Semua Kabar

We are now in the era of weight-loss drugs.

Decisions on how these drugs will be used look likely to shape our future health and even what our society might look like.

And, as researchers are finding, they are already toppling the belief that obesity is simply a moral failing of the weak-willed.

Weight-loss drugs are already at the heart of the national debate. This week, the new Labour government suggested they could be a tool to help obese people in England off benefits and back into work.

That announcement – and the reaction to it – has held a mirror up to our own personal opinions around obesity and what should be done to tackle it.

Here are some questions I’d like you to ponder.

Is obesity something that people bring on themselves and they just need to make better life choices? Or is it a societal failing with millions of victims that needs stronger laws to control the types of food we eat?

Are effective weight-loss drugs the sensible choice in an obesity crisis? Are they being used as a convenient excuse to duck the big issue of why so many people are overweight in the first place?

Personal choice v nanny state; realism v idealism – there are few medical conditions that stir up such heated debate.

I can’t resolve all those questions for you – it all depends on your personal views about obesity and the type of country you want to live in. But as you think them over, there are some further things to consider.

Obesity is very visible, unlike conditions such as high blood pressure, and has long come with a stigma of blame and shame. Gluttony is one of Christianity’s seven deadly sins.

Now, let’s look at Semaglutide, which is sold under the brand name Wegovy for weight loss. It mimics a hormone that is released when we eat and tricks the brain into thinking we are full, dialling down our appetite so that we eat less.

What this means is that by changing only one hormone, “suddenly you change your entire relationship with food”, says Prof Giles Yeo, an obesity scientist at the University of Cambridge.

And that has all sorts of implications for the way we think about obesity.

It also means for a lot of overweight people there is a “hormonal deficiency, or at least it doesn’t go up as high”, argues Prof Yeo, which leaves them biologically more hungry and primed to put on weight than someone who is naturally thin.

That was likely an advantage 100 or more years ago when food was less plentiful – driving people to consume calories when they are available, because tomorrow there may be none.

Our genes have not profoundly changed in a century, but the world we live in has made it easier to pile on the pounds with the rise of cheap and calorie-dense foods, ballooning portion sizes and towns and cities that make it easier to drive than walk or cycle.

These changes took off in the second half of the 20th Century, giving rise to what scientists call the “obesogenic environment” – that is, one that encourages people to eat unhealthily and not do enough exercise.

Now one in four adults in the UK is obese.

Wegovy can help people lose around 15% of their starting body weight before the benefits plateau.

Despite constantly being labelled a “skinny drug” this could take someone weighing 20 stone down to 17 stone. Medically, that would improve health in areas like heart attack risk, sleep apnoea and type 2 diabetes.

But Dr Margaret McCartney, a GP in Glasgow, cautions: “If we keep putting people into an obesogenic environment, we’re just going to increase need for these drugs forever.”

At the moment the NHS is planning to prescribe the drugs only for two years because of the cost. Evidence shows that when the injections stop, the appetite comes back and the weight goes back on.

“My big concern is the eye is taken off the ball with stopping people getting overweight in the first place,” says Dr McCartney.

We know the obesogenic environment starts early. One in five children is already overweight or obese by the time they start school.

And we know that it hits poorer communities (in which 36% of adults in England are obese) harder than wealthier ones (where the figure is 20%), in part due to the lack of availability of cheap, healthy food in those less affluent districts.

But there is often a tension between improving public health and civil liberties. You can drive, but you have to wear a seatbelt; you can smoke, but with very high taxes alongside restrictions on age and where you can do it.

So here are some further things for you to consider. Do you think we should also tackle the obesogenic environment or just treat people when it’s starting to damage their health? Should government be far tougher on the food industry, transforming what we can buy and eat?

Should we be encouraged to go Japanese (a rich country with low obesity) and have smaller meals based around rice, vegetables and fish? Or should we cap the calories in ready meals and chocolate bars?

What about sugar or junk-food taxes? What about wider bans on where calorie-dense foods can be sold or advertised?

Prof Yeo says if we want change then “we’re going to have to compromise somewhere, we’re going to have to lose some liberties” but “I don’t think we’ve come to a decision within society, I don’t think we’ve debated it”.

In England, there have been official obesity strategies – 14 of them across three decades and with very little to show for it.

They included five-a-day campaigns to promote eating fruit and veg, food labelling to highlight calorie content, restrictions on advertising unhealthy food to children and voluntary agreements with manufacturers to reformulate foods.

But although there are tentative signs that child obesity in England may be starting to fall, none of these measures have sufficiently altered the national diet to turn the tide on obesity overall.

There is one school of thought that weight-loss drugs may even be the event that triggers the change in our meals.

“Food companies profit, that’s what they want – the only ray of hope I have is if weight-loss drugs help a lot of people resist buying fast foods, can that start the partial reversal of the food environment?” asks Prof Naveed Sattar from the University of Glasgow.

As weight-loss drugs become far more available, deciding how they will be used and how that fits into our wider approach to obesity will need to be addressed soon.

At the moment we are only dipping our toes in the water. There is limited supply of these drugs and because of their huge expense, they are available on the NHS to relatively few people and for a short time.

That is expected to change dramatically over the next decade. New drugs, such as tirzepatide, are on the way and the pharmaceutical companies will lose their legal protections – patents – meaning other companies can make their own, cheaper versions.

In the early days of blood-pressure-lowering medicines or statins to reduce cholesterol, they were expensive and given to the few who would benefit the most. Now around eight million people in the UK are taking each of those drugs.

Prof Stephen O’Rahilly, director of the MRC Metabolic Diseases Unit, says blood pressure was tacked with using a combination of drugs and societal change: “We screened for blood pressure, we advised about lower sodium [salt] in foods and we developed cheap, safe and effective blood pressure drugs.”

That’s analogous, he says, to what needs to happen with obesity.

It is still not clear how many of us will end up on weight-loss medication. Will it only be for those who are very obese and at medical risk? Or will it become preventative to stop people becoming obese?

How long should people take weight-loss drugs for? Should it be for life? How widely should they be used in children? Does it matter if people using the drugs are still eating unhealthy junk food, just less of it?

How quickly should weight-loss medications be adopted when we still do not know the side-effects of long term use? Are we OK with healthy people taking them entirely for cosmetic reasons? Could their availability privately widen the obesity and health gap between rich and poor?

So many questions – but, as yet, few clear answers.

“I don’t know where this is going to land – we’re on a voyage of uncertainty,” says Prof Naveed Sattar.

Top picture: Getty Images

BBC InDepth is the new home on the website and app for the best analysis and expertise from our top journalists. Under a distinctive new brand, we’ll bring you fresh perspectives that challenge assumptions, and deep reporting on the biggest issues to help you make sense of a complex world. And we’ll be showcasing thought-provoking content from across BBC Sounds and iPlayer too. We’re starting small but thinking big, and we want to know what you think – you can send us your feedback by clicking on the button below.

Separate bills to let terminally ill people end their life are being considered at Westminster and in Scotland.

A coroner pays tribute to Katie Watson, who appeared on Channel 4’s Geordie Hospital.

But the NHS in England is still well below its target for seeing patients within 18 weeks.

The trial, involving patients in Yeovil and Taunton, is looking at reducing courses of antibiotics.

Marine pilot Ian Lawrence and his family spent a year volunteering on a hospital ship.

Copyright 2025 BBC. All rights reserved.  The BBC is not responsible for the content of external sites. Read about our approach to external linking.

There is nothing in life that is free of risk. That includes vaccines. But the evidence is compelling that the benefits of getting immunised with those vaccines recommended in the UK far outweigh the possibility of serious side effects.

The level of benefit from Covid vaccines is well documented. And the Oxford/AstraZeneca vaccine is credited with saving more lives in the first year of its use than any other – 6.3m globally compared to 5.9m for Pfizer/BioNTech’s jab.

However, we need to discuss not just the huge positives that Covid vaccines brought, but also the small minority left injured or bereaved by the AstraZeneca vaccine.

Around 50 families affected by rare blood clots have begun a group legal action for compensation under the Consumer Protection Act, arguing that the vaccine was not as safe as the public were entitled to expect.

This includes people who have been left with severe physical injuries, those who are unable to work, and bereaved families who lost a loved one due to vaccine damage.

They are a tiny fraction of all those vaccinated, but that is no comfort to the families affected, who feel like they have been airbrushed out of the pandemic and that their pleas for support have been ignored.

Those families include Jane and Ian Wrigley from Buckinghamshire.

Jane, 62, used to run, ski and climb mountains. Now she can barely walk due to extreme weakness down her left-hand side.

Two weeks after receiving the AstraZeneca vaccine in March 2021, Jane was admitted to hospital. She suffered blood clots in her brain and required emergency surgery to remove part of her skull. Jane’s medical records clearly state that she suffered these blood clots as a direct side effect of the vaccine.

Her husband Ian is now her full-time carer. Jane told me: “Before I had the vaccine I was a very independent, active woman doing half marathons and enjoying my life. Now I’ve lost every bit of independence.”

Her case, and those of others affected by blood clots, raises serious questions about whether the system is letting down those who have suffered serious harm as a result of taking Covid vaccines.

Almost 25m adults in the UK received a first dose of the Oxford/AstraZeneca vaccine in 2021, and nearly all those had a second.

It is estimated that the Covid vaccine programme prevented over a quarter of a million hospital admissions and over 120,000 deaths in the UK up to September 2021.

The side effects of vaccination are usually mild and short-lived such as a sore arm, fever and fatigue.

However, in the very rare event that something goes seriously wrong, we have a right to expect that we will be supported. This is a kind of social contract between individual and state.

That’s where the Vaccine Damage Payment Scheme (VDPS) comes in. The VDPS was established in 1979 in the wake of a scare over the safety of the whooping cough vaccine in use at the time.

The government-backed scheme offers a one-off financial payment of £120,000 in the event that, on the balance of probability, a vaccine has caused at least 60% disablement.

Between the late 1970s and 2020 there were just below 6,500 claims under the scheme for all vaccines and 944 awards.

Covid vaccine: Fighting for a payout

The Oxford AstraZeneca vaccine is credited with saving millions of lives but it was also responsible, in rare cases, for serious side-effects – blood clots in the brain – which could be fatal. This is the story of those fighting for compensation.

But something dramatic has happened since the pandemic. There have been more than double the number of claims under the VDPS for Covid jabs than during the previous four decades for all other vaccines combined.

Since the pandemic there have been almost 16,000 claims against Covid vaccines and 180 awards. Just over half of all claimants have yet to find out if they have been successful.

So what is happening? Of the awards, all but a handful are for damage done by the AstraZeneca Covid vaccine, which is no longer used.

There is a long list of different health conditions that qualify for a payment but the AstraZeneca jab had one specific rare side effect not seen in the mRNA vaccines produced by Pfizer and Moderna, which are now the mainstay of all Covid booster campaigns.

The side effect is a type of blood clot, often in the brain, combined with low platelet levels, almost always within a few weeks after receiving the first dose. This can cause damage in the brain and to multiple other organs.

Platelets are cells that help your blood clot, and it was so unusual to see blood clots combined with low platelet levels, that experts coined a new medical term: vaccine-induced thrombosis with thrombocytopenia, or VITT.

These were so unusual that the signal was not seen in the clinical trials of the vaccine involving more than 23,000 participants, but only once the jab had started being rolled out across Europe and given to millions.

In mid-March 2021, a dozen European countries briefly suspended use of the AstraZeneca jab while the clots link was investigated.

Then, in April that year, the UK restricted the vaccine to the over-30s, and a month later to the over-40s because it became clear that younger people were at higher risk from the clots.

Several other European countries, when they resumed using the AstraZeneca vaccine, set the age limit much higher: France to those aged over 55; Germany, Italy and the Irish Republic to the over-60s. Denmark halted its use altogether.

In early April 2021, safety regulators in the UK and Europe had concluded that blood clots combined with low platelets should be listed as a rare side effect.

The rare syndrome was also reported among recipients of the J&J Janssen Covid jab, which uses the same type of vaccine technology, in the United States.

Sarah Moore, a solicitor with the law firm Leigh Day, says the families she represents have been driven to sue AstraZeneca because of the inadequacies of the VDPS.

“The scheme offers too little, too late, to too few people,” she says. She describes the £120,000 payment as “woefully inadequate”, pointing out that the figure had not increased since 2007.

Had the sum kept pace with inflation, it would now stand at £197,000.

Ms Moore says some of her clients need 24-hour care, cannot wash or dress themselves, have been left with severe physical or cognitive deficits and will never work again.

The case of Jane and Ian Wrigley also illustrates another criticism of the VDPS: delay.

The couple waited over two years for a payment under the scheme, despite the clear-cut nature of the case. Assessments under the VDPS are done on paper and do not involve physical examination.

Last year, the government announced that it had modernised the operations of the VDPS to allow cases to be processed more quickly and increased the number of staff dealing with claims from four to 80. But a huge backlog of claims has built up.

Peter Schulze, 49, is another member of the group action against AstraZeneca. He too suffered VITT blood clots after receiving the AstraZeneca vaccine in April 2021 and now needs 24-hour care.

His submission to the VDPS was completed in July 2022, yet he is still awaiting a decision, despite VITT blood clots being clearly mentioned in his medical records.

Finally there is the 60% disablement threshold for successful claims, which has ruled out hundreds of people who are officially recognised as having been damaged by Covid vaccines.

Ms Moore says she had a female client who was now blind in one eye, with other physical and psychological injuries, but was told she didn’t reach the 60% threshold.

She says under normal civil claim rules, blindness in one eye could lead to compensation of more than £200,000. It was “absolutely heartbreaking”, she added, for people to be told that the vaccine has caused their injuries yet be informed they are not disabled enough to qualify for a payment.

During the pandemic, the government granted vaccine manufacturers legal indemnity. This did not prevent people from making a claim for compensation against pharmaceutical firms, but determined who would pay in the event of a successful action.

Then-Health Secretary Matt Hancock told the Commons: “We are providing indemnities in the very unexpected event of any adverse reactions that could not have been foreseen through the robust checks and procedures that have been put in place.”

Ms Moore says she has not seen a copy of this legal undertaking but believes it means that the government will pick up AstraZeneca’s legal costs and would be responsible for paying compensation in the event of a successful claim.

AstraZeneca made no profit from its Covid vaccine, Vaxrevia, but its total revenue in 2023 was $45.8bn (£35.1bn) with profits of $5.9bn.

In May AstraZeneca withdrew Vaxrevia citing a “surplus of available updated vaccines”. The UK government did not buy any doses for its booster programmes and all Covid vaccines used in the UK for this autumn’s booster campaign are either Pfizer or Moderna, both of which use mRNA technology.

Prof Adam Finn is one of the UK’s leading experts on vaccines, and throughout the pandemic was a member of the JCVI, the body which advises the government on immunisation.

He was involved in key decisions on recommending the order in which the public received Covid vaccines and the age restrictions put on the AstraZeneca jab when the clots risks emerged.

Prof Finn, who is professor of paediatrics at the University of Bristol, says Covid vaccines were a massive success and “really saved a lot of people’s lives”. He is not involved in the legal action and believes the decisions taken in the UK around the vaccines’ use were correct.

But he says the VDPS is “clearly not working as it should” and that payments should be index-linked so that they reflect changes in the cost of living. He also criticises the “very arbitrary” 60% threshold for payouts.

Prof Finn adds that it’s necessary “to take a really good look” at compensation for all current and future vaccines.

I point out to Prof Finn that there was a danger in a report like this that it could undermine confidence in vaccines. He rejects this: “The only way to retain trust is to be honest.”

But he does think the inadequacies of the VDPS risk undermining that public confidence in vaccines.

While only a small proportion of people have been affected, he says, “they’ve been very seriously harmed and that is going to attract public attention. It’s going to be reported, and people are going to reflect on that, and people will want to see those people treated fairly”.

In a statement, AstraZeneca said: “We cannot comment on ongoing litigation. Our sympathy goes out to anyone who has lost loved ones or reported health problems. Patient safety is our highest priority.”

The statement added that AstraZeneca’s vaccine “has continuously been shown to have an acceptable safety profile and regulators around the world consistently state that the benefits of vaccination outweigh the risks of extremely rare potential side effects”.

The health secretary Wes Streeting recently met with people who have been injured or bereaved as a result of vaccine damage.

In a statement the Department of Health and Social Care (DHSC) said the meeting was to “listen to their concerns” and said “the government will look closely at these as we continue to learn and apply the lessons of the pandemic”.

The statement added: “Our deepest sympathies are with those who have suffered harm.”

The DHSC said the administrator of the VDPS had made operational changes to the scheme in an effort to reduce the time claimants wait for an outcome.

The workings of the VDPS will be considered in the next module of the Covid inquiry, which will begin taking evidence in January 2025.

Ms Moore, who expects to give evidence to the inquiry, says her clients are not “anti-vax”.

She says: “We are acting for people who stood up and got vaccinated. By definition they’re all pro-vaccination. This is an act to support vaccine confidence.”

As for the legal action against AstraZeneca, that could drag on for years.

Additional research by Catherine Snowdon

BBC InDepth is the new home on the website and app for the best analysis and expertise from our top journalists. Under a distinctive new brand, we’ll bring you fresh perspectives that challenge assumptions, and deep reporting on the biggest issues to help you make sense of a complex world. And we’ll be showcasing thought-provoking content from across BBC Sounds and iPlayer too. We’re starting small but thinking big, and we want to know what you think – you can send us your feedback by clicking on the button below.

The appointees have “committed to demanding definitive safety and efficacy data”, the vaccine sceptic said.

Separate bills to let terminally ill people end their life are being considered at Westminster and in Scotland.

But the NHS in England is still well below its target for seeing patients within 18 weeks.

The trial, involving patients in Yeovil and Taunton, is looking at reducing courses of antibiotics.

Marine pilot Ian Lawrence and his family spent a year volunteering on a hospital ship.

Copyright 2025 BBC. All rights reserved.  The BBC is not responsible for the content of external sites. Read about our approach to external linking.

People not knowing about options to make their cervical screening easier and more comfortable is “costing lives”, a cancer charity warned last month.

To find out what having the test is really like for first timers, the BBC spoke to six people who have had their first cervical screening, formerly known as a smear test, in the last six months.

Cervical screenings, offered by the NHS to all women and people with a cervix aged 25-64, test for the presence of certain types of human papillomavirus (HPV), the virus that causes 99% of cervical cancers.

During the test, a nurse uses a speculum – a tool to open the vagina – and a brush to take a sample of cells from the cervix.

This is what having the test done for the first time was like for six people, and what they wish they’d known beforehand.

Erica Donnelly, 26, who lives in Sunderland, waited about a year to book her screening appointment after receiving an invite.

“I was in a massive panic about it because I have PTSD relating to sexual trauma, so I was really extra nervous about that,” she says.

When she finally had the test done last month, she brought her partner with her for support and to help her in case she had a flashback or a panic attack. Having them there also made the experience feel more “comfortable and casual”, she says.

Bianca Ionici, 27, who lives in London, says she put off her cervical screening “for at least two years” because of concerns about pain.

But after getting another invite which contained a lot of information about the process, Bianca booked her screening in January.

Other people say they booked their screenings as soon as they could.

Eleanor Gratton, who had her test at the end of last year aged 25, says her friends were scared the process would be “uncomfortable and painful”. But as more and more people in her group had their screenings, she says they didn’t find this to be the case.

Jessica Tse was “really anxious” before her cervical screening in December.

“I didn’t know if it was going to hurt”, she says.

But the nurse was “talking to me, distracting me throughout” and explained the procedure “really clearly”, she adds.

“Pain-wise, it was uncomfortable and it was something I hadn’t felt before,” Bianca recalls.

But “it was over before I knew”, she says.

Others say they didn’t experience any discomfort – like Megan Burns, a social media content creator living in Brighton.

“It was nothing,” says Megan, who had her first screening in September aged 25. “I couldn’t feel anything.” She says the fact she’d already had two children made her less anxious about the experience.

“These nurses have seen everything,” Megan adds.

Some people feel under pressure to shave their pubic hair or wear their best underwear, she says. But speaking as a former healthcare worker, Megan says “you’re there to do a job, you don’t care about these things”.

While most people only feel light pain at their appointments, some people do experience more discomfort at their appointments.

“Some people find cervical screening uncomfortable, but it shouldn’t be painful,” the Eve Appeal says. It notes that some conditions like endometriosis, vaginismus and being menopausal can make the screening painful.

The NHS says that patients are in control of screening and “can ask the nurse to stop at any time”.

People can ask for adjustments to make their screening easier or more comfortable. These include:

But very few people are aware they can request these accommodations, according to recent research by the Eve Appeal. Less than a quarter of people surveyed said they knew they could request a smaller speculum and only 12% said they knew they could ask for a double appointment.

Some of the people the BBC spoke to said they weren’t aware they could have asked for accommodations.

Bianca says she asked the nurse to use a smaller speculum after reading about it online.

But she thinks information about adjustments should be flagged more clearly when you book the appointment, because some need to be thought about in advance – like bringing a friend or booking a double slot.

Jack Latham, a 28-year-old personal trainer living in Kent, says he received his first screening invite aged 25, just after he came out as trans. He says his GP was “incredibly supportive” and there was even a poster in his surgery’s waiting room encouraging trans men to have a cervical screening.

Trans and non-binary people who have a cervix should still have regular cervical screenings.

Jack says he’d put off the appointment out of fear, until he went for a blood test in summer 2024 and the nurse offered him a cervical screening on the spot.

“It was so much quicker and much less of a bigger deal,” Jack says. “It’s nowhere near as bad as you think it will be.”

Some trans men previously told the BBC they had not been invited to get cervical screenings because they were listed as male on medical records, though they still had a cervix.

The NHS wants to encourage more people to go for their cervical screenings. NHS England has promised to eliminate cervical cancer by 2040.

Women aged 25-49 are encouraged to have a screening every three years, while women aged 50-64 should have one every five years.

NHS England data from March 2024 showed 44.5% of women aged 25-29 had not been screened in the last 3.5 years. For those aged 30-34, this figure was 35.3%.

The proportion of younger women who have been adequately screened has been falling a little in recent years.

Dr Sue Mann, NHS national clinical director for women’s health, told the BBC in a statement that medics know that some women find screenings “very worrying and uncomfortable”.

She emphasised that adjustments are always available and that women should book their screenings, even if they were invited months or years ago.

A display at the Vagina Museum in east London last year encouraged visitors to write improvements they’d like to see to the NHS’s cervical screening service on slips of paper.

Artist Ella Clancy, who produced the display, says common requests included more information about the adjustments available – especially asking for smaller speculums – nurses talking people through exactly what they were doing as they performed the screening and staff being more trauma-aware.

Eleanor says there should be more education around what HPV is. School pupils are typically vaccinated against HPV between year eight and year 10 but Eleanor says it wasn’t clear at the time what the jab was for.

Jessica thinks doctors should explain the results using plainer language, and says she had to call her GP for further explanation after receiving her results letter.

Some people prefer to carry out medical tests in the comfort of their own homes where possible. Do-it-yourself cervical tests are available in some countries, and researchers at King’s College London trialled them in London in 2021 with “fantastic” results. They involve doing a vaginal swab which is then sent to a lab.

The NHS said last year it was assessing whether to roll the scheme out more widely.

Eleanor says she felt “reassured” knowing that a healthcare professional performed her first screening, but would try doing an at-home version of the test after that if the option were available.

Jack, on the other hand, has his doubts. He says he’d prefer an at-home kit for “the convenience and flexibility” but that he’d “have some hesitation about whether I’d done it correctly”.

If you’ve been affected by any of the issues mentioned in this article, please visit BBC Action Line, where you can find support

Separate bills to let terminally ill people end their life are being considered at Westminster and in Scotland.

People who test negative for HPV will be screened every five years, rather than three.

But the NHS in England is still well below its target for seeing patients within 18 weeks.

The trial, involving patients in Yeovil and Taunton, is looking at reducing courses of antibiotics.

Marine pilot Ian Lawrence and his family spent a year volunteering on a hospital ship.

Copyright 2025 BBC. All rights reserved.  The BBC is not responsible for the content of external sites. Read about our approach to external linking.

MPs have voted in favour of proposals to legalise assisted dying in England and Wales.

The bill will now face many more months of debate and scrutiny by MPs and peers, who could choose to amend it, with the approval of both Houses of Parliament needed for it to become law.

It is also possible the bill could fall and not become law at all.

The bill – called the Terminally Ill Adults (End of Life) Bill – would make it legal for over-18s who are terminally ill to be given assistance to end their own life.

But there are requirements:

Under the bill, a doctor could prepare the “approved” substance (the bill does not detail what medication this is) but the person themselves must take it.

No doctor or anyone else would be allowed to administer the medication to the terminally ill person.

The doctor would stay with the person until they had self-administered the substance and died (or the doctor determines the procedure has failed).

The person could decide not to take it, in which case the doctor would have to remove the substance immediately.

Doctors would also not be under any obligation to take part in the assisted dying process.

This is called physician-assisted suicide. Voluntary euthanasia is different and is where a health professional administers the drugs to the patient.

Deaths covered by the assisted suicide bill would not need to be investigated by a coroner.

But the bill would make it illegal for someone to pressure, coerce or use dishonesty to get someone to make a declaration that they wish to end their life or to induce someone to self-administer an approved substance.

If someone is found guilty of either of these actions, they could face a jail sentence of up to 14 years.

What’s not included in the bill is how much the system would cost, who would pay and what the workload would be.

And there is no detail about the judicial process – namely, how the evidence would be put before the High Court judge.

Lord Thomas, former Lord Chief Justice, told the BBC’s Today Programme that it cannot be a “rubber stamping process” and judges must be satisfied there is no coercion.

The person seeking assisted dying would be advised to consider telling their family and GP, but would not legally have to.

The law would apply to England and Wales. A separate bill is already under discussion in Scotland.

Meanwhile, politicians in Jersey and the Isle of Man have already backed plans to introduce assisted dying and the process to bring in legislation is under way.

At least a dozen MPs who backed the bill or abstained now say they are likely to vote against it.

Dr Florian Willet was arrested last September following the death of a woman in a forest in Switzerland.

The proposals still have to go before the upper house and supporters hope it will become law by 2027.

Peter Wilson says his wife Beverly Sand, who had terminal cancer, took her own life in 2022.

The move is among several tweaks to the assisted dying bill which were debated by MPs.

Copyright 2025 BBC. All rights reserved.  The BBC is not responsible for the content of external sites. Read about our approach to external linking.

Listen to Jane read this article

At the urology department of Burnley General Hospital, 26-year-old Ryan (not his real name) is having a drug solution inserted through a catheter – part of his treatment for a condition known as ketamine bladder. This procedure will not completely reverse the damage inflicted by Ryan’s previous addiction to the Class B drug, but it will help him manage the symptoms.

Ketamine, a powerful horse tranquiliser and anaesthetic, is a licensed drug and can be prescribed medically. However, when misused, it can cause serious and sometimes permanent damage to the bladder. The hospital is watching Ryan for signs of kidney failure, too. He worries about finding a girlfriend and having children. But he is stoical when he talks about passing blood and having to urinate numerous times a day.

“You could not be a ketamine addict for 30 years, 20 years,” he says. “You’d die.”

He is under the care of consultant urologist Haytham Elsakka, who says he has witnessed a rise in young patients whose bladders have been damaged by ketamine use. “Some of them are in their 30s, but most of them are 16 to 24,” says Dr Elsakka. Around half of young patients end up needing surgery, he adds. Other risks from recreational use include liver failure, damage to the urethra, incontinence and impotence.

“We have seen young people under the age of 25 who’ve completely lost control of their bladders, who have had to have surgery, including bladder removal,” says Abigail Wilson, lead clinical pharmacist for national drug and alcohol charity WithYou.

In and around the town of Burnley, Ryan is far from alone. Lancashire County Council says it is helping a growing number of families affected by ketamine addiction in the Burnley area. According to WithYou, which runs a ketamine support service for young people aged 11 to 24, the number seeking help across Lancashire increased from 32 in 2018-19 to 123 by the end of 2024.

And the area is not unusual. In England, the number of under-18s entering drug treatment who describe ketamine as one of their problem substances rose from 335 to 917 between 2020-21 and 2023-24, according to the National Drug Treatment Monitoring System.

An anonymised 2023 survey of more than 13,000 secondary schoolchildren from 185 schools across England reported 11% of 15-year-olds had been offered ketamine at some point. The same study, conducted for NHS England, suggested the use of ketamine among schoolchildren had more than doubled in the last decade from 0.4% in 2013 to 0.9% in 2023.

The drug came into the spotlight following the death of Friends actor Matthew Perry aged 54, after which a coroner found ketamine had been the primary cause. Doctors and experts subsequently described how the market for the drug in the US has exploded as it has grown in popularity among Hollywood celebrities.

And thousands of miles away, among ordinary young people in UK towns, ketamine – also known as special K, vitamin K, or kit kat – has also become fashionable. Although highly dangerous, it is often seen as a sociable way to get high, with users buying it in powder form and snorting it.

Now, just 11 years after ketamine was reclassified from Class C to Class B, the UK government is seeking expert advice on whether to make ketamine a Class A drug. This would mean anyone supplying it could be handed a life sentence.

But some experts are sceptical this would make much of a difference. While ketamine use appears to be on the rise among the young, there is a sharp divide in opinion around what can be done to halt that.

One Saturday afternoon in September 2023, the hottest day of the year, a 16-year-old called Preston McNally took ketamine with three friends in Burnley. High on the drug, he fell into the Leeds and Liverpool canal that flows through the town. Preston’s friends had also taken the drug and did not call for help straight away, an inquest was later told.

The coroner said Preston drowned due to ketamine intoxication. The inquest also heard that he had told his sister he was trying to quit just before he died.

Those on the front line are well aware of the scale of the problem. “The amount of mums that have said to me, ‘It’s everywhere’,” says Fr Alex Frost from St Matthews Church in the town. He runs a support group for parents of ketamine users. “It’s in the schools, it’s in the parks.”

Across Lancashire, recorded offences for possession and supply of ketamine rose by nearly 70% from 54 in 2023 to 91 in 2024. “What we have seen, probably within the last 12 months, is the upturn in the use, particularly around children,” says Insp Matt Plummer of Lancashire Police. “Sometimes the parents have no idea.”

Once ketamine was known as a party drug, associated with the club scene. But there’s evidence to suggest that has changed. In a 2024 report into drug trends in Greater Manchester, school-aged children recounted how they used it with friends to “chill” in the local parks or at home.

Those who go on to use it away from social settings are often doing so “to self-medicate unmet mental health support needs such as anxiety and trauma”, says the author of the report, Robert Ralphs, a professor of criminology and social policy at Manchester Metropolitan University.

One mother, who we are calling Claire, told the BBC she was oblivious to the fact that her 14-year-old daughter Lexi (not her real name) was addicted to ketamine until the teenager ended up in hospital with severe stomach cramps.

Lexi, who lives on a neat, well-cared-for street in Burnley, loved sport and dancing. But after she started secondary school, she says, a friend introduced her to ketamine.

“I knew it was illegal… and it was a horse tranquiliser,” says Lexi. “That’s all I knew. I didn’t really want to do it, but I just thought, well, everybody else is doing it and I didn’t really want to be the odd one out.”

One reason that so many young people are gravitating towards ketamine is they can buy it for pocket-money prices, according to Lexi. “It were easy to get – like, really easy,” she says.

In Burnley, friends will chip in for the £15 to £30 it costs for a gram and share it.

To feed her habit, Lexi would ask her mum for a couple of pounds for the bus or some make-up – or sometimes she would steal a £10 note. If Lexi had been coming home drunk or smelling of weed, her mother Claire would have twigged. Claire says: “I was absolutely gobsmacked, just distraught, really, thinking: how did I not know?”

What makes ketamine especially dangerous is that lots of people, particularly young people, wrongly see it as a lower-risk drug, says Mrs Wilson of the WithYou charity.

At lower doses, she says, it has a similar effect to alcohol. “The effects can wear off from about 40 minutes to just over an hour after taking it,” she adds. “If you want to keep those effects, then repeat dosing is required to continue them.”

And this means users’ habits can escalate rapidly, according to Aaron (not his real name), who lives in a small town outside Burnley and took his first snort of ketamine when he was just 16.

“Your tolerance goes up extremely quickly and within the first month you’re doing stupid amounts,” he says. Soon he was spending £200 month on the drug.

Higher doses can lead to a state known as a K-hole, “which is where you become completely detached from reality and also paralysed”, says Mrs Wilson.

Then there is the psychological impact. The WithYou charity is helping Lexi recover from dependence on the drug, but also trauma and self-harm. Once, when she was high, she was the victim of a sexual assault. When kids are on ketamine, they are extremely vulnerable.

Some of the families of ketamine addicts the BBC has spoken to want the drug reclassified as Class A. But this would also mean children caught in possession of ketamine could face up to seven years in jail rather than five. Putting ketamine in the same bracket as heroin and cocaine “may increase the stigma and make young people less likely to discuss their use and seek help”, warns Prof Ralphs.

The government is currently seeking expert advice from the Advisory Council on the Misuse of Drugs (ACMD) on whether the drug should be reclassified. “Ketamine is an extremely dangerous substance and the recent rise in its use is deeply concerning,” says Dame Diana Johnson, the policing minister. “It is vital we are responding to all the latest evidence and advice to ensure people’s safety and we will carefully consider the ACMD’s recommendations before making any decision.”

Families in the Burnley area say the authorities also need to do more to help those suffering as a result of what Fr Frost calls an “epidemic” of ketamine use.

In response, Lancashire County Council says it is “dedicated to supporting children and young people affected by ketamine use in our community” and that it “will continue to work tirelessly to address the challenges posed by ketamine use and to provide the necessary support to those in need”.

There is scepticism from those on the frontline that increased enforcement will solve the issue.

“It’s not a case that we can just arrest our way out of the ketamine issue,” says Insp Plummer. “You could arrest 10, 15 people a day for the possession of ketamine if you found them, but it’s not going to change the cycle, particularly with kids.” He adds that generally children caught with ketamine are given informal words of advice and referred for support, not charged.

And some experts query how effective reclassification would be. These include Prof Ralphs, who observes that the 2014 shift from Class C to Class B has not prevented the recent rise in usage among young people. He also suggests that would have no impact on people’s decisions to supply it either, as most ketamine dealers already supply Class A substances as well. He adds that reclassification “will not deter young people from using it if their underlying mental health and wellbeing needs continue to be unmet”.

In the meantime, no one yet knows what the long-term effects will be for children who start taking ketamine at 12, 13 or 14. Community leaders and the families the BBC spoke to say they cannot wait for change, and that urgent action is needed now to try to prevent more young people suffering.

Lexi says she is trying to move forward with her life. Since the doctors at the hospital told Lexi where her life could be heading, she has not used ketamine.

Getting the drug out of her head is still not easy. She insists she will never take another dose of ketamine. But, she says, “the urge is always there for me to do it again”.

If you’ve been affected by the issues raised in this article, help and support is available via BBC Action Line.

Top image credit: Getty Images

BBC InDepth is the home on the website and app for the best analysis, with fresh perspectives that challenge assumptions and deep reporting on the biggest issues of the day. And we showcase thought-provoking content from across BBC Sounds and iPlayer too. You can send us your feedback on the InDepth section by clicking on the button below.

Habibur Masum has pleaded guilty to manslaughter, but denies murdering Kulsuma Akter in Bradford.

Habibur Masum has pleaded guilty to manslaughter, but denies murdering Kulsuma Akter in Bradford.

Swords, cleavers and a variety of other knives were taken off the streets in the initiative.

Habibur Masum pleads guilty to manslaughter but denies murdering Kulsuma Akter in Bradford.

A woman who worked as a psychiatrist for decades using forged certificates is told to pay compensation.

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A law to give terminally ill adults on the Isle of Man the right to end their own lives is entering its final stages, making it potentially the first jurisdiction in the British Isles to legalise assisted dying.

Anyone over the age of 18 and with a prognosis of 12 months or fewer to live would be eligible, under the legislation being debated in the Manx parliament.

The bill will not be passed yet, since the Isle of Man’s lower house has rejected an amendment that would have meant people would only need residency on the island for one year to take advantage of the legislation.

The House of Keys continued to insist on five-year residency and have sent the legislation back to the upper house.

The move comes as MPs in Westminster are scrutinising a bill that would legalise assisted dying in England and Wales. A separate bill is under discussion in Scotland.

People on the Isle of Man eligible to request assisted dying would have to:

The measures have been a matter of strong debate in Tynwald, the island’s parliament.

It is likely the bill will receive Royal Assent and become law, with the scheme possibly up and running by 2027.

Jersey – a self-governing territory like the Isle of Man which can make its own laws – is also moving ahead with legislation to establish an assisted dying service.

Former GP Dr Alex Allinson introduced the private members bill to Tynwald and has been pivotal in ushering it through the legislative process.

He hopes this will be the last time it will need to be debated by the directly elected chamber.

“The passage of this bill has been a long and careful process starting in 2022 and has been properly consulted on, scrutinised and put through a full parliamentary process,” Dr Allinson says.

“It lays the basis for further work to implement a service on the Island for those facing a terminal illness who would like more autonomy and dignity at the time of their death.”

Among the key clauses in the most recent version of the bill are measures on age and length of prognosis.

The Terminally Ill Adults (End of Life) Bill, introduced by backbench Labour MP Kim Leadbeater, is currently being scrutinised by MPs in Westminster.

If passed it would become law in England and Wales.

It has some similarities to the Isle of Man legislation – people must be terminally ill, over 18 and registered with a GP.

Both bills spell out the need for patients to have the mental capacity to make the choice and be deemed to have expressed a clear, settled and informed wish, free from coercion or pressure.

The Isle of Man bill says people would be expected to have fewer than 12 months to live, but the Leadbeater bill has adopted a more conservative six months.

The Manx suggestion of needing five years of residency on the island to be eligible is to try to stop people going there to take advantage of the scheme, as people do by travelling to Switzerland’s Dignitas clinic.

On the Isle of Man, two independent doctors will need to agree the request for assisted dying, but Leadbeater has recently suggested that cases in England and Wales could be approved by a panel of experts rather than a single judge, as was originally proposed.

That change has proved controversial, but is one of about 300 amendments being considered by a cross-party committee of MPs.

Meanwhile, the legislation being proposed in Jersey has very similar restrictions to the Westminster plans. However, it has a proposal that would extend the right to die for terminally ill adults with six months or fewer left to live to 12 months for people with neurodegenerative conditions

As with the Westminster legislation, the Isle of Man has experienced some passionate campaigning both for and against the proposed new law.

A third of doctors who responded to an Isle of Man Medical Society survey in 2023 said they would consider leaving if the legislation was introduced.

Some doctors fear the legislation will be a “slippery slope” that will see the scope of the laws extended.

Isle of Man GP Dr Martin Rankin is a member of the Medical Society and is worried about the dangers of coercion, where vulnerable people are pressured to end their lives early.

“The safeguards that are in place on this one, I’m not going to know if somebody has been coerced by a relative into ending their life sooner than they wish.

“So I really won’t be getting involved in it.”

However, there have been some passionate campaigners who have spent years fighting for this legislation.

Millie Blenkinsop-French lost her son James to neck cancer, aged only 52.

It was a very difficult, painful death that cemented her belief in assisted dying for the terminally ill.

“Nobody in their right mind would be against assisted dying if they had to sit, like I did, and watch my son die.

“I wish with all my heart and soul that assisted dying had been in then, I really do, because he would have opted for it. He wasn’t a stupid boy, he was a very intelligent young man.

“And it’ll give an awful lot of people the chance that James didn’t have, give an awful lot of people the chance to say, you know, ‘enough is enough, let me pass over’.”

The Isle of Man legislation now looks set to become law, but as politicians in Jersey, Westminster and Holyrood also consider their own proposals, the wider debate about assisted dying is far from over.

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At least a dozen MPs who backed the bill or abstained now say they are likely to vote against it.

Dr Florian Willet was arrested last September following the death of a woman in a forest in Switzerland.

The proposals still have to go before the upper house and supporters hope it will become law by 2027.

Peter Wilson says his wife Beverly Sand, who had terminal cancer, took her own life in 2022.

The move is among several tweaks to the assisted dying bill which were debated by MPs.

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In the next 24 hours and then over the following fortnight up until the Spring Statement, the government is going to talk a lot about a broken welfare system that is failing the people who use it, the economy and taxpayers.

Taking a tough call on fixing it goes against the instincts of much of the Labour Party and has already sparked an internal backlash that could rise to ministerial level, as well as protests.

The government is making two key related judgements. The first is that the country cannot afford to sustain recent ballooning increases in the health-related benefit bill and caseload, in particular for mental illness.

At the same time, it will argue that a job is the best medicine.

Underlying this is an assumption that a health-related benefits system that was built-up to deal with industrial injuries can’t apply to the post-pandemic service economy workforce.

The net result is likely to be significant changes to Personal Independence Payments, aiming to reduce eligibility for the highest levels of payments, especially among those of working age with mental illness.

In addition, there will be a levelling of the generosity of the health component of Universal Credit. This will save billions of pounds, and about a billion of that will be reinvested in trying to help get those capable of part-time work some help for a partial return.

The Department for Work and Pensions (DWP) is rolling in real-time data. “Cluster analysis maps” reveal to ministers exactly who is claiming out of work benefits and where they are.

As the numbers continue to increase, the data is being cut by sector, postcode, age and type of illness. Every pattern is being analysed.

The idea was that the data would firstly offer the government insight into how it could make billions of pounds of cuts to a rapidly growing bill in order to help the Chancellor meet her self-imposed government borrowing rules.

Secondly, it was meant to point to more fundamental reforms to welfare, also designed to temper the same ballooning rise in the costs of dealing with ill health among the working population.

The data has thrown up answers.

That poor mental health is driving the rise in claimants is clear. To a lesser extent, so too is the role that raising the state pension age has played, with many thousands who would previously have been retired now claiming health-related benefits.

But it has also thrown up a major question too: does cutting welfare to incentivise people to work more hours in fact do the opposite – nudging them out of the workforce altogether and ultimately increasing the benefit bill?

If this is the case – and it is by no means a universally accepted interpretation of what has happened – then the question is whether further cuts could in fact increase the numbers claiming? And should Labour instead invest in getting people back into work?

When I visited a job centre in Birmingham alongside the Work and Pensions Secretary Liz Kendall in the Autumn, I was taken aback by how the work coaches were talking as much about health as about work.

“There’s a lot of mental health, depression and anxiety,” Qam told me.

GPs have reported that their surgery time is dominated by trying to work out whether their patients are “fit for work”. Roughly 11 million fit notes are issued every year in England alone, with 93% assessing the patient as “not fit for work”. That has doubled over a decade. In the latest quarter, 44% were for 5 weeks or more absence.

From that pool of growing in-work sickness, a significant proportion ends up on some form of incapacity benefits. The Treasury’s bill for health and disability benefits, which was £28bn in the year before the pandemic, is now £52bn a year. It is forecast by the Office for Budget Responsibility (OBR) to hit £70bn by the end of the decade.

The pure financial aim here is to “bend the curve” down to nearer £60bn in that period. This means restricting both the generosity and eligibility of some – or all of such – payments. It could require a wholesale cash freeze so that benefits do not rise with inflation, for example, or the abolition of entire categories of recipients.

An Institute for Fiscal Studies report published last week showed that wider measures of mental ill health have rocketed since the pandemic. Between 2002 and 2024, the number of 16-64-year-olds claiming disability benefits for mental or behavioural health conditions increased from 360,000 to 1.28 million.

Every day in 2023 there were 10 extra “deaths of despair” (defined as deaths from alcohol, drugs or suicide) in England and Wales than the average between 2015 and 2019. Average sickness absence rates across the whole economy remained structurally higher than pre-pandemic.

Of particular concern is how this affects young people. In a recent report DWP adviser Prof Paul Gregg points to the “incredibly low” chances of sustained returns to the workforce once a person has been on incapacity benefits for two years.

About two fifths of new incapacity benefit claimants under 25 came directly from education. The latest DWP analysis shows these trends are now closely related to broader socio-economic vulnerabilities such as limited education and also with precarious sectors such as retail and hospitality.

The question that remains is whether so many people really are more sick – and what role (if any) is played by the reduction in stigma around mental health.

But then there is the question of how to address it.

Another major factor is that rise in the state pension age, which the DWP calculates, resulted in 89,000 older workers instead claiming health-related benefits. However, the sharp increase in claimants of such benefits since the pandemic is not only attributable to ageing populations or increasing mental health diagnoses.

Research suggests there are significant systemic and policy-driven causes. At its heart the problem is perceived to be that the current welfare structure has become overly binary, failing to accommodate a growing demographic who should be able to do at least a bit of work.

This rigidity – what ministers refer to as a “hard boundary” – inadvertently pushes individuals towards declaring complete unfitness for work, and can lead to total dependence on welfare, particularly Universal Credit Health (UC Health), rather than facilitating a gradual transition back into employment.

This has been bad for the economy, for employers, terrible for the public finances, and deeply concerning for the career prospects of individuals.

History helps here. Health-related benefits are often a disguised form of unemployment. The caseload for incapacity benefits (which include not just UC Health but previous incarnations) since the 1970s shows the UK heading for a record of one in 12 adults of working age in receipt.

But this is not the first such build-up. It happened in the late 1980s when Margaret Thatcher was prime minister, and it was reversed in the early 2000s under New Labour.

The launch in 1986 of Restart Programme, a forerunner to JobSeekers Allowance modelled on Ronald Reagan’s policies in the US, helped return many claimants to the workforce but also pushed a staggering number into incapacity claims.

Over the decade and a half of this policy, there was a 1.6 million increase in people in receipt of the benefit. But at the time this migration from claimant unemployment into incapacity was apparently a deliberate strategy, as it helped deal with headlines about “three million unemployed”.

The government has not yet published its analysis on the jobs market, but Prof Gregg’s early thinking was made clear in a report for the Health Foundation. He argued that, historically, the welfare system responded effectively through a middle ground that allowed individuals to combine part-time work with partial welfare benefits. He puts this down to reforms introduced in the early 2000s, such as tax credits.

This is essentially the crystallisation of Iain Duncan Smith’s critique of then chancellor George Osborne’s welfare cuts of 2016. He told me at the time that they were “deeply unfair” on working people and the vision of a proper welfare-to-work scheme “could not be repeatedly salami-sliced”.

Some argue that those reforms created a situation where individuals, unable to sustain full-time work, gravitate towards more generous health-based welfare program.

Crucially, claims began to rise in 2018. At the DWP ministers have tried to research the reasons behind the increase in caseload – and found that about a third of the increase can be explained as the predictable consequence of policy or of demographics.

With an ongoing flow of new claimants arriving in the system (nearly half a million in the last financial year) the onus is now on finding a prevention rather than a cure.

And this is where it becomes tricky – one suggestion involves eliminating the current welfare trap by reintroducing intermediate support for part-time work. However, that requires extra funding, as well as a way of providing more personalised job searches and better mental health support.

Another option is passing responsibilities to employers. In the Netherlands, employers bear significant responsibilities and financial costs if they fail to adequately support employees facing health challenges. In the early 2000s, the Dutch also had very high levels of incapacity but they now report employment rates of 83%.

The structure of the jobs market in the UK makes that challenging to replicate – for example there are more insecure zero hours contracts.

And given that businesses feel under pressure from National Insurance rises and a slow economy, could they really be cajoled into helping?

The questions arising from the data will matter for the economy, for the public finances, our health, and young people’s careers and livelihoods, at a time of considerable change.

Fundamentally, it is a question of what the benefit system is for, at a time when illness is being redefined, and when the trends are, frankly, scary.

Then there is the question of whether the public wants to pay even higher taxes in the hope of delivering long-term gain. Welfare-to-work programs can pay for themselves eventually, but the Government feels it needs to book faster cuts.

That’s because all of this is in the context of what “fiscal headroom” the government did have against the Chancellor’s self-imposed borrowing targets being wiped out since the Trump shock to the world economy, the Budget and the announcements of extra European defence spending.

But government insiders are at pains to argue that the primary motivation for any cuts is not regaining the extra room for manoeuvre. “We don’t need the OBR to tell us that we need to fix welfare to get people back to work. We don’t need the OBR to tell us we need to make the NHS more productive. And we don’t need the OBR to tell us that the taxpayer should be getting more value for money,” a source told me.

“Headroom or no headroom the Chancellor is determined to push through the change we need to make Britain more secure and prosperous.”

Ultimately, the economic imperative is clear – to bring a cohort of young people suffering a combination of mental ill health and joblessness back into work.

And the government believes there is no way of doing this without, at least at first, hurting the incomes of ill people. There is going to be quite the backlash from disability charities, and in turn from backbench Labour MPs.

That’s why it’s no exaggeration to say this month’s explosive row about welfare will come to define this Government.

BBC InDepth is the home on the website and app for the best analysis, with fresh perspectives that challenge assumptions and deep reporting on the biggest issues of the day. And we showcase thought-provoking content from across BBC Sounds and iPlayer too. You can send us your feedback on the InDepth section by clicking on the button below.

Business Secretary Jonathan Reynolds says his party must get better at countering Nigel Farage’s message.

Chancellor Rachel Reeves has delivered her Spending Review, setting out budgets for government departments.

The chancellor’s focus on the NHS and defence will mean a spending squeeze elsewhere, writes the BBC’s political editor.

The government plans to scrap the Vagrancy Act and bring in laws to focus on crimes like organised begging by gangs.

Rachel Reeves’ spending review will have a huge impact the Welsh government’s budget.

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From Sunday, it will be illegal for businesses to sell or supply disposable vapes.

The government hopes the ban will reduce environmental damage caused by the devices and help cut the number of children and young people vaping.

From 1 June 2025, businesses will be banned from selling or supplying any single-use vapes, whether that’s in shops or online.

Retailers caught breaking the law in England face a minimum £200 fine, with a prison sentence of up to two years for repeat offences. Penalties are broadly similar in Scotland, Wales and Northern Ireland.

Trading Standards will be able to seize any single-use vapes they find.

Only devices considered to be reusable will be legal. That means that they must have a rechargeable battery, a replaceable coil, and be refillable.

It won’t be illegal to own a disposable vape after 1 June. Customers can still return them, and retailers have an obligation to get rid of them.

Vaping products are already subject to 20% VAT but, unlike tobacco, they do not currently attract a separate additional tax.

A new vaping duty will start on 1 October 2026. It will be charged at a flat rate of £2.20 per 10ml vaping liquid.

At the same time, tobacco duty will be increased to preserve the financial incentive for cigarette smokers to switch to vaping.

Advertising and sponsorship ban

The government’s Tobacco and Vapes Bill – which is currently making its way through Parliament – will outlaw vape advertising and sponsorship.

It will also restrict the flavours, packaging and display of vapes and other nicotine products.

Children have been targeted with colours, branding and flavours such as bubble gum or candy floss, to push a product that can lead to nicotine addiction, the British Medical Association has warned.

The government is also cracking down on iIlegal vapes, which are widely available and are much more likely to contain other harmful chemicals or drugs.

More than six million illegal vaping products were seized by Trading Standards officers across England between 2022 and 2024, according to analysis by the BBC.

The ban on disposable vapes was introduced to tackle their impact on the environment.

Almost five million single-use vapes were thrown away each week in 2023, according to the Department for Environment, Food, and Rural Affairs (Defra).

As well as lithium-ion batteries, vapes also contain circuit boards. If these aren’t not disposed of properly, they can leak toxic compounds such as cobalt and copper.

That means fish, and marine mammals could mistake vapes for food and ingest poisonous chemicals.

The Local Government Association (LGA), also says that single-use vapes are “a hazard for waste and litter collection and cause fires in bin lorries”.

However, recycling disposable vapes is not straightforward because of their size and the way they are manufactured, which makes them difficult to take apart.

These minerals and the lithium could – if recovered – be reused for green technologies such as electric car batteries or in wind turbines.

There is currently no large-scale disposable vape recycling in the UK. There are so many different types of vape on the market that it is difficult to develop a standard recycling process.

Around 18% of 11 to 17-year-olds (980,000 children) have tried vaping, according to a 2024 survey by health charity ASH (Action on Smoking and Health).

About 7% (390,000 children) said they currently vaped, down from 8% in 2023, but still well above the 4% figure recorded in 2020.

In contrast, just over 5% of 11 to 17-year-olds (280,000 children) said they currently smoked, while just under 3% (150,000 children) said they both smoked and vaped.

Among all age groups over 16, the use of vapes has risen, with about 5.1 million people using a vape or e-cigarette in 2023.

The Office for National Statistics (ONS) says 5.9% of people aged 16 and over vaped every day, up slightly from the previous year, while another 3.9% did so occasionally.

The group with the highest rate of vape use – nearly 16% – was 16-24 year-olds.

Vaping is nowhere near as harmful as smoking cigarettes, which contain tobacco, tar and a range of other toxic cancer-causing chemicals, and is one of the largest preventable causes of illness and death in the UK.

But because vaping may itself cause long-term damage to lungs, hearts and brains, it is only recommended for adult smokers trying to quit as part of the NHS “swap to stop” programme.

The vapour inhaled contains a small amount of chemicals, often including the addictive substance nicotine.

“Vapes can be an effective way for adult smokers to quit – but we have always been clear that children and adult non-smokers should never vape,” the Department of Health and Social Care has said.

More research is needed to fully understand the effects of vaping, but in December 2023, the World Health Organization (WHO) warned “alarming evidence” was growing about the damage it causes.

In February 2025, the government said a £62m research project would track 100,000 eight to 18-year-olds for a decade to better understand the risks.

Officers also identified seven men who they believed to be working for less than the minimum wage.

Separate bills to let terminally ill people end their life are being considered at Westminster and in Scotland.

But the NHS in England is still well below its target for seeing patients within 18 weeks.

Disposable vapes are still being sold in some shops despite a recently introduced ban, the BBC finds.

The trial, involving patients in Yeovil and Taunton, is looking at reducing courses of antibiotics.

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Ministers, health staff and the public gathered in London last week for a summit to discuss the 10-year NHS plan in England. It was the final roadshow in a nationwide tour to help set out the strategy the government says will rescue the “broken” NHS, which has a waiting list of nearly 7.5 million patients and public satisfaction of just 21% – a record low.

Not for the first time, moving healthcare away from hospitals and into the community is being touted as a way of treating people better and for less. Research suggests that every £100 spent on community care would otherwise cost £131 for hospital care.

This helps explain why Health Secretary Wes Streeting has promised to turn the NHS into a neighbourhood health service.

Washwood Heath, a community health clinic that was set up in a deprived part of east Birmingham two years ago when the Conservative government was in power, is a living, working example of what this could look like. Here, hospital doctors, GPs, nurses, occupational therapists, council social care teams, mental health professionals and charity staff work under one roof.

The three-storey building combines an urgent treatment centre offering some of the services usually provided by hospitals, as well as a diagnostic service (for MRI scans, X rays and ultrasounds), alongside mental health care and wider social support.

In practice, this allows for addressing social problems such as housing issues, alongside treating physical health conditions, plus arranging support for daily tasks such as washing and dressing.

The target is the most frequent users of health services – and the aim is to keep them well and out of hospital.

“We want to work with the 10% of the population that is responsible for 70 to 80% of its use,” explains Richard Kirby, head of Birmingham Community Healthcare NHS Trust, one of the key partners at Washwood Heath. “The NHS cannot meet their needs on its own – it requires partnership working.”

Streeting himself is on board. Speaking to the BBC this week, he said that Washwood was a “pioneering service” and he is firm that the model could “be the future of the NHS”.

However not everyone is convinced. And while few argue against the principle of more care within the community, there are wider questions around just how feasible it is on a bigger scale.

In the middle of the clinic, staff gather around five touchscreens, each containing up-to-date information about patients from east Birmingham who are in hospital or making calls to the ambulance service. Their goal is to get these patients discharged from hospital as swiftly as they can – and keep them out.

One way of doing this is by arranging remote monitoring from the ‘virtual wards team’ (which allows doctors to keep an eye on patients who would otherwise have to stay on the wards), as well as ordering equipment such as mobility aids and medicine dispensers to be delivered to their homes.

The team is also automatically alerted if a patient registered at the clinic calls for an ambulance or is admitted to hospital. There is a live link to the local Heartlands Hospital, where the clinic’s own team of therapists and paramedics see patients face-to-face on the wards and liaise with hospital staff to try to get them home.

“Our job is to identify which patients will benefit from our help,” says nurse Dani Fullerton. “It’s so different from anything I have done before.”

One issue the neighbourhood teams are homing in on is loneliness – they have identified this as a way to keep down hospital numbers.

Government commissioned research published in 2020 suggests the cost of severe loneliness to be more than £9,500 for each person in that category, due to the combined impact on wellbeing, health, and work productivity.

So, at the centre, local neighbourhood teams plan intense support for the most vulnerable residents, knitting together not just what the NHS and council provide, but what charities can offer too.

“We have patients going to GPs and A&E basically because they are lonely,” says Christine Francis, who is employed as a ‘social prescriber’. Her job is to help find new activities and groups for the lonely and then accompany them until they are settled.

“The NHS cannot solve [loneliness]. But I can link patients in with befriending services or, if they can get out and about, local groups such as knitting groups or organised walks.”

Ms Francis also works with groups who can help with house cleaning and tackle other issues associated with poor mental health, such as hoarding.

At present some doubt there is enough robust evidence from the research to show the effectiveness of social prescribing. The neighbourhood team is adamant their approach is making a difference, however, based on what they’ve seen first-hand.

Hamzisah Aslam, an occupational therapist at Birmingham Council, recalls visiting one patient with health and alcohol problems, whose home was littered with cardboard boxes and rubbish. The visit, also attended by a GP, mental health professional and social prescriber, lasted more than an hour.

“Afterwards, we had a five-minute debrief and drew up a plan and it was actioned the next day – you would never be able to do that if we were all working individually.”

Some GPs I spoke to have also observed a positive impact. Dr Subeena Suleman says the neighbourhood team worked with two patients from her practice who were frequent visitors because of their range of health and social issues. An estimated 100 appointments at the GP surgery were freed up over six months.

“It meant we had more time for other patients,” says Dr Suleman. “We even started offering longer appointments of up to 30 minutes for those that need it.”

In the first 12 months since Washwood Heath began operating, GP visits among the local population supported by the centre fell by 31%, A&E attendances by 20% and admissions to hospital by 21%.

However, there is not yet robust evidence to quantify how much more efficient the new model would be if expanded across the city.

The most recent addition to the centre is an emergency service for patients with respiratory illness that opened in December to address the fact that around 40% of admissions to the nearby Heartlands Hospital related to lung and breathing conditions.

So far the service, which is staffed by UHB respiratory specialist nurses and doctors, has taken in 670 patients. Christopher Thomas is one of them. He used to be a builder and worked with asbestos. Now 77, he has chronic obstructive pulmonary disease, which he believes has links to his job.

Recently, he went to hospital after coughing up blood, and was told he had pneumonia – but rather than being kept in hospital, he was discharged into the care of Washwood clinic’s respiratory service.

This, he says, worked far better for him. “I was able to stay at home to rest and take my medications and I can just ring the team at Washwood if I have any concerns.”

Respiratory medicine consultant Dr Rifat Rashid is also positive. “Here we can see and test patients quickly – there are not the delays we have in hospital waiting for results.”

But there are broader benefits for the hospital too in her view – she says GPs are starting to refer their patients directly to Washwood Heath and ambulances are also now bringing patients to the centre rather than the hospital.

Despite the benefits of fewer admissions, ultimately hospitals are no less full – while fewer people in the Washwood area are being admitted, patients from elsewhere have filled the beds.

The model is being expanded across the city – the aim is to have a network of six community hubs and 25 to 30 integrated neighbourhood teams, covering Birmingham’s population of 1.4 million people.

Not every centre will be identical. For example, in the north of the city, there might be a focus on helping with frailty to support the older, more affluent population demographic.

There are of course costs – these are estimated at less than £100,000 as the six hubs as the centres will use existing buildings and redeployed staff.

Richard Kirby thinks the model could easily be replicated nationwide. “We believe this is the right model,” he insists.

But there is a catch. As he puts it, “It only works when the whole system buys into it.”

Part of the problem with making the whole system buy into it is money. Ruth Rankine, an NHS Confederation primary care director, believes that during times, such as now, when money is tight, collaboration generally becomes harder.

“People are too focused on their budgets and making sure it goes on where they immediately need it,” she says.

But clinics like Washwood Heath require collaboration and pooling resources.

The other issue, she argues, is that the hospital sector has, in places, “been a bit cynical”. “The problem is that it takes time to get results – you need to invest in front and then it can be years before it has an impact.”

Another concern is around finding suitable premises. In Birmingham, officials I spoke to acknowledged they were lucky to have a network of large health centres (as they were beneficiaries of a short-lived finance programme launched in the 2000s to improve community NHS buildings) but many other places around the country do not.

This is a concern for Dr Richard Vautrey, a GP from Leeds who has been involved in national NHS politics since the early 2000s in his role as a British Medical Association negotiator and, more recently, as president of the Royal College of GPs.

“There just isn’t enough of the right premises,” he argues. “In many places, GPs and community colleagues cannot work side-by-side because the buildings are too outdated and cramped.

“We’ve had all the talk over 40 new hospitals, but where are the 1,000 new neighbourhood clinics?”

There are deeper rooted political pressures too that make a nationwide rollout of centres like those in Birmingham a challenge.

Even though the work in east Birmingham ticks a lot of the boxes set out by independent peer and NHS surgeon Lord Darzi in his report for the government last autumn, after being commissioned by Wes Streeting, this is not the first time such calls have been made. Lord Darzi himself set out similar goals in a report for the Blair government in 2007.

Ms Rankine has had a front-row view of this. She worked for the Department of Health and NHS executive for more than a decade from the mid-1990s. “We’ve been talking about this for 20, 30 years, but failed to achieve it on any sort of scale.”

And today, there are a series of contradictory priorities facing the NHS. Often it is those considered the most pressing that are addressed first.

Hugh Alderwick, Director of Policy at the Health Foundation think-tank, who advised Labour in opposition, points out that the big focus is on hitting the 18-week hospital waiting time targets.

“It’s pulling in the opposite direction of this ambition to move care out into the community,” he observes.

So can the government really reshape the NHS into a neighbourhood health service? Dr Vautrey, for one is optimistic.

“It can,” he says. “But it will take determination, effort – and money.”

Top picture credit: Getty Images

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