Gender Incongruence: Puberty Suppressing Hormones

Karin Smyth Excerpts

Wednesday 30th April 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Ms Lewell. I congratulate the hon. Member for Reigate (Rebecca Paul) on securing this debate, on the constructive tone in which she has engaged with me and my Department, and on the way that she opened the debate.

The Government’s approach is governed by three principles. First, the health and wellbeing of children and young people is our primary concern—a point made by the hon. Member for Strangford (Jim Shannon). Secondly, evidence-led, effective, ethical and safe healthcare must be provided to all who need it, when they need it—a point well made by my hon. Friend the Member for Macclesfield (Tim Roca). Thirdly, this Government believe in the dignity and equality of every single one of His Majesty’s citizens.

Since the election, we have been calmly and cautiously guided by the evidence. We take children’s healthcare extremely seriously. That is why we remain committed to implementing the Cass review, and ensuring that children and young people who are looking for support in relation to their gender receive the highest quality of care, as one would expect of any other child health service in the NHS.

[Tracy Gilbert]

Dr Cass was clear in her review that the model of care for people with gender incongruence, and particularly for children and young people, needs to be changed to take into account their holistic care needs. Will the Minister update us on her Department’s progress in implementing those findings?

[Karin Smyth]

I thank my hon. Friend for that intervention; I hope to get on to that subject in my speech. It is important that people are aware of that progress.

I know that many people are concerned about the ethics of this research, as the hon. Member for Reigate and the right hon. Member for South Holland and The Deepings (Sir John Hayes) both noted. I assure hon. Members that the UK has, as we know, extremely rigorous and robust ethical approval pathways, and that no clinical trial can proceed without the necessary independent scientific approvals.

We already regularly use those processes to consider clinical trials in children so that we can evaluate new treatments for a whole range of conditions, including cancer, depression, respiratory infections, or any illness. Many aspects of the methodology of this trial are still being looked at, such as how long it will follow children, how many children will be on the trial and how the demographics of the trial will be constructed. That is all still to be confirmed and approved; many hon. Members asked about those points today. All participants in the trial will also be part of the ongoing observational study.

Following the decision by the Secretary of State for Health and Social Care about puberty blockers, which was based on the evidence, we needed to make sure that we got on with helping scientists, researchers and clinicians to do their jobs. Some people have called for the Government to stop those experts from pursuing this line of inquiry, and we have heard such calls again in this debate. They have argued that the decision to halt the sale and supply of puberty blockers should be the end of the matter, and that young people should not have access to this medication, come what may. That would be to ignore the distress and real experiences of young people, and the Government have no doubt that it would drive people towards possible illegal and underground routes, shutting off young people’s access to conversations with professionals and the opportunity to pause and consider other options.

Instead, as Dr Cass suggests, we can set out a proper path to treatment that involves young people, their parents, clinicians and mental health professionals. Knowing that they are on a path will reassure young people that they are being taken seriously. The cautious process that they will have to work through before joining a trial means that young people will have access to support and counselling, which may result in them deciding against joining the trial and pursuing a medical route. That is an approach entirely missing over recent years.

We all agree that treatment should be offered based on the best available evidence, and clinical trials in the UK are considered to be the gold standard for evaluating healthcare interventions. The Cass review found:

“The evidence base underpinning medical and non-medical interventions in this clinical area must be improved.”

That is why we have commissioned the PATHWAYS programme of research, one aspect of which includes the world’s first clinical trial designed to help us to better understand the relative benefits and potential wider effects of the use of puberty blockers in affected children.

We must look at the most appropriate medical and non-medical approaches to support physical, emotional and psychosocial health. That is why the trial forms just one component of a wider study and a growing portfolio of research, jointly hosted by NHS England. That includes looking at the experiences of the 9,000 adults who, as children, were cared for under a previous model of NHS care, which I know the hon. Member for Reigate has described as a “medical scandal”. Dr Cass was clear in her review that both a clinical trial on puberty blockers and a data linkage study, which many hon. Members have raised today, are important to improving the evidence base on gender incongruence in children and young people.

Regardless of individuals’ views on the practices of the Tavistock, I hope we can all agree that learning from the experiences of those thousands of people who have accessed puberty blockers is important; it will provide different and separately valuable information from the clinical trial. That data alone, however, will not provide the answer as to whether we should—or should not—consider routinely prescribing these drugs in the future, or continue the ban indefinitely.

The adult gender services have now committed to sharing their data, a point also raised by hon. Members. I acknowledge that we need to move quickly, and I expect to be making progress on this soon. We will consider all data that is relevant to puberty blockers, including from the adult gender clinics.

As with all clinical research, the team leading the trial must ensure that approval is obtained from the regulatory authorities, including one of the Health Research Authority’s independent ethics committees and the Medicines and Healthcare products Regulatory Agency. Those are all standard steps where the research receives full scrutiny. Once approvals are granted, the study protocol will be finalised and published, and only then can the trial commence. I am not able to comment on the finer details of that today, but we will issue further updates when they are available, and I commit to keeping Members updated.

I assure hon. Members that entry into the trial will be guided by strict eligibility criteria. It will involve only young people under the care of the NHS children’s gender services who have received a full assessment, where other appropriate forms of support have been offered and where their clinician supports a referral to the trial. Under the law, if a child is under 16, a parent will have to consent to their participation, and the child also needs to agree.

I am repeating myself slightly, but that level of caution was entirely missing over recent years. This is a more considered and evidence-based approach. In the past, puberty blockers were presented as the magic pill that young people needed to access; this trial will give children and young people the support they need to make these major decisions.

As we have heard today, we are currently in a situation where some people think it is unethical not to provide these treatments, and some think it is unethical to provide them. The reality is that we do not have definitive evidence. When that happens, we routinely ask for the study to be checked by an independent ethics committee. We spell out the uncertainty to young people and their parents, so that they can balance any such risk against their desire to join the trial before deciding whether they wish to participate.

[Sir John Hayes]

Will the Minister give way?

[Karin Smyth]

I am sorry, but I am tight on time.

Uncertainty is common to many new treatments, but through that process, we ensure that those treatments are no longer used in the absence of such evidence. During the trial, an independent committee checks whether new results have emerged from other countries around the world—a question that was raised several times—and, if those results provide evidence that the benefits or risks are clear, such that we could issue clinical guidelines based on them, the trial would be stopped.

We need better-quality evidence to support the NHS in providing reliable and transparent information and advice to children and young people, and their parents and carers, in making important treatment decisions. That is exactly what NHS England and the National Institute for Health and Care Research programme will provide.

I was asked to provide an update on implementing the Cass review, which, beyond that research, we are absolutely committed to doing. From what we heard this afternoon, I am not entirely sure what the Liberal Democrat position is, but we are very clear that we will continue to work on that in lockstep with NHS England. We have opened the three services, and a fourth is planned in the east of England from this spring.

Those services operate under a fundamentally different clinical model, where children and young people get the tailored and holistic care they need from a multidisciplinary team of experts in paediatrics, neurodiversity and mental health. At first, those services saw patients transferred from the now-closed gender identity development service at the Tavistock, but I am pleased that all the services now take patients from the national waiting list. NHS England aims for there to be a service in every region of England by 2026. That will help to reduce the waiting list and bring the services closer to the homes of the children and the young people who need them.

Draft Health and Social Care Information Standards (Procedure) Regulations 2025

Karin Smyth Excerpts

Tuesday 29th April 2025 General Committees

[The Minister for Secondary Care (Karin Smyth)]

I beg to move,

That the Committee has considered the draft Health and Social Care Information Standards (Procedure) Regulations 2025.

It is a pleasure to serve under your chairship, Ms Jardine. The statutory instrument was laid before the House on 25 March 2025. I am grateful to be here to debate the draft regulations which, if approved, will make provision for the new procedure that the Secretary of State for Health and Social Care and NHS England must follow when preparing and publishing information standards.

Information standards relate to the processing of health and adult social care information. They provide a common set of requirements that must be followed when health and adult social care providers use, process and share information. They might cover quite technical issues relating to IT systems, or they might relate to how information is collected or managed. They provide the common language or languages through which the systems and organisations of the NHS and adult social care can interact.

For the health and adult social care system to work effectively, data needs to be processed in a transparent and standardised way, using common specifications, so that it can be understood and used by health and care professionals across different settings. Information standards can ensure that information is shared easily and in real time between organisations. That supports the co-ordination and delivery of care, clinical safety, planning and research.

Let me talk briefly about the benefits of this instrument. Information standards are not new; under powers set out in the Health and Social Care Act 2012, public health and care providers must have regard to information standards. However, low compliance makes it hard to deliver the improvements required across health and adult social care. The Health and Care Act 2022 made provision for information standards to be mandatory, and the regulations set out the process that must be followed in developing and publishing all mandatory information standards. That includes requirements to seek views and/or advice from those with relevant expertise during the development of an information standard, which will ensure that future information standards are able to meet the needs of the system.

The procedures outlined in this instrument are proportionate and transparent. They will ensure that information standards are fit for purpose, kept up to date and reviewed regularly, as needed, and that they keep pace with technical developments and evolving priorities.

In closing, a significant burden is created when information held in one system or organisation is not easily available in another—something I think we have all seen. In the health and care system, such constraints are a significant barrier to achieving the aims of the Government’s health mission. We need to create a modern health and adult social care service, and improvements to interoperability, enabled by the establishment of a robust information standards framework, are an important step towards delivering that. I commend the regulations to the Committee.

--- Later in debate ---

[Karin Smyth]

First, I thank the shadow spokesperson for the Conservative party’s support in bringing forward the regulations. As he rightly said, some of this work continues work done under the last Government and results, as I said in my introductory remarks, from the 2022 Act.

As I also said, standardisation has not been taken up across the system in the way that we would like, and this instrument provides a framework everybody can lean into. To go to the hon. Gentleman’s last question first, that reflects our need to make sure that, for the benefit of patients, clinical safety, patient support and efficiencies in the system, we have a framework that everyone works to and brings their standards into—I will not veer into something more technical that is beyond my ken, on the detail of computer systems. We wanted to make sure that we had that framework in place, and we were keen to bring it forward in an SI that is transparent for the House, so that we can all understand how this proposal is part of the wider Government mission.

As I said, this proposal started off under the last Government, and it has been brought forward now. There was an engagement exercise with stakeholders, and the response was published in November. We therefore need to issue the regulations now, particularly in advance of the Data (Use and Access) Bill. So that is the timing issue. I cannot comment further on trade deals, but that is why we are doing this: to make the system in England work better for all our patients.

To the hon. Gentleman’s point about cross-border issues, I am an MP in Bristol, and I understand those issues. We are looking at our responsibilities for England. We are keen to work with the devolved Administrations on all healthcare and cross-border issues. The Department will continue to talk to them, and I hope they are willing to continue to work with us. If there is anything further to add, I will make sure that it is communicated to the hon. Gentleman.

On the hon. Gentleman’s point about the CQC, he will be aware that the organisation has undergone a number of difficult issues in the recent past. We have had new leadership in place since before Christmas, and it is keen to provide support on wider issues. Safety, in particular, is in its remit, and the hon. Gentleman, as a practising clinician, will be acutely aware of the need for different systems to be able to talk to each other to highlight issues of safety and so on. We will absolutely ensure that the CQC is working as part of this wider system.

Colleagues and staff at NHS England obviously have concerns about changes, but the need to have data that works across the whole system—that has that interoperability at its core—is a priority for everybody working in it. That is clearly part of what the NHS needs to do, and although some people may move, that is absolutely a priority for the NHS moving forward.

To the hon. Gentleman’s point about the RNID, I had not heard that. Clearly, accessibility for all is important. I am happy to make sure that we get back to him and the RNID on that issue.

[Dr Evans]

If it would be of use, I am happy to give the Minister the letter the RNID provided to me before this meeting, to give her the context. I believe that the RNID would also be happy to give briefings, if that would help.

[Karin Smyth]

I thank the hon. Gentleman for that, and I am sure that officials have talked with the RNID. It is absolutely right that he brings that issue to my attention, and I will make sure we get a reply back to him and the RNID on the detail and on the time it will take to enact these standards. I visited the NHS England team up in Leeds, where we spoke about providing wider access—for example, by using the app—and about working with groups such as the RNID to make sure that what we produce is accessible for disabled people. The hon. Gentleman raises a really important point, and I will make sure that we get back to him on it.

With that, I will make sure that we check the record, and if there is anything else, we will get back to the hon. Gentleman. Otherwise, I would be grateful if the Committee could support the SI.

Question put and agreed to.

Hospitals

Karin Smyth Excerpts

Wednesday 23rd April 2025 Commons Chamber

[The Minister for Secondary Care (Karin Smyth)]

It really is a pleasure to close this debate on behalf of the Government. I think there have been 33 contributions from hon. Members from across the House.

Nowhere is it more apparent that the NHS is broken than in our crumbling hospitals. Over 14 years, the NHS was starved of capital and the capital budget was repeatedly raided to plug the holes in day-to-day spending. Lord Darzi’s investigation into the NHS in England made it clear that we have crumbling buildings and IT, mental health patients sharing showers in Victorian-era cells infested with vermin, and parts of the NHS operating in decrepit portacabins. Some 20% of the primary care estate predates the founding of the health service in 1948.

I thank the Liberal Democrats for bringing forward this debate. We broadly agree on the disgrace that the backlog of repairs, the decades-long cannibalisation of capital budgets and the unfunded fantasy of the new hospital programme had become. Where we disagree is on the cause and the solution. As we have heard today, the Liberal Democrats are completely silent on the part they played as members of the coalition Government. They were active and enthusiastic partners in the decision to impose austerity, and our NHS was starved of funding on their watch. The practice of raiding capital budgets to keep things afloat started in 2014, on their watch. The disastrous top-down NHS reorganisation, which wasted billions of pounds and contributed to record-high waiting lists, happened on their watch.

As for the solution, the Liberal Democrats are silent on how they would pay for and accelerate the new hospital programme. They are playing the same cynical game that we saw from the Conservative party: they are dangling the prospect of a new hospital while being unable to explain where the funding would come from or how the construction industry could deliver it within the timeframe. It is indeed opportunism, as my hon. Friend the Member for Gateshead Central and Whickham (Mark Ferguson) said. We all remember the Rose Garden, as my hon. Friend the Member for Watford (Matt Turmaine) said. The Liberal Democrats opposed the autumn 2024 Budget, which delivered record investment in our NHS. In sharp contrast, this Government are prepared to take the decisions needed to back up our promises with the funding needed to deliver them, and we are determined to rebuild confidence and trust in politics by promising only what we can deliver.

I have met many hon. Members in person and heard them in the Chamber today, and I know others are not here who would have wanted to contribute. As the Minister, let me say plainly that I agree with everyone’s anger. I share that anger because, when I tour hospitals up and down the country—I did so recently in Doncaster and in Oxfordshire, where I visited the Warneford hospital—I often see equipment and infrastructure that was procured 20 years ago when I was working for the NHS in Bristol. Seeing these physical reminders of the past when I tour hospitals fills me with a mixture of pride and shame. I feel pride because I was part of a generation of leaders who delivered hospitals fit for patients in the biggest hospital programme in NHS history delivered under the last Labour Government, and I feel shame because our legacy was squandered and patients have paid the price. We understand the legacy, and Lord Darzi was very clear that the task for us is to take action. That is why the Chancellor took the necessary decisions in her Budget to meet this challenge, and why we have put the programme on a firm financial footing.

As my hon. Friend the Minister for Care said, we are not just writing the wrong; we are taking pressures off hospitals, shifting the focus of our NHS from hospital to community, recruiting over 1,500 more GPs to take the pressure off A&E and harnessing the power of AI to help people who depend on care to stay at home. That point was well made by my hon. Friends the Members for Stroud (Dr Opher), for Aylesbury (Laura Kyrke-Smith), for Milton Keynes Central (Emily Darlington) and for Calder Valley (Josh Fenton-Glynn). As he made me sponsor him, may I wish my hon. Friend the Member for Calder Valley good luck in the marathon this weekend? The challenge before us is immense, but every member of this Government is up for the fight.

Members made a number of points, and I will try to get through them in the time available. I could not agree more with those who made the point that we have to break out of the vicious cycle of false economy. This Government were elected on a manifesto to end short-termism, easy answers and sticking-plaster politics. When we came into government we were saddled with a bill of almost £14 billion in backlog maintenance. My right hon. Friend the Chancellor has given us the funding this year to back NHS systems with over £4 billion of operational capital. A lifesaving cash injection of £750 million for targeted estate safety funding is a vital first step towards fixing our crumbling estate. That is crucial not only for patients, but for staff morale, as my hon. Friend the Member for Carlisle (Ms Minns) said. There is also £440 million to tackle crumbling RAAC concrete, keeping patients and their families safe. We are opening new mental health facilities, with more in construction, and that state-of-the-art provision will give the best possible care outcomes.

Furthermore, I assure Members that, unlike the previous Government, we will never raid capital budgets to plug day-to-day spending, and the Treasury has updated its fiscal rules to make that impossible. My hon. Friend the Member for Crewe and Nantwich (Connor Naismith) said that big promises with no plans are what got us into this mess, and that was echoed by my hon. Friend the Member for Mid Cheshire (Andrew Cooper), who talked about the false hope and the waste of the past. My hon. Friend the Member for Banbury (Sean Woodcock) echoed that point and reiterated the point about trust, which was almost shared by the hon. Member for South Devon (Caroline Voaden).

Members have called on the Government to reverse course and commit to a timeline that is unfunded, unrealistic and undeliverable. That has been recognised by a National Audit Office report, which stated that

“some schemes publicly promised in 2020 now face substantial delays and will not be completed by 2030…with implications for patients and clinicians.”

The delivery of these hospitals existed only as a figment of Boris Johnson’s imagination and this Government are doing the hard yards of putting the new hospital programme back on track. The NHP previously received a red rating from the Infrastructure and Projects Authority, now known as the National Infrastructure and Service Transformation Authority. Its latest review, which it carried out in January, rated the NHP as amber. That reflects the measures that we took to put the programme on a firm footing, as my hon. Friend the Member for Harlow (Chris Vince) rightly said.

Some Members, including the Chair of the Select Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), have asked us to publish the individual scores of each scheme following the outcome of the review, but may I just take issue with the hon. Lady’s use of the word “shady”? The Secretary of State and the Department will continue to co-operate with her Committee, but to be clear, as part of our analysis, schemes were prioritised into upper, middle and lower thirds, which gave a delivery schedule for the programme to align with the funding envelope, and there was no final individual score for each scheme. There is no formal delineation among schemes in wave 2, and schemes remain scheduled to start construction as outlined in our plan for implementation.

I briefly say to my hon. Friend the Member for Mitcham and Morden (Dame Siobhain McDonagh) that it was a pleasure to meet Councillors McCabe and Garrod from her constituency and to understand their passion about the loss of resources. That is echoed in many low-income areas, and we have to reverse that loss of resources as we go forward with our 10-year plan.

We are taking a systematic approach to building the next generation of hospitals, known as Hospital 2.0, allowing trusts to benefit from economies of scale, provide excellent patient care and facilities, and ensure that staff are supported with technology for decent working environments. It contributes to our growth mission, putting more money in people’s pockets and supporting our supply chains. In response to my hon. Friend the Member for Milton Keynes North (Chris Curtis), we do abide by the Hospital 2.0 scheme. It is a systematic and centralised approach that will save taxpayer money, while driving innovation and laying the foundations for a new relationship between Government and industry. I am disappointed if it is official Liberal Democrat policy to oppose that approach.

I know the clock is against me but I want to end by saying that I completely understand why colleagues are so concerned about the plans, when previous Governments have so badly let them and their constituents down. I also hear the point made by the hon. Member for South Antrim (Robin Swann) about Northern Ireland. Northern Ireland benefits from the Barnett consequentials for revenue and capital. It is devolved and it can look at alternative means. The Department will continue to work with all devolved Administrations across all issues, but they do have particular problems.

Staff and patients deserve better, so I want to offer them some reassurance about our record since July. We promised to sit down with resident doctors and end the damaging strike action—promise made, promise kept. In October, we said we would recruit more GPs by April and we recruited more than we said—promise made, promise kept. We promised 2 million extra appointments in our manifesto and we smashed that target seven months early—promise made, promise kept. Last month, over 80% of patients in England referred for cancer had it ruled out or diagnosed within 28 days, the first time that target has been met for years, and waiting lists are now consistently falling.

We have gripped this critical issue since July, from day one with the review. The Secretary of State and I met MPs and the NHP team before the completion of the review. I met all colleagues the day after the announcement in January and I have had individual meetings. I will keep my promises to visit, when the diary allows. I am really looking forward to North Devon. I am also visiting Hillingdon, where I grew up, with my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales), and possibly visiting some old haunts. I have committed to visiting Basingstoke, with my hon. Friend the Member for Basingstoke (Luke Murphy). We will progress at pace on RAAC and wave 1. I am committed to holding more meetings with wave 2 and wave 3 MPs in the coming weeks and months to keep colleagues abreast of updates and to provide them with the opportunity to ask questions directly of the team. That is how I will work with colleagues across the House to make sure the programme happens.

Finally, the hon. Member for Sleaford and North Hykeham (Dr Johnson) talked about her experience of the PFI scheme she worked under and the nonsense she had to deal with. Her Government could have changed that at any point. My experience of a PFI scheme in Bristol was waking up about a year ago after I had had my melanoma removed, in an almost brand new hospital with fantastic facilities in a single, individual ward with my husband beside me. Maybe it was the drugs that made me feel a little bit bleary-eyed, but what I thought then was how proud I was to have been part of the development team, as part of the primary care trust board, bringing forward a fantastic hospital for north Bristol that serves patients so well. That would never have happened under another Administration. We rebuilt the hospitals under the previous Labour Government. I am proud of that record. We did it before; we are going to do it again. That is what a Labour Government do.

Question put (Standing Order No. 31(2)), That the original words stand part of the Question.

--- Later in debate ---

That this House regrets the appalling state of repair of NHS hospitals across the country; notes that the NHS maintenance backlog rose to £13.8 billion in 2023-24; further notes the sustained pattern of cannibalising NHS capital budgets to keep day-to-day services running; condemns the previous Government’s record of starved repair budgets and exploding maintenance backlogs, which made sewage leaks, cracked walls, crumbling ceilings and sinking floors commonplace; further condemns the previous Government for launching the New Hospitals Programme with no realistic plan to fund or deliver it; also notes that the Chancellor has announced new fiscal rules to ensure capital budgets can no longer be cannibalised, with transfers from capital to resource budgets not permitted; recognises that the previous Government left a New Hospital Programme which was unfunded, unrealistic and undeliverable; welcomes that the Government has taken action to review that Programme and has published the New Hospital Programme Plan for Implementation, to put the Programme on a sustainable footing; supports the Government’s investment in the Plan, which will increase to up to £15 billion over each consecutive five-year wave, averaging around £3 billion a year from 2030; and further supports the work being done to bring forward construction of the reinforced autoclaved aerated concrete replacement schemes wherever possible, to ensure that patient and staff safety is prioritised.

[Karin Smyth]

On a point of order, Madam Deputy Speaker, could you advise me whether it is in order that the hon. Member for Sleaford and North Hykeham (Dr Johnson), who opened the debate for the Conservatives, was not in her place for the close of the debate? I think that is discourteous to the House, and I would like your advice on how we rectify this matter.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

The point of order is most definitely on the record. It is a point of courtesy to be here for the close of a debate if you are here for the opening. No doubt, Opposition Front Benchers will make that very clear to the Member.

NHS Pensions

Karin Smyth Excerpts

Tuesday 1st April 2025 Commons Chamber

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on NHS pensions in the light of the statutory deadline for both remediable service statements and remediable pension savings statements being missed.

[The Minister for Secondary Care (Karin Smyth)]

I thank the hon. Member for Hinckley and Bosworth (Dr Evans) for asking this question, which gives me the opportunity to provide further information following the written parliamentary statement that I issued yesterday to update the House on the delivery of remediable service statements to affected members.

I have extended the deadlines for the NHS Business Services Authority to issue statements to ensure that members have enough time to make informed decisions. Once members have received statements, they will be able to use a tool provided by His Majesty’s Revenue and Customs to retrospectively adjust their annual allowance between 2015-16 and 2022-23.

Separately, the original deadline to issue the 137,000 remediable pension savings statements was 6 October. The NHS Business Services Authority issued statements to 57,000 members by this deadline, of which 23,000 were found to contain incorrect information; these have since been recalculated and reissued. The NHS Business Services Authority is working to issue outstanding statements as quickly as possible.

A revised delivery timetable has been developed and shared with trade unions and employer representatives. By the end of March, 106,000 statements had been issued. Statements for 11,000 members will be produced once further information has been received from their employers. The remaining 20,000 statements require additional manual input from the NHS Business Services Authority before they can be produced, and will be issued in July. There have been delays on all sides, which we have been aware of since last July. In fact, the Department had escalated issues of design with the previous Government, as I am sure the hon. Gentleman understands.

We know that this matter is really important and that there are high numbers of high earners in the NHS, which is why we have taken the decision to be open and transparent about the timeline that we can now commit to, having worked tirelessly to reduce the delays. Although these delays will cause inconvenience to some members, I have been crystal clear that no one will face any financial detriment as a consequence. Compensation arrangements are in place for direct financial losses, certain HMRC interest charges, and the costs of financial and accountancy advice.

The Government do acknowledge the impact of the delays on affected members. We are working hard to issue outstanding statements and to protect members from any financial detriment the delays may cause.

[Dr Evans]

What is going on with NHS pensions administration under this Government? I declare an interest as someone with an NHS pension. Today, the Government have missed the statutory deadline for issuing remediable service statements to doctors, and they are now pushing the deadlines back to December 2026. In mid-March, the Government confirmed that just 21 statements had been issued out of 380,000; as of yesterday’s written statement, there are still more than 370,000 outstanding. This creates huge tax liability uncertainties.

We and the British Medical Association have been raising concerns for months. Why has it taken the Government so long to act? Ministers have announced a revised delivery plan, but how will it work in practice? Will there be more staff to help with the backlog? What changes are being put in place to ensure that the deadline is not missed again?

What was most concerning, however, was the complete absence of any mention of the remediable pension savings statements in the written statement. This issue really matters, as doctors who are taking on overtime or who work privately rely on these statements to be able to track their contributions and avoid excessive tax bills. According to Dr Sharma from the BMA,

“There’s no doubt that without up-to-date information, doctors will be pre-emptively reducing or turning down extra work to avoid additional pension…bills that they might not even be due.”

The statutory deadline for the 137,000 statements was, as we heard, 6 October 2024. In February, Ministers confirmed that 60,000 were outstanding and that the majority would be issued by the end of February; by March, however, the backlog had actually grown to 70,000. Can the Minister explain how two legal deadlines have been missed? Will the Government be following up with the regulator to ensure that this does not happen again? Do the Government have confidence in the NHS Business Services Authority? With the Secretary of State abolishing NHS England, what does this mean for the future of this vital organisation?

We all want to see waiting lists fall, but as one newspaper put it today,

“Labour’s pledge to slash NHS waiting lists is being sabotaged by a litany of administrative errors, pension delays and punitive tax rules.”

I urge the Government to take swift action.

[Karin Smyth]

As I outlined in my response and in the written ministerial statement, we have taken action. We were made aware of some of these problems when we came into office in July, and we have pushed the NHS Business Services Authority to move faster than it would have done under the hon. Gentleman’s Government, so that action is happening quicker than it would have done before. We do have faith in the NHS Business Services Authority to get on with this and ensure that there is no financial detriment, in line with the timetable outlined yesterday, and as I have further made clear today.

Madam Deputy Speaker, the hon. Gentleman could have asked me more about waiting lists, which have fallen for the last five months in a row. He could have asked me about the 2 million more appointments that have been provided to deliver for patients seven months early. He could have asked me about the hundreds more GPs who are now working in the health service, or the impact of cancelling the strikes on services for people, or the record funding. In fact, last week in the Chamber he spoke on behalf of the National Pharmacy Association; this week, he could have congratulated the Minister for Care, who is sitting next to me, on the agreement to produce more pharmacy services.

We are making improvements to the NHS every day. The Darzi report reported not only the breadth but the depth of the decline that we inherited. We are resolving that, and fixing the fundamentals of the NHS.

[Chris Vince (Harlow) (Lab/Co-op)]

I thank the Minister for coming to the House and giving her response. We all know the issues she is talking about when she mentions the state of the NHS that we inherited, and I echo that with the issues I hear about from patients and staff at Princess Alexandra hospital in Harlow. On pensions, can she outline what the Government have done to mitigate the delays in the process?

[Karin Smyth]

It is important that people have confidence in the pension system. That is why we took action in July on coming into office to understand the depth of the problems that occurred under the previous Government. This is a complicated issue, which is why we want to be clear with people that there will be no financial detriment to them. We will continue to work with employers and trade unions to ensure that the issue is resolved as quickly as possible, in line with the timelines I have outlined.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

The delays will be deeply worrying and will make financial planning very difficult for those affected, all of whom are people who have dedicated their working lives to supporting the NHS and tirelessly saving lives. NHS workers and their families are being left in the dark by Government delays and may as a result miss out on using their full allowances, which is unacceptable—they deserve better.

The revised delivery plan prioritises members based on their likelihood of facing financial detriment, so clearly some financial detriment is expected for those who are impacted. Can the Minister estimate what the likely financial detriment is of missing the statutory deadline, or how much compensation, as she just mentioned, is likely to be paid? Can she tell us why the NHS Business Services Authority has failed to meet the deadlines? In response to a written question from my hon. Friend the Member for St Albans (Daisy Cooper), the Minister said that there are 112 people working on it. Will she confirm whether that is likely to be sufficient to ensure that future deadlines are met?

[Karin Smyth]

I thank the hon. Lady for her question. I do not have to hand the exact number of people working on this, but I will make sure that I respond to her on that point in writing. We are ensuring that individuals do not face detriment as a result of these delays. The NHS cost claim back compensation scheme provides resources for direct financial losses incurred by the NHS pension scheme members impacted by the McCloud remedy, including professional service fees and certain HMRC interest charges that may arise, as I outlined in my statement. HMRC has also confirmed that self-assessment late filing penalties will be waived on appeal in certain circumstances where a member receives a delayed pension savings statement as a consequence of the implementation of the McCloud remedy.

[Jayne Kirkham (Truro and Falmouth) (Lab/Co-op)]

Does the Minister agree that it is important that the affected members receive those statements to allow informed decision making? The Government have worked to minimise financial detriment to those affected, but this issue is part of the mess we have been clearing up. We have had record investments into pharmacies and more GPs, and we have cut waiting lists and stopped the junior doctors’ strikes. We are on the road to recovery.

[Karin Smyth]

My hon. Friend is absolutely right that we are on the road to recovery—and that, of course, is what the Opposition cannot stand. This is a complicated issue, as they well know. As I said, we inherited this complication in July, when we were made well aware of it. The Conservatives could have done more about it while they were in government, but it is yet another issue on which they have let people down—this time, it is staff.

We will ensure that we remedy that. The timelines are available in the written ministerial statement that I issued yesterday. We will continue to work with trade unions and employers to ensure that people understand. As my hon. Friend said, it is important that people do understand their own personal positions.

[Madam Deputy Speaker (Caroline Nokes)]

I call the Chair of the Health and Social Care Committee.

[Layla Moran (Oxford West and Abingdon) (LD)]

I have to say that I am none the wiser about what exactly has happened. If we are to ensure that this will not happen again—that these deadlines will be met—we need to know how we got into this position. It may well be the fault of the previous Government. Will this Government commit to a full review of exactly how we got here, so that we can ensure that the published deadlines are met this time?

[Karin Smyth]

The Chair of the Health and Social Care Committee makes a good point, as she so often does, about what went on previously. This is an issue from the McCloud judgment that runs across many Departments. It was a problem under previous Governments, starting with the coalition Government. I know that the Public Accounts Committee, on which I served, and the Treasury Committee have looked at the matter over time. The Department will certainly co-operate with any inquiry and investigate what happened across Government. I am happy to get back to the hon. Lady on that point.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

This issue appears to be yet another example of the hangover left by the previous Conservative Government. Does the Minister agree that part of getting the NHS back on its feet includes cleaning up this mess and cutting waiting lists, which have already dropped for five months in a row?

[Karin Smyth]

My hon. Friend makes absolutely the right point. As I have said, Lord Darzi has helpfully outlined the breadth of the mess that we inherited back in July, and it makes for stark reading. We have still not had an apology from the Conservative party, so I am happy to take an intervention now if anybody decides to provide one. In these issues, we are seeing the depth of the destruction that the Conservatives have caused widely across Government. We will continue to fix that on behalf of the British people.

[Dr Andrew Murrison (South West Wiltshire) (Con)]

I declare my interest as a practising doctor and a public sector pensioner who has been through the McCloud process. Does the Minister understand that we will not improve productivity in the NHS as far as doctors are concerned if they continue to retire routinely in their mid-50s—in their prime? They do so because their accountants tell them that they would be foolish not to, given the fiscal environment and the structure of the NHS pension scheme.

[Karin Smyth]

I understand that point. Obviously, it is a source of much discussion. The change came about during the pandemic to encourage people to return to work, and it is a complex issue. We want to continue to use the skills of doctors at all stages of their careers, and we shall continue to work with them, the British Medical Association and others to make sure that there is no detriment to their returning to service in the NHS.

[Lewis Atkinson (Sunderland Central) (Lab)]

I declare an interest as a member of the NHS pension scheme. Can the Minister confirm that this issue arose only because the previous Government carried out their NHS pension reforms in a way that was found to be age discriminatory? More widely, does she agree that giving NHS staff the terms and conditions and the reward and recognition that they deserve also requires prompt action each year on agreeing the NHS pay award, which the Conservative party routinely failed to do when in Government?

[Karin Smyth]

My hon. Friend makes an excellent point on our commitment to staff to be clear on their terms and conditions, and our commitment to honouring that reward. That is why we acted promptly when we came into office. We have issued statements and provided answers to parliamentary questions to make sure that people are clear about the system and that we are transparent.

[Bob Blackman (Harrow East) (Con)]

It takes rather a long time to train a doctor—up to six years—so it is a good job that the previous Government had the opportunity to train more doctors. Will the Minister look at one aspect of concern, which is that if doctors start reducing their overtime hours because of fiscal aspects, it will hamper the opportunity to get more patients treated and to shorten the length of waiting lists?

[Karin Smyth]

As I said in response to the right hon. Member for South West Wiltshire (Dr Murrison), we understand that, and we will continue to work with all staff in the NHS to make sure that we deliver on our commitment to reduce waiting lists, which were left at a shocking level by the previous Government.

[Daisy Cooper (St Albans) (LD)]

I have a constituent who is suffering both financial and emotional distress as a result of these circumstances. I wrote to the NHS Business Services Authority, and it took four months to get a response. In written questions to the Government, I have asked how I might make representations about my constituent being affected by financial distress. The response that I received from Ministers simply said that NHSBSA has all the evidence that it needs, and there is no need for anyone to provide extra evidence. There is a very real risk that some people who are affected by this are suffering financial distress but have not been identified by NHSBSA. For those people, can the Minister please outline what mechanism we as Members can use to make those people known to NHSBSA, so that they can access their pension choice earlier?

[Karin Smyth]

I am sorry to hear about the emotional and financial distress of the hon. Lady’s constituent. If there is a gap, I am happy to go back to the NHSBSA on her behalf and make sure that I update the House.

[Lincoln Jopp (Spelthorne) (Con)]

Does the Minister have full confidence in the chair of the NHS Business Services Authority?

[Karin Smyth]

As I said in my statement, we have confidence in the business authority to undertake the actions that I have outlined.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for her answers to the questions. Waiting lists are clearly beyond the pale. If the Government were able to address the remedial pension savings statement, we might be in better position to entice our doctors to take on additional hours. Will the Minister confirm that this is a Government priority, and that there is an understanding that a functioning NHS requires straightforward paths to working overtime, and payment at every level?

[Karin Smyth]

One of our major priorities is ensuring that the entire NHS workforce are doing the work that they are trained and committed to do, so that they can get down those waiting lists and deliver an NHS that is fit for the future. The staff, as Lord Darzi has outlined, have felt very severely the detriment caused by the previous Government. They are working under really difficult conditions, and we want to make sure that, through the 10-year plan and the NHS Long Term Workforce Plan, we offer them hope, so that they are ready to deliver the services that they have been trained to deliver.

[Madam Deputy Speaker (Caroline Nokes)]

I thank the Minister for her responses this afternoon. I will allow a moment for the Front Benchers to swap over.

NHS Pension Scheme: Remediable Service Statements

Karin Smyth Excerpts

Monday 31st March 2025 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

In 2014 and 2015, the previous Government reformed public service pension schemes with the intent to better balance the interests of public service workers, employers and taxpayers. When the reforms were introduced, they provided “transitional protections” which allowed members who were closer to retirement age to remain in the previous “legacy” schemes rather than move to the “reformed” schemes. In December 2018, the Court of Appeal found that these protections in the judicial and firefighters pension schemes gave rise to unlawful discrimination—the McCloud and Sargeant case.

Governing legislation—the Public Service Pensions and Judicial Offices Act 2022— was enacted to remedy the discrimination identified by the courts. A core element of the remedy is providing affected members with a choice of pension benefits, legacy or reformed, for the period the discrimination had effect. Schemes must provide affected members with remediable service statements which set out how this choice will affect the value of their pension benefits. Members who have already retired must be provided with a remediable service statement to allow them to make their benefit choice retrospectively.

The governing legislation requires that a statement is provided to each affected member on or before 1 April 2025 or “by such later day as the scheme manager considers reasonable in all the circumstances in the case of a particular member or a particular class of member.” Today, I am updating the House on the delivery of remediable service statements for affected NHS pension scheme members.

The production of remediable service statements involves a complex and challenging programme of work. Technical complexities, some of which extend beyond the NHS pension scheme, have affected delivery timelines for statements.

The NHS Business Services Authority, as the scheme administrator of the NHS pension scheme, is prioritising the delivery of remediable service statements. However, in order to ensure that affected members receive robust statements that enable informed decision making I have agreed to a revised delivery plan for these statements with the authority, on which it is communicating with affected members. The revised delivery plan prioritises members based on their likelihood of facing financial detriment as a consequence of the discrimination. Government acknowledge that the revised timelines mean many members will receive their statement later than anticipated and that this will have an impact, especially on those retired members who will financially benefit from their choice.

As part of the revised delivery plan, Government will be holding the NHS Business Services Authority to account against extended deadlines for the delivery of remediable service statements. These extended deadlines are detailed in the table below:

NHS England Revised Financial Directions 2024-25 and 2025-26

Karin Smyth Excerpts

Monday 31st March 2025 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

I am revising the 2024-25 financial directions to NHS England made on 26 March 2024 and setting the 2025-26 financial directions to NHS England. The amendment to the total revenue resource use limit for 2024-25 has been agreed with NHS England as required under section 223D(4) of the National Health Service Act 2006.

The directions reflect recent funding settlements with HM Treasury and include a number of transfers of funding between NHS England and the Department of Health and Social Care. The 2024-25 revisions include additional funding received in-year for the NHS pay awards and other in-year pressures, including elective activity. The 2025-26 total is as set out by HM Treasury at the autumn Budget, but with some additional transfers between NHS England and DHSC. They will be published on www.gov.uk. The existing NHS mandate remains unchanged by these publications.

[HCWS569]

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 25th March 2025 Commons Chamber

[Paulette Hamilton (Birmingham Erdington) (Lab)]

3. What assessment he has made of the adequacy of the provision of health services for women.

[The Minister for Secondary Care (Karin Smyth)]

The Government are committed to improving women’s health outcomes. We have already taken urgent action to tackle the gynaecology list through the elective reform plan, and we recently announced an £11 million trial using AI tools to detect breast cancer cases earlier. The 10-year health plan will set out how we will tackle the factors that lead to poor health outcomes and the improvements we expect to see.

[Paulette Hamilton]

What assessment has the Minister made of the adequacy of research into and the provision of fibroid treatment for women, taking into consideration that fibroids are three times more likely to appear in black women than in white women?

[Karin Smyth]

The Government welcome the work my hon. Friend has undertaken and the work of the Caribbean and African Health Network in highlighting health inequalities for black women. She highlights shocking and unacceptable statistics. The National Institute for Health and Care Research has funded a significant amount of research into women’s health issues, including a £1.5 million trial comparing treatment options for fibroids. I am happy to make sure she is updated on that work and on the details of that work.

[Mr James Cleverly (Braintree) (Con)]

Early diagnosis and treatment of breast cancer can make a huge difference to the women involved, and, of course, to the prognosis and the cost to the state of health provision. I welcome the reference in the cancer plan to early diagnosis, but what specifically will the Government do to encourage greater awareness of the full range of breast cancer symptoms, and to encourage women to get early diagnosis and treatment for better outcomes?

[Karin Smyth]

I thank the right hon. Gentleman for that question and for the work he has supported on behalf of his wife to raise awareness. Screening access and uptake are shockingly low across the country right now, and looking at that is a key part of what we need to do to ensure that women come forward for the screening test. The AI work will support the faster response time so that we can get women treated more quickly, and will absolutely form part of what we need to do in the coming years.

[Nadia Whittome (Nottingham East) (Lab)]

I want to put on the record my thanks to the Health Secretary for coming to Nottingham last week and meeting some of the families who have been harmed by extremely serious failings in maternity services at Nottingham University Hospitals NHS trust, and for his sincere commitment to them. It was clear just how moved he was by their stories. One of their asks is that the Government implement the 22 recommendations from the Shrewsbury and Telford Ockenden review, so I ask the Minister today to commit to doing that.

[Karin Smyth]

I know that my hon. Friend and other Members representing that area have supported the trust and particularly the families who have been affected. As she highlights, my right hon. Friend the Health Secretary visited last week and was deeply moved by those stories, and has committed to visiting again. The Government are working through those recommendations and will update the House shortly.

[Jess Brown-Fuller (Chichester) (LD)]

Following on from the question asked by the hon. Member for Nottingham East (Nadia Whittome), I held a debate in Westminster Hall a few weeks ago on maternity services and spoke to families across the country who have experienced failures in the system that ultimately left them without their babies to take home. It was a devastating experience for all involved. The immediate and essential actions in the Ockenden review were supported by the previous Government, and the Secretary of State for Health has been vocal in his support for their implementation. However, those families want to know how quickly they will see real change in maternity services up and down the country so that families can confidently go to deliver their babies.

[Karin Smyth]

The hon. Lady is right to highlight the impact of the failures in maternity services on women and their families across the country. As she highlights, my right hon. Friend the Health Secretary takes this matter personally and is looking at it. We will continue to work closely with Donna Ockenden on those recommendations and will continue to update the House regularly. This is an important issue for Members across the House representing their constituents, whether in this Chamber or Westminster Hall, and we are very keen to ensure that we support staff, build that confidence for women and their families and give them a good experience of maternity services.

[Joani Reid (East Kilbride and Strathaven) (Lab)]

4. What assessment he has made of the potential implications for his policies of the independent review into data and statistics on sex and gender by Professor Alice Sullivan.

--- Later in debate ---

[Kevin McKenna (Sittingbourne and Sheppey) (Lab)]

6. What steps his Department is taking to help tackle inequalities in nursing career progression.

[The Minister for Secondary Care (Karin Smyth)]

I know that this subject is very close to my hon. Friend’s heart, after many years of NHS service. Ensuring great careers for NHS staff, including nurses, has been a key theme of our engagement with staff to shape the 10-year plan. I will shortly set out further measures to improve progression for nurses and their colleagues in other key NHS professions.

[Kevin McKenna]

I thank the Minister for her answer. Nurses across the profession are increasingly taking on complex roles and responsibilities, yet many do not have access to higher pay bands that reflect these changes, and there is too much variation around the country. As well as looking at this, will the Minister ask the Department of Health and Social Care to implement a consistent model for supported, structured progression from band 5 to band 6 for early career nurses based on the completion of key competencies and the acquisition of necessary experience?

[Karin Smyth]

My hon. Friend is right that NHS staff, including nurses, should be paid appropriately for the work they are asked to do and will be asked to do in future. We are working with the NHS Staff Council to ensure that the national job evaluation scheme is implemented fairly and consistently across nursing and all professions.

[Alison Bennett (Mid Sussex) (LD)]

My constituent Ben has spent two decades working as a nurse. He tells me that his paramedic and midwife colleagues received automatic pay band increases post qualification while he and his nursing peers did not. Ben and his hard-working nursing colleagues have missed out on tens of thousands of pounds compared to colleagues in other disciplines. Does the Minister agree that something must be done urgently to make up for this inequity?

[Karin Smyth]

I am absolutely clear that we need to make sure that the job evaluation scheme looks at staff across the piece and that people are rewarded appropriately for the work they are asked to do. We will do that as part of our discussions with the NHS Staff Council, and we will be working consistently with staff as part of the 10-year plan to ensure that people are rewarded. We depend on these staff, and we want to encourage them to be part of the NHS workforce. That is the approach we intend to take.

[Sojan Joseph (Ashford) (Lab)]

7. What steps his Department is taking to reduce the number of people waiting for NHS treatment.

--- Later in debate ---

[Christine Jardine (Edinburgh West) (LD)]

For eight years, I have seen how a young constituent has been able to completely control his previously life-threatening seizures with medicinal cannabis, but at huge cost to his family—a cost that is prohibitive for other people. Will the Secretary of State meet me to discuss how we can make access to such treatments more affordable, accessible and safe, so that we can help more people?

[The Minister for Secondary Care (Karin Smyth)]

We recently had a helpful debate in Westminster Hall on this topic. We are doing more research on this issue to ensure that the evidence base is there. I am happy to discuss the matter further with the hon. Member.

[Mohammad Yasin (Bedford) (Lab)]

In the ongoing discussion on assisted dying, one point on which we all agree in this House is the urgent need to improve palliative care. I therefore welcome the Government’s recent £100 million commitment to supporting hospices, including those that help my constituents. Can the Minister confirm whether long-term funding for hospices will be a priority in the upcoming 10-year health service plan?

--- Later in debate ---

[Karin Smyth]

Those statistics are shocking. Campaigns here and elsewhere have helped to raise awareness of endometriosis. The update to National Institute for Health and Care Excellence guidelines will help, as will more appointments, and our commitment to the 18-week target. Training for GPs is now part of the core curriculum, and we expect that to yield good results. NHS England and the Office for National Statistics have look-across to the statistics on diagnostic metric standards. I am happy to update my hon. Friend outside the Chamber, and I know other Members are also interested in how we are delivering on these commitments.

[Mr Gagan Mohindra (South West Hertfordshire) (Con)]

My constituents in South West Hertfordshire remain concerned about the significant delay to the redevelopment of Watford general. With the Chancellor already bringing a second emergency Budget before the House tomorrow, and with care homes, hospices and charities facing unsustainable pressure from this Government’s national insurance increases, what reassurances can the Minister give my constituents that the Labour party truly care about healthcare, rather than scoring political points?

--- Later in debate ---

[Tulip Siddiq (Hampstead and Highgate) (Lab)]

Much to my alarm, the North Central London ICB has recommended the closure of the maternity unit at the Royal Free hospital in my constituency. The Secretary of State knows the Royal Free well. Will he meet me to see how I can save my local maternity unit, which looked after me so well when I had gestational diabetes?

[Karin Smyth]

These local services are so important for local women, as my hon. Friend has experienced. It is really important that reconfigurations are discussed with local Members of Parliament, representing their constituents. This is obviously a matter for the local ICB, but I am happy to discuss it further with her.

[Daisy Cooper (St Albans) (LD)]

Following my long-running campaign, I am grateful to the Government for finally updating the outdated Treasury rules that were preventing local health boards from spending more money on keeping city centre GP locations. Will the Government now issue guidance to local health boards and NHS trusts to accelerate the pooling of resources, so that we can get more services out of hospitals and on to our high streets, especially as our high streets need extra footfall right now?

Down’s Syndrome

Karin Smyth Excerpts

Wednesday 19th March 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mr Turner. I congratulate and thank the right hon. Member for Beverley and Holderness (Graham Stuart) for securing this debate, and for giving us all the chance to mark World Down Syndrome Day on Friday. No one has done that better than my hon. Friend the Member for Thurrock (Jen Craft) this afternoon. Her child is the beating heart of her family, and that joy is absolutely with all of us. She has spread that joy today and we are grateful to her.

I am also grateful to the right hon. Member for Beverley and Holderness for his support for the Down Syndrome Act. As he highlighted, I was pleased to support the Act with his right hon. Friend and my constituency neighbour at the time, the former Member for North Somerset, Sir Liam Fox. It was a marvellous thing to be part of. As my hon. Friend the Member for York Central (Rachael Maskell) said, it was a simple but quite brilliant piece of legislation. I am always grateful to the hon. Member for Hinckley and Bosworth (Dr Luke Evans) for quoting my comments from different times at the Dispatch Box; hopefully they were all carefully chosen.

This Government want to see a fair Britain where everyone lives well for longer. I absolutely recognise the importance of the Down Syndrome Act in helping to achieve that. The Act gives people with Down syndrome the building blocks they need for a healthy life, and we have heard about some of those today: access to the health and care services they need, receiving the right education, securing living arrangements that work for them and being supported into employment were mentioned by the hon. Member for Carshalton and Wallington (Bobby Dean) and my hon. Friend the Member for York Central, as well as the Lib Dem spokesperson, the hon. Member for Chichester (Jess Brown-Fuller).

By raising awareness and understanding of the needs of people with Down syndrome, we can help ensure that every person with Down syndrome has the opportunity to live a full and fulfilling life. Today’s debate is an excellent opportunity to come together to mark World Down Syndrome Day. I commend those in the Public Gallery, and the many people who have been in contact with or are known to Members. This year’s theme is “improve our support systems”, which is incredibly important. It is something that we are striving to achieve through developing the statutory guidance under the Down Syndrome Act.

We are committed to ensuring that people with Down syndrome receive the care and support they need to lead the lives they want to in their community. However, as we have heard this afternoon, there is significant work to be done to make that a reality. The Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), is working hard to implement the Act. Under the Act, the Secretary of State for Health and Social Care is required to give guidance to relevant authorities in health, social care, education and housing services on what they should be doing to meet the needs of people with Down’s syndrome.

As Members have highlighted, the Act was formally commenced on 18 March 2024 by way of regulations. That brought into force all the provisions of the Act, and it was a necessary step towards the publication of the guidance. I do not think it has been mentioned today, but shortly after that point we had the general election, and I appreciate that the delays are frustrating for campaigners and people involved. The Minister for Care has written to sector partners and the all-party parliamentary group on Down syndrome with an update on the guidance and next steps. That includes our intention to put the guidance out for consultation by the summer.

Engagement with people with Down syndrome, their families and supporters, sector colleagues and experts has been invaluable throughout the development of the guidance. Over 1,500 responses were received to a national call for evidence, which is being used to inform the guidance, in addition to sector engagement and a review of the evidence to gain a better understanding of the specific needs of people with Down syndrome and how those can be best met by relevant authorities.

On 26 November 2024, the Minister for Care convened a roundtable of partners to discuss how we can improve life outcomes for people with Down syndrome, and the opportunities that the guidance presents in support of that. We are grateful for the collective efforts and insights of individuals and organisations across the country, which have enabled us to make great strides in our development of this important piece of guidance. We recognise that some time has passed since the Act became law in April 2022.

[Graham Stuart]

Several colleagues have mentioned the need for specificity—if the Minister is coming on to that, then great. Would it be fair to say that it is the intent of the Government—I am not looking for cast-iron promises, because we know how challenging these things are—that we should see the guidance issued before the end of this year, all things being well?

[Karin Smyth]

We want to ensure that the guidance is published as soon as possible, and we appreciate patience while we make that happen. It is important that we continue to work with people and organisations with lived experience to develop the guidance. We hope that the update we provide will assure everyone of the priority attached to that important piece of work.

As for the scope of the guidance—with regard to other genetic conditions or learning disability—a commitment was made during the Bill’s passage through Parliament to consider the links and overlaps with other genetic conditions and/or a learning disability. Therefore, the guidance will be Down syndrome-specific, in line with the Government’s statutory duty—which we are clear about—under the Act. It will also include references to where it could have wider benefit. We want to take the opportunity of the guidance to help as many people as possible and to provide examples of good practice to support relevant authorities to implement improvements in practice.

On employment, we heard through engagement with our partners that employment is crucial to improving life outcomes. People with Down syndrome can bring many skills and strengths to the workplace. We want every person with Down syndrome who can and wants to work to have the right support and opportunity to do so. That is why a dedicated chapter on employment will be included in the guidance.

On implementing the guidance, we know that ultimately much depends on how the guidance is put into practice across our communities. To support implementation, NHS England published statutory guidance on 9 May 2023 to require that every ICB had a named lead for Down syndrome. I think that the right hon. Member for Beverley and Holderness said that there was only one, and I recognise the name, because it is my own area—well done, them. That might not have happened, but it was said in 2023.

The executive lead on Down syndrome will lead on supporting the chief executive and the board to ensure that the ICB performs its functions effectively in the interests of people with Down syndrome. We recognise the importance of ensuring that people with Down syndrome are able to make complaints, if they have concerns about the quality of and access to care. We expect the named lead to ensure that concerns are acted on at the local level.

[Dr Luke Evans]

Will the Minister give way?

[Karin Smyth]

I am sorry, but I think I have only a minute to go.

This week has been a powerful reminder of how far we have come regarding awareness of Down syndrome. It has also made us reflect that much more remains to be done. When the guidance is launched for public consultation, we will welcome Members’ support to ensure that the communities they represent are aware of it and can share their views.

I will just highlight the issue of regression, which my hon. Friend the Member for Thurrock mentioned. The guidance will deal with specific health needs, and regression will be part of that.

I thank the right hon. Member for Beverley and Holderness again for securing the debate and other hon. Members for joining the discussion. In particular, I thank the co-chairs of the APPG, the right hon. Member for East Hampshire (Damian Hinds) and my hon. Friend the Member for Mid Cheshire (Andrew Cooper), for their work, and everyone who works tirelessly to improve our support systems and services. It is incumbent on us all, working with people with Down syndrome, their families and carers, to get this done.

I appreciate that a number of requests have been made for different individuals and groups to meet my hon. Friend the Minister for Care. He is keen to do that. I will not make specific commitments, although the right hon. Member for Beverley and Holderness tempts me to do so, but I will make the commitment that my hon. Friend will be in touch via his office with colleagues who made such requests, to ensure that we make best use of the time and bring people with us on the implementation of this guidance, which is so crucial—I remember my time on that Bill well. I am thankful for the opportunity to be part of the debate this afternoon.

Contingencies Fund Advance

Karin Smyth Excerpts

Thursday 6th March 2025 Written Statements

[The Minister for Secondary Care (Karin Smyth)]

The Department of Health and Social Care�s new cash requirement for the year exceeds that provided by the main estimate 2024-25. The supplementary estimate has not yet received Royal Assent.

The Contingencies Fund advance is required to meet commitments until the supplementary estimate receives Royal Assent, at which point the Department of Health and Social Care will be able to draw down the cash from the Consolidated Fund in the usual way, to repay the Contingencies Fund advance.

Parliamentary approval for additional resource of �1,400,000,000 will be sought in a supplementary estimate for the Department of Health and Social Care. Pending that approval, urgent expenditure estimated at �1,400,000,000 will be met by repayable cash advances from the Contingencies Fund.

[HCWS503]

Maternity Services

Karin Smyth Excerpts

Tuesday 25th February 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Sir Christopher. I am grateful to the hon. Member for Chichester (Jess Brown-Fuller) for raising this extremely important issue. It touches so many of our constituents and so many families across our country, and I know how many of them she and other Members have spoken to. As the Secretary of State said, it is an issue that keeps him awake at night. The hon. Lady spoke very movingly about her friend Steph and Steph’s son, Bendy, whom I know she remembers very fondly. We have had too many decades of similar stories, but she did good service to her friend and Bendy today.

I will do my best to answer as many questions as possible—it has been a wide-ranging, respectful and thoughtful debate—but the Minister for Patient Safety, Baroness Merron, who leads on this issue for the Department, will be happy to write to colleagues where necessary.

The hon. Member for Chichester asked a number of questions at the end of her speech, and I hope that I will address most of them. I completely understand why she is pushing on behalf of the families that the Secretary of State met for the maternity services plan to be outlined. Families have waited long enough, but we want to make sure we get it right, so we are taking time within the Department to discuss the next steps with officials and ensure that any plans we put out are as strong and effective as possible; we have had too many plans that have not been. Those families will receive an update on the next steps very soon.

I will come on to some of the essential actions from previous reports, but I will re-emphasise that all Donna Ockenden’s recommendations were accepted and are being worked on. I will pick up on that later in my speech.

On workforce and training, we will publish in the summer the refreshed long-term workforce plan. That will set out how we will build a transformed health service over the next decade, and obviously it will include midwifery.

[Helen Maguire]

Will the Minister give way?

[Karin Smyth]

I will, but I will not be able to get through my speech if I keep giving way.

[Helen Maguire]

I will be very brief. La Retraite sixth form in London has a T-level qualification in health with midwifery, linked up with Guy’s and St Thomas’, and it is proving successful. Will the Minister consider working with the Secretary of State for Education to look at rolling that out throughout the country? It is proving really successful in getting new midwives into the system.

[Karin Smyth]

The hon. Lady raises something very close to my heart. I spoke frequently in opposition about apprenticeships and the need for the health service to work on that. I actually visited that centre with the chief nursing officer and met students there. It was a lovely visit; we had a fantastic morning with really enthusiastic young people who wanted to go into the profession. The hon. Lady makes an excellent point, and we will continue to work with Guy’s and St Thomas’ on that. Others could take note of what they are doing.

We understand the issues with the CQC. They are well documented and were further highlighted by the hon. Members for Cheltenham (Max Wilkinson) and for Chelmsford (Marie Goldman). We do not think now is the time to make changes to the statutory limitation power, because we want the CQC to prioritise improving its regulatory approach and focusing resources on the recovery plan in line with the Dash report. Once that is done and the CQC is working better, the Government have committed to reviewing that statute of limitation power.

With regard to phonelines, Sands and Tommy’s do fantastic work for bereaved parents across the country— I know that from my own Bristol South constituency. We are always open to new ideas and suggestions from the experience of people working on the ground. I will ask officials to consider recording triage phonelines as part of our longer-term work on maternity and neonatal services. Many hon. Members raised general points about communications. The hon. Member for Chichester was right to mention communication for parents—both mothers and fathers. That was a point well made, and I will pick it up later.

Donna Ockenden rightly commands huge respect across Government, parties and the NHS. She was right to say that previous Governments were “asleep at the wheel” on maternity care. We have heard already, but it is worth restating, that babies of black ethnicity are twice as likely to be stillborn as babies of white ethnicity. The maternity workforce is experiencing significant challenges and safety in maternity care is very far from where we want it to be.

Hon. Members highlighted their meetings with families. The Secretary of State and Baroness Merron have met a number of bereaved families over the past few months, as I know others have done. My hon. Friend the Member for East Worthing and Shoreham (Tom Rutland) talked about the families he has met. He highlighted that when he talked to me recently about issues in his constituency.

As with so many issues in healthcare, there is no quick fix to the challenges we face. There have been too many high-profile independent reviews into maternity services over the past few years. With remarkable consistency, they all point to the same thing: a culture that belittles women, downplays concerns and puts reputations above all else, even patient safety. We know that is wrong and we know what needs to happen. It is now time to crack on and deliver.

We are making steady progress on recommendations from all 15 areas of the Shrewsbury and Telford review, such as workforce accountability and bereavement care. Much of that progress has been made through NHS England’s three-year delivery plan. The plan seeks to make maternity and neonatal care safer, fairer and more tailored to every woman’s needs, by setting out expectations for informed choice and personalised care planning, to improve women’s experience in labour and birth.

Some of the initiatives have been highlighted today. The saving babies’ lives care bundle, helping to reduce stillbirths and pre-term births, has been rolled out to every trust in England. I am pleased that all 150 maternity and neonatal units in England have signed up to the perinatal culture and leadership programme, an initiative to promote and sustain a culture of safety. There are also initiatives to reduce inequality. As I know from my constituency, women living in deprived areas are more likely to suffer adverse outcomes. It is right that local systems are trying to bridge the gap through equity and equality action plans.

We have set clear expectations for escalation and accountability through the three-year plan. We are supporting staff to hold up their hands when things go wrong, through the freedom to speak up initiative. The public can monitor the progress of the three-year plan against the Ockenden recommendations, through their local maternity and neonatal systems and integrated care boards. Local women and families, should they choose, can see what progress has been made, who is accountable and how the system is changing. NHS England is also investing £10 million every year to target the 10 most deprived areas of England.

Safety must be the watchword at every step of the journey. NHS Resolution’s maternity incentive scheme is rewarding NHS trusts that prove they are taking concrete steps to improve the quality of care for women, families and newborns. As highlighted by the hon. Member for Hinckley and Bosworth (Dr Evans), since 2010 the neonatal mortality rate has shown steady signs of improvement, decreasing by a quarter for babies born after at least 24 weeks of pregnancy. The stillbirth rate in England has decreased by 22% and the overall rate of brain injuries occurring during or soon after birth has fallen by 3%.

We all know there is so much more to be done to improve outcomes for mothers and babies, and to ensure that they receive the safe care that they need. There are ongoing initiatives to ensure lessons are learned from every tragic event, to prevent similar events in future. Hospitals carry out internal perinatal mortality reviews, which aim to provide answers for bereaved parents about why their baby died, and give them some closure. The reviews also help hospitals to improve care and ensure we learn the lessons from every tragedy.

The maternity and newborn safety investigations programme conducts independent investigations of early neonatal deaths, intrapartum stillbirths and severe brain injury in babies after labour. All NHS trusts are required to report those incidents, carry out an independent investigation and make safety recommendations to improve services in future. For those parents who go through the heartbreak of losing a baby, we must do everything we can to support them in their grief. That is why the Government extended the baby loss certificates; as of last week, we have issued almost 100,000 to grieving parents. It is also why, through the three-year plan, we have made provision for seven-day bereavement care supported by investment, and why we will continue to support the work of Sands and Tommy’s, which do so much for bereaved mums and dads across the UK.

The hon. Member for Chichester rightly talked about the importance of workforce and meeting safe levels of staffing. Throughout the winter I have seen up close NHS staff doing their absolute best in appalling circumstances that were not of their own making. I know that however dedicated our NHS staff may be, they cannot provide the right care without the right support. That is why we are committed to tackling the retention and recruitment challenges in the NHS, and why work is under way to modernise NHS working cultures and make our hospitals more attractive for top talent. That includes a much stronger focus on health and wellbeing, more support for flexible working and a renewed commitment to tackling inequality and discrimination.

Bringing in the staff that we need will take time, but it is an absolute priority for this Government and for me personally. NHS England is leading a range of initiatives to boost retention of existing staff and ensure the NHS remains an attractive career choice for new recruits. I say to the hon. Member for Strangford (Jim Shannon) that we are keen to work with all devolved Governments to ensure that and to share learning.

There is a dedicated programme for the retention of midwives, an issue highlighted by the hon. Member for Chichester and my hon. Friend the Member for Calder Valley (Josh Fenton-Glynn). The initiative contains a range of measures, including a midwifery and nursing retention self-assessment tool, mentoring schemes, strengthened advice and support on pensions, and the embedding of flexible retirement options.

NHS England has also invested in retention leads for every maternity ward. Alongside investment in workforce capacity, that has shown promising signs of bringing down vacancy, leaver and turnover rates. The leaver rate declined from 10.3% in September 2023 to 9% in September last year. There has been progress, but we know that there is more to be done. As of November, there were a record number of midwives working in NHS trusts, with around 24,700 working full time, up by over 1,300 compared with the year before.

While all this work is going on, we are also doing the hard yards of fixing the foundations of our NHS and making it fit for the future. I am pleased that the National Institute for Health and Care Research has commissioned over 40 studies looking at how we can prevent pre-term births and improve care for babies and women. It has launched a £50 million funding call, challenging researchers and policymakers to come up with new ways of tackling maternity inequalities and poor pregnancy outcomes.

While that work is going on, we will continue to talk to staff about the 10-year plan. My right hon. Friend the Secretary of State is attending a staff event in Peterborough on Thursday, and I will be attending one next week. We want to know how we can better support our staff, ensure we unleash their potential and give patients the care they need. A central part of the 10-year plan will be our workforce—how we train them and provide the staff, technology and infrastructure the NHS needs to care for patients across our communities. The hon. Member for Epsom and Ewell (Helen Maguire) is right to highlight the estate, which is also a problem in this area. We need to consider all policies, including those that impact maternity and neonatal care.

Over 95,000 people have responded to the consultation so far, and we want to hear from more. We have heard in this debate about midwifery-led care from my hon. Friend the Member for Lichfield (Dave Robertson), and about mental health support from the hon. Members for Eastleigh (Liz Jarvis), for Winchester (Dr Chambers) and for Dewsbury and Batley (Iqbal Mohamed). I hope that they contribute to the consultation.

I am conscious that I need to give the hon. Member for Chichester a few moments to wind up. We know that we will not be able to fix these issues overnight. We are committed to investing in safety, workforce retention and tackling inequalities, and we are making steady progress. As was highlighted, most women have safe care with a healthy baby, and are made to feel special at a very special moment. That is a testament to the staff. We need to make sure that that happens for all women, everywhere. A lot of work has been done. There is a lot left to be done, but I am confident that we will build a maternity and neonatal system that delivers for every woman.