NHS Adult Gender Services: Independent Review

Wes Streeting Excerpts

Thursday 18th December 2025 Written Statements

[The Secretary of State for Health and Social Care (Wes Streeting)]

Today, NHS England has published the independent review of NHS adult gender services, led by Dr David Levy. The review was commissioned by NHS England in June 2024 in response to a recommendation in the Cass review final report. The review has sought to pinpoint areas for improvement, drawing attention to where the quality of NHS adult gender dysphoria clinic services could be raised, and recognising the positive existing practice that can be shared across services.

To inform this review, Dr Levy visited all commissioned NHS adult GDCs from October to December 2024. The review included engagement with NHS clinicians, executive and management staff in the hosting trusts, current and former patients, and those on waiting lists.

Although the review acknowledges the positive signs of progress across GDCs, such as patients feeling heard and understood and a strong commitment by staff to patient care, it highlights the challenges faced by GDCs and recommends a co-ordinated system-wide approach for improvement. Key findings of the review are:



Poor productivity across many adult GDCs, coupled with increasing demand, has led to unacceptably long waiting times, signalling the urgent need for an expanded number of services and targeted improvement programmes to enhance efficiency and productivity.

Significant variation exists in the quality and productivity of clinics, pointing to the need for a standardised approach to care that incorporates holistic assessments and a complexity measure sensitive to individual patient circumstances.

The referral process into the GDCs would benefit from streamlining and it is recommended that the current system of self-referral is ended in favour of a single referral route via GPs.

GPs may not always have sufficient experience or confidence to fully support patients with gender dysphoria, particularly in relation to prescribing and monitoring hormone treatments. It calls for GDCs to take responsibility for initiating and managing hormone prescribing during the first year of treatment, prior to transferring care to primary services.

In response to the findings of this review, we and NHS England will take forward a set of immediate priorities:

Creating a new single, national waiting list for adult gender services to be implemented in April 2026.

Raising the referral threshold to 18 years to align with the age of discharge from the NHS children and young people’s service.

Bringing an end to self-referrals into the service and, in parallel, providing advice and guidance for those finding it difficult to secure a referral.

Establishing challenging but achievable productivity goals for every service that can then guide and inform the commissioning of additional services, underpinned by a clear understanding of the regional demand through the national waiting list.

We are making progress beyond this review. NHS England has increased the number of adult gender dysphoria clinics in England from seven to 12 since 2020, and has established a national quality improvement network for adult gender services. In order to support the wellbeing of patients awaiting their first appointment with a GDC, I previously announced the development of a “waiting well” pilot for patients on the waiting list for the GDC in the south-west.

I will place a copy of the review in the Library of both Houses. This Government have always made it clear that anyone accessing gender services deserves the highest quality of care and support, and to be treated with dignity and respect. The publication of this review marks a significant step forward in our commitment to ensuring safe, effective and evidence-based care for anyone accessing gender dysphoria services across the NHS.

[HCWS1214]

Victims of Abuse: NHS Specialist Support

Wes Streeting Excerpts

Wednesday 17th December 2025 Written Statements

[The Secretary of State for Health and Social Care (Wes Streeting)]

It is a shameful truth that some of the most alarming health inequalities are those faced by victims and survivors of domestic abuse and sexual violence. They can find it harder to get help from NHS services and have a higher risk of poor health. This cannot continue. As this Government launch our violence against women and girls strategy, the health commitments within it set out how the NHS will play its part in keeping the most vulnerable in our society alive, safe and well.

The Prime Minister and the Minister for Safeguarding and Violence Against Women and Girls, my hon. Friend the Member for Birmingham Yardley (Jess Phillips), are leading a robust cross-Government approach to tackle the scourge of child sexual abuse and exploitation, which are among the most devastating crimes that any child can endure. They sit at the crossroads of violence against women and girls, safeguarding and public health, and the consequences are profound. The trauma inflicted can echo throughout a child’s life, affecting their mental health, relationships, and overall wellbeing. Protecting children from these abhorrent crimes, and supporting those who have suffered them, is not only a moral duty but a collective responsibility that rests with all of us.

Child house model

In April, as part of our response to recommendation 16 of the independent inquiry into child sexual abuse, we set out ambitious proposals to strengthen therapeutic support for victims. Today, I am pleased to announce a further step in delivering on that promise. The Government will provide up to £50 million in new funding to expand the child house model—the Barnahus model—to every NHS region in England. This internationally recognised model, which is rightly viewed as the gold standard for supporting children who have experienced sexual abuse, will ensure that, wherever a child lives, they can access the specialist, trauma-informed care they need to begin recovering and rebuilding their life.

The child house model puts children, regardless of gender, at the heart of the support they receive, bringing mental health professionals, social workers, police, justice services and specialist advocates together under one roof. Instead of being passed from service to service, children receive holistic, compassionate support in a safe, welcoming environment reducing trauma and strengthening justice processes to hold perpetrators to account.

By creating a single place where services come to the child, the model prevents repeated retelling of experiences and offers wraparound support for families. Non-abusing parents and carers also receive counselling, practical help and guidance, enabling them to be strong, supportive pillars in their child’s recovery. Currently, England has just one child house in north London. By expanding the model across every NHS region, we are addressing this inequality head-on and treating child sexual abuse as the healthcare priority it is.

This investment sits alongside our wider work to transform children’s mental health services. We are committed to reducing waiting times for CAMHS—child and adolescent mental health services—support, accelerating the roll-out of mental health support teams in schools and colleges, and investing an additional £13 million to pilot enhanced training so that school-based teams can better support young people with complex needs, including trauma.

Steps to safety

As health services are often the first place people turn to for help, it is vital that survivors are able to access the specialist support they need when it matters most. We are also training NHS staff to spot the telltale signs of abuse—and, to help victims and survivors take the first steps to safety, we will roll out a new referral service across GP practices nationwide.

From April 2026, we will begin a phased roll-out of this initiative to make sure that support services are established in every region before expansion. Regions will offer: training to all staff in the GP practice so that they can identify and respond to domestic abuse and sexual violence; a specialist support worker linked to a group of general practices to support GP practice staff and support and advocacy for victims; clear links with local specialist services to refer people into. This builds on innovative approaches already operating in England, and we will aim to ensure that dedicated referral services exist in every area of England by 2029. This phased roll-out will end the current postcode lottery where support depends on location.

In addition, we will be launching a new mandatory safeguarding learning programme for the entire NHS workforce in 2026. It will cover all aspects of domestic abuse and improve support for victims across the health system. This will help me ensure that, whenever and wherever a victim or survivor contacts the NHS, it is there for them and treats them with compassion, care and dignity.

I am also delighted that my hon. Friend the Member for Lowestoft (Jess Asato) is bringing her considerable expertise to bear as an adviser to my Department on treating violence against women and girls, so that we deliver on this plan and seize opportunities to go further, faster.

We are clear: the full power of the state will be deployed in the largest crackdown on violence perpetrated against women and girls in British history. These actions mark a decisive turning point: recognising child sexual abuse as a critical healthcare priority and ensuring victims and survivors of violence and abuse receive the best support to rebuild their lives.

[HCWS1203]

Puberty Suppressants Trial

Wes Streeting Excerpts

Wednesday 17th December 2025 Commons Chamber

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the pathways puberty blockers trial.

[The Secretary of State for Health and Social Care (Wes Streeting)]

Let me just start by acknowledging the sensitivities around this issue and the strong beliefs held around this House. For all the division and divided opinion, I believe that there is a determination shared by everyone in this House to do the right thing by a vulnerable group of children and young people. It is for those reasons that I am taking the course of action that I am. Put simply, that is to follow expert clinical advice and take an evidence-led approach.

The Cass review found shocking levels of unprofessionalism, a lack of clinical oversight and puberty blockers prescribed to children without sufficient evidence that doing so was safe or beneficial to those children and young people. What Dr Hilary Cass uncovered was a scandal. That is why, on coming to office, I made the temporary ban brought in by my predecessor, the right hon. Member for Louth and Horncastle (Victoria Atkins), a permanent one. Dr Cass also recommended a thorough study to establish how best to support children and young people who suffer gender incongruence. That is the pathways study.

The study has four main parts, one of which is the clinical trial to study the effects of puberty-suppressing hormones on young people’s physical, social and emotional wellbeing. The other aspects of the pathways study will track the physical, social and emotional wellbeing of all young people attending UK NHS gender services. It will look at young people’s thinking and brain development, following both those who are and are not taking puberty-suppressing hormones, and it will gather evidence directly from young people, parents and staff about their experiences of living with gender incongruence.

The bar for the trial to be approved was extremely high and oversight will be rigorous. Children cannot consent to being on the trial, so places will require parental consent, as well as the assent of young people. It is because protecting and promoting the health and wellbeing of affected young people is our primary concern that there are also strict eligibility criteria in place to join the pathways clinical trial. As such, the number of young people who would expect to qualify for the trial will also be low. Participants must undergo thorough mental and physical assessments and will be followed over a number of years with regular wellbeing checks. Puberty blockers have also been used to delay puberty in children and young people who start puberty much too early. Use in those cases has been extensively tested and has met strict safety requirements for that use.

The study is led by King’s College London and the South London and Maudsley NHS foundation trust. It has been carefully checked by independent scientists who advise the National Institute for Health and Care Research and by the Medicines and Healthcare products Regulatory Agency, and received approval from a research ethics committee. I am treading cautiously in this area because the safety of children must come first.

[Dr Johnson]

I must first declare my interest as a consultant paediatrician who has looked after children with gender dysphoria in the past and is likely to do so in the future. We must remember that we are talking about vulnerable children.

The first and most obvious question is: why? Why have this Government chosen to fund experiments with puberty blockers on physically healthy children? Despite saying he was comfortable with this trial in a briefing to MPs, the Secretary of State told the media on Friday and the Select Committee this morning that he is in fact uncomfortable with it. Why is it even being considered before the data linkage study is complete?

Some 9,000 children went through the Tavistock clinic, and many of them came out regretting being encouraged to irreversibly damage their bodies. We should look carefully at those outcomes before we make the same mistakes. What steps is the Secretary of State taking to secure the data from the Tavistock and have it analysed? What steps is he taking to hold to account those obstructing access to data linkage information? What assessment has he made of the motivations of those obstructing that data, when this is a study to safeguard children?

And what of the trial itself? We know that 226 children will go through this trial. Is that a limit or a target? Those children will be randomised to get puberty blockers now or in a year’s time, and all will be analysed at two years. They will still be children. They might be only 11 years old. How can the results demonstrate a meaningful outcome? The control group is not properly randomised, but chosen from the Horizon intensive trial group. Is the Secretary of State concerned that this will introduce bias?

The criteria for getting puberty blockers in this trial require just one parent to consent and the clinician to think that it will benefit the child, but on what basis will the clinician decide? The Cass review said that the vast majority of children with gender dysphoria would recover, with only a few persisting with trans identities into adulthood. It is not possible to predict which those children will be, so does the Secretary of State accept that the vast majority of children in this, his Streeting trial, who will be given drugs will be physically healthy children whose distress would get better without any puberty blockers, and that the vast majority of the children in this trial are therefore being unnecessarily experimented on with risky medications under his leadership?

[Wes Streeting]

The shadow Minister asks, “Why?” There is a simple answer. It is because this was recommended by Dr Cass in the Cass review, which was commissioned by my predecessor, Sir Sajid Javid. I think that was the right thing to do, and it is why, when my predecessor brought forward the Cass review, I supported it in opposition. I certainly did not try to play politics with an extremely vulnerable group of children and young people.

I will tell the hon. Lady why. It is because, under the previous Government, those puberty-suppressing hormones were prescribed without proper oversight, supervision or safety, yet we did not hear a peep about that fact for years until Dr Cass, commissioned by Sir Sajid Javid—who deserves enormous credit—did the study, which was published and widely supported and which contained this recommendation. The Conservatives may have changed their tune in opposition, but I remember what they said in government when they published the Cass review and supported its recommendations, so I think their response now is a real shame.

The shadow Minister accuses me of inconsistency, so let me be clear. Am I comfortable that this clinical trial has undergone the proper process and ethical approval to ensure the highest standards and supervision? Yes, I am comfortable about that. Am I uncomfortable about puberty-suppressing hormones for this group of young people for this particular condition? Yes, I am—because of risks. It is why I was also uncomfortable when I upheld the temporary ban by my predecessor and then put in place a permanent ban. The reason I was uncomfortable with that, too, is because I had to look children and young people, and their parents, in the eye when they told me in no uncertain terms that that decision was harmful to them, as have many other clinicians who have opposed that decision.

Whatever my discomfort in this extremely sensitive area, the reason that I have made this decision is that I am following clinical advice and, as Health Secretary, it is my responsibility to follow expert advice. Had the Tavistock clinic faced such challenge and scrutiny a decade ago, we would not be in this mess. The Conservatives were right to commission the Cass review and they were right to accept its recommendations. I accept that there is now a difference on this particular recommendation, but I would urge Members not to walk away from the cross-party consensus we built behind that approach but to build on the work that Dr Cass has done.

Let me turn to the important questions raised by shadow Minister. There will be two groups within the trial, as well as a further control group of children and young people with gender incongruence who do not receive puberty-suppressing hormones. At least 226 participants are required in order to detect a statistically significant difference between the two treatment groups. However, this is not a target and no young person will find themselves on this trial because there is a drive to make sure that a certain number of young people are participating. In order for anyone to participate in this trial, it has to have the most robust clinical oversight from clinicians within the service, as well as national oversight and the consent of parents. It is only where young people will be deemed to benefit that they will be on this programme.

The shadow Minister asks about the data linkage study. That is important. The data linkage study will be undertaken, but when it is completed it will not provide us with the same evidence as this clinical trial. That is why Dr Cass made a distinction between this trial and the data linkage study.

The hon. Lady also asks about the motivations of those who withheld data. That is an extremely important question. It is utterly appalling that anyone in a position of responsibility in the NHS withheld data on a very vulnerable group of children and young people. I accept that there were many well-meaning people involved in these services at the Tavistock clinic, but the fact that Dr Cass found such a lack of rigour, such a lack of standards and such a lack of proper oversight is disgraceful. It is the clinicians who are well meaning and ideologically driven who have given me the most cause for concern in this whole debacle and who have done more harm to children, young people and the trans community than most other people who have taken part in this debate.

I appreciate the work that Dr Cass has done, and I am glad that she is in the other place, bringing welcome scrutiny. Were she not supportive of this approach, I might think again, but she has made her recommendation and given her support. I am following clinical advice. It is not comfortable, but I do believe it is the right thing to do, on balance.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call Health and Social Care Committee member Danny Beales.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

The hon. Member for Sleaford and North Hykeham (Dr Johnson) asks, “Why?” Well, it is because trans people exist and their health needs exist. As the Secretary of State has clearly outlined, an independent review made a series of recommendations. There were clearly failures of healthcare, and a further recommendation was that a clinical trial should address this issue. I believe that the Conservatives supported the Cass review, but when it comes to implementing this part of it, they suddenly have collective amnesia about what Dr Cass recommended. Does the Secretary State agree that, in the absence of a trial, there will still be access to these drugs? We know that young people are seeking out private provision. They are seeking unregulated providers of these drugs, so is not a clinical trial both appropriate and the best and safest way of managing any potential risks?

[Wes Streeting]

The risk that my hon. Friend sets out was one of the considerations that I had to when weigh up—first when upholding the temporary ban, and then when making the ban permanent. I do worry that, outside of a trial, we may continue to see unsafe or unethical practice. I think we will be doing a service to medicine in this country as well as internationally if we have a high-quality trial with the highest standards of ethics, approvals, oversight and research from some of our country’s leading universities and healthcare providers to ensure that, for this particular vulnerable group of children and young people, we are taking an evidence-based approach to health and care.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat spokesperson; you have one minute.

--- Later in debate ---

[Wes Streeting]

I can absolutely assure the hon. Member that we are doing that wider research and that of course we will take into account high-quality international evidence, as well as the research we are undertaking domestically. It is so important that we recognise that, for many young people with gender incongruence, even if approved, puberty blockers will never be the right medication. One of the things I have been most saddened by in the discourse among adults in this debate, many of whom should know better, is the elevation of puberty blockers to the status they have received in public discourse and debate; many young people out there think not only is this the gold standard of care, but that it is the only care available, and, of course, that is not true.

NHS England has opened three new children and young people’s gender services in the north-west, London and Bristol, with a fourth planned for the east of England in 2026. We aim to have a service in every region of England in the coming years. These services use a different model with multidisciplinary teams, including mental health support and paediatrics, within specialist children’s hospitals to provide good clinical care. The new services will increase capacity and reduce waiting times so that patients can be seen sooner and closer to home. We have also commissioned additional support for young people waiting to be seen through local children and young people’s mental health services.

[Preet Kaur Gill (Birmingham Edgbaston) (Lab/Co-op)]

I thank my right hon. Friend for his leadership. As a former children’s services manager, I am concerned that credible safeguarding warnings from clinicians and academics about puberty suppression in children are not being heard. Will the Secretary of State meet those experts and review the younger age limit for participation in this trial, given that children as young as 10 are currently set to be involved?

[Wes Streeting]

Let me reassure my hon. Friend and the House that I am absolutely open to receiving representations and evidence from clinicians involved in the care of children and young people, with insight, expertise and data, including those who might be critical of the approach that the trial team is setting out or, indeed, critical that the Cass review included this recommendation. That is important because the many things that have gone horribly wrong in this area have included the silencing of whistleblowers and the silencing of rigorous debate and discussion.

We have to have this debate with due care and sensitivity for young people in this vulnerable group in particular and for the wider trans community, who feel extremely vulnerable in this country at the moment, including as a result of decisions I have taken as the Health and Social Care Secretary. We have to consider all of that in the round, but we must make sure that at all times we are following the evidence, that we are open to scrutiny and challenge, and that where we are making these finely balanced judgments, we are doing so with rigorous debate, testing the arguments, the evidence and the data. That is why I welcome the urgent question and this discussion.

[Madam Deputy Speaker]

I call Health and Social Care Committee member Joe Robertson.

--- Later in debate ---

[Joe Robertson (Isle of Wight East) (Con)]

The Secretary of State said earlier that there is an extremely high bar for him stepping in and stopping these tests using puberty blockers. What bar could be higher than a Government protecting children from being tested on with drugs specifically to stop or alter their sexual development? There is not a unified clinical view on this. It is his choice; he is the Secretary of State. These tests are on him.

[Wes Streeting]

I certainly do not need to be told what my responsibilities are on this. I always take responsibility for the decisions I take. I acknowledge the extent to which the hon. Gentleman and members of his party seek to weaponise this issue, and to personalise it. [Interruption.] We can simply refer back to his question and to the shadow Minister’s reference to the “Streeting trial”—if that is not personalising, I do not know what is.

I’ll tell you what: I will take an evidence-based approach. I have done that on this issue from day one. Had the Conservatives done so, we would never have seen the Tavistock scandal. We would never have seen puberty blockers dished out willy-nilly to children and young people in this vulnerable patient group. I have sought at all times, including when I sat on the Opposition Benches, to treat this debate with the care, sensitivity and humility it deserves, and not to be tribal in my interactions. I only wish this Conservative Opposition would take the same approach.

[Madam Deputy Speaker]

We are only at the start of this urgent question, so I ask Members to reduce the temperature in the Chamber.

[Rachel Taylor (North Warwickshire and Bedworth) (Lab)]

I thank my right hon. Friend for the care and sensitivity he has taken to this subject all along. It has been an undeniably difficult year for transgender people in Britain. I have spoken to young trans people who have been pushed to the brink of suicide by what they hear—that they do not have a right to exist, that they do not deserve rights, that they are legitimate targets for ridicule. We all in this House have a responsibility to lower the temperature and focus on their welfare, health and dignity.

King’s College operates the highest standards of safety. Does the Secretary of State agree that its expertise and rigour will support the wellbeing of participants and ensure that we get the robust evidence we need and that vulnerable children are no longer treated as political punchbags?

[Wes Streeting]

My hon. Friend is absolutely right that we must engage with due care and sensitivity on this issue. I can share with the House that these exchanges, Government policy, what is said by me and others, are followed extremely closely by this group of children and young people, who are extremely online, and by the wider LGBT+ community. My hon. Friend is right that trans people are often at the wrong end of the statistics as victims of hate crime, discrimination and mental ill health. We must always tread carefully when talking about suicide in this context, and bear in mind the warnings of the Government’s adviser on suicide prevention, Professor Louis Appleby, and the way in which that issue has been deployed irresponsibly by critics of the ban on puberty blockers that was put in place—we bear all those things in mind. I do think we have a high-quality trial set up. I do have confidence in the clinicians. We have had a cross-party briefing from the clinical team. I am happy to repeat that exercise, to keep coming back to the House and to arrange briefings for MPs and peers on a cross-party basis so that we can follow this closely, as we should.

[Tom Tugendhat (Tonbridge) (Con)]

I welcome the care with which the right hon. Member has approached much of this, and I appreciate that he has before him some very difficult decisions, especially because of the way the report was written. But I must come back to the simple truth that these are very young children, and decisions will be made for them—I appreciate by parents, taking that element of consent—that are genuinely irreversible. Whatever happens, we will see eight, nine, 10-year-olds grow up to be 18, 20, 25-year-olds—at least we hope we will—who have effectively been experimented on. Some of those children will resent greatly not just the system and their parents, but those who allowed this to happen, and here I identify the Department for Health and Social Care, not necessarily the Secretary of State himself. What provision is he putting in place to ensure that should those children wish to bring legal action against the Department, against those who took these decisions at a time when they were not able to give any form of informed consent, they will be able to have redress and their day in court?

[Wes Streeting]

I first thank the right hon. Member for the way in which he puts his concerns. I know he is concerned about this trial and that he has stated publicly his opposition to it, and I enormously respect the way in which he has done that. These are finely balanced judgments, and I acknowledge that.

The Cass review found that puberty blockers have been prescribed routinely without good evidence for their safety or effectiveness, and that is why a clinical trial was proposed. They are licensed and used safely in much younger children for precocious puberty or in older adults for certain cancers. For adolescents, the interaction with all the different processes of puberty may be very significant, which is why more evidence and a better understanding of their impact is needed in this patient group. Anyone on the trial can choose to stop taking puberty-suppressing hormones and leave the trial at any time; they do not need to give a reason. If a young person decides to stop taking puberty-suppressing hormones, their care in the NHS, including the gender service, will not change in any other way, and their doctors will explain to them and their parents or guardians what treatment options are available.

I know that there are concerns about the longer-term impacts on fertility. Prospective participants will be given comprehensive information on the advantages and potential risks of the hormones, including details about preserving fertility. Doctors will explain the possible long-term consequences and available options. Young people will also be offered consultation with a fertility specialist. The young person and their parent or guardian must clearly demonstrate a full understanding of all these issues—only then, after that, would a clinician sign off on admission to the trial.

[Several hon. Members rose—]

--- Later in debate ---

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

I hope we can all agree that the young people involved should not be used by anyone as a political football. Can my right hon. Friend please assure me that the process and trial will be clinically led, not defined by rhetoric—in this place or anywhere else?

[Wes Streeting]

I can certainly give my hon. Friend that assurance.

[Christine Jardine (Edinburgh West) (LD)]

I also welcome the tone and sensitivity that the right hon. Gentleman has taken on this issue—not just today, but throughout. We all recognise that we should be led by evidence, which is absolutely vital. The trans community is a reality. They feel very vulnerable and very attacked. People who have been on the medications for some time are now concerned that they may no longer be available. What can the right hon. Gentleman tell us to reassure those people that they will be safe?

[Wes Streeting]

As I reported when we put in place the permanent ban, there have been arrangements for people who were previously being prescribed puberty blockers. People who wanted to access them, but could not once the ban came in, have not been able to do so through authorised means.

I recognised when I took the decision, and as a result of representations I have received, both directly and in writing, that it caused considerable pain and distress to a very vulnerable group of children and young people and to the people who care very much about them. I have not been indifferent to that; I have taken it very much into consideration. However, with respect to all the people I have met, no amount of political pressure should move a Health Secretary away from the clinical advice and expert opinion that should underpin these sorts of decisions.

[Tom Hayes (Bournemouth East) (Lab)]

I welcome the trial. I commend the Secretary of State for following clinical advice and the Government for trying to build a consensus for one of the most minoritised communities in our country.

May I ask the Secretary of State—a man who I know to have empathy and thoughtfulness—to speak directly to trans people who will be watching this debate? At this Christmas time, they may be struggling with estrangement from family and with other difficulties. Can he speak to the dignity and worth to which they are entitled, and send a message that this House has their back?

[Wes Streeting]

I am grateful to my hon. Friend for that question. I recognise that the decision I took, within days of coming into this office, was received by trans people in particular, and the wider LGBT+ community, as a negative decision that detrimentally impacted their rights and identity. That is why it was an uncomfortable decision for me to take; I knew how it would be received and had to balance up the risk. I believed—and still believe, by the way—that it was the right thing to do, for the right reasons: a clinically led decision.

When it comes to the care and health of children and young people in particular, I make no apology for exercising extreme caution. I do want trans people in our country to know that this Government respect them and their identity, and want them to live with dignity, safety and inclusion. That is the approach that the Government are taking. I realise that decisions that I have personally taken have not been received in that way. That has not been comfortable for me, but I do believe it has been the right thing to do.

[Sir Bernard Jenkin (Harwich and North Essex) (Con)]

If we were resting this judgment on purely clinical evidence, we would tell every child that whatever sex they were was immutable and could not be changed, and that if they took these puberty blockers they might well find that they had irreversibly changed the course of their lives. How is a child of 10 or 11 going to be capable of making that judgment?

Whatever the Cass review says, in the end this is the Secretary of State’s judgment. I remember the covid inquiry repeatedly saying that it was wrong for Ministers to hide behind “the science”. Equally, there is no single clinical advice on this question: clinicians are as divided as the rest of society. We rely on the Secretary of State’s judgment. I am afraid that I think he has got it wrong.

[Wes Streeting]

I thank the right hon. Gentleman for his question and for how he puts his criticism, too. As I said earlier, and for the avoidance of doubt, I know what my responsibilities are. I understand the decisions that I take in this office and that I am accountable for those decisions. I do not resile from that. I am following clinical advice; I think that is the right thing to do in this area.

On the question of sex, the right hon. Gentleman is right: sex is immutable. Even if there has been treatment with hormones or surgery, underlying biology none the less means that trans women, for example, would still need to be screened and treated bearing in mind their biological sex, and the opposite is true for trans men. We have to draw that distinction between biological sex and gender identity.

Whatever my discomfort and personal views about this particular trial or about the notion of young people using puberty blockers in this way, I cannot ignore, and should convey faithfully to the House, conversations that I have had with trans young people and adults. They have described in powerful and unforgettable terms not just the life changing, but the life enhancing experience that they have had. I am thinking particularly of the university student I met; if she walked into this Chamber now, we would assume that she was born female. She is living her best life and described in very powerful and unforgettable terms the impact that treatment has had for her and her quality of life. At the same time, I think of high-profile cases such as Keira Bell’s. That is why we have to tread extremely carefully in this area, to follow evidence and to build an evidence base. It is also why these are such finely balanced judgements and why I can be simultaneously uncomfortable with the permanent ban that I put in place and uncomfortable with the clinical trial. I hope that I have reassured people that I think very deeply about these issues before taking decisions.

[Jacob Collier (Burton and Uttoxeter) (Lab)]

As the Health Secretary has said, this is a deeply troubling time for the trans community; I have heard that loudly from my trans constituents who have come to surgeries and from my postbag, too. When suicide rates among trans people are much higher than among the general population, we know where denying that they exist or denying them life-saving healthcare lead. What reassurances can the Secretary of State give my trans constituents and the families who support them? They are extremely worried that they will not be able to access the healthcare that they need.

[Wes Streeting]

I am grateful to my hon. Friend for his question. The reassurance that we can provide trans people in our country is that we are committed to making sure that they have access to the highest quality, evidence-based healthcare. That does not just apply in the case of children and young people; I also hope to report to the House before the Christmas recess the work undertaken in the learning disability mortality review into adult services. We are committed to making sure that we provide high-quality care to a particular vulnerable group of children and young people.

[Kirsty Blackman (Aberdeen North) (SNP)]

Although I disagreed with the permanent ban, it is to the Secretary of State’s credit that he has been very clear about all the competing issues that he is balancing to make his decisions, and I appreciate that. There are young people who are hoping to be part of the clinical trial and to receive puberty blockers, whether that will genuinely make a difference to their lives or they believe that it will make a difference to their lives. How will he ensure that appropriate support is given to those young people who do not get to be part of the trial, when they have been hoping that it will change their lives?

[Wes Streeting]

I am grateful to the hon. Member for the way that she asks her question, as a critic of some of the decisions that I have taken in this space. The reassurance that I can offer is that the study will look at the holistic care that this group of children and young people receives, and ensure that wider evidence-led therapeutic support, including mental health support, is available, so that regardless of whether a young person receives puberty blockers, they will certainly receive that wider range of support.

[Emily Darlington (Milton Keynes Central) (Lab)]

I appreciate the science-based approach taken by the Secretary of State. We use puberty blockers for many different conditions, so will the trial look at the data that has been amassed from the use of puberty blockers for other conditions? I wish to state on the record that puberty blockers are reversible. The evidence shows that when people stop taking them, they stop working—that is the science behind them. Finally, young people in my constituency are more likely to age out of gender services than to get their first appointment, so what are we doing to shorten the waiting time, not just for puberty blockers but for the whole range of services provided to trans children by the NHS?

--- Later in debate ---

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. If hon. Members do not keep their questions short, I will not get everybody in. The answers need to be just as short.

[Wes Streeting]

I will try to do that, Madam Deputy Speaker.

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

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

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

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

[Wes Streeting]

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

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

[Peter Swallow (Bracknell) (Lab)]

It is fair to say that the recommendations of the Cass review were not welcomed by everyone—not least by all members of the LGBT+ community—but the Conservative party commissioned the review and accepted its findings, and the Labour party supported the review and supported its findings. Does the Secretary of State share my concern that there are those who would now seek to cherry pick which of the findings they agree with and which they do not? Is it not the case that an independent review with such serious and important findings should be accepted in its entirety?

[Wes Streeting]

When it was published—I was in the Chamber at the time—there was an overwhelming consensus in the House. There were some people who criticised and challenged the Cass review at the time, including some outside the House in the LGBT community. I have always supported the Cass review, which was led by one of our country’s best paediatricians. Because of that, I am proceeding in the way that I am, which is the way that Dr Cass—now Baroness Cass—recommended. I will continue to follow the evidence and implement the Cass review comprehensively.

[Sarah Pochin (Runcorn and Helsby) (Reform)]

A survey published today by Transgender Trend shows overwhelming public support for non-intrusive medical approaches for under-16s with gender dysmorphia. The public want this state-sponsored child abuse stopped, so will the Secretary of State represent the will of the people, stop the trial and instead introduce statutory legislation to access the evidence data from the 2,000 children and young people already given puberty blockers through the Tavistock scandal?

[Wes Streeting]

I will take the hon. Member’s question in three parts. First, the opinion polling that she mentions shows that people in this country are overwhelmingly kind, and they want to ensure that trans people, and LGBT people more broadly, are treated with kindness, compassion and inclusion. Secondly, I do not dismiss the opinion polling that shows that a majority are against this kind of trial. Thirdly, the reason I am doing this is that I have to think about this extremely small group of people. I do not know what it is like to walk in their shoes and I have to think very carefully about what is in their best interests. The best way to do that is to build the evidence base that we need to provide high-quality healthcare. I strongly, strongly do not agree with her characterisation of this study, which is in itself irresponsible.

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

Some of the political debate around this subject has saddened me, not least the way that trans people’s reality and experience has been denied. We even have evidence of British trans people from the 4th century—they have existed forever. Will the Secretary of State confirm that the trial is a real attempt to get a proper evidence base for treatment for young people that is really needed?

[Wes Streeting]

My hon. Friend is correct that the study is about building the right evidence so that we get high-quality, safe healthcare for this vulnerable group of children and young people.

[Aphra Brandreth (Chester South and Eddisbury) (Con)]

Children struggling with gender dysphoria and their families are trying to find their way through very difficult and often distressing times. We should be helping them, not experimenting on them. Should we not be following the example of other European countries, such as Denmark and Finland, which have shifted their policies towards counselling rather than medical interventions?

[Wes Streeting]

I assure the hon. Member that as part of this study, and as part of the roll-out of services across the country, we are focusing on the therapeutic support that she describes. We are implementing the Cass review, which recommended this particular trial for this particular purpose, and we will follow the evidence. Of course we look at what other countries are doing, why they are doing it and what research emerges.

[John Slinger (Rugby) (Lab)]

I have immense respect for my right hon. Friend, in particular for his commitment to equal access to healthcare. Will he say a little more about the mental health support available for children and young people involved in the trial, those who will not be able to be in the trial, those who are currently receiving puberty blockers, and those for whom the ban is causing immense stress or worse?

[Wes Streeting]

My hon. Friend is absolutely right. Regardless of whether people are receiving this medication or not, we need to ensure that they receive the right therapeutic support to enable them to have healthy, happy childhoods and to understand themselves, the world they live in and how they relate to it in a way that does not cause them distress or harm. That is my objective in this process.

[Carla Denyer (Bristol Central) (Green)]

For young people questioning their gender, the pathways trial is currently the only route by which they are allowed to access puberty blockers, which are a treatment that can provide vital respite from the anguish of going through puberty in a body that does not match your gender, before long-term decisions may or may not be made as an adult. I therefore welcome the announcement of the trial, while recognising that significant barriers to entry remain. How will the Secretary of State ensure that as many young people as need to can access the trial, including those who need to access puberty blockers as part of support to improve their mental health?

[Wes Streeting]

I do not doubt the hon. Member’s sincerity and integrity on this issue, but I say to her respectfully that when she talks about barriers to entry, those “barriers” are safety and clinical oversight, as well as parental consent and the assent of the young person. I do not believe that those are barriers; I believe that those are necessary bars for participation in this trial.

[Linsey Farnsworth (Amber Valley) (Lab)]

May I associate myself with the comments of other Members who have said that we are talking about humans who deserve to be treated with dignity? As a former Crown prosecutor, I firmly believe that evidence is hugely important, and the Cass review said that there is not enough evidence at present that puberty blockers are safe. Does the Secretary of State agree that the responsible thing for the Government to do is not simply to ignore the plight of such young people, but to conduct the clinical trial to obtain the robust evidence needed to direct policy going forward?

[Wes Streeting]

My hon. Friend is absolutely right. Given that I work for a former Crown prosecutor, I could not possibly disagree with her on evidence.

[Iqbal Mohamed (Dewsbury and Batley) (Ind)]

I thank the Secretary of State for his response to the urgent question. One thing we should all agree on is that the human rights of all, including trans people, must be protected and delivered by the Government and supported by us all. The reason we are here today is to discuss the risks and potential adverse consequences of the proposed pathways trial. The trial compares the timing of treatment initiation, rather than using a placebo. There is no arm that provides psychotherapy as a treatment option without puberty blockers, and there is no arm to assess children who do not receive any of those options. Will the Secretary of State consider ensuring that all the various arms and channels are tested as part of this trial to get a complete picture, rather than a partial picture, which may be misleading?

[Wes Streeting]

May I thank the hon. Member for the way in which he put his question? It is so important to emphasise that right across this House, there are many people who oppose this trial, but who do want to see trans people well supported and protected and to respect their identities. That is important for everyone to bear in mind.

The hon. Member talks about placebo. For obvious reasons in this case, a placebo would not be appropriate, because it would be very obvious whether a young person was receiving the real medication or the placebo, but the trial design has included a control group. The way in which the trial is established will help us to distinguish between the benefits of receiving or not receiving this particular medication, and there will be really close oversight of the impact on development, but he is right that we need to judge these things on the question of risk. That is what led Dr Cass to make her recommendation, and that is why I support it.

[Steve Yemm (Mansfield) (Lab)]

I welcome the Secretary of State’s answers today and his ongoing support for the Cass review. From his previous answers, it is clear that he has seen public opinion. Is he prepared to call an independent clinical review, given the high degree of public concern about the trial?

[Wes Streeting]

I am very happy to receive further clinical representations on this issue and to hear from experts on it. I hope the public will understand why, on this particular issue, I am not simply led by opinion polling. I have to follow the clinical advice and evidence, particularly given the enormous risks that surround these children and young people, including the risks that weighed on my shoulders and conscience when I denied access to puberty blockers by upholding the temporary ban and then making it permanent.

[Carla Lockhart (Upper Bann) (DUP)]

It is nigh-on child abuse to give children puberty blockers. This trial will take confused little minds and vulnerable children and place them on a medical pathway with profound, life-altering consequences. Childhood is a time of uncertainty, yet the state is intervening with drugs that many former patients now say they were never even capable of consenting to. How can this Government justify experimenting on children, rather than prioritising safeguarding, evidence and psychological support?

[Wes Streeting]

The hon. Lady has offered a political opinion, not a clinical judgment. By that logic, we would not have any medicine for children and young people; we would never have undertaken clinical trials or studies, because we would have judged that children and young people could not take part in them. That is objectively not a sensible position.

I understand the sensitivity surrounding this issue, and the hon. Lady is right to say that people in our country have received life-changing clinical interventions that they later regretted. As part of that regret, they have shared that they did not feel, at the time, that they were making or could have made an informed decision. That is why this trial is set up in such a way that it has such strong clinical oversight locally as well as nationally. It cannot happen without not just the assent of a young person but the consent of their parent or guardian. Those are important protections and safeguards. I do not share the hon. Lady’s characterisation of the trial.

[Alex Sobel (Leeds Central and Headingley) (Lab/Co-op)]

I support the pathways clinical trial, but it is clear that many, many young people presenting with gender incongruence will not be able to access it, for whatever reason. I am concerned about the mental health of those who will not be able to access the clinical trial. What additional support can the Secretary of State provide for those people, particularly around their mental health?

[Wes Streeting]

The study includes a lot of research around wider therapeutic support and interventions, including mental health support. We are rolling out more clinics and services across the country to bring that care closer to home.

[Several hon. Members rose—]

[Jim Shannon (Strangford) (DUP)]

May I thank the Secretary of State for all that he does? He deserves credit. A mother from my constituency phoned me this morning and said:

“Why is money being spent on this pathway when my child has been waiting for clinical support for 3 years and the waiting list is so long she may be moved to adult treatment? Why is Government prioritising the tiny few over the many? With our children’s mental health services at breaking point and parents at their wits end trying to get their child diagnosed”,

how do the Government look in the eyes of the parents with rare diseases whose drugs are not funded by the NHS when they are funding this trial?

[Wes Streeting]

I say respectfully to the hon. Gentleman, whom I like very much, and to his constituent, that it is because I have also had to look into the eyes of people in this community who have not received the right care and seen the deleterious impact it has had on their mental health and wellbeing. I have had to deal with parents who have suffered loss and bereavement. We have to make sure that we are doing the right thing by everyone. This should not be an either/or choice.

[Several hon. Members rose—]

[Samantha Niblett (South Derbyshire) (Lab)]

Trans people do not wake up at 18 suddenly trans; it starts before then. When we talk about protecting children, it means protecting trans children so that they can transition into adulthood knowing that they had parents and doctors who advocated for their needs. But this trial is not a prison sentence, so will the Secretary of State talk about whether people are entitled to withdraw from it if they change their mind?

[Wes Streeting]

They certainly can, and if they withdraw, they will still get the wider therapeutic support they deserve.

[Jonathan Hinder (Pendle and Clitheroe) (Lab)]

We are talking here about physically healthy primary school-age children being injected with drugs to stop them growing up. There is nothing medically wrong with these children; what they need is love, support and compassion to help them to accept their healthy bodies. They are perfect just the way they are.

The Health Secretary says that he is “uncomfortable” with this experiment, and his instincts are correct. In the haunting words of Keira Bell, a courageous young woman and a victim of the Tavistock scandal:

“I was an unhappy girl who needed help. Instead, I was treated like an experiment.”

When these children who are now going to be experimented on become adults, they will want to know who did this to them. This time, the truth will be that this was state-sanctioned, out in the open and—I am afraid to say—at the Health Secretary’s say-so. I am begging the Health Secretary to use his power as the politician in charge to do what he must know is right and stop this.

[Wes Streeting]

I wish I had certainty on this issue, and in some ways I envy my hon. Friend for his certainty. Having occasionally found myself to be a lonely voice in my party when sat on the Opposition Benches, I respect the fact that it is not easy to be a minority, dissenting voice, especially when one feels so strongly about an issue. I respect my hon. Friend’s position, even though I disagree with it—I do think this trial is the right thing to do. He is right that we need love, compassion and empathy for these young people; we also need to understand what health and care support will produce the best outcomes for them, which is what the trial is about.

[Dr Scott Arthur (Edinburgh South West) (Lab)]

I thank the Secretary of State for his leadership on this issue. Nobody envies him the decisions he has to make, but he has made the right decision on this.

During my election campaign, I met a fantastic mother—no mother could have loved their daughter more. She told me about how, when her daughter entered puberty, she had to come to terms with her biological sex, and about the impact on her mental health. To delay puberty, she stopped eating. She ended up arriving at hospital in an ambulance, so weak that she had to be treated in that ambulance. I welcome the fact that the trial will look at some of the side effects of puberty blockers, but will it also consider the impact of not taking puberty blockers in some cases? Will the Secretary of State also tell us how the House will be kept up to date on the trial as it progresses?

[Wes Streeting]

I can certainly promise my hon. Friend that we will keep the House regularly updated. The risks he has described have weighed heavily on my conscience when putting in place a permanent ban on puberty blockers; I have understood the risk involved, and the vulnerability of this particular group of children and young people. I also meant to say, in response to my hon. Friend the Member for Pendle and Clitheroe (Jonathan Hinder), that the parents of trans young people love their children very much. That has been at the heart of so many of the representations I have received, from parents as well as from young people.

[Josh Newbury (Cannock Chase) (Lab)]

The Conservative party welcomed the Cass review on its publication, including its clear recommendation that this trial take place. Eight years ago, the then leader of the Conservative party supported self-ID and declared that trans women are women; now, we have dog-whistle statements such as, “If we leave these children alone, many will get over it,” which the shadow Minister said just yesterday in Westminster Hall. Does the Secretary of State agree that a rigorous clinical trial is the only way we will get the impartial evidence he needs to make informed decisions on gender-affirming care for trans young people?

[Wes Streeting]

I absolutely agree with my hon. Friend that we need a strong evidence base, that we need to conduct these conversations with great care, consideration and compassion, and that we need to recognise the vulnerability of this particular group of children and young people, and the fear that so many trans people in our country feel about whether this is a country that accepts and respects them. The political climate has changed since we made all the progress we have made on LGBT equality over the last 20 or 30 years, but do I think the character of this country has changed? Do I think we are less inclusive, less respectful, less loving or less caring? Absolutely not—those are the hallmarks of this country and of the British people. We might be having a debate about the efficacy of this trial, but I think the overwhelming majority of people in this House are doing so in the spirit of wanting trans people to live healthy, happy lives in which they feel safe, included and respected in our country.

NHS: Winter Preparedness

Wes Streeting Excerpts

Monday 15th December 2025 Commons Chamber

[Stuart Andrew (Daventry) (Con)]

(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on winter preparedness in the NHS.

[The Secretary of State for Health and Social Care (Wes Streeting)]

The NHS’s national medical director says:

“This unprecedented wave of super flu is leaving the NHS facing a worst-case scenario”.

This is backed up by the data. On any given day last week, an average of 2,500 patients were in hospital beds—a 55% increase on the week before, and almost double the number from 2023. One hundred and six flu patients are in intensive care, compared with 69 the previous week. There are 1,300 more staff off than in the week before, and the number of calls received by NHS 111 last week was 446,000—8% higher than at this time last year.

It is clear from both the NHS and UK Health Security Agency data that there is a real risk for the NHS and for patients, and it is at this moment of maximum danger that the British Medical Association has chosen to go ahead with Christmas strikes, when they will inflict the greatest level of damage on the NHS.

The BMA said this dispute was about pay, but we gave doctors a 28.9% pay rise. Then it said it was also about jobs, so I offered a deal to halve the competition for jobs to less than two applicants per post. It is now clear what these strikes are really about—the BMA’s fantasy demand for another 26% pay rise on top of the 28.9% doctors have already received. I also offered to extend the BMA strike mandate, so it could postpone this action and go ahead once flu has subsided. The fact that it also rejected that offer shows a shocking disregard for patient safety. Since this strike represents a different magnitude of risk from previous industrial action, I am appealing to ordinary resident doctors to ignore the BMA strike and go to work this week. Abandoning patients in their hour of greatest need goes against everything that a career in medicine is meant to be about.

The entire focus of my Department and the NHS team is now on getting the health service through the double whammy of flu and strikes. We have already vaccinated 17 million people, which is 170,000 more than last year, and 60,000 more NHS staff. We have invested in 500 new ambulances, 40 new same-day emergency care and urgent treatment centres, and 15 mental health crisis assessment centres. The NHS will also be recalling resident doctors to work in emergency situations, and we will not tolerate the dangerous attempts to block such requests that we have seen from the BMA in the past.

I am proud of the way that the NHS team has pulled together through strike action in the past, and I know they will move heaven and earth to keep patients as safe as they can this winter. I am just appalled that they are having to do so without the support of their colleagues in the BMA.

[Stuart Andrew]

This winter, a serious flu wave and rising respiratory syncytial virus infections are pushing the NHS to its limits. Flu admissions, as we have heard, are up 55% in a week, and RSV cases are rising, especially in older people. However, the Government have failed to prepare, as we pointed out earlier in the year.

In July, the Health Secretary accepted Joint Committee on Vaccination and Immunisation advice to expand the RSV vaccine to over-80s, but that expansion seems to have been quietly dropped. Flu vaccine uptake remains dangerously low, with fewer than 30% of some key groups vaccinated. Most worryingly, that includes NHS staff, who are going off sick because of flu, adding to staffing pressures. Delayed discharges are worsening: 19,000 more bed days have been lost this year. Still there is no winter discharge plan, no new funding and no clarity—and today, yes, resident doctors confirmed further strike action this week, which will add pressure to a system already under significant strain. That is why we would ban strike action, but at the same time this Government are literally making it easier for unions through their Employment Rights Bill.

When the NHS is under this level of pressure, families deserve the reassurance that care will be there when they need it, so I ask the Secretary of State: will he now publish the Government’s plan for managing winter pressures, including on delayed discharges and emergency care? Given that he is worried about a double whammy of rising flu cases and a strike, what extra resources is he providing, and if he is not, where is the money coming from? What action will he take to ensure RSV vaccine access for older people, and what will he do to raise flu vaccine uptake in vulnerable groups, particularly in NHS staff? Families are frightened, and some are already grieving. This crisis was not inevitable, but the Government’s failure to prepare has made it much worse.

[Wes Streeting]

I will ignore the political nonsense about banning strikes and clamping down on trade unions. I will, however, take on directly the charge that we have not prepared for this winter.

We have delivered over 17 million flu vaccinations this season—hundreds of thousands more than this time last year—and 60,000 more NHS staff than last year are also getting their jab. We are on track to deliver the 5 percentage points increase in flu vaccine uptake in healthcare workers, as set out in our urgent and emergency care plan. On children and young people, half a million two to three-year-olds have been vaccinated, which is the same as last year, and 3.6 million school-age children have been vaccinated, which is up 100,000 on last year. We will be going back to schools to do repeat visits in areas where uptake in schools has not been as high as we would like. For care home residents, flu vaccination uptake is 71%. We are on track to meet the RSV vaccination uptake target for 2025-26 in the published urgent and emergency care plan, so we are doing a lot on the vaccination front to prepare.

In fact, on winter planning more generally, we started earlier and did more than ever to prepare for this winter. We had stress-tested winter plans trust by trust. Local NHS leaders ran scenario-based exercises, including managing surges in demand and responding to virus outbreaks to test and strengthen their winter readiness plans, which are now being put into action. We have strengthened access by boosting GP access to keep people well and out of hospital. Through advertising campaigns, new online access routes and more GP practices open for longer hours over the Christmas period, we are making sure more people can be seen closer to home. That matters, because when people can get help early from their GP, they are less likely to end up in A&E.

We are also going further to improve our urgent and emergency care performance this winter. That is set out in our urgent and emergency care plan. We are investing almost £450 million into UEC this winter, meaning: 500 new ambulances on the roads; expanding same-day and urgent treatment centres; providing targeted support to the most challenged trusts; creating capacity and keeping flow moving by sharing weekly data with trusts; encouraging the use of alternative community services; and streamlining in-hospital discharge processes to get patients discharged more quickly from hospital when it is safe to do so, including joining up the NHS and social care, where relationships between health and social care have been improving year on year. If I think about where we are this year compared to last year, there has been sustained improvement. A lot done; more to do.

Of course our job is made harder by strike action. That is why the Government are doing everything we possibly can to get the NHS through this winter. I just wish we were doing it with the BMA, rather than against the BMA.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

I would like to pay tribute to all the incredible staff at St George’s hospital in Tooting. I did my A&E shift with them this week, together in the trenches.

The Labour Government inherited an NHS that was bursting at the seams. With flu cases on the rise, the NHS feels as though it is working with one arm tied behind its back. Over half a million people this year were treated in corridors in A&E. That is unsafe and undignified. The all-party parliamentary group on emergency care, which I have the privilege of chairing, working very closely with the Royal College of Emergency Medicine, published a report outlining our recommendations to end so-called corridor care. I know this is a matter about which the Secretary of State cares deeply, so will he meet us to discuss the report’s recommendations to provide safe and more dignified care for patients and staff?

[Wes Streeting]

I echo my hon. Friend’s thanks to frontline NHS staff for what they are doing against a very challenging backdrop, which will be made all the more difficult this coming week. I also thank her personally for her ongoing frontline service, which she performs in addition to her duties in this House. I am always delighted to meet her and I would be very happy to discuss her report with her.

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

It is obvious already that this year is going to be very difficult for the NHS, with many A&E departments already overwhelmed, hospital wards full and too many patients looking at spending their Christmas on a corridor. Indeed, corridor care has been common throughout this year and even trusts that have seen improvement in other areas, such as Shrewsbury and Telford in my constituency, are struggling to make real progress in urgent and emergency care. In July this year, one in five people who arrived at an A&E in Shropshire had to wait more than 12 hours, and that was before the double whammy of a record winter flu epidemic and an irresponsible doctors’ strike.

Will the Prime Minister chair regular Cobra meetings to address this emergency? Will the Minister agree to make flu vaccines available to far more people and roll out an emergency vaccination scheme in communities to reach people who have been missed? Finally, will the Government support Liberal Democrat calls for a dedicated winter crisis unit, providing the locum doctors and social care support needed to discharge patients and free up hospital beds?

[Wes Streeting]

We are doing much of what the Liberal Democrat spokesperson asks; the hon. Lady is absolutely right that we need to focus on delayed discharge and demand management, and the system is doing all of those things. It is challenging in the NHS. The House will know of our determination to end corridor care. We have certainly ended the nomenclature of “temporary escalation spaces”, which makes corridor care sound like it is both normal and acceptable in the NHS, neither of which is true. I will stop short of asking the Prime Minister to chair Cobra meetings. That would not be the right mechanism or response, but of course he and I meet regularly to discuss winter pressures, and I will keep him apprised of the situation.

[Alex McIntyre (Gloucester) (Lab)]

I thank the Secretary of State for his statement. Gloucester residents are rightly worried about the rising flu levels. I was struck down a few weeks ago and can attest to how tough the current strain is. Does he agree that in this context it is reckless of the BMA to be taking its members out on strike, and will he call for resident doctors in Gloucester to go to work next week to keep their patients safe?

[Wes Streeting]

It is one thing for the BMA to have rejected the offer we made; it is quite something else to have done that following a 28.9% pay rise—but we are where we are. The thing that I find utterly inexplicable and indefensible about the BMA’s position is that we offered it the chance to extend its strike mandate to the beginning of February, in order that strikes could be delayed into January, to give the NHS a clear run at an extremely difficult and challenging winter and the most challenging time of the year for the NHS. The only reason the BMA is choosing this week to strike is that it knows it will inflict maximum damage on the NHS, but in doing so it risks avoidable harm to patients. That is unconscionable, indefensible and unnecessary, and I ask ordinary members of the BMA, whatever their views on the offer or this Government, to bear that in mind when deciding whether or not to leave their patients this week.

[Steve Barclay (North East Cambridgeshire) (Con)]

Given the pressures from flu and strikes, can the Secretary of State confirm that the evidence he gave to the pay review body remains correct—that any pay rises must be funded from within his Department? If so, given that the Office for Budget Responsibility says that inflation next year will be 3.5% and he has offered 2.5% across the NHS, and said that a 1% increase would cost £1.5 billion, does he intend to give NHS staff a real-terms pay cut, or to take £1.5 billion from headline Government commitments?

--- Later in debate ---

[Wes Streeting]

It is as if the ghost of Christmas past has come to visit: one of my predecessors is here to remind the BMA of what it used to have to deal with. Perhaps the BMA will be a bit more content with the ghost of Christmas present—and that is before we are threatened by the ghost of Christmas future—[Laughter.] I am being slightly tongue in check, but the right hon. Gentleman asks a serious question, and I will treat it seriously.

We put in evidence to the pay review body process. The pay review body will make its recommendation, which we will consider. We are in active discussions with Agenda for Change unions about whether we can reach an agreement on future years, including exploration of the prospect of a multi-year offer. I have made the same approach to all health unions, including the BMA and resident doctors. The challenge with resident doctors is that their expectations are some way from affordability. They are asking for a 24% pay rise on top of the 28.9% they have already had. That is not acceptable. As the right hon. Gentleman’s question implies, I have a responsibility to the entire NHS workforce, particularly the Agenda for Change staff, who have not done as well as doctors. Addressing that is not only a practical issue for me, but a moral one.

[Danny Beales (Uxbridge and South Ruislip) (Lab)]

First, I associate myself strongly with the Secretary of State’s comments about today’s regrettable decision by the BMA and its members.

In the light of the pressures of flu and RSV, does my right hon. Friend think it is time to ask the Joint Committee on Vaccination and Immunisation to look again at its recommendations on the ages at which the two vaccines are made available? Specifically on RSV in infants, does he think it is time to ask NHS England to look again at the decision to switch from an infant-based delivery model to a maternal-based delivery model on the ground of cost, without taking into account the lower infant RSV vaccination uptake now?

[Wes Streeting]

I thank my hon. Friend for his support and questions. We will indeed reflect on our performance after this winter, just as we did after last winter. He raised interesting points about the way in which we deliver vaccines. As for the questions about eligibility and timing, we rely on the expert advice of the JCVI, which will also look at the data on how this winter has panned out. We look forward to receiving its recommendations in due course.

[Joe Robertson (Isle of Wight East) (Con)]

The Secretary of State says that the strikes come at a time of maximum danger for the NHS and has called on the junior doctors to call off the strikes. I agree with him, but will he accept at least some responsibility for the second round of strikes on his watch? Last year he conceded a bumper pay deal to the same junior doctors with no strings attached. It is hardly surprising that they judge him a soft touch on pay and have come back for more this year.

[Wes Streeting]

Regardless of the result today, I think that the BMA is finding that I am not a soft touch and that we will not accede to a completely unreasonable and unaffordable demand. The reason we made that pay award within weeks of coming into government was that we did not think that the BMA’s treatment at the hands of our predecessors had been fair, and we recognised the issues that it was raising on pay. Indeed, the irony of this round of strikes, and previous rounds of strikes under this Government, is that I recognise that whether it is about pay, jobs or working conditions, resident doctors make a whole series of fair and reasonable points, and we are doing our best to address those.

I think that 28.9% is a meaningful step in the right direction on pay. Our offer of emergency legislation, which is unusual in this House, would make a real difference, reducing competition for jobs from 4:1 to less than 2:1—but the BMA has rejected that course of action. In the end, I think that people will judge the BMA’s actions to be unreasonable. Of course the issues that it raises are serious and substantial, but we see similar issues raised not just across the NHS but across the entire public sector.

We cannot fix everything for everyone everywhere all at once. Most reasonable people accept that; for reasons I cannot understand, the BMA does not.

[Ms Stella Creasy (Walthamstow) (Lab/Co-op)]

The Secretary of State is rightly proud of the work that has been done to vaccinate people, and he will be acutely aware that we are heading into the super-spreader festive season. There are parents across the country who want to protect their own parents by getting their children vaccinated, but right now there is a gap in the system: 16 and 17-year-olds are not covered. Even if people try to pay for a vaccine at a wholly private provider, they cannot get a vaccine for that cohort, and NHS pharmacists are turning away parents who want to pay for a vaccine. Can I press the Secretary of State to correct that gap, so that families who want to protect their loved ones can do so and 16 and 17-year-olds do not give their grandparents the worst Christmas present ever?

[Wes Streeting]

We will review eligibility, distribution and means of accessing the vaccine in the usual way. People should enjoy themselves over the Christmas period. It is a time for family and seeing loved ones and friends, but people should be mindful of the risks posed by this most virulent strain of flu. If people are symptomatic and likely to give someone they love something they would rather not have this Christmas, they may want to hold off for a week until they have recovered.

[Andrew George (St Ives) (LD)]

I strongly endorse the Secretary of State’s emphasis on the importance of vaccination, not least to protect the resilience of frontline NHS staff and face down the anti-vaxxers and vaccine-hesitant. Nevertheless, will he reflect carefully on his emphasis on the shift from hospital to community at this time, given that emergency departments are still in crisis and corridor care is still a norm across much of the country?

[Wes Streeting]

I am grateful to the hon. Gentleman for giving me the opportunity to say, for the avoidance of doubt, that accident and emergency is for accidents and emergency situations. It is not an “anything and everything” walk-in service, and A&E departments are already stretched ahead of strikes. For patients who are in need of medical care or attention but are struggling to access their GP or wondering which NHS service local to them would be most suitable, NHS 111 provides a suitable service to triage and point them in the right direction. Of course if someone requires an ambulance, they should dial 999 in emergencies, and if it is an accident or emergency, people should attend emergency departments in the usual way.

[Justin Madders (Ellesmere Port and Bromborough) (Lab)]

Late on Friday, I received notification that the Eastham walk-in centre was to be temporarily closed for four weeks, which appears to be a move in response to the real pressures in the NHS, as I think most of the staff are to be redeployed to the local A&E. Given that previously I and my hon. Friend the Member for Birkenhead (Alison McGovern) campaigned vigorously to keep the centre permanently open, I would be grateful for any assurances the Secretary of State can give that this step is temporary and indeed indicative of the real pressures that the NHS is currently facing.

[Wes Streeting]

My hon. Friend can rest assured that he has my support as he keeps his eye on the temporary nature of this closure. I share his desire for it to be temporary.

I would make this point, too. There is a view among some in the BMA that somehow these strikes are consequence-free for patients and the NHS on the basis that we can just cancel some operations and it is okay because consultants will be covering. That is quite a cavalier attitude to take to fellow frontline staff who will be having their annual leave cancelled and finding themselves recalled right now. It also really minimises how patients feel when they cannot access a walk-in service, such as my hon. Friend’s, or indeed have waited, often for far too long, for a diagnostic test, scan or operation. They will have psyched themselves up and be ready for that appointment, but then find it cancelled because of strikes. The BMA might try to kid everyone else that the strikes are consequence-free for patients, but BMA members really ought not to kid themselves.

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

Will the Health Secretary ensure we have clarity on advice regarding the use of face masks, particularly where they are mandated? He will be aware that conflicting advice is issued by various agencies, which confuses people and reduces confidence. Will he ensure that advice is rigorously evidence-based?

[Wes Streeting]

The right hon. Gentleman is right to call for an evidence-based approach. That is why the Government are not mandating mask use across the NHS or social care. We are supporting leaders in providers to make their own judgments based on the situations in their trusts as to whether wearing of masks by patients and visitors is necessary, given the pressures they are under. Even in those cases, there is an understanding that people may not wish to comply, but I hope that, if asked to do so, they would comply.

[Ms Polly Billington (East Thanet) (Lab)]

Does my right hon. Friend share my concern that, in the run-up to Christmas, NHS staff will be having to change their Christmas plans to cover emergency shifts as a result of this ridiculous strike, and patients will have emergency operations, and indeed scheduled operations, cancelled?

--- Later in debate ---

[Wes Streeting]

My hon. Friend is right to raise the issue of disruption. Although we have carefully laid plans to manage industrial action this week, the thing I am really worried about as we look towards the end of this week is the long tail that takes us into next week, the following week and the new year. That is for a few reasons. First, in our experience, there is always a need to recover the service following such disruption; ironically, sometimes the worst disruption is seen in the weeks that follow and not just during strike days. Secondly, this is normally the busiest time of the year, and we normally get through it because we have experienced consultants who are willing to put in extra shifts over the Christmas and new year period, recognising those pressures. Those same people are now going to be absolutely knackered because of the toil of covering for their resident doctor colleagues over the five-day period. I really think that, in choosing the timing of these strikes, the BMA has been highly inconsiderate of colleagues, and I do not think it has even thought about patients.

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

My constituent Fred is eligible for a flu vaccination, but has had his appointment cancelled three times due to a lack of vaccines in the local area. Pharmacies and GPs are asked to guess what their need will be, sometimes a year in advance and without sight of the JCVI’s eligibility criteria, and this naturally results in conservative estimates, so that they do not have waste. What emergency measures are the Government taking to get additional vaccines to rural and coastal areas like mine, in order to slow down the crisis in our A&E?

[Wes Streeting]

There is no shortage of the vaccine, which makes things even more frustrating for our constituents, and for the hon. Member; they know that there are flu vaccines available, but they are not in the right place at the right time. I am extremely sorry that her constituent has suffered that inconvenience and setback three times. She has placed her concerns on record, and we will look at what has happened in her constituency. We will look at the supplies, and I will make sure that my Department works with her to resolve that situation. More generally, where we have seen reports of shortages, or of suppliers being caught short, we have acted rapidly to remedy the situation.

[Rachael Maskell (York Central) (Lab/Co-op)]

I refer the House to my entry in the Register of Members’ Financial Interests as a former leader on healthcare in a trade union, and also as a clinician in respiratory medicine. I am deeply concerned about patients right now. I recognise that the Health Secretary shared a lot of information with the House on Wednesday evening about how he wants to take things forward. Could he set out the process of engagement, not least with ACAS? Could ACAS sit down with the BMA, and work through the proposals to see if they could be enhanced or tweaked, so that we achieve the right resolution for patients and the NHS, and abate these forthcoming strikes?

[Wes Streeting]

I have lost count of the number of times I have met the BMA personally, or spoken on the telephone, including as recently as this afternoon, with the chair of the resident doctors committee and his predecessors. Of course, we are always willing to consider bringing in people who can help to close the gap between those on either side of the table. In the past, the BMA has not been too fond of ACAS. We will let this round of strikes pass. Our first priority now has to be managing our way through this period and recovering the NHS into the new year. There will then, by my reckoning, be at least six weeks without strikes, and of course we will do our best to resolve the situation with the BMA.

I would just say to my hon. Friend, to the House and to the BMA that there really is not much further for the Government to go. We have given a 28.9% pay rise already. The BMA wants to talk about future years’ pay, but we have not even had a recommendation from the Doctors and Dentists Review Body. I think it is extraordinary that BMA members are out on strike on pay after the 28.9% pay rise. On jobs, the BMA peddles to its members the idea that there were just 4,000 extra specialty training places up for grabs; it seems to completely sideline the point about emergency legislation to deal with UK graduate prioritisation, which is exactly what it asked from us, in all the meetings that I had with it. Since it has rejected that offer, it should not expect to see the legislation. If BMA members want to see the Government move forward constructively with them, they really need to stop striking, stop harming the NHS and maybe start thinking about patients while they are at it.

[Bradley Thomas (Bromsgrove) (Con)]

These strikes, at a time of peak seasonal pressure on the NHS, are reprehensible, and the BMA should be thoroughly ashamed of itself. Does the Health Secretary agree that we should use this opportunity to reassert our collective societal trust in vaccines, and encourage anyone who is vulnerable or eligible to get a vaccine, to mitigate the effects on themselves and on wider society? Given his comment that there is not much more that the Government can offer, does he at least acknowledge that the Government’s unconditional inflation-busting offer last year, just weeks after they came into office, must surely have emboldened the BMA?

[Wes Streeting]

I thank the hon. Member for being helpful in two ways. First, it is always good to hear voices from the right making the case for vaccine uptake. That contrasts the Conservative party starkly with Reform UK, which we hear peddle anti-science nonsense. Secondly, I thank him for reminding resident doctors and the BMA of what they used to have when the Conservative party was in government. Maybe I do not look so unreasonable after all.

[Fred Thomas (Plymouth Moor View) (Lab)]

I want to place on the record my immense thanks to staff at Derriford hospital in Plymouth, who are working tirelessly to keep people safe during the busiest winter yet. I am sure that the Secretary of State will want to join me in giving those thanks. The south-west has seen a 93% increase on last year in the number of beds taken up by those with flu. Does the Secretary of State agree that the run-up to Christmas is a dangerous and reckless time for doctors to go on strike? What would he say to all the other staff at Derriford, who will have to take up that work on the frontline as we approach Christmas?

[Wes Streeting]

First, I thank the staff of Derriford hospital. I have visited it a number of times over the years, and have seen them coping with pressures at the height of summer, during peak tourist season, and in the depths of winter; I was there this time last year. They do a really good job in very difficult circumstances, and my hon. Friend champions them regularly and consistently, publicly and privately.

My hon. Friend is absolutely right about the challenges that we face in our urgent and emergency departments. Our urgent and emergency care plan addresses the underlying issues that he raises, but of course, we have more to do in the coming weeks to help manage the NHS through this winter, and we are already reflecting on how we will plan for next winter, too.

[Richard Tice (Boston and Skegness) (Reform)]

This afternoon, I am hearing of resident doctors who are not BMA members, and who plan to go to work, as we would urge them to, being pressured and bullied by the BMA not to go to work. They are being told that locum doctors have been booked in their place, at huge extra cost to the NHS. Does the Secretary of State join me in absolutely condemning this pressure and bullying by the BMA?

[Wes Streeting]

No member of staff should be bullied for going to work this week and doing the right thing by patients. I am grateful to resident doctors who have been at work during previous strike actions, and I hope that we will see resident doctors do the same this week.

I ask resident doctors, regardless of their views on the offer that this Government have made, to think really carefully about the risks that the BMA is playing with, and I use that term advisedly, by choosing to schedule strikes this week. The most reasonable thing would have been for the BMA to accept the offer of an extension to its strike mandate, and to have simply postponed its strikes to January. It would have reflected well on the BMA. It would have shown that the BMA cared and had consideration for its colleagues who are under pressure this week. It would have shown that it cared and had consideration for patients who risk suffering this week because of its action. It is for the BMA to say why it rejected that perfectly reasonable offer, and why it has chosen the most dangerous time to be out on strike. I think this is probably the most shameful episode in the BMA’s history since it marched against the foundation of the NHS.

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

I thank the Secretary of State and his whole team for all that they are doing to fix the NHS, including boosting the number of appointments by more than was in our manifesto last year. In Southwark, there is particular NHS pressure on GP access. Southwark council is helping to expand and improve provision, but how do the Government ensure that GP practices’ self-reported access times—four in five people can see a GP within two weeks—are accurate and heading in the right direction?

[Wes Streeting]

That is part of GPs’ contractual obligations. Accurate reporting is absolutely central, both from an ethics and integrity perspective, and because it helps to inform us about the state of the service, and how we can improve care for patients. I am happy to look at the situation in my hon. Friend’s constituency with the integrated care board, to ensure that data and information are being collected and provided accurately for him and for public consumption.

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

I hope that the Secretary of State will give a little more consideration to the rather important point raised by the hon. Member for Walthamstow (Ms Creasy) about 16 and 17-year-olds not being able to be vaccinated.

If any junior doctor—whether or not a member of the BMA, but particularly if a member of the BMA—decides on ethical grounds to go into work during the period of the strike, and then faces sanctions from the BMA, will the Government protect them?

[Wes Streeting]

Two things: first, we will certainly give serious consideration to the point made by my hon. Friend the Member for Walthamstow (Ms Creasy)—the JCVI will do that in the usual way, and we follow its advice —and secondly, resident doctors have been to work in previous rounds of strikes, and I have not been made aware of bullying or intimidation of them. Of course, that should not be happening, and if it does, my priority will be protecting doctors who are doing the right thing. My expectation is that no one will be intimidated for making the moral and ethical judgment that going to work is the right thing to do by patients, by their colleagues and by the NHS this Christmas.

[Sarah Coombes (West Bromwich) (Lab)]

The Government were elected to pick the NHS up off its knees, and that is exactly what we are doing by putting tens of billions extra into the NHS—that includes giving a 28.9% pay rise to doctors. That money is delivering a 20% reduction in NHS waiting lists in my area. However, despite that progress, families are worried by the spectre of these strikes and a surge in super flu. I know that the Secretary of State is working flat-out to support the NHS. Families in Sandwell can support the NHS at this time by taking up a vaccine, but what more can they do to support it?

[Wes Streeting]

People can check their eligibility for a vaccine online or via the NHS app. They can and should seek to protect themselves. If people need healthcare, they should seek to access it. I do not want people to be deterred unnecessarily by strike action. It is important that people get the right care in the right place. Unless it is an accident or an emergency, the best thing to do is to call 111; from there, patients will be directed to the most appropriate service.

My hon. Friend is right about the progress that we are making with the NHS since coming into office. That is one of the many reasons I am so disappointed by the BMA’s action. This is lose-lose: it is bad for the NHS, and therefore for patients, and it leaves doctors working in poorer conditions for longer than I, they and the country would want.

[Ayoub Khan (Birmingham Perry Barr) (Ind)]

We are told that the NHS is adequately funded, but in Birmingham and my constituency, the ambulance service does not respond. People dialling 999 are informed that they ought to catch a taxi to the hospital, because there are no ambulances. There is not just corridor care; ambulances are also being used as facilities in which to care for vulnerable people. What can the Government do to ensure that ambulances are ready and available to pick up those who need that service?

--- Later in debate ---

[Wes Streeting]

This Labour Government are investing more in the NHS—£26 billion, rising to £29 billion over the spending review period. Urgent and emergency care is improving. Ambulance response times are improving year on year. I recognise that there are particular challenges with the West Midlands ambulance service. We are going as hard and fast as we can to repair the damage done by 14 years of Conservative Government. We are able to do that only because people chose to vote Labour at the last general election.

[James Naish (Rushcliffe) (Lab)]

At a Hanukkah event in Nottingham last night, I spoke to a medical undergraduate who welcomes the Government’s commitment to halving competition, and the offer that was put to the BMA. Lots of medical professionals, be they hospital doctors, GPs or allied health professionals, are struggling to find work. Will the Secretary of State outline how this offer, and the Government’s other work, would have helped those individuals?

[Wes Streeting]

This is the futility of the BMA’s position. The steps that we were proposing to take—both increasing the number of specialty places and bringing forward emergency legislation to deal with UK prioritisation—would have reduced the competition ratio from around 4:1 today to less than 2:1. That would have kicked in during the current round. We would have been able to bring forward emergency legislation and a new application round in the spring. The BMA has rejected that approach, and we will not proceed on that basis.

It is for the BMA to explain what its dispute is all about. We were told that it was all about jobs. What it seems to be about in substance is that the BMA wants a 26% pay rise, in addition to a 28.9% pay rise. I think the BMA is missing a degree of perspective about not just the state of the public finances but the pressures on other parts of the NHS and the public sector. The Government are committed to improving, consistently and year on year, the pay, terms and conditions of staff, and, crucially, the conditions in which patients are seen and treated. We cannot fix it all at once.

In fact, when this and previous Governments have floated the idea of raising extra money, BMA committees have sometimes been among the first to complain about the prospect of higher taxes, including on pensions, and other issues. It seems that their view is that everybody else should pay higher taxes for their higher salaries, and no one else matters. For me, those Agenda for Change staff who have been left behind are the first priority.

[Stuart Anderson (South Shropshire) (Con)]

Everybody knows that South Shropshire is the most beautiful rural constituency, but that rurality brings remoteness, which brings challenges with an ageing population, and with additional strikes there is concern about whether adequate healthcare will be provided this winter. Will the Secretary of State set out how that will be done, so that residents of South Shropshire will not go without?

[Wes Streeting]

The hon. Gentleman is absolutely right to raise the interests not just of our cities and towns but of rural communities. I was proud of the emphasis that we placed on rural services and coastal communities in our 10-year plan for health, and we take that into account with our urgent and emergency care plan. I have been encouraged by the way that some of our ambulance services that are dealing with remote and rural constituencies are responding this year compared with last year, but there is still much more for us to do, particularly across the midlands. We want consistent year-on-year improvement so that whoever someone is and wherever they live, the NHS is always there when they need it.

[Chris Curtis (Milton Keynes North) (Lab)]

I thank the Secretary of State for his statement and for his hard work in trying to bring an end to these unacceptable strikes. When such strikes happen, particularly at this time of year, it draws attention away from the hard work that staff across our national health service are constantly putting in during these difficult times. That is why later this week I will visit Milton Keynes hospital to thank staff for what they are doing over Christmas, particularly given the important work that they have put into supporting my family through what has been a difficult year. Will the Secretary of State please join me in thanking staff, particularly at Milton Keynes hospital, for working hard during a difficult time when we are tucking into our Christmas dinners next week?

[Wes Streeting]

Through my hon. Friend I thank staff at Milton Keynes hospital for all their hard work—I have had the privilege of visiting recently—and I thank all NHS staff for what they are doing throughout this week and throughout a very challenging winter. We know that staff are working under pressure and that their pay, terms and conditions need to improve. Most importantly, we know that conditions for patients need to improve, and we are far better able to do that if we work together, and if the BMA is more reasonable not just about the scale of the asks, but about the pace with which it is demanding change, recognising our responsibility to all staff, not just doctors, and crucially to patients.

[Vikki Slade (Mid Dorset and North Poole) (LD)]

More than 34,000 residents of Dorset are over the age of 80 and therefore excluded from the RSV vaccine. They have been told that it is too dangerous for them to take, but they are now extremely worried because cases are going up. Will the Secretary of State sit back round with the Joint Committee on Vaccination and Immunisation and review the decision to exclude them, so that residents such as Joan in Wimborne, who has to care for her even older and more disabled husband, can get reassurance this winter that she can protect herself and him?

[Wes Streeting]

I am not a clinician or a scientist, but the JCVI is full of them and we follow its expert advice. It will, in the normal way, review how this winter has gone and look ahead to future pressures, but it is important that we are guided by the evidence, whatever the political pressure.

[Oliver Ryan (Burnley) (Lab/Co-op)]

I am so angry. I am sorry to say this, but I feel that by its actions today, the BMA is killing our NHS, and quite possibly my constituents and patients over the Christmas period, and it has become almost the midwife for privatisation under Reform. The Secretary of State has been robust in his role as patient advocate in chief, and more power to him in that, but will he go a step further and join me in appealing to resident doctors in my constituency and elsewhere, and say, “Go back into work and look after my constituents.”?

[Wes Streeting]

I certainly hope that when making the decision about whether to go to work this week, resident doctors bear in mind the pressures that the NHS is under, the consequences of their actions on their colleagues not just this week but in the coming weeks, and—crucially —the impact that risks having on patients, which is the most important consideration. I ask resident doctors to bear in mind that we offered the BMA the chance to postpone the strike action into January. I think that is a reasonable offer, and the BMA’s rejection of it shows how thoroughly unreasonable it is. I follow what resident doctors say, and I worry that too many seem to think that these strikes are consequence free for everyone but the Government. If only that were true, and if only the strike was not placing intolerable pressure on other NHS staff, and an intolerable risk to patients, which I think is unconscionable.

[Mr Adnan Hussain (Blackburn) (Ind)]

Coroners have warned that without change, unsafe pressures and delayed care at Royal Blackburn hospital risk further deaths. Blackburn also has one of the worst GP-patient ratios in the country, with over 3,000 patients per GP, leaving many of my constituents unable to access early care and pushed into A&E out of desperation, not misuse, only to face fear and delay. With winter admissions rising, what targeted support for staffing, bed capacity and GP access will be provided to places such as Blackburn? Does the Secretary of State accept that winter resilience is impossible without fixing primary care in the hardest hit communities, such as Blackburn?

[Wes Streeting]

Thanks to the decisions taken by this Labour Government, we have increased funding for general practice by £1.1 billion, we deployed not just 1,000 more GPs to the frontline in our first year as promised but 2,500 and, through reforms to the Carr-Hill formula, we are restoring the deprivation link to health funding. As a result, the poorest communities with the greatest needs are receiving greater care, support and investment. All this is undoing the damage left by 14 years of Conservative government and it is only possible because people chose to elect Labour MPs.

[Jim Dickson (Dartford) (Lab)]

Last week, I met leaders from Darent Valley hospital in my constituency. Apart from discussing progress made on the new intensive care unit that the Government are investing in at the hospital, which is a sure sign that the Government are starting to turn the NHS around, it was clear from the conversation that the rise in flu admissions is already having a big impact on A&E waiting times and that care is having to be administered in corridors. Does the Secretary of State agree with the message that the hospital leadership team wanted to amplify: anyone who wants to help the NHS should go to their GP or their local pharmacy and get a vaccination as soon as possible, if they have not already done so?

[Wes Streeting]

That is very good advice on vaccination. If people require health services and it not an accident or an emergency, they should call 111, visit the website or use the NHS app. There are plenty of services available to help people, but as people will have seen on their television screens and social media feeds, the current pressures mean that the emergency department is not a place to be, unless they have had an accident or it is a genuine emergency.

[Tim Farron (Westmorland and Lonsdale) (LD)]

Across Cumbria and Morecambe Bay, the teams working in A&E, on hospital wards and in our ambulance crews are doing a stunning job dealing with the winter pressures in a community where, in my constituency, the average age is 10 years above the national average. Their jobs are made more difficult by the fact that 25% or more of the beds in our local hospitals are occupied by people who do not meet the criteria to reside. On top of that, the local trust in Morecambe Bay is planning to make bed cuts for financial reasons alone. We hear about additional investment in the NHS, but it does not feel like we are having that in Morecambe Bay and Cumbria. Will the Secretary of State personally investigate that, so that we are not cutting beds at a time when we need them more than ever?

[Wes Streeting]

We do flex beds depending on needs. For example, there were just over 101,000 beds open on average per day in the past week, which was up on the previous week and broadly the same as it was this time last year. We are investing in the NHS, and we have to ensure that people get the right care, in the right place at the right time. That means not just investing in secondary care; if anything, it means investing in the front and back doors of the hospital—primary care, community services and social care—to deal with the flow of patients through hospitals.

I do not pretend that these are easy issues or that everything is going swimmingly in the NHS—quite the opposite. I have seen conditions on our screens in the past week or two that I would not want to be treated in, someone I love to be treated in, or anyone to be treated in. It is a reflection of that fact that we inherited an NHS that was in enormous crisis. It will take time to recover. The key for me is achieving year-on-year improvements to get the NHS back on its feet and to ensure it is fit for the future.

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

I put on record my thanks to the staff at Princess Alexandra hospital in Harlow for their work to support residents in my constituency not just at Christmas but all year round.

Clearly, the BMA’s decision to take strike action over Christmas is hugely disappointing. As a former teacher, I remember that if we took industrial action, we always tried to avoid taking it over exam season, for similar reasons. Will the Secretary of State reiterate his point about the deal he put forward to the BMA? In particular, reducing the number of applicants per job is hugely important and should be welcomed by resident doctors, or potential resident doctors.

[Wes Streeting]

My hon. Friend is absolutely right. Responsible trade unions think about the wider workforce and the impact on service users, whether they are children or other users of public services. Crucially, for most trade unions in this country strike action is a last resort. It is astonishing that the BMA chose to go on strike after a 28.9% pay rise, well ahead of the Government making any decisions on future years’ pay and with the Government willing to discuss future years’ pay with the BMA.

It is extraordinary that the BMA has chosen to go on strike after we proposed to take action on jobs, including by bringing forward legislation at an expedited pace. By the way, that involved ensuring that the legal advice was watertight and that, operationally, we could deliver a new application round. It involved working trust by trust to secure the extra training places, and working with my counterparts in Scotland, Wales and Northern Ireland. Even after all that effort was strained to bring forward something quickly for this application round, the BMA rejected it. It is unreasonable, and to have rejected the offer of postponing strikes until the new year on the grounds of patient safety and doing the decent thing by their colleagues was unconscionable.

[Alison Bennett (Mid Sussex) (LD)]

Next week, families such as mine will be coming together across the generations to celebrate Christmas, and there will be a mix of people who have been vaccinated and those who have not, whether by choice or by default. Teenagers and young adults are struggling to access vaccinations, and they cannot walk into a pharmacy like an adult can. Is the Secretary of State content that everything is being done to ensure that if families want to get their young people vaccinated, they will be vaccinated in time for Christmas?

[Wes Streeting]

Yes. The JCVI makes evidence-based recommendations, and we follow its evidence. With the best will in the world, we of course give out practical, common-sense advice, but we should not infantilise our constituents. They are perfectly capable of working out who can get together this Christmas. They really do not need Government Ministers to start issuing directions about who can get round the table for Christmas dinner and who can get together in the days after. In the exchanges we have in this House there is sometimes a degree of patronising of the British people. They really, really do not need us. They really do not need our advice on the seating plan at Christmas dinner; what they need is for NHS services to be there when they need them, and that is what the Government are focused on.

[Robin Swann (South Antrim) (UUP)]

I commend the Secretary of State for his action to try to prevent industrial action. Nye Bevan had his own challenges with the BMA.

The covid inquiry made a number of recommendations with regard to co-ordination and preparedness across all four nations. What interaction has the Secretary of State had with the devolved nations in respect of this wave of flu, RSV and access to vaccinations?

[Wes Streeting]

I speak regularly with my counterparts, and the Ministers who are either side of me this afternoon have been engaging with our counterparts in recent weeks on these issues. We have a good relationship with devolved Administrations, regardless of party or where they sit across the United Kingdom, and that is a good thing.

As for the history of Labour Governments’ interactions with the NHS, that is not lost on me. The BMA marched against the NHS. It may be the case that the BMA does not really feel it needs the NHS—the BMA will be all right regardless—but my constituents cannot afford private healthcare, let alone earn money working in it. We will do everything we can to save the NHS, get it back on its feet and ensure that it is fit for the future. It is the only NHS our country has ever had and, compared with all the alternatives, I would not give up on a publicly funded public service—owned by us and there for all of us—for anything.

[Mr Joshua Reynolds (Maidenhead) (LD)]

Vaccination rates among the over-65s are not where we would like them to be, so will the Secretary of State adopt an emergency vaccination scheme in village halls, supermarkets and—if needed—jab vans to get to the people who have been missed?

[Wes Streeting]

There are many examples of great community-based vaccination initiatives. Many of those initiatives are supported by faith-based organisations, which is really important given the vaccine hesitancy in some of those groups. I do not believe that people are hard to reach; I believe that public services often do not try hard enough, and our approach is to do so. We will reflect on our success this year and seek to build on it for future years.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State very much for his answers—the BMA is losing public support, and clearly the Secretary of State is gaining it. I wish him well in his role.

Official figures show that flu cases in Northern Ireland nearly doubled to 954 in recent weeks, and flu-related admissions also doubled, with hundreds being treated in hospitals. There are issues with the supply of the flu vaccine, to the extent that people are unable to get their jabs in pharmacies and GPs are only offering them to select groups. I know that the Secretary of State is in regular contact with the Minister in Northern Ireland, Mike Nesbitt. What discussions have taken place to increase the supply of the flu vaccine and ensure it is accessible to those who need it?

[Wes Streeting]

I thank the hon. Gentleman for his question. Given that politicians are somewhere below traffic wardens and estate agents in terms of public popularity at the moment, it is quite an achievement for the BMA to have found itself even less popular with the public, but I think it has made very clear through its actions and rhetoric this week that it does not care about public opinion. In fact, the BMA does not seem to care much about the public at all.

The hon. Gentleman is quite right that we need to make sure we have a good supply of vaccine available across the whole of the United Kingdom. We work closely with the devolved Administrations, and I speak regularly with my Northern Ireland counterpart. Should the Northern Ireland Executive ever need support or assistance, we are always willing to provide it wherever we can.

[Lee Anderson (Ashfield) (Reform)]

On a point of order, Madam Deputy Speaker. During the urgent question, the Health Secretary suggested that Reform UK were vaccine sceptics—that is not the case. I have had all my vaccines since being born, and I will continue to have vaccinations, including the flu jab. Is there anything you can do to encourage the Health Secretary to be a little bit more accurate with the facts?

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Unfortunately, I am not responsible for the content of speeches made by Front Benchers or by Back Benchers. That is not a matter for the Chair, but the hon. Member has most definitely got his point on the record.

[Wes Streeting]

rose—

[Madam Deputy Speaker]

Does the Secretary of State wish to respond? Hopefully, we are not going to prolong the debate.

[Wes Streeting]

Further to that point of order, Madam Deputy Speaker. I just wanted to welcome the hon. Gentleman’s endorsement of vaccination. It is by far the most sensible thing he has ever said—that is a low bar, but he has cleared it, and I am very grateful to him. He might want to have a closer look at who his party platforms at its conferences, but that is not a matter for this urgent question.

[Madam Deputy Speaker]

We do not wish to prolong the urgent question.

Tees, Esk and Wear Valleys NHS Foundation Trust: Statutory Inquiry

Wes Streeting Excerpts

Thursday 11th December 2025 Written Statements

[The Secretary of State for Health and Social Care (Wes Streeting)]

On three occasions this year, I have met with some of the families who lost their loved ones under the care of Tees, Esk and Wear Valleys NHS Foundation Trust. I would like to place on record my deep and sincere condolences to all the families who have taken the time to speak to me. Each one of them has suffered an unimaginable loss, and their courageous and tireless campaigning—not only on behalf of their loved ones, but also on behalf of everyone in urgent need of mental health support—has been inspirational.

I am grateful for their time and for sharing their experiences. What happened to their loved ones is unacceptable. Patients should be safe in mental health services, and their families should be assured that they are safe. Too many people have experienced care that has been well below the high standard that we all deserve when we are at our most vulnerable. I would also like to thank the many local MPs who have campaigned on behalf of their constituents and brought these issues to my attention.

This Government take these concerns extremely seriously. After careful consideration, I have decided to establish a statutory inquiry, under the Inquiries Act 2005, into the deaths of mental health patients at Tees, Esk and Wear Valleys NHS Foundation Trust. I am concerned that services at the trust have not improved to the extent that they should have, and that there has been a lack of transparency around the circumstances of some of these tragic incidents. I believe a statutory inquiry is the only way to get to the bottom of the failings at the trust and to ensure we derive the learning required to prevent such poor outcomes in the future.

Information on the chair and terms of reference will be confirmed as soon as possible.

[HCWS1161]

Resident Doctors: Industrial Action

Wes Streeting Excerpts

Wednesday 10th December 2025 Commons Chamber

[The Secretary of State for Health and Social Care (Wes Streeting)]

With permission, Madam Speaker Deputy, I shall make a statement on industrial action by resident doctors. I thank you, Mr Speaker, business managers and the official Opposition for facilitating this evening’s statement.

As we head into winter, our hospitals are running hot and the pressures on the NHS are enormous. Flu season has come earlier, with a sharp rise in cases and the peak still to come, and this year’s strain is more likely to affect older people more severely. Already, the number of patients in hospital in England with flu is the highest on record at this point in the year. It is 50% higher than this time last year and 10 times higher than in 2023. Some 95% of hospital beds are occupied, growing numbers of staff are off sick and we are already seeing the pressure in our A&E departments. It is against that backdrop that the British Medical Association is threatening to douse the NHS in petrol, light a match and march its members out on strike. This represents a different magnitude of risk to previous industrial action.

The BMA resident doctors committee is in dispute on two issues: pay and jobs. On pay, resident doctors have already received a 28.9% pay rise—the highest in the public sector. For a first-year resident doctor, that is the equivalent of a £9,400 pay rise. I have been consistent, honest and up front with resident doctors that we cannot go further on pay this year. There is a gap between what the BMA is demanding and what the country can afford. Nor would further movement on pay be fair to other NHS staff, for whom I am also responsible and many of whom will never in their careers earn as much as the lowest-paid doctor. As I have made clear to the BMA and other trade unions, I am open to discussing multi-year pay deals with any trade union if we stand a chance of bridging the gap between affordability and expectations.

On jobs, I have much more sympathy with the BMA’s demands. I have heard the very real fears that resident doctors across the country have about their futures; it is a legitimate grievance that I agree with. My Conservative predecessors created training bottlenecks that threatened to leave huge numbers of resident doctors without a job. In 2019, there were around 12,000 applicants for 9,000 specialty training places. This year, that number has soared to nearly 40,000 applications for 10,000 places.

It used to be the case that UK graduates competed among themselves for specialty roles; now, they are competing against the world’s doctors. That is a direct result of the visa and immigration changes made by the previous Conservative Government post-Brexit, and it is compounded by the Conservatives’ decision to increase the number of medical students without also increasing the number of specialty training places.

Taxpayers spend £4 billion training medics every year—we then treat them poorly, and some leave to work abroad or in the private sector. It is time that we protect our investment and give bright, hard-working UK medical graduates a path to becoming the next generation of NHS doctors. Our 10-year plan for health set out our commitment to provide that path. It pledged to introduce 1,000 extra specialty training places and prioritisation of medical graduates from the UK and Ireland.

Today, in an offer to resident doctors, I can announce that I am able to go further. I want to thank Sir Jim Mackey, the chief executive of the NHS, and his team, who have been going trust by trust to see how many extra places can be funded and are needed. Thanks to their hard work, I am in a position today to be able to offer 4,000 specialty places for resident doctors, starting with an additional 1,000 for those applying this year.

In the Department of Health and Social Care, we have been working intensively on UK graduate prioritisation. The barriers have been legal ones, so I have been working intensively with my team to see how quickly we could introduce legislation. Thanks to their efforts, the co-operation of colleagues across Government, and my counterparts in Wales, Scotland and Northern Ireland, I can notify the House tonight that, subject to the agreement of resident doctors, we intend to introduce urgent primary legislation in the form of a Bill to be presented to Parliament in the new year.

The legislation will prioritise graduates from UK medical schools over applicants from overseas during the current application round and in all subsequent years. The reforms will also prioritise doctors who have worked in the NHS for a significant period for specialty training. This will not exclude international talent, who will still be able to apply to roles and continue to bring new and vital skills to our NHS, but it will return us to the fair terms on which home-grown medics competed before Brexit. The impact of these changes is that instead of four doctors competing for every training post, it will now be fewer than two doctors for every place. That is a good deal for doctors.

Following discussions with the BMA, we are also addressing the specific costs faced by resident doctors that do not apply to other NHS staff. Although I cannot go further on pay this year, I am able to offer today to put money back in resident doctors’ pockets by reimbursing royal college portfolio, membership and exam fees, with the latter backdated to April. The allowance for less-than-full-time resident doctors—many of whom are parents and carers—will be increased by 50% to £1,500, helping to close the gender pay gap.

In recent days, I formally made this offer to the BMA resident doctors committee. The BMA will now survey its members in the coming days on whether to accept this offer and end its dispute with the Government. The BMA told us that it will survey its members quickly and give us less than 48 hours’ notice of whether the strikes are going ahead. That presents serious operational challenges for NHS leaders, who need certainty now as to whether they are cancelling patient appointments and cancelling staff annual leave to cover strikes.

In my determination to prevent the havoc that strikes would cause this Christmas, I therefore made one more offer to the BMA, which I will now share with the House, the country and frontline doctors. So that the BMA could run a genuine ballot of its members and call off next week’s strikes while that ballot ran, I offered to extend its strike mandate. This would have allowed enough time for the BMA to reschedule next week’s strikes for the end of January, were the offer to resident doctors rejected in a ballot. It would have avoided the chaos that looming strike action threatens at the most dangerous time of year by removing the spectre of strikes next week. I knew that extending the BMA’s strike mandate would leave me open to attack from political opponents; that was a risk I was willing to take to stop the Christmas strikes going ahead. Madam Deputy Speaker, I must report to the House that the BMA’s leadership said no.

In the coming days, as the NHS prepares for strike action that may or may not happen, there are patients whose operations will be cancelled. There are NHS staff who will have to tell their families that they will not be home for Christmas because they have to cover for their resident doctor colleagues. This was entirely avoidable—no one should be in any doubt that the BMA has chosen to play politics with people’s lives this Christmas, and to continue holding the spectre of strikes over the NHS. I ask resident doctors to bear that in mind when they cast their votes.

The power to end these strikes now lies in the hands of doctors. Resident doctors face a choice: to continue the damaging industrial action in which everyone loses, or to choose more jobs, better career progression, more money in their pockets and an end to strikes. The deal that is on offer would mean emergency legislation to put our own home-grown talent first; to increase the number of extra specialty training places from 1,000 to 4,000, with a quarter of those places delivered now; to reduce the competition for training places from around four to one to less than two to one; to put more money in doctors’ pockets by funding royal college exam fees, portfolio fees and membership fees, with exam fees backdated to April; and to increase the less-than-full-time allowance by 50% to £1,500. It is a chance for a fresh start, to end this dispute and look ahead to the future with hope and optimism—a chance to rebuild resident doctors’ working conditions and rebuild our NHS. I urge every resident doctor to vote for this deal, and I commend this statement to the House.

[Madam Deputy Speaker (Judith Cummins)]

I call the shadow Health Secretary.

[Stuart Andrew (Daventry) (Con)]

I thank the Secretary of State for advance sight of his statement, and sincerely thank him for making me aware last night of his intention to come to the House today and make a statement. Given that the next set of planned industrial action is due just a few days before Christmas, and at a worrying time when winter pressures are increasing early, with more flu patients needing hospital beds, we all want to see an end to these strikes. We on the Opposition Benches offer our thanks and gratitude to all those in the workforce who have worked so hard to try to minimise the impact of the strikes so far.

In his statement, the Secretary of State talks about the competition for places. This is not new information. He said himself that the figures have soared in the last two years. Why is it only now that he is addressing it, so close to a damaging strike? He could have dealt with this issue back in the previous talks with the unions, but he did not. I have said, though, that I want us to be constructive in opposition, so I welcome the work that he has done to offer more places to UK doctors. Depending on the detail of the legislation, we will help to secure that aim. I make this offer to work with him to ensure that we get there.

On the 4,000 places that the Secretary of State has announced, and the 1,000 specifically announced for this year, can he tell the House in which specialisms those places will be? Can he break it down into GPs, surgery, obstetrics, anaesthetics and so on? Is he confident that there are enough trainers and that there is enough capacity in the training settings he has chosen? GPs are trained in general practice and in hospitals, and there is community training for some specialists, such as paediatrics. When will these places be available for applications? Will he also look at replicating the Australian model of placing any international doctors in areas of the country with the greatest need? We know we need to address those issues.

All of this is dependent on the BMA accepting the offer, but what if it does not? After all, its track record speaks for itself. We warned that giving pay awards with no conditions would encourage the BMA to come back for more, and it has. If its members rejects this offer, what are his plans to manage and deal with the situation? As the Secretary of State has said himself, the NHS is under pressure from combined flu and RSV, so what is he doing to ensure that those who are eligible for the vaccines actually have them? What additional resources has he made available to manage the strikes if they happen, and for winter pressures if they do not?

Does the Secretary of State recognise that if the BMA membership reject this offer and carry on with the strikes, his Government’s own Employment Rights Bill will make things much worse next year? Will he think again about the reductions in the minimum thresholds for strikes and reintroduce the minimum service levels? Does he expect that this new legislation and the announcements he has made today will have any implications for the Equality Act 2010? If so, what are they, and how will he address them? Will he have to disapply the Act?

These strikes must end. The BMA is behaving appallingly, but if the Secretary of State does not deal with those issues around thresholds and minimum service levels, it will only get much worse, with unions like the BMA causing more issues. It is patients—our constituents—and their families and loved ones who will suffer.

[Wes Streeting]

First, I thank the shadow Health Secretary for the constructive terms on which he has agreed to work with the Government. That should give resident doctors across the country who receive their survey the confidence of knowing that, should they vote for this deal, emergency legislation will be introduced in the new year. We will be able to work at pace, because with the majority that the Labour party has in this House, and with cross-party support in the other place, we can make sure that we expedite the legislation and achieve our goal of making the changes for international medical graduates that we have always intended to make, and that we committed to well in advance of today. By expediting those changes, there will be a direct impact on people applying for speciality places now and those who, even in recent weeks, have experienced the disappointment of not receiving the training place they had hoped for. We can keep that hope alive. We can improve the number of specialty places available if resident doctors vote for this deal, so I urge them to do so.

The shadow Health Secretary asked why we had not dealt with this before. I am tempted once again to revert to my usual analogy of the arsonist heckling the fire brigade, but given the constructive terms on which he has offered to work with us on this, I will pull my punches a little. I will say, however, that putting together the 1,000 extra places now, and bringing together the legislation urgently, requires significant operational detail. He is right: we have to ensure that we have enough trainers. Jim Mackey and his team have literally been working trust by trust to ensure that we can give the shadow Health Secretary, the House and resident doctors an assurance that we can facilitate those extra places.

When it comes to the legislation, the shadow Health Secretary will know, and people will appreciate, that this is fiendishly complicated. I have had to secure agreement from business managers, as we have a packed legislative programme. We have had to make sure that the Bill would be legally watertight and consistent with both domestic law and our international treaty obligations, and I have needed support from my counterparts in Wales, Scotland and Northern Ireland. I must thank them sincerely for the spirit in which, regardless of party, they have worked with this Government; we can give resident doctors that assurance.

As for what will happen if the strike goes ahead, let me say first that the shadow Health Secretary was right to say that frontline staff and NHS leaders did a superb job of managing previous rounds of strike action. In fact, during the last round we did indeed maintain 95% of planned care, and I believe—we will see when the waiting list figures are published in January—that the impact on waiting list progress will therefore not have been as severe as it might have been. However, I must be upfront with the shadow Health Secretary and the House and point out that there is a very different degree of risk this time. While we are aiming to maintain 95% of elective activity, I cannot guarantee that. I cannot give that assurance in all good conscience, given the level of pressure that we are under.

I offered to extend the mandate, so that the BMA could reschedule the same amount of strike action for January, if its members reject this offer, and I do not understand why the BMA would not do that. I find it inexplicable. As a Labour MP, I have spent a lot of time in rooms with trade unions and negotiating, and I honestly cannot think of a single other trade union in this country that would behave in this way. I am shocked by it. I am shocked because of the risk that it poses to patients and the pressure that it places on other NHS staff, and shocked because it threatens the recovery of the NHS that we all care about.

I would say this to resident doctors who are following these exchanges: listen to what the Conservative party has said about trade union laws, and about their rejection of the deal that we struck within weeks of coming into office. There is not a more pro-NHS, pro-doctor Government waiting in the wings. There is a Labour Government who are committed to the NHS, and committed to the NHS workforce, who have gone further than any other Government before on pay, on terms and conditions, and on the pace at which we are improving them. These were never grounds for strike action before, and they are certainly not grounds for strike action now. I appeal to resident doctors, over the BMA, to do the right thing, to vote for this deal, and to work with a Government who want to work with them.

[Paulette Hamilton (Birmingham Erdington) (Lab)]

I have always been a massive advocate for all medical and nursing staff, and I absolutely understand what a difficult job our healthcare workers do, but given that flu is running rampant across the country and most NHS staff—including resident doctors, but also nurses and other staff—are suffering at this moment, will the Secretary of State join me in urging the leadership of the BMA and the doctors to see sense and put patients first at this difficult time?

[Wes Streeting]

I agree entirely with my hon. Friend. She brings considerable frontline experience to this House, having worked in the NHS and dedicated her life to it. I am pretty sure that as well as speaking for her constituents, she speaks for so many other NHS staff. I do not want to see nurse pitted against doctor, or NHS staff pitted against each other. I do not want to see people resenting each other at a time when we should be pulling together to get the NHS back on its feet, and to make sure that it is well down the road to recovery. That is why, even at this late stage, I urge the BMA to think again. There is nothing to stop me extending the strike mandate tomorrow and giving Jim Mackey and NHS leaders the opportunity to stand down planning for strikes next week, even at this late stage. It would be an extraordinary gesture of good will, and it would be a Christmas present for the country. It would benefit doctors, resident or otherwise, and all NHS staff. Most importantly of all, it would benefit patients. I hope that message is heard in good faith by the BMA, even now.

[Madam Deputy Speaker]

I call the Liberal Democrat spokesperson.

[Dr Danny Chambers (Winchester) (LD)]

I thank the Secretary of State for his statement. People will be hugely alarmed at the threat of more industrial action right before Christmas, and we cannot forget how we got here. We know that the previous Government under-resourced the NHS. It was overburdened, people felt underappreciated, and the whole system was being held together by the good will of the staff.

Having said that, the timing is terrible, because we have the worst winter flu outbreak in decades, right before Christmas. We have to urge the BMA to work constructively to resolve this dispute in a way that is fair for both patients and taxpayers. Given that resident doctors received a 29% pay rise last year, I think most of the public feel that pushing for another 28.9% this year is unaffordable and unreasonable.

The Secretary of State touched on resident doctors’ legitimate concerns. The previous Government increased medical school places without increasing the facilities to deliver the necessary specialist training placements, so this was a predictable bottleneck that we are now up against. Waiting lists are long, we need more doctors, and we have doctors who have been trained largely at the taxpayer’s expense struggling to find work. We very much welcome the extra 4,000 placements that were announced today, which are hugely necessary. Can we ensure that they will address the acute shortages in general practice and psychiatry? To put those 4,000 places in context, 10,000 doctors applied for 500 psychiatric training places last year, and the Secretary of State said that about 40,000 doctors have applied for 10,000 places this year. Is there work to try to increase places as quickly as possible in the next few months and years?

At Winchester hospital, one in five beds is taken up by people who do not have any social care packages. That is not good for them, because they are stuck in the hospital, and we want to get them home for Christmas, but it will also affect the flow through the hospital right now, during a winter flu crisis.

We welcome this action and urge the BMA to call off the strikes, but can we address the legitimate grievances that the Secretary of State has mentioned?

[Wes Streeting]

I thank the Liberal Democrat spokesperson for his support, as well as for the constructive challenge. He is absolutely right to describe the challenge that we inherited, and we are seeking to deal with it. We have taken a number of steps along the way. For example, we promised to recruit an additional 1,000 GPs to the frontline in our first year. We expanded the additional roles reimbursement scheme in order to do that, and we were actually able to recruit an extra 2,500. The international medical graduate dimension of the deal means that the extra speciality training places go even further.

Although I would never pretend that the steps we have taken in our first 18 months in office have solved everything all at once—there is no shortage of things to solve—I say to those BMA members considering how to cast their vote that we have delivered a 28.9% pay rise, have taken action on international medical graduates through urgent legislation, and have expanded speciality training places. This is real progress. It is meaningful change in people’s pockets and to their lives, working conditions, career progression and prospects. 

The BMA should please not let the perfect be the enemy of the good. We have a lot of fires to put out on a lot of fronts as a Government, and that does take time. We are committed—and I am personally committed—to working constructively with the BMA on things like workforce planning to address those issues, if it is willing to work with us. That is all I ask. It is all I ask from any part of the NHS workforce. It should work with us constructively, understand our constraints, work through the challenges with us, and we will all get to a better place and create a rising tide in the NHS that lifts all ships.

[Alex McIntyre (Gloucester) (Lab)]

I thank the Secretary of State for his statement. My residents in Gloucester are rightly worried about strike action in the run-up to Christmas, and the impact that it will have on waiting lists in my patch in Gloucester. I am not surprised that there is no one here from the Reform party to hear about the challenges that our NHS is facing, and I am really shocked that there is nobody from the Green party, but there we go. Can the Secretary of State confirm that there will be resident doctors sitting at home in Gloucester tonight who will want to vote for this deal, who will not want to go on strike next week, and who want to get the NHS back on its feet? The BMA should do the right thing, and call off the strikes next week. It should listen to its members, and let us together get on with the work of repairing our NHS and the damage the Conservative party did.

[Wes Streeting]

I wholeheartedly agree with my hon. Friend. I was about to say that it is always a disappointment when Reform and Green Members do not appear in the Chamber, but I would not want to be accused of misleading the House. I am sure they had a better offer, and there is a Christmas party up the road.

In all seriousness, my hon. Friend is absolutely right. The tragedy of the past couple of rounds of industrial action is that each round costs about a quarter of a billion pounds. Each round, despite the best efforts of NHS leaders and frontline staff, does cause disruption, and we all lose when that happens. One of the things that is really hard for staff is that they are also confronted in a very real way with the impact of the state of the NHS on their patients. They are not in it for themselves, but because they believe in public service and want to improve the health of our nation. We are so much better able to achieve our shared goals if we work together, and we can grasp that opportunity if doctors vote for this deal, we draw a line under this dispute, and we try to reset the relationship between me and this Government on one hand, and the BMA’s leadership on the other.

[Madam Deputy Speaker (Judith Cummins)]

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

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

This is just not the time for a strike. As much as we have huge sympathy with many of the grievances of resident doctors, we understand that the next few weeks will be critical for how the next few months will be for the NHS, so I echo calls for the BMA to listen to reason. However, I spare a thought, and I hope the Secretary of State does, for the overseas doctors we rely on so heavily, because there is an acute workforce shortage. How, through this plan and this legislation, will the Secretary of State avoid creating a two-tier system that risks undervaluing the critical work that overseas doctors do to prop up our NHS?

[Wes Streeting]

I thank the Chair of the Select Committee for that contribution, which is really important on two fronts. First, she is absolutely right that this really is not the time for this kind of disruption, and I think the BMA knows that. I do not think that those I am dealing with are bad people. I think they are frustrated with me and this Government—they do not think we have gone far enough—and I am equally frustrated with them, and the fact that they do not recognise how far we have come, and how fast, but that is the nature of the dispute. With the extended mandate, there is an opportunity for us all to park this and, in the worst-case scenario, revisit it in January. I hope, even now, that the BMA will seize that opportunity. I think it would do it the world of good in the eyes of the public, and in the eyes of its members and the wider NHS family.

I am really glad that the Chair of the Select Committee raised the point about international medical graduates and the overseas workforce. The NHS has always been an international employer. We have been so fortunate as a country that, since 1948, people have come from around the world to help us build and sustain a national health service. Without them, it would collapse, and we never want to be a country that closes the door to international talent.

What is extraordinary is that many of those overseas doctors, when they see the competition ratios and compare our approach to that of their home country and other countries, think we have lost the plot. They cannot believe we do not already do this, so I think they will understand what we are doing and why. I hope they will be reassured that international recruits who have given service to the NHS will also be able to apply for specialty places, because we want to recruit and retain great talent, but they will also recognise how this is a game changer for the ratios for homegrown talent. I think they will understand that. I think they will respect that. Not least, I have been at pains as Health Secretary, given some of the ugly rhetoric that has come from one corner of this Chamber, to emphasise that, while some people in this House might tell those international recruits to go home, as far as we are concerned they are home.

[Jen Craft (Thurrock) (Lab)]

My mum, a former shop steward, always drummed it into me that there are no winners in a strike. Never is that as stark as in the situation we are facing now. There will be healthcare workers in my constituency, already under tremendous pressure, who will be looking at the situation coming up in the next few weeks with dread. That includes resident doctors who will be looking at that uncertainty and wanting some surety as to where they should go. The Secretary of State has been incredibly reasonable and has set out a plan that I plead the leadership of the BMA to get on board with. Call off these strikes to get us through winter and through this difficult period for the benefit of patients and for the whole NHS. Will the Secretary of State join me in echoing that plea?

[Wes Streeting]

I am grateful to my hon. Friend and I hope that point is not lost on the BMA. On the Labour Benches, we are the party of labour. We were created by the trade union movement to represent the interests of working people. That has been our calling for more than a century, since this party was founded. We have shown through our actions, not just our words, that this is a party in government who are committed to defending and extending the rights of working people, to improving pay and conditions, to clamping down on exploitation, and to making sure that this is a Government with and for the people.

The BMA has a willing partner with this Government. I sometimes feel like the Government have changed, the policies have changed and the approach has changed, but the BMA’s tactics towards us have stayed the same. I understand their cynicism about politics and their grievances with the situation they are working in, but I ask them also to recognise the progress we have made when we work together. There is an opportunity confronting them now to make further progress and I urge them to seize it.

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

These strikes will have a massive effect on my constituents in Farnham and Bordon. I am already getting emails from constituents who are concerned about the fact that their operations will be cancelled. The BMA is being entirely irrational and it holds the lion’s share of the blame for this situation, but the Secretary of State also has to take some responsibility for what is going on. If he gives the doctors a 29% pay rise with no strings attached, it is absolutely no surprise that they come back for more. I welcome the 4,000 extra places. I would like to press him on exactly where those 4,000 places will come. Would it not be better to have published that in the workforce plan, which is continually delayed by his Department? When will that workforce plan actually come about?

--- Later in debate ---

[Wes Streeting]

I thank the hon. Gentleman for the first bit. As for the rest of it, let me just say that the NHS workforce plan we inherited came in the 14th year of the Conservative Government. It was so absurd—it was so absurd—that on its trajectories for the increase in staffing numbers, within this century, 100% of the public would have to work for the NHS to sustain that level of workforce growth. And that is against the backdrop of AI, machine learning, genomics and the revolution in life sciences and medical technology that will change the NHS workforce and change the face of medicine.

We are working with the royal colleges, think-tanks and trade unions to make sure that in the new year our workforce plan is more credible. The hon. Gentleman is right to say that we are taking a bit longer with the workforce plan than I had originally intended. We are doing that because I was asked to do so by the partners that we will need, to ensure that the modelling and assumptions underpinning the workforce plan are good. I am always prepared to take a little bit more time to get it right, than to rush something out. That is the spirit in which I have engaged in workforce planning.

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

With a 28% pay rise and 4,000 extra specialty training places, it is starting to feel like the BMA resident doctors committee is deeply committed to not taking yes for an answer. It is not just about the services; it is about the parent who wants their kids to have their elective appointment before Christmas. It is real people in my constituency and across the country who are suffering, so I urge the BMA to come to the table and be reasonable. While we are looking at the training crisis, will the Health Secretary look at the specific areas where we have real training crises, such as mental health, GPs, sexual health and palliative care? There are a lot of areas in the NHS where this deal can be a win-win, as we can both open up the extra training places and solve some of the workforce crises that we know about right now.

[Wes Streeting]

My hon. Friend is absolutely right. I do wish the BMA would take yes for an answer sometimes; I would like it even more if the BMA gave yes as an answer to me once a while, but that has not happened in a little while. He is right to talk about the need for workforce planning. The workforce plan, which is in production, is all about making sure we have the right people in the right place at the right time. He mentioned mental health specifically. Our manifesto committed to 8,500 extra mental health workers over the course of this Parliament, and I am happy to report that we have already delivered well over 6,500. There is lots done, but more to do.

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

I find it rather shocking that when the Secretary of State for Health has offered the BMA leadership an opportunity to strike a few weeks later, they have turned it down, presumably because they prefer to strike at Christmas, when, frankly, lives will be lost as a result. Am I missing something here? Why is it, according to the Secretary of State, that the BMA leaders seem to be so determinedly militant? Does he think that in reality, they simply do not represent the views of their own membership?

[Wes Streeting]

I will say to the right hon. Gentleman that we are doing everything we can to mitigate against harm during the proposed strike dates, but I cannot in all honesty and integrity assure him that no patient will come to harm next week should the strikes go ahead, because the situation is so dire. I really urge the BMA to reflect on that overnight and into tomorrow and to ask themselves—perhaps their members will also ask this of their reps—whether it is really necessary to strike next week, given the offer of an extension to mandate.

To the right hon. Gentleman’s final point, when I was the president of the National Union of Students, I was once asked by a Labour member of a Select Committee that I was appearing before whether I was speaking for my members or for my activists. There is sometimes a difference between the two. I know that lots of people have campaigned hard for pay restoration and that many people are involved in the Doctors Vote campaign in pursuit of that aim. I think there are many doctors, however, who recognise that there has been real progress on pay and that what we are putting forward now is meaningful progress on jobs, too. I say to all members of the BMA: do not let the perfect be the enemy of good, especially when the stakes are so high.

[Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)]

I congratulate our own frontline team, because this is a great deal. I came to Parliament partly to speak up for our NHS, and I have spoken in many debates. I have also trained many surgeons over the years, and I know that my fellow surgeons will be up for this deal. College presidents will support it, and I urge all resident doctors to support it, too. I will just issue a word of caution from my son, a resident doctor, who is up there in the Gallery: if we increase the number of trainees, we will also need to increase the number of consultants and GPs. If we do not do that, we will simply push the bottleneck down the road.

[Wes Streeting]

My hon. Friend is absolutely right about the need to address bottlenecks and to do adequate workforce planning. He draws attention to his son, in the Gallery, who is a resident doctor and no doubt a voter—it is almost tempting to break the rules and start appealing to voters in the Gallery for a yes vote in the survey.

I would say one thing to any resident doctors who are watching, and not just the immediate members of my hon. Friend’s family. I do listen carefully to what resident doctors say and how they feel, so I know there will be some who are listening to my hon. Friend and thinking, “It’s all right for you and your generation—you’ve had it easy. We are fed up with these consultants and college presidents telling us what to think and feel.” I hope that they know the extent to which my hon. Friend has fought their corner and spoken up for their concerns—not just on the Floor of the House, but in meetings with Ministers. He keeps us anchored in the sentiment and experiences of all parts of the profession, especially resident doctors. I know that my hon. Friend feels a real commitment to ensuring that resident doctors have a bright future and a bright career. I hope they will heed his advice, just as I do.

[Mr Louie French (Old Bexley and Sidcup) (Con)]

Given the seriousness of the pending strikes, it is understandable that the Secretary has decided to focus his comments today on the BMA and this upcoming strike. I ask the Health Secretary this question constructively: what assessment has he made of the impact of the giveaways he has just announced on the likelihood of future strikes and on other NHS staff, particularly nurses, who are already feeling hard done by following last year’s pay rise?

[Wes Streeting]

That is a very thoughtful and appropriate question. Just to reassure the House, the Minister of State for Health and I have been working with Agenda for Change unions, particularly Unison, the Royal College of Nursing and GMB, to ensure that we are dealing with the structural reform of Agenda for Change that they are seeking. We have been exploring how we can deliver fairer pay for other parts of the NHS workforce and an improvement to the conditions and status of the nursing profession specifically, while maintaining fairness for all NHS workers. That is one of the considerations I have had to bear in mind when it comes to what we can offer the BMA and resident doctors. I have been very clear with the resident doctor reps about that privately, and I am happy to restate that publicly.

Doctors have not had a bad deal from this Government, frankly, and I have a responsibility to all parts of the NHS workforce, especially those who are lowest paid and who often lie awake at night worrying about their bills.

[Dr Simon Opher (Stroud) (Lab)]

On international medical graduates, I commend the Secretary of State. It is something we have discussed in the past, and bringing forward emergency legislation is absolutely crucial here, so I thank him for that. I also want to mention trainers in the NHS. I can reassure the Conservatives that we will make this happen. I have been a GP trainer for 25 years. We will work to make this happen; that is what we do in the NHS.

I have many resident doctor friends who do not like this action. Can we urge those doctors to talk to their fellows and try to call off this strike? It is not generally well supported among resident doctors, and it is something that we can change.

[Wes Streeting]

My hon. Friend makes a really good point. Sometimes during ballots people who are opposed to industrial action choose not to cast a ballot at all because they know that the turnout threshold is material. In the coming days, it is absolutely vital that every resident doctor makes their voice heard. This is their chance to tell me and their reps how they want to proceed on this deal. I respect the fact that the resident doctors committee has chosen today to present the deal in neutral terms to its members so that they can make a choice. I really do respect that. Now I urge resident doctors to make their views known and take the opportunity in front of them so that we can move forward together to make real changes to their lives.

[Several hon. Members rose—]

[Andrew George (St Ives) (LD)]

I welcome the Secretary of State’s statement and the manner in which he has been handling the issue. However, I want to ask him about the way he summarised the position at the end of his statement. He presented it as a choice between striking and having more jobs and the other parts of the offer. I seek clarity on the matter. Is he genuinely saying that he is going to withdraw that? Was that purely for oratorical effect, or is that his negotiating position?

[Wes Streeting]

I regret to say that if the BMA rejects this offer, we will not proceed with it at this time. I wish that we were not in this transactional lock. I wish we could just move forward together in a spirit of partnership, with a bit of give and take. That is not where we are, and I think I would be crucified by the public if I were to take a different approach. It would be the wrong thing to do and it would incentivise people to strike further, and I cannot tolerate that any longer.

[Justin Madders (Ellesmere Port and Bromborough) (Lab)]

Our constituents will consider it absurd that we spend billions of pounds every year on training doctors who will never work in the NHS. I am pleased that we are grappling with this issue, just like the Secretary of State is grappling with many others. He has shown that by working constructively through the issues, we can, hopefully, reduce industrial action. I contrast that with the comments from the shadow Secretary of State, who talked about bringing back the minimum service level laws. Will the Secretary of State remind the House that those laws were so unworkable that no public sector service ever actually used them? In fact, we had the highest levels of industrial action in 40 years under the previous Government.

[Wes Streeting]

My hon. Friend has so much expertise on health and on employment rights and trade union law, and he is right. That is why this Government have chosen a different approach. We want to work with all our trade unions, we want to work with the BMA, and we can still do so if we hit the reset button and each of us commits to building a more constructive relationship.

[Jim Shannon (Strangford) (DUP)]

I congratulate the Secretary of State and I fully support his stance on the resident doctors’ strike action. “Stand firm” is the message that I send to him, and I ask that God bless him and his team.

This will be the 14th strike since March 2023 and it is expected to cause major disruption. With the recent influx of flu, some wards have 70% occupancy. That could put the healthcare system under extreme pressure. Accident and emergency in the Ulster hospital, Belfast city hospital and the Royal Victoria hospital are under intense pressure. If they did not have the doctors from India and Africa, we would be under real pressure. What discussions has the Secretary of State had with the BMA about the impact this strike will have on emergency care and, ultimately, on getting patients back home before Christmas?

[Wes Streeting]

I am grateful to the hon. Gentleman for his support. He is right to raise concerns about the impact on urgent emergency care. We will do our best to keep the show on the road, but I cannot make guarantees in the way that I would want to about the quality or timeliness of care. I place on record my thanks to my counterpart in Northern Ireland, Mike Nesbitt, as well as to my counterparts in Wales and Scotland, for the constructive approach that they have taken in making this possible.

[Laurence Turner (Birmingham Northfield) (Lab)]

I draw attention to my membership of the GMB and my chairship of its parliamentary group. The BMA is currently in dispute with its workforce over an offer of 2% for this year, which is below the inflation rate on the retail prices index and the consumer prices index. Does my right hon. Friend agree that there is a striking inconsistency between the heads of claim that the BMA has advanced and its own record as an employer?

[Wes Streeting]

I should also declare that I am a member of the GMB and Unison. I say to my hon. Friend that there is a striking inconsistency between what the BMA is demanding for its members and what it proposes to pay its own staff. There is a word for that. In the spirit of trying to engage more constructively, I will not use it. However, I urge the BMA to engage constructively with us and with its own staff. It certainly will not want to see me on the picket lines outside BMA House.

[Kim Johnson (Liverpool Riverside) (Lab)]

I am a lifelong trade unionist and a proud member of Unite and Unison. I was proud to stand on the picket line with resident BMA doctors in my Liverpool Riverside constituency recently. They talked about the challenges around fees, and I am sure that they will welcome the fact that more money will be put in their pockets. There was some inconsistency, however. Will the Minister clarify that all resident doctors of all specialisms will be subject to the fee waivers?

[Wes Streeting]

I can give my hon. Friend the assurance that the royal college fees that I outlined in my statement will be covered by us. That will be a material saving in resident doctors’ pockets. Exam fees will also be backdated, recognising that many doctors will have already done those exams and paid the fees. I hope that that gives my hon. Friend and resident doctors in her constituency the confidence that this is a good deal and one that we can move forward on and campaign on together.

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

I have worked so many Christmases and new years as a nurse in the NHS, and I know the weary dread with which so many colleagues are facing this threat of strike action, particularly against the background of a spike in respiratory illnesses. It will be devastating. In a good year without strikes, it would be bad enough.

I really commend the Secretary of State for the work he has done to address what have been long-running sores in the experience of resident doctors. Some of this is genuinely transformational, and what I know a lot of clinical colleagues have been after for so long. But healthcare is a collective activity. It is the multidisciplinary team that delivers healthcare, not individual doctors or individual nurses, so can I recommend that the Secretary of State keeps focusing on that collective improvement to the NHS, as I know he has been doing? I implore everyone in the BMA who is listening: let’s just put this to bed now. It is time for everyone to have a healthy Christmas.

--- Later in debate ---

[Wes Streeting]

Of course, my concern is always patients, first and foremost, but it has been playing on my mind and my conscience that, going into this December, a lot of consultants, nurses, allied health professionals and other NHS staff are more tired than they would otherwise have been because they are putting in those extra shifts and extra effort both to cover the previous round of strikes and then to help the NHS to recover in that long tail that follows in the days and weeks afterwards. I really feel for them at the moment because of the conditions they are working in. I think all of us would breathe a sigh of relief—and also, frankly, express a great deal of gratitude, myself included—if the BMA were to take up the offer of postponing strikes until January. It is not too late. I urge it to think about that overnight and to do the right thing.

[Shaun Davies (Telford) (Lab)]

I thank my right hon. Friend for his leadership, and also the NHS bosses up and down this country for theirs. They often do not get the praise that they deserve in this House. This situation is bad for patients and their families and also for NHS staff, but above all it is bad for trust and confidence in our NHS. We know that there are people in this House and across the country who want to attack the very principle of the NHS. Does my right hon. Friend agree that the BMA needs to take into consideration that this is about not just the deal on the table today but the very principle our NHS?

[Wes Streeting]

My hon. Friend is absolutely right. To be honest, the thing that causes me most anxiety is that, although I know that the NHS is on the road to recovery, we are surrounded by an enormous amount of jeopardy. We need, as much as we possibly can, to make sure that we are not inflicting avoidable damage or setbacks on our progress, and it feels like that is what this round of strike action represents. My hon. Friend is right to praise NHS leaders and managers. I know how emotionally invested they are in seeing their patients and their staff through this Christmas, and I urge resident doctors and the BMA to take up not only the deal but the opportunity to at least put off strike action to January.

[Rachel Taylor (North Warwickshire and Bedworth) (Lab)]

I thank the Secretary of State for all his work on this matter so far, but I know that people in my constituency are going to be really worried about what might happen to them over the Christmas period. I thank all those hard-working NHS staff, be they nurses or doctors, who have continued to look after us and are facing a really difficult situation over this Christmas. Does my right hon. Friend agree that we need to urge the BMA to call off this strike and, in doing so, will he commit to continuing that dialogue with the profession so that it knows that he really understands the challenges it faces, the training opportunities it needs and the job opportunities it deserves?

[Wes Streeting]

I entirely agree with my hon. Friend. This is the point that I have impressed on the chair of the resident doctors committee. This deal is not the end of the conversation about jobs and career development in the NHS, because there are plenty of problems for us to solve. Although we cannot afford to go further on pay this year, what we have done so far—28.9%—is not the extent of what the Government can and are willing to do on pay. It just requires a bit of give and take, and I think we will make much more constructive and meaningful progress if we work together. I have my part to play in that, and from my point of view, we need to reset the relationship. It has hit the buffers somewhat in recent weeks. I am willing to do that. We have people we can work with on the resident doctors committee, but I think we are going to have to grasp the olive branch as it is presented today so that we can make more progress in the new year.

[Mike Reader (Northampton South) (Lab)]

People in Northampton are on a bit of a rollercoaster: they have seen the benefits of a Labour Government in the £16 million that has been secured for our new urgent care centre at Northampton general, but they will now rightly be worried reading the news. Will the Secretary of State send a message to my constituents to assure them that they will be kept safe should the BMA take this disastrous action?

[Wes Streeting]

I congratulate my hon. Friend on all his campaigning to secure investment in his constituency. One thing I can assure everyone in our country is that NHS leaders, frontline staff and I will do everything we can to mitigate harm during these strikes; I am afraid what I cannot do is guarantee that there will be no harm. That is the thing that keeps me awake at night at the moment, and that is the thing that the BMA should keep foremost in their minds when deciding whether or not, even at this late stage, to take up the offer to postpone strikes until January and take the mandate extension.

[Amanda Martin (Portsmouth North) (Lab)]

As a proud trade unionist, I know that trade unions are there to represent their members’ interests and views, yet by pushing ahead with this strike action, the BMA appears set to ignore its members. The offer on the table is real and comes from a Government who are listening and making positive change. Would the Secretary of State urge the BMA to take stock, think again about patients and its colleagues, and pause action while its members are consulted on the new terms? It has nothing to lose from pausing, yet the NHS and the population have so much to lose.

[Wes Streeting]

I completely agree with my hon. Friend. The BMA has put the offer to its members in neutral terms, but the fact is that it is now going to run a hasty survey over the next few days in order to give us what will still be less than 48 hours’ notice of whether or not these strikes will go ahead. If it took up the mandate extension, it could run a referendum properly and give its members more time to consider and discuss the offer in the workplace and with their families and reps. I do not see how more participation in the conversation and in the ballot could possibly be a bad thing.

As I have made clear to resident doctors, there are no downsides for the BMA in this. In fact, the only person who risks having a downside is me if, even after accepting the mandate extension, the deal is rejected and the doctors go out on strike again in January. This is not even a win-win scenario; this is a potential win-lose scenario, so I do not know why the BMA would not take it up.

This is a great offer for doctors. I know there will still be more to do, whether that is the implementation of the 10-point plan that Jim Mackey has come up with, my offer to work with the BMA trust by trust and employer by employer to see progress, or any of the other things we can do together. If we work together, we can get more done together. If we are working as partners rather than adversaries, we will all enjoy it a lot more and we will make more progress, and that is the opportunity that is available.

[Lizzi Collinge (Morecambe and Lunesdale) (Lab)]

I am very concerned that flu has hit hard and hit early this year. Hospital bed occupancy for flu is more than 50% higher than it was this time last year and resident doctors are central to tackling that. I have to admit to being very shocked that the BMA turned down an offer that would allow it to postpone next week’s strike. Does the Secretary of State share my worry that any strike action would make tackling this flu crisis much harder?

[Wes Streeting]

My hon. Friend is absolutely right. It also costs us roughly a quarter of a million pounds each time the BMA does this, and we cannot afford to keep paying that. It may say, “Well, then just do a deal with us and you will not have to fork out,” but then why would the rest of the NHS workforce, or the entire public sector or the entire economy, not go on strike? That is not constructive, and it is not going to get the NHS or Britain out of the enormous hole it was left in by the Conservatives. We are making real progress together, and I thank resident doctors for that. We will make more if we work together.

[Lewis Atkinson (Sunderland Central) (Lab)]

The coming weeks are always the most dangerous time of year for the NHS, and it is important to note that the patient safety risks arising from the strike will be present not just during the strike period but in the weeks following it. Some of my most daunting, and indeed scary, times in the NHS involved working alongside resident doctors, nurses and others in the early hours of the morning in January and late December to try to ensure that ambulances could still be offloaded under the most difficult circumstances. In that spirit of one team working for patient safety, I urge the resident doctors to accept the offer that the Secretary of State has set out. Will he confirm that NHS England and local NHS leaders will have his full support in taking the difficult decisions that they need to take to keep patient flow going and emergency care going during this period if strikes do take place?

[Wes Streeting]

I thank my hon. Friend for what he says and for the experience he brings to bear. I hope his urging is heeded by the BMA. I can give him that assurance. I think its operational leaders will face some fiendish choices in the coming days and weeks if strike action goes ahead. They will have my full backing. Myself, the Minister for Health and the Minister for Care are working closely with both the NHS and the social care sector, but this will be extremely challenging, and that is why I urge the BMA to adopt that “one team, one NHS” approach that he urges them to adopt.

[Josh Newbury (Cannock Chase) (Lab)]

I too thank the Secretary of State for the lengths he is going to for resident doctors. As somebody who worked in our NHS before coming to this place, I know what a pressured time winter is for staff and patients alike. With strikes at this time of year, NHS staff will this week be taking calls from harried managers and cancelling plans to be with their families at Christmas to cover shifts, and of course patients will have their operations cancelled. Does he share my concern about the human impact of this planned strike?

[Wes Streeting]

That is the only thing I have been thinking about in recent days, and it is why I have offered to extend a strike mandate for the first time, even though the BMA has asked me to do that on previous occasions in different contexts. I think it is a sensible compromise, and it avoids that dreaded phone call to the NHS staff member who has to cancel their holiday plans for Christmas and go back to work. Most importantly of all, it avoids that dreaded phone call to the patient who has been gearing themselves up for that test or scan that they are worried about, or that operation or procedure that they have waited far too long for. Indeed, it avoids the dreaded situation of someone having to call 999 in an emergency uncertain about whether the ambulance is going to arrive on time and anxious about whether they will be waiting in a car park, in a queue, in the back of an ambulance or, indeed, on a trolley in a corridor.

It gives me no pleasure at all to acknowledge that the bleak situations I have described are in play today in the NHS. Activity is already being stood down, but even if this strike action were not looming, the NHS is not in a state that I would want myself, the people I love, the people I represent or anyone in our country to be treated in, because of the enormous pressures that it is under.

With that in mind, and after listening to the contributions we have heard from across the House from Members on both sides who are not anti-doctor or even anti-BMA, I urge the BMA to do the right thing—not just to adopt this deal, but even at this late stage to adopt the offer of mandate extension in order to put off till January the spectre of strike action, and to give their members time to think, vote and make a decision on whether to accept a deal that would make a meaningful material difference to their job prospects, to their careers and to the future of our national health service. It is not too late to change course. It is not too late for the BMA to change its mind, and there is never any shame in doing so for those who think that is right.

I thank all hon. Members for their contributions, and you, Madam Deputy Speaker, for giving us so much time on such an important issue.

National Maternity and Neonatal Investigation: Progress Update

Wes Streeting Excerpts

Tuesday 9th December 2025 Written Statements

[The Secretary of State for Health and Social Care (Wes Streeting)]

This statement updates Members on the national maternity and neonatal investigation. In June 2025, I launched a rapid national investigation into NHS maternity and neonatal services. Baroness Amos was appointed to lead this investigation to examine the systemic causes of unacceptable care affecting women, babies, and families.

She and her team have made significant progress since then, having met with over 170 individual family members, including site visits where they have met further families and NHS staff to gather evidence and hear about their experiences of maternity and neonatal care. These local visits have included in Barking, Oxford, East Kent, Kings Lynn, Somerset and Bradford, and Gloucestershire.

Today is the first of three publications that are expected from the investigation. Baroness Amos’ update today sets out reflections and initial impressions since the investigation was launched of the work done and the picture that is starting to emerge. I want to recognise the extraordinary courage that bereaved and harmed families have shown in coming forward to share their experiences. What they have described is deeply distressing, and I cannot imagine how difficult it must be for them to relive these moments.

Baroness Amos highlights the significant challenges faced by women and families within maternity and neonatal care. She has also heard how fathers and non-birthing partners frequently feel unsupported, and how discrimination against women of colour, younger parents, and those with mental health challenges leads to poorer outcomes. Her reflections provide a valuable perspective of the issues and barriers that prevent the delivery of high-quality maternity and neonatal care.

We know that there is a diversity of views among families on the immediate action that needs to be taken. Families do not all agree, and we have a responsibility to listen to all of them. For example, some families want a full statutory public inquiry. Others are focused on systemic change that will prevent future harm. Some want individual case reviews and accountability. Others prioritise learning lessons quickly. I am absolutely committed to recognising this diversity of views and finding a way forward that delivers both accountability and urgent action.

As the investigation progresses, an eight-week call for evidence will begin in January 2026, and engagement will continue with national organisations and seldom-heard voices from communities facing health inequalities. This will be brought together by the investigation to build one set of national recommendations to improve the safety and experience of maternity and neonatal care.

Baroness Amos will deliver two further publications next year. The initial findings will come in February 2026, and a final report and recommendations are expected in spring 2026.

While there is still much to be done, today’s update is a key step forward in improving maternity and neonatal care, and families’ experiences. We are setting up the national maternity and neonatal taskforce early next year, which I will chair. It will develop and oversee the implementation of a new national action plan, based on the recommendations made in the national investigation’s final report. In the meantime, we are pressing on with important improvements to maternity safety, including a new early warning system to spot and tackle emerging safety concerns, and the roll-out of a programme to avoid brain injury in childbirth.

I would like to express my gratitude to Baroness Amos and her team for their dedication to the investigation and their work to date. The Government recognise the urgency of the concerns raised, and I would like to thank the bereaved and harmed families for their courage and bravery in sharing their experiences with the investigation.

[HCWS1148]

Mental Health Conditions, Autism and ADHD

Wes Streeting Excerpts

Thursday 4th December 2025 Written Statements

[The Secretary of State for Health and Social Care (Wes Streeting)]

I am announcing today the launch of an independent review into the prevalence of, and support for, mental health conditions, attention deficit hyperactivity disorder, and autism.

Over the past decade there has been progress in reducing stigma and an increase in public awareness of mental health conditions, ADHD and autism, and the importance of psychological wellbeing. Yet the prevalence of common mental health conditions for adults has increased to one in five, and many people who are autistic or have ADHD are struggling to access the right support. This Government have already taken significant steps to stabilise and improve NHS services, but there is much more to do.

I am deeply concerned that many adults, young people and children with mental health conditions, ADHD and autism have been let down by services and are not receiving tailored, personalised or timely support and treatment.

That is why I am announcing this independent review to understand the rises in prevalence and demand on services to ensure that people receive the right support, at the right time and in the right place.

The review will look to understand the similarities and differences between mental health conditions, ADHD and autism, regarding prevalence, prevention and treatment, the current challenges facing clinical services, and the extent to which diagnosis, medicalisation and treatment improves outcomes for individuals. This will include exploring the evidence around clinical practice and the risks and benefits of medicalisation. The review will also look at different models of support and pathways, within and beyond the NHS, that promote prevention and early intervention, supplementing clinical support.

I have asked Professor Peter Fonagy to chair this review with the support of two vice chairs, Professor Sir Simon Wessely and Professor Gillian Baird. They each have specific expertise on mental health and neurodevelopmental conditions and extensive clinical and academic experience.

The review will appoint an advisory working group, which involves a multidisciplinary group of leading academics, clinicians, epidemiological experts, charities and people with lived experience, to directly shape the recommendations and scrutinise the evidence.

I have asked the chairs to provide a short report within six months setting out conclusions and recommendations for responding to the rising need, both within Government and across the health system and wider public services.

The terms of reference will be published on gov.uk.

[HCWS1132]

Budget Resolutions

Wes Streeting Excerpts

Tuesday 2nd December 2025 Commons Chamber

[The Secretary of State for Health and Social Care (Wes Streeting)]

I begin by addressing the British Medical Association’s reckless call for resident doctors to strike in the run-up to Christmas. That is a cynical choice, coming as flu cases surge and we enter the most dangerous time of year for hospitals, and it is completely unjustified. After a 28.9% pay rise, the Government offered to create more jobs and put money back in resident doctors’ pockets. The BMA rejected that out of hand. My door has always been open, I have never walked away from the table and I stand ready to do a deal that puts patients first. We will prepare for this round of strike action.

I am extremely proud of the hard work and performance of NHS leaders and frontline staff who did so well to minimise costs and disruption during recent rounds of strike action. In fact, during the most recent round, we were able to maintain planned elective activity to cut waiting lists at 95%. Yet I must be honest with the House and with the country: if this strike goes ahead, this time will be different. Our hospitals are running hot and the pressures are enormous. That is why I urge the BMA not to go ahead. Not only does it put the progress we are making together in the NHS at risk; it threatens to do so in the worst way and at the worst time possible.

[Florence Eshalomi (Vauxhall and Camberwell Green) (Lab/Co-op)]

Does the Secretary of State agree that the hard-working staff at St Thomas’ hospital across the bridge, who deal with patients from right across the country, including many who have had surgeries and operations booked for many months, still kept the show going during the last rounds of strikes? Will he please do everything in his power to make sure that the strike does not go ahead?

[Wes Streeting]

I can certainly give my hon. Friend that assurance, and I absolutely endorse what she says about our local hospital, which I know very well. I genuinely thank frontline NHS staff, without whom the performance and improvements we are seeing simply would not be possible.

Let me turn to the substance of this debate. There was once a time, not long ago, when this place was bound in consensus on a number of issues addressed by this Budget. We used to be united on the need for a national health service as a publicly funded, public service, free at the point of use. The last Labour Government built a shared conviction that in 21st-century Britain, no child should grow up shackled by the scourge of poverty. We could go back as far as the Government of Benjamin Disraeli and find a Conservative Prime Minister committed to public health in a way that Labour and Conservative Prime Ministers have been in my lifetime. We did not always agree on how to get there, but there was at least agreement on the destination. However, as the opposition parties lurch to the right, consensus after consensus is breaking. [Interruption.] Admittedly, the Liberal Democrats have moved further to the left since their days in coalition; that is true. Maybe do not lead with your chins on that one, comrades.

Regardless of our friends on the centre left, old battles that were won must now be fought all over again, so it falls to Labour not just to cut waiting lists, improve the health of the nation and lift children out of poverty, but to win the argument, as well as hearts and minds. It falls to Labour to persuade people that we can and must help people lead healthier, longer lives, free from preventable disease; rebuild our national health service as a public service, free at the point of need; and give every child the best possible start in life, free from the scourge of poverty. Labour has won those fights before, and we will win them again.

[Calum Miller (Bicester and Woodstock) (LD)]

The Secretary of State knows, because his Department shares responsibility for special educational needs and disabilities education, that that is a major challenge facing the young people whose opportunity he so rightly champions. How will the announcement that the Government will take responsibility for that from 2028 alleviate the growing deficits facing many county councils across this country, which it is estimated will grow to nearly £17 billion by the time the national Government take over?

[Wes Streeting]

That is a good question, and I give the hon. Gentleman the assurance that my Department is working closely with the Secretary of State for Education and colleagues right across Government to make sure that we get that right. We have growing levels of need for provision for children with special educational needs and disabilities. We can all see in our casework, let alone through debates in the House, the unmet need, and its impact on children’s education, health and life chances. We are committed to modernising and reforming the system so that it meets needs and sets children up to not only survive but thrive. That is the ambition of this Government.

On Sunday, the Leader of the Opposition said that she would reinstate the two-child benefit limit. At the stroke of a pen, she would plunge half a million children back into destitution, shame and hunger. Gone are the days when David Cameron attempted to ape Gordon Brown on issues of inequality and poverty; in fact, the 2010 Conservative party manifesto included the word “poverty” 20 times and committed to an anti-poverty strategy. The 2024 Conservative manifesto mentioned the word once, in a chapter on foreign affairs. Was that because, after 14 years of Conservative rule, the stain of child poverty had been removed from our nation? No, of course it was not. The Conservatives plunged 900,000 children into poverty, more than a million children relied on food banks last year, and children are being admitted to hospital for malnutrition in 21st-century Britain—but now, this Conservative party does not even pretend to care.

On public health, remember it was George Osborne who introduced the sugar tax, and Boris Johnson who introduced legislation to ban certain “buy one, get one free” deals and free refills of fizzy drinks, yet today their successors dismiss these policies as nanny state. Their party is more apologetic about their record on public health than it is about Liz Truss’s catastrophic mini-Budget.

We are seeing the NHS’s founding principles contested for the first time in generations. The Leader of the Opposition says,

“we need to have a serious, cross-party national conversation”

about charging for healthcare. Well, if she wants one, she’s got it, and it will be a short conversation. The answer from this side is “No, over our dead body.” We will always defend the NHS as a publicly funded public service, free at the point of use, owned by us, and there for all of us. Of course, it is not just the Leader of the Opposition saying these things; the leader of Reform wants to replace the NHS with an insurance-style system. [Hon. Members: “Where are they?”] They are obviously not here to advocate for their policies. They find it increasingly hard to defend them. They want a system that checks your pockets before your pulse, and asks for your credit card before providing your care.

Where is the hon. Member for Clacton (Nigel Farage)? He is not normally the shy, retiring type—unless, of course, he is being asked challenging questions, like whether paracetamol is safe, whether he believes in science or whether he racially abused schoolchildren. In fact, it is reported that he told a Jewish contemporary at school that “Hitler was right”. Admittedly, he was at school a lot longer ago than me, but had I grown up in the aftermath of the second world war, I think I would remember if I had supported the losing side. His politics are a disgrace. He cannot stand by his record, and that is why he is not here to defend it, and why he is regularly referred to in his constituency as “Never-here Nigel”. But as we are in a debate on these issues, let me take on the Opposition parties’ arguments, whether they are here or not.

The Conservatives say that the route out of poverty is work, not welfare. I do not disagree that those who can work should work, but six in 10 households impacted by the two-child limit have at least one parent in work, and they are still in poverty because of low wages and a high cost of living. The Conservatives say that it is the responsibility of families, not the state, to ensure that children are well fed. I agree that parents have a responsibility to look after their own children, but life is a bit more complicated than that. It is far too easy for others who have never walked in the shoes of parents like mine to pass judgment on people whose lives they will never understand.

The Conservatives sneer about “Benefits Street”. They have never been there. They have not got the first clue what life is like for people living on welfare. They say that lifting the two-child limit helps only the feckless and irresponsible, so let me tell them about the mum who came to see me at my advice surgery one Friday afternoon with her three children in tow. She had fled domestic violence and had been rehoused on the other side of London in a bed and breakfast. That remarkable woman was hand-washing her girls’ uniforms, doing a three-hour round trip every day to get her kids to school and holding down three separate jobs. Please do not tell me that women like her are feckless or irresponsible, or on the take. She is facing down hardships and challenges that would break many of us. I will tell Conservative Members who is feckless and irresponsible. It is the people who exploited the covid pandemic, ripped off Britain and lined the pockets of the Conservative party.

Conservative Members say that abolishing the two-child limit is not affordable, but the policy is fully funded. It is paid for by cracking down on tax avoidance and evasion, and a tax on online gambling. What they really mean is that they would make different choices. They would put the interests of gambling firms over the wellbeing of children. By labelling it as unaffordable, they betray their view that the prosperity of our country has nothing to do with the talent of its people, but we know that by investing in our people, we are investing in a more prosperous future. Growing up in poverty is not an inconvenience; it is a trap. On average, the poorest children start school already behind, get worse exam results, are less likely to make it to university, earn less, are more likely to develop long-term illness, end up paying less tax, and are more likely to need welfare support and the NHS.

Investing in our children is a moral mission; morally, we do not believe it is right to punish children for the circumstances of their birth, or the choices of their parents. This is also a down payment on a better future. It is far better and more cost-effective to invest in children now than pay the price for social failure later. I stand here today as the product of the wise investment of the British taxpayer. It was taxpayers’ contributions that clothed me, housed me, fed me and educated me when I was growing up. As a result, I am now in a position to pay back that debt to society—and to pay it forward to the next generation, too.

We should all be proud that this Budget funds the biggest reduction of child poverty of any Budget this century. My right hon. Friend the Chancellor takes that prize from Gordon Brown, who took it from Denis Healey, because lifting children out of poverty is what Labour Governments do. And why is it that every time Labour enters office, there is the moral emergency of child poverty? It is because, since records began, every single Tory Government left child poverty higher than they found it. That is why they must never be allowed back in power.

[Paul Holmes (Hamble Valley) (Con)]

Will the Secretary of State give way?

[Wes Streeting]

Gladly. Please do defend keeping children in poverty.

[Paul Holmes]

I am grateful to the Secretary of State for intervening, but this is my intervention, not his. Why was he part of a Cabinet that stood by and punished his colleagues for voting against the two-child benefit cap? Why do we now see this sudden conversion and revisionism? Why does he think that most people in this country who were polled are against the removal of the child benefit cap?

[Wes Streeting]

Let me say two things in response. I am almost certain that my hon. Friends will be delighted that he has intervened in defence of their plight at the hands of the Labour Whips, but he knows as well as I do that the Whip was removed from some of my hon. Friends not because of the substance of the issue they were raising but because we never, ever accept people voting against a King’s or Queen’s Speech. [Interruption.] That was the issue. He asked me a fair question, and he has got an honest answer. He should take it on the chin.

The hon. Member also asked why many people in our country believe that the two-child cap was right. It is because our Conservative predecessors peddled the myth and the lie that people in receipt of welfare are on the take, and are just looking for handouts, rather than help. We Labour Members take a different view; we recognise, as I have set out, that so many people affected by the two-child cap are in work and in poverty. That is one of the many scandals of the damage that more than a decade of Conservative rule did. The Conservatives broke the link between a hard day’s work and a fair day’s pay. In addition to the measures that we are taking on child poverty to remove the two-child limit, we are also increasing the national minimum wage. We are increasing it even higher for young people. We are doing this because this is the party of work, the party that wants to make work pay, and the party that is genuinely committed to waging war on poverty.

Just as we must win the argument for lifting children out of poverty, we must win the argument for the founding principles of our NHS. Having left the NHS in the worst crisis in its history, the right now argues that it is unaffordable and should be abandoned. The NHS was broken, but it is not beaten, and Labour is already breathing new life into our health service. Waiting lists are falling for the first time in 15 years. Ambulances are arriving 10 minutes faster in stroke, sepsis and heart attack cases.

Patient satisfaction with GPs is up from 60% to 74%, and nearly 200,000 more patients were given a cancer diagnosis or the all-clear on time.

With Labour, the NHS is on the road to recovery. That is in no small part because the Chancellor is reversing 14 years of austerity and investing in our NHS. We promised an extra 2 million appointments; we have delivered 5 million. We promised to recruit an extra 1,000 GPs; we have recruited 2,500. We promised to end the 8 am scramble; we have widened the window that patients have to request appointments and have made booking available online. A lot done and a lot more to do.

At this Budget, we announced the next steps on the road to recovery: 250 new neighbourhood health centres with the first ones in Birmingham, Barrow, Truro and Southall, and £300 million more to invest in technology to modernise healthcare. Next year, we will receive recommendations from Baroness Casey on laying the foundations to build a national care service.

The NHS does not just face an existential political challenge from the Conservatives and Reform UK; it faces a sustainability challenge.

[James Naish (Rushcliffe) (Lab)]

I appreciate the announcement about the 250 new neighbourhood health centres, but I am concerned for my constituency—a more affluent constituency that has health centres that were built in the ’60s. They are genuinely falling apart and need significant investment to ensure that GPs can continue to deliver outstanding service to my constituents. Could the Secretary of State provide some reassurance, or agree to meet me to discuss how we can ensure that deprivation is not the only aspect considered in that excellent initiative?

[Wes Streeting]

My hon. Friend is absolutely right. Of course, we want to ensure that investment is deprivation linked. We want to reverse the damage the Conservatives did when they pursued what I would characterise as the Royal Tunbridge Wells strategy, when our former Prime Minister, the right hon. Member for Richmond and Northallerton (Rishi Sunak), declared with pride to Conservative party activists that he had taken funding from the poorest communities in the country and funnelled it to the richest. There could be no shorter or clearer exposition of Conservative party values and politics in action than that claim.

To my hon. Friend’s point, he is absolutely right that within many affluent communities there are also pockets of deprivation, and we have to ensure that the NHS is there for everyone in every part of the country. We are dealing with enormous undercapitalisation in the NHS, totalling some £37 billion as identified by the noble Lord Darzi. It will take time to address that challenge, but I think my hon. Friend’s constituents know from his assiduous hard work and visible campaigning as a constituency MP that he will ensure that their needs and interests are not forgotten or overlooked by this Government.

Of course, as we improve the health of our health service, we also need to address the health of our nation. Children in England face some of the poorest health outcomes in Europe. Obesity in four and five-year-olds is reaching record levels—a health time bomb that leaves them at greater risk from cancer and heart disease later in life. What kind of start in life are we giving our children, and if we allow it to continue, what kind of future are we leaving to them? Our children will lead shorter, less healthy lives; our NHS will buckle under a tidal wave of chronic conditions; and our economy will suffer because businesses will be denied the potential of the next generation.

This Labour Government are tackling the sickness in our society. Whether it is the extension of the soft drinks industry levy, free school meals, a warm home discount that reaches millions more, the generational ban on smoking, Awaab’s law, cutting pollution and cleaning up the air that our children breathe, we are combating the drivers of ill health in children’s lives: poor diets, damp homes, dirty air and a lack of opportunity. In short, we are tackling poverty, because every child deserves a healthy start in life, and prevention is better than cure.

The leader of Reform, the hon. Member for Clacton, says we should instead be educating people to make healthier choices—I assume that he will not be leading from the front on that campaign. But we know that Reform and the Conservatives oppose our agenda to improve public health. They oppose our investment in the NHS. They should just be honest and admit that they now oppose the NHS itself. [Interruption.] Conservative Members do not like it, but I challenge them to dispute a single claim I just read. Let me repeat the charge sheet for their benefit: they oppose our investment in the NHS. Have they not opposed every budget spending review since Labour came to office? [Interruption.] Honestly, from a sedentary position, the hon. Member for Kingswinford and South Staffordshire (Mike Wood), who does not want to intervene because I think he knows he is leading with his chin on this, wants to suggest that somehow the Conservative party left a legacy that they could be proud of. They inherited the shortest waiting times and the highest patient satisfaction in history. They left us the longest waiting lists and lowest patient satisfaction on record. No wonder so few of them have turned up to defend that shoddy record.

The Conservatives oppose our public health agenda, do they not? I thought this was an area where we had built consensus, but not under their present leadership. I have already quoted what their leader, the right hon. Member for North West Essex (Mrs Badenoch), has said. Maybe they were not listening—the country certainly is not. I would have thought, though, that their own side would at least listen to what she said. She says she wants a debate about charging for healthcare. I do not know whether they have heard that or whether they stand by it. Maybe we could just see a simple show of hands—how many of her own side want to see charging for healthcare in the NHS? Not a single hand has gone up. That does not bode well for the future of the Leader of the Opposition, but let’s leave the Conservative party to revel in its irrelevance.

In fact, I was probably one of the few people who paid any attention to what the shadow Health Secretary, the right hon. Member for Daventry (Stuart Andrew), said at the Conservative party conference. I noticed that he did not mention a single policy. I say to the Conservatives: if we are doing such a bad job, why would they not do anything differently? Would they cut the £26 billion this Labour Government are investing in the NHS, and if not, if they oppose this Budget, how would they pay for it? The Conservatives seem to think that the British people are so stupid that they will forget which party wrecked the NHS and led it to the worst crisis in its history.

To conclude, this is a Government who are cutting waiting lists, giving children a healthier start in life and lifting 500,000 children out of poverty. In doing so, we are restating the case for universal healthcare that is publicly owned, publicly funded and free at the point of use. We are showing that progress is possible after 14 years of decline, that things can get better. Abolishing the two-child limit is not a handout, it is a hand up. Our country cannot prosper while 6 million people languish on waiting lists, 4.5 million children grow up in poverty and 1 million young people are not in education, employment or training. But if we protect people’s health, give them the opportunities to put their talents to use and give them a strong foundation, they will build a good life for themselves and a better Britain for all, and we can fulfil the lost promise that tomorrow will be better than today.

[Madam Deputy Speaker (Judith Cummins)]

I remind all Members that the courtesies of this House require Members to inform other Members if they intend to name them in the Chamber.

I call the shadow Secretary of State.

--- Later in debate ---

[Stuart Andrew]

Well, we did not spend tens of billions of pounds in pay rises just for the same old problem to come back. There should have been proper reform, and conditions for those pay rises, but the Government did not make that happen, and here we are again.

The NHS Confederation has also warned that local services cannot continue to absorb the costs of ongoing strikes by the BMA without consequences for patient care. I pay tribute to frontline staff, who have been trying to keep everything going. I remind the Secretary of State that we have the answer: ban doctors from striking, like the Army and the police, and introduce minimum service levels, using the legislation that our Government passed. That would protect patients and taxpayers, so why won’t he do it? Labour’s Employment Rights Bill will make things much worse, because it reduces the vote threshold for calling a strike, and there will be no minimal service levels.

In addition, the Government have shown that they cannot stand up to the unions. By pushing up inflation, the Budget will make it harder to reach pay settlements across the rest of the NHS workforce. Even an additional rise in NHS pay of just 1% of what the Secretary of State included in his pay review body evidence would create another £1.5 billion hole in his budget. Is he confident that he can head off wider industrial action with a 2.5% offer, especially given that benefits are rising much faster under this Government?

The OBR has also raised the unknown risk of increasing drug prices. My understanding is that the spending review assumed that spending on branded medicines would rise by 25%—or £3.3 billion—between 2025-26 and 2028-29. In winding up, will the Minister clarify what happens when the negotiated price costs more than what was assumed in the spending review? The rest of the money is surely intended to be used to deliver more care and to cut waiting lists, so are frontline services at risk?

[Wes Streeting]

I am grateful to the shadow Health Secretary for giving way. We should be clear that the deal struck with the United States is the first and only deal with the United States that secures 0% tariffs and mitigations against most-favoured-nation pricing. It will ensure that patients get access to good drugs. For the avoidance of doubt, although some costs are unpredictable because of the complexity of medicine pricing, of course we will not cut NHS budgets to fund the pharma deal.

[Stuart Andrew]

We will see what happens. It would be interesting to know exactly where the money will come from. [Interruption.] The Secretary of State just said that if the prices go up, there will be no cuts to the NHS budget, but where will the money come from? Which other part of the national health service and social care will the money come from? We will have to wait and see.

The Budget last week made no mention of social care. After all, Labour’s only plan is to delay coming up with a plan for a few more years, despite the urgency and the scale of the challenge. Many of us entered the cross-party talks in really good faith, and they were encouraging, but we have only met once. Surely we should be getting on with it. The message was loud and clear that we want to work together, but we want to get on with it. Please can we have another meeting, so that we can get on with tackling this really important issue?

It is not quite true to say that social care is unaffected by what was announced. The increase in the national living wage will be welcomed by those on the lowest incomes, but the Nuffield Trust estimates that it will cost the social care sector £1.2 billion. The sector is already struggling with last year’s national insurance contributions hike, so who will pay for this? Will there be funding cuts to other parts of the health budget? Will self-funders have to fork out yet more again, or will it be passed on to local authorities, inevitably leading to council tax rises? What impact will this national living wage increase have on wider pay in the sector?

--- Later in debate ---

Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 342) with explanatory notes (Bill 342-EN).

[Wes Streeting]

On a point of order, Madam Deputy Speaker. I have to confess a sin. Earlier today, in the debate on the Budget, I referenced the hon. Member for Clacton (Nigel Farage) and did not notify him in advance. This was particularly egregious because I was not very nice about him. With that in mind, and out of respect for the customs and conventions of this House, I would like to apologise to the hon. Member and put this note on the record. I have, of course, written to him in similar terms.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I am grateful to the right hon. Member for giving me advance notice of his putting this point on the record. I am not sure that it is a sin, or whether he will be absolved of it, but it has been noted.

Oral Answers to Questions

Wes Streeting Excerpts

Tuesday 25th November 2025 Commons Chamber

[Laura Kyrke-Smith (Aylesbury) (Lab)]

4. What steps his Department is taking to improve patient access to GPs.

[The Secretary of State for Health and Social Care (Wes Streeting)]

I am pleased to report that both access to general practice and patient satisfaction with general practice have improved since Labour came to office. Over 75% of patients find it easy to contact their practice —an improvement of 14 percentage points since the general election. Not only have we recruited an extra 2,500 GPs; crucially, more patients are receiving continuity of care, backed by an additional £1.1 billion. Lots done, lots to do, and certainly a long way to go, but general practice is on the road to recovery.

[Alex Baker]

I am proud to see this Government’s improvements to GP services making a real difference locally, with over 2,000 more GPs hired and new investment already reaching practices like Jenner House surgery in Farnborough. However, many of my older and more vulnerable constituents tell me they are still struggling to get through on GP phone lines, especially as more practices move online. What steps is the Secretary of State taking to ensure that phone lines remain accessible for those who rely on them, so that everyone benefits from our NHS health plan? [Interruption.]

[Wes Streeting]

Well, Mr Speaker, you couldn’t script this! We have a doctor in the House—my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley)—whose phone was alive as this very issue was raised by my hon. Friend, such is the commitment of doctors in our NHS to be available to patients wherever and whenever they are needed.

This Labour Government were elected on a pledge to end the 8 am scramble, and that is exactly what we are doing. We know that not everyone wants to contact their practice online. That is why practices must offer patients the option to telephone or visit in person in addition to online access. I thank GPs up and down the country for the work they are doing and the progress we are making in improving online access, access generally and patient satisfaction—lots done, lots to do.

[Laura Kyrke-Smith]

The number of qualified GPs in Buckinghamshire has risen by 8% in the last year thanks to this Government’s determination to recruit and retain more GPs. It is a great start, but I still hear from too many people in Aylesbury who cannot get through to their GP surgery or cannot get a quick enough appointment when they do. My constituent Jane, whose husband had suffered a stroke, was advised that he needed a GP appointment the next day, but it took a month to get one. I know my right hon. Friend is determined to keep improving access to primary care for people in Aylesbury and across the country, so can he set out his next steps?

[Wes Streeting]

I certainly can, and I am sorry that my hon. Friend’s constituent was let down. Everyone who needs a same-day appointment should be able to book one, and that is what we are working towards. As she says, we are recruiting more GPs. We are also investing £102 million to create additional space for appointments, including in 21 GP practices in my hon. Friend’s local integrated care board system. Nowhere is the state of the NHS, and the crumbling legacy we inherited, more evident than in the NHS estate, and that is why I am proud that in her Budget, the Chancellor will be setting out plans to roll out a new generation of neighbourhood health centres to deal with the crumbling NHS we inherited and to build an NHS that is fit for the future.

[Mr Speaker]

Can’t be possible—we have not had the Budget yet!

[Dr Kieran Mullan (Bexhill and Battle) (Con)]

There are a number of exciting opportunities for extended GP premises in my constituency—in places like Martins Oak in Battle, Little Common and Old Town, and Oldwood in Robertsbridge. One major challenge is the rates that the NHS district valuer is willing to offer for construction sites; they have just not kept up with the inflation we have seen across all sectors of construction. I did have a meeting with the Minister for Care and it was helpful to start those discussions, but we have not made the progress that we need to. Can we have a further meeting, and will the Secretary of State outline what he will do to ensure that district valuers are offering rates that can allow construction to go ahead?

[Wes Streeting]

I thank the hon. Gentleman for raising some of the practical challenges that stand in our way to improving and expanding the primary care estate. We are looking into the issues that he raises. We want to ensure that we can modernise the estate as effectively and quickly as possible. When there is progress to report, I have no doubt that the Minister for Care will be in touch.

[Lisa Smart (Hazel Grove) (LD)]

Over the summer, my team and I conducted a health survey across my constituency, and 40% of those living in the most deprived and most urban parts of my patch—Heaviley, Little Moor and Great Moor—were struggling to access GPs. What more can the Secretary of State do to ensure that urban and deprived communities get their fair share of GP access?

[Wes Streeting]

I am sure that the hon. Member’s constituents will have noticed what an assiduous and active Member of Parliament she has been in actively soliciting their views. I hope that they and she will find it reassuring to know that we are taking action to deal with the very inequalities that she mentions. The Royal College of General Practitioners found that in the poorest parts of the country, there are an extra 300 patients per GP. It cannot be right that the poorest parts of the country receive the poorest service too. That is why we are reforming the Carr-Hill formula so that deprivation is the driver of funding and prioritisation. That will help us to improve services for everyone and to tackle the gross health inequalities that blight our society.

[Liz Twist (Blaydon and Consett) (Lab)]

2. What steps he is taking to ensure parity of esteem between mental and physical health services.

--- Later in debate ---

[Elaine Stewart (Ayr, Carrick and Cumnock) (Lab)]

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

[The Secretary of State for Health and Social Care (Wes Streeting)]

In England, for the first time in 15 years, waiting lists are falling. Through record investment and modernisation, we have cut backlogs by more than 230,000, and we smashed our target for additional appointments in our first year, delivering more than 5 million. There is a long way to go, but the NHS in England is on the road to recovery. Unfortunately, in Scotland the SNP cannot seem to get the car started.

[Elaine Stewart]

While the NHS is on the road to recovery in England thanks to the investment of this Labour Government, there are 61,000 patients in NHS Ayrshire and Arran on a waiting list for treatment, almost 11,000 of them for over one year. Does the Minister agree that after record levels of funding for Scotland in the last Budget, people in my constituency should be asking the First Minister and his Government, “Where’s the money gone, John?”

[Wes Streeting]

My hon. Friend is absolutely right. More patients are waiting a year for treatment in Ayrshire and Arran than in the entire south-west of England—that is shocking. Thanks to the investment the Chancellor has made, Scotland is receiving an extra £1.5 billion this year and £3.4 billion next year—the biggest funding increase since devolution. Labour is cutting waiting lists in England. Labour is cutting waiting lists in Wales. Why is the SNP failing where Labour is succeeding?

[Joe Robertson (Isle of Wight East) (Con)]

The Secretary of State has failed to end industrial action like he said he would. How is that helping to reduce waiting lists?

[Wes Streeting]

Industrial action sets back our progress on waiting lists, but frankly, the Conservatives presided over an absolute mess—not just over the course of 14 years, when waiting lists rose every single year during the Conservatives’ time in power, but in their catastrophic mishandling of industrial relations. We came in, and we settled with the British Medical Association—[Interruption.]

[Mr Speaker]

Order. Mr Fox, you were the last voice I heard. I want to hear what the Secretary of State has to say. If you do not want to, you can go and get a cup of tea.

[Wes Streeting]

We came in, and we settled with the resident doctors with a 28.9% pay rise. It should be clear to them from the questions that Opposition Members have asked and the extent to which they have opposed a pay rise for not just resident doctors but NHS staff more generally that there is not a more pro-NHS, pro-doctor Health Secretary or Government waiting in the wings. It is either the Conservative party, which lumbered the NHS in this crisis in the first place, or the Reform party, which does not believe in the NHS at all.

[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I would first like to say I am sorry that the Minister for Public Health and Prevention is unwell and convey to her the best wishes of the Opposition.

I would like the Secretary of State to consider a patient who has waited a year for a procedure and then, after three waiting list validation calls, finally sees the consultant to check that the procedure is still necessary. If the consultant agrees that it is, do the Government figures show that patient as waiting for a year or a much shorter period?

[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.

[Dr Johnson]

The Secretary of State does not seem entirely sure, so perhaps he can write to us with an answer—

[Wes Streeting]

I said that there is a clock stop.

[Dr Johnson]

As someone who is on the waiting list myself, I do hope that the Secretary of State is correct. Waiting lists for procedures and operations requiring day care or overnight admission are both rising and higher than they were a year ago. Orthopaedic surgery waiting lists are up, yet this Government scrapped our major conditions strategy and say that they have no plans for a musculoskeletal conditions framework. Gynaecology surgery waiting lists are up, yet the Government scrapped and are now reviewing the women’s health strategy. Waits for procedures and operations in ophthalmology, general surgery, neurology and gastroenterology are going up too. When is the Secretary of State going to get a grip of the surgical waiting lists?

[Wes Streeting]

I honestly cannot believe the brass neck of Conservative Members; their time in government led to the longest waiting times and lowest patient satisfaction in the history of the national health service. The best news I can offer the shadow Minister, and others like her who are on a waiting list, is that we have a Labour Government who are reducing waiting lists for the first time in more than 15 years.

[Sally Jameson (Doncaster Central) (Lab/Co-op)]

6. What steps he is taking to help reduce the repair backlog at Doncaster Royal infirmary.

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[Josh Newbury (Cannock Chase) (Lab)]

8. What assessment he has made of the adequacy of the provision of health services for men.

[The Secretary of State for Health and Social Care (Wes Streeting)]

May I first commend my hon. Friend not just on leading the recent International Men’s Day debate, but on his courage in speaking so openly about his own experience of sexual assault and the need to tackle the stigma surrounding it? [Hon. Members: “Hear, hear.”] For too long, men’s health has been overlooked, with a reluctance to accept that men suffer specific inequalities and hardships as men and boys. We know that men are less likely to come forward for healthcare. From partnering with the Premier League to rolling out health support in the workplace, we are meeting men and boys where they are and supporting them to live longer, healthier lives.

[Josh Newbury]

The publication of the first ever men’s health strategy for England was a historic step forward, including the drive to improve care for men with prostate cancer, the most common form of cancer in men under 50. I place on record my admiration for the right hon. Lord Cameron for speaking publicly about his diagnosis and successful treatment. The commitment to expanding home-based testing and remote monitoring is welcome, but can the Secretary of State tell the House what the Department will do to increase awareness and access to testing among the men most at risk, including those under 50?

[Wes Streeting]

I join my hon. Friend in commending Lord Cameron on his openness. Raising awareness, as we know, encourages men to come forward and leads to more diagnosis. He has done a great public service in talking about his own experience. We are improving care for men diagnosed with prostate cancer and undergoing active monitoring or treatment. We will be introducing support for individuals who are on prostate cancer active monitoring pathways to enable them to order and complete prostate-specific antigen blood tests at home from 2027. As for screening and the case being made for targeted screening, I await the recommendations of the National Screening Committee. We will study those carefully. We know that this is contested within the sector, so it is important that we have an evidence-based discussion, thrash out the arguments and reach the right way forward.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I welcome the Secretary of State’s indication that he is awaiting the outcome of that report on screening for prostate cancer. If that report recommends what many of us hope it will recommend, will he act quickly to develop the report’s recommendations, whatever they are?

[Wes Streeting]

We are expecting the draft recommendations, and then a three-month consultation period will follow, but I want to act quickly on the evidence and what the recommendations contain, not least because we know that as well as it being a prevalent form of cancer, some groups—particularly black men, men with a family history of prostate cancer and men with BRCA gene mutations—are at higher risk. Black men are twice as likely to die with prostate cancer than white men. There is therefore an imperative to act. Whatever the recommendation, we need to do much better on diagnosis and treatment of this terrible condition.

[Ben Goldsborough (South Norfolk) (Lab)]

9. What steps his Department is taking to improve access to NHS dental services in Norfolk.

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[The Secretary of State for Health and Social Care (Wes Streeting)]

Women’s health is a priority for me, for my Department and for the Government. Since I last answered questions in the House we have extended the NHS health check to include the menopause for the first time, following the brilliant campaigning of Menopause Mandate and others. We have also made the morning-after pill free in pharmacies. The Prime Minister is co-ordinating work across Government to tackle violence against women and girls, and in the health and care services we will play our part in protecting and supporting victims. I have also asked the Government’s women’s health ambassador to renew the women’s health strategy that was introduced by the last Government, so we can ensure that it is driving the right progress in the future.

[Josh Dean]

When my constituent Rachel attended numerous A&E departments with severe abdominal pain, swelling, fever and nausea, her fears of a ruptured ovarian cyst were repeatedly dismissed. In her day-to-day life Rachel is a professional advising on antimicrobial resistance around the world, but as a patient she felt that her concerns were being ignored and that she was being pushed aside. She is determined to use her experience to challenge the unacceptable medical misogyny that she and other women across the UK still face too often. What action are the Government taking to ensure that women are not left to endure painful reproductive health conditions, and will the Secretary of State agree to meet Rachel to hear her story at first hand?

[Wes Streeting]

I thank my hon. Friend for describing Rachel’s experience. We have introduced Jess’s rule and we are rolling out Martha’s rule, so that, whether in primary or acute care, patients’ voices will be heard and they will be given the power to ensure that health professionals are listening and responding appropriately. However, my hon. Friend is right to acknowledge that much of this arises from medical misogyny. It is not just a case of changing rules and regulations; it is a case of changing culture and practice, so that women are not just seen but heard and listened to. That is a fundamental problem that we determined to address—and of course I should be delighted to meet Rachel to hear about her experience at first hand.

[Mr Speaker]

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

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

Diethylstilbestrol, or DES, was prescribed to women until the 1980s to treat miscarriage. Those who took it were themselves at greater risk of breast cancer, and their daughters have a higher risk of rare cervical cancers. It is estimated that a whopping 300,000 women have been affected. Two weeks ago the Secretary of State made an apology to victims, but they rightly want more than “sorry”, and they have pointed out that the current screening regime is insufficient. Will the Secretary of State meet me, and campaigners and victims, in order to understand how this was allowed to happen, who will be held accountable, and how those women can go about securing compensation for this egregious scandal?

[Wes Streeting]

I thank the Chair of the Select Committee for raising that extremely serious issue. I am glad that she has drawn it to the House’s attention. I have apologised, on behalf of the state, for the failure that occurred and for the harm that has arisen as a result. My hon. Friend the Member for Bournemouth West (Jessica Toale) has been campaigning diligently, and the DES Justice UK campaigners have done a magnificent job in raising public awareness. I am always delighted to meet the Chair of the Select Committee because I know which side my bread is buttered on, but I should be particularly delighted to meet her to discuss this specific issue.

[Mr Speaker]

I call the Liberal Democrat spokesperson.

[Helen Morgan (North Shropshire) (LD)]

The impact of health inequalities on women’s health are starkest when it comes to maternity care, with many NHS trusts requiring improvement. Black and Asian women, and those from the most deprived communities, are far more likely to suffer the worst outcomes or even lose their babies. The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives have vocally opposed the removal of the ringfence from the service delivery fund, saying that funding provided to drive change following the Ockenden review has disappeared at the stroke of a pen. Will the Secretary of State commit himself to reinstating that ringfence, and to ensuring that all the immediate and essential actions arising from that review of the failings at Shrewsbury and Telford hospital NHS trust are taken as soon as possible?

[Wes Streeting]

I thank the Liberal Democrat spokesperson for her question. She is right to raise the inequalities at the heart of poor maternity care, as well as failures in services overall. We are taking a number of actions, but on the issue of funding specifically—I think this will become a recurrent theme across a range of issues during this Parliament—the approach that we are taking as a Government is to try to devolve more power, responsibility and resources to the frontline. As we do so, we are removing national ringfences.

I appreciate what the hon. Lady says about the risk. It is important that we, and no doubt Parliament, scrutinise the situation to make sure that outcomes across the board improve and that the focus that this House wants to bring to issues like maternity safety is delivered in practice, but I think we are right to drive at the issue of devolution. Decisions are better taken within communities, close to communities and at a local-system level, but she is right to be vigilant about this issue, and we on this side of the House are absolutely open to challenge. If systems are not acting in the way that we want and it is having an adverse impact, we will reconsider.

[Cat Smith (Lancaster and Wyre) (Lab)]

11. If he will set out a timeline for responding to the Hughes report, published on 7 February 2024.

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[Alison Griffiths (Bognor Regis and Littlehampton) (Con)]

12. What steps he is taking to help prevent industrial action in the NHS.

[The Secretary of State for Health and Social Care (Wes Streeting)]

Trade unions, representing the majority of NHS staff, are engaged in constructive dialogue with the Government, particularly around reform of Agenda for Change. All NHS staff have received above-inflation pay rises. No other staff in the public sector have received a pay rise as high as that of resident doctors. We offered extra jobs, prioritisation for UK graduates and help with out-of-pocket expenses. Against that backdrop, it is simply appalling that British Medical Association leaders led their members out on strike, even though a majority of resident doctors supported the Government’s offer.

I am pleased to report to the House that, thanks to NHS leaders and frontline staff, including the resident doctors who turned up, the NHS met its ambitious goal and 95% of planned elective activity went ahead, meaning that 850,000 patients got the procedures and operations they needed, despite the BMA’s reckless action. None the less, the time and money that this has cost us is detrimental, and I hope the BMA will come back to the table constructively.

[Alison Griffiths]

After warnings from the NHS Confederation and NHS Providers, my constituents are still rightly concerned that services may yet be cut, appointments lost and operations delayed as a direct result of the BMA’s industrial action. These strikes did not need to happen. What will the Secretary of State do to reassure patients in Bognor Regis and Littlehampton that their safety and wellbeing is a priority for this Government, who have no timetable and no plan, and who have made no progress towards ending these damaging rolling strikes?

[Wes Streeting]

I must say that a bout of collective amnesia has swept the Opposition Benches, because the Conservatives seem to have forgotten the absolute calamity of bad industrial relations over which they presided. The difference between Members on this side of the House and the Conservatives is that we have never closed the door to talks; we have always been willing to engage with resident doctors in good faith. Unlike under that party, resident doctors have received a 28.9% pay rise from this Labour Government. It is a reminder to resident doctors across the land that the grass is not greener on the other side, and that they should work with a Labour Government who want to work with them.

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

13. If he will publish a national strategy for palliative care.

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[Sarah Olney (Richmond Park) (LD)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health and Social Care (Wes Streeting)]

Obesity robs children of the best possible start in life, hits the poorest hardest, sets them up for a lifetime of health problems and costs the NHS billions, so I can announce to the House that we are expanding the soft drinks industry levy to include bottles and cartons of milkshakes, flavoured milk and milk substitute drinks. [Interruption.] We are also reducing the threshold to 4.5 grams of sugar per 100 ml. This Government will not look away as children get unhealthier and our political opponents urge us to leave them behind.

[Mr Speaker]

The only thing I will say is that at least we are hearing it first in this House and not on Sky.

[Sarah Olney]

I congratulate the Secretary of State and the Department of Health and Social Care on the launch last week of the men’s health strategy. My constituent Philip Pirie, who sadly lost his son to suicide, has been calling on the Government to launch a public health campaign to reduce the stigma of suicide. Nearly 75% of those who lose their lives to suicide have not been in contact with mental health services, and that is why we need to reach out. Will the Secretary of State meet me and my constituent to discuss such a campaign?

[Wes Streeting]

I am sure that my hon. Friend the Minister for Care would be delighted to meet. The men’s health strategy sets out precisely the challenge in those terms. Through the partnerships that we have already announced, such as with the Premier League, as well as the people who have been knocking on our doors to get involved in such a campaign, I am absolutely confident that together, collectively across the House and across the country, we can tackle this terrible stigma.

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[Stuart Andrew (Daventry) (Con)]

Thank you, Mr Speaker. Can I ask the Secretary of State why he has not sorted out the strikes and disputes?

[Wes Streeting]

I wish the shadow Health Secretary a very happy birthday—21 again! It is good to see him here.

We continue to hold the door open to the British Medical Association. If it wants to engage constructively, we are ready and willing. What we will not do is be held to ransom. What we cannot afford to do is pay more than we already have. What we are able and willing to do is go further to improve their career progression and job prospects, and to work with them to rebuild the NHS, which the Conservative party broke.

[Mr Speaker]

Order. I have a lot of topical questions to get through.

[Stuart Andrew]

But, Mr Speaker:

“The power to stop these strikes is in the Government’s hands.”—[Official Report, 6 February 2023; Vol. 727, c. 660.]

“They need to sit down and negotiate to end the strikes, but Ministers are too busy briefing against each other.” Those are not my words, but the Secretary of State’s words when he was standing here on the Opposition side. He said it was so simple. The Secretary of State is embroiled in a leadership battle that is taking over the need to focus on averting walkouts, and the Employment Rights Bill reduces voting thresholds on strikes and scrapping minimum service levels. Does the Secretary of State accept that things are only going to get worse as a result of the Bill? And in his words, does he agree that patients have suffered enough?

[Wes Streeting]

I was very clear in opposition about the Government’s responsibility to sit down and negotiate, and that is exactly what I have been doing. It takes two to tango. As for the other trivial nonsense the right hon. Gentleman mentions, I have been very clear that I am a faithful. Of course, if he were a gameshow, he would be “Pointless”.

[Katrina Murray (Cumbernauld and Kirkintilloch) (Lab)]

T4.   There is a higher prevalence of multiple sclerosis in Scotland than in any other part of the UK. What steps is the Department taking to ensure that people living with MS can access both a timely diagnosis and equitable specialist care, regardless of where they live in the UK?

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[Helen Morgan (North Shropshire) (LD)]

Every MP will be aware of the huge value that unpaid carers add to the NHS, taking the pressure off paid carers while often under intolerable pressure themselves. We were therefore really pleased to hear the news this morning that thousands of unpaid carers will have their cases reviewed, after they had been left with huge debts as a result of a failure of Government over a long period of time. However, it has been reported that debts will continue to accrue and overpayments will continue to be pursued for as long as a year from now. Given his responsibility to unpaid carers, will the Secretary of State raise the issue with colleagues, urging them to suspend repayments until the recommendations are enforced, and ensure that those people propping up the care system are treated fairly from today, not from in a year’s time?

[Wes Streeting]

I am grateful to the hon. Member for that question, as this is a terrible situation and one of the many messes that this Government are now working to clean up. I will certainly ensure that the issue she raises is taken up with my right hon. Friend the Work and Pensions Secretary.

[Tristan Osborne (Chatham and Aylesford) (Lab)]

T5. The Public Accounts Committee has recently scrutinised the state of clinical negligence in the UK. At £60 billion, the Government liability for clinical negligence significantly increased under the last Government. The Government have commissioned David Lock to review the issue. Does the Secretary of State agree that reform is desperately needed in this space?

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[Wes Streeting]

I am happy to report to the hon. Gentleman that we are well on the way towards delivering the 8,500 more mental health staff we promised in our manifesto, with over 6,500 already there. Digital tools can play a role, and I am pleased to report that, given the evolution of our online tools via the NHS app, ensuring that we have high-quality and clinically verified apps will be part of our approach, so that people have access to high-quality digital tools, not ones they have googled on the internet.

[Kenneth Stevenson (Airdrie and Shotts) (Lab)]

T6. As a faithful, I commend the Secretary of State for reaffirming his commitment to driving forward digital innovation in the NHS. Does he agree that Scotland should mirror the UK so that we do not fall behind the pace with developments that could be game changing in terms of outcomes for patients and staff alike?

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[Wes Streeting]

Yes, Mr Speaker. [Interruption.] Opposition Members do not like to hear it, but we are bringing waiting lists down for the first time in 15 years, patient satisfaction with general practice is rising, and we are delivering the investment, modernisation and change the country voted for.

[Pippa Heylings (South Cambridgeshire) (LD)]

T9. Two weeks ago, when I asked the Government whether they had had discussions with the Cambridgeshire integrated care board on the 16,000-strong petition to save beds at the Arthur Rank hospice, I was informed that it would not be possible to provide a response within the usual time period. I have a simpler request today: will the Minister meet me and the new Central East integrated care board to discuss how to identify need and strategically commission beds?

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[Sarah Smith (Hyndburn) (Lab)]

About 38% of children in my constituency are sadly growing up in poverty. This Government are committed to ensuring the best start in life for all children, so in addition to the increase in mental health support teams in schools, does the NHS workforce plan currently address the vital need for trained specialist community public health nurses in schools?

[Wes Streeting]

My hon. Friend is absolutely right about the need to improve the quality of the paediatric workforce. We are considering that as we revise the workforce plan. I am proud that already, with just one decision that we took in the first year of this Labour Government to expand free school meals, we are lifting 100,000 more children out of the poverty they were left in by the Opposition.

[Seamus Logan (Aberdeenshire North and Moray East) (SNP)]

In 2024-25, the NHS trust in the Secretary of State’s constituency collected £2.4 million from patient and visitor parking and a further £1 million from staff parking. Given that those costs fall hardest on the poor and the most seriously ill, will the Secretary of State consider abolishing this inequitable burden on the sick, their relatives and those who care for them?

[Wes Streeting]

If I were the hon. Gentleman, I would be more worried about the situation close to home and the SNP’s abysmal record of failure: while waiting lists are falling in Labour-led England and Labour-led Wales, in SNP-led Scotland they are rising, despite the biggest funding settlement since devolution began. It is a record that should make him and his party blush.

[Stuart Andrew]

On a point of order, Mr Speaker. I know that you have been incensed by the unprecedented briefings we have seen by the Government in the run-up to the Budget. It beggars belief that, despite your clear statements on this issue, they have done it again today by announcing that the Chancellor will announce £300 million for NHS tech in her Budget tomorrow—not through a briefing to journalists but with an article on the gov.uk website. This happened just today, after a Minister stood at the Dispatch Box yesterday and said:

“I can assure the hon. Member, given the respect that the Government pay to this House and to their obligations in it, that if there is an important policy announcement to be made, it will be made to this House.”—[Official Report, 24 November 2025; Vol. 776, c. 32.]

Given that that was clearly not the case in this instance, despite your statements, can you advise us as to what we as Members of this House can do?