Luke Evans MP: speeches

Speeches

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  I entirely agree with the hon. Lady’s end point and with the thrust of what she says. Causality is not causation, and we need to be very careful. When we get to the later clauses of the Bill, that will be at the forefront of our discussion. We cannot deny the reason we are having this legislative debate in the first place: the observation that black men in particular are subject to community treatment orders far more than any other group in the country. However, we must not make a lazy causal analysis and say, “Well, just because that is the case.” For example, black men have a higher risk of prostate cancer, and white people a higher chance of coeliac disease, because of the genetic basis. Is there something in that? Is there systemic bias by clinicians, as she hinted? That all needs to be explored. The hon. Member for Shipley beat me to the punch when it comes to my closing statement. We owe it to our children and young people not to legislate in haste, so I welcome the spirit of the amendments, and I welcome the debate, but we must be careful to ensure that we are truly legislating for and defining exactly what we know. Otherwise, we risk creating other inequalities and unintended consequences or, worse still, a system that becomes even more flabby and difficult to manoeuvre through. That is the last thing we want for our patients, clinicians and the public.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  I will try to elucidate a little further. We know that some people have fluid capacity, such as those with dementia or depression. How do we ensure that people have safeguards for themselves and the wider community, while respecting their capacity and allowing them to be masters of their own destiny? The Bill literally says that we want to see individual autonomy, and by definition, there is always a balance to be struck. The Bill shifts more to the paternalistic side, which brings some challenges because it could create gaps in protections, as I will explain. There are clinical situations in which a person in mental health crisis—for example, in the early stages of a manic episode or a severe personality disorder crisis—may present with superficial capacity but be at grave risk of harm. Are we confident that clinicians can assess capacity accurately in real time, in often pressured and emergency contexts? Might we inadvertently tie the hands of practitioners trying to prevent suicide or serious self-injury? If capacity becomes the gateway to protection, what support and guidance will be provided to ensure that it applies fairly, consistently and safely? That is important when we talk about detention, because detaining people is one thing; the next thing is how we get them out. To understand that, it is worth focusing on the crucial interaction between the Bill and liberty protection safeguards. It is worth my briefly explaining to the Committee what LPS are, how they evolved and why they matter. Liberty protection safeguards are the new legal framework that replaces the old deprivation of liberty safeguards, or DoLS. DoLS were designed to protect people who lack capacity, but had become widely criticised as complex, slow and limited mainly to hospitals and care homes. In response, the Conservative Government introduced LPS through the Mental Capacity (Amendment) Act 2019, to simplify the process and extend protections to community settings such as supported living and people’s own homes. Given that we are talking about Darzi’s shift, that is important. With that context, I turn to the key concerns before us today: how the Bill interacts with LPS, especially when individuals move from hospital detention to community care. To illustrate why this matters, let us consider the case of Mrs A. She is a 55-year-old woman with bipolar disorder and mild dementia. She was detained under the Mental Health Act after a severe manic episode put her at risk. While in hospital, the Act governed her detention and treatment. After several months, Mrs A stabilises enough to be discharged, but because of her dementia, she lacks the capacity to consent to her care arrangements in the community. She requires supported living, with 24/7 care, which means that she will continue to be deprived of her liberty, but now in the community. Because she is no longer detained under the Mental Health Act upon discharge, the liberty protection safeguards must authorise the deprivation of liberty in the community. This requires careful consideration. An LPS assessment and best intention decisions are required, and formal authorisation must be in place before she leaves hospital. This transition point is critical, because without clear protocols, Mrs A could find herself deprived of liberty without lawful authorisation—a breach of her human rights. Information sharing between hospital staff, community providers and local authorities may be delayed or incomplete. There may be confusion among professionals about who is responsible for co-ordinating the handover. Training gaps might lead to the inconsistent application of safeguards. The Bill reforms detention in hospitals, but there is some opacity regarding how the handover to LPS in the community will be managed. Will the Bill ensure a seamless transition, with no gaps in safeguards? If it does not, then how will this be provided? Will there be statutory duties to mandate information sharing and co-ordinate reassessments? How will professionals across health and social care be trained to navigate both systems effectively? The Bill rightly aims to reduce inappropriate detentions and enhance patient autonomy in hospital, but protections under LPS in the community must be equally robust to maintain dignity and rights post discharge. How will the Government guarantee parity of safeguards across settings? The Bill also seeks to address disproportionate detention rates among ethnic minorities. We must be equally vigilant that the reforms and the wider LPS regime do not perpetuate inequalities once individuals leave hospital. We therefore need to ask the questions: what monitoring is done and what safeguards will be in place? On detention, I gently ask the Minister to clarify the Government’s plan to manage the vital interface between the Mental Health Act and LPS, even as the Bill stands, to embed clear statutory duties, guidance and accountability to protect all individuals like Mrs A throughout her care journey. What is the Government’s view on distinguishing between those with and without capacity in the context of detention for self-harm risk? Has the Department assessed the clinical and operational implications of requiring real-time capacity judgments before detaining someone at risk to themselves? Will the Government consider a limited override provision in extreme cases where the risk is immediate, catastrophic and the capacity assessment is finely balanced? We will see more of these kinds of cases as we go forward, with more and more people living with the likes of dementia or acquired brain injuries. If the Government do not support the amendment as drafted, might they consider refining the code of practice to provide clear guidance on how capacity, autonomy and right to self are waived? The amendment presents a thoughtful and principled intervention. It is not perfect in my eyes, but it challenges us, rightly, to consider whether our mental health laws strike the right balance between protection and personal freedom. Amendment 53, like its partner on section 2, reflects a growing consensus that the law should better respect the autonomy of people with mental health conditions, especially when they have the capacity to make informed decisions. In introducing a necessary distinction, if someone can truly understand the consequences of refusing treatment and they pose no risk to others, should the state override their decision on their own behalf? The amendment would add a capacity-based distinction into section 3, mirroring the earlier amendment on section 2. Specifically, if a patient lacks capacity to consent to a medical treatment, they may be detained if there is risk of serious harm to themselves or others. If a person has capacity, they may be detained only if there is risk to others. In short, if a person is mentally unwell but understands the consequences of refusing treatment in this case and only poses a risk to themselves, they would not be eligible for detention under this amendment. Imagine a woman with anorexia nervosa who is dangerously underweight, has a good understanding of her condition and the risk, and refuses in-patient treatment. Under the Bill as it stands she can be detained, but under the amendment if she is judged to have capacity and only poses a risk to herself, she could not be detained under section 3. Therefore, there are huge and far-reaching consequences to the amendment. The wider science is moving towards capacity, but it needs to answer some of these questions. Some are even being grappled with now—take the Terminally Ill Adults (End of Life) Bill. This truly cuts to the heart of humanity and I am sure there are varying views not only across the Committee, but across society. Similar questions will arise when it comes to capacity. To that end, the question posed is not simple. In some cases, such as severe anorexia or chronic suicidal tendencies, capacity may be technically present but clinically contested. The stakes could not be higher. The amendment challenges us, and therefore the Government—and rightly so—to ask: are we doing enough to balance liberty and care? Do we have the right clinical tools, legal thresholds and ethical safeguards in place? New clause 24 is on a different but related subject. This Back-Bench amendment relates to the application for admission in respect of patients who are already on hospital grounds but have not yet been formally admitted. This is really important, because it comes down to the ability. As my hon. Friend the Member for Solihull West and Shirley said, when it comes to the mechanism this is the day-to-day reality. Someone, just because they turn up in A&E, is not under the care of A&E per se until they are admitted. That is when the clinicians will take control. If they just give their name, at what point do we have that grey area? That is the matter of contention in day-to-day working. Currently, under section 5(1) of the Mental Health Act, applications for detention or admission can be made only in relation to patients who are already admitted to hospital—that is the key part. This leaves a grey area for people who come to hospital voluntarily, perhaps by walking into A&E and seeking help or being brought by an ambulance or the police, but have not yet been formally admitted. The amendment would explicitly allow applications for admission to be made as soon as someone attends or is brought into hospital to seek help, even before formal admission.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  That would be a very useful piece of data, but I was in fact talking about new clause 24 and the grey area of hospital detentions. That data is probably easier to collect. I specifically ask the Minister to keep in mind the collection of data on those who turn up to A&E but end up having to be taken out of the hospital to be sectioned, for example. That is the nub of the issue and the practicality of what is going on. In a number of incidents, although the law is set in a way that is supposed to be helpful, the interface unfortunately becomes very difficult. The Minister has rightly pointed out that there are different ways to deal with this. The new clause is one such potentially heavy-handed way of dealing with it. At the same time, it comes from the good place of trying to address what clinicians deal with in A&E day in, day out. However, we need some data and some teeth behind that to understand and appreciate how much of a problem it is and to then come up with a solution. I hope that clarifies my question.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  The hon. Gentleman makes a pertinent point about the pressure on CAMHS. In Leicestershire, about 45% of CAMHS referrals are for things like autism and ADHD, and the problem is that it takes a lot of services away from those who have eating disorders or depression, or who self-harm. Does he believe there is scope to reorganise services to make sure they are appropriate where there needs to be treatment? A child suffering with severe anxiety and self-harming tendencies should not be on a pathway with someone who has autism, for example. Has he given any thought to how this Bill might be a way of opening that door?

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  I will direct my remarks at new clause 11 and the amendments spoken to by the hon. Member for Guildford. New clause 11 seeks a clear, costed and consultative plan to help ensure that integrated care boards and local authorities are properly equipped to deliver the community-based services that individuals with learning disabilities and autism need and, of course, deserve, so that they are not unnecessarily detained under part 2 of the Mental Health Act. Let me begin by recognising the good intentions across the House when it comes to reducing inappropriate and prolonged detentions in mental health settings. There is broad consensus that detention should be the last resort. However, good intentions must be matched by a concrete, deliverable plan because, as the evidence has shown, too many people are being held in hospitals or other facilities, not because of clinical need, but because the right community support simply is not there.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  The Minister is right about the registers, but I did notice that the Children’s Wellbeing and Schools Bill introduced the unique identifier number. That came about after the Lord Laming report into Victoria Climbié, who was “lost in the system.” It also builds on the work of the Children’s Commissioner, which found that around 10,000 children are not in school. Is there a role for getting some of the identifiers that we are looking at here in place along with that unique identifier number? Equally, how does that unique identifier input into the Bill’s provisions on risk registers, now that that piece of legislation has passed Third Reading? There will be an interaction, but the unique identifier is much broader and the dynamic support register is held slightly differently. What work have the Government done to ensure that there is bridging and understanding about what that would look like, not only in the short term but in the long term?

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  The Minister makes a fair point about best practice. However, did the Government consider any mechanism for how best to share best practice across areas? Especially as the Bill also covers Wales, as heard this morning, it might be useful—across the integrated care boards—to understand the Government’s thinking on how to ensure that best practice in exemplar places, where care is really good, can be shared to help places where care might not be so good.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  It is a shame that the hon. Member for Shipley is not in her place to hear me speak to the rest of the clause 4, having considered the amendments to it first— [ Interruption. ] Oh, she is here just in time. I am grateful to the Government and the Chair, as the clause stand part debate allows things to be more structured. I want to discuss proposed new part 8A of the Mental Health Act 1983, which will introduce welcome changes to provisions specific to people in England with autism or learning disabilities who are subject to detention under the Act. At the outset, let me say that the Opposition welcome the Government’s recognition that people with autism or learning disabilities require a tailored and rights-based approach within our health system. We know—the evidence points clearly to the fact—that such individuals have been inappropriately detained in institutional settings, often for years, without the care and support that they truly need. The creation of a statutory care, education and treatment review in legislation was a step in the right direction. It therefore makes sense in this part of our proceedings to discuss such reviews. The background is really important to understanding what the measure will do. Care, education and treatment reviews were introduced in 2015 as part of the Transforming Care programme, a joint initiative between NHS England and the Department of Health and Social Care under the last Government. The TCP was launched in response to the Winterbourne View scandal, which we have heard mentioned a few times, where serious abuses of people with learning disabilities and autism in private hospitals were exposed. The purpose of CETRs in the Transforming Care programme was to ensure multi-agency oversight of care plans for people with learning disabilities and/or autism, particularly those with complex needs detained in in-patient or secure settings. They were there to promote person-centred care by involving patients, families and a broad range of professionals; to identify barriers to discharge and support safe, timely moves to community or less restrictive settings; and to improve care quality and reduce inappropriate long-term in-patient stays. The implementation timetable started in 2015 with CETRs introduced as a mandatory part of the TCP, initially focusing on children and adults with learning disabilities and/or autism in in-patient settings. In 2017 to 2019, CETRs were expanded and refined, with NHS England producing guidance and a framework for conducting reviews consistently. Ongoing, CETRs are now embedded across the health and social care systems, extending beyond learning disabilities to other groups with complex mental health needs, including secure mental health services. CETRs are multidisciplinary independent reviews designed to improve the care and treatment of people with complex mental health needs, particularly those detained in secure hospitals or secure settings, such as children and young people with learning disabilities, autism or complex mental health needs, or in other in-patient settings where there are concerns about the appropriateness of their care, treatment or placement. The purpose is to ensure that the care, education and treatment plans are appropriate, person-centred and holistic; to identify and address any barriers to overcoming recovery and discharge; to promote co-ordinated working between health, social care, education and other relevant services; and to support the least restrictive care principle, one that we have now enshrined in the Bill—helping people to move to less restrictive settings where possible. There are, however, some complications. The number of CETRs has increased over recent years, especially with the growing recognition of the need for better oversight of complex needs. Several hundred CETRs take place annually across England and Wales, primarily within secure and specialist mental health services. Exact numbers are quite difficult to pin down and vary by service user populations, health trusts, NHS England monitoring and the reporting of the activity. What is a CETR made up of? That is really important. A typical CETR involves a multidisciplinary panel including independent clinical reviewers such as a senior psychiatrist or clinician not involved in direct care; representatives from social care services; educational specialists, especially for children and young people; advocates or independent mental health advocates; the patient or service users themselves, where possible, to ensure their voice is central; family members or carers where appropriate and with consent; and commissioners and other relevant professionals involved in the person’s care pathway. Under the review process, the panel examines the individual care, the treatment, the education and progress. It assesses whether the current placement and treatment plan are meeting the person’s needs and whether there is scope to support transition to less restrictive or more appropriate settings. Recommendations may be made on changes to care, treatment plans, discharge or support arrangements. CETRs are a very valuable safeguard. They bring together the independent clinicians, the social care professionals, the educators, the advocates and, crucially, the patients and their families to review the care and treatment being provided. The aim is to ensure that the treatment is person-centred, appropriate and geared towards recovery, while also exploring opportunities to move people to less restrictive environments when safe to do so. That said, while CETRs are increasingly used, questions remain about their consistency, effectiveness and impacts on outcomes. On page 12 of the explanatory notes, paragraph 46 states that “recommendations are not always being acted upon”, which is contributing to “the perpetuated detention of people with a learning disability and autistic people, often without therapeutic benefit.” That is really significant. To that end, how many CETRs are conducted annually and what are the mechanics in place to ensure that the reviews lead to meaningful change in care, rather than becoming a procedural exercise? I must admit that I struggled to find that information. If I, as someone looking into it, am struggling, there is a concern about how wide that information and data is.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  Far be it from me to tell the Minister what to do, but if I were a wise Minister, I might look at where my predecessors had benefitted from further information and where they may have stumbled. The Bill has been looked at for a number of years by many people from outside and inside the House. Many have been involved throughout its progress, including a former Prime Minister, who tabled amendments in the other place. There is definitely the ability to learn from what the last Government found and to use that information in the kinds of plans that we need.

• 10 Jun 2025 · Mental Health Bill [ Lords ] (Second sitting) · Hansard source

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  Amendment 52 would amend clause 5 to introduce an important distinction in the grounds for detention under section 2 of the Mental Health Act, namely on whether a person has the mental capacity or competence to consent to admission. This amendment, tabled by my hon. Friend the Member for Runnymede and Weybridge, raises questions that go to the heart of how we balance liberty and protection, autonomy and risk in our mental health system. Under the current Mental Health Act, and indeed under the Bill as drafted, an individual can be detained for assessment if they are experiencing a mental disorder and if serious harm could be caused to themselves or others unless they are detained. There is no distinction based on whether they have the capacity to consent to care. In other words, a person who has full understanding and decision-making ability may still be detained against their will to protect them from themselves. The amendment proposes a change to that approach, so that if someone lacks the capacity to make a decision about admission and treatment, the current protection should apply—they can be detained if they are at risk of harming themselves or others. But if someone has capacity, understands what is happening and what the risks are, and still refuses care, they should be detained only if they pose a risk to others and not just to themselves. I will give a brief example to try to bring that to life. Imagine a young adult, aged 22 and living with long-standing depression. They have attempted suicide in the past, but they now clearly and repeatedly say that they do not want to be admitted. They understand the risks, are coherent, consistent and judged by clinicians to have capacity. Under the Bill as it stands, that person could still technically be detained, but under this amendment they could not unless they pose a risk to someone else. Why does this amendment have merit? There is much in it that is compelling. It puts autonomy at the centre of the mental health framework, which the Committee discussed and agreed on earlier. It aligns more closely with the Mental Capacity Act 2005, which already allows people to make unwise decisions so long as they understand what they are doing. It also echoes the principles in the UN convention on the rights of persons with disabilities, which calls for supported decision making over substitute decision making. It could reduce unnecessary or overly paternalistic detentions, especially of people from marginalised groups who are already disproportionally affected by coercive care.

• 3 Jun 2025 · Dementia Care · Hansard source

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  If the hon. Lady will bear with me, I am going to canter through what we have done in the past 14 years, because it was, after all, under the premiership of Lord Cameron that the challenge on dementia set the ambition for England to be “the best country in the world for dementia care and support and for people with dementia, their carers and families to live”. So, on to the point. In 2012, the then Prime Minister set the challenge to make us a global leader and increase awareness and research. This included the dementia friends initiative—a public campaign to boost understanding, over 1 million dementia friends trained by 2015 and increased research funding, which doubled from 2010 to 2015. In 2015, the Prime Minister’s challenge on dementia 2020 set national goals for diagnosis rates, care quality and research impact, including a national target for dementia diagnosis rates of 66.7%, which was met in 2015. In 2016 and 2017, the UK Dementia Research Institute, launched under Theresa May, was a flagship initiative backed by £290 million from the Government and charities. This actually delivered £300 million in dementia research and innovation by March 2020, a full year ahead of schedule. We had the NHS long-term plan in 2019, which committed to enhancing diagnosis. In 2019 we also had the dementia moonshot pledge from Boris Johnson, with an extra £160 million. This was followed up in 2022 with the Dame Barbara Windsor dementia mission—a £95 million fund to accelerate research into treatment and early diagnosis. Of course, the pandemic hit and we had the recovery, and that is why the Government set out the 2023 major conditions strategy, which would have included dementia. There is therefore a question for this Government as to the priority they have given to dementia since taking office, and it is worth looking at why concerns are being raised. This Government, rightly so in their own right, did not opt to proceed with the major conditions strategy. That might surprise some Members, as we heard the current Minister, the hon. Member for Bristol South (Karin Smyth), who is in her place, call for a dedicated dementia strategy a number of times when she was in opposition. Only last year, she said the following in a Westminster Hall debate on new dementia treatments: “As my hon. Friend the Member for Oldham East and Saddleworth said, it is disappointing that the Government shelved the plans for a dedicated dementia strategy. England remains the only nation without a specific dementia plan. That is very short-term thinking, and it would be interesting to hear from the Minister about that. In 2022, I said: ‘We cannot give confidence to people suffering with dementia and their carers without a much clearer plan that is in place very quickly.’ —[Official Report, 14 June 2022; Vol. 716, c. 141.] That remains the case today.” —[ Official Report, 11 January 2024; Vol. 743, c. 192WH.] So I would like to ask the Minister: does he stand by these comments and can we therefore expect a dedicated dementia strategy? It is easy for the Conservative side of the House to understand that governing is difficult. Good intentions make fine Opposition speeches until they collide with reality. Does the Minister plan to carry on with a dedicated strategy, and would he be kind enough to confirm that today? On the topic of strategies and comments made by Labour Ministers before they took office, I note that in a Westminster Hall debate on inequalities in dementia services only in May last year, less than a week before the general election was called, the shadow Health Minister and now the independent hon. Member for Gorton and Denton (Andrew Gwynne) promised a carers strategy. He said that carers are “a vital part of the fight against dementia, and they will be at the heart of Labour’s plans in Government. There will be a carers strategy under the next Labour Government, because we value the vital work our carers do. It will be a cross-Government strategy with the Department for Work and Pensions, Department for Education and the future of work review all feeding into it along with the Department of Health and Social Care. There is a brighter future for those living with dementia and their families and carers. Labour will deliver it.” —[ Official Report, 16 May 2024; Vol. 750, c. 228WH.] That is a laudable aim. However, since the election, it appears that all is not quite as it seems. In an oral question in the other place in November, Baroness Merron made it clear that she had “not committed to a national carers strategy”, stating, “I do have to say to the noble Baroness that I have not committed to a national carers strategy. However, in our joined-up approach, we will certainly be looking at what is needed. That will be very much part of our considerations on the workforce strategy, which Minister Karin Smyth will be leading on. It is crucial to the delivery of services.” —[ Official Report, House of Lords, 19 November 2024; Vol. 841, c. 107.] I therefore ask the Minister today whether specific plans are still in place for a national care strategy.

• 3 Jun 2025 · Dementia Care · Hansard source

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  I am grateful, first, for my hon. Friend promoting me and, secondly, for his expertise in this area because I understand that he has worked with Dementia UK. He is absolutely right—he has beaten me to the chase. One of the real concerns that charities and patients have raised is exactly that: the removal of this crucial diagnosis target. We only need to look at Wales where that was not the case. The national diagnosis rate is 56%—10% lower than in England. On top of that, the Government are presiding over a major top-down restructuring with cuts to integrated care boards and NHS England, while forcing through devolution on the 21 county-run authorities responsible for social care, while raising taxes in the employment national insurance contribution on care providers, which will get passed on to local councils, while raising taxes on the very dementia charities and others that provide support, while ditching the fast-track social work scheme as we learned last week, while terminating the NHS and care volunteers response that helps support care, and while scrapping the cross-party talks on social care and instead swapping it to an independent commission led by Baroness Casey, who still seconded to the Home Office. We can all see what is being taken away and taxed. It is what is going to benefit dementia support and care that is much harder to spot. In the rough and tumble of this place, it is not lost on me how much this issue touches the Minister himself. He has spoken bravely and openly about his family’s struggle, and I have the utmost respect for him and what he has been through, and I have been through similar with my grandmother Dot. I do not question his heart; I simply gently challenge the Government on their policies to achieve better dementia care for all. To that end, I have a couple of questions. Will the Government commit to setting a new target to increase dementia diagnosis rates across England? With integrated care systems facing restructuring and budget resolutions, how does the Government plan to hold local systems to account on dementia diagnosis, especially across the NHS and social care? We have seen in Wales how irregular data collection on dementia diagnosis affects overall diagnosis rates. What steps will the Government take to improve the quality of data in dementia diagnosis, particularly when it comes to follow up? Given the growing prevalence of dementia in our care homes, what steps will the Government take to support providers and ensure that the social care workforce is trained effectively to meet the needs of care users? With the upcoming spending review and the long-awaited 10-year plan for the NHS expected in the next couple of months, I trust the Minister sitting in front of me. He is the right person to highlight to the Government the seriousness and importance of tackling dementia, just like the last Government understood. I return to where I started: dementia steals the most from those left remembering, because the greatest heartbreak is losing someone who is still here. But with compassion for families, dignity for those who suffer and the relentless pursuit of a cure, we can offer not just care, but hope.

• 3 Jun 2025 · Dementia Care · Hansard source

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  I think we have established that dementia is a thief, not once but twice: first of the mind, then of the memories, leaving the greatest pain not with the sufferer but with those who remember. I thank the hon. Member for South Devon (Caroline Voaden) for securing such an important debate and for speaking so passionately and openly about her story, as did many across this House. I also thank the Alzheimer’s Society, Alzheimer’s Research UK, Dementia UK and all those people who advocate for dementia and their families. As we have heard, there are 1 million people living with dementia in the UK, and that figure is projected to rise to 1.4 million by 2040. One in six hospital beds are occupied by dementia patients, and dementia sufferers are three times more likely to see their GP. Modelling suggests that 70% of care home residents are people living with dementia. In this House I often enjoyed the tired lines from the then Opposition about how the Conservatives never did enough on x or y or z. As Labour Members are ably demonstrating, it is easy to stand across the aisle and say that nothing is ever enough, but as they are learning, delivering in the real world is far harder than demanding from the sidelines. On dementia, the Conservative Government led from the front with more funding, better diagnosis and a national commitment to change lives. We all agree that we must continue to do more, but to do that we need direction and action, and that is what we are exploring here today, almost one year on from the introduction of a Labour Government.

• 2 Jun 2025 · Draft Human Medicines (Amendments Relating to Hub and Spoke Dispensing etc.) Regulations 2025 · Hansard source

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  It is a pleasure to serve under your chairmanship, Mr Stuart. I will not go through everything the Minister set out, but we are amending the Human Medicines Regulations 2012 and the Medicines Act 1968 to enable hub and spoke dispensing. The regulations before the Committee will improve seven key areas. They will enable cross-business outsourcing; clarify the legal definitions of wholesale dealing and retail sale; extend outsourcing to NHS GPs; establish hub and spoke frameworks, legally defining what the hub and spoke model is and enabling hubs to assemble medicines; tighten up labelling and information rules; introduce data-sharing provisions; and clarify premises-based supply. The pros of doing that, and the reason why the previous Government were introducing legislation to do so, is that it will provide efficiency gains, improve access, modernise the legislation, and improve patient safety and data protection. There are some cons and concerns, however, particularly regarding the complexity of implementation and whether pharmacies will need to invest in new systems. There are data privacy risks, as the world is seeing an increasing number of cyber-attacks, which is a concern as we are adding more areas for data sharing. In addition, the regulatory ambiguity resulting from removing definitions from the 1968 Act may cause initial confusion during the transition. Between 16 March and 8 June 2022, the previous Government consulted on legislative proposals to allow pharmacies and dispensing doctors to access hub and spoke dispensing models. Two different models were proposed: “Model 1 is where the patient presents a prescription to the spoke. The spoke then sends the relevant information on to the hub so that they can carry out their agreed dispensing actions. The hub then sends these dispensed medicines back to the spoke, which may have further responsibilities to perform such as providing advice on the medicine to the patient, before supplying them to the patient. In model 2, the same pathway is followed in that the patient presents a prescription to the spoke, which then sends the relevant information to the hub. The hub then assembles and prepares the medicine before supplying the completed order directly to the patient.” On Monday 13 May 2024, shortly before the general election was called just over a year ago, the previous Government published a response to the consultation. The majority of respondents, being medium and larger pharmacy chains, representative sector organisations and other related businesses, supported the proposals. However, a majority of individuals, smaller pharmacies and independent pharmacies did not support the policy change. At the time, the proposed next step was to make several amendments to the 2012 regulations, including the creation of two new models: spoke-hub-spoke and spoke-hub-patient. The previous Government intended to lay a final statutory instrument before Parliament and the Northern Ireland Assembly with a view to the legislation coming into force on 1 January 2025. However, because of the election, that statutory instrument was not laid. The Minister reiterated this Government’s position in response to a question from the hon. Member for Warrington South (Sarah Hall): “A wide range of community pharmacies and representative organisations fed into the public consultation on hub and spoke reform, and I am pleased to confirm that their responses were overwhelmingly positive in support of model 1 of hub and spoke, which we will be going with.” —[ Official Report , 25 March 2025; Vol. 764, c. 774.] There are two problems here—the implementation and the principle—and I will take them in turn. The impact assessment, which was updated in April 2025, found uncertainty about the potential costs of establishing the hubs, the operating costs and the level of uptake of hub and spoke dispensing. Paragraph 78 stated: “It has not been possible to determine the initial set up costs for hubs, due to the variety of different hub solutions and because we do not have a concrete assessment of the number and types of hubs that might open due to this policy.” Paragraph 136 said: “The key uncertainties in this IA are around the level of take up of hub and spoke arrangements and the net level of savings to dispensing costs that could arise”. And paragraph 137 said: “Ultimately hubs are private businesses who would need to conduct their own analysis and research into the level of market interest when deciding how much to invest in building hub capacity.” In the light of that, can the Minister tell us whether there will be any further funding to implement this change? How will he record data on uptake and changes? And what incentive is there for businesses to take this up? Will it be mandated? Given the abolition of NHS England, where will the data be collated, who will collate it, and when will it be published? I have now addressed the practical part, so I will now focus the Committee’s attention on the other part. The previous Government proposed to take forward both models: model 1, which was patient-spoke-hub-spoke-patient; and model 2, which was patient-spoke-hub-patient. I have been contacted on the latter by Pharmacy2U, which is the largest online distance-selling pharmacy. Every month, Pharmacy2U dispenses more than 3 million items directly to the homes of 1.5 million customers, so it offers an alternative for patients. It asks why there was no formal consultation on the changes from the previous Government’s position, whether Ministers had considered whether this change excludes the perspectives of distance-selling pharmacies, and what the expected impact of excluding model 2 will be.

• 2 Jun 2025 · Draft Human Medicines (Amendments Relating to Hub and Spoke Dispensing etc.) Regulations 2025 · Hansard source

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  Of course, and I thank the hon. Gentleman for that point, with his august history as a pharmacist. My job in the Opposition is to raise these issues with Ministers for consideration. At the heart of my point is that, by choosing only one model and not offering two, we are closing down the opportunity for not only patients but businesses. If we want to invent in the NHS, that seems a bad way of doing it. It is why the last Government suggested that having a couple of models allows people to invest in, invigorate and improve our system, because otherwise, innovation will fall behind. That is at the heart of the questions I am posing to the Minister. That leads me nicely on to my follow-up question. Does this mean that the Minister will choose not to introduce model 2? Is that likely to be in line in the future, and if so, when? Those questions go to the principle of this. The last Government decided that there were two options to accommodate all different fields, be it dispensing GPs, community pharmacies, large-scale chemists and pharmacies or, indeed, distance-selling pharmacies. It is really important to take into account the whole environment we have in the health service. We will not divide the Committee, but we would like answers to those questions about the practicalities and policies behind the regulations.

• 22 May 2025 · Business of the House · Hansard source

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  Last Friday, I was lucky enough that my private Member’s Bill was the second Bill listed. Unfortunately, it was timed out—rightfully so—for the assisted dying Bill. Two of my constituents, Roux and Ada, have been in contact with me about my Bill, which is about dog-on-dog attacks. I must declare an interest: Roux and Ada are my whippets and they live with me, but they are concerned about dog-on-dog attacks, as are many people up and down Leicestershire. Could the Government find time to have a debate on dog-on-dog attacks and responsible dog ownership?

• 22 May 2025 · Mental Health Bill: Legislative Scrutiny · Hansard source

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  I commend the hon. Member for Bracknell (Peter Swallow) and his Committee for the report. We on the Opposition Benches will be looking favourably at it, especially as the Bill goes into Committee. I have one technical question. He talked about restraint for people who have autism and learning disabilities. Currently, the timetable for working out whether they have a mental health disorder or it is related to their condition is 28 days. Did his Committee look at that from a human rights perspective, to see whether it is the right time in which to make that assessment?

• 22 May 2025 · Diego Garcia Military Base · Hansard source

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  I respect the expertise of the Defence Secretary, so I hope he can help me here. The ICJ said that it was a non-binding decision. The International Tribunal for the Law of the Sea is the court that he is worried about. The country will wonder why he would not challenge this in the court, stand by it, and see what that process would look like. If he was worried he would lose, will he publish the documentation that shows why he was advised that he would lose, so that the country can understand why he is not making that challenge? If he failed in that challenge, he could appeal as well. To the public it looks like we are just giving into the deal without even using the courts that we could legally use.

• 21 May 2025 · Immigration · Hansard source

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  Will the hon. Member give way on that point?

• 21 May 2025 · Immigration · Hansard source

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  The Liberal Democrat spokesman spoke about numbers and safe and legal routes. Could he tell us how many routes he would open up and with which countries?

• 21 May 2025 · Immigration · Hansard source

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  Will the hon. Member give way?

• 21 May 2025 · Immigration · Hansard source

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  Will the Minister give way?

• 21 May 2025 · Immigration · Hansard source

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  Will the Minister give way?

• 21 May 2025 · Immigration · Hansard source

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  In 2020 the Prime Minister—then Leader of the Opposition—pledged as point 6 of his “Another future is possible” plan that the Yarl’s Wood detention centre would close. To my knowledge, as of today it is still open. Given my hon. Friend’s experience, is she aware that Yarl’s Wood will be closing? Has she heard the Government commit to closing it, and if so, when will that be?

• 21 May 2025 · Immigration · Hansard source

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  Will the hon. Member give way?