National Maternity and Neonatal Investigation

Julian Lewis Excerpts

Tuesday 30th June 2026 Commons Chamber

[James Murray]

My hon. Friend asks a question about staffing, and ensuring not only that we have the right levels of staffing, but that people in the service have the right responsibilities, so that we do not have members of staff suffering from burnout or having a workload that they cannot cope with. Those are critical issues that the taskforce will consider in its development of the national action plan.

[Sir Julian Lewis (New Forest East) (Con)]

Last Wednesday, and again today, the Secretary of State expressed his shock at the number of senior clinicians who refused to take part in the Nottingham review. May I repeat a suggestion that I made last Wednesday? Those clinicians should be named publicly. That is a step that he could take straight away. If a parliamentary question for written answer is tabled, asking him to name those clinicians, will he answer it? I cannot think of a better or more justifiable use of parliamentary privilege.

[James Murray]

I will take away the right hon. Gentleman’s suggestion and think on it, because it is critical that we have accountability. As I said in response to earlier questions, I find the decision of senior clinicians not to take part in the Nottingham inquiry utterly unacceptable, and incomprehensible on a personal level. We must ensure that that never happens again.

Neuropsychiatric Conditions: PANS and PANDAS

Julian Lewis Excerpts

Thursday 25th June 2026 Commons Chamber

[Wendy Chamberlain]

As always, the hon. Gentleman is ahead of the game; I was going to mention this. I am very much looking forward to the guidance, but we need to ensure that it is understood and shared.

[Sir Julian Lewis (New Forest East) (Con)]

The hon. Lady mentioned the all-important fact that early diagnosis, coupled with the prescribing of a quite common antibiotic —I believe amoxicillin is one of them—can make a crucial difference. In May last year, I asked in a written question whether the Secretary of State for Health and Social Care would take steps to facilitate the circulation of material to general practitioners, advising them on how to recognise PANS and PANDAS, and treat them with antibiotics and anti-inflammatory medications. The response that I got from the Minister for Care was that this is all a matter for the National Institute for Health and Care Excellence, which is an independent body. The Minister said that NICE has

“no plans to issue guidance on paediatric acute-onset neuropsychiatric syndrome (PANS) and paediatric autoimmune neuropsychiatric disorder associated with streptococcus (PANDAS)”.

He also said,

“should the evidence base develop further, we would look to the NICE to update clinical policy.”

It seems that the early use of antibiotics is not yet accepted by the medical establishment. Does the hon. Lady know whether there is hard evidence to show that the medical establishment needs to get its act together on the matter?

[Wendy Chamberlain]

The right hon. Member may recall the debate we had in a previous Parliament on this subject. The Minister at the time gave the commitment that she would ensure that GPs and other medical practitioners were aware of the guidance that PANS PANDAS UK was producing. I hope we will hear today that the Minister is looking at that. There is clearly a challenge, and although the condition is recognised by the World Health Organisation and by NHS England, there is more to do to minimise the postcode lottery and ensure that we can get support for young people.

[Sir Julian Lewis]

I am sorry if I did not express myself clearly enough. It is not so much a question of the non-recognition of PANS and PANDAS, but whether it has been recognised that early treatment with antibiotics can make all the difference.

[Wendy Chamberlain]

I am sure the Minister can address that in her closing remarks. We absolutely need to ensure that. As the right hon. Member has said, amoxicillin might be one of the antibiotics that could be used. It is straightforward to use, and in the vast majority of cases it works, but if it does not, potentially PANS and PANDAS could be ruled out.

Too many families face rejected referrals, long waits and, in some cases, misdiagnosis. Only a small proportion of cases are diagnosed within the NHS, and many people are forced to travel long distances or turn to private care. That is not possible for all families; getting the private care needed for their child can bring families to their knees. To give an example from my constituency, in the same GP practice, one GP will provide support and the other does not recognise the condition. That makes things very difficult.

A number of families whom I have engaged with have had to seek private support, and that makes me ask—I hope the Minister is sympathetic to this—what about the children from families who are reliant on NHS support, and do not get the diagnosis? They may be absent from school for long periods. Their family may be written off as problematic, and the children as having problematic behaviours, when ultimately the condition could be at the root of the problem. From the point of view of our ongoing economic wellbeing, we need to support children’s being in education as much as we can. That is why the research is so important—because we need to ensure that families can get the support that they need, no matter their financial situation.

A National Institute for Health and Care Research-funded evidence synthesis is under way; that has changed since the last time this topic was debated. It is already highlighting significant gaps in our understanding, particularly around effective treatments. Also, with other members of the all-party parliamentary group on PANS PANDAS, which I chair, we met doctors some time ago who are researching how the brain functions. Their work suggests that there may be biomarkers that indicate a higher likelihood of developing the conditions, and they have produced fascinating research that I encourage colleagues to read. We need to understand how severe the impact of PANS and PANDAS can be on a child. It is clear that further research is urgently needed to aid both diagnosis and treatment, which often needs to be ongoing.

Awareness and training are fundamental. Without them, as has been mentioned, healthcare professionals miss the signs, and teachers misinterpret symptoms. Children who experience sudden neurological decline are too often viewed through the lens of behaviour, anxiety or neurodivergence, rather than as having a medical emergency. From the children that I have engaged with through the youth board, I have learned that it is a terrifying experience for a young person to deal with those symptoms.

I am pleased to say, however, that we are at an important turning point. The UK clinical guidance, which the hon. Member for Harlow (Chris Vince) mentioned, is expected later this year, and there has been significant work since the last debate, which I held in September 2023, to bring PANS and PANDAS further into the policy landscape. I pay tribute to PANS PANDAS UK for that, because the charity has been the key driver in making that happen. Guidance alone will not be enough, however; it must be consistently embedded across the NHS, so that we end the postcode lottery in diagnosis and care. I suspect that we will hear about some of that from other Members. The consequences are profound; the human cost of delay and misdiagnosis is devastating. Children lose the ability to attend school, lose previously secure skills, and experience severe psychiatric and physical symptoms.

Just a few months ago, I hosted a roundtable in Parliament, at which the PANS PANDAS UK youth board members were able to speak directly to MPs about their experiences. As MPs, we engage with parents in the first instance, but it was very powerful to hear directly from children who are experiencing the condition. They might not be in the Gallery, but many of them will be voting; as we were informed, they are the voters of the future and are paying attention to what we do right now. It was an eye-opening session, particularly for those who had not heard of the condition. The children spoke about wanting to be believed and understood, and wanting to get help more quickly. Their message was clear: earlier recognition could change everything. They explained how PANS and PANDAS have impacted their lives; they described watching their peers progress, while they feel stuck behind, and being too unwell to attend school and so having to repeat years. That adds to a feeling of isolation. We can all remember when we were younger and times when childhood was quite cruel.

Families have described watching their child disappear in front of them. Parents leave work to provide care: 36% report having to stop working entirely, and many families face financial losses as a result, as well as from seeking private care. At the youth board roundtable, we also heard from the siblings of children diagnosed with PANS and PANDAS—I believe that my hon. Friend the Member for Henley and Thame (Freddie van Mierlo) has a constituent in Parliament this afternoon who is part of the sibling community. It was a stark reminder of how these conditions impact entire family units; there is the financial impact of having to seek healthcare, and of a parent leaving their job, and the impact of home becoming an unstable and unpredictable environment.

The conditions also have a devastating effect on learning. Nearly half of affected children miss more than six months of school, and over a third miss more than a year. They often experience the sudden loss of core learning skills. Under the current system in England, which is designed to support gradual, stable learning needs, rather than acute onset, as well as under aspects of the proposed special educational needs and disabilities reforms, there is a real risk that those children are misunderstood. Without clear guidance, education professionals default to familiar frameworks. A sudden loss of skills can be misinterpreted as a behavioural issue or neurodivergence, leading to inappropriate support and a delay in the medical intervention required. That is why the alignment between health, education and local authorities is so critical.

I obviously speak as a Scottish MP. We must ensure alignment across the UK, so that there is no postcode lottery in the level of support available. My Scottish Liberal Democrat colleague Adam Harley, the new MSP for Strathkelvin and Bearsden, recently raised a constituent’s case in the Scottish Parliament; I was particularly disappointed in the response of First Minister John Swinney, who referred to PANS/PANDAS as a “rare disease”. It was clear that he knew nothing about it. Despite my own correspondence with his Government, we have seen limited progress in Scotland. I must emphasise that it is not a potentially rare disease; it is an undiagnosed one. I genuinely believe many children with PANS/ PANDAS have not been diagnosed and are therefore not getting the support they need. That underlines the need for close engagement with devolved Governments to ensure a truly joined-up approach to improving support.

Today’s debate will largely focus on children and young people with PANS/PANDAS, but it is equally important to recognise the challenges faced by adults. One adult with PANS/PANDAS shared with me that she has experienced mostly neuropsychiatric symptoms, rather than physical ones. Research shows that PANS and PANDAS can be associated with systemic inflammation and autoimmune responses affecting the whole body, including conditions such as arthritis and other inflammatory diseases. In that person’s case, tests revealed ongoing systemic inflammation that has damaged tissues and organs over time, as the immune system mistakenly attacks healthy cells, rather than protecting them. Too often, the symptoms that PANS/PANDAS can manifest are put in the “too difficult to deal with” basket.

These are the practical steps that we are asking the Government to consider. First, when the UK clinical guidance is published later this year, there must be a clear commitment that steps will be taken to ensure that it is embedded consistently across the NHS, not left to chance, and that appropriate stakeholders are engaged to support its dissemination.

Secondly, we need training for healthcare professionals and those working in education, so that symptoms are recognised early and acted on appropriately. Thirdly, we must have a renewed commitment to research funding, building on the work of the National Institute for Health and Care Research, to address the significant gaps in evidence and improve treatment pathways. I ran the London marathon—my first ever—at the end of April, and one of the charities I was fundraising for was PANS PANDAS UK. It should not take fundraising to deliver the funds that are needed for the research that will provide the right support for these children.

Finally, there must be clear signposting and alignment with the forthcoming local authority guidance to ensure that schools and services are equipped to meet their legal duties. As one clinical psychologist working with a young person with PANS has stated,

“Without training…pupils risk unnecessary and avoidable long-term loss of skills.”

I will be pushing on exactly this matter in Scotland.

This debate is an opportunity to put these issues firmly on the record, to raise awareness across Parliament and to ensure that families living with PANS and PANDAS feel heard. I am grateful to colleagues here today and look forward to hearing their contributions and the Minister’s response.

--- Later in debate ---

[Freddie van Mierlo (Henley and Thame) (LD)]

I thank my hon. Friend the Member for North East Fife (Wendy Chamberlain) for securing the debate and for her advocacy in raising the profile of PANS/PANDAS. I also thank the hon. Member for Carlisle (Ms Minns) for the comments she made. I hope that she gets a response from her ICB very soon—I am waiting for one from mine.

Last month, I attended a meeting organised by the all-party parliamentary group on PANS PANDAS, which my hon. Friend the Member for North East Fife leads, to hear from young people directly on their experiences of the condition and the impact on their lives. What stuck with me from that meeting was a powerful comment by one of the young people there, who said, “We don’t want your sympathy. We want your action.” Let that comment last with the Minister, too—action, not sympathy.

One young advocate at the meeting was my constituent, 10-year-old Albie and his mother, who are watching the debate today from the Gallery and braved the heat to come here from Oxfordshire. Albie’s brother is diagnosed with PANS/PANDAS, and Albie has become a tireless and devoted campaigner on his brother’s behalf. Albie has launched a letter-writing campaign. He is already 19 months deep into his campaign and has become pen pals with the most powerful and influential people in the country, including His Majesty the King, the high sheriff of Oxfordshire, the Prime Minister, various Ministers, NHS leaders and leading clinicians and, of course, the Speaker’s Office.

Albie proudly showed me in a constituency surgery and again this afternoon his beautiful handwritten letters and the responses, all stored safely in a binder. I am proud to have on my wall in my office here in Westminster a thank you card from Albie, with his trademark drawing of a panda. His next campaign is to write to all 26 main children’s hospitals, asking them to send a doctor or member of staff to the PANS PANDAS UK clinical professionals conference in October in Royal Leamington Spa. His hope is that if more clinicians learn about recognising and treating PANS/PANDAS, children like his brother will receive help more quickly. Albie is an inspiration to all of us and is driven by love for his brother. I wish him continued success, and he has assured me today that he is already dusting off his pencils to write to the right hon. Member for Makerfield (Andy Burnham).

However, at just 10 years old, Albie should not be having to do this. He feels compelled to do it because the NHS and successive Governments have failed families like his. His family have had a difficult time getting the diagnosis and treatment needed, and that is not unusual. When surveyed, only 2% of patients and families said that GPs recognised that their child could have PANS/PANDAS. The path to diagnosis can take months or years, with persistence from parents required to advocate for children. Many are forced to spend thousands of pounds on private assessments and treatment because NHS support is inadequate. When asked by a show of hands at the all-party group meeting, every single young person said their family had paid for private treatment. It is unacceptable that an entire condition requires, by default, private care. It bakes in inequality and places extreme stress and strain on parents. I know as a parent that I would do anything for my child, and Albie’s mum is no different, but the financial pressure placed on ordinary, hard-working families like hers is devastating.

The lack of specialist clinicians and knowledge within the NHS appears to be a major cause of this, with too many clinicians misidentifying the condition and refusing treatments being deployed in the private sector. We urgently need better guidance for the NHS to close this gap. Families are fighting to be heard by professionals who all too often dismiss or do not recognise PANS and PANDAS. I therefore welcome the announcement that NICE will review independently produced guidelines from the PANS clinical guideline development group and PANS PANDAS UK through the guideline collaboration programme. However, I am concerned by my most recent correspondence on this topic with the Minister for Women’s Health and Mental Health, who sits in the other place, in which she said:

“Should the evidence continue to increase, organisations such as the NICE will consider updating clinical policy”.

My reading of this is that there is no clear commitment that clinical guidance will be adopted by NICE, and I would be grateful if the Minister here today could comment specifically on that point.

[Sir Julian Lewis]

At the risk of labouring the same single point I want to make again and again, there really does seem to be no downside to telling all GPs that if there is any question at all that a child might have PANS or PANDAS, the GP should prescribe them one of the basic antibiotics, because they could benefit from it tremendously, and there is no risk of harm.

[Freddie van Mierlo]

I wholeheartedly agree with the right hon. Gentleman. There are very few downsides of prescribing an antibiotic, especially in this instance, given the seriousness of the condition. As he says, there is really no good reason to withhold this medication.

A second challenge facing families is the impact on a child’s ability to participate in education, as they miss months of school because they are too unwell to attend. That not only affects their learning but limits opportunities to socialise, make friends and have a community beyond home. Every child has a right to an education. PANS/PANDAS does not limit ambition or ability, but our education system is placing limits on children with the condition. Section 19 of the Education Act 1996 is in place to stop that happening, and it requires local authorities to arrange suitable education for children who cannot attend school due to illness. However, the provision is not always effective for children living with PANS/PANDAS, and parents still need to be advocates for their own rights, rather than being proactively told them and guided through the process.

There is a wider point. Families are often left fighting for support from multiple systems at the same time, including healthcare, education and local authorities, while trying to take care of a very unwell child. It is the last thing they need. There are steps that the Government can take to limit the challenges. First, PANS/PANDAS must be researched in greater depth. It is currently unknown how many people are affected by PANS/PANDAS in the UK, and there is no official guidance on the diagnosis and treatment of those conditions in the NHS. Secondly, we need training of health professionals to recognise and treat the condition. PANS and PANDAS are conditions with a high risk of long-term disability, exclusion from society and failed education. Families express that if only their children’s condition had been recognised sooner by health professionals, it could have had a significant impact on their child’s wellbeing and outcomes.

Thirdly, we must improve the support offered to children in education. The publication of local authority guidance is anticipated this summer, and it is important that it ensures that schools and services meet their statutory duties for children with PANS/ PANDAS. Thousands of families are fighting for support from multiple systems while taking care of unwell children. It is time for the Government to do their part, and eliminate the barriers to diagnosis and treatment for those living with PANS/PANDAS.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Mrs Sharon Hodgson)]

I thank the hon. Member for North East Fife (Wendy Chamberlain) and the Backbench Business Committee for bringing forward today’s debate. I think we can all agree that, although the number of attendees has been small, it has been mighty in terms of the quality of contributions we have heard from hon. Members. I am also grateful for the opportunity to speak today on the subject of PANS/PANDAS.

As hon. Members have highlighted, these conditions cause significant distress to many children and young people and their families. It is therefore vital that we approach this issue with both scientific care and genuine compassion, recognising and responding to the lived experiences of those affected. We have heard from hon. Members today about some of those experiences, and I thank them all for their contributions.

As we have heard, PANS and PANDAS are closely related, but distinct, clinical syndromes in which an infection can trigger acute and often dramatic changes in both physical and mental health—often as quickly as overnight, as we heard from the hon. Member for North East Fife. They are areas of evolving clinical understanding, with diagnosis based on observed signs and symptoms rather than definitive tests. That means that it is typically a diagnosis of exclusion, requiring clinicians to rule out other causes. While this can make diagnosis complex, it underlines the importance of a holistic, joined-up, child-centred approach.

Treatment is similarly tailored and delivered through multidisciplinary teams, with psychological therapies such as cognitive behavioural therapy commonly used to manage symptoms, along with pharmacological interventions where appropriate. Alongside clinical interventions, supportive care is essential. This includes helping families to understand the condition, supporting school attendance where possible, and ensuring access to appropriate mental health services. Effective care requires co-ordination across services to provide consistent and holistic support.

We recognise the challenges that families face—I welcome the families who are in the Gallery today—particularly as these conditions can sit at the intersection of physical and mental health services. Good clinical practice emphasises the importance of a holistic and multidisciplinary approach, including close collaboration with parents, schools and other agencies. However, the absence of definitive biomarkers and fully understood mechanisms has contributed to a variation in how care is delivered. In response, NHS England began working in 2020 with the charity PANS PANDAS UK, which I commend on its work in this area to improve awareness, understanding and care. This led to the establishment of the PANS/PANDAS steering group, which brings together representatives from key royal colleges, specialist clinical bodies and the charity sector.

The steering group has since progressed several important initiatives. First, work is under way to develop the first UK clinical guidelines for PANS and PANDAS, led by a multidisciplinary group and supported by the Royal College of Paediatrics and Child Health. My hon. Friend the Member for Carlisle (Ms Minns) asked me about timelines for that guidance. I am happy to tell her today that those guidelines are expected to be published in autumn this year, and they will support more consistent care across the system. Until then, clinicians are advised to draw on existing international guidance, including the Nordic clinical guidelines, which were published in 2021.

Secondly, a dedicated research group is advancing efforts to strengthen the evidence base, including through a nationwide surveillance study. Thirdly, a cross-sector group is developing practical guidance for local authorities to improve support for children and young people living with PANS and PANDAS. That guidance is due to be published later this year, and it will ensure more consistent access to appropriate educational and social care services. As we have heard today, clear and consistent frameworks are essential to improving co-ordination across services and strengthening recognition of PANS and PANDAS.

NHS England’s forthcoming children and young people’s modern service framework will address health system challenges that affect all children and young people, improve access to specialist advice, promote more integrated working across physical and mental health services, and strengthen the strategic commissioning role of integrated care boards. More widely, NHS England is also supporting local systems to implement neighbourhood multidisciplinary teams, bringing together professionals across health and social care and wider services to deliver joined-up, community-based care, ensuring that all children and young people can access co-ordinated support and paediatric expertise closer to home.

The Lib Dem spokesperson, the hon. Member for Mid Dunbartonshire (Susan Murray), asked me about discussions with the Scottish Government and devolved Administrations. I understand that there have been no direct discussions so far, so I commit that, following this debate, my officials will engage and raise this issue with devolved Government counterparts at the next opportunity.

Alongside these developments, there remains a clear need for high-quality research, and this includes improving understanding of the underlying causes of PANS and PANDAS, refining diagnostic criteria and building stronger evidence on the effectiveness of different treatments. The Department supports research through the National Institute for Health and Care Research, and we welcome applications across all areas of health, including for these conditions. Recent collaborations include the “PANS PANDAS Unveiled” project, which completed an evidence and gap map on the epidemiology, prevalence, treatment and experiences of PANS/PANDAS. In the meantime, integrated care systems are responsible for planning services for their populations and should continue to draw on emerging evidence and guidance to improve care and outcomes.

[Sir Julian Lewis]

I detected that the Minister was moving towards her conclusion, so I thought I would intervene before she did. She has a fine record, before she became a Minister, of campaigning on mesh-damaged women. That was an occasion where something simple was done that led to very complicated problems. Here, we have a complicated condition, but it is thought that something simple could be done—namely, guidance should be given to all GPs that if this condition is even suspected, a simple course of antibiotics should be given. I have not yet heard anything in what she has said as to whether the research backs that up. If the research has not been done, will she undertake to make sure it gets done and that general practitioners are advised accordingly?

[Mrs Hodgson]

I thank the right hon. Gentleman, who I have worked closely with on a number of health matters over a number of years, and he mentions the work that we did together on mesh. I studied my speech after listening to your earlier intervention and the conversation about antibiotics—

Nottingham Maternity and Neonatal Services

Julian Lewis Excerpts

Wednesday 24th June 2026 Commons Chamber

[James Murray]

Let me repeat what I said earlier about my humble admiration for Jack and Sarah Hawkins and their campaign for justice over baby Harriet. My hon. Friend is absolutely right to refer to the failings as systemic. This is not a handful of cases or problems; this truly is a problem that affects the entire system. The culture and the systems that are in place have let people down, and that is why our response must be so comprehensive.

My hon. Friend mentions the input of families into the taskforce and his constituent Ashley Harper, who raised that matter. I am very happy to discuss with him after this statement how we can ensure that the taskforce represents the views of all families.

[Sir Julian Lewis (New Forest East) (Con)]

When whistleblowers tried to alert society to what was happening, was any action taken against them, and if it was, does that indicate that there needs to be strengthened protection for whistleblowers? At the other end of the spectrum, are those clinicians who refused point blank to take part in the review process going to be named?

[James Murray]

The right hon. Gentleman raises an important part of the dynamic that has been exposed through Donna Ockenden’s review: people not feeling able to challenge what is happening—feeling that they are being intimidated or forced to stay silent—even when they want to raise issues of great importance. We must ensure that the right structures and culture are in place not only so that women and their families can raise their concerns, but so that staff, midwives and others working in maternity and neonatal services have the confidence to raise their concerns through whatever mechanism is most appropriate in the circumstances. They must have confidence in the mechanism to raise their concerns.

The right hon. Gentleman spoke about clinicians who refused to take part in Donna Ockenden’s review in Nottingham. As I said earlier, although more than 800 members of staff contributed towards the review, I was appalled at the number of senior clinicians who did not agree to take part. That is why it is so important that we change the law—applying the duty of candour through the Hillsborough law to ensure that this can never happen again.

Resident Doctors: Industrial Action

Julian Lewis Excerpts

Thursday 26th March 2026 Commons Chamber

[Wes Streeting]

The Chair of the Health and Social Care Committee is absolutely spot on. I am relieved to report that I was doing exactly what she mentions only last Friday; I was walking the corridors of Queen’s hospital in Romford. I was there in January as well, seeing the worst of the situation. I have been spending time on the frontline in the places that were under the most pressure, just as I did last winter. I went along, not to look down my nose at people, but to listen, and to see at first hand what was happening, why it was happening, and what we need to do differently. The team at Queen’s hospital can really take pride in what they have achieved, but we have to sustain that progress. Last week, there were no trollies on the corridor, and in February they saved 10,000 corridor hours. That is thanks to brilliant frontline staff and senior clinical leadership on the front door, and we will see that again during strikes.

There is a certain irony about the fact that during resident doctors’ strikes, urgent and emergency care improves, because we have more experienced, senior clinical decision makers in urgent and emergency care. There is something to learn from that. I do not say that to denigrate resident doctors for a moment—they are learning and building their experience, and we do not want to lose that—but we are seeing that improvements can be made, and have to be made everywhere. We have to see this as a priority, because corridor care can never be the safest care, and it is never dignified care.

[Sir Julian Lewis (New Forest East) (Con)]

One thing we have not yet heard is the Secretary of State’s assessment of the motivation of the BMA committee members who are so militantly rejecting a deal that he evidently regards as generous. As he says, they are refusing even to sit down and talk with him. What is behind that? Why are they behaving in what appears to be an unreasonable and extreme way? To what extent does he think they represent resident doctors?

[Wes Streeting]

If the committee had ever taken me up on my offer to meet the entire committee, I might be able to answer the question, but since it has never done so, I do not know. It is for resident doctors to decide, based on what I have set out, if the committee’s rejection of this offer is reasonable.

Given the material benefits that the offer would bring to resident doctors in a matter of days—an additional 1,000 jobs and significant pay uplifts—and what that would mean for the next few years, I have to be clear that this is our best and final offer. We cannot go any further. If I may say so, we are at a point where the public would judge that we have gone as far as we can; I think quite a lot of people in the country who are watching would say that we have gone further than we should. I do not take that lightly. Resident doctors should not look a gift horse in the mouth, and I hope that they will make those representations to their committee.

Puberty Blockers Clinical Trial

Julian Lewis Excerpts

Monday 23rd March 2026 Westminster Hall

[Jamie Stone]

I thank the hon. Member for his intervention, which was, I believe, made with as much sincerity as the previous intervention.

[Sir Julian Lewis (New Forest East) (Con)]

I believe many children were treated with puberty blockers, among other drugs, before the Gender Identity Development Service programme was closed down. Does the hon. Member know what has happened to all the data from those children who were previously treated, or why it should be necessary to treat any more children with these drugs until enough time has elapsed to enable that data, and the treatment’s consequences, to be verified?

Meningitis Outbreak

Julian Lewis Excerpts

Tuesday 17th March 2026 Commons Chamber

[Wes Streeting]

I thank my hon. Friend for the excellent work he does as a member of the Select Committee, and reassure him that we are taking the Committee’s letter and advice very seriously. I think he is right to ask us to look again at the 2023 strategy.

I also reassure my hon. Friend that to price gouge or profiteer in this situation would be a totally immoral and irresponsible thing to do. More generally, we are not advising the public to pay for a vaccine. If it is decided that any vaccination is required, that will be offered on the NHS. The menB vaccine is already offered to infants, and the menACWY vaccine, for adolescents and young adults, is free on the NHS. That is the advice. I understand that people may wish to make individual choices, but the advice stands, and I would urge people not to allow themselves to be ripped off by those trying to exploit understandable public anxiety.

[Sir Julian Lewis (New Forest East) (Con)]

I have heard a suggestion that this type of meningitis is more widespread in some countries than in others. Is there any truth in that, and if there is, would there be wisdom in suggesting to young people travelling to the countries concerned that they ought to add the vaccination as a prophylactic against that possibility?

[Wes Streeting]

I am not sure about the point of prevalence, but we will look carefully at the genesis of this outbreak. Of course, in common with the point raised by my hon. Friend the Member for West Ham and Beckton (James Asser), we will think about what advice ought to be offered. As ever when it comes to travel advice, we rely on the evidence available, and with our partners at the Foreign, Commonwealth and Development Office, we regularly offer good travel advice to British citizens travelling abroad where there may be exposure to greater health risks.

Palliative Care

Julian Lewis Excerpts

Thursday 5th March 2026 Commons Chamber

[Sir Julian Lewis (New Forest East) (Con)]

I begin by congratulating the hon. Member for York Central (Rachael Maskell) most warmly on her exemplary record in campaigning for better palliative care. I will address just one segment of her panoramic presentation, namely the work done by the charity that she briefly mentioned, Together for Short Lives. It provided me with a detailed briefing and I apologise in advance if I make some points that others, who may have received the same briefing, anticipate making.

Children’s palliative care enables babies, children and young people with life-limiting conditions, life-shortening conditions or severe medical complexity to live as well as possible until they die. Palliative care for children and young people is defined by the charity as

“an active and total approach to care, from the point of diagnosis throughout the child’s life, death and beyond.”

By embracing physical, emotional, social and spiritual elements, children’s palliative care helps to achieve the best possible quality of life and care for every child with a life-limiting or life-threatening condition and their family.

Giving families an opportunity to set out what they need and want is key to this approach. Children’s palliative care is holistic and is provided by a network of services in hospitals, homes and children’s hospices by the NHS and the voluntary sector, including children’s hospices. These services should be planned, funded and provided in a way that enables children and families to access them when and where they need them.

The key problem is the one that I am about to set out:

“In England, integrated care boards have a legal duty to commission palliative care for children, young people and adults that it considers necessary.

Across England and the wider UK, there is huge variance in the extent to which palliative and end of life care for seriously ill children and young people is being formally planned, funded and provided in ways that meet national and regional standards.

Of particular concern is children and families’ access to end of life care at home”—

we heard this from the hon. Member for Taunton and Wellington (Gideon Amos)—

“24 hours a day, seven days a week, provided by nurses and supported by advice from consultant paediatricians who have completed sub-specialty training in paediatric palliative medicine (also known as GRID training).

Despite some improvements, freedom of information…requests published in March 2025 have revealed that less than a fifth…of ICBs currently commission these services on a formal basis. Meanwhile, over a third…are still failing to meet this established national standard.

As a result, many families feel abandoned by a complex system which should support them to provide care once their child is diagnosed.”

I have been asked by the charity to raise a rather large number of questions, which I am going to cut down to just six, if I can manage to squeeze them in. The charity stresses the fact that the Government’s decision to allocate up to £80 million in ringfenced NHS funding for children’s hospices in England over the next three years is very welcome, but many challenges remain.

These are the six questions that I have picked out of more than a dozen and a half that I was presented with. First, will the Minister confirm that the modern service framework for palliative and end-of-life care, which we heard about from the hon. Member for York Central, will explicitly acknowledge the difference between adult and children’s palliative care and ensure that the needs of seriously ill children are not overlooked?

Secondly, can the Minister confirm that the framework will take a holistic approach and address the wide-ranging needs of seriously ill children and their families, including medical, emotional, social, psychological and practical needs?

Thirdly, will the Minister commit to using the upcoming 10-year workforce plan to examine how the existing children’s palliative care workforce can be used as equitably as possible, organising services into NHS-commissioned children’s palliative care operational delivery networks, such as I gather are used in neonatal care services, in order to help to achieve that?

Fourthly, can the Minister commit to increasing investment in specialist paediatric palliative medicine training by £2.4 million annually to address the funding gap identified by the charity Together for Short Lives?

Fifthly, do the Government support the call of the Royal College of Nursing for nurse-to-patient ratios in all health and care settings? Will they commit to tackling the shortage in NHS community children’s nurses?

Finally, with ICB funding for children’s hospices varying significantly across England, how is the Minister ensuring that every seriously ill child and their family, regardless of where they live, has equitable access to palliative care?

Oral Answers to Questions

Julian Lewis Excerpts

Tuesday 24th February 2026 Commons Chamber

[Dr Ahmed]

I am grateful for my hon. Friend’s invitation. She is right: we need to think of innovative ways of attacking the mental health issues that face our country, and particularly our young people. Those include digital and face-to-face therapies, both of which we are expanding at a rapid pace. I am delighted to pass on her invitation to the Minister for Mental Health.

[Sir Julian Lewis (New Forest East) (Con)]

Has the Minister had any opportunity to form conclusions about whether excessive involvement with social media and other online potential harms has contributed to an apparent significant increase in the levels of mental health disorders?

[Dr Ahmed]

The right hon. Gentleman is right to highlight this very live issue. As a doctor, a parent and a Minister, it is live in my mind, as it is in the minds of hon. Members across the House. It is important that we follow the evidence, and act safely and proportionately in response to that evidence. The right hon. Gentleman will know this Government’s ambition, and the direction that we want to set to ensure that young people are kept safe online.

Hughes Report: Second Anniversary

Julian Lewis Excerpts

Wednesday 11th February 2026 Westminster Hall

[Sir Julian Lewis (New Forest East) (Con)]

I will try to add something new to the excellent start to the debate by both the previous speakers, who showed a great command of the overall situation, by quoting my constituent Emma, who got in touch with me yesterday after learning that the debate would take place. I will briefly summarise her concerns, which she set out in the following way:

“In the main, the point is that so many have been injured, left on NHS waiting lists, paying for prescriptions and transport to and from appointments. Not being able to work—or restricted working hours. Limited access to PIP…Very little support for those who had mortgages due to the benefit system not supporting mortgage costs”

and

“loss of pension contributions, as none of us is getting any younger.”

This lady is exceptionally strong. Despite the injuries she suffered personally, she has been a rock and a leader for other mesh-injured women in or near my constituency. I hold her in the highest esteem; in fact, I salute her courage. What she has to say is, in a sense, an argument that has already been won. The Cumberlege report won that argument, and the Hughes report wanted to recommend what should happen next. I am delighted to see Henrietta Hughes in the Gallery—and seemingly acknowledging that I am right about that difference between the two reports.

Let me briefly quote from Henrietta Hughes’s admirably concise list of 10 recommendations. Recommendation 1 was:

“The government has a responsibility to create an ex-gratia redress scheme providing financial and non-financial redress for those harmed by valproate and pelvic mesh. This scheme should be based on the principles of restorative practice and be co-designed with harmed patients.”

Recommendation 3 was:

“The government should create a two-stage financial redress scheme comprising an Interim Scheme and a Main Scheme.”

Recommendation 4 was:

“The Interim Scheme should award directly harmed patients a fixed sum by way of financial redress. These payments should start during 2025.”

Recommendation 8 was:

“Both the Interim Scheme and the Main Scheme should be administered by an independent body which commands the confidence of patients.”

What is the point of an interim scheme? It is to recognise that there will be tremendous complexity in individual cases, but at least these mesh-injured ladies would get a minimum of help—I think £25,000 has been suggested—straightaway, while the more complex calculations can be done later. Yet despite that being the very point of an interim scheme—that we can do this quickly and work on the harder parts subsequently—we have seen no progress.

What does that remind us of? It reminds me of the Post Office. It reminds me of the infected blood scandal. What do all those things have in common? A large number of people who have been injured in some way or another—either physically, or with their character or freedom damaged, often beyond repair—and who are owed very large sums of money by way of redress or compensation. We know what happens in the end: there is enough public protest to ensure that there is action. I hope that the level of public awareness is no less for this cause than it is for other, similar scandals because all the victims were women. That would be even more disgraceful than that this all happened in the first place.

--- Later in debate ---

[Karin Smyth]

I want to address the main concerns and, as I said, the Under-Secretary of State is very keen to talk with Members and campaigners.

We remain committed to working alongside Dr Hughes and her team to better support patients and ensure that steps are taken to prevent similar harm in the future, both in this area and across the wider patient safety landscape. That is obviously crucial. Many Members mentioned the importance of women’s voices being heard in this area, and many of us were involved in the campaign in the previous Parliament. We must make sure that women’s voices are better heard in the health system. As my hon. Friend the Member for Morecambe and Lunesdale (Lizzi Collinge) said, the campaigners are doing that, and I pay tribute, as she did, to In-FACT, as well as Sling the Mesh and the very many other patient groups that have raised this on behalf of women. They should not have to, but I commend their work.

I assure Members and people listening to the debate that we remain committed to advancing this work across Government and to looking at lessons from any cases in which patient safety has been affected. I fully understand why colleagues are asking for an official response to the Hughes report here and now. It is important that we get it right, and we need to carefully consider all options and the associated costs before coming to a decision on the report’s specific recommendations. I am sure that many Members have seen the letter that my hon. Friend the Under-Secretary of State wrote to the Patient Safety Commissioner in November, and I reconfirm, as he wrote, that that work includes looking at the costs.

We must take forward the lessons learned from this work—including, as the right hon. Member for New Forest East (Sir Julian Lewis) and my hon. Friend the Member for Ellesmere Port and Bromborough (Justin Madders) highlighted, work on similar areas—and the Government are doing that. We must ensure that our approach provides meaningful, often ongoing support to those who have been so profoundly affected.

The Government have to consider options for financial redress collectively, with input from a number of Departments, and we started that work immediately. As was mentioned, the previous Government did not respond to the report when it was published, but we have picked up that work. Initially, Baroness Merron was the lead Minister, and it is now the Under-Secretary of State, my hon. Friend the Member for Glasgow South West.

I assure the hon. Members for Strangford (Jim Shannon) and for Aberdeenshire North and Moray East (Seamus Logan) that my hon. Friend recently met the devolved Government Health Ministers to discuss their respective positions further. He will continue to do so across all devolved Government areas; as Members have said, patients there are affected too. We have to proceed with care to ensure the correct approach. We are committed to providing updates at the earliest opportunity, once all relevant advice and implications are considered.

[Sir Julian Lewis]

Will the Minister give way?

[Karin Smyth]

I will continue, if I may.

On non-financial redress, the Department is committed to meeting the needs of current patients with clinical requirements via three principal avenues. The first is improving clinical services and treatment to patients, and the second is commissioning further research and development programmes on sodium valproate and pelvic mesh to address the remaining knowledge gaps. I commend my hon. Friend the Member for Bexleyheath and Crayford (Daniel Francis) for sharing again his personal experiences and for laying bare the deep complexity and the need for more research and development, to which my hon. Friend the Under-Secretary of State is committed. The hon. Member for Leicester South (Shockat Adam), with his clinical knowledge, also added useful experience to the debate. That is absolutely what my hon. Friend will be taking forward. The third avenue is initiating longer-term preventive measures that will help ensure that the system can pick up on adverse trends in patient care and act more quickly in the future.

I will take each avenue in turn. On improvement of clinical services, although the number of women up to the age of 54 who have been prescribed sodium valproate has nearly halved since 2018, there is a significant group of patients already affected who have complex and varied needs, and the health system has to ensure that that cohort receives high-quality and tailored care. NHS England has committed to a pilot project on foetal exposure to medicine in the north of England, involving multiple clinical specialties and a wide range of clinical experts, that will undertake a comprehensive review of the service. Eighty patients have been seen as part of the pilot, representing 560 appointments and 650 clinical hours. We have received feedback from patients on the value for their quality of life of being seen by clinical experts and wider multidisciplinary teams. We are considering options to commission this service further nationwide.

NHS England has also completed an internal review of mesh centres across England. Mesh centres undoubtedly offer a valuable and impactful service, with nearly 3,000 patients now seen since their introduction. However, as a relatively new service, distinct areas for improvement remain, and we will look closely at the results of the internal review and promptly deliver the necessary improvements.

With regard to further research and development, the National Institute for Health and Care Research has been commissioned for a £1.56 million study to develop patient-reported outcome measures for prolapse, incontinence and mesh-complication surgery. In the longer term, those measures will be integrated into the pelvic floor registry, which monitors and improves the safety of mesh patients. Further research is also taking place in this area, and we will ensure that future work takes into account the recommendations of the pilot project and of the mesh centre audit.

On longer-term prevention work, recent discussions with NHS England and the Medicines and Healthcare products Regulatory Agency indicate that longer-term improvements in digitisation will help position the UK as a world leader in reducing valproate-exposed births and applying the insights to other teratogenic medicines. The Department will explore increasing centralisation and visibility of the annual risk acknowledgment form across care settings, as highlighted in the Hughes report, and may consider expanding the medicines and pregnancy registry to better link data with research outcomes.

--- Later in debate ---

[Karin Smyth]

I am happy to answer that at the end of my comments, but first I will take the intervention from the right hon. Member for New Forest East.

[Sir Julian Lewis]

I appreciate that the Minister does not have primary responsibility for this area, but it worries me that we are hearing an awful lot about process. What I fear is really going on is that Ministers have been told at the highest possible level, by the Chancellor or a Treasury Minister, that the money for redress will not be made available and they have to take that as their starting point. She may not be able to confirm this now, but I would like an answer as to whether a conversation of that sort has taken place.

[Karin Smyth]

I thank both Members for their comments. Experienced parliamentarians will know what I will be able to say. As my hon. Friend the Under-Secretary of State, the hon. Member for Glasgow South West, outlined in his letter, costs—I think that is what the hon. Member for Aberdeenshire North and Moray East was alluding to—are part of the overall consideration, along with the complexity, in the work that he is leading on behalf of the Department across all Government Departments.

Puberty Suppressants Trial

Julian Lewis Excerpts

Wednesday 17th December 2025 Commons Chamber

[Wes Streeting]

I will try to do that, Madam Deputy Speaker.

We will ensure that young people get good access to wider evidence-led support. I have had to wrestle with the fact that some trans people enter adulthood without ever receiving any sort of healthcare, and I have been heavily criticised by those people in particular for some of the decisions that I have taken. We are working to reduce waiting times, as I have described.

My hon. Friend says that puberty blockers are reversible. We hear contrary views about that from Members across the House, some of whom say that puberty blockers are irreversible. The truth is that the evidence in this area is mixed, which is why we need to build a stronger evidence base.

[Sir Julian Lewis (New Forest East) (Con)]

The Secretary of State deserves our sympathy for having to negotiate such an ethical minefield. Will he tell us whether the data exists from all the people who had puberty blockers under the old regime? He mentioned having met one person for whom they had worked well and one person for whom they were a disaster. Surely it should be possible to do a systematic survey of the dozens, if not hundreds, of people who went through that. Might that be a more constructive and less dangerous way forward?

[Wes Streeting]

The right hon. Member is right that we need that data linkage study. That will happen, but it will not produce the same evidence base as a clinical trial, and that is the distinction between the two. It is frankly a disgrace that people have sought to withhold that kind of data and it is really important that we get this right.

I appreciate the right hon. Member’s sympathy. I have wrestled with this issue probably more than any other ethical decision that I have had to make in this office. I do not seek any pity or sympathy for doing so—it is the job that I signed up to and a job that I love doing. I have taken great care and sensitivity in this area because of the particular vulnerability of this group of children and young people.