Healthcare: Bolton

Luke Evans Excerpts

Wednesday 15th October 2025 Westminster Hall

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

I too congratulate the hon. Member for Bolton North East (Kirith Entwistle). She covered a huge amount within her allotted time. The only sadness is that we have only an hour, and I have only a couple of minutes to try to address many of her points.

The biggest message that we take home today is that Bolton must not be left behind. The hon. Member has been exemplary in stepping forward and making that case. I would slightly and gently push back and say that I do not think that Bolton was left behind by the previous Government. The trajectory she is working towards is already there, if we look at examples of the investment that was made by the previous Government, most notably the £20 million, which made up part of the £40 million in levelling-up funding, for the medical college at the Royal Bolton Hospital, and listen to Professor Holmes, who said:

“It is incredibly rewarding for us at the University to witness our flagship facility reach this important milestone of practical completion.

It is a privilege to be home to one of the nation’s leading clinical skills facilities here in Greater Manchester and this is a key step in our aim to become a national centre of excellence for health.”

On top of that, there was a £20 million investment in the elective care centre, which has opened with four theatres dealing with about 5,000 patients. The hon. Member for Bolton North East was right to pick up on the maternity and women’s health unit, which is really important. In 2023, we saw a £38 million investment to help the unit, and it will hopefully be done by 2027. I have no doubt that she will be there to wag the stick to make sure that it is. I hope that she and the Government will be successful in that.

I want to tease out a couple of questions for the Government. The hon. Member stressed maternity, which is really important. At the general election, the Labour party made firm commitments on maternity services, so I ask the Minister: when will the national maternity safety ambitions be published, and will targets be set around the maternity mortality gap? What will be done to address it?

The hon. Members for Bolton North East and for Bolton South and Walkden (Yasmin Qureshi) both rightly raised the integration of system and service, which is also a concern on the Opposition side. We have seen top-down reorganisation, especially around integrated care boards, and I am sure the Greater Manchester integrated care partnership will have been asked to make reductions in its headcount.

The problem is that the Government have not set out how they will pay for those redundancies, or what that shape will look like, so they are trying to make transformative change and looking internally. There is real concern about that among the Opposition, so I hope the Minister will be able to set out how much that will cost and whether the redundancy package will be coming forward, because we hear it could be up to £1 billion. As the chief executive of NHS England has said, if we do not hear something in the next few weeks, the NHS will have to turn to plan B—if there is a plan B. I would be grateful if the Minister could set that out.

Finally, on GPs, we also know that the Government have stated in the 10-year plan that GP leaders will be pivotal in shaping and delivering these new services and will be supported to do so with two new contracts from 2026. Of course, we have learned in the past couple of weeks that GPs have entered a formal dispute with the Government because of the contractual changes, so I would be grateful to understand what the Minister is doing—although it is not in her brief—and what her team are doing to try to pull it back from the brink and hopefully resolve some of the contractual issues, particularly when it comes to access.

To close on a personal note, I congratulate the hon. Member for Bolton North East on her work as a manbassador. As someone who, since stepping into this House, has campaigned on mental and physical health for men and boys, I know it often gets left behind. I made that point on the Floor of the House only a couple of weeks ago, so it is fantastic that she is championing men and boys. We need advocates for both sexes, both ways round, when it comes to men’s and women’s health. It is not a competition; it is not one or the other—it is “and”, and she typifies that. No man or boy should be left behind, but nor should Bolton.

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairship this afternoon, Ms Lewell.

It was a valiant effort from the hon. Member for Hinckley and Bosworth (Dr Evans) to raise things such as top-down reorganisation and the state in which the Conservatives left the health service after their 14 years in government. It is as a result of that record that I am delighted to have my hon. Friend the Member for Bolton North East (Kirith Entwistle) here, alongside such strong representation from Labour, following the electorate’s verdict on the last 14 years only 14 months ago. She has been an excellent campaigner since joining Parliament, and securing this important debate is part of that. I am grateful to other hon. Members for taking part.

As a result of the action taken by my hon. Friend the Member for Bolton North East in securing this debate, I met the chief executive, Fiona Noden, and the local ICB to understand, in a more granular fashion, some of the issues I expected my hon. Friend to raise. She was right to thank the staff—both at a leadership level and across the board in Bolton—for their great work. I commend that leadership for meeting regularly, and my hon. Friends the Members for Bolton North East and for Bolton South and Walkden (Yasmin Qureshi) for meeting regularly with those leaders. That happens in my own patch, but it does not happen everywhere. As I often say, it is a really valuable local relationship, because it makes hon. Members more informed and NHS managers better leaders as well.

As we have heard so eloquently, the NHS faces pressures all over the country, including in Bolton and north-west England. Our 10-year health plan is designed to fix that. I thank my hon. Friend the Member for Bolton North East for holding one of those important consultation events. They were very powerful. As a result of the work that she and others have done to bring the patient voice directly to Government and make it a fundamental part of the plan, I think our plan has widespread support. I hope her constituents can hear their voices reflected in the plan that we have developed: it is about access to healthcare for everyone, no matter where they live or how much they earn. We must make sure that our health service is based on that need.

The three shifts—hospital to community, treatment to prevention, and analogue to digital—will ensure that community and neighbourhood health services get the investment they need and that patient communication is more joined up. We are also working with the NHS to make the tough choices that are needed to get it back on its feet.

We will create an NHS where patients have more control, staff have more time to care, bureaucracy is reduced, power is devolved and the health inequalities that we have so sadly heard about again this afternoon are narrowed. That includes creating a new operating model with fewer, larger ICBs, enabling them to harness a shared budget of sufficient size to improve efficiency and reduce running costs. It is a 10-year plan, but of course we are already seeing some improvements and we have set key targets and milestones along that trajectory. As my hon. Friend the Member for Bolton South and Walkden said, we cannot all wait 10 years. We have to see that improvement along the way.

Child health is crucial. We have heard about the inequalities and poverty that many children in Bolton experience. That is why the Government have committed to raising the healthiest generation of children ever, and will soon publish an ambitious strategy to reduce child poverty, tackle the root causes, and give every child the best start in life.

A huge part of realising our ambitions for the NHS is about improving access to dentistry services. The Government understand that, which is why extra urgent dental appointments are being made available across the country, including in Greater Manchester. That is expected to deliver an extra 17,897 urgent dental appointments across 2025-26. Additional dentists have also been recruited in areas that need them most, and we are committed to delivering fundamental contract reform before the end of this Parliament.

All of that will deliver better dental care for everyone in England, including those in Bolton. We also recognise that we need to go further to improve the oral health of children, which is why we are providing funding to local authorities to roll out the targeted, supervised toothbrushing programme for three to five-year-olds. As a result of the programme, Bolton has received over 32,000 donated products to implement supervised toothbrushing alongside an additional £127,000 this financial year.

Hon. Members rightly raised the issue of RAAC at Royal Bolton hospital, which is obviously deeply concerning for staff and patients. Let us be very clear: the safety of patients and staff has to come first. Each trust with RAAC issues has invested significant levels of NHS capital to mitigate safety risks. Locally, the Bolton NHS foundation trust has received over £9.5 million to mitigate the RAAC risk and for eradication works at Royal Bolton hospital. The trust will continue to have access to further necessary funding for RAAC removal, enabling the hospital to complete development and modernisation upgrades.

Hon. Members also raised the important subject of women’s health. As part of our work in this area, we are tackling waiting lists, of which gynaecology is a substantial part. We will see those waiting lists come down and we will soon make emergency hormonal contraception free in pharmacies, but we know that there is much more to do for women. That is why we will look at where we can go further and reflect that in an updated women’s health strategy to better meet the needs of women in Bolton and across the country.

This year the Secretary of State announced a rapid national independent investigation into NHS maternity and neonatal services. He will also chair a maternity and neonatal taskforce to develop the action plan based on the investigation’s recommendations. I am happy to report encouraging local initiatives such as Bolton’s new maternity and women’s health unit, which is set to open in early 2027, as well as a focus on paternal support and investment in strong community-based care and specialist parental mental health support, which we know is so important.

Issues around mental health were raised this afternoon. Mental health support in maternity is made possible only by strong mental health services across the board. That is why we are transforming mental health services. We have heard about Opposition Members serving on the Public Bill Committee and we thank them for their work. We need to build new dedicated mental health emergency departments, improve outreach, and increase overall funding to benefit Bolton and the rest of the country. That includes transforming mental health services in 24/7 neighbourhood mental health centres, building on the existing pilots, and investing up to £120 million to bring the number of mental health emergency departments up to 85.

We also heard about urgent and emergency care this afternoon. We will be publishing an urgent and emergency care plan. The plan will reduce A&E wait times, provide almost £450 million of capital investment for same-day emergency care and mental health crisis assessment centres, and get more ambulances back on the road. The local picture is promising. In Bolton, 12-hour wait times are down compared with a similar time last year, and meaningful infrastructure improvements are being delivered. We are not complacent, however, and we know the situation is not acceptable for people.

A large part of the contributions was about improving general practice and recognising the need for people to feel they have access to it, because that is where most people have contact with the health service. That improvement is a crucial part of our agenda. It is heartbreaking to hear about patients not getting the testing or treatment they need, and of course Leah and her son should not have had to endure that shocking ordeal. I hope that they are getting the support they need, and I am sure that my hon. Friend the Member for Bolton North East will be supporting them.

On access, my hon. Friend will be aware that part of our negotiations with doctors has been about increasing online access, which was rolled out on 1 October. That is helpful to know if that is available in her patch. New funding for the advice and guidance scheme is helping GPs to work more closely with hospital specialists to access expert advice quickly and speed their patients through the system, so they get care in the right place as soon as possible.

[Dr Luke Evans]

Hearing Leah’s story was very concerning and upsetting. When it comes to further online access, one of GPs’ biggest concerns is about what to do with the emergencies that may come in through a computer at 6.20 pm as a result of that access, having to make that assessment when the system is supposed to be closing, and the ability to move GPs to take them away from face-to-face consultations to deal with online access. How will the Government square the circle of access versus patient safety? That is at the crux of the dispute.

[Karin Smyth]

The shadow Minister opens up a discussion that could take some time. Clearly, practices regularly manage emergency situations. The system that we have put in place aims to make sure that patients have access during the day. Different practices will obviously have different opening times—that is a matter for the local system—but I know that if an emergency comes forward, practices all over the country do all they can to make sure that patients are safe. There are also disclaimers on their websites about the times of operation and so on. If there are any individual cases that he wants to raise, we will look at them, but that urgent emergency interface is a matter of negotiation locally and I think most practices understand how to manage it.

I am pleased to report that we are investing more than £1 billion extra in GP services and £82 million in the primary care workforce to ensure that places such as Bolton get the resources and GPs they need. On infrastructure, a new £102 million fund will create additional clinical space across more than 1,000 practices in England. As a result of those efforts, 8 million more appointments have been delivered this year compared with last year. Our shift to a neighbourhood health service is exactly about the joined-up, accessible and locally accountable care that we all want to see, and that my hon. Friend the Member for Bolton North East rightly highlighted. That is also what staff in the system want to see.

On waiting lists, we published our elective reform plan to deliver the change that we promised at the last election. Between July 2024 and June 2025, we delivered more than 5 million additional appointments compared with the previous year. There has also been a reduction in the number of people on the waiting list of over 200,000. I think patients and members of the public are seeing and feeling that progress, and although there is a long way to go, staff are starting to feel it too.

Since June 2024, the number of people on the waiting list at Bolton NHS foundation trust has reduced by more than 7,000, and the number of patients waiting over a year has more than halved. Those are tangible improvements in a very short time, and we thank the staff for their hard work to achieve that. Patients deserve better, but they are seeing progress. We know there is more to be done.

I thank hon. Members for bringing their knowledge and experience of Bolton’s health services to this debate. I know that they and my hon. Friend the Member for Bolton West (Phil Brickell) will continue to advocate strongly on behalf of the people of Bolton, continue to work closely with local leaders, and continue to hold the Government to account for the promises we are making. That conversation between local Members of Parliament about what is actually happening on the ground, which we all hear about in our inboxes, in our surgeries and when we talk to local people, is an important part of what they are doing to raise these issues. I hope that my response shows how much the Government are committed to addressing these issues and working to improve healthcare for the people of Bolton.

Jhoots Pharmacy

Luke Evans Excerpts

Wednesday 15th October 2025 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister.

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

Only this weekend, the National Pharmacy Association chief executive, Henry Gregg, said that he is concerned that

“reports of Jhoots Pharmacy branches across England failing patients risks damaging community pharmacy’s reputation and could imperil its ability to secure a good 2026-27 funding settlement.”

Communities across the country have been left without functioning pharmacies. Doors have been locked without notice, patients have arrived to find no pharmacist, no prescriptions and no stock, and staff have gone unpaid and been threatened with the sack. Jhoots Pharmacy faces allegations of not paying wages, having premises repossessed and serious regulatory breaches. The General Pharmaceutical Council has already intervened several times, yet for many patients it is too late—they simply cannot get their medicines. This is not an isolated business failure; it exposes a deeper fragility in the community pharmacy network on which local people depend for basics and often lifesaving care.

I have four questions for the Minister. First, when was NHS England first made aware of these closures, and has the Minister met the Jhoots leadership? If not, why not? If he did, what was the outcome? Secondly, has the Department assessed how many people have been left without local pharmacy access as a result of Jhoots’s actions, and what is the Minister doing to remedy this, considering it is happening across the country? He mentioned ICBs, but there are several involved. Thirdly, what mechanisms exist to ensure continuity of care when a contractor collapses or walks away? Again, he mentioned ICBs, but is there a national contingency plan? Finally, will the Government now review whether the current model, under which chains are expanding rapidly through acquisition and debt, is fit to safeguard community pharmacies in the long term? Linked to that, can the Minister definitively confirm that the funding settlement has not been compromised?

The 10-year NHS plan states that it wants to move more care into the community, yet it is completely missing a delivery chapter on how to achieve that. At the same time, we have issues such as Jhoots. I hope the Minister will be taking steps to investigate this issue in its entirety and to safeguard against this type of incident happening again, and will spell out the delivery aspect of the 10-year plan.

[Stephen Kinnock]

I thank the shadow Minister for his questions. He asked about first awareness of what was happening with Jhoots. He will be aware that it entered the market through the purchase of a number of Lloyds pharmacies that were no longer a going concern in 2023, so the question about due diligence on Jhoots as an operator is probably something he should be asking one of my predecessors from his party, which was in power at the time. Since those purchases, Jhoots has expanded rapidly, and that has been where we have seen the question marks around its ability to operate and the serious downgrading of services.

I have not met the management of Jhoots. We are looking at a whole range of legal and regulatory enforcement procedures, and the decision we have taken is that it is better not to interfere in any way in those processes, but I am certainly monitoring that very closely. If we receive legal advice that suggests that such a meeting would be a good idea, I will of course be open to it. However, the current legal position based on the advice we have received is that it would not be appropriate at this time.

On local pharmacy access, integrated care boards have a statutory responsibility to ensure adequate pharmacy provision. Some ICBs, for example, have allowed dispensing GP practices to provide dispensing services to affected patients, while others have worked with local GP practices to advise patients to nominate alternative nearby pharmacies for their prescriptions. We have looked at the impact geographically, and our view is that in most cases there is alternative pharmacy provision to Jhoots within striking distance. However, there are four or five areas of the country where that is not the case, including in the constituency of the hon. Member for West Dorset (Edward Morello), who secured this urgent question. I am very conscious of that. In those cases, extra provision needs to be made through ICBs and GPs—that may be through distance selling or by other means—to ensure that patients have pharmacy access.

The shadow Minister asks about continuity of care and national contingency. The situation is challenging because, as I mentioned in my remarks and as officials have said, we have not seen this rapid decline in service before. We are working at pace to strengthen the regulatory framework and we are looking at contingency plans. I do not see any reason why the overall funding settlement for pharmacy should be undermined. We will continue to protect community pharmacy as a crucial part of our NHS.

Mental Health Bill [Lords]

Luke Evans Excerpts

Report stage
Tuesday 14th October 2025 Commons Chamber

[Madam Deputy Speaker (Judith Cummins)]

Members will have noticed that many people are standing to speak and there is not a significant amount of time for the debate, so with the exception of Front-Bench contributions, there will be an immediate four-minute time limit. I call the shadow Minister.

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

When we last debated the Bill on Second Reading, I said that protecting someone’s freedom for their own safety is not a licence to own their life, but a duty to help them find it again. That principle still guides us today, because good intentions alone do not mend a troubled system. Compassion without competence is not care; it is sentiment without substance.

On Second Reading, I spoke of bridges and rough roads, and of how resilience and recovery depend on the strength of the structures that carry people through their hardest times. Tonight, we return to that bridge. The question before us is not whether we believe in reform—after all, there is cross-party agreement on that—but whether the Government have built the foundations to make it stand. Warm words are plentiful, but the reality is that too many people are still falling through the gaps: detentions are still present, community services are stretched, and families are left navigating a maze of bureaucracy while waiting for help that may never come.

We all know that reform cannot be delivered on aspiration alone. It requires a delivery plan, a workforce and a system capable of learning from its own mistakes. We know the chapter on delivery is missing from the 10-year NHS plan and there is further risk tonight that we miss another opportunity. After all, the principles in the Bill are the right ones. They are even on the face of the Bill—choice and autonomy, least restriction, therapeutic benefit, and treating the person as an individual—but those principles need power behind them and that power lies in delivery.

This Report stage is our chance to turn those words into commitments. New clause 31 requires the Government to publish a fully costed delivery plan within 18 months of the Act passing into law, setting out how integrated care boards and local authorities will deliver adequate community services. Crucially, the plan must be developed through consultation with those who know best. That is vital, because although we support the many aims of the Bill, the Government already have a pretty dismal record of announcing reforms without any credible plan to deliver them.

Let us take the ongoing NHS reorganisation. In March, Ministers made a surprise announcement of the abolition of NHS England and its absorption into the Department of Health and Social Care, yet six months on they cannot say what it will cost, how many staff will be lost or how it will be paid for. The Health Service Journal reports growing confusion inside the system and warnings from NHS leaders that the lack of clarity risks paralysing decision making. Written questions to the Government simply receive the answer

“some upfront cost in the millions”

yet independent estimates say the cost is over £1 billion. Even the chief executive, Sir Jim Mackey, points out that the Treasury must agree funding for integrated care board redundancies within weeks or the NHS will have to turn to a plan B.

The same chaos is playing out across integrated care boards, with local leaders warning that there is already destabilisation due to the 50% reductions. If Ministers cannot manage their own top-down reorganisation, why should anyone believe they can deliver a more ambitious overhaul of mental health services without a clear costed plan, especially when waiting lists have risen in the last three consecutive months?

This Labour Government have already cut the proportion of spending on mental health. As Dr Lade Smith CBE, the president of the Royal College of Psychiatrists, said at the time:

“It is illogical that the share of NHS funding for mental health services is being reduced at a time of soaring need and significant staff shortages.”

Going on, she said that:

“The proportion of NHS funding allocated to mental health services will decrease”,

which will

“equate to these vital services missing out on an estimated £300 million or more that they would have received if their share…had been maintained.”

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

It is a decrease in the proportion of the mental health investment standard for the first time in, I believe, nine years. It is incredibly concerning. It was hard-won, cross-party support that made that proportion go up over time. It was incremental, but it was starting to make a difference to the system. Does the hon. Gentleman agree that it would be helpful if the Government clarified whether that will continue in 2025-26? When Baroness Merron came to our Committee, she could not confirm that. If there is not going to be a continuation, the system needs to know by now, frankly, so that it can prepare adequately for it.

[Dr Evans]

The Chair of the Health and Social Care Committee is absolutely right. A simple answer from the Minister today, on Report, would go a long way to alleviating those fears from the mental health sector. I look forward to his response on that.

Amendment 40 would add a simple but important requirement that each care and treatment plan must include an assessment of the levels of risk to public safety posed by the patient in the community. The purpose of the Bill is right; the Government want to make the system more compassionate, therapeutic, patient-centred and modernised, and we strongly agree with that ambition. However, modernisation must go hand in hand with public confidence, and the public and patients themselves must know that every plan for treatment and discharge is rooted not only in care, but in safety.

In Committee, I argued that the framework still omits one dimension, which is public safety. As far as I can see, there is still no explicit requirement in the Bill for clinicians to assess and record the level of risk posed to the public.

[Joy Morrissey (Beaconsfield) (Con)]

My hon. Friend is making an excellent point. Constituents have come to me about patients with schizophrenia, for example, who had been released before their psychosis had fully passed, with one such instance tragically ending in the death of another resident. All of these situations could have been prevented if the patient had been kept safely in a bed until they were at a proper level of medication and the psychosis had passed. Does the shadow Minister agree that that is something we need to take forward in this Bill? It is a win-win for all parties.

[Dr Evans]

I thank my hon. Friend for raising that tragic case. Those are the kind of cases that this amendment seeks to deal with. We have only to look at the tragic cases of Nicola Edgington and Valdo Calocane to see how escalating risk happens, with huge consequences for the families, patients and victims.

When I raised this matter in Committee, the Minister gave a very thoughtful answer. He said that:

“if any risk at all to public safety is perceived, that must be documented… It is a basic expectation of the professional management of a particular patient that any risk identified to public safety and protection must be in there.”

I welcome that.

With amendment 40, I am simply asking, if that is indeed the Government’s position, why not make it clear in the Bill? The Minister conceded in Committee that

“I take the hon. Gentleman’s point on whether or not it should be in the Bill. I will come back to him on that, because I would be rather surprised if it were not made very clear somewhere that that is a basic expectation; if it were not, that would obviously need to be looked at, but I am reasonably confident that it is.” ––[Official Report, Mental Health Public Bill Committee, 12 June 2025; c. 171.]

Unfortunately, expected in practice is not the same as required in law. We know from past reviews that there is a gap in the risk assessment and that communication can be too inconsistent. Putting such a requirement in statute would not be bureaucracy; it would simply clarify that. The Minister may argue that it already exists in professional codes, in the Mental Health Act code of practice or even in risk management frameworks, but the statutory duty does not. Our amendment would put that duty squarely in the Bill.

Talking of safety, I will turn to new clause 29, which would ensure that no child is placed on an adult mental health ward except in truly exceptional circumstances, and only when it is demonstrably in their best interests. The Government argue that guidance already covers that, but this guidance has no teeth; it can be ignored or inconsistently applied. Again, guidance without legal backing is too easily ignored. That was why the Joint Committee on Human Rights argued in its letter that this part of the Bill needs strengthening. The Minister also said that placing these safeguards in legislation would remove flexibility for clinicians in emergencies, but new clause 29 does allow for exceptional circumstances; it simply requires that they are justified, recorded and subject to oversight.

Research from University College London found that there has been a 65% increase in the number of children and young people admitted to adult wards for mental health disorders, and this increase is sharpest among teenage girls with eating disorders. They are the most vulnerable, and they are the ones who bear the brunt of this.

[Joy Morrissey]

That is another reason why I am shocked that the mental health budget is decreasing. I am seeing an increase across my constituency—and I am sure it is the same in many others—of girls in secondary school presenting with severe mental health issues, suicidal tendencies and eating disorders, and they are desperately crying out for additional mental health support.

[Dr Evans]

My hon. Friend is absolutely right that that support needs to be there. Fortunately, it is not the budget that is reducing but the proportion of funding, and it shows the priorities of this Government when it comes to mental health.

I am concerned that without new clause 29, a child may be harmed or traumatised and placed in an adult ward without proper justification—and it will be little comfort for the family to hear that guidance was breached.

Amendment 41 stands up for the simple but vital principle that when a child is detained under the Mental Health Act, the person legally recognised to act for them—their nominated person—should hold parental responsibility. Only where there are legitimate safeguarding concerns should that be set aside. At first glance, this may seem technical, but it speaks to something profound about how the law views childhood, family and the balance between protection and autonomy.

The Government are right to use the Bill to modernise the old “nearest relative” system, which was too rigid, too bound by bloodline and at times blind to the complexities of family life. Under the Bill, however, a child under 16 deemed competent could nominate any adult—that could be a 19-year-old boyfriend or peer or someone exercising control—and once nominated, that person gets full control. It is a legal authority. We need to ensure that protection is there for the person if there is a breakdown on the family side. [Interruption.] I see that Madam Deputy Speaker is encouraging me to wind up, so I will solidify my comments into a more erudite approach.

The point is that in law this principle is already clear in the Children Act 1989, which defined it as the foundation stone of what families should look like. With this amendment, I believe we have solved the concerns the Minister had at Committee stage about the state of a family in the modern era. In any other walk of life the legal framework exists, so why would we weaken it when it comes to mental health?

We discussed the issues with A&E and the grey area there in Committee, and I was grateful to the Minister for meeting beforehand to discuss them. I know that he took on my comments about solving the practicalities, and I hope he will look at them seriously.

For this House, there is no greater moral burden than deciding for someone who cannot decide for themselves—where care ends and where control begins. That is exactly what the House is addressing with this Bill: how to protect without diminishing, how to act with compassion without surrendering precision, and how to empower without imposing. Involuntary care must never be the reflex of a system, be it under pressure or out of principle. The House agrees on this position; the challenge is delivery. Compassion demands more than good intentions. It demands delivery, discipline and detail. With this Bill, the Opposition lays the challenge of delivery. It must be not just a pledge but a plan. The public will judge us all not just on how kindly this House speaks, but on how faithfully it serves those who depend on us most.

[Mr Richard Quigley (Isle of Wight West) (Lab)]

I will speak to new clauses 28 and 36 and amendment 39, which I tabled not just as an MP but as a father. After what my family have been through, I believe that any parent would do the same.

Yesterday, alongside the right hon. Member for Salisbury (John Glen), I had the privilege of hearing Dr Kate Szymankiewicz speak about her daughter Ruth. She shared not only the tragic circumstances of Ruth’s death but the type of person Ruth was: her dream of becoming a vet, her kindness, and how friends described her as a character straight out of an Enid Blyton novel. That is the Ruth her family remember and cherish. As parents, we became part of a world we never wanted to know. I am privileged to have met Kate, but we agreed that we wished our paths had never crossed because of what that meant.

Ruth was admitted to an in-patient facility for treatment of an eating disorder, but instead of receiving the care she needed, her family were shut out and allowed only two two-hour visits per week. They spent more time travelling than they did with their daughter. Ruth was just 14 years old when she fatally self-harmed, just five months into her stay.

Three months from that date, my family were faced with the same hospital, Huntercombe, as the only choice of a bed for our daughter. At that same hospital, when a child asked if they could have an extra type of jam for breakfast in the morning, they were told it did not have the budget, and when asked why Minstrels were no longer part of snack time, they were told that they were eating too many. That is the problem with NHS-funded private provision: even at £900 a night, the operators plead poverty.

My wife and I have two vivid memories of our youngest being prised from us without any warning. We thought that was normal. Six months of nasogastric tube feeding—we thought that was normal. Illegal restraint so bad that it caused post-traumatic stress disorder—we thought that was normal. Forgetting to feed our daughter 11 times—we started to realise that that was normal, but not acceptable. Instead of wishing to improve its practice, the hospital has accused me of making this up.

If a child is facing any other physical illness such as cancer, or even something more short-term that requires a hospital stay, parental visits and involvement are quite rightly seen as a means of enhancing care. I genuinely struggle to understand why our clinical consensus around mental health continues to support a model where already vulnerable children are isolated from their parents—the very people who know and love them most. Children on these wards are treated as wilful—they are not; they are children—and without empathy or sympathy. Many consultants we encountered opted not to apply the National Institute for Health and Care Excellence guidelines. Staff were poorly trained and in fear of psychiatrists, who ruled the roost and prevented people from speaking up. The private equity firms are focused not on long-term treatment but just on turning mental health into money.

My amendments do not seek to undermine the Bill’s strengths, nor the important work undertaken by the Department. In fact, the cross-party support I have received, including from the right hon. Member for Salisbury, reflects how uncontroversial they are.

The Minister and I have had robust and constructive discussions on the matter, but I ask him to confirm that he will do everything in his power to ensure the following. Parents must not be shut out of their child’s care, as evidence shows that regular parental contact enhances care outcomes. The placement of children on adult mental health wards under the Mental Health Act must be limited strictly to exceptional circumstances, and practitioners must be actively compelled where appropriate to involve themselves in the development and delivery of a child’s care and treatment plan.

We have a duty to ensure that the tragic circumstances surrounding Ruth’s death are never repeated. The Government were elected with a phenomenal majority, winning places we never thought possible—including my own constituency of Isle of Wight West—on a platform of meaningful change. If we do not use this moment to do the right thing and acknowledge that children in mental health services need their parents more often than not, I fear that we may never get another chance.

--- Later in debate ---

[Dr Danny Chambers (Winchester) (LD)]

I begin by thanking colleagues across the House who have worked so constructively on this long-awaited Bill. There has been a shared recognition that the current mental health system is failing too many people and that reform is urgently needed. I thank the Minister for engaging with us so constructively throughout the process, including as recently as yesterday; it is much appreciated.

When I speak to people in Winchester—I know that hon. Members have very similar stories—mental health is one of the issues that comes up the most. We have families waiting months or even years for treatment, we have parents watching their children deteriorate, and we have people languishing on waiting lists when they would rather be working or studying.

The Bill represents the biggest reform of mental health care in over 40 years. It strengthens patient autonomy, modernises detention procedures and rightly removes police stations from the definition of places of safety. These are vital and much needed steps forward and I know that Members on all sides welcome them.

I will speak briefly to several new clauses tabled in my name, each aimed at strengthening the Bill’s impact for some of the most vulnerable people it seeks to protect. New clause 26 would ensure that every hospital has a dedicated liaison service for the carers of patients detained under the Mental Health Act. This is a vital step to support carers during what can be an unimaginably difficult time and to close blind spots that too often exist when someone is caring for a loved one with serious mental illness.

We know that parental mental health concerns are now the most common factor in children’s social care assessments, and that those children are at much higher risk of developing mental ill health themselves. Yet only about a third of mental health professionals in in-patient settings ask whether a patient is a parent. These children and the carers who support them are too often invisible. By identifying and supporting carers properly, new clause 26 would help close those gaps and ensure that no family has to struggle in silence.

[Dr Luke Evans]

We did not discuss this specifically in Committee, but I would be interested to know about the interaction between the independent mental health advocates, which are being expanded and which we all agreed with in Committee, and a new liaison service. I worry about the duplication. Will the hon. Member explain how that crossover would work in practice?

[Dr Chambers]

That is a prescient point. At the moment, there is no responsibility to ensure that children in particular, and other carers too, are identified. Even if they are put in advance choice documents, if the person making those decisions does not identify them, that will not come about. We would have to be careful that there is not unnecessary duplication; however, the initiative the hon. Gentleman puts forward is not a belt-and-braces approach to identifying young carers and other carers who are struggling.

New clause 7 seeks to end the detention of children on adult wards, requiring the number to be reduced to zero within five years—other Members have discussed that today—and the Secretary of State to set out how that will be achieved. It simply cannot be right that children are still being treated on adult wards. It is unacceptable and can seriously hinder recovery and effective care.

Although the Bill rightly focuses on hospital-based treatment, the process has also laid bare how fragile our wider mental health services have become, with the lack of early support in primary and community care and the shortage of initiatives that help people long before they reach crisis point. That is why new clause 14 would place a duty on integrated care boards to ensure that community services have the resources they need to meet the demand and report on that regularly. Keeping people well in their communities must be at the heart of any modern mental health strategy, because if we get the community care right, we prevent crises, reduce pressure on hospitals and help people live healthier, more independent lives.

Finally, new clause 22 would establish a veterans’ mental health oversight officer. That dedicated role would ensure that those who have served our country receive the understanding and tailored care they deserve when they come into contact with mental health services. Too often, veterans experience mental ill health, sometimes linked to their service, and they find themselves in systems that do not fully recognise their unique experiences. The proposal would help change that by providing proper oversight; encouraging joined-up working across the NHS, veterans’ services and the third sector; and ensuring that compassion and accountability sit at the heart of how the Mental Health Act is applied to veterans.

Taken together, the proposals are about making our mental health system even more humane, more joined up, and more focused on prevention and recovery. I hope the Government will take them in the spirit in which they are intended, which is to strengthen this important Bill, which we very much support, and deliver a system that truly supports those who need it most.

--- Later in debate ---

[Gregory Stafford (Farnham and Bordon) (Con)]

As a member of the Bill Committee, I had the opportunity to closely examine the development and scrutiny of this Bill alongside my Opposition colleagues. We sought to strengthen the legislation, particularly in relation to safeguarding children and ensuring robust protections for those admitted under the Mental Health Act framework.

Given the shortness of time, I will speak only about amendments 41 and 42. They make the vital clarification that the nominated person for any patient under the age of 16 must have parental or guardian responsibility unless there are clear and established safeguarding concerns. In essence, that would ensure that the parents remain the lawful decision-makers and the first and most natural safeguards for their child’s welfare.

Let us consider, for a moment, what is at stake. Imagine a vulnerable 14-year-old girl, frightened and confused during a psychiatric admission. In that moment of distress, a well-meaning adult—or, worse, someone with a hidden agenda—could persuade the child to nominate them as their representative. That individual would then gain legal powers to object to treatment or discharge decisions, while the parents—the very people who know the child best and have both a moral and legal duty to protect them—could be sidelined.

Once such a nomination is witnessed, it carries legal force. The rights and responsibilities of parents could, in effect, be overridden. Although that may sound hypothetical, it is not. Family courts have seen precisely how manipulative individuals exploit vulnerable young people. Groomers, traffickers and abusers thrive in the legal grey zones. If we are not crystal clear that only a court may displace parental responsibility, we risk leaving the door ajar for such exploitation. I ask the Minister to assure the House in winding up that no child under 16 will be permitted to override parental authority simply by nominating someone else, without a full and proper judicial process.

The Bill does have fallback provisions, which are of course welcome, but they are not watertight unless the law explicitly confirms that only a court can transfer or restrict parental rights.

[Dr Luke Evans]

My hon. Friend makes an excellent point. The only protections that I can see in schedule 2 are an age requirement, a stipulation not to be disqualified by a previous court order, and the presence of a witness. There is therefore no pre-emptive way of protecting people, which is why amendment 41 is so important.

[Gregory Stafford]

My hon. Friend is absolutely right. Both he and I made those points in Committee. I am surprised that the Minister does not see the risks here. The safeguard that my hon. Friend talks about must be beyond any doubt. The amendment in his name provides exactly that clarity. It would prevent unrelated or loosely connected individuals from stepping into a role that rightfully belongs to those with both a legal duty and an emotional bond—the parents or guardians—and it would preserve the fundamental principle that parents should not find their role diminished by accident or administrative oversight.

As I was saying, this is not an abstract risk; it is a very real and foreseeable consequence of the unclear drafting. These amendments do not weaken the rights of patients. They strengthen the protections around them. They ensure that in modernising this law, quite rightly, we do not inadvertently undermine the oldest and most important protection of all: a parent’s duty to safeguard their child. We must ensure that the state can only curtail that right under the strictest judicial scrutiny, with evidence tested and the child’s welfare paramount. In doing so, we will make this legislation not only legally sound but, in my view, morally right.

New clause 31, tabled by my hon. Friend the Member for Hinckley and Bosworth (Dr Evans), would require local authorities and ICBs to supply a fully costed plan to ensure they are able to provide adequate community services for people with learning disabilities and autistic people. I support that entirely. As vice-chairman of the all-party parliamentary group for special educational needs and disabilities, and from speaking to groups in my constituency such as Last Wednesday and Growing Hope, I know that the process around SEND is complicated and not fit for purpose. Fortunately, we have a chance to help it slightly with this Bill, so I ask the Minister to support new clause 31.

Suicide Prevention

Luke Evans Excerpts

Thursday 11th September 2025 Commons Chamber

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

I thank the hon. Member for Doncaster East and the Isle of Axholme (Lee Pitcher). He honours John by securing the debate. All hon. Members who have spoken have honoured respectively the people they held so dear, in the most powerful way possible by turning personal grief into public purpose. I therefore thank them all for giving their time to speak.

There was a TikTok video that went viral. It opens with a young woman energetically and innocently asking:

“Be honest: who do you call whenever you’re at your lowest? Who’s that one person?”

The stitched video replies come in, with men answering. The replies are harrowing and insightful:

“Nobody. I’m a man. No one cares.”

“Not a single soul.”

“Nobody.”

“No one, cause I am all alone.”

“I think I speak for a lot of people when I say I don’t call anyone.”

“Nobody. I’m a guy—no one gives a s***”

“Speaking for the guys, literally no one.”

“You all call someone?”

“There’s no one. Nobody who cares.”

“No one. I’m a man. No one cares.”

“Not a single person. I wouldn’t turn to a single person on this earth as they will use it against me.”

“I wouldn’t call anyone.”

“What—we can call somebody?”

That small insight from a seemingly jokey platform hits on what we—the House and wider society—must look at to try to understand why men feel they are not valued. Why do they feel they cannot call someone? Why do they fear doing so will be used against them? Why do they fear asking for help? Many hide in plain sight, struggling and battling until it is too late. After all, we know from the Samaritans that about two thirds of suicide victims are not known to mental health services.

Hon. Members may wonder why I am choosing to focus my comments on men when the latest data from the Office for National Statistics shows that suicide rates are at their highest level since 1999. As we have heard, men account for three quarters of all suicides in the UK. The latest paper by the Centre for Policy Research on Men and Boys puts that in stark light. It showed that more men under 50 die in the UK due to suicide than for any other reason; 14 men every day die by suicide in the UK; 74% of all suicides are male; three times as many men die by suicide every year than die in a vehicle accident; and by 2023, over 90,000 men in England and Wales had died by suicide this century. That is enough to fill Wembley stadium.

There is so much to do in this area. I want to highlight the focus and progress of the previous Government. Through the NHS long-term plan, an additional £57 million was provided by the former Conservative Government between 2019-20 and 2023-24 to fund suicide prevention and bereavement services in every local authority. My former colleague Sajid Javid, who was touched tragically by the experience of losing his own brother to suicide, was instrumental in starting the development of the suicide prevention strategy, which was published in 2023. Key initiatives included the development of a new nationwide, near real-time suspected suicide surveillance system that aimed to provide early detection and timely action to address changes in suicide rates. The strategy in its entirety set out over 100 actions to make progress across Government Departments, the NHS, the voluntary sector and national partners.

In 2021, the previous Government also announced £150 million of funding for crisis mental health facilities and patient safety in mental health units. In January 2023, it was announced that £7 million of funding would be allocated to new mental health ambulances, with £143 million going towards 150 new projects, including schemes providing alternatives to A&E. That is welcome, but the stats show that, even with all that focus, the trend is worsening.

Despite all that work and prioritisation of funding, we have yet to hear anything substantial from this Government about what they are doing on suicide prevention. As we know from one example, training can make a difference. Samaritans reports from its rail team that, for every one life lost, it is estimated that six lives are saved by interventions made thanks to the training given to National Rail and rail operating staff. That is proof that things can be done.

Just yesterday it was World Suicide Prevention Day and the Prime Minister was asked twice about the topic. In response he said, first:

“May I also thank those dealing with suicide prevention? Probably everybody in this House knows someone who has taken their life. It touches all of us and we must do everything we can, together, to prevent suicide.”—[Official Report, 10 September 2025; Vol. 772, c. 862.]

Secondly, he said:

“I think that suicide prevention matters to everybody in this House. I will reaffirm our commitment and I will work across the House with all Members to deal with suicide prevention.”—[Official Report, 10 September 2025; Vol. 772, c. 868.]

Those are positive, warm words from the Prime Minister, which we are all pleased to hear. However, I think that we, across this House and among the public, would be interested in hearing the tangible actions taken by this Government after one year in office. Will the Minister provide an update on what direct, practical steps this Government are taking on suicide prevention, including the implementation of the recommendations in the strategy? What points—for example, disparities in the difference across ethnicities and races in the UK—are being addressed?

I know that the Government have been consulting on a wide range of issues, particularly when it comes to men’s health and the men’s health strategy. I have been shining a light on those issues since I was elected in 2019, so I thank the Government for taking that important step forward. I understand that the Government are due to publish the mental health strategy and I commend them for that. Indeed, I note than in an Adjournment debate earlier this year, the Minister for Care stated:

“In November, my right hon. Friend the Secretary of State for Health and Social Care brought together leading campaigners, experts and the Premier League to gather ideas and inform our strategy and our 10-year health plan. We take suicide prevention extremely seriously, because every suicide is a tragedy that has a devastating and enduring impact on families, friends and communities.”—[Official Report, 24 March 2025; Vol. 764, c. 757.]

His Majesty’s Opposition welcome that step forward, but in looking at the 10-year plan, I note that suicide is mentioned only three times. I think that everyone here hopes to see it feature heavily in the upcoming men’s health strategy. Will the Minister provide an update on timescales for the strategy and how it will consider suicide prevention?

Will the Government look at the prospect of a Minister for men and boys if the evidence points in that direction? We have a Minister for Women, as we believe that women have different problems across society. By that very logic, men and boys have different needs too. If we are to go down the route of segregating policies on sex, there appears to be a compelling argument to have a men’s Minister to work across Departments. That cannot be starker if we consider that for every woman who dies by suicide in the UK three men die.

Another achievement by the previous Government was the launch of the suicide prevention grant fund, as we have heard, providing £10 million to 79 organisations between August 2023 and March 2025. In my constituency, the charity First Step Leicester, Leicestershire and Rutland received £76,845 and the grant was used to improve specialist counselling work in prisons and to build on pilot projects. It is therefore a regret that the suicide prevention grant came to an end in March 2025 and has yet to be renewed or replaced. In response to a written question in April, the Minister for Care stated:

“There are currently no plans to run another grant fund.”

Will the Minister explain the basis behind the decision earlier this year not to renew or replace the suicide prevention grant fund, and what alternative provision, if any, is being provided?

[Liz Twist]

I thank the shadow Minister for his comments. There is no question but that we all want to work together to achieve the best outcome. May I remind him, however, that the £10 million voluntary services grant was a one-off grant and that the last Government failed to renew the funding—the £57.1 million that was mentioned—for local authorities’ prevention work?

[Dr Evans]

I thank the hon. Lady for all the work she does with the APPG. I am looking holistically at the different parts of what we are trying to do in this space. I have already outlined all the funding that the previous Government put in, and I will come on to some of the other problems, such as the national insurance rise, because she will know that they will have a devastating impact.

At the time, the Minister also stated:

“We will be evaluating the impact of the fund, and the services that have been provided by the grant-funded organisations. Learning from this evaluation will help to inform…the Government’s mission to reduce the lives lost to suicide.”

Could the Minister provide further details about that evaluation, such as when it will be completed and whether the Government would reconsider their decision to end the grant funding if the results show that it has had a positive impact in supporting suicide prevention?

Charities were not exempted from the increase in employer national insurance contributions in the Budget. That has significantly hampered their financial situation. We just have to listen to what the Samaritans said in response to the spending review last year:

“The reality is that funding for suicide prevention has dwindled down to next to nothing. To deliver our life-saving work, charities are reliant on donations—on the generosity of the public. And this is even more precarious at a time when many people across the country are facing economic hardship.”

I point that out not to score political points, but to draw attention to the fact that the Labour Government need to set a direction and plan to deal with the leading killer of men and women under the age of 30.

In closing, I want to recognise that yesterday was World Suicide Prevention Day. Every year, 720,000 people across the world take their own lives. The theme this year was, “Changing the Narrative on Suicide”. It calls on us all to challenge harmful myths, reduce stigma and foster open, compassionate conversations about suicide. That leads me to where I started: if men do not know their value, if they do not know they have someone to confide in and if they do not truly believe that we care, we will not break the cycle, we will not make a difference and, ultimately, we will not save lives. That is the challenge laid before society, this House and, ultimately, this Government.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I believe we have a new Minister, Dr Zubir Ahmed—congratulations on the promotion and welcome to the Dispatch Box. Just in case you need to know, we have been touched by young male suicide in my constituency of Sussex Weald, so I will be listening closely to your response.

Eating Disorders: Prevention of Deaths

Luke Evans Excerpts

Tuesday 2nd September 2025 Westminster Hall

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

The hon. Member for Isle of Wight West (Mr Quigley) said that he wants to push for change, and he is a tremendous advocate for doing exactly that. We are six months on from a very similar debate on eating disorders. The fact that so many Members across the parties are here to support the debate shows the strength of feeling.

In the short time that I have, I will not repeat everything that I said last time. Following the debate in April, I wrote to the Government to find out more and ask some questions. I received a letter from Baroness Merron on 12 June. The first question I had asked was whether the Government had a plan for eating disorders. The reply stated:

“The Department has no current plans to create an eating disorder strategy”.

It went on to say:

“NHS England is currently refreshing guidance on children and young people's eating disorders. The refreshed guidance will highlight the importance of awareness and early recognition of eating disorders within schools, colleges, primary care, and broader children and young people’s mental health services.”

I hope that the Minister can provide us with an update on when that updated guidance will be brought forward.

Back in April, I also posed the question whether the Government would be open to having a cross-party meeting or roundtable with experts in APPGs. I have not yet had a response to that question, either in a debate or in the letter that I received, but I think it would go a long way towards helping to explore this issue in a way that would make a difference.

In the previous debate, the hon. Member for Bath (Wera Hobhouse) raised an issue around the recording of death. She said:

“Accurate recording will raise awareness and ultimately save lives.”—[Official Report, 1 April 2025; Vol. 765, c. 30WH.]

The Minister responded:

“I share the concern of the hon. Member for Bath about accurate recording of deaths to understand the extent to which eating disorders and other factors have caused or contributed to deaths. This matter is being explored with the national medical examiner for England and Wales, the Office for National Statistics and the Coroners’ Society of England and Wales.”

Can he provide an update on where that has got to and what the outcome is?

Back in April, the Minister also gave us great expectations about the 10-year health plan:

“Through the 10-year health plan, this Government will overhaul the NHS and ensure that those with mental health needs, including those living with eating disorders, are given the support that they need.”—[Official Report, 1 April 2025; Vol. 765, c. 49WH.]

He also said:

“Raising awareness of eating disorders and improving treatment services is a key priority for the Government, and a vital part of our work to improve mental health services.”—[Official Report, 1 April 2025; Vol. 765, c. 47WH.]

I will be grateful if the Minister can respond to the Beat CEO, who has said:

“We’re very disappointed to see that mental health hasn’t been consistently highlighted as a priority throughout the Government’s 10 Year Health Plan, and that there are no specific commitments on eating disorders.”

That is a concern—not as a party political point, but because people who are suffering can now see it written that there is no strategy, and it is not mentioned in the 10-year health plan. I will be grateful if the Minister can alleviate the concerns about whether this issue is truly a priority.

Finally, one of the big plays that the Government have made is changing integrated care boards. In the last debate, the Minister said:

“The Government’s view is that ICBs are best placed to make decisions as close as possible to the communities that they serve and to target and, if necessary, reallocate funding accordingly.”—[Official Report, 1 April 2025; Vol. 765, c. 47WH.]

The changes brought forward by this Government have seen a reduction in staffing of 50% in many ICBs. Are the Government concerned? Has any analysis been done of whether there will be an impact on commissioning in respect of eating disorders, given the severity that has been highlighted across the Chamber?

It is often said that treatment is about progress, not perfection. I guess that much the same could be said about formulating policy as we deal with the rising number of people with eating disorders. To that end, I hope that the Government will take these questions as part of the process, helping to highlight this area in which we all want to see progress as the Minister brings his policies to bear on this country.

--- Later in debate ---

[Stephen Kinnock]

I will come on to talk about the guidance that is being produced. There is a risk that we can end up with a proliferation of documents, strategies and plans. Our view is that the more streamlined we are and the clearer the lines of accountability, the better the performance becomes. We are committed to the guidance, and I will talk a bit about that, but we are not convinced that having strategies alongside guidance, plans and other documents will help the process.

Members here will be well aware of the increase in the prevalence of mental health conditions, including eating disorders, since the pandemic. The increase in demand has placed significant pressure on services, but the extra funding is making a difference. The latest quarterly figures from NHS mental health services monthly statistics show that, between April and June 2025, 3,138 children successfully entered treatment in community eating disorder services. That is the highest figure on record since NHS England began collecting this data in 2021.

At the same time, waiting lists to begin routine eating disorder treatment have shortened by 20% from the year before. NHS England has also commissioned the Royal College of Psychiatrists to carry out a national audit of eating disorders. That audit is collecting data on eating disorders across community and in-patient settings to drive improvements in the identification and treatment of eating disorders. The audit will monitor how services are performing against standards, and highlight any inequalities in access to care. That will help services to provide safe, effective, patient-centred, timely, efficient and equitable care.

In addition to improved services for the treatment of eating disorders, we are also working to tackle their underlying causes. In particular, we are deeply concerned about harmful online content that promotes negative body image, harmful eating behaviours, suicide or self-harm to those who are most vulnerable. The Online Safety Act 2023 has now come into force and delivers on our commitment to make the United Kingdom the safest place to be online. By now, all sites with a significant user base in this country are required to have conducted children’s access and risk assessments, and to follow the new children’s safety codes to prevent them from accessing harmful content, such as promotion of eating disorders. Ofcom now has the ability to investigate or carry out enforcement action against any site that will not abide by those codes.

Hon. Members today have raised the need for early intervention to lower the numbers of hospital admissions from eating disorders. We know that the earlier the treatment is provided, the better the chance of recovery, and we are committed to ensuring that everyone with an eating disorder can access specialist help. As part of our mission to build an NHS that is fit for the future, there is a critical need to shift the treatment of eating disorders from hospital to community, including children’s community eating disorder services, crisis care services and intensive day-hospital or home-treatment services. Improved care in the community will give young people early access to evidence-based treatment involving families and carers, thereby improving outcomes and preventing relapse. By preventing eating disorders from progressing into adulthood, we will build on our aim of raising the healthiest generation of children.

We have also committed to expanding mental health support teams to reach full coverage in England. To date, we have expanded MHSTs to 52% of pupils; they are working hard in schools to support staff and students alike in meeting the mental health needs of children.

[Dr Luke Evans]

I thank the Minister for giving way. I am pleased that his Government have continued the roll-out, because we share the aim of trying to deal with this early. On that point, there was mention of the updated guidance, and clearly these hubs are going to need that guidance if it is updated. Will he set out when that guidance will be brought forward?

[Stephen Kinnock]

I absolutely will; that is just coming up in my comments. I am not sure that the shadow Minister will be satisfied with the answer, but I will refer precisely to the question that he is asking.

The MHSTs will continue to provide assistance to school staff in raising staff understanding, recognition and awareness of eating disorders, ensuring that they can provide crucial early intervention for children at risk.

Early intervention is also a priority for adults with eating disorders, as set out in the NHS’s adult community mental health framework. NHS England has established 15 provider collaboratives focusing on adult eating disorders. Those collaboratives are working to redesign care pathways and focus resources on community services. By providing treatment earlier and closer to home, we will see better outcomes for adults with eating disorders and their families.

Turning to the guidance, which a number of hon. Members, including the shadow Minister, have raised, we are producing updated guidance to help services to implement those transformations. NHS England first published guidance in 2019 for adult eating disorder services to ensure that they are integrated with day-patient services or in-patient care. A new service specification for adult eating disorder in-patient provision has been through a public consultation and will progress to publication this year. So I can guarantee that it will be published before 1 January, but I cannot give the shadow Minister a precise date.

[Dr Evans]

Forgive me if I misheard, but the Minister said that that was for adults. Can he comment on children and schools?

[Stephen Kinnock]

Can I come back to the hon. Gentleman on that? I will double-check. My understanding was that this was for both. My notes do say “for adult eating disorder services”, but my understanding was that this was a holistic process that would include children and schools. I will come back to him to confirm that point, so apologies if that is not entirely clear. Actually, I am sorry—it is next in my comments. NHS England is also producing updated national guidance for eating disorders in children and young people. That will reflect the full range of eating disorders in children and young people, and the treatment options available to CYP and their families to address them. It will focus on early identification and intervention, community treatment and support, and it will highlight the importance of integrating schools, colleges and primary care to improve support. Before the hon. Gentleman intervenes, he will have noted, as I have, that there is no specific date for that, so I will come back to him on that. The adult one will be before 1 January.

I would like to address the very serious concerns that have been raised about reports of people with eating disorders being offered end-of-life care. Let me be absolutely clear: these reports are deeply troubling, and I acknowledge the distress that they will have caused to families and all those affected by eating disorders. The Royal College of Psychiatrists has been crystal clear that eating disorders are not terminal illnesses. It has updated its guidance to re-emphasise that important point, so that no person, nor their loved ones, should ever feel that treatment has reached a point of no return.

NHS England is clear that all those with severe, complex or long-standing eating disorders should have access to eating disorder services, including hospital care when needed. A personal recovery model, with a focus on harm minimisation, symptom management and quality of life, is well established in providing hope and opportunities for recovery for many people with eating disorders. English law provides a robust framework for safeguarding a patient’s best interests.

I assure hon. Members that we take these concerns very seriously. We will continue to work with clinicians, NHS England and families to ensure that the highest standards of care are upheld, and that every person is given hope and support in their recovery.

Hon. Members have raised how those with eating disorders are disproportionately at risk of self-harm or suicide. The national suicide prevention strategy has highlighted the increased risk, and is committed to working with policy, clinical and personal experience experts to explore bespoke suicide prevention activity when needed. Specialists in eating disorders must ensure that they take a holistic approach to eating disorder treatment, and ensure that they are not likely to inadvertently increase the risk of suicide.

Several hon. Members, as well as the APPG report published in January this year, have raised the creation of a national register for eating disorder deaths, and the holding of a confidential inquiry into all eating disorder deaths. I reassure colleagues that the Department of Health and Social Care is wholeheartedly committed to learning from deaths, in order to prevent future tragedies and to improve quality of care.

The Department receives and responds to prevention of future deaths—PFD—notices relating to eating disorders, and it uses that work to inform practice going forward. For example, the medical emergencies in eating disorders—MEED—guidance was created following a coroner’s report and has since been rolled out nationwide. This Government are determined to focus funding directly to frontline services, in order to best support those currently struggling with this deadly illness.

Similarly, we share the concerns that have been raised about eating disorder deaths not being accurately recorded. It is vital that the extent to which eating disorders have caused or contributed to deaths is properly known. That matter is currently being explored with the national medical examiner for England and Wales, the Office for National Statistics and the Coroners’ Society of England and Wales.

To draw my remarks to a close, I would like to thank all the hon. Members here today. The fact that the debate was so well attended reflects how important the issue is to all of us and our constituents. The service that we provide can often be a matter of life and death. We are all very conscious of the gravity of the responsibility that we hold in that context. I thank all those in attendance for advocating for their constituents and all those across the country who have been affected by an eating disorder.

NHS Pensions: Frontline Patient Care

Luke Evans Excerpts

Thursday 17th July 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 and the impact of administrative delays on frontline patient care.

[The Minister for Secondary Care (Karin Smyth)]

As the House knows, the NHS pension scheme is administered by the NHS Business Services Authority, which is facing challenges, as are all public sector pension schemes, as a result of the coalition Government’s public sector pension reforms in 2015, which in 2018 were found to have been discriminatory—known as the McCloud remedy. The work to remedy that is complex, and much of that I have already detailed in a written ministerial statement on 31 March and a subsequent urgent question. It is complex, technical work, and as the NHSBSA began to produce individual statements, it became clear that its initial estimate of the time needed for each one was too low. My written statement of 1 July updated the House that the NHSBSA did not meet its deadline to deliver statements to certain classes of member by that date and set out the actions that I was taking.

Let me be clear that this Government remain absolutely committed to providing affected members with their statements at the earliest opportunity, and that is what we are doing. The authority is developing a revised plan, and I will hold it to account against the new deadlines. I met the chief executive of the authority and was very clear about my disappointment in the progress, my expectation for the authority to remedy the situation for members, and the need to have a more robust assessment of the delivery plan. I also ensured that the independent chair of the NHS pension board is ready to set up an independent review of the delivery plans. I met her yesterday and was clear that I expect a thorough review of the process and a realistic assessment of delivery, and to hear her initial assessment. She will give her full report after the summer recess.

I will set new deadlines, including for members who are expecting statements this month. I will update the House as soon as possible, of course, both on the progress with the assessment and on the revised deadlines. Let me be clear that members will not face further financial detriment as a consequence of remediable service statement delays, interest on related pension arrears will be paid at 8%, and my Department and the authority have already put in place compensation arrangements for direct financial losses that members may have incurred.

People who have served in our NHS deserve their dues, and we will prioritise members based on need. Let me end by reassuring the House that there will be no direct impact on frontline care. I will continue to update the House.

[Dr Evans]

I declare an interest, for myself and on behalf of the shadow Front-Bench team, as we all have NHS pensions.

In April, Mr Speaker granted us an urgent question because the Government have no real plan for NHS pension statements. Today we return because the Government have now admitted in writing that a new plan is failing— deadlines were missed, then pushed back, and now we have no idea what they are. Just 1,359 statements have been issued out of a required total of 381,920—just 0.35%. Further still, there is no comment on the remediable pension savings statements. Has the Government’s own delayed deadline of July been met or discussed?

This matters. Hundreds of thousands of frontline doctors are not getting their pension statements. The British Medical Association is clear that senior doctors are stepping back from extra work for fear of unexpected tax liabilities. In short, taking on extra work risks an extra tax bill of thousands of pounds. When I raised this in April, the Minister retorted that I could have asked about the impact on services of cancelling the strikes. Well, I will do so now, as the strikes are back on. It will be the senior doctors who have to pick up the slack—the very doctors who are avoiding extra shifts for fear of the tax. If they will not take on the extra work for fear of the heavy tax burden, we have a huge problem.

This should be a priority for the Government, especially as we plan for winter pressures. What will the Minister do to remedy the situation with RSS? What will she do regarding RPSS? Ministers cannot just announce new deadlines and then miss them, so would she be kind enough to publish a delivery plan? Finally, she said that the Government have faith in the NHS Business Services Authority. Is that still the case? Will she demand that the Pensions Regulator steps up and expedites its investigation, given that the referral was made in December 2024? In the end, doctors are counting on her, and so are their patients.

[Karin Smyth]

As I outlined in my initial response and further to the written ministerial statement, we have asked for an independent review of the process and will report back as soon as possible with a realistic deadline for that. With regard to the strikes, we will continue to be open to discussing the avoidance of those strikes, and I hope that the Opposition will support us in that.

Rare Cancers Bill

Luke Evans Excerpts

Report stage
Friday 11th July 2025 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister.

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

I rise to speak on behalf of His Majesty’s official Opposition in support of the Rare Cancers Bill, and to welcome its thoughtful and necessary intervention on behalf of a group of patients who have been under-researched, under-represented, and under-acknowledged for too long. I commend the hon. Member for Edinburgh South West (Dr Arthur) on bringing this Bill forward, and on his ongoing dedication to the issue.

The case for the Bill is clear: rare cancers—defined, in line with the UK rare diseases framework, as conditions affecting fewer than one in 2,000 people—are individually uncommon but collectively account for more than 20% of all cancer diagnoses. However, as we know, patients with rare cancers routinely face delayed diagnosis, limited treatment options and far fewer opportunities to participate in clinical research.

The Bill does not claim to be a silver bullet, but it does mark a significant step forward in how we think about and legislate for research, regulation and data access in rare cancer care. It is focused, proportionate and strategically aligned with the existing NHS and National Institute for Health and Care Research frameworks.

Clause 1 places a duty on the Secretary of State to carry out a review of the law relating to marketing authorisations for orphan medicinal products that are for the diagnosis, prevention or treatment of cancer. It also rightly requires that the review includes comparisons with regulatory approaches in other countries. This is vital. The explanatory notes rightly observe that research into rare cancers is often commercially unattractive because of small patient populations and high developmental costs. If our regulatory environment creates further barriers to entry, patients suffer—not because the science does not exist but because the system does not support it.

The UK’s current approach to orphan designation lacks the pre-authorisation incentives found in systems such as the European Medicines Agency and the US Food and Drug Administration. The review required under the Bill is the opportunity to ask whether we are doing enough to attract the research and development that rare cancer patients deserve.

[Sir Christopher Chope]

I am not quite sure whether my hon. Friend is responding to the amendments or making a Third Reading speech. I hope he will address the amendments I have tabled, including those that relate to clause 1, about which he has just spoken.

[Dr Evans]

If my hon. Friend bears with me, I will turn directly to his amendments. It is important to first set out the context, because we must understand the clauses if we are to debate the amendments to them.

Clause 2 makes crucial changes to the Secretary of State’s duty under the National Health Service Act 2006 by stating explicitly that it must include research into cancers that, in the opinion of the Secretary of State, are rare. Although this matters, the research agenda is often driven by numbers and funding scales. By mandating that rare cancers be part of the agenda, the Bill begins to shift the culture towards inclusion, equity and long-term thinking.

I particularly welcome the creation of the national specialty lead for rare cancers, modelling the NIHR’s existing structure of research delivery leaders. This individual will be tasked with promoting and facilitating research, advising on trial design and convening collaboration. The success of this role will depend on it not just being symbolically supported but having a clear remit, adequate funding and a strategic alignment with the wider NIHR research delivery network.

Clause 3 amends section 261 of the Health and Social Care Act 2012 to allow NHS England to disclose information from cancer registries for the purpose of identifying and contacting potential clinical trial participants. This is a significant and necessary step. The Bill distinguishes between a disease registry, like the National Disease Registration Service, and a contact registry, such as Be Part of Research. Making sure that these systems can speak to each other will be of significant benefit when it comes to matching patients with opportunities. Importantly, the clause reaffirms that any such data sharing must remain compliant with the Data Protection Act 2018. As proposed new subsection 6A to the 2012 Act makes clear,

“A power conferred by this section to process information does not authorise the processing of information which would contravene the data protection legislation”.

This is a safeguard that we must preserve, not weaken, if we are to maintain public trust in the system.

At this point I turn to the amendments tabled by my hon. Friend the Member for Christchurch (Sir Christopher Chope). He approaches private Members’ Bills in the way that a jeweller examines diamonds—with a magnifying glass, a steady hand and absolutely no tolerance for flaws. We may grumble as the clock ticks on, but deep down we all sleep better knowing that he is reading the footnotes. This Bill is no different; he has approached it with rigour, and I thank him for his commitment to precision and improving clarity and accountability. As he pointed out, the Bill is not trivial. Therefore, it is not only right, but indeed the duty of this House, to scrutinise closely legislation and amendments laid before us.

To that end, several of the amendments aim to tighten the Bill’s drafting or introduce firmer deadlines. For example, amendment 4 would reduce the timeframe for the review under clause 1 from three years to two. Amendment 2 would require the Secretary of State to

“set out a timetable for implementing any changes in the law recommended by the review.”

I understand the concern that reviews can drift, but the three-year period reflects the complexity of the subject: a UK-wide review of the Human Medicines Regulations 2012, including benchmarking against other jurisdictions and engaging multiple agencies. Compressing the timeline might jeopardise the depth or quality of the analysis. Likewise, a statutory timetable for implementation could constrain the Government prematurely, before the review’s conclusions are even known.

[Sir Christopher Chope]

I am very grateful to my hon. Friend for his unprompted comments. He will know that the funding is sufficient to staff the review only for one year. If there is only funding for one year, why does it take three?

[Dr Luke Evans]

My hon. Friend knows, far better than I, not to look at legislation in isolation. The Government will at some point bring forward the cancer plan, which will have a direct crossover with the Bill, so it is right to give the Government the freedom and space to implement the legislation. If we rush it, we could get it wrong, which would be even more detrimental for those who suffer with rare cancers.

Other amendments address definitions and discretion. For example, amendment 5 would remove

“in the opinion of the Secretary of State”

from the definition of rare cancer, and amendment 8 would remove similar wording in relation to NHS England’s discretion. At first glance, the amendments may seem like matters of tidy drafting, but retaining discretion is important, especially as regards rare cancers. Prevalence data can be uncertain or lagging, and flexibility allows for expert judgments about edge cases in which rigid definitions may unintentionally exclude patients from trials or research that could benefit them.

On top of that, there are concerns even about simple definitions. We are still exploring the difference between, for example, pre-cancerous and cancerous cells. If someone goes for a smear, that is what they are told. This is a new area. Who knows what will come up in the future? Simply defining rare cancers on the basis of lagging prevalence data is a risk, and it is therefore right that the Government and the Secretary at State have discretion to direct in one way or another.

However, I would grateful if the Government would answer the question, which has been rightly posed, of who or what will fill the role when NHS England is abolished. It is not clear exactly what that will look like. I have asked the Minister this question several times, in relation to the Mental Health Bill and other areas, and it is a question that this House should rightly ask. Who will be responsible for what, when and why?

That said, amendment 7, which would ensure that the proposed national specialty lead is appointed within six months of Royal Assent, deserves serious consideration. Patients have waited long enough. If the Government are confident that the post can be established promptly and resourced effectively, I would welcome that ambition being stated at the Dispatch Box today.

Finally, I must express my concern about amendment 9, which proposes to remove the data protection safeguard in clause 3(4). Although the provision may be declaratory, in that it reaffirms existing legal obligations, it none the less offers clarity and reassurance. In an area as sensitive as health data, such clarity matters, and the subsection’s removal could cause unnecessary concern, even if the underlying law remains unchanged.

In conclusion, this Bill is not about grandstanding. It is modest in financial cost, careful in its drafting and realistic in its scope, but its impact could be significant. For patients living with rare cancers, and clinicians and researchers striving to support them, the Bill offers real hope—hope for faster access to innovation, hope for more inclusive research and hope for a regulatory system that works for the many, not just the minority. Every patient matters, whether they are one in two or one in 2,000. As we stated on Second Reading and in Committee, we support the Bill, and I thank the House for giving me the chance to explain why.

--- Later in debate ---

[Dr Luke Evans]

I again thank the hon. Member for Edinburgh South West (Dr Arthur) for his tireless work on this important Bill. It has united the House, and rightfully so, because it speaks to something fundamental: the need for people with rare cancers to be seen, heard and addressed.

The Opposition have supported the Bill from the outset, and as the shadow Secretary of State, my right hon. Friend the Member for Melton and Syston (Edward Argar), and my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) have said, we will continue to do so today. We would like to thank the charities and campaigners who have worked tirelessly to bring this issue forward: Pancreatic Cancer UK, the Brain Tumour Charity, Cancer52 and many more. Their work has helped to put rare cancers firmly on the agenda, and this Bill is part of their legacy.

I have been on the other side of this, delivering the news, particularly when I worked on an upper gastrointestinal hospital ward as a junior doctor. Delivering the news that someone has pancreatic cancer is one of the toughest things I have ever had to do, and it is worse still for the relatives who have to receive that news. I long for a day when no doctor has to deliver a death sentence to a patient, and this Bill brings that a step closer.

My hon. Friend the Member for Sleaford and North Hykeham spoke in Committee about the repurposing of drugs, and I want to highlight its importance. Treatments that were developed for other conditions may be lifesaving for people with rare cancers. It is vital that the Bill’s scope allows for innovation to thrive. Conservative Members urge the Government to embed the provisions of the Bill in the forthcoming national cancer plan. I hope the Minister will confirm that that will happen, and hopefully he will tell us when it will be published.

Finally, as the expert jeweller, my hon. Friend the Member for Christchurch (Sir Christopher Chope) said on Report—his keen eye for a flaw is important—there is the glaring problem of the pending abolition of NHS England, which poses practical questions about data sharing and, of course, oversight. Conservative Members will do all we can to ensure that the legislation remains workable under the new structures, and I hope the Government will do that too.

The Bill will not solve everything overnight, but it is a serious step forward and a statement that even the rarest conditions deserve our fullest attention. As Maya Angelou said,

“when you know better, do better.”

The House knows better, thanks to the tireless work of the hon. Member for Edinburgh South West, and the Bill will help ensure that we do better too.

Glaucoma Awareness

Luke Evans Excerpts

Wednesday 9th July 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Pritchard. I, too, thank the hon. Member for Leicester South (Shockat Adam), who is a colleague both in my region and in primary care. His powerful testimonies about patients and what they suffer are exactly why he is an asset to this House. He presents information that we all need to hear when we debate health issues.

The hon. Member for Alloa and Grangemouth (Brian Leishman) spoke about the fantastic Perth royal infirmary. It is lovely to hear a success story. We do not hear enough success stories about the NHS, because the good news, despite what we hear in this place, is that the NHS broadly does a fantastic job for many patients, and we should never forget that. The experience he described is what we want to see across the country when it comes to dealing with glaucoma.

The hon. Member for Strangford (Jim Shannon) is nothing if not tenacious and consistent because, when I checked the records, I saw that in April 2024 he introduced a similar debate to raise this cause and to make sure people hear about it. He is a credit to his party and the people he represents when it comes to raising health issues.

The hon. Member for North Ayrshire and Arran (Irene Campbell) talked about NHS working groups. I have worked in places that have had PEARS—primary eye care acute referral schemes. Patients love them, GPs love them and I think the opticians and those who work in the services love them too, because they allow better joined-up care, which is what we all want.

Glaucoma is actually a spectrum of conditions. Ocular hypertension affects 3% to 5% of people in the UK aged over 40. Primary open angle glaucoma affects about 2% of people in the UK older than 40, but when we break that down, it affects 1% of people aged 40, 3% of people aged 60 and about 8% of people aged 80. With a growing elderly population, we can see why this is a problem. Primary angle closure glaucoma affects about 0.4%. There are also some rarer ones, but the point is that glaucoma affects about 700,000 people, who could potentially go blind.

Are the Government considering the call of the Association of Optometrists, and it is a simple one, to commission a national glaucoma pathway? I ask the Minister to think about that.

The National Institute for Health and Care Excellence guidance on glaucoma is very clear:

“If any of the following risk factors for glaucoma are present, consider advising people to have their eyes examined by an optometrist…Older age. People 60 years of age or older should be examined every 2 years until they are 70 years of age, when they should be examined annually—free examination is available through the NHS…Family history of glaucoma. People older than 40 years of age who have a first-degree relative (parent, sibling, or child) with open angle glaucoma should be examined annually—free examination is available through the NHS…Ethnicity. People older than 40 years of age who are of black African family origin should be examined…Certain people are entitled to…NHS-funded eye examinations by optometrists…These include people …With a family history…as described above…Aged 60 years or older…In receipt of certain benefits”

or

“Who have been advised by an ophthalmologist”

to have a follow-up. This is really important, as we have heard today, when we are talking about awareness. People should get their eyes checked, check their availability and, if they are 60 or over, make sure they understand that they can get their eyes checked through the NHS.

This issue was raised in a debate at the end of April 2024, just a few weeks before the election. It is worth looking at what was said by the then shadow Minister, the hon. Member for Gorton and Denton (Andrew Gwynne), who went on to be a Health Minister:

“I have a degree of frustration with the Government’s approach to the issue. Given the statistics, I would like to see the Minister commit today to turbocharge access to ophthalmology services and make eye tests more commonplace for people who do not routinely test their eyes, but also to get people access to eye care services once conditions have been diagnosed.”—[Official Report, 30 April 2024; Vol. 749, c. 51WH.]

And he finished his remarks by saying:

“We will support the Government in the remaining weeks or months that they have to get this policy right, but mark my words: the next Labour Government see this as a priority and we will act.”—[Official Report, 30 April 2024; Vol. 749, c. 53WH.]

Now that we are one year into this Government, it is worth checking the record to see whether that priority has been given.

Forgive me for being a bit of a pedant, but I checked Hansard to see how many times glaucoma has been mentioned. There have been four mentions since the election, only two of which were in the context of health. One mention was made by the hon. Member for Leicester South last month, and the other was made by the hon. Member for Strangford in a debate on rare retinal disease. That does not seem like it is a priority.

I am being a bit of a pedant, but I also looked through the 10-year plan again, and there were two mentions of eye care, one of which was “ophthalmology” and the other was “optometrists”. The Minister will argue that it is a strategy document, but it raises the question: what is the plan for glaucoma?

The last Government concentrated on several areas. These included early detection and greater use of community optometry, with an emphasis on the importance of routine tests. There was £500 million a year for sight tests and optical vouchers, supporting more than 12.5 million NHS sight tests provided free of charge. The budget was demand-led rather than limited by volume, and the public were encouraged through campaigns and social media advertising to get tested. Integrated care boards expanded local services for minor and urgent eye care, pre- and post-cataract checks and glaucoma referral filtering. The post-covid backlog recovery programme also received £8 billion.

I am getting death stares from you, Mr Pritchard, so I will move on to my main points and my questions for the Minister.

[Mark Pritchard (in the Chair)]

The shadow Minister needs to be brief. He has had five minutes, and I gave six minutes to the Liberal Democrat spokesperson. I will give the shadow Minister another 30 seconds.

[Dr Evans]

Is there a plan or a strategy for considering a glaucoma pathway? Will the Government also commit to the workforce? The Health Service Journal has noted that the plan, as it stands, has no delivery chapter. Where is the delivery chapter for the 10-year health plan?

[Mark Pritchard (in the Chair)]

To be clear, it is important that the Chair is both neutral and fair in the distribution of time.

[The Minister for Care (Stephen Kinnock)]

Thank you, Mr Pritchard. It is a pleasure to serve under your chairship.

I thank the hon. Member for Leicester South (Shockat Adam) for securing this important debate to raise awareness of glaucoma. I enjoyed our meeting some time ago, when we discussed this and other related issues at length. I am keen to ensure that we keep that dialogue going, and not just in this Chamber. This is a timely debate as it follows Glaucoma Awareness Week, which ran from 30 June to 6 July.

Losing one’s eyesight can be devastating, and I pay tribute to the charities that do so much to help people live with glaucoma or to research a cure, such as Glaucoma UK, the Glaucoma Foundation and the Royal National Institute of Blind People, to name just a few.

Last week, the Prime Minister set out our plan to get the NHS back on its feet and fit for the future. Underpinning our plan are three big shifts: from hospital to community, from analogue to digital and from sickness to prevention. The plan was developed through extensive engagement with the public, patients and staff, including the eye care sector. All three shifts are relevant to preventing and managing conditions such as glaucoma in all parts of the country. More tests and scans delivered in the community, and better joint working between services, will support the management of conditions, including glaucoma, closer to home.

I turn to glaucoma detection. This Government take glaucoma very seriously, as it is one of the main causes of sight loss. It is a time-sensitive condition, and early detection and treatment can help to slow down or prevent vision loss. I acknowledge the vital role played by community optometry in protecting people’s eye health across the country. That includes the hon. Member for Leicester South, who of course is an optometrist and has significant expertise in this sector. I also pay tribute to all the hon. Members who have contributed to this debate with such passion and conviction.

Sight tests play a vital role in the early detection of glaucoma. Most glaucoma patients are identified through routine sight tests. It is not possible to “feel” glaucoma; it does not cause any symptoms and the eye pressure does not always cause pain. That is why regular sight tests are so essential, so that conditions such as glaucoma can be diagnosed and treated as early as possible.

It is recommended that everyone should have a sight test every two years, and more often if it is considered clinically necessary. The NHS invests over £600 million annually in the provision of sight tests and optical vouchers, and high street opticians deliver more than 13 million NHS sight tests annually, which are free of charge for eligible patients. NHS sight tests are widely available across the country for millions of people and those who are entitled to receive them include children, individuals over the age of 60, individuals on income-related benefits and individuals diagnosed with glaucoma or considered to be at risk of glaucoma.

We understand that some people might not prioritise sight tests, compared with other healthcare, or they might not know that sight tests are recommended every two years. That is why we always look for opportunities to remind the public through social media. I was pleased that the Department supported Glaucoma Awareness Week and highlighted the importance of regular sight tests through our social media platform last week. I will also take this opportunity to urge anyone who might be watching or reading this debate, “Visit your optician if you have not had a sight test in the last two years. Please check on the NHS website to see whether you are eligible for any help in paying for a test.” NHS sight test providers in the high street also display information about NHS sight test eligibility.

Some high street optical practices are also being commissioned by integrated care boards to provide glaucoma referral refinement services. Moving more care into the community is one of the key priorities in our 10-year plan; we want to see care happening as locally as possible for patients. Where a patient has been identified as having raised eye pressure, local glaucoma referral refinement schemes provide additional tests to confirm whether a referral into secondary care is absolutely necessary. These schemes can save patients time and worry, and reduce unnecessary referrals, while freeing up space for others who need specialist attention in hospital. More than 70% of ICBs currently have some coverage of referral refinement in place.

For those patients who do need to be seen in secondary care, it is vital that they have access to timely diagnosis and any clinically necessary treatment. We have wasted no time in getting to work on cutting NHS waiting lists and ensuring that people have the best possible experience during their care. We promised change and we have delivered early, with a reduction in the list of over 230,000 pathways, including ophthalmology. The waiting list has been reduced by over 24,000 patients since July 2024; it has fallen from 606,819 to 582,385 as of February 2025. In addition, we have exceeded our pledge to deliver an additional 2 million operations, scans and appointments, having now delivered over 4 million additional appointments.

[Dr Luke Evans]

The Minister will probably be aware of the Full Fact and Sky News report that examined the speed at which appointments are being delivered. The Government have indeed delivered 4 million appointments, but under the last Conservative Government there were 5 million appointments within a similar time period, so we are actually seeing a slowdown in appointments. How will that affect people with eye conditions or other health conditions?

[Stephen Kinnock]

I thank the hon. Gentleman for that intervention. In our manifesto, we of course set a target of 2 million additional appointments within the first year of a Labour Government, and we have delivered 4 million. The key thing is to ensure that we get people off the waiting list. Regarding the figure of 5 million that he referred to, I do not know whether there was more activity, but somehow it was not helping to reduce the waiting lists, because we saw the waiting lists rise consistently. The key metric is, of course, the waiting list being reduced, and I am very pleased to say that, when it comes to eyecare, a reduction of 24,000 patients has been delivered since July 2024.

That marks a vital first step to delivering on the commitment that 92% of patients will wait no longer than 18 weeks from referral to consultant-led treatment, in line with the NHS constitutional standard, by March 2029.

In addition to making progress on reducing waiting lists, we recognise the challenges facing ophthalmology services as one of the largest out-patient specialities in the NHS, and demand is set only to increase due to the ageing population. NHS England has worked with 11 ICBs to test a new way of delivering eyecare that aims to reduce pressure on hospital eye services.

The new model is emblematic of our shift from analogue to digital, as it uses IT connectivity between primary and secondary care services to improve the referral and triage of patients, with patient data and images being assessed by clinicians to determine whether patients need a secondary care appointment. It is called the single point of access approach. The SPOA approach reduces unnecessary hospital appointments, reduces the time from referral to treatment and allows more patients to be managed in the community. The ICBs testing the SPOA model have consistently demonstrated a reduction in unnecessary secondary care appointments and a significant reduction in wait times, both in time to treatment and to follow-up care. NHS England is continuing to share the learning from the accelerator sites for the SPOA with ICBs.

I want to see more ICBs adopting that approach for the benefit of patients, including those with suspected or diagnosed glaucoma. I believe that the SPOA has tremendous unharnessed potential and is a great example of how, by harnessing technology, we can improve the way the overall system works and facilitate the interface between primary and secondary care that we know is at the heart of so many of the challenges that we face across our health and care system.

Looking at the shift from sickness to prevention, although glaucoma cannot be cured, if it is caught early, treatment can prevent sight loss. The National Institute for Health and Care Excellence plays a crucial role in evaluating new medicines, medical devices and other technologies to determine their clinical and cost-effectiveness before recommending them for NHS use. NICE has published guidelines on the diagnosis and management of glaucoma. It has also published guidance on interventional procedures that provide recommendations on whether glaucoma-related procedures are safe and effective enough for wider use in the NHS.

A number of treatments are available for glaucoma, including eye drops, laser treatment or surgery, aiming to lower eye pressure and prevent or slow down optic nerve damage to reduce the risk of sight loss. Although there are treatments for glaucoma, it is a lifelong condition that requires regular monitoring. Historically, that has taken place in hospital but, in line with our aim to move more care from hospital to the community, there is no reason why, when clinically appropriate, that activity could not be undertaken outside of hospital. We know that some ICBs are already commissioning glaucoma monitoring in the community.

We must also recognise that, if diagnosed late, glaucoma can sadly lead to irreversible sight loss. The hon. Member for Leicester South spoke passionately from clinical experience about the significant impact that sight loss can have on an individual. Emotional support is therefore vital. There are various resources that aim to improve the support, including mental health support, available to patients through their sight loss journey. That includes NHS England’s patient support toolkit for commissioners and providers and the RNIB’s 2023 patient support pathway. Those sit alongside talking therapies and psychological therapies, which are widely available and to which patients can refer themselves directly. We are also taking steps to update the form for certificates of visual impairment to improve the signposting of patients to local support services.

Finally, I recognise the potential for research and innovation to help us to understand sight loss and to develop new treatments, including for glaucoma. The Department for Health and Social Care funds eyecare research through the National Institute for Health and Care Research. NIHR infrastructure funding provides investment in research expertise, specialist facilities, a research workforce and services that help to support and deliver research studies through a range of clinical areas, including eyecare research. That includes the NIHR Moorfields Biomedical Research Centre, which received funding of almost £22 million for five years from 1 December 2022, and is solely dedicated to eyecare research. The Moorfields BRC has been key in advancing research through a range of studies and clinical innovations in the glaucoma field. One of its flagship projects is a large-scale trial investigating the use of vitamin B3 to slow the progression of glaucoma. Recruitment for that study is ongoing at multiple sites across England.

As I have set out, the Government take glaucoma extremely seriously. Community optometry continues to play a vital role in preventing glaucoma. We are committed to improving eyecare services and patient outcomes, to reducing avoidable sight loss and, in particular, to harnessing the power of technology to drive those improvements forward. I also hope that this debate has further helped to raise awareness and may prompt a few more sight tests as a result. Once again, I congratulate the hon. Member for Leicester South on securing this important debate.

GP Funding: South-west England

Luke Evans Excerpts

Wednesday 25th June 2025 Westminster Hall

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

It is a pleasure to serve under your leadership, Dame Siobhain, and to be here. I pay tribute to the hon. Member for Newton Abbot (Martin Wrigley) for securing this debate on a topic that I am all too familiar with, having spent time as a GP. This place may not be so familiar with the inner workings of GP practices, so it is fantastic to have the chance to discuss it. I declare an interest: many of my immediate and wider family are GPs, and it is important to put that on the record.

This debate has allowed us to discuss a huge variety of things, including the Carr-Hill formula and the QOF. We did not touch on DES and LES—directed enhanced services and local enhanced services. Rural dispensing practices are a really important funding stream. We have talked about the partnership model, retention, joining up services, ICBs and their toolkits, the interaction with the planning department and rurality, which has a particular impact on services in my area.

I want to pick up on the comments made by the hon. Member for Mid Dorset and North Poole (Vikki Slade). Fair play to her for going out and shadowing a GP to see what their life is all about. At the heart of what she said was the good care that goes on. If we were to believe the Daily Mail, every GP is on the golf course and only cares about the money. The money is important, but GPs care far more about the patients and the quality of care they give. That is what drives them and gets them out of bed each day. We in this house must not forget that when we discuss healthcare, because it is important. We will get far better healthcare than ever before in the last few decades, and we must not lose sight of that.

I am grateful to the hon. Member for Newton Abbot for giving me my first chance as a shadow Health Minister to debate general practice and ask the Minister some questions. Without further ado, I will turn to those questions. First, what is the Government’s current position on primary care and its models? In an interview in The Times in January 2023, the current Secretary of State for Health and Social Care said:

“I’m minded to phase out the whole system of GP partners altogether and look at salaried GPs working in modern practices alongside a range of other professionals.”

He went on to speak at events held by the King’s Fund and the Institute for Public Policy Research, where he acknowledged that he has

“observed a GP partnership model in decline where very soon we’re going to have more salaried GPs than partner GPs”

and that the

“status quo is not an option”.

Then 18 months ago, just six months before the election, the Secretary of State stated,

“What we were minded to do is to sort of phase it out over time. I’m still not sure whether or not the GP partnership can survive in the longer term. But I haven’t reached a sort of firm conclusion that says that it shouldn’t.”

In the light of that, and given the importance of the partnership model, could the Government clarify their position with regard to the partnership model and any other models that are being considered?

[Vikki Slade]

I thank the hon. Member for his comments about my visit to the GP, because it was an absolutely wonderful experience. If the proposal is to phase out the partnership model and move to a salaried model, how would that work, given the severe cuts that ICBs are facing? With 50% cuts to most of the ICB funding, somebody will have to pick up the costs of running these organisations, rather than the clinical side of it.

[Dr Evans]

The hon. Lady is spot on. I posed my question to the Government because we know that primary care is one of the most efficient parts of the NHS. Why? Because the people running those businesses—they are businesses, and we have to be open and honest about that—pay attention to where the money comes in and goes out. They take full pride in it, first, because they care, and secondly, because their salaries are paid from the profit that comes out of that. Again, “profit” is a dirty word that people do not like to use, but it is the reality of what we are dealing with when it comes to how we break down the funding.

The Government have proposed to get rid of NHS England, and it is still unclear not only how much that will cost, but how much it will save and where the administrative burden will fall. On top of that, we do not know what will replace the partnership model if we lose it, and this is the question to be asked. Given that it was only six months before the election that the Secretary of State stated his intent, I too am keen to find out the answer.

I have a second question to pose to the Government. There are concerning reports this month in the Health Service Journal, which has had sight of a leaked version of the Government’s 10-year plan to improve the NHS. It says that the plan will push back the Government’s ambition to increase the share of NHS spending on primary and community care to 2035, rather than 2029 as originally promised. Can the Minister confirm or deny those reports?

When it comes to funding, the Government raised taxes directly on GPs as part of the national insurance increase. Has the Department made any assessment of how much of the £886 million uplift that has been allocated to GP practices will be needed to meet the increase in employer’s national insurance contributions?

I turn to the figures for the ARR scheme. The Government announced in April that they thought they had reached 1,500 new GPs, but as the RCGP pointed out at the time, although having

“more GPs employed in the workforce is encouraging, when considering full time equivalent GPs—which gives the most accurate picture of the GP workforce and the care and services GPs are able to deliver for patients—the numbers published today are lower, at 851 GPs”.

The increase is encouraging, but when we dig into the data, it appears that we are simply seeing more locum doctors coming back into the scheme. I would be grateful to understand exactly how the numbers are made up, and where the inference of 1,500 GPs comes from.

More importantly, where is the scheme going in the future? Is it time-limited? Will it continue? Will it be expanded and, if so, what does that look like? Although it is an important part of addressing provision, we also need to understand exactly what is going on. Initial reviews of the data suggest that appointments have not kept up with the pace of the introduction of GPs, so I am interested to understand from the Minister why, despite the supposedly new GPs coming in, the number of appointments has not increased proportionately. I would be grateful for any comment on that.

Finally, I turn to recruitment. Training new GPs has understandably been seen as the priority when it comes to solving the long-term workforce problems in England. As Pulse magazine puts it:

“This is probably one of the areas of workforce planning that could be considered a success. Health Education England, which has been incorporated into NHS England, has been able to meet its target of over 4,000 new GP trainees a year.”

The NHS workforce report, launched under the previous Government in 2023, made commitments to increase that. It set goals to increase the number of GP specialist training places to 6,000 by 2031, ensure that all foundation-year doctors do a rotation in general practice, and require GP registrars to spend the full three years in general practice.

There has been progress, but along with progress come new problems. The British Medical Association has warned that up to 1,000 GP registrars could face difficulty when qualifying in summer 2025 without funding for GP practices to recruit newly qualified, unemployed or underemployed GPs. What active steps are the Government taking to avoid that, and what support will they be offering newly qualified GPs?

[Dr Simon Opher (Stroud) (Lab)]

The ARR scheme in my practice at May Lane surgery in Dursley is employing newly qualified GPs who provide a lot of extra appointments for the surgery, so the scheme is working quite well for newly qualified GPs.

[Dr Evans]

I am pleased to hear that the scheme is working well, but the question is—as the hon. Member would know if he had been here for the start of the debate and all the way through it—what does it look like going forward?

In other places, are locums simply being stepped into the ARR scheme because there has been a shift in the way that GPs commission their work and PCNs are looking to deal with that? That is the question at the heart of it. We seem to be training more GPs than ever, yet at the same time, we have a disproportionate number of people at the top end who are not able to find work.

It is important to build up multidisciplinary teams that take account of the pharmacists, nurses and mental health workers around GPs, and I welcome the fact that the ARR scheme allows that. It has been widened to get more funding but, as the hon. Member will know, there is a discrepancy in how much doctors are funded for and there are limitations on how long they can work in the scheme. If I were to return to practice, I would not qualify under the scheme. The Government need to pose these questions; although the scheme is welcome, does it solve the whole problem? I do not think so, and my final set of questions relates to that.

We have seen a trend in international medical graduates coming to work in the UK, with the number of international medical graduates overtaking domestically trained medics for the first time in 2023. Have the Government considered something similar to the Australian scheme? Australia classifies locations using the modified Monash model or the Australian statistical geography standard to rank areas from major cities to remote regions, and then prioritises overseas doctors into the areas of most need. That could help to deal with the disparities across different parts of the UK. Will the Government consider that model in attempting to address those disparities? Whether it is right for the UK is for the Government to decide.

Hospitals might save your life, but your GP has been quietly guarding it for decades. That fact is often lost in our debates, so it has been a privilege to remind the Government, the House and the public of that fact today. I look forward to the Government’s response.

--- Later in debate ---

[Stephen Kinnock]

I am impressed by the way the hon. Gentleman did that and I congratulate him on it. If he would care to write to me to set that out, I will have a look at it and get back to him.

I want to take this opportunity to briefly outline what we have done since July 2024, and what we intend to do, to ensure that GP funding and services in the south-west are fit for purpose and capable of meeting the needs of the local population. In February, we concluded the annual consultation between the Department of Health and Social Care, NHS England and the general practitioners committee of the British Medical Association. For the first time in four years, GPC England voted in favour of the GP contract package, which illustrates the progress we are making to rebuild our relationship with the profession.

The 2025-26 contract is already improving services for patients and making progress towards the Government’s health mission. It supports the three key shifts the Government want to achieve: from analogue to digital; from sickness to prevention; and from hospital to community care. Patients across the country can expect online GP services to be available throughout the day, and better continuity of care for those who would benefit most. Patients can also expect a stronger focus on prevention, in particular to tackle the biggest killers, such as cardiovascular disease.

In 2025-26, we are investing an additional £889 million into the core GP contract to fix the front door of the NHS. Despite the difficult financial situation this nation faces, we are backing our health workers with above-inflation pay rises for the second year running. We are accepting the Doctors and Dentists Review Body’s recommendation of a 4% uplift to the pay element of the GP contract on a consolidated basis.

[Dr Luke Evans]

The Minister talks about contracts, which is an appropriate point to question him again on his Government’s position on the GP partnership model. It is not clear what that looks like from any of the documentation, so I would be grateful to understand that or, if the Secretary of State is considering new models, what they are and when we can see them.

[Stephen Kinnock]

We recognise that the partnership model has many strengths. It is a very important part of the system, and it helps to drive efficiency, innovation and a kind of go-getting approach to general practice. That is what we want to see—innovative approaches.

We are committed to substantive GP contract reform. We see the partnership model as a really important part of that, but we also recognise that fewer GPs are interested in going into partnership. The partnership model is not the only model delivering general practice; GP practices can and do choose to organise themselves in different ways. Many practices cite evidence of good outcomes on staff engagement and patient experience through the partnership model. I do not think it is right to say that there are any specific plans to change the partnership model, but we recognise that there are a number of other ways, and we will always keep the way in which the contract is delivered under review.

--- Later in debate ---

[Stephen Kinnock]

That is an extraordinary statistic. There are clearly major imbalances in the way the system works and general practice is funded in our country. A little later I will come to the Carr-Hill formula; I am sure hon. Members will have seen announcements trailed in the media today about what my right hon. Friend the Health Secretary will say shortly in a speech in Blackpool. The issue raised by the hon. Member for Tiverton and Minehead (Rachel Gilmour) is directly pertinent to the work we are doing around the formula for funding GPs, to ensure that it is needs based, unlike the current, deeply anachronistic and dysfunctional funding system.

On funding, general practices are funded through a range of streams, the majority from core payments known as global sum payments. The rest is made up of incentive schemes, premises payments and enhanced and additional services. The Carr-Hill formula is applied as a weighting of 50% to 60% of GP funding allocated through the core contract, and is a workload-based formula designed to reimburse practices for their expected workloads.

The formula takes into consideration patient demographics, such as age and gender, and factors such as morbidity, mortality, patient turnover and geographical location. I am truly proud that today my right hon. Friend the Health Secretary is in Blackpool to announce that we are reviewing the Carr-Hill formula, which is outdated and not fit for purpose. Currently, GP surgeries that serve working-class areas receive on average 10% less funding per patient than practices in more affluent areas, and that needs to change.

Politics is about choices. For 14 years, the Conservatives —propped up for five years by the Liberal Democrats, I am afraid to say—chose to favour the richest. Who can forget the right hon. Member for Richmond and Northallerton (Rishi Sunak) boasting about how he had deliberately redirected funding from deprived urban areas to leafy suburbs? This Labour Government are reversing that ethos. Our decision to reform the Carr-Hill formula is a clear example of how we are putting our Labour values into practice.

We recognise the importance of ensuring funding for core services is distributed equitably between practices across the country. In our upcoming 10-year health plan, that is what we will do, through our review and reform of the Carr-Hill formula. Alongside that work, the Advisory Committee on Resource Allocation—ACRA—will be asked to advise on how the setting of ICB allocations can better support the reduction of health inequalities, to ensure that resources are targeted where they are most needed.

On workforce and recruitment, we recognise the difficult situation whereby patients have been unable to get GP appointments and recently qualified doctors have been unable to find jobs. That is why, in August last year, we announced £82 million in ringfenced funding, allowing primary care networks to recruit newly qualified GPs through the additional roles reimbursement scheme. More than 1,700 GPs have now been recruited through that scheme.

As part of the 2025-26 GP contract package, we made the additional roles reimbursement scheme more flexible, to allow PCNs to accommodate local workforce needs better. That includes removing restrictions on the number or type of staff covered, including GPs and practice nurses. When I took up my ministerial responsibilities in July, I was astonished to find that it was not possible to recruit GPs through the ARRS. We have bulldozed that red tape, which has resulted in a dramatic increase in the number of GPs on the frontline.

[Dr Luke Evans]

On that point, what would the Minister say to junior doctors, now coming to be registrars, who will be looking for a job? Should they look to the ARRS as the way forward when they qualify? What will he say to them if they do not get a job? Should that be the route they look to? Is it an expansion he is asking for? What are the alternatives for those graduating in August?

[Stephen Kinnock]

We have been really pleased with the take-up under the ARRS. It is a rapid and clear way of recruiting, particularly because it has the ringfence and the reimbursement system underpinning it. We absolutely encourage newly graduating GPs to take up opportunities through the ARRS; it is an important tool for bringing more GPs on to the frontline. The challenge is not so much the number of qualifying and graduating GPs in the pipeline, but getting them to the parts of the country that need them most. That variation in provision is the No. 1 priority. The review of the Carr-Hill formula will also have important synergy with the issue of recruitment and workforce.

[Dr Luke Evans]

It seems pertinent to ask this question now: the Australian scheme I mentioned is one way that another country has dealt with the issue. Would the Government consider placing overseas doctors in the areas of most need? Is that something under consideration?

Mental Health Bill [ Lords ] (Ninth sitting)

Luke Evans Excerpts

Committee stage
Tuesday 24th June 2025 Public Bill Committees

[Zöe Franklin]

I beg to move, That the clause be read a Second time.

The new clause would require local authorities and commissioning bodies to promote and report annually on mental health wellbeing in regard to any guidance published by the Secretary of State.

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

I thank the hon. Lady for giving way so early in her speech. I mentioned my concern about this provision on Second Reading: a rough road is not the same as a broken bridge. We are dealing here with the most severe mental health issues. The new clause talks about wellbeing, which affects everyone. Trying to report that and fit it into this criteria risks diluting the very aim of the Bill in trying to deal with the most severe mental health issues. I would be grateful for clarification on the difference between mental wellbeing, which affects everyone, and mental health issues, which not everyone has.

[Zöe Franklin]

When it comes to enabling the Mental Health Act to function, having an understanding on the ground of the picture across our communities regarding mental health wellbeing is very important. That is why we tabled the new clause, which would allow us to get community care right. That would then feed into the crisis care that we are discussing in this Committee.

--- Later in debate ---

Brought up, and read the First time.

[Dr Evans]

I beg to move, That the clause be read a Second time.

I rise to speak in support of the new clause, which was tabled by the Conservative party. It would place a duty on the Secretary of State to review the effectiveness of the regulatory authority’s role under the Mental Health Act 1983 within one year of the Act’s passage.

Allow me to provide the current legal and regulatory context. Under the framework in the Mental Health Act 1983, the Care Quality Commission, which is the regulatory authority in England, is tasked with monitoring and regulating providers of mental health services. We have debated some of this, and there are issues still to be addressed.

The CQC inspects hospitals, community mental health teams, and other relevant services to ensure compliance with statutory safeguards and standards. It publishes reports on providers and issues recommendations where it identifies failings. Additionally, there is an existing reporting framework under the Act whereby the Secretary of State is expected to oversee and ensure the Act’s proper implementation, with periodic ministerial reports to Parliament and CQC inspection outcomes made publicly available. However, there is currently no statutory requirement to review the CQC’s own role and effectiveness in carrying out these specific mental health functions. The gap means that although providers are scrutinised, the regulator itself escapes similar structured accountability and review.

This question was debated in the other place and I welcome the comments from the Minister in the Lords, Baroness Merron, who, in a letter, rightly highlights existing transparency measures. She states that,

“findings from CQC’s monitoring activity are reported annually in their Monitoring the Mental Health Act report, which is laid before Parliament and published publicly.”

That is true. She also notes the annual quality account reports produced by NHS healthcare providers under the Health Act 2009, which cover patient safety, treatment effectiveness, and patient feedback. True. Those are indeed important components of the current oversight framework, and we support the continuation and strengthening of those transparency mechanisms.

[Dr Neil Shastri-Hurst (Solihull West and Shirley) (Con)]

My hon. Friend makes a powerful point about transparency, but it is not just about that. Does he agree that it is also about having an evidence base that allows reform and improvement of the regulator?

[Dr Evans]

I do, and to expand the point, this is about understanding the performance of CQC as well. We know from the Dash report and from Mike Richards that there are, and have been, concerns about CQC performance. That is at the heart of this new clause—to try to make sure we actually look at the performance and regulation of the regulator. Those reports focus on the performance of mental health services and providers, but they do not amount to a dedicated statutory review of the regulator itself—specifically, the CQC’s role, effectiveness, and capacity under the Mental Health Act.

Annual reports primarily reflect the CQC’s monitoring outcomes rather than a comprehensive, independent evaluation of whether its regulatory functions are being discharged optimally, or whether it is adequately equipped to meet the new challenges posed by the legislation. In other words, reporting on what the regulator monitors is not the same as reviewing how well the regulator performs its duties.

The new clause would address that distinct gap by mandating a focused review with a parliamentary report and a Government response, thereby strengthening accountability at the regulatory level. The new clause aims to establish an additional layer of scrutiny, not duplicative reporting. It would require the Government, within 12 months of the Bill becoming law, to conduct a formal review of the CQC’s effectiveness, specifically in regulating mental health services under the 1983 Act. It mandates an assessment of whether the CQC is adequately fulfilling its duties, including monitoring, inspection, and enforcement responsibilities, as well as whether it will be capable of carrying out its duties under the new legislation. Given the well-documented problems in mental health, it seems entirely appropriate to address the key point: is the regulator regulating effectively?

[Dr Shastri-Hurst]

My hon. Friend makes a strong point about having a review to ensure that the regulator is operating effectively. Does he share some of my concerns that a one-off review may not demonstrate ongoing oversight and scrutiny of the performance of the regulator?

[Dr Evans]

We do not want to introduce too much bureaucracy, but ensuring an accountable statutory mechanism to ensure adequate oversight is incredibly important. Much of the debate about the Bill has been about whether we put things in primary legislation or in policy, or whether we allow policy and legislation to be done at a secondary level—or even leave them for the organisation to deal with. My concern with the CQC is that we have not seen the organisation step up in the way that it should do. That does not mean that it is not making progress, but we need to see further progress.

--- Later in debate ---

[Stephen Kinnock]

I am grateful to the Opposition spokesman, the hon. Member for Hinckley and Bosworth, for bringing this issue forward.

Two major independent reviews into the Care Quality Commission have reported under this Government: one by Dr Penny Dash, on the CQC’s operational effectiveness as a regulator of all health and social care providers including those in mental health, the other by Professor Sir Mike Richards on its single assessment framework. The CQC has accepted those recommendations in full, and although we are confident in the progress that the CQC is making, we recognise that the reviews did not closely inspect its statutory role in relation to monitoring the use of the Mental Health Act.

Those powers and duties are entirely distinct from those that the CQC uses to regulate the health and social care sector under the Health and Social Care Act 2008. In recognition of that gap, as the Opposition spokesman pointed out, we committed in the other place to report on that specific aspect of the CQC’s role in the first of the Government’s annual reports on the implementation of the Bill, which will be laid before Parliament one year after Royal Assent.

[Dr Evans]

The Minister mentioned the Government’s annual reports, but at other times he has said that they will issue written ministerial statements. Will he clarify which it will be? There is a big difference between a couple of paragraphs in a written ministerial statement laid before the House, and a full report. When debating the other clauses, new clauses and amendments, the Government’s answer has been that they will report back to Parliament in a year’s time. I am grateful for that, but clarity would be helpful, because a full and comprehensive report would give more weight to the Opposition in terms of understanding and transparency.

[Stephen Kinnock]

I can confirm that the information will be in a section of the written ministerial statement that will be tabled within 12 months of Royal Assent. We think that requirement makes the Bill more robust and effective, because it is an integral part of the entire ecosystem that we are looking at in terms of implementing this legislation and making sure we have the institutional capacity and capability. We think it helps to have the information as an integral part of the written ministerial statement, but the hon. Gentleman is right to point out that we should be clear in the definitions and language we use.

The written ministerial statement will be an overall implementation report. It will contain a number of sections, one of which will be on the role of the CQC and the inspection function. It will include reflections from the new chief inspector of mental health, Dr Arun Chopra, on the CQC’s statutory functions under the Mental Health Act, as well as its role as a key partner in the delivery of the reforms. The written ministerial statement—the report—will be laid before both Houses of Parliament within 12 months of Royal Assent. I hope the hon. Member for Hinckley and Bosworth therefore feels able to withdraw his new clause.

Question put, That the clause be read a Second time.

--- Later in debate ---

Finally, clause 59 states that the Bill’s short title will be the Mental Health Act 2025, once it becomes an Act of Parliament. I therefore commend clauses 55 to 59 and Government amendment 39 to the Committee.

[Dr Evans]

I will be brief. On this clause, I will be grateful if the Government can ensure good co-operation between the devolved powers, and if the Minister can set out how he will engage with the Welsh Government before exercising the power.

On clause 57, what consideration has been given to cross-border issues to ensure that there are no unintended consequences between the likes of England and Wales or Scotland and England? Clause 58 covers commencement; will there be a clear published timetable for that over the next 10 years? Will Government allow Parliament sight of the transitional provisions? We have talked about the annual written ministerial statement, which we have clarified, but will there be further tracking reports that we can look at?

Clause 59 states that the Bill will not impose new public spending or taxation, and yet the impact assessment lists £1.9 billion for the NHS in England, £396 million for local authorities, £2.5 billion for supporting housing and social care, and £287 million for legal costs and tribunals. Clearly, costs are associated with the Bill’s implementation over the next 10 years, so a money resolution is rightly required. When I raised those issues on our first and second days in Committee, the Minister rightly could not answer, because we had not had the Government’s settlement. We have now had that settlement, so I will be grateful to understand how the funding is to be applied to mental health on the community side and with regards to the Bill. Finally, given that we are dealing with Scotland, Wales and Northern Ireland, what are the Barnett consequentials of the Bill in ensuring the support implied in the clauses?

I am grateful to the Committee, the Clerks, the Chairs, everyone here and everyone who has helped me prepare. Committee stage has been a joy, but also a long trial to get through. I am glad to be present as the Bill proceeds, because it is the right thing for the country.

[Stephen Kinnock]

I thank the shadow Minister for his question about devolved powers. We have worked closely with the Welsh Government on the Bill. The Senedd has yet to vote, but the Welsh Government in their legislative consent memorandum recommended that it grants consent to the Bill. We also seek a legislative consent motion from the Northern Ireland Executive for extending—in Government amendments 37 and 38—the remit of the Human Rights Act 1998 to cover private care providers when providing certain services arranged for or paid by local by public authorities. I will look into the cross-border issues and, if something is there, I will certainly write to update the shadow Minister.

On the published timetable, the written ministerial statement will absolutely be a report on progress over the 12 months and will have a forward plan in it. I cannot say at this moment whether it will be a forward plan all the way through the proposed 10-year commencement period, because some of that will go beyond the spending review period, for example, but I assure the hon. Member that a timetable will at least cover the period of the initial spending review. I do not know whether there will be tracking reports—I will check that point with officials—but my sense is that the written ministerial statement will be the main hook to hang this on.

The shadow Minister asked about the money resolution. We have the overall financial envelope for the DHSC. There is now—how should I describe this?—intense dialogue going on between departments within the DHSC and across portfolios, so I think it will take a couple of weeks before we get the carve-up of the envelope across the different portfolios.

I note the shadow Minister’s point about the Barnett consequentials. I will look into it and come back to him.

It remains for me to thank you, Mr Vickers; everyone in Committee, for their very hard work; and all the staff and officials, to whom we are hugely grateful. I commend the Bill to the Committee.

Question put and agreed to.

Clause 55 accordingly ordered to stand part of the Bill.

Clause 56 ordered to stand part of the Bill.

Clause 57

Extent

Amendments made: 37, in clause 57, page 68, line 3, at end insert “subject to subsection (2).”

This is consequential on amendment 38.

Amendment 38, in clause 57, page 68, line 4, leave out “This section, section 55” and insert—

“Section (Human Rights Act 1998: extension to certain private care providers), section 55, this section”.—(Stephen Kinnock.)

This ensures that NC10 extends to England and Wales, Scotland and Northern Ireland.

Clause 57, as amended, ordered to stand part of the Bill.

Clause 58 ordered to stand part of the Bill.

Clause 59

Short title

Amendment made: 39, in clause 59, page 68, line 25, leave out subsection (2).—(Stephen Kinnock.)

This removes the privilege amendment inserted in the Lords.

Clause 59, as amended, ordered to stand part of the Bill.

Bill, as amended, to be reported.