequate training, equipment or record keeping, and he employed staff to do a job for which they were not qualified. Such events are required to have a certain level of medical cover, and although the staff he employed that night did their best, they did not have the level of medical training they should have had. He performed an inadequate risk assessment. Particularly horrifically, he had worked in the arena providing medical cover for a long time.

Of course, most of the time, all was well. However, the system, such as this individual had one, was weak, and when faced with the attack and multiple seriously injured casualties, fell apart. The consequence is that, despite the best efforts of his staff and many others who were present, a poorer quality of healthcare was given than should have been provided had he done his job properly.

Quite reasonably, that caused anger and questions. How on earth could someone be allowed to set up a service to deliver healthcare and safety provision, not through volunteers but as a company, and not provide the proper staff, training or equipment? It was either dishonest or incompetent. It was disgraceful, and the inquiry report was rightly scathing.

The report recommended that the regulation of event medical care be considered, saying that the CQC had suggested that it was the right organisation to provide that. It also recommended that the Government set a standard of medical care for different events to which individuals should be held to ensure consistency, and strongly recommended that sanctions be put in place so that people who do not comply, such as the company in this case, would be subject to criminal or civil sanctions, or both, for their actions. I was outraged when I read the report. Of course, we all want the highest quality healthcare for everybody on all occasions, but we have to consider soberly whether these regulations are the best way to achieve the outcome we all want to see.

The regulations remove exemptions for on-site healthcare at sports events and music festivals, but there is a question of scale. Manchester Arena holds up to 21,000 people, and sporting events or festivals can have many more participants and spectators. There are strong arguments that such events, which usually have commercial healthcare providers, should provide a great service with suitably qualified staff, and should face sanctions if they do not. However, not all sports events are at Wembley, Silverstone or Twickenham, and not all music events are Lost Village, Glastonbury or Manchester Arena.

What will be the effect on grassroots sport? Some small-volume events are high-risk sports and need medical cover, as the Minister suggested, but how small is too small to require healthcare? What regulation will the Government put in place for that? As the regulations also affect volunteers, will they discourage volunteering in healthcare provision? If so, will that affect the ability of sports events to take place, and how many events will be affected? The Government have admitted that they do not know the answer.

The other small peculiarity is whether medically qualified staff will need to step back in favour of non-medically qualified staff who have a first aid certificate to avoid the need for registration, which I will come to in a moment. Will cover, in some cases, be downgraded to first aid cover that, unlike TDDI cover, does not require registration? If there is such a downgrade, will it be good or bad for patients?

What is first aid? The Health and Safety (First-Aid) Regulations 1981 define it as

“cases where a person will need help from a medical practitioner or nurse, treatment for the purpose of preserving life and minimising the consequences of injury and illness until such help is obtained”,

or as the

“treatment of minor injuries which would otherwise receive no treatment or which do not need treatment by a medical practitioner or nurse”.

As the Minister said, first aid will remain exempt from registration, but it is not entirely clear whether that remains the case where it is provided by a healthcare professional. The CQC website says that first aid is exempt where it is provided by a non-healthcare professional with first aid training or by a healthcare professional who is acting in an emergency or unexpected situation, but if a person is at a sports event specifically to provide healthcare for people who might have an injury, is that an unexpected event? Does it count as first aid, or is it TDDI?

I note that many of the people who responded to the consultation said that it is not clear where first aid finishes and TDDI starts. It is important that the Government define that more clearly. If they do not, there is a risk that people will not provide healthcare when they could provide it perfectly competently, because they are concerned they do not have the registration status to do so and fear the sanctions that may be imposed, when those sanctions have been decided.

Some of this might be covered by the guidance. The recent Government scoping exercise planned 49 types of guidance, including the purple book and the green book. But it is notable that whereas the Health and Safety Executive used to publish the purple and green books or their equivalents together, they are now provided separately; the purple book costs £50 to read an online copy and the green book costs £30 to read an online copy. That might not be of any particular consequence to Twickenham, Wembley or Manchester Arena, but it is of consequence to people running very small events, whether sporting, cultural or musical.

Can the Minister say when the event healthcare standards will be published? He is asking us to vote to hold people to a standard he has not written yet. Will it be free to access? What consideration will be given to support specific courses? The Rugby Football Union, for example, provides specific courses for healthcare provision at its matches. What role will it play in event healthcare standards? What provision will be made for children? Children are not just small adults and specific healthcare considerations may apply.

Another issue, which the Minister himself touched on, is whether the CQC is fit for purpose. The Secretary of State said that it is not. I have not heard the Minister say what additional resources will be provided to the CQC to deliver the additional regulations. There is a difference between healthcare providers in a muddy field or on the side of a hill compared with medical care providers in a hospital with a full suite of equipment. What extra training will the CQC need to regulate this? What will be provided? Is the Minister confident that it can be done, particularly in time for the deadlines imposed by the regulations we are being asked to vote for today, given that the event healthcare standard has not even been written or published yet, and given the Government’s propensity to delay the publication of things such as the workforce plan, which was due over a year ago and has still not been published?

Another issue is mountain rescue. I should declare an interest as a former member of a mountain rescue service—the Minister is smiling. The service follows insurance licensing rules and the purple book. It also has training for remote rescue medical technicians that is governed by the Mountain Rescue England and Wales medical sub-committee under the auspices of the University of Lancashire. It has expressed significant concerns. First, if there is a healthcare professional on the team, what effect do these regulations have? Will they be able to carry the controlled drugs that they are able to provide for the rescue services if they need to administer healthcare on the side of the mountain? These are volunteers, not paid employees. Who will do the paperwork, who will pay for it and who will fund it? Will the Government consider exempting mountain rescue services and volunteers from the charges?

Will England be a less attractive place for events? The costs and numbers appear far higher than the Government estimate. Sports bodies have done a survey that suggests that almost half of doctors will withdraw from doing voluntary events because of the regulations. What about the wider costs for sports and events? They currently face costs for national insurance, employment costs, rising inflation and Martyn’s law, and now there will be the cost of these regulations. What sanctions will there be? It will be against the law to breach the regulations, but what will happen to people who do?

What will be the effect on international sporting events? Some international teams bring their own medical teams with them. The individual medical team applies for temporary GMC registration, usually a couple of months before they come over for events. They may provide TDDI to those in their care. Will that be affected by the regulations? Will they need to register or not? Physiotherapists too have asked whether the care they provide will count as TDDI or as first aid. Will they need to register?

In the previous Government’s assessment in 2023, the cost was put at £1,200 per registration and an ongoing £1,900 per annum. What will be the effect of meeting the event healthcare standard on the smallest events and how will volunteers manage those costs?

The Government have created an exemption for transport within a site. I want to understand why. For example, my husband was injured in an accident at Silverstone a couple of years ago. He received healthcare in the car, and then as he was being transported to the ambulance building within the complex. He was given excellent care, for which I am very grateful. The helicopter then came and took him to Coventry hospital. Why have the Government chosen to regulate the on-site care that a person receives in the vehicle they were driving, for example, and the care provided in the hospital, but not in the gap between the two? That seems a little peculiar to me. The Minister has obviously thought about it carefully, and I wonder what reason he will give.

The healthcare professional in charge at some events can be quite junior. I went to an event with 18,000 people and met the medical team there, which was led by a doctor three years post qualification. That seemed quite a junior doctor to be covering a whole medical team. I also noted that the responsible officer was his employee. Although there is no rule that stops a responsible officer being an employee, I should explain that the responsible officer is the doctor who signs off on one’s annual appraisal and General Medical Council revalidation every five years. Clearly, there is a conflict of interest if a person’s boss is asking to be signed off. Can the Minister please look at that to see whether it is appropriate a responsible officer to be an employee, as that was also happening in an event setting?

Although I think the draft regulations are born from a good place with an important motivation, and it is important that they are done correctly, we do not currently know their cost, effects, scope or standards, including their effects on grassroots event boards. We therefore cannot have confidence that they will achieve the goal we want. Everyone in this room—everyone in the country—wants everyone to receive the best possible healthcare, but I am not convinced at this stage that the Government have really got this right.

--- Later in debate ---

[Dr Ahmed]

My hon. Friend raises an excellent point; I am very happy for the CQC to take that away and answer her specific question. On the issue of what constitutes first aid or more complex medical care, all of us who have been medical cover at events have sometimes come across the incongruous situation where being a medically qualified doctor is sometimes not enough to provide first aid. Those incongruities have existed for as long as I have been in practice, and I do not think the regulations particularly change that. It is often down to individuals’ interpretation of first aid, as well as their insurance cover, and I am sure that we do not want to overly complicate this matter.

[Dr Johnson]

Will the Minister give way?

[Dr Ahmed]

The hon. Lady knows that I often indulge her interventions, but not today. These regulations are a response to a public inquiry and are designed to ensure that the CQC has the scope and oversight of events and arenas. It is for the CQC over the next 15 months to provide some of these definitions and clarity, and they are absolutely the right people to do it. On that basis, I ask colleagues to support this very necessary measure to protect those the people we were elected to serve.

Question put.

Oral Answers to Questions

Caroline Johnson Excerpts

Tuesday 14th April 2026 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

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

I welcome the Minister to her post.

To provide cancer care of the best quality, we need the right workforce. Before the election, the Secretary of State said that he would double the number of medical school places, but he now appears to be quietly dropping that plan. He said that he would provide thousands more medical training jobs, but now he is rowing back on that promise. He said in 2024 that he would publish a comprehensive NHS workforce plan, which was promised for summer 2025 and then for autumn 2025. We are now in spring 2026. When will the workforce plan be published, and does the Secretary of State still intend to double the number of medical school places?

[Mrs Hodgson]

We are well aware that there are issues with the workforce across the NHS, which is why we are working on a new workforce plan that will be published in the spring—very soon.

[Dr Johnson]

I hope that it will be published very soon, because for people with cancer, being seen quickly is key.

Let me return to what the Minister for Care said to my hon. Friend the Member for Hinckley and Bosworth (Dr Evans). The Government appear to have decided that referrals will no longer be triaged by a consultant, and that a set proportion will be rejected. What evidence do the Government have that it will be safe for others to provide this triage? If a set proportion are to be rejected, does that mean that the Government will ask doctors to change their clinical thresholds, and if so, what evidence do they have that that is safe? Surely the Minister would not compromise patient safety for a short-term improvement in figures.

[Mr Speaker]

I presume that that question was about cancer.

Sudden Unexpected Death in Childhood

Caroline Johnson Excerpts

Tuesday 24th March 2026 Westminster Hall

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

It is a pleasure to serve under your chairmanship this morning, Sir John. I declare an interest as an NHS consultant paediatrician and as a member of the Royal College of Paediatrics and Child Health. I congratulate the hon. Member for Rossendale and Darwen (Andy MacNae) on securing today’s important debate.

The death of a child is every parent’s worst nightmare. It is perhaps even more horrific when such a death happens suddenly, without warning and when no explanation can be found. I would like to convey my condolences to the family of Frankie Grogan, to Cheryl, Darren and Louis, to Nathan and Fiona, to the Rogers, Pitts and Williamson families, and to all other families grieving such a profound loss.

Childhood death is thankfully rare. However, more than 3,400 children aged nought to 17 die in England each year, and in around 40 cases the death cannot be explained. Parents are left with more questions than answers. Why has this happened? Why now? Since many cases are unwitnessed, did the child suffer? What was the cause? Could it have been prevented? Will it happen again to a sibling or a future child?

I want to focus on two questions today: how do we identify the cause of death in more cases? And how can we use that information to prevent future deaths? We can do that because we have done it before. In the 1980s, 2.35 children per 1,000 live births died within between a week and two years. That has been reduced by over 90%. The key factors were research, the Back to Sleep campaign, general safe sleeping advice and the avoidance of cigarette smoke. There is more to be done, but with the right plan, we have shown that lives can be saved.

I would first like to acknowledge some progress, including through the work of Baroness Kennedy, whose 2004 report and subsequent work with the Royal College of Pathologists and the Royal College of Paediatrics and Child Health led to the introduction in 2008 of a standard set of clinical samples, called Kennedy samples, that must be taken in the event of a sudden child or infant death. In most of the trusts I have worked in, there is now a box in each emergency department with all the samples and a list of what needs to be taken so that nothing is missed in any cases.

Child death overview panels, which were also established in 2008, are multidisciplinary panels to review the deaths of all children aged nought to 17. That process was further updated in 2018. When a child dies, all registrars must inform the child death overview panel, of which there are currently 58 in England. An expected death goes to a review meeting to look at the detail of the causes and whether it can be prevented in the future. In an unexpected death, there is an urgent joint agency response meeting including police and education, and a review meeting takes place later. All that information then feeds into the national child mortality database, set up in 2019, which is there to spot patterns and aims to prevent future deaths. It produces several reports each year with detailed guidance for Government on how deaths can be prevented.

It might be helpful to discuss an example. In December 2024, the NCMD published a report on child deaths due to asthma or anaphylaxis. I commend those who produced that report, including my medical colleague Dr Emilia Wawrzkowicz. They found that certain factors increased the risks of asthma or anaphylactic death in children, and that milk was most likely to trigger a fatal reaction. They found problems with auto-injectors that were forgotten, out of date or not with the child, or that the training had not been adequate, particularly in schools. They found issues with indoor air pollution, a failure to recognise life-threatening asthma and that children did not have asthma action plans.

Work has been done in many of those areas, which will have saved children’s lives since. My hon. Friend the Member for Rutland and Stamford (Alicia Kearns) has been promoting Benedict’s law, which hon. Members voted for just last week, to ensure that children at school are protected from anaphylaxis. Can the Minister update the House on progress in delivering the recommendations of the national child mortality database’s report? At the moment, the Government are not obliged to produce a response to the recommendations of the national child mortality database’s reports, unlike many other reports, and I think they should be. A more recent report was on the effect of consanguineous marriage on the rate of child deaths. It would be helpful to have Government responses to show that those reports are being read and acknowledged, and that the work that has been done is leading to change.

I worry about the effect of the imminent abolition of NHS England on the national child mortality database’s work. Child death overview panels do very good work in investigating each child death individually, but ICB funding cuts mean that not only bereavement staff, but investigatory staff, are being cut. The mergers of ICBs mean that local knowledge may be lost as the areas become very large. That is not in line with the statutory guidance in the Children Acts. Can the Minister update us on the Government’s plans in that area?

Whole genome sequencing offers an increased likelihood of finding children’s causes of death, but there is a long wait for results; it can take six months. Families are in great distress while they wait for those results, as we have heard. The Government suggest that they want to expand genome sequencing work, but it has already taken a very long time and the workforce plan has not yet been published. What are the Government doing to make sure we have the right staff and the right capacity to deliver that ambition?

Skin biopsies can be very helpful, particularly in diagnosing inborn errors of metabolism, which in children can cause illness and death, but they are not yet available everywhere. Can the Minister update the House on what is being done to roll out these tests so that, where possible, all causes can be found?

The Liberal Democrat spokesperson, the hon. Member for Mid Sussex (Alison Bennett), mentioned the fact that there are not enough pathologists. That is very important because it causes distress and delays, including to post-mortems, and it means that families have to wait much longer for results. Also, some children tragically die overseas, as happened to one of my patients relatively recently. In such cases, SUDC panels rely on being told about it and find it more difficult to investigate. Does the Minister have any comments on that?

Hon. Members talked about research. The Lullaby Trust has been doing gene sequencing on tissue samples from children who died of sudden unexplained death. In four of 20 cases, the tests were able to find evidence of infection, so there is hope that people who have been bereaved by a sudden unexplained death in the past can, with more modern techniques and retained tissue samples, discover the cause in the future. However, that will only happen if the research takes place. This research is charitably funded. We heard about the charity-funded research being done in Bristol, but the Government also need to fund research so that we get as much information as possible to prevent these deaths.

Lastly, I will talk about bereavement support. We have heard about the vital role that it plays in helping families, including siblings, in their time of grief, but I have heard about cuts to that as a result of mergers and funding changes to ICBs. In one case, a phone line has been taken away, meaning that families who want to approach bereavement support have to email and wait for a response—I can see hon. Members frowning. This is clearly not good enough, so I urge the Minister to look carefully at it and take the time to find out what is going on in each ICB regarding the commissioning of these services, so that we are not leaving families without the support they need during the most awful time they could ever experience.

What we have heard today is a call for action. We have heard a call to explain the unexplained, support families better, improve on research and, ultimately, to prevent the deaths of children.

[Sir John Hayes (in the Chair)]

In calling my long-standing friend, Mrs Hodgson, I let hon. Members know that she has agreed to leave a couple of minutes at the end for Mr MacNae to wind-up. In turn, he is about to agree to leave a couple of moments at the end for me to move the motion.

--- Later in debate ---

[Mrs Hodgson]

Yes. I thank the hon. Member for his very moving speech; he often moves me to tears in moments such as this. I will take that away, and ask my officials to look at the work of Queen’s University Belfast, because he makes a very important point.

The shadow Minister, the hon. Member for Sleaford and North Hykeham (Dr Johnson), made a couple of points. I will write to her on the Government’s responses to recommendations, because it is a valid point and one that we should be aware of in future. On the point about ICBs making services more effective by cutting duplication and making sure we have the right people in the right places to deliver quality services, that is something I will also be paying particular attention to, as the Minister with responsibility for children’s health.

[Dr Caroline Johnson]

My point was less that mergers of ICBs would make services more efficient, but more that that is leading to services being cut, which may make them less good, and that the principle that CDOPs look at the local area is diluted if the local area becomes very large.

[Mrs Hodgson]

I take on board what the hon. Lady says. When I write to her on the point about responses to recommendations, I will elaborate further on that point, having made sure that I have understood it correctly.

Puberty Blockers Clinical Trial

Caroline Johnson Excerpts

Monday 23rd March 2026 Westminster Hall

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

It is a pleasure to serve under your chairmanship this afternoon, Mr Mundell. I must first declare an interest as an NHS consultant paediatrician. I thank James Esses for the petition and the thousands of people who have signed it, including many of my constituents, for enabling today’s important debate. I also thank the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) for leading the debate so well.

The petition asks the Government to cancel the puberty blockers trial and to safeguard vulnerable children. Perhaps it is worth considering whether clinical trials in children are a good idea in principle. The answer, of course, is yes. Children are not just small adults; they have different illnesses from adults, they present with different symptoms and respond differently to medication, and they require different doses at different ages. Properly designed clinical trials ensure that children’s medicines are safe and effective for them.

However, today we are discussing one particular trial: a proposal to give puberty blockers—gonadotrophin-releasing hormone analogues—to children, specifically for gender incongruence. Perhaps at this point it is worth considering why doctors and others prescribe medication; we do it to treat or cure disease, to treat or lessen symptoms and to aid in diagnosis.

What does this trial seek to do? On the face of it, it seeks to establish whether puberty blockers are a safe and effective treatment for gender incongruence. ICD-11 defines gender incongruence as:

“A marked and persistent incongruence between an individual’s experienced gender and the assigned sex”.

To suggest persistent incongruence with gender stereotypes is wrong could undo years or decades of rolling back gender norms. If it is not causing the person any distress, why would we want to treat it, especially when we know that most children, even those with gender dysphoria who do have distress, will get better without any puberty blockers?

Currently, there is no way to identify which children will persist with a trans identity as adults and which will not. The much-delayed data linkage study could help with that. It could enable more targeted interventions and may also provide information on the long-term outcomes for people who have taken puberty blockers in the past. However, the Government insist on pushing on with the puberty blockers trial anyway, before the data linkage study is complete. Why? In written parliamentary questions, Ministers have said that they expect the data linkage study to be finished by April 2027, so what is the rush?

What is the point of the treatment? It has been suggested that it helps transgender adults pass more easily as the opposite sex and potentially avoids surgical operations in adulthood, but how on earth can it be ethically, morally or medically right to treat a large group of children with risky medication to give cosmetic benefits to a much smaller number of adults?

There are also cosmetic risks to the treatment. The penis grows very little between the ages of three and 10 years. The use of puberty blockers restricts growth, meaning those with a persistent trans identity may struggle with having enough tissue for a vaginoplasty surgery, and those who do not have a persistent trans identity may struggle with normal intimate relationships.

As mentioned earlier, the Secretary of State has said that he has confidence in this trial. Now it has been paused, we can presume that he is not quite so sure. But can we, patients and the general public have confidence in this trial? There are certainly causes for concern. In fact, there are so many that I cannot speak of them all today, but I would like to speak of a few in the time I have available.

First, on the selection of patients, we have had a dramatic change in the demographic. There has always been a small number of children uncomfortable in their own bodies, but there has been a rapid increase, which is not fully understood, particularly among girls. Many of them are in care, some have autism spectrum disorders and many are same-sex attracted. We need to understand this before prescribing irreversible treatments.

We do prescribe—and I have prescribed—drugs that are high risk or potentially harmful to children. An easy example would be chemotherapy, but that is being given to save a child’s life; it is not used to pause a perfectly normal physiological process in a physically healthy child. The risks of these treatments have been listed today, but I will list just a few: fertility problems; idiopathic intracranial hypertension; demineralisation of bone density, leading to fractures; in some studies, an increase in depression and anxiety; and the long-term loss of sexual function in some patients. We have discussed consent. How do you get consent from a parent of a child—a boy or a girl at Tanner stage 2—about long-term sexual function and fertility?

On the design of the trial, it is said to be a randomised controlled trial. Well, it is, but that is a bit of a fudge, because instead of an actual randomised controlled trial where some patients receive puberty blockers and some do not, it has given some now and some slightly later, with a very short difference in the timing. The comparison group that does not have any puberty blockers at all is taken from a slightly different population, which introduces an unnecessary bias. The trial’s organisers have said that they are doing that because they think the children would get the drugs from elsewhere or from abroad, but that is not how we do medical trials. When I have raised this issue, Ministers have responded that it cannot be blinded, but blinding and randomisation are not the same thing. The trial is also far too short to provide data on long-term outcomes.

On the process of the trial, the hon. Member for Gower (Tonia Antoniazzi) raised questions about what children are being asked as part of this trial. Why is the trial proposing to ask children about their sexual experiences? Why is this helpful to the trial?

[Iqbal Mohamed]

Will the hon. Member give way?

[Dr Johnson]

I will not because I am aware of the time.

The Commission on Human Medicines’ report heard that, because trials of puberty blockers have been blocked, some clinicians are trying to use other drugs to limit puberty, such as spironolactone and cyproterone acetate. There have been reports that the number of prescriptions for spironolactone in 10 to 17-year-olds is going up. Could the Minister confirm whether that is the case and what the Government are doing to look into it?

The MHRA was happy with the process; now it is not. What has changed? None of the issues raised seem to have not been raised before. The Government are being secretive about it: in February, Ministers brought forward a written statement referencing an MHRA letter in November, but the Minister is refusing to publish it. I have asked Ministers whether they talked to MHRA officials about the trial before February 2026, and they will not answer the question. There was a letter between the MHRA and KCL; I asked when it was received, when the Department became aware of it and when Ministers became aware of its contents. They will not tell me.

What about the people controlling the trial? As has also been mentioned during this debate, Professor Jacob George has been recused from further involvement. According to the MHRA’s statement, this is “a precaution”, because of social media posts made before his involvement. Why have those who have made the opposite type of comment not been recused too? This will inevitably make members of the public think there is bias involved.

There is an oversight board. What has the Minister done to ensure that the clinicians and scientists on that board are impartial, and that it is balanced between both perspectives? The Tavistock trial was supposed to report to the MHRA, but it did not, seemingly with no consequence. There will be lay members on the board with lived experience; will one of those be a detransitioner, or will they all be people on one side? That would increase the perception of bias in this trial.

In summary, this is a trial of risky medication on healthy children, most of whose features of gender incongruence will resolve in time, given normal puberty. What is particularly worrying is that, at the end of this treatment, the trial has so many flaws that it is bound to be disputed, whatever the result.

To give this treatment, the lead clinician will need to think that there is a reasonable prospect of a patient benefiting from puberty blockers. Given all that has been said, how can any clinician believe that that is the case? I hope we can all agree that we do not need a clinical trial to know that helping a child to be at peace with themselves and their body is infinitely preferable to a lifetime of harmful medical intervention.

Type 1 Diabetes: Infant Testing

Caroline Johnson Excerpts

Monday 9th March 2026 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Alec. I declare an interest as an NHS consultant paediatrician and a member of the Royal College of Paediatrics and Child Health. I congratulate the Minister on her new role. It is a very important role in the Government, and I know that she will do it with great care and thoughtfulness.

I congratulate the hon. Member for North Ayrshire and Arran (Irene Campbell) on introducing this important debate. I also give condolences to Lyla’s family and commend them on their bravery and their courage. I pay tribute to their work to prevent the same tragedy from happening to other families.

When one becomes a doctor, one gets trained in resuscitation. Many people are familiar with the resuscitation ABC—“airway, breathing, circulation”—but the full version is ABCDEFG: “airway, breathing, circulation, don’t ever forget glucose.” Sadly, some people do, as we have heard today. Every doctor is taught the signs of diabetes mellitus, what to look for and when to test sugar. I am hesitant to legislate medical guidance, because that still requires the awareness of the guidance’s existence. Changing the guidance in law instead of simply in practice may also reduce flexibility as evidence-based judgment comes to the fore. What is the Minister doing to increase awareness among doctors and wider clinical teams, as well as families and the wider public, so that we do not see cases of tragedy and near misses like those that we have heard about today?

Diabetes type 1 can present at any age, but it commonly presents in primary school and the early years of secondary school. Detection before it develops is challenging, and presentation is often very acute in children. It is an autoimmune condition, so antibodies are developed by the insulin-producing cells in the pancreas, creating a deficiency in insulin, which is the cause of the illness.

The ELSA study, which has been mentioned, is looking at how we can detect that before a child becomes sick. It will look at 70,000 children. It starts with a simple finger-prick test, similar to that for sugar. It tests for three antibodies; if the person has any of those, they get a second test for four antibodies. We know that if they have two or more of those antibodies, their chance of becoming diabetic in the next 10 years is 75%. We also know that a medication called teplizumab, which was licensed in August 2025 for children over eight years old, may be able to prolong that time. There may be opportunities for further awareness and investigation for early diagnosis, but also for further drugs to be developed, which can delay the onset of diabetes in people who are susceptible to it. The analysis for the first 17,000 patients showed that 75 children had one antibody and 160 had two antibodies.

One of the challenges is determining the best age to test. When did these antibodies develop? What do they develop in response to? Does the test need repeating? If so, how often? I commend my hon. Friend the Member for South Northamptonshire (Sarah Bool) for her ten-minute rule Bill, which will provide leadership on those very important questions.

I also want to ask the Minister about diabetes treatment. For those who are diabetic, blood sugar control is a lifelong preoccupation, as my hon. Friend described. This is not just about the short-term risks of hypoglycaemia and diabetic ketoacidosis, although those are serious enough; the long-term complications from poor diabetic control include heart failure, strokes, amputation and blindness. The latest report from the Royal College of Paediatrics and Child Health showed that there were 33,437 children in England with diabetes mellitus, of whom 93.3% have type 1. These children have regular health checks, but only 66% of the over-12s receive those health checks. What is the Minister doing to increase the proportion? Haemoglobin A1c, or HbA1c, is a chronic measure of what the sugar level has been over time. It is 70.8 in black children, compared with 63.1 in white children and 63.9 in Asian children. What is the Minister’s understanding of what causes that disparity and what is she doing to improve the HbA1c in all children?

Technology can really help. The latest figures from an RCPCH study in this area, from 2023-24, show that continuous glucose monitoring of children increased from 49% to 79%, insulin pump usage increased from 45% to 56% in a year, and the use of the hybrid closed loop system increased from 15% to 36% in just one year. Such devices really improve diabetic control. What are the Government doing to increase the rollout of these technologies?

No one in this House wants to see any child become very sick or to see any family suffer the heartache that Lyla’s family have suffered. I pay tribute once again to Lyla’s family. This debate, the petition and the media reporting of this debate will all raise awareness, and I have no doubt that that will contribute to saving the life of some child somewhere in our nation. I look forward to hearing the Minister’s response on how she will increase clinician awareness and widen public awareness, improve research into screening and new treatments, improve early diagnosis, and roll out the best technologies and treatments to improve diabetic control for patients with diabetes.

Draft Human Medicines (Amendment) Regulations 2026

Caroline Johnson Excerpts

Tuesday 3rd March 2026 General Committees

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

It is a pleasure to serve under your chairmanship, Mrs Harris. The Opposition do not intend to divide the Committee on these regulations, as anything that improves trust in medicines and vaccines is important. We need to increase the uptake of vaccines; it has fallen gradually and continues to fall, and we need to reverse that.

I have a couple of technical questions. As the Minister said, the principle behind the amendment to regulation 3 of the 2012 regulations is to make prescribing pharmacists equivalent to doctors and dentists. However, regulation 3(8) currently refers to,

“another doctor or dentist…of the same…practice.”

Given that pharmacists will now also be included, should that be amended to “another doctor, dentist or pharmacist”, or “a doctor or dentist”?

Regulation 5 redefines an “occupational health vaccinator” and refers to a list in part 4 of schedule 16 to the 2012 regulations. That significantly broadens the list to include individuals such as speech and language therapists who are not accustomed to dealing with injectable medications, but appears to exclude operating department practitioners, who, as the Minister will be aware of from his practice, are used to dealing with injectable medications. Could the Minister explain the reason for removing those practitioners from the list?

Regulations 8 and 9 talk about the vaccine group direction. The patient group direction is essentially a group prescription, where a clinician signs off the circumstances in which medication—say, paracetamol —may be given by a non-prescriber. We had such a direction for the covid-19 vaccine during the pandemic. This vaccine group direction would be different, so why does the Minister feel that we need a different process to the patient group direction that is already available for vaccines, which are prescription medicines? Instead, those directions can be signed by someone who is not a clinician—such as a manager in the Department of Health or, in fact, a private company—and they do not need to have any clinical skills or qualifications at all. A clinician, or one of the people listed, must decide whether the conditions have been met, and they can then give the patient the medicine without having prescribed it.

I want to ask a couple of questions on this issue. How does that improve trust, when we have a vaccine-sceptic population and lots of material on social media, some of which is not entirely accurate? How does allowing a prescription to be written by someone with no clinical experience help with trust and those rates? Is there a plan to contract out vaccine provision to the private sector, because that is what this provision allows for? Who is ultimately responsible? Is it the non-clinician who signs the vaccine group direction? Who is the clinician ultimately responsible for the decision to give the vaccine in the event that someone has an allergic reaction or an adverse reaction of some other type?

[Dr Ahmed]

I am grateful to the shadow Minister for her support; she is a learned Member of this House, and I know she takes these matters extremely seriously both here and in her own clinical practice.

She raised a technical point on whether the sub-paragraph should include the word “pharmacist”, given the updating of the regulations—I am very happy to explore that further to ensure that the wording is optimal. I also want to reassure her on the point she made about the workforce; training and a governance framework will be set up by the UK Health Security Agency, which will oversee all of this. Whether it is an operating department practitioner or anyone else, there will be a basal level of training that can reassure all Members of this House, whether we are the clinician prescribing the vaccination or the citizen receiving it. This will be overseen very tightly by the UKHSA.

[Dr Johnson]

Before the Minister moves on, can I just ask him why ODPs appear to have been removed from the list?

[Dr Ahmed]

I am not clear on why they have been removed from the list. However, I certainly expect that anyone who is reasonably trained will be able to deliver vaccines in the settings that we have proposed, which include community hospitals and everywhere in between, when we need to think about hard-to-reach communities.

The shadow Minister also asked a question on vaccine group direction versus patient group direction. The primary difference is that the VGD allows for the separation of the decisions to treat and provide consent by a registered healthcare professional, which still need to exist, from the administration of the vaccine, which is then done by a separate individual. That is not possible under a PGD, so it is about separating the roles. However, I reassure her that the consent process in prescriptions is paramount, and she is right that it must continue to be if we want to invite people’s confidence in the vaccination process.

--- Later in debate ---

[Dr Johnson]

Can the Minister confirm that the vaccine group direction—unlike a patient group direction, which ultimately needs to be signed by a clinician—would not need to be signed by a clinician, and can instead be signed by a senior manager either within a company or department?

[Dr Ahmed]

I will clarify that for the shadow Minister, but we are both cognisant of the wider point that clinicians ultimately take responsibility for prescriptions and informed consent of the vaccination process, and that will still continue. Healthcare professionals will still be seeking consent for treatment; the VGD simply means that they can be separate to the person who is then administering the vaccine in practice. There is no suggestion that there will not be clinical oversight or governance of this process—it is quite the opposite. This provision is designed to tighten governance frameworks and make them more transparent.

As I set out at the start of the debate, the proposed amendments aim to support the ongoing development of a vaccination system that is fit for the future. They are designed to build upon the benefits that HMRs have provided to date, as well as wider lessons learned during the pandemic, including recent polio and MMR catch-up programmes. In amending these regulations, the Government are seeking to maintain important safety measures while also increasing the effectiveness of the system’s supply chains and workforce in vaccination programmes.

The science unequivocally tells us that, after clean water, vaccination is the most effective public health intervention for saving lives and promoting good health. It is therefore a solemn duty of this Government to do all we can in this space to support the health system’s ability to deliver vaccines for all those eligible and, in turn, help support vaccine uptake. Given the overall support of the proposals in the consultation, and the ongoing need to support the continued safe and effective supply, distribution and administration of vaccines both now and in future, it is our intention to make permanent the provisions discussed during the debate. I commend the draft regulations to the Committee.

Question put and agreed to.

Eating Disorders Awareness Week

Caroline Johnson Excerpts

Thursday 26th February 2026 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Ms Vaz. I congratulate the hon. Member for Bath (Wera Hobhouse) on securing this important debate and on her work in this area.

Eating disorders are deeply complex conditions. On the surface, disordered eating can take a variety of forms, including restricting the amount or the type of food eaten; binge eating large amounts of food in a short period and then purging that food through forced vomiting; excessive exercise; and laxative misuse to avoid weight gain. Beneath that surface lay a horde of drivers, such as control, shame, anxiety, obsessive-compulsive disorder, poor body image, and mysophobia, which is also known as germophobia.

The covid pandemic provoked intense scrutiny of germs and cleanliness, took away people’s control over when they could go out and when they could see their friends, and drove their activities from the personal to the online, so it comes as no surprise that it saw a spike in eating disorder referrals. By early 2021-22, 3,400 people were treated for an eating disorder, compared with 1,900 in the same period in 2019-20.

The last Government introduced the mental health investment standard to increase mental health spending in local health systems, and it also included a pledge to increase mental health spending as a proportion of total health spending every year. With mental health accounting for over 20% of demand for health services, and a 2021 report finding that eating disorders cost the UK economy a £9.4 billion per year—

[Valerie Vaz (in the Chair)]

Can I ask you to speak up, please? People in the Gallery cannot hear.

[Dr Johnson]

I am sorry.

The last Government’s work to channel more resources into mental health could not have been more welcome. This year, 2025-26, will be the first since 2016-17 that mental health spending has not risen as a proportion of health spending. That contravention of the mental health investment standard has raised alarm bells at the Health and Social Care Committee. Can the Minister enlighten us as to why the Government have decided to break the mental health investment standard after nearly a decade of progress? Does he think the percentage is now about right? Does it concern him that some ICBs have cut funding for mental health services? How does he expect that to impact on patients suffering from eating disorders?

I am particularly concerned about the impact on children and young people, and I declare an interest as a consultant NHS paediatrician. Some 6.4% of adults have a diagnosed eating disorder, but 12.5% of 17 to 19-year-olds have been diagnosed with an eating disorder since 2023. That amounts to one in five girls in that age group—four times the prevalence in boys. What specific action is the Minister taking to improve early intervention?

The previous Government got the ball rolling on establishing mental health support teams in schools, and had reached 35% coverage by the time of the general election, with a commitment to increase that to 100% of schools and colleges in England by 2030. Does the Minister plan to build on that work? What further action is he taking to improve links between eating disorder services, schools and families to ensure a joined-up approach to accessing specialist help and early diagnosis, which, as we have heard, is critical?

The hon. Member for Didcot and Wantage (Olly Glover) spoke of the challenges of transition. As a paediatrician, I see the challenges of transitioning many paediatric and adolescent conditions between children’s and adult services, but can the Minister say what he is doing specifically for those transitioning with eating disorders?

In my role as chair of the APPG on emerging drugs and online behavioural trends, I know the effect of social media on children’s and young people’s behaviours. Researchers from University College London, who examined evidence from 50 studies in 17 countries, found that social media usage is linked to eating disorders in young people, as it viciously promotes the idea that it is essential to be thin and fit, triggering a potentially extreme preoccupation with body image, weight and shape. Those obsessions are compounded by AI content, which can depict simply unachievable so-called perfection. As the hon. Member for Bath said, there are harmful videos online, with algorithms driving that harm, and those who look at these things seeing them more and more.

I recently held a policy debating competition among year 10 and year 12 students in my constituency, where students chose the topic of debate. Many of them spoke in favour of a social media ban for children as young as 16. It is a difficult issue, and that is not a perfect solution, but having just got a new mobile phone myself, I wonder why, when someone buys a phone, it cannot be set at a fixed age that can be changed only by the adult who pays the bill. A change in the law to restrict social media for under-16s would help to reduce that problem. I am interested in the Minister’s thoughts on that.

NHS guidance on eating disorders for ICBs has been raised in the debate. The NHS has refreshed that guidance, which is welcome, but patients will feel the difference only if it is actually implemented. The Minister has confirmed that there will not be a dedicated strategy for eating disorders, and there is no mention at all of eating disorders in the 70,000-word 10-year plan. Is the Minister confident that the refreshed guidance for ICBs will be sufficient on its own to improve care for people with eating disorders and to get waiting lists down? Does he have a strategy for how it will be enforced?

We have talked about the effects on families and carers. What action is the Minister taking to engage families, carers and supportive charities in plans for care? What support is available for parents, carers and siblings?

Workforce is key to delivering this strategy. We know that waiting times for eating disorder treatment are getting worse; analysis from Beat found that, in some cases, people with eating disorders face a three-and-a-half-year delay between falling ill and starting treatment. For someone with an eating disorder, that is three and a half years deeper into the illness. As we have heard, that makes it all the more difficult to treat the patient effectively and quickly pull them out of that difficult, dark place. What steps is the Minister taking to increase workforce capacity to help treat these patients and restore some stability and normality to their lives? I feel as though I ask this question every time, but the NHS long-term workforce plan is still not with us, having been delayed from last year, so when will it be published, and what tangible action will it take to boost the NHS eating disorders service?

It is not just about hiring more staff; it is also about where we are hiring them. That is important work, but more needs to be done to build on the progress. The Healthcare Quality Improvement Partnership produced a highly detailed report about in-patient eating disorder service provision in the UK. As expected, there were blackspots for those vital services in many rural and coastal areas, such as in Lincolnshire. For adults and families in constituencies such as mine, where the closest service may be an hour’s car journey away, accessing eating disorder services is remarkably difficult. The Government have been insistent that rural and coastal areas will not be left behind on healthcare, but the blackspots tell us otherwise.

[Dr Arthur]

I thank the hon. Member for giving way—I have to say that she is one of my favourite Tories. Does she agree that there is a real inequality here? A one-hour car drive is a challenge, but if someone does not have a car, it is even more difficult. If they have a child, they might have to take a day off work to take them somewhere. So getting services, or capacity in the community, closer to people should absolutely be the ambition, shouldn’t it?

[Dr Johnson]

I completely agree. This is not just about people who have a car; for people who do not have a car and who are reliant on public transport, it can be even more difficult. People also struggle to take time off work because of the financial cost. For those who do have a car, there is also the cost of the petrol or diesel to get to the appointment. I would appreciate it if the Minister could update us on what he is doing to ensure that the neighbourhood and community slant of the three pillars of his health improvement plan are working in that regard.

As the hon. Member for Bath said, in-patient services are limited in capacity. In my paediatric practice, I have seen patients waiting on acute general paediatric wards—sometimes for several weeks—but those are really not the right place for them to be cared for. Could the Minister update us on what he is doing about increasing capacity in regional services?

I would like to speak a little about two other types of eating disorder: avoidant/restrictive food intake disorder and Prader-Willi syndrome. ARFID involves limiting the amount or variety of food consumed. It is not just picky eating. I have seen a teenager who lives on just plain pasta, nuggets and chips, and a younger boy who lives on a single flavour of one brand of milkshake and no solid food at all. That can be driven by fear and sensory and other issues. What is the Minister doing to make sure that services are available for these young children? NHS England’s refreshed eating disorder guidance recommends:

“ICBs should develop and deliver ARFID care pathways”.

What steps is the Minister taking to improve early diagnosis of ARFID, and what work will be done to train primary carers to identify it in children and adults, particularly in cases of neurodivergence?

Prader-Willi syndrome is a rare genetic disorder causing excessive appetite and overeating, which can lead to dangerous weight gain and restricted growth. Around 2,000 people live with Prader-Willi syndrome in the UK, and there is no cure. It is not mentioned in the NHS guidance, so what work is the Minister doing to ensure that people suffering from PWS have access to the care they need? What steps are we taking to expand genetic testing at birth to identify PWS and improve early access to treatment for these patients?

To sum up, mental health challenges are on the rise, and eating disorders are no exception. I urge the Minister to implement a clear approach to tackling eating disorders for adults, children and young people.

--- Later in debate ---

[Dr Ahmed]

I wholeheartedly agree. The Government are committed to ending the revolving door for many conditions—this is an exemplar, in many ways—by joining up care and the streams of information that underpin it. One of our main commitments in our 10-year health plan is to have more joined-up care, to move it from sickness to prevention and to move from hospital into community, where that join-up can happen.

This community can thrive only when it is built on a foundation of timely, effective care. That is why we are focused on reforming eating disorder services so that people can access help when they need it, not after their condition has escalated. That approach underpins the new NHS guidance for children and young people’s eating disorder services, published last month, which is clear that care should be timely, joined up and delivered as close to home as possible.

As many here know, demand for mental health support, including eating disorder services, rose sharply during the pandemic, and the rise has been sustained thereafter. Although services remain under significant pressure, as a result of the additional investment there are some green shoots in system capacity and capability to better meet rising demand and reduce the waits that hon. Members have described.

In December 2025, 83.3% of routine referrals to children and young people’s community eating disorder services and 78.8% of urgent referrals started treatment within four weeks and one week respectively. That is a marked improvement in performance, compared with the situation six months earlier. In June last year, only 72.2% of routine referrals and 63.7% of urgent referrals were seen within four weeks and one week respectively. Although those are encouraging signs, I am under no illusion: too many children and young people are still waiting far too long for support. That is exactly why further reform and delivery are needed.

The Government’s long-term approach to mental health reform is set out in the 10-year health plan, which is clear in its direction. It shifts care from hospital to community, from sickness to prevention and, of course, from analogue to digital, which will be so important when it comes to having joined-up care. I assure hon. Members that those shifts are not abstract principles, but practical changes that are already being embedded. I know that they matter deeply for people living with eating disorders, and the families and loved ones who support them.

But I recognise that plans alone do not deliver care. Delivery depends on people and having the right workforce with the right skills in the right places. That is why, on top of the workforce plan that will come to fruition in late spring or early summer, we are investing in the workforce. We are committed to providing an additional 8,500 new mental health professionals across child and adult mental health services, to cutting waiting times and to ensuring that people access treatment and support earlier than ever before.

We are also working to strengthen skills and capability across the system. NHS England has introduced comprehensive training to ensure that staff across mental and physical health services can recognise eating disorders early and respond safely and effectively. That training supports clinicians working not only in the community but in primary and, crucially, acute care settings, where I used to work. I often saw such patients on my acute general surgical receiving ward rounds. The training includes specialist programmes, including the Royal College of Psychiatrists’ eating disorders credential, expanded access to family-based therapies, cognitive behavioural therapy for eating disorders, and dedicated training on ARFID, which the hon. Member for Sleaford and North Hykeham (Dr Johnson) mentioned. That work is about giving staff the skills, confidence and, crucially, clarity they need to deliver safe, high-quality care and reduce some of the avoidable harm that we have discussed today.

I am pleased to say that funding for children and young people’s eating disorder services has increased significantly, from £46.7 million in 2017-18 to an actual spend of £106.3 million in 2024-25. With that extra funding, we have focused on enhancing the capacity of community eating disorder teams across the country, because we know that timely, effective care leads to better outcomes, supports recovery and helps to prevent conditions escalating to the point at which hospital admission becomes inevitable.

When admission is necessary, stronger community care can reduce length of stay when it is safe. We recognise the concerns that in-patient capacity remains under pressure in some parts of our country. There are reports of individuals being discharged at very low body mass due to bed availability, as the hon. Member for Bath highlighted. Discharge decisions must always be about clinical judgment and patient safety, not capacity constraints. NHS England reassures me and continues to work with providers and integrated care boards to ensure that sufficient specialist provision and safe step-down pathways will be in place.

[Dr Caroline Johnson]

The Minister’s speech is very interesting. He talks about an increase in capacity, much of which will require workforce. I noticed that when he mentioned the workforce plan, he said “spring or early summer”, which is a change from his previous wording, which was always “spring”. Is that a sign that it is being delayed further?

[Dr Ahmed]

As always, the hon. Lady reads too much into my words. I am a Scot, so for me, spring and summer sometimes mean the same thing—and indeed winter. I can reassure her that there was no subtext to that nuance earlier in my speech. We remain committed and are on track to deliver on the workforce plan.

We recognise concerns, of course, and NHS England is addressing them. Prevention must be central to how we respond to eating disorders, particularly for children and young people. That is why we are also providing £13 million to strengthen the role of mental health support teams in schools and colleges through enhancements, so that concerns about disordered eating and body image can be identified and addressed much earlier. Acting sooner improves outcomes, reduces the need for more intensive treatment later and helps to ensure that our young people get the support they need, at the right time.

We are encouraged by the progress being made, but I am under no illusions. I know that sustained improvement depends on clear, consistent expectations for high-quality care across the whole pathway. That is why, alongside the 10-year health plan, we are developing a modern service framework for severe mental illness, which I can reassure the House will include eating disorders, to help to reduce avoidable harm from them and improve outcomes for persons affected by them. However, to get it right, we need expert input across the system, so my noble Friend Baroness Merron, the Minister responsible for mental health, will be hosting a roundtable discussion with eating disorder charities, clinicians and those with lived experience, to ensure that the modern service framework delivers meaningful improvements for people with eating disorders, with lived experience at the heart of it.

We have spoken, rightly, about online safety issues as they intersect with mental illness and eating disorders. As a parent, I of course remain deeply concerned about the widespread availability online of harmful material promoting eating disorders, suicide and self-harm, which can be far too easily accessed by people, including young people, who may be vulnerable. The UK’s Online Safety Act 2023 makes platforms—including social media, search and pornography services—legally responsible for keeping people, especially children, safe online. All providers must mitigate the risks of illegal harm on their services, and all providers of services likely to be accessed by children must take steps to mitigate their risks to children, especially as regards content related to eating disorders.