Community Audiology

Luke Evans Excerpts

Thursday 18th December 2025 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Vickers, and I wish you and your team a merry Christmas. I thank the hon. Member for Uxbridge and South Ruislip (Danny Beales) for inadvertently creating what seems like a medical symposium; I feel as if I am back at one of my Christmas grand rounds—they often used to pick something a little bit strange and wacky to debate. I did not quite expect to be talking about spaniels’ ear canals, but I enjoyed the flashback none the less.

The hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) rightly talked about couples. When I was a GP, I saw couples become yin and yang, supporting each other on the basis of who had the hearing loss, who had the brains and who had the dexterity. If one of those problems is not sorted, there can be real impacts for the others. We should consider that when we deal with patients. The hon. Gentleman’s point about drawers of waste was a personal hobby horse of mine too—though it was not hearing aids, but often medication brought back to me, or seeing thousands of bandages or eye drops left over when I went on home visits, for example. That is a really important point and the NHS is not very good at picking up on it.

I thank the Father of the House, my right hon. Friend the Member for Gainsborough (Sir Edward Leigh), for raising the issue of stigma. My grandfather was particularly bad and stubbornly did not want to get a hearing aid, and even when he did get it, he would not wear it. My right hon. Friend also joked about his wife not hearing him, which reminded me of “Captain Corelli’s Mandolin”; at the start of the film, the pea is taken out of the ear, but at the end, because of all the nagging, he is desperate to get the pea reinserted.

My right hon. Friend also raised the issue of workforce, which is incredibly important when it comes to trying to solve some of these problems. The hon. Member for Uxbridge and South Ruislip set out clearly and coherently both the landscape and where we find ourselves. That is really important because, when people think about care delivered close to home, hearing loss services are among some of the most visible examples on the high street and in our community settings across the country. I visited the Specsavers on Hinckley’s high street, as well as the pharmacy in Newbold Verdon, only a couple of months ago to see what they provide.

There is a real opportunity to bring care towards people, which makes high streets a good bellwether for this Government’s ambition on prevention and community care and how that is being translated into practice. There are three issues I would like to press the Minister on. The first is the funding pressures on the ICBs, the second is access and self-referral, and the third is national oversight and data.

On access and self-referral, under previous NHS operational planning guidance, ICBs were asked to increase direct access and self-referrals into audiology services. That was a good move; it meant that people concerned about their hearing could go straight to specialist care without needing to see a GP first. In many areas, that has been a success. However, as we heard during the debate, 12 ICBs that commission hearing loss services still require a GP referral. That adds delays for patients and places unnecessary pressure on general practice, not necessarily for any clinical benefit. Against that backdrop, it is a little disappointing to see that self-referral was not included in the most recent operational planning guidance for 2025-26, nor in the medium-term planning framework. The question is why. Would the Minister explain why self-referrals seem to have been deprioritised, and what concrete steps the Government are taking to ensure that access to audiology does not depend simply on where someone lives?

On funding pressures and core services, Members have rightly highlighted the significant variation in access to routine audiology services, particularly earwax removal. In too many parts of the country, people are either being pushed back to the ENT departments or told to pay privately. I am glad that we have an eminent surgeon in the Chamber, the hon. Member for Bury St Edmunds and Stowmarket; from a GP’s perspective, I understand why some were reluctant to go back to having their ears syringed and I often dealt with complaints about why it was not suitable, as suction is the gold standard.

The question is how we provide that in a way that is deliverable to the community and provides to the patients, but is also at least cost-neutral for primary or secondary care. There is a conundrum there. That situation will be made worse, as the Father of the House pointed out, by our ageing population. When ICBs are under pressure and their budgets are changing—they are being cut by 50%—how do we ensure that that it is deliverable? That poses the question of how sustainable it is to place the responsibility of the full range of audiology services on ICBs, considering they are under constraints, and how will the Government square that circle. There is also the opportunity of public-private partnerships and neighbourhood centres to help to deliver audiology services. That could come as sites or services. I would be grateful if the Minister could set out what his vision is in this space, considering we are trying to take a leftwards shift.

There are also opportunities for new thinking. As I mentioned, I went to see a pharmacist. What supports have been put in place for new providers to come in? Pharmacists seem keen to be able to take on more services, and they often have sites directly in the heart of our communities—the closest place to our residents. Is there some consideration of what can be done to innovate in that space?

On data, oversight and accountability, one of the most striking features of audiology is how difficult it is to assess the performance nationally. The Government were right to set out their ambition to meet the NHS standard that 92% of people should wait no longer than 18 weeks from referral to treatment, and in most specialties we can clearly see how the system is performing against that ambition. However, in audiology it is harder, especially as the referral-to-treatment waiting time data, which was paused during the pandemic for understandable reasons, has since been retired by NHS England.

Looking ahead, given that the Government have confirmed their intention to bring forward legislation to abolish NHS England, with the statutory functions being taken into the system, will the Minister consider looking again at reinstating the referral-to-treatment waiting time data for direct audiology as a way to monitor the leftward shift that the Government are pushing for? If so, will that be done at ICB level or under the Department of Health and Social Care?

I would be grateful if the Minister could clarify two points. First, when does the Government expect to introduce the legislation in 2026? Secondly, it would be helpful to understand when we can expect the workforce plan: we were told that it was coming in the summer, then the autumn and, now that we are on the last day of business before Christmas, I expect it is coming in the new year. Knowing when that plan is coming, and how audiology will play a part in that, is really important.

Given the Kingdon review only came forward in November, it is unfair of me to ask whether the Government have fully assessed it yet. The review had 12 recommendations and also pointed out the oversight, and there is a question about how that will be resolved. With all the changes to ICBs, NHS England and the Kingdon review, I would be grateful to know when we will likely hear whether all recommendations have been accepted and will be resolved.

Audiology may not always attract attention in this House, but it is a vital part of our community healthcare and a real test of the Government’s commitment to prevention and access. I hope the Minister can provide clarity on the questions I have asked today. I wish you, Mr Vickers, your team, your colleagues, everyone in this House and my constituents a very merry Christmas.

[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your chairship, Mr Vickers. I start by thanking my hon. Friend the Member for Uxbridge and South Ruislip (Danny Beales) and congratulating him on securing this important debate. Having now been in the same room as a specialist in ear, nose and throat, a former GP and a vet, I am not sure that I am entirely qualified, and I approach this debate with some trepidation. I certainly enjoyed the debate and, as the Father of the House rightly said, it was a privilege to be able to hear some of the insights, direct experience and expertise of hon. Friends and Members.

My hon. Friend the Member for Uxbridge and South Ruislip has also been doing a huge amount of good work in promoting the flu vaccine ahead of winter, in his constituency and more widely, and I pay tribute to him for that. It was a pleasure to visit his constituency a few weeks ago, where I met the incredible team at the Pembroke centre in Ruislip Manor to hear about how they are delivering, designing and developing their thoughts about neighbourhood health hubs and the neighbourhood health service, which will be a pivotal part of our 10-year plan.

The Royal National Institute for Deaf People estimates that one in five people in the UK—almost 12 million adults—are deaf, have hearing loss or experience tinnitus, and by 2035 that figure is projected to rise to over 14 million. For people with cognitive disabilities, hearing loss can have a real impact on their quality of life, causing confusion for people with dementia, making communication and social interaction more difficult and increasing loneliness and isolation.

That is why our community audiology services are so important. They represent a comprehensive range of hearing care delivered in local, accessible settings, such as GP surgeries, community clinics and community diagnostic centres. They help people of all ages, offering assessments, hearing aid fittings and support for those with tinnitus and balance issues. They advise on equipment such as amplified telephones and alerting devices, while working alongside occupational therapists to support people to stay independent. They form part of a wider team with speech, language and other community services, acute care, and the ear, nose and throat department for issues that cannot be managed in the community.

Community audiology services face challenges, particularly on waiting lists and inequality of provision. Members across the Chamber raised some of those points. The Father of the House rightly pointed out that there are 6.7 million people who should use a hearing aid but do not. We must overcome the stigma associated with hearing loss.

The hon. Member for Honiton and Sidmouth (Richard Foord) was right to talk about the connection between hearing loss and the propensity for falls. My hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) shared his tremendous expertise as an ear, nose and throat surgeon, and I thank him for his insights about the Hear for Norfolk project, which is a very interesting model indeed. Perhaps we can follow up on it in the new year.

The hon. Member for Winchester (Dr Chambers) gave a remarkable exposition on hearing loss in dogs—I have to say that I did not have that on my bingo card for this afternoon—from which we all learned a tremendous amount. He also made a number of important points about hearing loss in humans, and we absolutely take them on board.

The hon. Member for Hinckley and Bosworth (Dr Evans) rattled off a number of questions for me, and I desperately tried keep track of them. I got some of them and did not get others, so I will happily write to him on the points that I am unable to address now. He raised an important point about self-referral, which of course depends on local commissioning arrangements. There is inequality and unwarranted variation in the ability to self-refer. We want more self-referral. We think there are opportunities in upgrading the functionality of the NHS app. Our objective is absolutely to be able to do this without having to go through a GP. There are some technology-related solutions, but I want to assure him that there is no conscious decision from the Government to deprioritise self-referral; I just think that there are some variations.

The old chestnut that we are constantly trying to crack is around devolving to ICBs the power and agency that they should have because they are closest to the health needs of their population, while ensuring that they are clear about the outcomes, frameworks and standards that we expect. We honestly hold our hands up and say that we have not got that right in all cases, but we are committed to self-referral as a principle and as a really important part of the shift from hospital to community.

On ICB budgets, we have secured £6 billion through the spending review process for capital upgrades. A lot of that will help us to ramp up what we are doing on community diagnostics. That is one way to square the circle around the investment that we need on the ground for ICBs to be able to do more in terms of the services they provide by improving the equipment, the kit and the technology they have. Part of the answer to the hon. Member for Hinckley and Bosworth’s question relates to capital investment really helping to boost the services provided.

The workforce plan is coming in the spring of 2026. I absolutely hear what the hon. Member says about the need to move forward on that. It has been a complex process. Obviously some of the changes and restructuring around what we are doing on NHS England have also had an impact on the process of putting the workforce plan together, but I am reliably informed that that will be in the spring of 2026.

Timely access and effective support to services can make all the difference to someone’s quality of life, wellbeing and independence. As part of our effort to shift care from hospital to home, this Government want to support people to live independently in the community, and community audiology will play an essential part in making that happen. Community audiology is commissioned locally by integrated care boards. Funding is allocated to ICBs by NHS England. Each ICB commissions the services it needs for its local area, taking into account its annual budget, planning guidance and the wider needs of the people that it serves.

This year, my right hon. Friend the Chancellor confirmed the Government’s commitment to getting our NHS back on its feet and fit for the future, with day-to-day spending increasing by £29 billion in real terms over the next five years. By the end of this Parliament, the NHS resource budget will reach £226 billion. That funding will support the growing demand for community health services, including audiology. It will help integrated care boards to expand diagnostic capacity, invest in local estates and equipment, and sustain the workforce needed to deliver high quality hearing care for patients of all ages. For the first time, we have published an overview of the core community health services, which include audiology, for ICBs to consider when planning for their local populations and commissioning processes.

Our medium-term planning framework for the next financial years sets out our ambition to bring waiting times over 18 weeks down, develop plans to bring waits over 52 weeks to zero, and to increase capacity to meet growth in demand, which is expected to be around 3% nationally every year. We are asking systems to seek every opportunity to improve productivity and get care closer to home, from getting teams the latest digital tools and equipment they need so they can connect remotely to health systems and patients, to expanding point-of-care testing in the community. Systems are also asked to ensure that all providers in acute, community and mental health sectors are onboarded to the NHS federated data platform and use its core products.

Our 10-year health plan sets out how we would make the shift from analogue to digital by making the NHS app the digital front door to services. We will make it easier for patients to access audiology services through self-referral. This will transform the working lives of GPs, letting them focus on care where they provide the highest value-add. This is how we will make sure everyone can self-refer—not just the most confident and health-literate. Patients can access NIH-funded audiology services directly without having to wait for a referral from their GP. That means improved access to care and shorter waiting times.

My hon. Friend the Member for Uxbridge and South Ruislip and other hon. Friends stood, as I did, on a manifesto to halve health inequality between the richest and poorest areas of our country. I know he will agree that access should not be based on where we live. A key part of our elective reform plan, published at the start of the year, is transforming and expanding diagnostic services so we can reduce waiting times for tests and bring down overall waits. NHS England is working closely with services to improve access to self-referral options, aiming for a more consistent offer right across the country.

[Dr Luke Evans]

I am grateful that a comprehensive plan is coming forward. One problem we have is joining the leadership up. The Kingdon review, which was launched in May and finished in November, made 12 recommendations that will help align with all the missions the Minister is bringing forward. Can he tell us when the Kingdon review will be accepted and analysed by the Government, and their position on the recommendations, because it is a key thread to delivering all the ambition that he has rightly put forward?

[Stephen Kinnock]

I can—we are absolutely committed to responding to the Kingdon review next year. We are working on pulling together our response to the report. It is extremely important, and there are serious lessons to be learned from it. We think Dr Kingdon has done an excellent piece of work, and we are very keen to build on it and take it forward.

Community diagnostics, such as local hearing assessment clinics and testing in community settings, are being rolled out more widely through the expansion of our community diagnostic centres. We are opening more of these centres—12 hours a day, seven days a week, offering more same-day tests, consultations and a wider range of diagnostics. I am very proud that we now have 170 CDCs across England.

Almost 2 million audiology assessments have been carried out by NHS staff since this Government took office, including 136,000 tests in October—the highest number of audiology tests for a single month in the history of the NHS. This is a crucial step in supporting the NHS to meet its constitutional standards and deliver quicker care to patients. I also want to salute the work of the Welsh Government, who have been pioneers in many respects with their plan, published this week, showing how Wales is also leading in audiology services on care in the community, training and infrastructure.

The hon. Member for Hinckley and Bosworth asked about the Kingdon report, and in this debate on audiology services, I must take this opportunity to thank Dr Camilla Kingdon for the excellent review that she chaired into failures in children’s hearing services. As I have just told him, the Government are committed to responding to the recommendations made by Dr Kingdon, and we will publish a comprehensive response next year.

Community audiology services face challenges, with long waits and inconsistency in access to services, but we are taking action through the medium-term planning framework, by expanding community diagnostic centres and as an integral part of our 10-year plan. My hon. Friend the Member for Uxbridge and South Ruislip and I come from a political tradition based on solidarity, and this Government stand for a health service that leaves no person behind. I know that he shares my determination to get timely access to community audiology services for all 12 million of our compatriots who need them.

I thank my hon. Friend once again for bringing forward this extremely important debate, and I thank all Members who have spoken. It only remains for me to wish you, Mr Vickers, as well as your entire team and everyone else in the Chamber, all the very best for Christmas and the new year.

Mental Health Bill [Lords]

Luke Evans Excerpts

Consideration of Lords message
Monday 8th December 2025 Commons Chamber

[Stephen Kinnock]

Yes, we absolutely do agree. As the hon. Gentleman will hear as I proceed with my speech, we have three options in respect of what will happen in exactly the scenario that he has mentioned, and that has been very much the spirit of the amendment on which we have agreed with the other place.

We will put patient feedback and outcomes front and centre by improving the transparency of reporting across in-patient and community mental health services. We will introduce an early warning system so that we can intervene earlier, using patient and staff feedback and clinical information to identify services that are at risk of providing poor-quality care. That is alongside our commitments to roll out mental health support teams in schools and colleges to full national coverage by 2029, to employ an extra 8,500 mental health workers by the end of the Parliament, and to pilot new 24/7 neighbourhood mental health centres across the country. Once implemented, this long-awaited and transformational Bill will give patients greater choice and autonomy and enhanced rights and support, and will ensure that everyone is treated with dignity and respect throughout their treatment.

Let me now briefly outline some of the commitments made by my ministerial colleague Baroness Merron in the other place. In response to the amendment tabled by Baroness May, the Government announced plans to launch a consultation on emergency police powers of detention. The consultation will look at in particular, but will not be limited to, sections 135 and 136 of the Mental Health Act 1983, as well as exploring joint working approaches across organisations. We have committed ourselves to working with stakeholders as we define the scope of the consultation.

In the other place, following engagement with Baroness Berridge, the Government tabled amendments in lieu regarding the appointment of a nominated person for a child under 16 who lacks competence. The amendment states that if no local authority has parental responsibility, an approved mental health professional—an AMHP—must appoint a person who has parental responsibility, a person named in a child arrangements order as a person with whom the relevant patient is to live, or a person who is a special guardian. If there is no suitable person with parental responsibility who is willing to act, the AMHP must consider the child’s wishes and feelings when deciding whom to appoint.

This amendment clarifies whom AMHPs should appoint as the nominated person, and gives priority to those with parental responsibility. We intend to use the code of practice to outline what factors and nuances an AMHP should consider when making the appointment decision. If the AMHP later discovers that another of those on the list is more suitable to act as the nominated person, the legislation allows him or her to terminate the appointment of the nominated person and appoint the special guardian instead.

I thank Members on both sides of the House for their support for the Bill, and look forward to hearing their contributions.

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

I have talked about roads and bridges throughout the duration of the Bill. We have now reached the end of the long road that was, of course, embarked on by Baroness May in 2018 with the independent Wessely report, which was the foundation of this legislation. It constitutes a cross-party, cross-departmental look at how we can improve the lives of people with the most serious mental health issues.

I was pleased to hear the Minister start to talk about the difference between mental health and mental wellbeing. That is fundamental when it comes to dealing with our policies and how we will take the country forward, because while not everyone has a serious mental health problem, everyone has problems with their mental wellbeing. Ensuring that we have that distinction worked out will be vital to providing the right support for the right people in the right place, and, ultimately, that is what the Bill is dedicated to doing. I have talked in the House about why that is so important. This Bill, above all others, deals with the most vulnerable people in society—those who are seriously mentally unwell—so I am pleased that we have reached a stage at which we can take it forward and put it into law.

I was also pleased to hear the Minister comment on the amendment from the other place, and the concerns raised by Baroness Berridge. I understand the points that he has tried to make and the clarifications that the Government have tried to introduce in relation to the amendment. He has said that he will look at the code of conduct in respect of the seriously difficult positions in which mental health professionals might find themselves during an evening of dealing with a parent who is contesting with a child the question of who is to be the nominated person. I am glad that the Government are looking at the code of practice, and we will not be dividing the House tonight.

That being said, as with the 10-year plan that the Government have brought forward, there is a synergy here. The synergy is this: Members on both sides of the House agree with the thrust of the 10-year plan and this Bill, but the problem is that there is no delivery chapter. That was the Opposition’s concern when the Government were taking the Bill forward. As the Minister conceded in Committee, it will be a challenge, but without a delivery plan it becomes very difficult.

[Tom Hayes (Bournemouth East) (Lab)]

Before I was elected, I ran mental health and complex needs services for five years. I saw a landscape that had pretty much been devastated under the Conservatives, and one way in which it had been devastated was through the loss of Sure Start. The Institute for Fiscal Studies produced a report this year that showed that Sure Start led to a 50% reduction in hospitalisations for 12 to 14-year-olds. The shadow Minister talks about the ways in which we can deliver better mental health. Does he agree that Labour’s roll-out of a revamped Sure Start is just one of the many ways in which we are helping to improve children’s mental health?

[Dr Evans]

The hon. Gentleman makes a very good point, but he has also missed the point. He gives me the opportunity to point out that one way in which the previous Government dealt with this issue was by bringing forward the mental health investment standard, under which the proportion of spending on mental health had to mirror the spending on physical conditions. That was starting to lead to real change. Alas, under this Government, there is a concern that the standard has not been met. We know that the proportion of mental health spending has fallen under this Government, according to the written ministerial statement that they put out.

That leads me on nicely to the point that I wanted to raise: how will we fund the models that are coming forward? That is the crux of the matter that people outside the House will be looking at; it is a direct question, and it is the only one that I have in this debate. We on this side of the House have raised this issue in the debates we have had on both palliative care and mental health, and I raised it with the Minister only last week. The Chair of the Health and Social Care Committee, the hon. Member for Oxford West and Abingdon (Layla Moran), has raised this question again and again. Are the Government committed to the investment standard or not? Is it something that they have dropped? The House and the wider public need to know, so that we can plan for service provision. If the Government are dropping it, that is on them, and they need to explain the reasons why they are doing so. Maybe there is alternative investment, but as a starting point, the investment standard will be crucial in dealing with the mental health challenge, which is growing despite the pandemic and all the investment that has already gone in.

[Tom Hayes]

I have written more mental health investment standard funding applications than I care to remember. Although investment is obviously important, one major challenge with that stream of funding was that I had to apply on an annual basis. There was no certainty around multi-year settlements, so I was repeatedly setting up projects for which I could not find the funding to keep them going. That created more disruption in mental health support. We need to have stable, continuous funding settlements that actually meet the need that has been identified by the data and patient experience. That is what the Government are delivering, and to latch on to a particular funding stream and claim that somehow it is not being provided with support, when actually there is the wider of goal of tackling mental health through different methods—

[Madam Deputy Speaker (Caroline Nokes)]

Order. The hon. Gentleman will know that there is ample opportunity for him to contribute to the debate. That was a very long intervention.

[Dr Evans]

I am grateful to you, Madam Deputy Speaker, for stepping in on that basis. We have had plenty of chances to debate this Bill, both in Committee and many times in the mental health debates that I am partial to. We could go through why the last Government changed the interventions of NHS England and brought in integrated care boards to allow for a joined-up structure to be put in place. We now see a new iteration coming forward but, yet again, we do not know how much it will to cost to get rid of NHS England. We do not know the redundancy packages for the ICBs and how much they will cost. That is fundamental.

One thing we do know is that, as the chair of the Royal College of Psychiatrists has said, the change to the investment standard alone will cost the sector £300 million. That is investment that could have made a difference to mental health provision. I do not want to get into the heated politics any further, and I do not want to delay the House any further this evening, but the Government’s position on the mental health investment standard is crucial when it comes to delivering this Bill.

I thank the Minister for his constructive approach, and for the way in which he has taken ideas forward and looked through the Bill in fine detail. I know he cares deeply about getting this right, as do many Members of this House. It is imperative to ensure that compassionate, modern care is delivered to those who need it most when it comes to dealing with serious mental health conditions.

[Madam Deputy Speaker]

I call the Liberal Democrat spokesperson.

[Stephen Kinnock]

With the leave of the House, I will make some brief concluding remarks. I am very grateful to Members of this House for their contributions both today and throughout the passage of this Bill. I believe that by drawing on the lived experience of both Members and our constituents, we will be able to strengthen the intended impact of this legislation on people with serious mental illness and their loved ones. The passage of this Bill has seen the best of parliamentary commitment and co-operation, and the conduct of Members and peers has been collaborative and well-intentioned throughout.

For too long, mental health reform legislation has sat on the shelf. This Government made a manifesto commitment to modernise the Mental Health Act 1983, and we have delivered that within our first Session, providing an opportunity to transform the way we support those with severe mental illness and providing patients with greater choice and autonomy. I am reminded of what a patient in the 2018 independent review said:

“I felt a lot of things were done to me rather than with me”.

This Bill takes forward many of the changes put forward by the independent review, the recommendations of which were rightly shaped by the views of patients, carers and professionals.

Many have asked about next steps and implementation. Post-Royal Assent, our first priority will be to draft and consult on the code of practice. We will engage with people with lived experience and their families and carers, staff and professional groups, commissioners, providers and others to do that. The code will go to public consultation, as well as being laid before Parliament before final publication. Alongside the code, we will develop the necessary secondary legislation. We will then need time to train the existing workforce on the new Act, regulations and the code. We estimate full implementation will take around 10 years due to the time needed to train the workforce and the need to ensure that the right community support is available. This timeframe necessarily spans multiple spending review periods and multiple Parliaments, so we are limited in the detail we can give about future spend and timelines. But we have committed to an annual written ministerial statement on implementation. This commitment will last for the 10 years or until the Bill is fully implemented, whichever is sooner.

[Dr Evans]

I appreciate that the Minister cannot commit to a financial spending envelope now, but is it not the case that the mental health investment standard is something that the Government could commit to?

[Stephen Kinnock]

Yes, I was just coming on to that, because the hon. Gentleman raised it in his speech. We are protecting the mental health investment standard in real terms, as it will rise in line with inflation. Our position is quite straightforward. We feel that for far too long the NHS has been run by a series of input-based targets which micromanage frontline leaders, while failing to ensure improvements in patient experience and care. We are bringing the era of command and control to an end, setting frontline leaders free to innovate and run their services as they know best.

I also remind the Opposition spokesman that we are investing £473 million in capital funding in mental health nationally over 2026-27 to 2029-30. That funding will: support the establishment of a 24/7 neighbourhood mental health service; deliver mental health emergency departments, known as crisis assessment centres; expand neighbourhood mental health services; eliminate inappropriate out-of-area placements; and increase crisis accommodation for people with learning disabilities and autism. I gently say to the hon. Gentleman that when we see a rising tide lifting all the boats, we are connecting our mental health spend to that rising tide. We are then seeing a rise in real terms on what this Government are spending on mental health across the board.

I am very happy to again meet the hon. Member for Winchester (Dr Chambers), the Liberal Democrat spokesman, and look at that particular issue. He raised it in Committee. I hope that some of the things I have just set out will help very much on the tragedy of suicide in our country. We are very conscious of how much we need to do to combat that.

I put on record my thanks to all Members and noble peers who have paid such a close interest in the development of the proposals, along with the officials and parliamentary staffers who have supported us to do so. The officials involved in the Bill are too many to mention, but I would like to pay tribute to colleagues in my private office, Emily Cowhig and Penny Sherlock, who have done such sterling work on the Bill, supporting me and the entire team throughout.

Transforming mental health care for the most vulnerable patients with serious mental illness requires the Bill to pass into statute. I am therefore grateful to hon. Members for their support in enabling us to do so.

Lords amendments 19B and 19C agreed to.

Terminal Illness: Mental Health Support

Luke Evans Excerpts

Wednesday 3rd December 2025 Westminster Hall

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

The old adage we often hear is that there are two certainties in life—taxes and death. We spend a lot of time in this House talking about the former and very little time speaking about the latter, even though we know it will affect us; I have argued that both as a doctor and in this House since I was elected.

I take my hat off to the hon. Member for Altrincham and Sale West (Mr Rand) for securing this debate. It is so important and it will affect all of us. We are informed by the work of our constituents, so I also put on record my thanks to Mike for his incredible story and for the memory of Sarah that he has brought to this place, at the highest level, so that we can have this debate about how we can improve the condition of those in their time of greatest need.

In the few minutes I have, I will distil this debate into three areas: first, the location of mental health care, secondly, the workforce and, thirdly, the plan. On the first point—I have raised this with the Minister before—hospices often provide a lot of mental health support, but they are struggling. Many are closing beds and many are in deficit. Together for Short Lives estimates that the national insurance contributions increase costs an average hospice at least £130,000. After a previous debate on hospices, I asked the Government in a letter of 10 November, to which I have not yet had a response, whether they will consider an impact assessment on the state of hospices.

The National Audit Office’s report into hospices states:

“DHSC and NHS England do not know what proportion of the total amount of palliative and end-of-life care provided in England is delivered by the independent adult hospice sector, and therefore how reliant they are on the sector.”

That is an important point in understanding the fabric and make-up of provision, as well as the postcode lottery in provision, which the hon. Member for Dewsbury and Batley (Iqbal Mohamed) pointed out. If we want to improve provision, we need to understand what is there in the first place.

To do so, we need to provide a workforce, as I also said in the letter. A letter I received from the Government on the topic of hospices stated:

“This summer, we will publish a refreshed NHS long-term workforce plan to deliver the transformed health service we will build over the next decade so that patients can be treated on time again.”

I raised this issue in the November debate. We are now into December, and winter, and we still do not know when the NHS workforce plan will come forward. I would be grateful if the Minister could respond to that point. It is especially important given that, in the last Budget, the Government cut the proportion of spending on mental health care. At the time, the president of the Royal College of Psychiatrists said:

“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.”

The previous Government brought in the mental health investment standard, but it is not clear whether this Government are adhering to it or keeping it in place. It will be important in ensuring that we have the investment to provide both the places and the workforce.

I welcome the bringing forward of the palliative care framework, which Opposition Members and many others on both sides of the House have asked for. I am pleased that the Government have set that out, because it will be the framework that provides the care we need across the country. It is also timely, given that the Terminally Ill Adults (End of Life) Bill is going through Parliament. An amendment to the Bill, which was nodded through with support from both sides of the House, will ensure that there is a financial plan for what palliative care should look like. It will be imperative that considerations about mental health care for the terminally ill are involved in that framework.

In his November debate, the hon. Member for Strangford (Jim Shannon) raised the issue of a 24/7 palliative care helpline, which many across the House and many charities have asked for. In the debate—before we had heard about the framework—I asked whether that would be looked at as part of the framework, because that 24/7 point of contact could form part of the mental health support that families get when they are struggling and in their time of need. I would be grateful if the Government would consider that.

I appreciate that this is not in the Minister’s brief, but I would also be grateful if he could set out how the palliative care framework will be put together. Who are the stakeholders? How can people like Mike and interested Members contribute to ensuring that we get it right? We want this House to do it only once; we want to get the framework right for England, and hopefully across the home nations as well, so it will be incredibly important that all stakeholders are involved.

We in this House need to ensure that others can hold what those who are struggling find too heavy to hold. That is the essence of what we are trying to do, whichever side of the House we are on or whether, like Mike, we are outside this House. We are trying to make sure that when someone is in their time of need, and when they feel the burden is too heavy, they can hand it on to someone else, who will help to carry that load.

[The Parliamentary Under-Secretary of State for Health and Social Care (Dr Zubir Ahmed)]

It is a pleasure to serve under your chairmanship, Sir Jeremy, and I start by sincerely thanking my hon. Friend the Member for Altrincham and Sale West (Mr Rand) for securing this debate. I also welcome Mike and his family to the Public Gallery, and pay tribute to Mike for all his efforts.

My hon. Friend raises an important issue that can affect so many people—all people perhaps, at some point—about ensuring that when someone is diagnosed with a terminal illness, they can receive the mental and emotional support that they need in the place that they need it. We want to be a society where every person receives high-quality, compassionate and personalised care from diagnosis through to the end of life. The Government are determined to shift more healthcare out of hospitals into the community to ensure that patients receive personalised care in the most appropriate setting.

Palliative care and end-of-life care services, including those provided by hospices, have a big role to play in that shift. Palliative care services are included in the list of services that an integrated care board must commission, promoting a more consistent national approach and supporting commissioners to prioritise palliative care and end-of-life care. To support that process, NHS England has published statutory guidance stating that ICBs must work to ensure that there is sufficient provision of care services to meet the needs of their local population. It also includes references to mental health, wellbeing and support for those with palliative care and end-of-life care needs.

Of course, there are many examples of voluntary initiatives, such as grief or bereavement cafés, or the Good Grief community, which aims to support people at the end of their life and their families through a programme of events and courses, and the provision of resources that often include pre-bereavement advice and support.

I know that my hon. Friend the Member for Altrincham and Sale West feels passionately about mental health support for those with palliative care and end-of-life care needs, and that he has been supporting Mike’s campaign for improved mental health services and support. I offer him my deep appreciation, as well as a meeting with the Minister for Care and end-of-life care officials, so that we can engage him around the palliative care and end-of-life care modern service framework that was recently announced, which we hope to publish in the spring.

The Government are also transforming the current mental health system, ensuring that people get access to the right care at the right time in the right place. That is why we are increasing our investment in mental health support by £688 million in cash terms.

The hon. Member for Hinckley and Bosworth (Dr Evans), who spoke for the official Opposition, talked about impact assessments. I gently say to him, in the context of this convivial and constructive debate, that when we came into office we had an impact assessment by virtue of the Darzi review, which highlighted in stark terms the difficulties that the NHS in its totality is under after 14 years—the difficulties that we inherited. I also point out that our real-terms investment of £26 billion is an increase to the NHS budget that will translate into, among many other things, a new national cancer plan. That will examine not only the process of getting the best treatments to patients, but improving communication, improving pathways, and instilling better and more bespoke mental wellbeing support into some of those pathways.

[Dr Evans]

The Minister is indeed right to say that there was an injection of cash, but the proportion of funding being spent on mental health was actually cut. The written ministerial statement is very clear that that proportion went from 8.78% to 8.71%, which the royal college said was about £300 million of investment. Can he confirm from the Dispatch Box—if he cannot, he can write to me later—whether the Government are still committed to the mental health investment standard, or is that commitment going to change? Currently, it is unclear whether they are still committed.

[Dr Ahmed]

The mental health investment standard is something that we expect ICBs to meet. I will gently push back on what the hon. Gentleman is saying because, as we have been so succinctly reminded in this debate, investing in mental wellbeing is about more than just headline figures. For instance, we need psychology in oncology, in children’s health, and in other forms of cancer care. The provision of such services is not always recorded in the way that the hon. Gentleman would wish it to be recorded, but there are still formats and sub-types of mental health support.

The Government are also keen to press ahead with our 10-year plan, and we are setting out ambitious plans to boost mental health support across the country while delivering the shift from hospital to community. As part of that process, we wish to open around 85 mental health emergency departments, reducing pressure on busy A&E services, which are the last places that people with mental health needs should be, and ensuring that people have the right support they need in a calm, compassionate environment.

We will also use new integrated health organisations to break down barriers between services, which I also think is really important in the context of this debate, and to ensure integrated and holistic care, addressing both physical and mental healthcare needs, with more freedom to determine how best to meet the needs of those local populations. That will build on the work that has already begun to bring down waiting lists. As I said, we are investing an extra £688 million this year to transform mental health services. On staffing, I am pleased to say that almost 7,000 extra mental health workers have been recruited since July 2024, against our target of 8,500 by the end of this Parliament.

We are also expanding talking therapies, and we have committed to continuing that expansion over the coming years. More adults already benefit from better access to those therapies, and the aim is for over 900,000 people to complete a course of treatment with improved effectiveness and quality of services by March 2029. Anyone who develops a common mental health condition, such as anxiety or depression, in any context, including terminal illness, can self-refer to talking therapies. [Interruption.]

Oral Answers to Questions

Luke Evans Excerpts

Tuesday 25th November 2025 Commons Chamber

[Wes Streeting]

A clock stop would be in place from the moment the patient saw the consultant. The reason we have had to do waiting list validation is that, in addition to driving waiting lists up, the Conservative party presided over a total shambles where patients were often waiting in duplicate slots on the waiting list, removed from waiting lists unnecessarily or waiting far too long. That is the mess we inherited from the Conservative party.

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

What’s the answer?

[Wes Streeting]

It is no use shadow Ministers heckling from the sidelines. When they had the chance, they drove waiting lists up, and they drove the NHS into the abyss.

--- Later in debate ---

[Mr Speaker]

I call the shadow Minister.

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

When it comes to hospital provision, the Conservatives believe that we should continue to use private providers to improve access and reduce waiting times. We believe the Government should not let spare capacity go to waste on ideological grounds; we should continue to make use of private-sector capacity to treat NHS patients where available. Does the Minister agree?

[Karin Smyth]

I am sure this is leading somewhere else but, broadly, yes, I think I do.

[Dr Evans]

I am pleased to hear that the Minister does, given that it is her current policy. The last time the Government brought in private finance, they brought in the private finance initiative, which brought in £13 billion of investment. The problem was that it cost the taxpayer a whopping £80 billion, and hospitals are still paying decades on. This time around, will the Government give a cast-iron guarantee and complete confidence to the public that this is not Labour’s version of PFI mark 2?

[Karin Smyth]

Yes, I can give the hon. Gentleman that guarantee. The last Government could have learned the lessons of some of the PFI schemes that were very costly and did not run. Why did they not learn those lessons? Why did they not take action to reverse some of the decline? Why did they not take control of the system and do something about it? We have learned the lessons from those schemes, thanks in part to the great work done by parliamentarians on Committees such as the Public Accounts Committee. The new system to build the new neighbourhood health centres, which are fundamental to our drive to shift care out of hospital, will be different and will be publicly owned; they will revert to the public. The schemes are fundamentally different, and I am very happy to talk about it in more detail.

Myalgic Encephalomyelitis

Luke Evans Excerpts

Wednesday 19th November 2025 Westminster Hall

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

I try to take a positive outlook. The one thing the pandemic did was shine a spotlight on the likes of long covid and ME, and I know from my medical career how difficult that can be. I would like to thank Sajid Javid, who in 2022 announced the plan for ME, and I congratulate the Minister because she brought it to fruition on 22 July 2025. There are some similarities between the NHS 10-year plan and the ME plan: the ME delivery plan is fantastic, and a lot of people agree with it, but, importantly, there has been a lack of delivery. Action for ME has said:

“The Plan also lacks clear accountability structures with no mechanisms to measure impact or deadlines to hit. We are concerned that despite this well-meaning Plan being published, it will have no material impact on the historically stigmatised and ignored ME community. Action for ME wants to work with MPs, Ministers and Officials to improve its implementation.”

It went on to say that the delivery plan on ME/CFS fails to include a “strategic approach” to ME research. However, that was not the only group to say so; the ME Association said:

“There is no clear ambition or strategy to drive consistent implementation of the NICE guideline recommendations”

across ICBs. It went on to say:

“Severe and very severe ME receives minimal attention, despite known risks during hospital admissions”.

It also said:

“Several of the Plan’s own deadlines have already passed, and it is unclear what progress has been made.”

In the short time that I have, I want to focus my questions on two areas: action and accountability. The first concerns the questions that those living with ME will have, particularly when it comes to the changes around the Department for Work and Pensions and what that will look like in the light of the imminent Timms review. I would be grateful to understand what plans the Government have for both Departments to discuss what this will look like, given the scale of the problems facing the 400,000-plus people with ME/CFS in this country.

Secondly, turning to the actual plan, we need to look at what actions will be delivered. I am keen to look at the section called “After publication of the FDP”, because it goes on to say that

“we will monitor the actions included in it. The DHSC secretariat will continue to engage with the Task and Finish Group in an appropriate form as required”.

Given the debate today, is that required, and what form will it take?

The document also goes on to say that a

“sub-group will be created to focus on improving care for those with ME/CFS.”

Has that group been created, and how many times has it met? It further states:

“We recognise the needs of those with ME/CFS and we remain dedicated to developing our approach as new research emerges and as we seek further engagement.”

Could I press the Minister on what that engagement is? Who is it with, and what does it look like? At the end of the day, there is a plan here and we do agree with it, but it is the actions and accountability within it that are truly going to make a difference.

ME may challenge the body, but it never diminishes a person’s worth or their hope that they carry. That is critical. When we have such a great plan, it is the action that is going to take it forward.

--- Later in debate ---

[Ashley Dalton]

I recognise my hon. Friend’s points, and I will cover some of them in my remarks. She will be aware that the women’s health strategy is currently being refreshed, so we hope to dovetail wherever possible.

I want to set out the steps that this Government are taking to change the misunderstanding, stigma and inconsistent care that patients have experienced. Through our ME/CFS final delivery plan, we will deliver better care, boost research and ensure that every person living with ME/CFS is treated with dignity and compassion.

First, let us acknowledge the reality. ME/CFS is a complex multi-system condition. Its fluctuating nature makes diagnosis and management challenging. Historically, services have been extremely varied, and in some cases patients have felt dismissed or rejected by the healthcare system. That is unacceptable. We have heard those concerns loud and clear through our extensive consultation on the interim delivery plan and through ongoing engagement with patients, carers, clinicians, researchers and charities. Last year’s prevention of future deaths report following the tragic death of Maeve Boothby O’Neill further highlighted the urgent need for reform, pointing to a lack of specialist beds and inadequate training for clinicians. We cannot and will not allow such failings to continue.

In July, we published the ME/CFS final delivery plan, marking a significant milestone in our commitment to improving lives. The plan is built around three core themes: boosting research, improving attitudes and education, and enhancing care and support. With a clear commitment to ensure that people with ME/CFS can live as independently as possible and see their overall quality of life enhanced, that plan will help us to take an important step towards achieving that, but we acknowledge that there is more to do. We will continue to build on the foundation of those actions well beyond the publication of the plan. It is the springboard—the beginning, not the end.

Although the final delivery plan does not include every suggestion received through the consultation responses or through the task and finish group, it does not mean that those proposals will not be considered in the future, subject to resource and funding. We look forward to continuing those conversations.

[Dr Luke Evans]

The Minister attended the task and finish group, as did I. Will it meet again to consider that?

[Ashley Dalton]

I will come to the task and finish group in my remarks.

Research is the key to unlocking better treatments and improving quality of life. As has been mentioned, we have seen progress through projects such as DecodeME, the world’s largest genetic study of ME/CFS, which is funded by the National Institute for Health and Care Research and the Medical Research Council. Preliminary findings from the study indicate genetic differences in eight areas linked to the immune and nervous systems in people with ME/CFS. That discovery of specific genetic signals may help us to understand the biological pathways involved in ME/CFS in the future.

However, we need to go further. That is why the plan includes a funding offer and a commitment to continue working with researchers, industry and patient groups. New awards announced this year include funding for repurposed treatments and £845,000 for a large infrastructure project called PRIME, or, to give it its full name, Building Infrastructure for Patients, Researchers and Industry for ME/CFS.

Together with the MRC, we are actively exploring next steps in ME/CFS research. For example, earlier this month we co-hosted the research showcase event for post-acute infection conditions, including ME/CFS. It brought together people with lived experience, researchers, clinicians and funders to help to stimulate further research in this field. We are now considering the discussions that took place at the showcase to explore the next steps to stimulate further research. The output of that event will be circulated as soon as possible.

The final delivery plan also sets out actions to improve access to specialist services—to provide better support for children and young people, and their families, and to address employment challenges. It aligns with our 10-year health plan, which includes the roll-out of neighbourhood health services, bringing care closer to home and ensuring that multidisciplinary teams can support people with complex conditions such as ME/CFS.

Provision varies across the country and we are determined to reduce those inequalities. The final delivery plan includes actions to improve service mapping and workforce training so that every patient, regardless of postcode, can access the care they need. NHS England is working closely with the Department to support ICBs in commissioning equitable evidence-based services. Two of the most important actions in the plan are focused on NHS services. NHS England has already started its work on co-designing resources for systems to improve services for mild and moderate ME/CFS.

[Dr Evans]

Given that NHS England is due to be abolished, who will take that on?

[Ashley Dalton]

While NHSE is in the process of being dismantled, all its functions continue, and the new Department of Health and Social Care will continue all its work. None of that is being got rid of; it is simply being brought together into a more efficient, new Department of Health and Social Care. The Department will continue to meet a group of key stakeholders to move the work forward on mild and moderate ME/CFS in the coming weeks. Additionally, I confirm that the DHSC has already started conversations with NHS England to explore a specialised service prescribed by the Secretary of State for Health and Social Care for severe ME/CFS. That work will continue.

Changing attitudes is as important as changing services to many people with ME/CFS who have faced disbelief or stigma. As outlined in the plan, we will address that by launching a public awareness initiative to improve understanding of the condition and the support available. We will work with schools, employers and social care providers to ensure that children and adults with ME/CFS receive the information and support that they need.

Suicide: Reducing the Stigma

Luke Evans Excerpts

Wednesday 19th November 2025 Westminster Hall

[Michelle Welsh (Sherwood Forest) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Mundell.

Today’s debate on reducing the stigma associated with suicide is of grave importance to my constituents, particularly those in Ollerton, which has one of the highest suicide rates in the country. We know that the suicide rate is three times higher for men than for women, and although there are many contributing factors to that, one of the most significant is the stigma associated with asking for help and speaking up about mental health. There are so many societal pressures saying what men should be and how they should act. Often that involves appearing strong and as if they can face any problem head-on and by themselves. This starts very early. As a mother to a boy, I know that the attitude towards boys is often that they have to be strong, be tough and face things head on, and that crying is a weakness. It is ingrained by society in boys at a very young age. As a mother, I am consistently having to battle with those things.

The stigma of suicide affects not only the person struggling, but the people around them. Often loved ones do not know that someone is struggling and are left feeling confused and heartbroken. There is a ricochet effect to suicide, especially on the family and friends left behind. I know that because our family lost someone to suicide. The act of suicide leaves you grieving for a life gone too soon. It leaves questions, anguish and guilt and a space that will never be filled again. Mark was a son, a brother and a friend. I therefore welcome the Government’s landmark new health strategy, which will help to tackle men’s mental health challenges.

I want to take this opportunity to highlight the incredible work of a Nottingham organisation: In Sam’s Name. After the death of Sam Fisher, Sam’s friend Richard McHugh wanted to create a safe place for males to break the stigma of talking about their mental health and help them realise that they are not alone. Their peer support group helps members find strength from men who have previous experience, or are also suffering with mental health issues themselves. Through the power of conversation, friendship and support, men in Nottinghamshire are saving lives. I will never fail to be astonished at the ability of people who have experienced unimaginable pain to use that in pursuit of making the world a better place for others. The organisation runs several groups in Nottinghamshire communities, including in Ambleside community centre in Ollerton, and has a partnership with our fantastic local football team, Ollerton Town football club. It is vital that we take this conversation directly to men where they spend their time, and that—especially in my constituency—is at the football.

We must also ensure that our communities are equipped with the necessary infrastructure to give help and support when it is needed. Access to healthcare in Ollerton is poor. Given its rural nature and high levels of deprivation, it is no stranger to the struggle to access basic services. Deprivation is a huge factor in suicide: rates in areas of high deprivation are almost double those in areas of low deprivation. If we are to reduce the stigma around mental health and suicide, people, no matter where they are born in the country, need access to healthcare and support. For Ollerton, that must include a super health centre where people can walk in off the street and access the healthcare they need. Working in collaboration with Ollerton Town football club, we want to transform lives, and that could work in combination with a healthcare centre.

I hope that the Minister will join me in recognising the importance of access to health services and support in showing men that there are places to help and people willing to listen. Nowhere is that more important than in Ollerton, where there is such a high rate of male suicide. Perhaps he would like to get on a train to sunny Ollerton, visit the football club and meet In Sam’s Name—

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

indicated assent.

[Michelle Welsh]

The shadow Minister has obviously been to Ollerton before.

The Minister should go to see the fantastic work In Sam’s Name does, because it could be replicated across the country and have a huge impact. It would also allow him to see an area with fantastic people who support one another, but which is suffering because it does not have the services or infrastructure to combat suicide, and that is what we need to save young lives.

--- Later in debate ---

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

I want to start by finishing where I left off in the main Chamber in the debate during Suicide Prevention Month. I talked about a TikTok meme that was going around about where men go, and who they turn to, when they are at their lowest. The answers in that video are all “no one”: “No one cares”; “There’s no one”; “It’ll be used against me.” I want to speak to the people in that video, because after I mentioned it, I received literally hundreds of messages, first to thank me for raising it, secondly to thank me for raging, because people are not listening, and thirdly to say, “Well, people don’t care.” Actually, the hon. Member for Richmond Park (Sarah Olney) and the Members from across the parties in the Chamber today do care.

This is an ongoing conversation that we are having, and action has been taken by previous Governments and is being taken by this Government. We must get out the message that things are happening and that people are talking about it and are interested in it. This is being looked at and discussed at the highest possible level to bring in changes to make the world a little bit better. It is thanks to the pressure that we apply in this place that such changes are made, and I think it is important to get that on the record.

When it comes to men’s health, I am very keen to point out that this is not an “or” issue—it is not about women or men, but about women and men. That is particularly the case for mental health and mental wellbeing because woman partners often spot the issue first. Women are the advocates we all need when we are having this discussion, and it is important to make sure that is on the record too. The last Government brought forward the women’s health strategy, and we now have an allied men’s health strategy. They are not in competition, but work in conjunction, which I think is important.

I followed up September’s debate on suicide prevention with a letter to the Ministers to raise a few points, and I think it would be prudent for me to use my time to press them home a bit further. The first point was about the £10 million suicide prevention grant fund, which was brought in to deliver specific support for 79 organisations between August 2023 and March 2025. The fund has now run out, and after that was raised, the Minister for Care responded in answer to a written question:

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

However, in April he followed up by saying:

“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 delivery of the Government’s mission to reduce the lives lost to suicide.”

In my letter, I asked whether we could have

“some details on the basis behind this decision”

as well as

“what alternate provision…is being provided”

and when we would hear about the evaluation. I was lucky enough to get a response on 13 November from the Minister in the other place who has responsibility for mental health. She addressed that point, but she simply said:

“As previously stated, the Department is evaluating the impact of the Suicide Prevention Grant Fund from 2023 to 2025, and the services that have been provided by the grant-funded organisations. The evaluation will be completed in due course and learnings from that evaluation will help to inform the delivery of the Government’s mission to reduce the lives lost to suicide.”

That is welcome news, but we have now gone from April to November, and I would like to understand when the evaluation will come, because it will be imperative in deciding how we take forward these services.

In that light, I welcome the men’s health strategy, particularly its emphasis on suicide. However, as my Liberal Democrat colleague, the hon. Member for Winchester (Dr Chambers), pointed out, the £10 million over two years seems to dwarf the £3.6 million across three years. That is a concern for the Opposition, especially when we look at how it is likely to be delivered, which is through the charity sector, as the national insurance changes have already taken a massive toll. For example, Mind has said that that tax increase will cost it £250,000, so its £1 million across a year suddenly starts to be whittled away. I am keen to understand how the Government will square that circle.

That leads me to my last point, which we have raised in the House before—I have certainly raised it both with the last Government and now with this one—on the issue of representation for men and boys. Before the election, the last Government were looking at having a men’s health ambassador. In my letter, I asked whether any consideration was being given to bringing in such an ambassador or about having a Minister for men and boys. I am open to suggestions about how that could work or would not work, but it strikes me that in the current climate, we have a Minister for Women, but not one for men and boys.

That leads me full circle back to where I started, which is that this is not an “or” issue, but an “and” issue. If we believe that women consult differently on their health, by definition men must do so too, so we need different pathways. The strategy is a good stepping stone from the Government, and I welcome it, but I just hope they use it as a springboard, rather than simply as a plank across a river.

We have talked a lot about the stigma, which is probably the most important thing, and heard a lot about how it is important to talk, but if we think about what the people in that TikTok video are really saying when they talk about how they feel there is no one, we as a society and this House have to not only listen, but show that we care, we have to make people believe that we care, and we have to follow that up with actions to allow people, in particular men, to get the help they need to help themselves. That is really important.

--- Later in debate ---

[Stephen Kinnock]

My hon. Friend is right. I do not know whether there is a connection, but it is possible that some of the perhaps more macho attitudes in some sporting environments are connected to the difficulties that some men—particularly men in those environments—have in reaching out, talking and being honest and open about their feelings. There may well be a connection. However, I hope that other sporting federations—the Rugby Football Union, the Welsh Rugby Union or whichever sporting association it might be—will look at what the Premier League is doing, and that we will perhaps see a blossoming of these initiatives across other sports and sporting disciplines.

The Premier League’s reach is unmatched. The partnership will engage men who are less likely to seek help and more likely to suffer in silence, meeting them in spaces that they trust, rather than waiting for them to access traditional health services.

[Dr Luke Evans]

It is great to hear about the Together Against Suicide partnership with the Premier League, but will the Minister explain how it works? Having looked at the details, it appears to be run in conjunction with the Samaritans. Is extra funding coming from the Premier League or from the Government to run the scheme? If the Samaritans provide the signposting, how are they being supported? In essence, it looks like an area to people together. Is that correct?

[Stephen Kinnock]

There are 11 premier league clubs that have signed up so far. The most visual way in which the partnership will manifest itself is through the advertising hoardings, which will be given over for periods of the game to advertise our Every Mind Matters campaign. That will offer talking therapies and an online mental health tool that we have developed. Anybody in the stadium—often there are 50,000, 60,000 or 70,000 spectators—can see that information flashing up. In some stadiums, there will also be mental health experts—wearing visible materials to show who they are and what they do—who people can come and talk to. The scheme is quite devolved, so each club will do things in a slightly different way. The Premier League is covering all the costs, so this is an entirely Premier League-funded partnership, with us providing the content, the steering and the opportunity to engage with the programmes, and the clubs are looking after the rest.

Ageing and End-of-life Care

Luke Evans Excerpts

Thursday 30th October 2025 Commons Chamber

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

I yet again thank the hon. Member for Strangford (Jim Shannon). He should be proud of Mona Shannon, and she will be proud of him not just for raising this topic today, but for all the work he does across this House talking about health, because he is assiduous and dedicated to timely health interventions, and that should be applauded across the House and this nation. I am indebted to him for securing this debate.

In the hon. Member’s speech, he mentioned who he had spoken to. I, too, have met the organisations Sue Ryder and Marie Curie, including at party conference, and I have met many other organisations, including LOROS and Rainbows, that cover my area. When I saw the title “Ageing Community” for this debate, I must admit that I thought the hon. Member should have applied for a five-day debate, considering what we could cover. I also notice the expertise in this debate. We have a secondary care surgeon, someone with public health experience at the back and me as a GP. It is turning into a multidisciplinary team, and there is a lot to unpack, whether it is prevention, mitigation, healthy lifestyles or looking at the best examples across the world. I recently travelled to Japan and Korea and saw how they look after their elderly and their approach to the lifestyle of the elderly. There is a lot to be learned out there, as across the world we all grapple with an ageing population.

There are other topics that we could talk about, and some were touched on. On social care, it is a shame that there has been a change from cross-party talks to an independent commission. I note that Baroness Casey is being taken back to the Home Office, which means she is spread thinly. There is a wider debate to be had on social care, which is: what do the British public actually want? Often we look at the Scandinavian model, but say that we do not want to pay the taxes for it. We want the household or family approach, like the Bangladeshi or Pakistani model, but we certainly do not actually want grandma or grandpa coming to stay with us and we want to stay working. Therein lies the problem in British culture. We are not 100% sure what we want when we cross over from the NHS into social care, and we are not sure how to provide it.

Some hard evidence of policies on an ageing community has been talked about, and unfortunately I have to raise the issue of winter fuel. In the Government’s analysis when they took away winter fuel payments—despite all the warnings—they knew that it would put 50,000 people into absolute poverty and 100,000 people into relative poverty. We can contrast that with the Opposition and our recent announcement on stamp duty. Jackson-Stops estimates that in the first year alone, up to 500,000 people above the age of 55 would consider downsizing because of that policy. I do not call that downsizing, as we heard in the debate on stamp duty—it is right-sizing, because it gives a real chance not only for more families to go upwards, but for people to move into more appropriate accommodation as they age.

There is a lot to be said in the debate about an ageing population, as the hon. Member for Shipley (Anna Dixon) pointed out, but I will focus my comments on the three questions that I think I caught from the hon. Member for Strangford: the assessment of the need for a national strategy for palliative care; what the Government are doing to ensure that palliative care is included in neighbourhood health centres; and the progress being made on 24-hour support.

I will start with the national strategy and funding, and let us give credit to the Government where it is due. When it comes to children’s hospice funding, they have continued the payment and extended it, which is welcome, although it does not offer enough mitigation for national insurance contributions. The Government will say that when it comes to adult funding, they have given £100 million. That is capital funding, though, and as one hospice worker put it to me, there is no point in having new curtains and a lick of paint if there are no staff.

As the Liberal Democrats pointed out, the National Audit Office report on the hospice sector that came out only yesterday states:

“DHSC and NHS England do not know what proportion of the total amount of palliative and end-of-life care provided in England is delivered by the independent adult hospice sector, and therefore how reliant they are on the sector”,

or what the real impact of Government funding is. It continues:

“In 2024-25, 11 independent adult hospices in England reported service reductions or staff redundancies, and other hospices announced plans to reduce services, in response to reduced income or increased costs. Cuts appear to be across all types of services offered by hospices. Most hospices reported the increase in the costs of service delivery within the palliative and end-of-life care sector as being the primary reason for service reductions…Six hospices have been designated by ICBs as ‘commissioner requested services’, a mechanism to forewarn ICBs of potential difficulties with services that, should they discontinue, would have significant impact on the local population”.

Hospice UK responded to that, saying:

“unfortunately the whole hospice sector is…struggling, just as demand for their services is rising. Surging costs mean 2 in 5 English hospices are planning cuts this year, and 20% ended last year with a deficit of over £1m.”

What does that actually look like in real life? In my area, LOROS is facing a deficit of £2 million. It has already had to reduce its in-patient capacity from 31 to 20 beds, and it is reducing its day therapy and cutting its physiotherapy, occupational therapy, social work, chaplaincy and complementary therapies, and closing the volunteer home-visiting service.

It is not just my region that is affected: a cursory look at Hansard will show that the Kirkwood hospice in Kirklees has made 19 redundancies; the Ashgate hospice in Derbyshire has 52 jobs at risk, with beds cut from 21 to 15; St Catherine’s hospice in West Sussex is looking at 40 job cuts, with half of its new rooms being mothballed; Weston Hospicecare—highlighted both here today by the hon. Member for Weston-super-Mare (Dan Aldridge), and by others, including my hon. Friend the Member for Bridgwater (Sir Ashley Fox) at other times—faces an increased national insurance bill of £139,000; the Arthur Rank hospice in Cambridgeshire is losing £829,000, which is forcing the closure of nine beds, 40% of its capacity; and Marie Curie has pointed out that its national insurance contribution costs have risen by £2.9 million.

Through all this, we have still never heard whether the Health team knew that this was going to happen and chose to push it through, or whether it was simply an oversight when it came to challenging the Treasury. Ever since the Budget, we have never heard an answer to that. At the time of the Budget, the CEO of Marie Curie, Matthew Reed, said:

“The Health Secretary himself has acknowledged that palliative and end of life care is not good enough, so we are shocked by the lack of measures in the budget to fix it. Palliative care needs are projected to rise by 25% over the next 25 years, around 147,000 more people each year, yet this government lacks a strategy to tackle the magnitude of this challenge.”

Have the Government made an assessment of how much the NICs increase has impacted the hospice sector? As has been mentioned, Together for Short Lives estimates that the average hospice is facing a bill of about £133,000.

I raised a lot of these questions in a debate in January, and the Minister for Care kindly wrote to me in response. It is not just about the financial side; we are looking at the structural aspect too. He wrote:

“As you are aware, integrated care boards…are responsible for the commissioning of palliative and end-of-life care services to meet the needs of their local populations. To support ICBs in this duty, NHS England has published statutory guidance and service specifications. In addition, the National Institute for Health and Care Excellence…has published quality standards and guidelines to support commissioners to carry out this duty. While the NICE guidelines are not legally binding, they act as a regulatory benchmark for best practice in palliative and end-of-life care…Whilst the majority of palliative and end-of-life care is provided by NHS staff and services, we recognise the vital part that voluntary sector organisations, including hospices, also play in providing support to people at the end of life and their loved ones.”

So there is a grey area about where hospices are covered, and that fits in with the NAO report.

[Anna Dixon]

As the hon. Member rightly says, ICBs are under a legal duty to commission palliative care services. Does he not recognise that the problems we are having, not just with hospice care but with the lack of availability of palliative and end-of-life care, often come down to poor commissioning—ICBs failing to commission in line with that statutory guidance—and the confusion that arises between charitable donations and that which should be commissioned by the NHS?

[Dr Evans]

The hon. Lady is spot on; that is exactly the point that I was getting at. While there is a legal duty in terms of palliation, what that palliation looks like is important. Her question was also raised by the hon. Member for Strangford, who asked whether it is now time to have a strategy dedicated to palliative care, given the rise in demand.

The letter goes on to say:

“Charitable hospices are autonomous organisations that provide a range of services that go beyond that which statutory services are legally required to provide. Consequently, the funding arrangements reflect this.”

We are in a grey area, and a palliative care strategy could well be a way to unlock this problem. I will be interested to hear what the Government have to say on this issue.

However, it is not just about finances and commissioning; it is also about the workforce. That is partly addressed in the letter:

“As set out above, we have committed to develop a ten-year plan to deliver an NHS fit for the future. This summer, we will publish a refreshed NHS long-term workforce plan to deliver the transformed health service we will build over the next decade so that patients can be treated on time again.”

By my calculations, we are coming up to Halloween and even bonfire night, and we still have not seen a workforce plan. My question to the Government is: when are we likely to see that?

That leads me on to my next point: how do the Government intend to ensure that palliative care specialists are included in neighbourhood health centres? The 10-year plan is laudable, and I think there is agreement across the political spectrum on its contents, but the one thing it is missing is a delivery chapter. How are we going to do it? The shift is correct, but we do not know how we are going to get there, so I would be grateful if the Minister could address that. The 10-year plan explicitly talks about public-private partnerships, and there is concern on both sides of the House that we could see PFI mark 2. If Members need to have their memory jogged, private finance initiatives brought in £13 billion to build hospitals and services, but at a cost of £80 billion to taxpayers.

Why does this all matter? In my last few moments, I will turn to the final question that was posed by the hon. Member for Strangford, which was about access to 24-hour support. I will quickly read out a couple of comments from one of my constituents, whose husband Mat sadly passed away from a brain tumour. She highlights this issue:

“During the day, the support was outstanding because I could call the community nurses and the palliative nurses, and they would always call me straight back. They would visit Mat daily to administer the medications needed in his syringe drivers. They were kind, caring and so supportive to us and our family.

The night times were different and frightening. Often during the night when I was trying to get support, he could see how scared and stressed I was, which made him more scared, often telling me he was okay just to try and not make me worry. Every night I used to be thinking what might happen tonight—will Mat have another seizure? Will he be in so much pain again? Will they call me back if I need support? How long will it take to get help to arrive?”

Marie Curie points out that only seven of the 42 ICBs in England have a single point of access. I raised this issue with the Minister in a letter in August, and he kindly responded in September. He pointed out that integrated care boards must commission on this basis. There is NICE guidance on “End of life care for adults”, under quality standard 13, and on “End of life care for adults: service delivery”, under NICE guideline 142, which talks about the fact that there should be some form of 24-hour care, but at no point did the letter address the issue of the phoneline. When I asked the Department about data, I was told in a letter:

“Regarding data about palliative care helplines, such as average waiting/response times, the Department does not collect or hold this information.”

Will the Minister look at that and consider whether the Department should hold such information?

The letter went on to say:

“We recognise that more could be done to support the palliative and end-of-life care sector. I have tasked officials within the Department and at NHS England to look at how improving the access, quality and sustainability of all-age palliative and end-of-life care to ensure that their proposals are in line with the ten-year plan.”

I would be grateful if the Minister could ask the Minister responsible whether there is indeed an update and what that looks like. At the end of the day, we are concerned not necessarily about inputs, but much more about outputs.

We know that death is certain for us all; only our willingness to face it seems optional. This is very much a British mentality, and I believe we need to change that when it comes to talking about death and our mortality. We need to speak more openly and candidly about what an ageing population looks like, for that is what we are. That is why the hon. Member for Strangford brought forward this debate, and he reminds us that we chase the days ahead while never quite noticing how swiftly they turn into years behind us. That leads me to reflect on the fact that, as politicians and as a society, we build a world to live longer, yet we all too easily forget to ask: how do we want to grow old?

--- Later in debate ---

[Dr Ahmed]

I am very concerned to hear what my hon. Friend has reported to the House. Clearly, coercion is unacceptable in all forms. Safeguarding is taken very seriously by the national health service and by the Department of Health and Social Care, and as the Minister with responsibility for patient safety, I am very happy to look into that further and to take it up with him after the debate.

As set out in the 10-year health plan, we are going to shift more care out of hospitals and into communities, and make care more personalised. If there is anywhere where that is most important it is palliative care and end-of-life care. Palliative care and end-of-life care, including hospices, have a big role to play in that shift, and they were highlighted in the 10-year plan as an integral component of neighbourhood health teams.

In England, integrated care boards are responsible for the commissioning of palliative care and end-of-life care to meet the needs of the local population. To support ICBs in this duty, NHS England has produced statutory guidance. That includes the need for 24/7 access to palliative care and advice, and a palliative care and end-of-life care dashboard that brings together all relevant data in one place. The dashboard helps commissioners understand the palliative care needs of the local population. Of course, the majority of palliative care and end-of-life care is provided by NHS staff and NHS services, and that has benefited from the record funding in the NHS that the Chancellor delivered in the last Budget.

I will not be able to address all the points made by the hon. Member for Hinckley and Bosworth (Dr Evans), as he was in a typically verbose mood, but if he wills the ends, he must will the means, and if he does not agree with the means, he must present his thesis as to the alternative model of funding that he wishes to see. Otherwise, it is a case of cutting services.

However, we recognise the vital part that voluntary sector organisations, including hospices, play in providing support to people at the end of their lives and to their loved ones. In recognition of that, £100 million of capital funding has been made available to hospices in England to ensure that they have the best physical environment for caring. That includes helping hospices to provide the best end-of-life care to patients and their families in a supportive and dignified environment. It includes funding to deliver IT systems and provide refurbishments and facilities for patients and visitors, so that they can see their family members at the end of their lives in a dignified environment—much more than just a lick of paint.

[Dr Evans]

Given the recent National Audit Office report and the fact that the tax increase to national insurance contributions has had the biggest impact on the voluntary sector, has an impact assessment been carried out into how much the cost has gone up for hospices in England to provide their services? If not, will the Minister consider it?

[Dr Ahmed]

The hon. Gentleman knows that the NAO report covers a period both when his party was in government and beyond. I go back to the point about NICs. If he wills the end, he must understand the means. I am very happy to have that conversation with him at length after the debate, respecting the confines of the time that I have—I do not want to test your patience, Madam Deputy Speaker.

I am delighted that the first £25 million of the £100 million fund has been passed to Hospice UK and has been spent on capital projects already. The Minister for Care, my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock), visited Katharine House hospice earlier this year, Wigan and Leigh hospice in July, and Noah’s Ark children’s hospice earlier this month to see directly for himself how that record investment is making a meaningful impact on the ground. We can confirm that the Department of Health and Social Care has now transferred the rest of the £75 million to Hospice UK for onward spending in 2025-26. We are also providing £26 million of revenue funding to support children and young people’s hospices. This is a continuation of the funding that, up until recently, was known as the children’s hospice grant. That funding will see circa £26 million allocated to children and young people’s hospices in England each year via local integrated care boards on behalf of NHS England. This amounts in total to £80 million of hospice funding over the next three years.

For many of us who are in good health, managing complexity and ageing seems a distant idea. The Government recognise that the number of people with palliative care and ageing needs is projected to rise significantly over the next quarter of a century. That is why we are shifting more healthcare out of hospital and into communities through our plan for change. That is why we are investing, through the National Institute for Health and Care Research, over £3 million in a policy research unit in palliative and end-of-life care. The unit launched in January 2024 and is building the evidence base on palliative care and end-of-life care.

Earlier this year the Minister of State for Care and, more recently, the Secretary of State met key palliative care and end-of-life care and hospice stakeholders at dedicated roundtables, and focused that discussion on long-term sector sustainability within the context of the 10-year plan. Following the recent publication of the plan, the Minister of State for Care tasked officials to work at speed to generate proposals to improve the access, quality and sustainability of all-age palliative care and end-of-life care as we start to implement the plan.

In closing, I hope that those measures assure the hon. Member for Strangford of the Government’s seriousness to build a sustainable palliative care and end-of-life care sector for the long term.

[Dr Evans]

Will the Minister give way?

[Dr Ahmed]

I will not, in the interests of time.

I reiterate my thanks to the hon. Member for Strangford for bringing forward this vital issue, and I thank all hon. Members who have spoken today. He can be assured that he has raised the voice of those who deserve dignity at the end of their lives, and that his call has been well and truly heard by the Government.

Oral Answers to Questions

Luke Evans Excerpts

Tuesday 21st October 2025 Commons Chamber

[Mr Speaker]

Can I just suggest to Members that their supplementary question should relate to the tabled question? That would be helpful. I call the shadow Minister.

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

With reports of over £1 billion in costs for integrated care board redundancies and the chief executive officer of NHS England warning that services could have to move to plan B, could the Secretary of State set out what plan B is?

[Wes Streeting]

We are absolutely committed to delivering the transformation that we have outlined, and we are working with ICB leaders and NHS leaders to do that in a timely way. Those savings will deliver better value for money and enable us to redeploy resources to the frontline where they belong.

[Dr Evans]

I thank the Secretary of State for his answer, but waiting lists have risen for three successive months now, doctors are on strike, GPs are in formal dispute with the Government, and the ICBs are cutting 50% of their staff and do not have £1 billion to pay for it, all while the NHS 10-year plan has been published but with no delivery chapter. When will the Secretary of State come to the House with the delivery plan for the NHS 10-year plan?

[Wes Streeting]

Not only have the Conservatives failed to get in the news, but they have clearly not been reading it either. There have been no doctors strikes in the NHS since before the summer, and we have sat down with resident doctors and their new leadership to try to avert future strike action. The hon. Gentleman is right to point out that the action taken by the previous committee—unnecessary and irresponsible as it was—has impacted on waiting lists in the last few months, as have higher levels of demand than anticipated. I say that by way of explanation, by the way, not by way of excuse. I am determined to make sure that we hit our target, as outlined in the Government’s plan for change, and I think he will find that in the coming months we will be back on track and well on course to achieving something that the Conservatives failed to do when they had the chance.

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.

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.