Community Audiology

Danny Beales Excerpts

Thursday 18th December 2025 Westminster Hall

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I beg to move,

That this House has considered community audiology.

It is an honour to serve under your chairmanship, Mr Vickers. I thank those who have joined us for the debate and the Front-Bench teams for giving up their time to put in the final shift of this sitting just before Christmas. I realise that I may not be on many people’s Christmas card lists after detaining them to the bitter end, but I appreciate their giving up their time and responding to this important debate. I am grateful to the Backbench Business Committee for securing this debate on community audiology, an under-discussed topic and a very important one in our communities.

Hearing and hearing loss are often the subject of stigma and shame, and sometimes light-hearted jokes in the media and film. Hearing loss is a serious issue—it is not a mild inconvenience—and it can be life-changing. It has a profound impact on the lives of millions of people across England and on the effective functioning of our health and care system more broadly.

Audiology services diagnose, treat and support people with hearing loss and deafness. They are critical to the quality of life and health of a significant proportion of constituents in all our communities. In 2024, 5.8% of people in England reported deafness and hearing loss. Although 94% of hearing loss is related to ageing, that is by no means the only patient group affected. In particular, I note that children’s audiology services are incredibly important to the life chances of children who are born deaf.

Untreated hearing loss has far-reaching consequences for physical and mental health, independence, employment and social participation. People with hearing loss are 2.5 times more likely to experience mental ill health related to social isolation and difficulties finding employment. Elderly people with hearing loss are 2.4 times more likely to experience falls, which in turn increases the risk of hospital admission, loss of independence and long-term care needs.

Untreated age-related hearing loss is one of the single largest modifiable risk factors related to dementia. Evidence suggests that treating adult-onset hearing loss between the ages of 45 and 65 reduces the incidence of dementia by 7%. In the context of an ageing population and the growing prevalence of dementia, that statistic alone should place hearing services firmly within our prevention agenda.

There are significant economic implications to poor service provision. The UK loses an estimated £25 billion a year in lost productivity and unemployment as a result of untreated hearing loss. On average, a person with hearing loss will see around £2,000 less a year than a non-disabled person, and 40% of people with hearing loss will retire early due to the challenges of communicating at work.

The demand for audiology services will only increase over the next few decades. The incidence of hearing loss increases by approximately one percentage point for every year of life. That means that at the age of 50, around 50% of people will experience some level of hearing loss, while 80% will by the age of 80. As our population ages, the pressure on audiology services will grow. As we embark on our mission to rebuild our NHS so that it is a first-class health service fit for the 21st century, it is crucial that we get our approach to audiology services right and in line with the Government’s three key shifts.

Audiology is exceptionally well suited to a nationally directed, community-based model for care, for five key reasons. First, most audiology services are low-risk procedures that can be easily carried out in community-based settings. Currently, 50% of national referrals to hospital ear, nose and throat teams are for uncomplicated non-surgical procedures such as earwax removal and age-related hearing loss. That is difficult to justify clinically or operationally, and sending those patients through complex hospital pathways places unnecessary pressure on ENT services, contributes to longer waiting times and is an inefficient use of specialist capacity. Instead, such procedures can be managed in a safe and effective way by audiologists in community settings.

Just this morning, as if perfectly set up for this debate, I met a constituent at the Christmas present-wrapping event for the fantastic ShopMobility charity in Uxbridge. This gentleman shared with me his wife’s experience in accessing audiology services in our community. His wife faces a more complex hearing issue—not something run of the mill that could be dealt with on the high street—that requires specialist intervention. She has been waiting around a year for a specialist appointment and follow-up at NHS ENT services to have the issue resolved. Shifting less complex cases out of secondary care settings would mean more capacity, more appointments and quicker health for my constituent’s wife, and many more people like her.

Secondly, delivering audiology services in community settings is far more cost-effective. Research by the University of York found that NHS adult audiology pathways delivered by community providers cost between 15% and 25% less than the same pathways delivered by an NHS hospital-based service. There is an obvious financial case for reform to a community-based model.

Thirdly, because audiology services are commissioned at a local level by integrated care boards and have in some cases already been transferred to community services, community audiology is not a new concept. We already have many good examples of good practice to build on, but unfortunately provision is variable and patchy. Thirty of the 42 ICBs in England already commission community-based services, with NHS services delivering assessment, hearing aid fitting, rehabilitation and long-term aftercare in primary care settings, community hospitals, outreach clinics and high street locations. Those services are delivered in partnership with GPs and private providers such as Specsavers. For example, the ICB in my constituency in north-west London commissions community audiology services, with self-referral across our whole area, providing a more consistent and accessible model than many parts of England have today.

Fourthly, delivering audiology in community settings assists the preventive healthcare agenda. People are not always forthcoming about seeking help for hearing loss. On average, it takes around seven to 10 years to acknowledge hearing loss and seek help, meaning that by the time most people present to services, the impact on their health and wellbeing can already be significant. Any barriers or difficulties in getting help can put people off asking for it, further delaying treatment and increasing their personal risk of things such as dementia, falls and mental health challenges, which I have outlined already.

Lastly, audiology provision in the community, especially models that enable patient self-referral without a GP appointment, are better for patients. They empower patients and support the early identification of hearing loss. They reduce travel time and other geographical barriers to access, particularly for older people and those with mobility issues. Community audiology services are particularly impactful for deaf children and their families. Children with hearing loss issues require more frequent appointments than adults—for example, to replace ear moulds for hearing aids as they grow—so community provision with appointments closer to home is particularly helpful for those families.

Taken together, the case for driving a quick shift to community-based audiology is clear. However, despite the opportunities, there remain several structural barriers to the rapid roll-out of community audiology services in every area. The recent Kingdon review of children’s audiology services set out many of the barriers in great detail. Its findings, which I would argue are relevant to audiology services in our country more generally, can be summarised in the words of the introduction: audiology is

“a ‘Cinderella’ service…often overlooked, undervalued and underfunded.”

The most significant issue is that the current system is fragmented and inconsistent, with a clear lack of national oversight. That is apparent from the fact that, astonishingly, the Kingdon review found that there is no national audiology lead in the Department of Health and Social Care, resulting a lack of ownership and accountability for the performance of services. It found that communication between the DHSC and NHS England on known service issues did not meet expected standards. I hope that the merging of the functions of NHS England and DHSC will be a key opportunity to resolve those challenges.

There is patchy coverage of audiology services throughout the country, with a significant postcode lottery of access. NHS audiology services are commissioned locally by ICBs, with tariffs set locally. Although local commissioning can support responsiveness to local needs, in this case it has resulted in wide variation in availability, quality and value for money. As I have said, only 30 of 42 ICBs commission adult community audiology services. In around half those areas, coverage is only partial, and in 12 ICBs no service is commissioned at all. In those areas, patients who are concerned about their hearing must first visit the GP and then be referred to a hospital-based service.

As I have set out, the lack of community provision leads to longer waits, poorer services and more expensive provision in some areas of England. NHS England’s 2023 guidance encouraged direct access and self-referral to audiology services to reduce pressures on GPs, yet evidently not all ICBs have implemented that guidance. Local commissioning and tariff setting has also created substantial inconsistencies in tariffs. In some areas, audiology service tariffs have been set below the cost of delivering care, which has forced some providers to reduce and compromise service quality by, for example, cutting follow-up appointments, outcome measurement and rehabilitation support.

In some areas, local commissioning within limited financial envelopes has resulted in activity caps based on financial envelopes rather than patient need, resulting in predictable waiting list growth. Some services have reportedly been asked to reduce throughput or pause the issuing of hearing aids entirely in order to remain within their contractual limits. This practice undermines the principle of care based on clinical needs and risks storing up greater costs for the future.

The lack of national oversight has produced issues with quality assurance. While many independent and third sector providers deliver high-quality services, there is clearly variation in quality of service, and currently no mandatory system-wide quality assurance requirement for all NHS-funded audiology provision. That lack of oversight has also led to certain services falling through the gaps of NHS provision. The starkest example is earwax removal, about which I am sure many of us will have had emails from our constituents. It is perhaps not the sexiest of issues, and not one that we often like to talk about. I will hold my hand up: I have had earwax removal several times—historically from my GP, and more recently in private Specsavers-based settings—so I can speak at first hand about the impact of these services, or the lack of them.

Historically, wax removal was carried out by GPs and nurses in GP practices. Following a change to the GP contract in 2012, it was no longer designated as a core service, and now, over a decade later, the majority of GP practices no longer provide it. As a result, patients who cannot self-care or self-fund their treatment in a private setting often have no option other than to refer themselves to specialist hospital ENT services when the problem gets much worse, unless they live in one of the very small number of ICB areas that do still commission the service as part of the community audiology pathway. Wax removal is a simple, basic procedure, and it is nonsensical that it is not always delivered in the community.

Data collection and oversight is also extremely poor. NHS England recently decided to stop referral-to-treatment waiting time reporting for audiology services, which has removed visibility of the full patient pathway. Diagnostic data suggests that audiology is now a poorly performing diagnostic service, with over 70,000 people waiting and some regions experiencing delays of more than 40 weeks. Without consistent data, commissioners and providers, and policymakers such as us, simply cannot understand where pressures are greatest and where intervention is needed most.

Like many areas of community services, audiology services are also seeing significant workforce planning issues. There are fewer than 10,000 audiologists and hearing therapists in the UK, and work by the National Deaf Children’s Society and the British Academy of Audiology found that 48% of audiology services have seen a decline in staffing since 2019, equating to an overall reduction of around 8% of the total workforce.

The Kingdon review described the audiology workforce as having been “neglected for years”, with low status, poor professional representation, limited governance and insufficient investment in research and training and development. Coherent workforce planning could be facilitated by the introduction of a single professional register for audiologists, as well as a much more consistent approach to professional development, training pathways and retention measures. This is incredibly important given the predicted increase in demand for services, and I hope that audiology services, and community and primary care workforce issues more generally, will feature centrally in the Government’s promised new workforce plan, as we seek to shift activity away from secondary care towards primary and community-based care.

I welcome the steps the Government have taken to move forward improvements in audiology services. The commissioning and publication of the Kingdon review was a very helpful step. The 10-year health plan for England, published in July, committed to enabling self-referral to clinical audiology, using the NHS app where appropriate, which is welcome. NHS England is supporting providers and ICBs to improve audiology services through capital investment, upgrading audiology facilities, expanding testing capacity via community diagnostic centres, and direct support through the national audiology improvement collaborative.

All those developments are welcome, but clearly there is much more to do. We now need a coherent national framework that gives audiology the strategic attention it deserves. That should include, first, a national commissioning framework for audiology services, including standardised tariffs and activity planning to reduce unwarranted variation and ensure that services are commissioned on the basis of patient need rather than short-term financial constraints locally.

Secondly, the framework should mandate system-wide quality assurance for all NHS-funded audiology services, regardless of provider, building on existing frameworks. Thirdly, it should require a clear national direction on the movement of audiology services into community and neighbourhood health models, setting out how services should integrate with primary care, ENT, social care and broader support services. Fourthly, it should require the reinstatement of referral-to-treatment waiting time reporting for audiology, so that performance is transparent and improvement efforts can be properly targeted.

Fifthly, the framework should require sustained investment in the audiology workforce, including for expanded training places, improved retention measures and the implementation of the Kingdon review’s recommendations on professional registration and governance. Finally, it should require action to ensure equitable access to core interventions such as earwax removal, so that access to basic hearing care is not determined by postcode or ability to pay.

Audiology services may not often feature prominently in political debate, but they matter deeply to millions of people. They matter to older people striving to remain independent, to working-age adults seeking to stay in employment, and to children, whose language, development and life chances depend on early and effective intervention. Community audiology offers a practical evidence-based opportunity to improve access, quality and value for money, but realising this opportunity will require national leadership, clear standards and some sustained investment.

I thank all Members and the Front-Bench teams for being here. I hope the Minister can address the issues in his response. If we are serious about prevention, reducing health inequalities and delivering care closer to home, then community audiology must be part of the conversation. I hope that, as we do so often in this place, we can all say “Hear, hear!”, not only as a mark of agreement, but as a promise of a better future for hearing services in every part of our country.

[Hon. Members]

Hear, hear!

--- Later in debate ---

[Danny Beales]

We certainly heard about some issues today that I did not expect to be on the agenda. The waxiness or not of dogs’ ears will certainly stay with me for a while. I am glad that the hon. Member for Winchester (Dr Chambers) clarified that he is a vet. I wondered whether checking dogs’ ears was a particularly Lib Dem thing to do to, so I am glad he clarified that he does it professionally rather than personally.

We have had contributions from experts across the health sector and experts by experience of hearing loss, and I think we covered many of the key issues for audiology, such as workforce challenges and occupational hearing loss, as well as rural areas, regional variation and unacceptable delays. My hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) made a powerful point about the importance of quality assurance of services. Yes, we want more community access, but it needs to be quality community access.

I thank the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), and the Minister for their kind remarks. I thank the Minister for visiting what he called the fantastic development of neighbourhood health services in Hillingdon. We are fortunate in that, as well as the developing neighbourhood hubs, we have an ICB community-based audiology service. Hillingdon is very fortunate in having community audiology services, and I hope such services will be provided in all ICB areas.

I welcome the Minister’s recognition of the importance of self-referral and the Government’s continued commitment to it. I also welcome his recognition of the need to deal with the issue of variation across the country. In his response, he mentioned the key opportunities in developing the workforce plan, which we expect in the spring, and this Government’s broader neighbourhood health agenda, and I hope that audiology will feature strongly in those developments.

Thank you, Mr Vickers, for your time and the Clerk for their time. I wish everyone a merry Christmas and a happy new year.

Question put and agreed to.

Resolved,

That this House has considered community audiology.

Puberty Suppressants Trial

Danny Beales Excerpts

Wednesday 17th December 2025 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call Health and Social Care Committee member Danny Beales.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

The hon. Member for Sleaford and North Hykeham (Dr Johnson) asks, “Why?” Well, it is because trans people exist and their health needs exist. As the Secretary of State has clearly outlined, an independent review made a series of recommendations. There were clearly failures of healthcare, and a further recommendation was that a clinical trial should address this issue. I believe that the Conservatives supported the Cass review, but when it comes to implementing this part of it, they suddenly have collective amnesia about what Dr Cass recommended. Does the Secretary State agree that, in the absence of a trial, there will still be access to these drugs? We know that young people are seeking out private provision. They are seeking unregulated providers of these drugs, so is not a clinical trial both appropriate and the best and safest way of managing any potential risks?

[Wes Streeting]

The risk that my hon. Friend sets out was one of the considerations that I had to when weigh up—first when upholding the temporary ban, and then when making the ban permanent. I do worry that, outside of a trial, we may continue to see unsafe or unethical practice. I think we will be doing a service to medicine in this country as well as internationally if we have a high-quality trial with the highest standards of ethics, approvals, oversight and research from some of our country’s leading universities and healthcare providers to ensure that, for this particular vulnerable group of children and young people, we are taking an evidence-based approach to health and care.

Transgender People: Provision of Healthcare

Danny Beales Excerpts

Tuesday 16th December 2025 Westminster Hall

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

It is an honour to serve under your chairmanship, Mr Turner, and I thank my hon. Friend the Member for North Warwickshire and Bedworth (Rachel Taylor) for bringing us this debate. I am proud to call her a colleague and a friend. She is an exemplary part of the LGBT movement, and I am proud to associate myself with her and her comments in this debate.

We have heard already about the extraordinary length of waiting lists for gender-affirming care. Based on current appointment rates, a trans person can expect to wait an average of 25 years across the UK for an initial appointment to start gender-affirming care. That is simply not good enough, and we would never accept this in any other patient category in our NHS. We have heard much in this debate about the delays in receiving this care and the devastating impact that has on the lives of transgender people. With that in mind, I would like to ask the Minister whether waiting times for transgender patients are included within the current target to cut waiting times to 18 weeks by the end of this Parliament. Can she commit specifically to decreasing the length of waiting times for gender care by the end of the Parliament?

The second issue that I want to raise—which we have heard about already—is the operation of NHS gender care services more generally, and shared care as an important component of them. Once a gender clinic deems a trans person’s medical transition complete, it discharges them from its care to that of the GP, who will then authorise hormone prescriptions and contact the clinic about any issues. However, GPs in my constituency —and many that we have heard about in this debate—are increasingly refusing to enter into shared care agreements. The rate of such rejections has gone up from 5% to 21% in the last 12 months. Will the Minister therefore commit to clarifying the roles and responsibilities of different NHS services for the provision of gender-related healthcare? It is unacceptable that those who have waited years or decades for initial appointments, who have jumped through all the hoops possible to get NHS gender care, and who are finally in receipt of NHS prescriptions from NHS doctors, are then in practice unable to receive a prescription because their GP has unilaterally decided not to perform blood monitoring tests and provide that shared care support.

It is vital, as has been said, that we ensure access to a range of health services beyond gender-specific needs, whether sexual health services, reproductive health services, or primary and secondary care more generally. The voluntary and community sector, including trans-specific groups, perform a vital role in providing services, brokerage, networking and support in the health service but they are often poorly funded. I encourage the Minister to see what the NHS can do to support trans-led health organisations within it.

Unfortunately and increasingly, a hostile environment is being developed across much of the media. It seeks to erase the existence of trans people from our past, present and future. It is vital that we speak up about their existence, and about the experience of our constituents. I have been contacted by many of my constituents who are trans to detail the impact that the media, political and public discourse is having on their lives. I welcome this debate as part of resetting that discourse in this place and in our society. Fundamentally, this is about treating all people with dignity and respect, and about recognising that trans people exist, as do their health needs.

[Karl Turner (in the Chair)]

We have four minutes remaining for three speakers.

NHS: Winter Preparedness

Danny Beales Excerpts

Monday 15th December 2025 Commons Chamber

[Wes Streeting]

It is as if the ghost of Christmas past has come to visit: one of my predecessors is here to remind the BMA of what it used to have to deal with. Perhaps the BMA will be a bit more content with the ghost of Christmas present—and that is before we are threatened by the ghost of Christmas future—[Laughter.] I am being slightly tongue in check, but the right hon. Gentleman asks a serious question, and I will treat it seriously.

We put in evidence to the pay review body process. The pay review body will make its recommendation, which we will consider. We are in active discussions with Agenda for Change unions about whether we can reach an agreement on future years, including exploration of the prospect of a multi-year offer. I have made the same approach to all health unions, including the BMA and resident doctors. The challenge with resident doctors is that their expectations are some way from affordability. They are asking for a 24% pay rise on top of the 28.9% they have already had. That is not acceptable. As the right hon. Gentleman’s question implies, I have a responsibility to the entire NHS workforce, particularly the Agenda for Change staff, who have not done as well as doctors. Addressing that is not only a practical issue for me, but a moral one.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

First, I associate myself strongly with the Secretary of State’s comments about today’s regrettable decision by the BMA and its members.

In the light of the pressures of flu and RSV, does my right hon. Friend think it is time to ask the Joint Committee on Vaccination and Immunisation to look again at its recommendations on the ages at which the two vaccines are made available? Specifically on RSV in infants, does he think it is time to ask NHS England to look again at the decision to switch from an infant-based delivery model to a maternal-based delivery model on the ground of cost, without taking into account the lower infant RSV vaccination uptake now?

[Wes Streeting]

I thank my hon. Friend for his support and questions. We will indeed reflect on our performance after this winter, just as we did after last winter. He raised interesting points about the way in which we deliver vaccines. As for the questions about eligibility and timing, we rely on the expert advice of the JCVI, which will also look at the data on how this winter has panned out. We look forward to receiving its recommendations in due course.

Urgent Care Centres: Hillingdon

Danny Beales Excerpts

Wednesday 10th September 2025 Commons Chamber

[David Simmonds]

I am grateful to the hon. Member. What he described is similar to the concerns outlined by my hon. Friends the Members for Beaconsfield (Joy Morrissey) and for South West Hertfordshire (Mr Mohindra) and others across the wider area, as well as by many people who have been in touch with me directly.

We know that minor injuries units in general, and the one at Mount Vernon in particular, are valued by people for whom A&E is not always the best place to seek treatment. Many local schools have been in touch to say that if there is an injury during the school day, minor injuries units are the ideal place for a child to get the treatment that they need. For older residents, particularly if they are not in the best of health and perhaps not up to the journey to an A&E department—many of which are under significant pressure—a minor injuries unit is the place to be. I know the Secretary of State and Ministers have responded very positively to the pleas of a number of Members across the House who have asked for the prospect of a minor injuries unit opening to serve their constituencies as part of the 10-year plan, so to see one lost that is already providing a good service seems to me a great shame.

The Minister will know that the Hillingdon hospitals NHS foundation trust has been financially challenged for many years; indeed, during my days as a non-executive director of the Hillingdon primary care trust, in the days of the last Labour Government, the overspend was significant. It is a challenge that has persisted to this day under Governments of all parties, despite numerous initiatives to try to resolve it. That is reflected in the poor state of the main hospital building, which is pending a rebuild. I should declare for the record that my wife is a doctor in that building. I know the Minister and the Government have accepted the programme of works set in place previously, which was granted planning permission by the local authority and announced under the last Government, to provide a new district general hospital at Hillingdon.

I am sure the Minister will know, because of her local knowledge, that we need to recognise that Hillingdon serves Heathrow airport as well as the normal district hospital population. The airport has a very large population of transitory people coming through it, many of whom are taken ill and add to the pressure on A&E. In addition, we have the largest number of asylum seekers per capita of any local authority in the country and a significant number of people in immigration detention, pending deportation. This is not just a hospital serving the normal day-to-day needs of the population area; it has particular and unique pressures, and a minor injuries unit is a means of beginning to take off some of that pressure for the benefit of local residents.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

My constituency neighbour perfectly describes the very difficult situation in Hillingdon inherited by the trust leadership and this Government, such as the hotels opened under the Conservatives putting pressure on the local system. I am pleased that the Government have committed to close hotels across the country and deal with this issue and are reviewing the fair funding of local authorities. That is much overdue in Hillingdon.

The hon. Gentleman describes the situation in Hillingdon hospital, with the need for a rebuild after 14 years with no funding. Again, I am pleased that the Minister, who knows Hillingdon very well—I am sure that did not influence the decision—finally provided the almost £1.4 billion that the hospital needs. Does the hon. Gentleman agree that those are positive steps forward? I agree that the decision on Mount Vernon hospital is concerning, and I have raised those concerns with the trust’s executive leadership myself. Does he agree that there have been positive steps forward on those long-term issues and that we need to continue to work together to improve neighbourhood healthcare?

[David Simmonds]

I am grateful that my constituency neighbour is here. Had he the same degree of history in Hillingdon as myself and the right hon. Member for Hayes and Harlington, I am sure he would recall that the hotels were set up and opened as part of a dispersal programme started under the Labour Government in the mid-2000s and led by Andy Burnham, who is now the Mayor of Greater Manchester. I know that has placed ongoing pressure on the local area, but the number of people put into that initial accommodation who are now stuck locally is very large.

I am sure the hon. Member for Uxbridge and South Ruislip (Danny Beales) shares my concern that, under the recent announcements about local authority funding, Hillingdon remains broadly the same as it always has been, but I welcome his commitment to carry on the work started under the previous Government for the rebuild of Hillingdon hospital. I know the right hon. Member for Hayes and Harlington will be very aware that the work undertaken on sewerage and electronics for that new build over the last few years has presented a significant challenge to residents in accessing the hospital—I am sure his constituents complain about it as much as mine have done.

Indeed, the challenges that will come during the rebuilding process of the hospital on what is currently its car park are a further argument for why a minor injuries unit is important in this period. It creates a bit of additional capacity to help with potentially challenging times at A&E and the difficult logistical challenge of accessing a hospital whose car park is already constrained and will be the building site for a new hospital. All those are additional reasons why a minor injuries unit remains important.

It is noteworthy in this context that the move away from an open access unit to appointment-only, which took place following covid, has significantly reduced the footfall at the Mount Vernon unit and has driven up the cost per visit compared with the previous position. This is part of a pattern that we have also seen in the Harrow part of my constituency at the Pinn medical centre, where the loss of a walk-in facility has led to more patients attending the local A&E, to longer waits and, ultimately, to increased cost to the NHS, because A&E attendances are more expensive than nurse-led walk-in services such as that which is available at Mount Vernon.

The Minister knows all this personally. She knows how much value the local community—not just in Hillingdon, not just in Ruislip, Northwood and Pinner, but across north-west London and into neighbouring Buckinghamshire and Hertfordshire—places on that service and how often Members of Parliament representing places like Watford and the Harrow constituencies have been in touch to share their concerns about the delays and challenges faced by patients attending A&Es in Watford, Hillingdon or Northwick Park, which are the main destinations for alternative treatment.

--- Later in debate ---

[Karin Smyth]

I will comment on that later. I understand that there is a meeting on Friday, to which I will allude.

In preparing for the debate, I met representatives of the trust, and I am grateful to those in the local NHS for their time in giving some further background. The trust is clear that it would be more efficient for urgent care services to be consolidated at the site in Hillingdon, bringing forward the urgent care nurse practitioner service at Mount Vernon into the urgent treatment centre at Hillingdon hospital. The rationale for having urgent treatment centres alongside A&E is well established clinically.

The hon. Gentleman referenced the 10-year plan—I am pleased he is such a fan—and the direction of travel. I am pleased to say that the trust also believes that people are better served by primary care hubs, so that more responsive care can be delivered closer to where people live. Three such hubs are being developed in Hillingdon, one of which will be in Ruislip. I am sure that he welcomed the announcement this week of the roll-out of the first of the 43 hubs, including the one in Hillingdon, which will deliver the neighbourhood health services model.

[Danny Beales]

Despite some of the heat in the debate, the misquoting of things that have been said and the unfortunate politicisation of this important local issue, about which there is general agreement among Members of all parties and in the community, the consensus that I hear is that people want more accessible services, more locally. There is a need for three hubs—the system wants that—and I am pleased that the Government have announced funding and prioritised Hillingdon. I have also heard that there is a potentially greater role for community pharmacies in providing urgent services and care. Does the Minister agree that more can be done by primary care providers across the board in Hillingdon and elsewhere?

[Karin Smyth]

I agree with my hon. Friend that that is the direction of travel that we want to see in all of our constituencies across the country.

The long-promised rebuild of Hillingdon hospital will be delivered by this Government as part of wave 1 of the new hospital programme. The money is guaranteed and construction will start between 2027 and 2028. We are already helping the trust to prepare for when we get spades in the ground, and it was a pleasure to visit the trust recently with my hon. Friend the Member for Uxbridge and South Ruislip.

The hon. Member for Ruislip, Northwood and Pinner raised the issue of consultation. I understand that there is a meeting with the trust, the integrated care board and the local authority on Friday, and I am sure that he and other hon. Members will be part of that. It is entirely proper for a Member of Parliament to raise issues about changes in their area—that is part of our democracy and democratic accountability. Now that this Government have put the new hospital programme in order, it is also proper for the House to hold us to account on its progress.

Defibrillators

Danny Beales Excerpts

Tuesday 2nd September 2025 Westminster Hall

[John Slinger (Rugby) (Lab)]

It is a pleasure to serve under your chairship, Mr Stringer. I thank my hon. Friend the Member for Bishop Auckland (Sam Rushworth) for securing this important debate. There can be no overstating the importance of publicly accessible defibrillators. If used within the first three to five minutes of a cardiac arrest, as hon. Members have said, they can increase the chance of survival by up to 70%. For a device that costs only a few thousand pounds, that is a truly remarkable statistic. I was told that stat by a remarkable constituent of mine, Naomi Rees-Issitt, at a defibrillator and CPR training session that she had arranged for the community. She knows more about the critical importance of defibrillators than most people, because she set up the OurJay Foundation after the tragic death of her son Jamie, who suffered a cardiac arrest. Although a defibrillator was nearby, it was inaccessible.

It is clear that a lack of accessible devices continues to hinder lifesaving intervention, but thanks to the incredible work of Naomi, her family and the OurJay Foundation, Rugby now has a significant number of accessible defibrillators. But it should not fall solely to charities and grieving families to bear the cost of this vital equipment. When the OurJay Foundation was established, Rugby had just seven 24/7 defibrillators for a town of 80,000 people. Today, thanks to its efforts, the number has risen to more than 170. They are triggered six to seven times a week. I welcome the Government’s commitment to improving access to automated external defibrillators, as hon. Members have referred to, so I will not rehearse that. The Government have also committed to providing a defibrillator in every state-funded school in England. Sadly, there remains no legal requirement for organisations to make AEDs available on their premises, although many have done so voluntarily. Could the Minister comment on whether the Government are considering this?

Naomi and the OurJay Foundation are also campaigning for AEDs to be put in every police car. Recent Home Office funding, which was very welcome, has enabled additional defibs for every force. Warwickshire police has secured 30 new defibs, which it is putting in specialist operations vehicles. I saw that for myself, alongside Naomi, and met the officers whose dedication to the public I commend. The urgency is underlined by recent figures from the Resuscitation Council, which show that out-of-hospital cardiac arrests in the UK have risen to 40,000 each year. The survival rate remains a devastating one in 10.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I thank my hon. Friend the Member for Bishop Auckland (Sam Rushworth) for bringing this important discussion. My hon. Friend the Member for Rugby (John Slinger) rightly points out the survival challenge. We know that survival is improved with quick access to these vital devices. Many Members have described deserts of access to these devices in their constituencies. In my own constituency there are only four devices per 10,000 people, so 70% of people do not have access in the three to five-minute timescale that my hon. Friend recommended. Does he agree that to improve that stat, it is vital that we get more devices in the community and, fundamentally, that we make it cheaper to access these devices for community groups, local and national Government and the police forces that he mentions?

[John Slinger]

I agree entirely. Obviously, there is not an unlimited amount of money, but we—whether Government, hon. Members, charities or businesses—must do everything we can to ensure more devices in our communities.

I will conclude by saying that Naomi is calling for Jamie’s law. This would make it mandatory for all police vehicles to carry defibrillators. I am sure that hon. Members in and beyond this room would agree that across our country we should do everything we can to increase the number of defibrillators, and am sure that I am not alone in having lost a friend who died young from a heart attack. I pay tribute to Naomi Rees-Issitt for her effort and her dedication to saving lives in the community in memory of her son. She is an example to all of us of taking action to save lives.

Services for Adults with Learning Difficulties: Hillingdon

Danny Beales Excerpts

Friday 4th July 2025 Commons Chamber

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I rise to discuss services for adults with learning difficulties and disabilities in Hillingdon. Approximately 1.3 million people in England have a learning disability. If we include those with learning difficulties, that figure is even higher. Yet too often our services, education system, NHS, workplaces and society as a whole are not inclusive of their needs, and they are often seen as an afterthought.

I was motivated to bring forward this Adjournment debate having recently had the privilege of meeting many adults with learning disabilities and difficulties and their families in the borough of Hillingdon. They expressed to me that, again, they feel like an afterthought, as they were appalled by the council’s recent decision to close another vital service for adults; many other services have been closed, moved or cut in recent years.

Before turning to the specific important services that have been lost or are under threat, it is important to note that, of course, many good organisations are working hard in challenging circumstances to provide support. In the NHS, the Hillingdon community team for people with learning disabilities provides specialist support for adults with learning disabilities in the community and across primary and secondary care. Those services, however, are largely around diagnosis and access to medical support—just one aspect of an adult’s needs.

DASH, a voluntary sector group, offers a range of sporting and recreational activities for people with a disability, all focused on encouraging people to socialise, but it too has struggled with decreasing funding in recent years. Hillingdon Autistic Care and Support provides an autism hub, advice and social activities for adults in the London borough of Hillingdon, but the slashing of its budget in 2023 led to the closure of the popular tea rooms—a café open to the public that offered training and work support to adults with autism. Unfortunately, that was a sign of even more damaging cuts to come. Following those proposals, an e-petition signed by 3,330 people called on the council not to withdraw the funding for the tea rooms. Despite that, the council pressed ahead, claiming that 20 people benefiting from training and support was not good value for money—a disappointing sign of things to come, with a council knowing the price of everything, but the value of nothing.

More broadly in the area of education, the Park View centre, part of the Orchard Hill college group near Uxbridge, has a range of on-site vocational opportunities. The college does excellent work in challenging facilities that were not purpose-built. I recently had the privilege of meeting a number of their learners and staff, and they showed me at first hand how much they have to offer our community and workplaces. As well as insisting I attend their next disco, their overwhelming message was that they love their job coach Holly, but unfortunately, there was only one Holly in the whole of the college. They wanted more work coaches, placements, internships and job coach support. Yes, learning is vital, but they wanted it to lead somewhere in adult life. They wanted real workplace experience and, ideally, a full-time or part-time role.

The Government’s commitment to invest more than £1 billion into workplace support for those with disabilities is a welcome step forward. I hope that the Department of Health and Social Care and the Department for Work and Pensions will work together to ensure that this investment is also targeted to help adults with learning difficulties get the support they desperately need.

Data suggests that the employment gap for people with a learning disability is still far too wide. Of the people accessing long-term social care, only 5% of those with a learning disability are in paid work, which is a shame on our society. Charities have previously called on the Government to set a new ambitious target for reducing the disability employment gap with strategic actions behind it. A previous Secretary of State for Work and Pensions said in March 2023 that he would set a new disability employment goal, but progress has been slow, and I hope the two Departments can work together to progress that. Such a gap is why supporting work placements, centres for training and volunteering is vital.

Following the closure of the Hillingdon tea rooms, another such facility is now under threat. There is a strong community-led campaign to save the Rural Activities Garden Centre, which provides employment opportunities, skills, lifelong relationships and a connection to our community for adults with learning difficulties across west London. Conservative-led Hillingdon council took the decision just last week to slash that vital service.

I have been shocked and saddened to see how the voices of adults with learning difficulties and their families have been silenced in this discussion, not even being allowed to speak or question the decision at the civic centre. We are now in this Chamber, and we can ensure that their voices and stories are heard; a number of them are in the Gallery with their families.

George is 28. He was separated from his parents at birth due to their inability to care for him at that time. He has spent years unable to eat without a feeding tube and has battled self-harm throughout his life. After decades of struggle for specialist support, four years ago George found something precious: a community at the Rural Activities Garden Centre, where he feels valued and understood. Since the announcement, and as a result of the fear that that vital support system may be stripped away, George’s challenges have again become overwhelming.

Oliver has been attending the RAGC for 10 years and has complex health needs. He is partially sighted and has severe learning difficulties and chronic kidney disease. More recently, he has suffered from post-traumatic stress disorder. Oliver’s battle with mental health impacted on his ability to do day-to-day tasks and the usual activities that brought him joy, but one comfort remained: the RAGC.

There is also Doug, who I have had the pleasure to meet. He is an adult with learning disabilities that impact on his ability to read, write and count. Where the private sector was unable to provide support to Doug with his additional needs, the RAGC saw past what he could not do and nurtured what he could. It watched him transform from a shy young man into a confident 32-year-old with purpose. After the closure meeting, Doug asked a simple but heartbreaking question: “Where do the staff go? What happens to me and my mates?”

I was also told of Georgia’s story. Before joining RAGC, she struggled with anxiety and undiagnosed autism, leaving her imprisoned in her own home. The garden centre helped her to develop skills and build confidence, and she even went on to compete in a wreath-making competition. It was the service now under threat that transformed her from someone who could not leave the house to someone who could confidently serve customers—what a transformation. She fears the closure will reignite those same issues that she has worked so hard to manage.

The difficulties of day-to-day life are often felt more acutely by adults with learning difficulties. It is the sanctuary that places such as the RAGC provide that makes it imperative we continue to fight for their survival. The Rural Activities Garden Centre makes employment opportunities, personal development and skills curation accessible for those who are often isolated. I have met so many people from right across the community who have volunteered there, gained skills and even moved into permanent jobs as a result. Families feel that their loved ones are cared for, safe and nurtured in this space, and it has given carers and families their own ability to have respite and time to care for themselves.

[John McDonnell (Hayes and Harlington) (Ind)]

I congratulate the hon. Member on securing this debate. He will know that the garden centre also provides an essential service to my constituents. I have visited the place for either 20 or 30 years—I am not clear—and it was commended by the former Conservative leader of Hillingdon council, who called it a jewel in the crown. That is why it has come as such a shock that this Conservative administration is now willing to close it with such brutality. Does the hon. Member agree that the council should, even at this late stage, think again and consult properly—including all those volunteers and parents as well as the people who use the centre—to look at a wider range of options? This does not have to happen now: the council just needs to listen to us.

[Danny Beales]

I concur completely with my right hon. Friend. We have both met those affected, their loved ones and their families, and we can really hear and see the value. Unfortunately, that value was not considered in the rushed decision made by the councillors—I will turn to the lack of consultation very soon, and I completely agree with him about that. It is not too late and, like him, I hope that the council thinks again.

The Rural Activities Garden Centre is another in a long list of closures at the hands of the local council. Following years of financial mismanagement by the leadership, the modus operandi has become to cut through its crisis. While the council’s cabinet sees nothing more than a line on a spreadsheet, behind this move are adults with learning difficulties, whose lives have been transformed by this service and who risk losing it all as a result of the council’s decision. By its own admission, it views the decision of the closure through the lens of profit. Failure to turn a profit means inevitable closure to Hillingdon council. That was the reason quoted at the recent decision-making meeting, but should social services have to make a profit to survive? To me, it defeats the objective of those services. By that logic, one wonders what will be cut next by Hillingdon council? What other social services or schools will it have in its sights?

This heartless approach to community services aside, Hillingdon council’s binary decision making in relation to profit is economically flawed. These services are not costs; they are investments in the future. The National Audit Office calculated that supporting someone with moderate learning disabilities in residential care costs £4.7 million over their lifetime. With proper community support such as the RAGC, that drops by £1 million. We save money while giving people the dignity, purpose and independence they deserve.

Perhaps the council’s inability to understand this basic economic principle of investment and returns sheds some light on why it is about to go bankrupt, receiving damning reports from its own chief financial officers. Still, Hillingdon council dismisses the RAGC as merely a “retail service”. Tell that to George, Doug, Oliver or Georgia. Tell the families who have watched their loved ones transform from isolation to independence that this is a “retail service”.

I recognise that there are similar stories across the country, unfortunately, scattering services, breaking up communities and destroying what works for short-term savings that create long-term costs, with our most vulnerable communities always the first to feel the brunt. The Rural Activities Garden Centre works. Its clients thrive. Their families are supported. The evidence is overwhelming, but evidence means nothing without political will, and political will means nothing without adequate funding.

We are not asking for the impossible. We are asking the council and this Government to back choice and independence for adults with learning difficulties and care packages and to recognise that supported employment is not a luxury to be cut when times are tough; it is a vital investment that pays dividends in human dignity and economic returns for national and local government.

The Rural Activities Garden Centre must be saved. Services like it across England must be protected. The people who depend on them deserve nothing less than our absolute commitment to their dignity, their potential and their right to belong. I appreciate the Minister giving up her time to be here today, with so many pressing issues across the health and care system. There are some specific issues I hope she will take away for further consideration.

First, I and local families would like to welcome the Minister to Hillingdon to meet disabled adults and those with learning difficulties, to hear their experience of a fragmented system and a council and NHS not working together as well as they could and should, which I hope could inform the broader review of social care taking place nationally.

Secondly, the Women and Equalities Committee report in 2023 on inequalities for people with learning disabilities outlined clearly that people with a learning disability, and those who care for them, are the real experts when it comes to their health and care needs. However, aside from the occasional opportunity to feed into consultations, far too often their voices are missing when it comes to decision making at both a local and national level. Their lived experience should be better reflected in efforts to reduce health inequalities and improve outcomes.

I hope the Government will look at how they can embed co-production and meaningful engagement in decision making on care packages and services and ensure that those with care packages and support are genuinely consulted and engaged in any service changes. There must also be clearer guidance for providers and commissioners of services about consultations and full equality impact assessments being conducted before services are changed, which has been woefully lacking in this case.

Thirdly, the NHS 10-year plan, launched yesterday, included welcome announcements about supporting people with health budgets, giving people personal health plans and a shift to prevention and community-based working for the NHS. Will the Minister address whether we can and should expect the same principles to lead work on adult social care support, too?

Fourthly, on enabling joint working, the Public Accounts Committee report in 2017, “Local support for people with a learning disability”, found that people with a learning disability who live in the community have patchy access to healthcare and limited opportunities to participate in the community—for example, by having a job. While the Department has the policy lead for people with a learning disability and care plans, responsibility for their support spans across Government. We even found that to be the case when discussing which Department should respond to this debate. Responsibilities cross the Department of Health and Social Care, the Department for Education, the Department for Work and Pensions and the Ministry of Housing, Communities and Local Government.

In its report, the Public Accounts Committee recommended that Government should

“set out a cross-government strategy for improving access to health care and opportunities”

for adults with learning disabilities to

“participate in the community, including employment, as well as how it will measure the effectiveness of this strategy.”

I hope we can return to this in future, because clearly all these Departments bear some oversight and responsibility for this important group of the population.

Lastly, I hope the Minister will join me in thanking Oliver, Doug, George and Georgia, as well as all the service users and their families, for building this project from scratch, many decades ago, planting the first trees, building the first planters, volunteering to keep it going in difficult times and creating this amazing life-changing project, and now also for their campaign to fight for its survival. I hope that Hillingdon council will think again, take the time to genuinely listen and get the decision right, working with the community. In the absence of that, I hope the Government will prioritise adults with learning difficulties in services like this one.

We were elected a year ago today on a manifesto of change, investing in people, transforming life chances and providing everyone with opportunity. These are the things that the Rural Activities Garden Centre, and so many other services in Hillingdon, have done, and can continue to do, for countless people in the borough of Hillingdon.

Department of Health and Social Care

Danny Beales Excerpts

Tuesday 24th June 2025 Commons Chamber

[Paulette Hamilton (Birmingham Erdington) (Lab)]

I am delighted to open this debate on the Department of Health and Social Care’s main estimate. My remarks will focus on the recent spending review, which includes some welcome funding increases and sets out some ambitious reform objectives. However, it also raises questions about deliverability, particularly of objectives to do with capital investment, efficiency savings and the role of social care.

Let me begin with capital investment. The Government have rightly emphasised the need to shift from analogue to digital systems across the NHS. The increase of nearly 50% in technology and transformation funding will mean that it reaches up to £10 billion by 2028-29, which is a welcome and substantial commitment. However, the NHS has a poor track record on digital transformation. The National Audit Office has highlighted the risks around fragmented delivery, unclear governance and unrealistic timelines, and those lessons remain highly relevant. Its 2020 report on digital transformation in the NHS found that despite £4.7 billion in national funding, many trusts were still reliant on systems that were outdated and not integrated.

The capital budget is being asked to do a great deal more than achieve digital transformation. The Government have committed to the new hospital programme, and to addressing critical infrastructure risks, such as those posed by reinforced autoclaved aerated concrete. Over five years, £30 billion is allocated for maintenance and repair, and £5 billion is allocated for critical risk. However, by the end of the decade, there will be no real-terms uplift in the capital allocations, compared with this year. In fact, in 2027-28, the funding settlement actually falls to £13.5 billion from £14 billion the previous year, meaning that inflation in construction costs and materials will significantly erode its purchasing power. The British Medical Association has warned that current funding cannot cover both the new hospital programme and essential maintenance, and now that programme must also compete for funding with the vital digital transformation. Can the Minister explain how the Department will choose its priorities from those competing essential demands on the capital budget?

Turning to resource spending, the Department’s day-to-day budget will grow by an average of 2.7% per year in real terms. That funding will be used to deliver several welcome commitments, including investment in elective recovery and urgent and emergency care; a £4 billion increase in adult social care funding; 700,000 additional urgent dental appointments annually; 8,500 more mental health staff; and £80 million a year for tobacco cessation programmes. Those are all positive steps.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I thank my hon. Friend for giving way, as well as for her excellent chairing of the Health Select Committee at the moment and for opening today’s debate. Does she agree that this Government’s record investment in our health service will be vital to turning around the health service after 14 years of under-investment and a lack of reform? As my hon. Friend has touched on, that investment also needs to be targeted to enable the three shifts that the 10-year plan talks about. In particular, we need to reverse the trend of more spending going towards secondary care while less goes to primary care. We need a big uplift in dentistry, which my hon. Friend has mentioned, but also in primary care—in GPs—and in pharmacy.

[Paulette Hamilton]

Hear, hear. My hon. Friend makes some valuable points, and I agree with every one of them.

Underpinning the settlement I have described, however, is the Government’s pledge to generate £17 billion in efficiency savings over three years, with a staggering £9.1 billion expected in the final year of this Parliament. Critically, those savings have already been factored into the settlement—in effect, they have been spent before they have been delivered. In the light of that, we need absolute confidence that there is a clear and robust plan to generate those savings. The Government are assuming an annual productivity improvement in the NHS of 2%, more than triple the long-term average of 0.6%. They appear to be relying on digital transformation to unlock the bulk of those savings, which is risky, given the history of digital change programmes in the NHS.

Another source of savings is the plan to cut reliance on temporary staff by reducing sickness absence and overhauling staff policies, including limits on agency spending and eliminating the use of agencies for entry-level roles. Again, this is a welcome ambition, but delivering it will be a significant challenge, one that will require meaningful, sustained improvements to staff wellbeing and working conditions. We cannot build a sustainable workforce on good will alone. Therefore, will the Minister say when we can expect an updated and fully costed workforce plan to deliver on these ambitions?

Delivering the reforming elective care for patients plan is also central to achieving those efficiencies. It proposes reforms such as optimising surgical pathways through hubs, streamlining referrals, expanding remote monitoring and reducing unnecessary procedures. The plan assumes a rapid transformation of services, with significant improvements in productivity and patient flow expected within just a few years. That is ambitious, especially given the context of ongoing workforce shortages, ageing infrastructure and rising demand. Reform is essential, but it must be realistic, properly resourced and paced to succeed. We cannot afford to set targets that look good on paper but falter in practice, damaging morale and patient care. What steps is the Minister taking to ensure that the projected £17 billion in savings will materialise and be delivered on time? What happens to those additional resources for frontline delivery if those savings are delayed or fall short?

I will also touch on adult social care, which is in desperate need of reform. The Casey commission has an important job to do, but the terms of reference for the first phase of Casey’s work state clearly:

“The commission’s recommendations must remain affordable, operating within the fiscal constraints of Spending Review settlements for the remainder of this Parliament.”

Now that those settlements have been reached, can the Minister provide clarity to the House about precisely what fiscal constraints Baroness Casey’s recommendations will have to conform to? The £4 billion for adult social care announced in the spending review includes an increase to the NHS minimum contributions to the better care fund.

Prostate Cancer Treatment

Danny Beales Excerpts

Tuesday 17th June 2025 Commons Chamber

[Dr Huq]

I completely agree with the hon. Gentleman that access should be based not on how deep somebody’s pockets are, but on need.

Abiraterone halves the risk of relapse. Each relapse literally costs the NHS millions—the definition of lose-lose. As many Members have pointed out, it is already successfully available on the NHS and routinely funded for use in metastatic cases in England, but sadly there is a catch: abiraterone is not available on the NHS for men with non-metastatic prostate cancer living in England.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I thank my hon. Friend for bringing forward this very important debate for her constituents, my constituents and people in the UK. Does she agree that since this issue was last assessed by the National Institute for Health and Care Excellence, there have been significant developments, as has been mentioned by other colleagues, both in the provision of the drug in other nations and the fact that it is now available off-patent, so it is much cheaper to access? That will fundamentally change the cost-benefit analysis that NICE did previously. Does she agree that her constituents and my constituents need this drug just as much as patients in Scotland and Wales who are benefiting from it?

[Dr Huq]

I totally agree. West London needs the same as the west of Scotland, the west of Wales, and all the other bits of those other nations. Men can access abiraterone on the NHS in Scotland and Wales, but not in England, even with an identical diagnosis. It seems at best anomalous that their postcode, not their prognosis, is determining their treatment, and we all know that the NHS is meant to be free at the point of need.

I would give anything to have had longer with my dad. I was reminded of him when, like the hon. Member for Harrogate and Knaresborough (Tom Gordon), I had someone come to see me: Peter Treadgold, who came to my advice surgery and pointed out that he is falling between the cracks. He had a long-standing diagnosis, with remission, and he diligently followed all the advice. He was under NHS monitoring for 20 years because he had heightened prostate-specific antigen levels, although he was never actually offered an MRI or ultrasound scan. Last year, his cancer came back, and he was told that he would need hormone and radiation therapy; abiraterone was not offered. Peter is one of the one in three people who get the devastating news that their cancer has come back, and has been denied access to a treatment that could save or extend his life.

The first time I heard of abiraterone was when I met Peter, because as my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) said, in my dad’s day, it would not have been cost-efficient. However, it is now a generic drug—it has gone off patent—but it is licensed only for metastatic cases. As my hon. Friend the Minister knows well, there is a complicated, convoluted process involved in getting it approved for non-metastatic cases. There is no question about the effectiveness of abiraterone. It has had one of the biggest trials known to mankind, a genuinely world-beating trial. When NHS England’s own clinical priorities advisory group plotted the clinical benefit against the net cost, abiraterone scored highest in that tabulation. It is calculated that two years of abiraterone treatment would halve the death rate for men with locally advanced prostate cancer, but we hear about budgetary challenges. I have written to the Minister and tabled questions, and have been told that NHS England has not identified the recurrent budget to support provision of the drug.

We should look long-term, at the remissions, and at the cost of chemotherapy, hospital appointments and other associated things. Those costs add up. University College London found that abiraterone would pay for itself if it were £11 a day. Do Members know what the NHS is actually paying? Does anyone want to hazard a guess? Oh, we are not doing call and response. Abiraterone costs £2.75 a day, now that it is off patent and has come down in price. That is less than three measly quid to avoid costly relapses, scans, chemo, hospital appointments and everything else—less than three little round ones to improve lives and reduce deaths. As we have heard, only people who can fork out up front for private treatment or private medical insurance currently have that option, and again, our NHS was not meant to be for private profiteering or big pharma drug pushers. People are seeing their pensions and life savings evaporate, and we are in a cost of living crisis. This drug should be universally available.

It took less than one year for abiraterone to be approved for men with non-metastatic prostate cancer in Scotland and Wales. In England, it is now three years and counting, and we still have not had a concrete resolution. Right now, abiraterone is the cheapest and most cost-effective it has ever been, and as the excellent Prostate Cancer UK put it, the postcode lottery must end. Lord Darzi’s independent investigations into the NHS found that the UK had higher cancer mortality rates than other comparable countries, and sadly, progress in diagnosing cancer at stages 1 and 2 is flatlining. Just over half of prostate cancers are caught at an early stage. That falls well short of the NHS target of 75%. I appreciate that Labour has just come into power after 14 years of the Conservative party, so it will take time to fix our health system, but we need it to be more responsive—to act early and rapidly, to use all the tools it can, and to offer preventive rather than after-the-fact care in every case. Abiraterone exemplifies all those things.

I welcome the Chancellor’s 3% real-terms increase in NHS spending to deliver the exciting plan to build an NHS fit for the future. With the 10-year plan coming soon and the national cancer strategy due this autumn, we have a real chance to deliver significant improvements for people living with cancer, so as is customary, I have a list of questions for the Minister. I will incorporate those of my hon. Friends—I think we are all friends here, even if we sit on opposite sides of the Chamber.

First, will the Minister commit to exploring ways of ensuring that additional NHS funding is used to make abiraterone available to all men who need it in England—and in Northern Ireland, as the hon. Member for Strangford (Jim Shannon) has pointed out? Secondly, will the Minister support the introduction of a national programme of screening for prostate cancer, like those that we have for comparable cancers in the United Kingdom? Thirdly, given the complexity of NHS England’s decision-making processes in relation to the availability of abiraterone—which sound like a right old bureaucratic nightmare—as the functions of NHS England are transferred back to the Department of Health and Social Care, will the Minister take steps to ensure that all decisions about access to medicine, including abiraterone, are timely and transparent? I know that she has had a long career in the NHS, and as I have said, she is on the side of the angels.

Fourthly, will the Minister commit to publishing an equality impact assessment, given the disturbingly disproportionate effect that prostate cancer is having on black men, who are more likely to develop it and to receive a late diagnosis, and less likely to receive the right treatment? I am doing this partly for Dad, who is watching from somewhere up above, but also for the black and minority ethnic men who are implicated here and now. This is the second time that you have been in the Chair, Madam Deputy Speaker, when I have been talking about health inequalities since Friday, when we discussed assisted dying. You have chaired both debates excellently.

Fifthly, in the light of the lengthy approval process, will the Minister assess the adequacy of the funding formula model—we have NICE and we have the Medicines and Healthcare products Regulatory Agency, and it all seems a bit knotty—and consider whether novel pharmaceutical treatments could be produced cost-effectively, especially, as my hon. Friend the Member for Uxbridge and South Ruislip said, when they come off-patent. I am arguing for simplification in cases in which drugs are already prescribed for limited use and there is a credible case for expanding their application to a generic treatment. We are halfway there; we just need to go that little bit further.

Prostate Cancer UK estimates that 672 men die prematurely each year because we have no access to abiraterone. Each week that this continues, 13 men in England will die from a cancer that could have been treated cheaply had they lived in Scotland or Wales. Labour is the party of the NHS, and a Labour Government introduced the UK’s first dedicated cancer strategy; so let us go for this win-win for all, end the iniquitous, unjust postcode lottery, celebrate the best of British science, and widen access to abiraterone for all those who need it, not just those who can afford it.

Hospitals

Danny Beales Excerpts

Wednesday 23rd April 2025 Commons Chamber

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

I am glad that we are taking the time today to discuss the immensely important issue of the state of our NHS hospitals. Nowhere is it more obvious that our NHS has been broken over the past 14 years than in our crumbling NHS estate. Our NHS has been starved of capital funding, and the backlog maintenance bill now stands at more than £11 billion. Research from the NHS Confederation shows that nine in 10 NHS leaders believe that the crumbling NHS estate is undermining their ability to tackle the elective backlog. This is devastating. It is apparent in my constituency, with Hillingdon hospital plagued by flooding, sewage overflows, failing lifts and outdated equipment.

The need for a new hospital in Hillingdon is not new—my predecessor’s predecessor described the hospital as no longer fit for purpose many years ago, and pledged at the time to replace it. The Lib Dems are right today in their condemnation of the previous Government’s record, with their fantasy hospital programme that seemed to exist only in the mind of Boris Johnson, and never in the reality of the Treasury’s decisions. Residents in Uxbridge have been led up the garden path time and again, with false promises upon false promises, a funding package that was never approved and building works that never began—to this day, not a stone has been laid and no ground has been broken. At the election, no business case had been agreed, the hospital design was still being tweaked, and no contractor had been appointed. Rather than being fully funded, only £70 million of £1 billion had ever been provided.

I am glad, therefore, that the Labour Government have prioritised capital investment, with capital spending increasing by £13.6 billion in the Budget, and I am grateful for the progress we are now making with a realistic, honest and deliverable timescale for the programme. After years of broken promises, people are fed up and need action, delivery and credible commitments. That is why it is disappointing that the Lib Dem motion today, if approved, risks leading again to unfunded commitments, promising to deliver all the hospitals simply through a new taskforce. That is not how hospitals are built or paid for. It does not feel to me like a credible funded programme; instead, it is a recipe for more talk, more delay and more inaction.

I know that the community in Uxbridge and South Ruislip are now reassured that Hillingdon hospital has been included in wave 1, with a capital envelope agreed in recent weeks of nearly £1.4 billion. Instead of more words or a taskforce, we have delivered solid agreements and funded commitments—a real plan for change. The hospital is now finalising its business case and design. A contractor will be appointed and on site in 2027, and construction work will start in 2028. It is essential that the new hospital programme continues to work at pace to provide my constituents and all residents in this country with the quality of care they deserve. I am sure the Minister would expect all Members to hold the Government to account for the delivery of the programme.

Turning to the concrete actions we could take to deliver the hospital programme more quickly, long-term revenue funding for new wave 1 teams is much needed so that they can work at pace, as well as a simplified planning process for new hospitals. I welcome the Government’s planning reforms and Planning and Infrastructure Bill. I hope that Lib Dem Members will support the Bill, which seeks to speed up the delivery of critical national infrastructure.

As well as investment in hospitals, we need investment right across our NHS estate, as has been discussed today. I have met GPs who are using store cupboards as consulting spaces and heard from pharmacies that want to do more but are desperately lacking the space to deliver Pharmacy First services in privacy. The Wakley centre, which provides sexual health services in my constituency, is crammed into an outdated building, using every inch of space, and is desperate for more modern space to do preventive work.

[Edward Morello (West Dorset) (LD)]

I agree entirely with the hon. Gentleman on the need for investment outside of hospitals, but does he agree that we also need smarter investment? Dorset NHS foundation trust, along with Somerset NHS foundation trust and university hospitals Dorset, has submitted a business case for an integrated electronic health record system that would allow them to work together, share information and, ultimately, save the NHS money. Does he agree that this is exactly the kind of technological advancement the NHS should be funding?

[Danny Beales]

We need to think not just about buildings, but about digital infrastructure and investment in a whole range of capital investment needs for the NHS for it to be a modern, fit-for-purpose service. It sounds like the measures the hon. Gentleman suggests are sensible.

There is a strong desire in the emerging 10-year plan to shift to neighbourhood health services, which would also require capital investment. Three neighbourhood hubs are planned in Hillingdon, but there are still no clear sites and no capital investment to make them a reality. We need a long-term infrastructure strategy for the NHS, alongside our 10-year health plan. I welcome the significant increase in capital spending for the NHS at the Budget. I also think the Government’s new commitment to protect capital budgets in the NHS is vital. Far too often, under the previous Government, those budgets were raided for short-term investment to plug revenue-based gaps; now that has come to an end, which is very welcome.

My constituents have waited long enough for Hillingdon hospital. We do not need more taskforces or reviews, but concrete funded plans of action. At last, we have from this new Labour Government a fully funded new hospital programme ready to be delivered. I look forward to construction starting and working with this Government to deliver health services that are fit for the future.