Department of Health and Social Care
Debate between Luke Evans and Joe Robertson(1 month ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Dr Luke Evans (Hinckley and Bosworth) (Con)
I will dispense with the formalities to jump straight in. The hon. Member for Oxford West and Abingdon (Layla Moran) asked whether the Government have a clear, funded and transparent plan. Simply put, the Government appear to have made commitments they cannot properly explain, cannot fully cost, and cannot tell Parliament how they intend to pay for.
We are of course talking about the UK-US pharmaceutical arrangement, which will see 0.3% of GDP in 2026, rising to at least 0.6% by 2036—or an overall medicine spend of 10% to 12% of the UK NHS budget by 2036. That may bring benefits and investment, it may avoid tariffs, and it may help some patients get treatment faster, but those benefits do not remove the three key basic questions: what will this cost, how will it be funded, and what will the NHS have to forgo as a consequence? Those questions remain unanswered, which is a running theme from this Government.
Since Labour took office in July 2024, the pharmaceutical sector has issued a serious set of stark warnings. In January 2025, AstraZeneca cancelled its £450 million expansion near Liverpool, citing as a factor in the decision
“the timing and reduction of the final offer compared to the previous Government's proposal”.
However, that was not isolated. In March 2025, the leaders of some of the UK’s biggest pharmaceutical companies warned that the country risked becoming “uninvestable”. That warning turned into decisions, with MSD cancelling its plans for a £1 billion research centre in London, Eli Lilly pausing its work on the Gateway Labs hub, and Sanofi saying that it would not make substantial UK R&D investment until it saw appropriate recognition of the value of innovation.
Joe Robertson (Isle of Wight East) (Con)
Given that there are so many unanswered questions and such little information, rather than estimates day, wouldn’t the better name for this debate be “a complete stab in the dark” day?
Dr Evans
Or guesstimates day, for want of a better pun. That is part of the problem. If the Government are so confident, why do they not produce the impact report so that they can justify this? At the end of the day, we have seen that those decisions are not isolated; they are different companies, making different decisions, but all with the same concern. It is a pattern: tax rises, more regulation, more red tape—a more toxic concoction.
The Government will say that the deal is part of the answer, but Ministers cannot point to potential benefits while avoiding certain costs. The House of Commons Library is clear that the Department’s main estimate for 2026-27 does not include budget cover to meet the expected increase in pharmaceutical spending associated with the UK-US arrangement. That is the central problem. The Government say that the total cost in the current spending review period is expected to be around £1 billion, but the former Minister, the hon. Member for Glasgow South West (Dr Ahmed), also said,
“Total costs over the Spending Review period are expected to be approximately £1 billion. The final costs will depend on which medicines NICE recommends and the actual uptake of these.”
That is an important admission, because the final cost depends on future NICE decisions and uptake, and other estimates are higher.
The Library briefing cites analysis suggesting that spending could be around £1.7 billion by the end of 2028, and around £14 billion by 2036, depending on the assumptions. Is the £1 billion the central estimate, and if so, what are the lower and higher ends of the estimate range? Why will the Government not publish the modelling so that we can see? My next question is even sharper: where is the money coming from? We know from leaked WhatsApp messages that Labour MPs have been asking who they can tax to pay for benefits, so where is the money coming from? Both the House and the public are right to ask.
The Government have said that additional costs will be funded from existing NHS budgets, with future funding settled at the next spending review. However, if the money is coming from existing NHS budgets, it is coming from somewhere within the NHS. It might be the workforce, services, capital or future growth, but it will not be cost free. As Jonathan Benger, the chief executive of NICE, put it,
“If they choose to spend money on defence, they’ve got to pay for that somehow, either by raising taxes or removing money from somewhere else. If they choose to spend money more on medicines, similarly, that has to be paid for.”
That is the reality.
The former Secretary of State told the House that the Government would not cut NHS budgets to fund the pharma deal, but the former Health Minister, the hon. Member for Glasgow South West, later turned around and said:
“The deal will be funded by allocations made at the Spending Review, where record funding for the NHS was secured. Future funding will be settled at the next Spending Review.”
Those statements need reconciling. If it is funded from NHS allocations, that is NHS money. Can the Minister rule out any cuts from the frontline?
Finally, I will turn to transparency. I want to point out that the UK-US pharmaceutical arrangement is not a treaty-based free trade agreement. It has not been through the Constitutional Reform and Governance Act process. We have not seen what is going on. The Government need to publish their impact assessment, and yet they cite commercial sensitivity. Of course, there is a way round that: the Minister could redact it and give that to the Committee so that we and this House can see what is going on.
I will cut my speech short there. I will simply pose—
British Indian Ocean Territory
Debate between Luke Evans and Joe Robertson(6 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Dr Evans
My right hon. Friend is entirely right in pinpointing some of the issues, and I will reverse my speech and deal with some of those first. On the 1996 Pelindaba treaty, formally ratified in 2009, although the whole treaty is about where countries can research and what they can do with nuclear weapons, the key part, article 4, is about the prevention of parking of nuclear explosives. Paragraph 1 states:
“Each Party undertakes to prohibit…the stationing of any nuclear explosive device”
on its territory. By definition, if the base goes across to Mauritius, it will be under the treaty, because Mauritius is a signatory. There is a slight misconstruing, because there is a specific carve-out. Paragraph 2 states:
“Without prejudice to the purposes and objectives of the treaty, each party in the exercise of its sovereign rights remains free to decide for itself whether to allow visits by foreign ships and aircraft to its ports and airfields”,
and it goes on.
What the treaty implies, and what it states specifically, is that Mauritius would have to be consulted and provide explicit permission for nuclear craft, whether submarine, boat or aircraft, to be there. Only yesterday we heard that that permission would not be granted. This question on the security of the nuclear aspect is unanswered, and I look forward to the Government trying to rectify that position, because they have not explained the interaction with the treaty. This is not operational; it is purely about legal text.
Joe Robertson (Isle of Wight East) (Con)
My hon. Friend is making an excellent speech, which contains more detail than the Government’s contribution. In a nutshell, is the fundamental problem not that when we give away British sovereign territory to another nation, we are vulnerable in perpetuity—whatever agreement we have sitting around it—to that agreement being torn up, disagreed with and not implemented?
Dr Evans
Absolutely. On a technicality, the Minister is right to say that the treaty in front of us has no problems, but at the end of the day it is about the interaction with other treaties once we have signed it and sovereignty has been given away. My hon. Friend is right that things would not be covered once Diego Garcia no longer belonged to us, and the Government are struggling to explain that difficulty.
Dementia Care
Debate between Luke Evans and Joe Robertson(1 year, 1 month ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Joe Robertson
As my hon. Friend knows, at the beginning of the year, the Government and NHS England removed dementia from their planning guidance, which sets their priorities for the year ahead. Crucially, they removed the diagnosis targets. That was a cruel blow to people living with dementia and their families. Will the Minister give his view on the Government removing dementia from their targets and priorities?
Dr Evans
I am grateful, first, for my hon. Friend promoting me and, secondly, for his expertise in this area because I understand that he has worked with Dementia UK. He is absolutely right—he has beaten me to the chase. One of the real concerns that charities and patients have raised is exactly that: the removal of this crucial diagnosis target. We only need to look at Wales where that was not the case. The national diagnosis rate is 56%—10% lower than in England.
On top of that, the Government are presiding over a major top-down restructuring with cuts to integrated care boards and NHS England, while forcing through devolution on the 21 county-run authorities responsible for social care, while raising taxes in the employment national insurance contribution on care providers, which will get passed on to local councils, while raising taxes on the very dementia charities and others that provide support, while ditching the fast-track social work scheme as we learned last week, while terminating the NHS and care volunteers response that helps support care, and while scrapping the cross-party talks on social care and instead swapping it to an independent commission led by Baroness Casey, who still seconded to the Home Office. We can all see what is being taken away and taxed. It is what is going to benefit dementia support and care that is much harder to spot.
In the rough and tumble of this place, it is not lost on me how much this issue touches the Minister himself. He has spoken bravely and openly about his family’s struggle, and I have the utmost respect for him and what he has been through, and I have been through similar with my grandmother Dot. I do not question his heart; I simply gently challenge the Government on their policies to achieve better dementia care for all.
To that end, I have a couple of questions. Will the Government commit to setting a new target to increase dementia diagnosis rates across England? With integrated care systems facing restructuring and budget resolutions, how does the Government plan to hold local systems to account on dementia diagnosis, especially across the NHS and social care? We have seen in Wales how irregular data collection on dementia diagnosis affects overall diagnosis rates. What steps will the Government take to improve the quality of data in dementia diagnosis, particularly when it comes to follow up? Given the growing prevalence of dementia in our care homes, what steps will the Government take to support providers and ensure that the social care workforce is trained effectively to meet the needs of care users?
With the upcoming spending review and the long-awaited 10-year plan for the NHS expected in the next couple of months, I trust the Minister sitting in front of me. He is the right person to highlight to the Government the seriousness and importance of tackling dementia, just like the last Government understood.
I return to where I started: dementia steals the most from those left remembering, because the greatest heartbreak is losing someone who is still here. But with compassion for families, dignity for those who suffer and the relentless pursuit of a cure, we can offer not just care, but hope.